Mount Vernon Countryside Manor
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
procedures and obey the rules of the road when operating a facility owned van. C. Ensure all residents and wheelchairs are safely secured.On 9/30/25 at 1:50pm, V5, Maintenance Staff, stated on 9/19/25 after the above referenced incident, all Transport Staff were reeducated on securing wheelchairs in the van, with return demonstration given. V5 stated all were required to pass a safe driving test he administered and all passed. V5 stated when V4 demonstrated how she secured Resident R1's wheelchair, she failed to properly secure
the chair, but upon return demonstration, did so appropriately. V5 stated he did not think V4 had been properly trained initially.On 9/30/25 at 2:25pm, V2, Director of Nurses, stated when Resident R1 was readmitted from ER, there was a skin tear to the left forearm and significant bruising to body in several areas, most likely due to anticoagulant therapy. V2 stated Resident R1 was now at baseline in all areas including level of functioning and cognition. V2 stated Resident R1 has had some occasional complaints of back pain which have been effectively controlled with analgesics.On 9/30/25 at 2:00pm, V1, Administrator, produced a 9/19/25 document titled Ad Hoc QAPI (Quality Assurance Improvement Plan). V1 stated the quarterly QA (Quality Assurance) meeting is scheduled for October 2025. V1 stated by 9/20/25, prior to the Surveyors entrance to the facility on 9/30/25, the facility implemented all the below referenced steps as stated in the QAPI Ad Hoc.Prior to the survey date, the facility took the following actions to correct the non-compliance:1. On 9/19/25, (V4) received disciplinary action regarding the appropriate procedure for securing a wheelchair during transport.2. On 9/19/25, a safety inspection was conducted on all vehicles.3. On 9/20/25, all drivers were educated on the proper procedure for securing wheelchairs during transport.4. On 9/20/25, all drivers were evaluated for competency by conducting a road test with (V5, Maintenance Staff).5. The Administrator or designee will audit resident transportation twice weekly for 4 weeks to ensure wheelchairs are secured for transport.6. The Administrator will report the findings of the audit to the QA Committee.
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MOUNT VERNON COUNTRYSIDE MANOR in MOUNT VERNON, IL inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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 MOUNT VERNON, 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 MOUNT VERNON COUNTRYSIDE MANOR or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.