F609 in Illinois. Pick another state for the same tag.
Against expectation — 2025
Illinois cites F609 more often than its own record predicts
Versus expected share1.19×
1.19 times the share F609 takes of citations nationally.
Share of Illinois citations2.90%
Of every deficiency written in Illinois in 2025, this is the portion that was F609.
Illinois2.90%
National2.45%
Share of all citations that were F609.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Illinois surveyors wrote
F609 findings written in Illinois, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
J · Immediate jeopardy, isolatedApril 16, 2026
Based on interview and record review the facility failed to ensure sexual abuse allegations were reported for 1 of 4 residents (R3) reviewed for abuse. This failure occurred when R2, who had known sexually inappropriate behaviors, went into R3's room and was observed with his hands in R3's briefs and staff did not report the incident. A reasonable person would likely suffer serious psychosocial harm, such as emotional distress or trauma and fear for safety as a result of sexual abuse. …
Based on Observation, Interview and Record Review, the facility failed to recognize and immediately report multiple allegations of staff to resident verbal and mental abuse to the facility's Abuse Coordinator and the State Agency for four of six residents (R1, R4, R5, R6) reviewed for Abuse in the sample of six. This failure resulted in multiple allegations of staff to resident mental and verbal abuse going unreported and left R4, R5 and R6 feeling mentally and physically upset and in fear of retaliation for reporting allegations themselves.Findings include:The facility's Elder Justice Act and Reporting Suspected Crimes Against Residents policy, dated 10/1/23, documents It is the policy of the facility to empower and enable any and all owners, operators, employees, agents or contractors of… …
D · No harm, potential for more than minimal, isolatedAugust 29, 2026
Based on observation, interview, and record review the facility failed to report an allegation of resident abuse to the State Agency for one of three residents (R1) reviewed for abuse in the sample of three residents. Findings include:R1's Physician Orders (POS) for August 2026 document the following diagnoses: Urinary Tract Infection (site not specified), Major Depressive Disorder, and Unspecified Dementia with Agitation. The POS also documents an order for Hospice Care.R1's Minimum Data Set (MDS) dated [DATE] indicates a Brief Interview for Mental Status (BIMS) score of 2, reflecting severely impaired cognition. …
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