F0921

F

Failure to Maintain Adequate Heat, Hot Water, Call Systems, and Building Repairs

Lacon, Illinois Survey Completed on 01-13-2026

Penalty

No penalty information released

Summary

The facility failed to provide adequate heating, hot water, and building maintenance, resulting in an environment that was not safe, clean, or comfortable for residents, staff, and the public. Facility policies on homelike environment, cold weather, and resident call bells required maintenance of safe temperature levels, regular inspection and maintenance of heating and air conditioning systems, and a functional call system accessible from resident beds, toilets, and bathing areas. During a tour with the Maintenance Director, water temperatures on one hall measured 110–116°F, while on another hall they were only 75–77°F. The Maintenance Director acknowledged an ongoing problem with a mixing valve on the affected hall and stated that it was supposed to have been fixed by a plumber but was not. Multiple bathrooms were in disrepair: one resident’s bathroom had chipped paint and missing drywall under the sink; two other rooms had no running water to sinks or toilets, wet and stained bath blankets on the floor under sinks, black slimy-looking substances in toilets, and a black mold-like area in front of a toilet. The Maintenance Director stated that the sink and toilet were clogged and he had not had a chance to fix them. Ceiling tiles across the front hallway were discolored with brown stains and a mildew smell was noted; the Maintenance Director attributed this to condensation leaking into the tiles when boilers were turned up and stated he was the only maintenance person and had difficulty keeping up with repairs.

Residents reported and demonstrated discomfort and lack of access to required systems. One resident was observed sitting in his room wearing a jacket and wrapped in a blanket, stating it was always cold on the southeast side of the building and that it smelled moldy in the front where ceiling tiles appeared wet; the wall behind his chair had gouges with crumbling plaster on the floor. When this resident pressed his call light, it illuminated only while the button was held down, and the second bed’s call cord consisted of open wires with no call button. Another resident was observed wearing a long-sleeve shirt and coat, reporting that his room had been warm until a recent weekend, that he told staff it was too cold but received no response, and that he stayed in bed wrapped in covers. A third resident, dressed in warm clothing with a shawl and blanket, stated her room was cold; a wall clock in her room showed 63°F. Another resident was using a handheld bell to call for assistance, stating he had no call light, and he and other residents confirmed there was no hot water in their rooms. Staff verified that certain room call lights stayed on all day or activated by themselves, that water on one side of the building only became warm but not hot, and that they heated water in an electric tea pot at the nurses’ station for showers and washing. The Administrator confirmed that water and room temperatures were not at proper levels and that many repairs were needed, while the Maintenance Director confirmed ongoing problems with the mixing valve and boiler and that water temperatures on one side of the building were in the mid‑70s°F.