Axiom Healthcare of Mount Vernon
Mount Vernon, Illinois · CCN 145517
40 surveys since 2010. The first finding at harm level was recorded in 2015.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
- Citations on record
- 196
- Surveys
- 40
- Harm or worse
- 17
- Immediate jeopardy
- 7
Findings at the most serious level CMS records. 1 of these were recorded as past non-compliance — corrected before the survey.
Older surveys no longer in CMS’s monthly file or on Care Compare. They are shown here.
The facility
- Certified beds
- 65
- Ownership
- For profit - Corporation
- Chain
- AXIOM HEALTHCARE
- County
- Jefferson · rural
- Medicare-certified since
- 1985
CMS ratings
- Overall
- 1
- Health inspection
- 1
- Staffing
- 1
- Quality measures
- 1
CMS’s own Five-Star ratings.
Compared with similar facilities
Since 2021, this facility recorded more weighted findings than most of its peer group.
Weighted by harm level, against 57 for-profit facilities with fewer than 66 beds in Illinois.
Last survey on record
Apr 7, 2026
216 days ago.
Counts surveys with at least one finding. A clean survey leaves no record here, so the real gap may be shorter.
Staffing
| Measure | This facility | Peer median |
|---|---|---|
| Nurse hours per resident day | 3.60 | 3.43 |
| Registered-nurse hours per resident day | 0.60 | — |
| Annual nurse turnover | 60.4% | 45.2% |
As reported by the facility to CMS, beside the peer-group median.
Enforcement
- Fines
- $355,763 across 7 penalties
- Payment denials
- 4
- Abuse icon
- Flagged by CMS on Care Compare
Federal civil money penalties and remedies as CMS currently publishes them. Amounts may still be under appeal.
Severity of recent findings
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J34.7% | K11.6% | L— |
| Actual harm | G710.9% | H— | I— |
| No harm, potential for more than minimal | D2539.1% | E34.7% | F2539.1% |
| No harm, potential for minimal | A— | B— | C— |
Most frequently cited here
In CMS’s current monthly file.
- F6863×
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
- F8033×
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
- F8123×
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- F8803×
Provide and implement an infection prevention and control program.
- F6102×
Respond appropriately to all alleged violations.
In the surveyor’s words
From the most serious findings on record at Axiom Healthcare of Mount Vernon, in the surveyor’s own words.
- Immediate jeopardy, patternF700Mar 25, 2025
Based on observation, interview and record review, the facility failed to use appropriate alternatives prior to installation of bed rails, adequately assess and monitor residents for risk of injury/entrapment prior to installation, ensure adherence to appropriate dimensions and manufacturer's recommendations, and failed to obtain a physician order for use of bed rails for 6 (R2, R3, R4, R7, R8, R9) of 9 residents reviewed for bed rails in the sample of 29. This failure resulted in R2's death by positional asphyxiation, when R2 was found in the sitting position on the floor beside the bed with legs straight out and head and neck between mattress and bed rail. This failure also has the potential for risk of serious harm/injury and possible death for R3, R4, R7, R8 and R9. […]
- Immediate jeopardy, isolatedF605Aug 28, 2026
Based on interview and record review the facility failed to ensure a resident was free from the use of unnecessary psychotropic medications, including polypharmacy for 1 of 3 residents (R1) reviewed for chemical restraints in a sample of 8. This failure caused R1 to develop extrapyramidal symptoms (involuntary movements) and lethargy which contributed to a severe weight loss, the development of pressure ulcers, and overall decline in health. R1 was hospitalized on [DATE] and admitted to the Intensive Care Unit with diagnoses of Septic Shock, Dehydration, Hypernatremia, Transaminitis, Hypoxia, Elevated Troponin, Failure to Thrive, Acute Kidney Injury, Elevated Lactic Acid, Elevated Brain Natriuretic Peptide (BNP), Acute Respiratory Failure, and Multi-Organ Failure. […]
- Immediate jeopardy, isolatedF684Mar 25, 2025
Based on interview and record review, the facility failed to seek emergency care for a resident with Type 2 Diabetes Mellitus who was experiencing elevated blood sugars too high for accurate readings to be obtained with facility glucose monitoring device for 1 of 3 residents (R16) reviewed for change in condition in a sample of 29. This failure resulted in R16's death with cause of death listed as possible diabetic ketoacidosis. This failure resulted in an Immediate Jeopardy, which was identified to have begun on [DATE] when the facility failed to seek emergency care for R16 who was experiencing high blood sugar readings which lead to R16's death as possible diabetic ketoacidosis. […]
- Immediate jeopardy, isolatedF698Mar 25, 2025
Based on interview and record review, the facility failed to provide safe administration of peritoneal dialysis by qualified trained staff as ordered by a physician for 1 (R22) of 3 residents reviewed for dialysis in the sample of 29. This failure resulted in R22 experiencing severe shortness of breath requiring transfer to local hospital, R22 receiving intubation and mechanical ventilation for respiratory failure to prevent imminent deterioration and further organ dysfunction from hypoxia and hypercarbia. […]
- Immediate jeopardy, isolatedF803Nov 21, 2023
Based on interview and record review, the facility failed to provide a mechanically altered diet as ordered for 1 of 4 (R17) residents reviewed for mechanically altered diets in a sample of 35. This resulted in R17 choking on [DATE], requiring the Heimlich maneuver, chest compressions, and evaluation in the emergency room , and a subsequent choking episode on [DATE], in which the Heimlich maneuver was again required. These failures resulted in an Immediate Jeopardy, which was identified to have begun on [DATE], when the facility failed to provide the proper mechanically altered diet as ordered. V1 (Administrator) was notified of the Immediate Jeopardy on [DATE] at 2:58 pm. […]
Read 28 findings in full →The most serious and the most recent: 28 of 196 on record.
Every survey on record
FindingsAt actual harm or above
- Aug 28, 2026Complaint6 findings · 3 harm
- Apr 7, 2026Complaint4 findings · 2 harm
- Dec 18, 2025Complaint1 finding
- Apr 2, 2025Complaint2 findings
- Mar 25, 2025Complaint20 findings · 4 harm
- Dec 19, 2024Standard14 findings · 1 harm
- Aug 5, 2024Complaint2 findings
- May 31, 2024Complaint4 findings
Show the 32 earlier surveys
- May 15, 2024Complaint2 findings
- Mar 12, 2024Complaint1 finding
- Jan 11, 2024Complaint1 finding · 1 harm
- Jan 5, 2024Complaint2 findings · 1 harm
- Nov 21, 2023Standard6 findings · 2 harm
- Oct 14, 2022Standard5 findings
- Jul 15, 2021Standard5 findings
- Apr 1, 2021Complaint1 finding
- Sep 16, 2020Complaint3 findings · 1 harm
- Nov 7, 2019Standard10 findings
- May 2, 2019Complaint1 finding
- Apr 24, 2019Complaint3 findings
- Oct 29, 2018Standard18 findings
- Dec 22, 2017Standard5 findings · 1 harm
- Jan 12, 2017Standard2 findings
- Jun 22, 2016Complaint1 finding
- Mar 25, 2016Complaint4 findings
- Nov 24, 2015Standard9 findings
- Oct 20, 2015Complaint4 findings
- Sep 29, 2015Complaint1 finding
- Sep 23, 2015Complaint2 findings
- Sep 8, 2015Complaint4 findings
- Mar 10, 2015Complaint2 findings
- Feb 18, 2015Complaint5 findings · 1 harm
- Oct 30, 2014Standard13 findings
- Nov 5, 2013—3 findings
- Jun 5, 2013—3 findings
- Sep 13, 2012—6 findings
- Dec 22, 2011—8 findings
- Sep 20, 2011—1 finding
- Nov 5, 2010—11 findings
- Oct 14, 2010—1 finding
Surveys that found no deficiencies are not in CMS’s files and do not appear here.
Comparable facilities
The nearest facilities to this one in the same peer group, by weighted findings.
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