Good Samaritan Home
Inspection Findings
F-Tag F0580
F 0580 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
when V9 typed Resident R1's assessments in Resident R1's progress note, V9 did not document correct times of when Resident R1 was complaining of everything. V9 verified she typed everything that occurred throughout the day in one progress note right before she sent Resident R1 out to the local hospital. V9 confirmed she should have documented Resident R1's events throughout the day as they occurred at the correct times.On 9/19/25 at 10:43 AM V12/CNA stated, I was getting resident's up for lunch, when (Resident R1) had put on her call light sometime between 11:00 AM and 11:30 AM. It was weird that (Resident R1) had her call light on because (Resident R1) is independent and never uses her call light. (V11/CNA) and I both went down to (Resident R1's) room. (Resident R1) was saying her eyes were bothering her, (Resident R1) couldn't see how she normally could, and that (Resident R1) couldn't really move her left leg. (Resident R1) stated
she was needing to go to the bathroom. (V11) and I assisted (Resident R1) to the bathroom. When (V11) and I assisted (Resident R1) up to the grab bar in the bathroom, (Resident R1) could hardly move her left leg and (V11) and I had to help guide it, to get (Resident R1) on the toilet. (V11) went and got (V9/Agency LPN) because something was not right with (Resident R1). (Resident R1) never requires assistance. (V9) came to (Resident R1's) room, but basically just told (Resident R1) that (V4/Resident R1's Nurse Practitioner) was already aware from the day prior and that (V9) would just monitor (Resident R1). I am not sure how (Resident R1) got back to her room after lunch because I was called to work on a different unit for a few hours. When I got back to the floor (V9) had asked me if I could come to (Resident R1's) room and help (V9) assist (Resident R1) to the bathroom. This was around 3:00 PM. When I got to (Resident R1's) room (Resident R1) stated she now was unable to move her left arm. I believe right after that is when (V9) got (Resident R1) sent out to the hospital.On 9/18/25 at 12:39 PM, V4/Resident R1's Nurse Practitioner stated she saw Resident R1 on 9/10/25 at the facility. Resident R1 told V4 she was having cramps in her legs, and it was worse at night along with vision changes. V4 stated she did initiate orders for V4, but at that time didn't see any stroke-like symptoms. V4 stated, (Resident R1) could move her left leg up and down when I had seen her and had no problems with weakness. I did initiate orders for (Resident R1's) complaints of leg cramps. I would have expected the facility to notify (V17/Resident R1's Physician) or myself right away if (Resident R1's) if (Resident R1) was experiencing increased weakness or required more assistance with ADL's (Activities of Daily Living).On 9/19/25 at 10:02 AM, V2/Director of Nursing verified she would have expected
a nurse to notify the resident's provider immediately with any significant changes in a resident's condition like Resident R1 was experiencing on 9/11/25 when Resident R1 first was requiring more assistance with ADL's and complaining of increased weakness and more severe vision changes.
Event ID:
Facility ID:
If continuation sheet
GOOD SAMARITAN HOME in QUINCY, 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 QUINCY, 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 GOOD SAMARITAN HOME or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.