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F0585
F

Failure to Post and Address Grievance Procedures

Galesburg, Illinois Survey Completed on 07-31-2025

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 post grievance and complaint procedures in prominent locations throughout the building and did not promptly address resident grievances, as required by policy. The facility's grievance policy states that forms should be available at all nurse's stations and front desks, and that grievances should be addressed and resolved within five days. However, during a tour, the Administrator confirmed that grievance procedures were not posted in any prominent locations. Additionally, during a resident council meeting, multiple residents stated they did not know where or how to file a grievance, and some reported that grievances were not followed up on promptly or at all. A specific incident involved a resident who filed a grievance with the assistance of the Ombudsman regarding issues with bathing, call light response times, and supply availability. The grievance requested a care plan meeting with the Ombudsman present. The Ombudsman submitted the grievance to the Administrator, but the Administrator did not document any investigation or resolution, and the Activities Director, who received the grievance weeks later, had not started addressing it. The lack of investigation and response to this grievance, along with the absence of posted procedures and resident awareness, demonstrates the facility's failure to honor residents' rights to voice grievances without discrimination or reprisal.

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