Shelbyville Manor
Inspection Findings
F-Tag F0604
F 0604 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
- 2025. V5 stated Resident R1 has always had body pillows in place while in bed and if Resident R1 is not in bed, Resident R1 is to be up
at the nursing station for closer supervision. V5 stated, Resident R1 transfers with one assist. V5 stated Resident R1 requires frequent visual checks because Resident R1 likes to get out of bed and ambulate throughout the day and night. V5 stated Resident R1 falls frequently because she is unsteady and requires assistance with walking. V5 stated that body pillows are to be placed under the sheet to keep Resident R1 from getting up and walking by herself. When asked about Resident R1's care plan, V5 looked at Resident R1's electronic health record and stated Resident R1's care plan does not include the use of the body pillow. V5 also stated Resident R1's record did not contain an assessment for the use of
the body pillows on Resident R1's bed. On 10/21/2025 at 11:17AM V7 Licensed Practical Nurse (LPN) stated, Resident 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 Resident R1 was in bed.On 10/21/2025 at 12:30PM, V11 Registered Nurse stated, If (Resident 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 Resident 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 Resident 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 Resident R1's bed before the fall. On 10/21/2025 at 12:45 PM, V8 (Resident R1's Hospice Nurse Practitioner) stated using the full body pillows on top of a concave mattress puts Resident R1 at a greater risk for injury as it creates an extra obstacle for Resident R1 to get out of bed. V8 stated Resident 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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SHELBYVILLE MANOR in SHELBYVILLE, 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 SHELBYVILLE, 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 SHELBYVILLE MANOR or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.