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F0559
D

Failure to Provide Written Notice of Room Changes

Lincoln, Illinois Survey Completed on 07-20-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide written notice of room changes to three cognitively intact residents who experienced multiple room moves. According to the facility's own policy, residents are to receive advance written notice, including the reason for the move, at least two days prior to relocation unless the move is medically necessary for safety and well-being. However, review of records and interviews revealed that no such written notices were issued to the residents or their representatives for any of the documented room changes. Interviews with the affected residents confirmed that they were not made aware of the reasons for their room moves and did not receive written notifications. One resident reported frequent room changes without explanation, while another stated he was never informed of the reason for his move. A family member of a third resident indicated she was only verbally notified of one move and was never given a reason or written notice for any of the moves. The Administrator in Training verified that the facility did not issue written notices for these room changes and was unaware of the requirement to do so.

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