Shelbyville Manor
SHELBYVILLE MANOR in SHELBYVILLE, IL — inspection on October 23, 2025.
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.
Inspection Findings
requires assistance with walking. V5 stated that body pillows are to be placed under the sheet to
electronic health record and stated R1's care plan does not include the use of the body pillow. V5 also
10/21/2025 at 11:17AM V7 Licensed Practical Nurse (LPN) stated, R1 likes to get up by herself and the body pillows that are on each side of the bed are to prevent falls. V7 stated there is no assessment for the body pillows in the chart or care plan but staff were told by the facility to keep the body pillows on while R1 was in bed.On 10/21/2025 at 12:30PM, V11 Registered Nurse stated, If (R1) is determined she will find a way out of her bed as she is a high-risk faller.On 10/21/2025 at 12:56 PM, V2 Director of Nursing stated the body pillows are used to prevent R1 from getting out of the bed. V2 stated a restraint assessment should have been completed for the use of the body pillows and reassessed after each fall. At that time, V2 looked at R1's electronic medical record and confirmed there were no restraint assessments in the medical record and no interventions on the care plan related to the use of the full-length body pillows. V2 stated that the fracture was related to the fall on 10/10/25 and the body pillows were in place on R1's bed before the fall. On 10/21/2025 at 12:45 PM, V8 (R1's Hospice Nurse Practitioner) stated using the full body pillows on top of a concave mattress puts R1 at a greater risk for injury as it creates an extra obstacle for R1 to get out of bed.
V8 stated R1 is at greater risk for falls and injury due to cognitive impairment, ambulatory, and receiving pain medication.
The Facility's Restraint Policy with a revision date of 11/2017 documents restraints will not be used to restrict a resident's freedom of movement.
This policy documents using a concave mattress to prevent a resident from getting out of bed as an example of a physical restraint.
This policy documents that an assessment will be completed prior to the use of the restraint, and a reassessment will be completed every 90 days.
The facility will assess for restraints with each resident to attain or maintain his/her highest practicable well-being in the least restrictive environment while preventing injury.
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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.