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Complaint Investigation

Timbercreek Rehab And Health Care Center

August 25, 2025 · Pekin, IL · 2220 State Street
Citations 3
CMS Rating 1/5
Beds 202
Provider ID 145275
Healthcare Facility
Timbercreek Rehab And Health Care Center
Pekin, IL  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

Timbercreek Rehab and Health Care Center in PEKIN, IL — inspection on August 25, 2025.

Found 3 citations. 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.

Inspection Findings

FF0580
Resident Rights Deficiencies

change shifts. (R1) kind of guarded her right knee.

That morning with (V16), she had been more

nursing progress notes, dated 8/4/2025 at 11:03 AM and signed by V6 (Licensed Practical Nurse),

evaluation and imaging. On 8/23/25 at 10:33 AM, V6 (Licensed Practical Nurse) stated, I took report on 8/4/25 (morning) and it was stated to me that (R1) was acting strange towards the end of the night shift. I assessed (R1) and when trying to assist her she recoiled and seemed fearful. I thought it could be her leg bothering her, but I wasn't sure. It was strange that (R1) wasn't allowing staff to help her.

That was new behavior for her. I was not aware of anyone notifying the (V7, R1's Physician), (V20, R1's Guardian), or (V2, Director of Nursing) prior to myself, that morning. R1's Emergency Department notes, dated 8/4/25 at 2:34 PM and signed by V21 (emergency room doctor), documents R1 was brought to the emergency room for right ankle swelling and later admitted to the hospital with a right closed Tibia-Fibula fracture and Dementia.On 8/23/25 at 12:10 PM, V2 (Director of Nursing) confirmed he was notified of the situation with R1 on the date she was sent out to the hospital (8/4/25). V2 stated he was unaware she was having symptoms of pain the day prior (8/3/25). V2 confirmed when R1 was sent to the emergency room it was discovered she had a lower right leg fracture of both bones and that V7 (R1's Physician) and V20 (R1's Guardian) was not notified of the change in R1's condition until 8/4/25.

The facility's Significant Condition Change and Notification policy, dated 12/2024, documents To ensure the resident's family and or representative and medical practitioner are notified of resident changes such as: A significant change in the resident's physical, mental or psychological status; Abnormal or unusual or new complaints of pain.

This policy also documents When any of the situation exist, the licensed nurse will contact the resident's representative and their medical practitioner.

The medical practitioner will be contacted immediately for any emergencies regardless of the time of day.

Non-emergency notifications may be made the next morning if the situation occurs on the late evening or night shift.

This applies to any day of the week including holidays. If the medical practitioner cannot immediately be reached in any emergency, the medical director will be called. If the medical practitioner cannot be reached, the director of nursing or the charge nurse can make arrangements for transportation to the emergency department.

Each attempt will be charted as to the time the call was made, who was spoken to, and what information was given to the medical practitioner.

All significant changes will be recorded on the (facility's electronic record program) communication board in the resident record.

Charting will include an assessment of the resident's current status as it relates to the change in condition.

145275 08/25/2025

Timbercreek Rehab and Health Care Center 2220 State Street Pekin, IL 61554

limited to: negative verbalizations and vocalizations (groaning, crying, whimpering, screaming),

the resident will undergo reassessment of pain at least once per shift and before and after every pain

are not limited to: Medications administered for the control or relief of pain, Medications administered for the control or relief of anxiety, Repositioning of the resident.

Management of the resident's pain is an interdisciplinary process, and it is to be included on the resident's interdisciplinary care plan.The facility's Controlled Substance policy, dated 12/2024, documents Controlled substances are subject to special handling, storage, disposal, and record-keeping requirements.

The facility will maintain compliance with these special provisions.

The licensed nurse or CMT (Certified Medication Technician) where applicable will sign the medication out on the Controlled Substance Proof of use form immediately and will document the medication on the Medication Administration record immediately after administering the drug.

The Controlled Substance Proof of use record is to be kept in the Controlled Medication Book.

When completed, these records are to be placed in the resident's permanent record.

145275 08/25/2025

Timbercreek Rehab and Health Care Center 2220 State Street Pekin, IL 61554

charting are things that often can't be caught up on.

Especially charting.

For example, that day

often complain of longer wait times and that staff morale has decreased.On 8/22/25 at 3:20 PM, V2

staff. V2 stated, Residents have complained to me about the staffing cuts that were made. We also have increased our census so we are getting more residents and more behaviors/care needs and we are scaling back on staff. It is noticeable to residents and of course staff feel it too.The facility's Facility Assessment, dated 7/13/25, does not include numerical staffing requirements necessary of nurses and nursing assistants for each shift, to meet the needs of the residents based on the resident population and census.

This same assessment documents, The facility's plan to ensure sufficient staff to meet the needs of the residents at any given time is based on the (state minimum) staffing calculator, which takes into consideration the facility census and acuity levels impacting staffing needs.The facility's (undated) Activities of Daily Living policy, documents, This facility provides each resident with care, treatment, and services according to the resident's individualized care plan.

Based on the individual resident's comprehensive assessment, facility staff will ensure that each resident's abilities in activities of daily living do not diminish unless circumstances of the resident's clinical condition demonstrate that the decline was unavoidable, including bathing, dressing, grooming, transferring, locomotion, ambulation, toileting, eating, communication including using speech, language or other functional communication systems specific to the needs of the individual resident.

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 PEKIN, 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 Timbercreek Rehab and Health Care Center or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


More Reports

About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.