Shelbyville Manor
SHELBYVILLE MANOR in SHELBYVILLE, IL — inspection on November 16, 2025.
Found 2 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
facility does not document the resident's 15-minute checks that would mean the facility cannot prove that any of those residents' interventions were in place prior to any fall. V2 DON stated the facility is going to ‘look at this system' to see how that can be rectified. V2 DON stated she has witnessed the staff caring for residents who have an alternate call light system but cannot say that the 15-minute check was completed every time due to lack of documentation. On 11/16/25 at 2:30 PM, V1 Administrator stated the facility does not keep separate files for fall investigations. V1 stated the only time a paper component would be available would be for a resident's fall that had to be reported to the State Agency. V1 Administrator stated whatever is in the Electronic Medical Record (EMR) is all that the facility would be able to provide. V1 Administrator stated the facility does not have a policy on staff documenting cares. V1 Administrator stated the expectation is for the staff to follow the care plan for each resident.
The facility policy titled Call System (Alternate) revised April 2021 documents all residents that are unable to use a call light system will be provided with an alternate source of monitoring for needed assistance.
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IDENTIFICATION NUMBER:
A.
Building
COMPLETED
11/16/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Shelbyville Manor
1111 West North 12th Street Shelbyville, IL 62565
SUMMARY STATEMENT OF DEFICIENCIES
risk to the residents are being replaced first. On 11/16/25 at 11:10 AM, V7 CPC stated V6 (R1) Power of Attorney (POA) called V7 to inquire about a water heater in R1's room having 'mold, rust and a bunch of stuff' all over it. V7 CPC stated she reported this to V1 Administrator in the next day's morning meeting. V7 CPC stated I don't know whatever was done with that, but I reported it to (V1).
That was (V1's) responsibility then, not mine. V7 CPC stated there was no progress note made about this concern. V7 CPC stated she did not remember what date V6 called her. On 11/16/25 at 2:30 PM, V1 Administrator stated the facility has ‘several' hot water heaters that are located in closets in resident rooms on three different hallways. V1 stated she was ‘just made aware' that three of those water heaters had ‘mold, mildew and rust' on them that could cause a potential health risk to a resident. V1 Administrator stated the water heaters ‘probably' don't get hot enough to cause a fire hazard but also should not have ‘mold, mildew and rust' on them within the resident areas. V1 Administrator stated V16 Maintenance Director is working to get them replaced.
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