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Complaint Investigation

Arcadia Care Morton

Inspection Date: August 21, 2025
Total Violations 3
Facility ID 145248
Location MORTON, IL
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Inspection Findings

F-Tag F0584

Resident Rights Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

hallway.On 8/18/25 at 2:07 PM V7/Housekeeping Supervisor confirmed at this time room [ROOM NUMBER]'s floor remained sticky with scattered debris, room [ROOM NUMBER]'s floor had small stains throughout the floor with a large brown sticky stain remaining underneath the bed and another large-yellowish brown stain slightly underneath the side table, room [ROOM NUMBER]'s floor remained scattered with crumbs, debris, and a red stain by the bed, room [ROOM NUMBER] had thick black marks

on the floor and the floor remained sticky, room [ROOM NUMBER] remained sicky with scattered debris throughout room, and A Hall (long and short) remained with scattered stains. V7 stated, This past weekend

we only had one housekeeper and one laundry aide for the entire building. I was here on Saturday, but we can't get everything done. Every other weekend is like that. On the weekend with one housekeeper, they will typically clean the dining room out from breakfast and lunch, clean the nurse's station, take out the trash from the rooms, clean the bathrooms, and do spot checks. During the week we typically schedule one laundry aide and two housekeepers, as well as me. One housekeeper will take A hall and one will take B hall. I assist with doing the small dining room, offices, and running the floor machine throughout the facility.

We had a call in today, so we had one laundry, one housekeeper, and then me. I did spot checks today on B hall but couldn't get to everything. I still have a little more to do in some of the rooms.On 8/18/25 at 9:18 AM Resident R1 stated housekeeping misses his room a lot for cleaning and states he does not believe housekeeping did much to his room over the weekend.On 8/18/25 at 2:14 PM Resident R8 stated, My trash has not been taken out of my room since last Friday and no one has cleaned my room since then. They are always short on housekeepers, and I get tired of my room not getting cleaned. I tell them all the time and then no one comes back to speak to me about it. I don't like when my room gets that dirty.On 8/19/25 at 1:45 PM, Resident R3 was sitting on his bed in his room. Resident R3's room had a very strong urine odor. Resident R3 stated housekeeping often does not come in and clean his room because they do not have enough help.On 8/19/25 at 11:46 AM V13/LPN (Licensed Practical Nurse) stated housekeeping is terrible and they do not do the job correct.On 8/19/25 at 11:56 AM, V14/CNA (Certified Nursing Assistant) stated the facility is dirty and they only have one housekeeper on each side of the facility per day and they cannot get to it all.On 8/19/25 at 12:40 PM V19/CNA stated that the facility is often not clean and stated there is only one housekeeper that cleans one time a day and is not able to get all the cleaning done. On 8/19/25 at 12:11 PM V15/Human Resource Director provided the hours worked per department for housekeeping and laundry for the dates 8/15, 8/16, 8/17, and 8/18/25. On 8/15/25 there were a total of 22 hours worked in housekeeping and laundry, 8/16/25

a total of 23 hours worked in housekeeping and laundry, 8/17/25 a total of 15 hours worked in housekeeping and laundry, and 8/18/25 a total of 23 hours worked in housekeeping and laundry. V15 stated at this time they use the calculation of 0.45 x (times) the census to determine how many housekeeping/laundry/and maintenance staff to schedule. V15 verified at this time 37.8 hours per day should have been staffed for 8/15, 8/16, 8/17, and 8/18 and were not.On 8/19/25 at 1:55 PM V1/Administrator in Training stated We (the facility) have 37.8 hours per day for housekeeping/laundry/maintenance. We currently are not meeting that.

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Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Arcadia Care Morton

190 East Queenwood Road Morton, IL 61550

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

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F-Tag F0684

Quality of Life and Care Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

hospital because (V23) stated we should be sending (Resident R2) since (Resident R2) is still a full code. I kept telling (V23) I was waiting to hear back from (V1) to see what to do. To be honest I am a brand-new nurse and wasn't sure what to do. I did not document the time correctly in the progress notes. I accidently put 5:22 PM but it was technically around 11:00 AM when I sent (Resident R2) out to the hospital.On [DATE REDACTED] at 2:37 PM V1/Administrator in Training stated she was the prior Director of Nursing when Resident R2 was sent out to the hospital on [DATE REDACTED]. V1 stated, If any resident, including residents on hospice, are a full code and are actively dying staff should notify the physician and send the resident out to the hospital immediately. There is no rule at the facility that staff must get a hold of the Director of Nursing first. (Resident R2) should have been sent out immediately when (Resident R2) was experiencing a change in condition and was actively dying. V1 verified five and a half hours was too long to wait to send Resident R2 out to the hospital on [DATE REDACTED].

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Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Arcadia Care Morton

190 East Queenwood Road Morton, IL 61550

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

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F-Tag F0725

Nursing and Physician Services Deficiencies
Harm Level: Actual Harm

F 0725 Level of Harm - Actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

was short 33 Nursing hours for 8/9/25 based on Facility Assessment staffing calculations. The facility's Daily Assignment Sheet dated 8/10/25 documents the total Nursing Staff hours were 185 hours for the day.

V21 documented on Daily Assignment Sheet the facility was short 38.5 Nursing hours for 8/10/25 based on Facility Assessment staffing calculations. The facility's Daily Assignment Sheet dated 8/16/25 documents

the total Nursing Staff hours were 176.9 hours for the day. V21 documented on Daily Assignment Sheet the facility was short 47.1 Nursing hours for 8/16/25 based on Facility Assessment staffing calculations. The facility's Daily Assignment Sheet dated 8/17/25 documents the total Nursing Staff hours were 177.5 hours for the day. V21 documented on Daily Assignment Sheet the facility was short 41.5 Nursing hours for 8/17/25 based on Facility Assessment staffing calculations. On 8/20/25 at 11:56 AM, V21 (Regional Director of Operations) confirmed staffing shortages on the above dates based on minimum staffing calculations.

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📋 Inspection Summary

ARCADIA CARE MORTON in MORTON, IL inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in MORTON, IL, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from ARCADIA CARE MORTON or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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