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Complaint Investigation

Pavilion Of Ottawa

February 20, 2026 · Ottawa, IL · 704 East Glover Street
Citations 1
CMS Rating 4/5
Beds 135
Provider ID 145426
Healthcare Facility
Pavilion Of Ottawa
Ottawa, IL  ·  View full profile →
Inspection Summary

PAVILION OF OTTAWA in OTTAWA, IL — inspection on February 20, 2026.

Found 1 citation. Severity: Standard violations.

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

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Inspection Findings

FF0585
Resident Rights Deficiencies

establish a grievance policy and make prompt efforts to resolve grievances.

residents (R3) reviewed for resident's rights in the sample of 14.The findings include:On 2/20/26 at

(two natural teeth) to staff including V1 (Administrator) and V2 (Director of Nursing). V8 said no one can tell her what happened to R3's missing tooth or how R3 lost her tooth.

Did it just come off in her mouth? What caused it to fall off? V8 said as of today, no one yet (at the facility) came back to tell her what happened.On 2/20/26 at 12:30 PM, V11 (CNA) said a couple of weeks ago, she noticed R3 tapping her mouth, she has dementia so she cannot speak, it looked like she lost a tooth. V11 said this was reported to the Nurse who said she will refer R3 to the dentist.R3's progress notes dated 1/27/26 documents, Oral visual check done, deny pain and discomfort, no redness or swelling on her gums noted. 1 right lateral tooth noted missing. daughter aware.On 2/20/26 at 12 PM, V2 (Director of Nursing) said an electronic mail was sent to V8 (R3's daughter) on 1/27/26 to let V8 know that the facility was looking into how R3 had a missing tooth. On 1/30/26, V2 said V8 added additional teeth missing per R3's profile picture.

Now there was a total of 2 missing teeth. As of today 2/20/26, there was no update to V8 because no one knew what happened to R3's missing tooth. R3 had not been referred to the dentist.

Review of the Facility's grievance log did not include V8's concerns of R3's missing tooth as confirmed by V1 (Administrator) and V2 (DON) Both said it should have been logged with the resolution. On 2/20/26 at 2PM, V1 (Administrator) said today, R3 will be referred to the dentist and V8 will be updated.The facility Policy on Grievance Complaint Process (undated) documents, 5.

Upon receiving a grievance and complaint report, the administrator or designee will begin an investigation into the allegation. 6.

The Resident Grievance/Complaint investigation report form must be completed within 5 working days of the incident. 7.

The resident or person acting on behalf of the resident will be informed of the findings of the investigation as well as any corrective action recommended within 10 working days of the filing of the grievance or complaint.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

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 OTTAWA, 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 PAVILION OF OTTAWA or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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