Evervella Of White Hall
Inspection Findings
F-Tag F0583
F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
photo and that no information including residents name was on the photo or was exposed. It continues, At
this time we do not believe there was a violation of HIPAA as (V34) stated there was no patient information
on the photo, information was not exposed, and the photo was deleted immediately. The policy Workforce Training - Privacy & Security Of Protected Health Information, undated, documents, Policy: All employees will receive appropriate training, regarding the policies and procedures for ensuring the secure and confidential receipt, transmission, storage, use and / or disclosure of protected health information.
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
11/21/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Evervella of White Hall
620 West Bridgeport White Hall, IL 62092
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0677
F 0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
Level of Harm - Minimal harm or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review the facility failed to assist 1 of 4 residents (Resident R3) reviewed for feeding assistance in the sample of 13. Findings include:Resident R3's Face Sheet, print date of 11/20/25, documents Resident R3 was admitted on [DATE REDACTED] with diagnoses of Parkinson's Disease with Dyskinesia and Major Depressive Disorder with severe psychotic symptoms. Resident R3's Minimum Data Set, dated [DATE REDACTED], documents Resident R3 has moderate cognitive impairment, requires set up clean up assistance for dining, requires supervision touch assist for toileting, partial to moderate assist with hygiene, sitting to standing position change, toilet transfer, and is occasionally incontinent of urine. On 11/16/25 at 7:34 AM Resident R3 is sitting in the dining room. Resident R3 has a plate of scrambled eggs, a muffin, a bowl of fruit loops, both juice and water, a Coke can, and both white and chocolate milk. Resident R3 is attempting to grab and use her spoon. Resident R3 is unable to manipulate the spoon. Resident R3's left arm and hand are extremely shaky. At 7:42 AM, Resident R3's plate is pushed aside. The plate remains untouched. At 7:48 AM, V6, Registered Nurse, asked Resident R3, why are you not eating? Resident R3 stated, I can't get my silverware. V6 put Resident R3's spoon in the cereal bowl. At 7:55 AM Resident R3's food remains untouched. Resident R3 is sitting fidgeting with the Coke can and her water glass. She is not drinking either just touching them attempting to grab them. At 7:57 AM, V7, Human Resource / Certified Nurse Assistant, asked Resident R3 to eat and could she get her something else. V7 asked if Resident R3 would like a banana and V7 walked away. V7 returned with a banana, cut it in half and put it on Resident R3's plate. At this time, Resident R3 is holding the spoon that is in the cereal bowl attempting to utilize the spoon. Resident R3 is holding the spoon straight up and down in the bowl and unable to scoop up the cereal. V7 walks away without helping Resident R3. At 8:09 AM Resident R3 is holding the spoon straight up and down in the cereal bowl. Resident R3's plate remains untouched. Resident R3 has not been able to get a bite of cereal. At 8:13 AM Resident R3 grabs the banana half, Resident R3 leans over her plate, Resident R3 pushes the banana against the plate, and Resident R3 manages to take 2 bites of the banana. At 8:21 AM Resident R3 has a portion of the muffin in her hand and takes one bite. At 8:24 AM, V1, Administrator, encourages Resident R3 to eat, but offers no physical assist. At 8:25 AM, V6 sits with Resident R3 and offers physical assistance for Resident R3 to eat the cereal. On 11/20/25 at 8:34 AM, V1, Administrator, stated if someone needs assistance with eating staff should assist them. On 11/20/25 at 8:36 AM, V6, stated if someone is struggling to eat staff needs to assist the resident.The policy Activities of Daily Living (ADL) Supporting, dated 7/15/25, documents, 2. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance: d. dining (meals and snacks).
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
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Facility ID:
If continuation sheet
EverVella of White Hall in WHITE HALL, 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 WHITE HALL, 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 EverVella of White Hall or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.