Vancrest of Urbana, Inc

In the surveyor’s words

From the most serious findings on record at Vancrest of Urbana, Inc, in the surveyor’s own words.

• Actual harm, isolatedF689Jul 9, 2025

  Based on medical record review, review of hospital records, staff interview, and review of the facility policy, the facility failed to ensure staff safely transferred residents via mechanical lift. This resulted in Actual Harm to Resident #19 on 06/06/25 when staff transferred the resident into a recliner via Hoyer lift. The Hoyer lift was not wide enough to accommodate Resident #19's recliner and the bar of the lift swung back and struck the resident in the forehead causing bruising and a laceration to her forehead which required an emergency room visit and repair with sutures. This affected one (Resident #19) of three residents reviewed for accidents. The facility also failed to prevent resident falls and failed to thoroughly investigate resident falls. […]

• No harm, potential for more than minimal, widespreadF812Apr 12, 2024

  Based on observations, policy review, and staff interview, the facility failed to date dry product when delivered to the facility, failed to discard expired foods, and failed to ensure staff changed gloves after touching surfaces before touching food while preparing food served to the residents. This had the potential to affect all 67 residents who received food from the kitchen. The facility census was 67. Findings include: 1. Observation on [DATE] at 8:20 A.M. of the dry food storage area revealed two bags of spiral noodles with expiration date of [DATE], seven bags of vanilla wafers with one bag open with no date, four bags of yellow cake mix, eight bags of powdered sugar, four bags of brown sugar, and three cans of three bean salad not dated with the date delivered to facility. […]

• No harm, potential for more than minimal, widespreadF812Mar 2, 2023

  Based on observation, staff interview and policy reviews, the facility failed to store food and maintain food in a safe fashion and and failed to serve food in a hygienic manner. This had the potential to affect 67 of 67 residents who receive food from the kitchen. The total facility census was 67. Findings include: Observation of the reach in refrigerator with Dietary Manager (DM) #113 in the central kitchen on 02/27/23 at 9:40 A.M., revealed turkey lunch meat was in a zipper plastic bag dated 02/20/23 and ham lunch meat was in a zipper plastic bad was dated 02/20/23. At the time of the observation, DM #113 stated the two lunch meats should only be stored in the refrigerator for three days and DM #113 removed the lunch meat zipper bags from the refrigerator so they could not be used. […]

• No harm, potential for more than minimal, widespreadF812Dec 21, 2021

  Based on observations, staff interview, review of job descriptions, and review of facility policy, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner. This had the potential to affect 60 residents who received food from the kitchen. The facility's census was 60. Findings included: Observations on 12/21/21 from 5:55 A.M. to 6:10 A.M. of the kitchen revealed the floor was dirty with debris and did not appear to be swept or mopped. There were old footprints noted on the floor and sticky spots. Further observations revealed the fryer had thick brown crusty crumbs caked to the sides and old dried out french fries. […]

• No harm, potential for more than minimal, patternF804Apr 12, 2024

  Based on record review, completion of a test tray, review of resident council notes, observations, and resident and staff interviews, the facility failed to serve palatable meals to the residents. This affected five (Resident #19, #21, #22, #25, and #66) of 17 residents reviewed for dietary services. The facility census was 67. Findings include: 1. Review of the medical record for Resident #19 revealed an admitted [DATE]. Diagnoses included congestive heart failure, hypertension, and anemia. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #19 was cognitively intact. Interview on 04/09/24 at 10:02 A.M. with Resident #19 revealed the food was often cold when she receives it. 2. Review of the medical record for Resident #66 revealed an admitted [DATE]. […]