Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

JERSEYVILLE MANOR

JERSEYVILLE, IL · 155 certified beds · Last Life Safety survey January 23, 2025

CMS Certification Number 145733 · first certified September 1992

Ownership

Operated by UNLIMITED DEVELOPMENT, INC. · Non profit - Other

No change of ownership on CMS record since January 1, 2016, when the records begin.

7
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
2
Tags cited more than once
Across separate surveys
5
Inspection & testing records
Of the citations on file

Position within IL

7 citations — more than 27% of the 666 certified nursing homes in IL. Compared within IL rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Improvingfewer citations at the latest survey than at its earlier surveys in the window.

The latest survey found 1 citation; the earlier surveys in the window averaged 3. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

Well past the typical window (December 2025 to March 2026), and past the point by which nine in ten IL facilities have been surveyed. This facility’s last Life Safety survey was January 2025. Facilities in IL are typically surveyed 11–13 months after the last one (median 12), measured over 759 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

1 inspection-and-testing tag has been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Physical environment (health survey)

1 physical-environment citation on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 7 Life Safety citations above. The Physical Environment Index

  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

How that compares

Citations on file over three years

Compared with the median facility in IL, and nationally. Surveyors differ markedly between states, so the IL figure is the meaningful one.

This facility7IL median15National median11
Citations on file over three years, compared
MeasureCitations
This facility7
Median facility in IL15
Median facility nationally11

Survey history

Citations at each Life Safety survey
32022-1232024-0212025-01
Citations at each Life Safety survey
Survey dateCitations
December 19, 20223
February 15, 20243
January 23, 20251

Most-cited tags

Most-cited tags at this facility
K-01332K-03632K-03531K-09181K-03451
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0133Install a two-hour-resistant firewall separation.22025-01-23
K-0363Install corridor and hallway doors that block smoke.22024-02-15
K-0353Inspect, test, and maintain automatic sprinkler systems.12022-12-19
K-0918Have generator or other power source capable of supplying service within 10 seconds.12024-02-15
K-0345Have approved installation, maintenance and testing program for fire alarm systems.12022-12-19

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 4
  • Construction Deficiencies 2
  • Gas, Vacuum, and Electrical Systems Deficiencies 1
Citations by CMS category
CategoryCitations
Smoke Deficiencies4
Construction Deficiencies2
Gas, Vacuum, and Electrical Systems Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

January 23, 2025 — 1 citation

Citations issued on January 23, 2025
TagWhat the surveyor checksStatus
K-0133Install a two-hour-resistant firewall separation.Deficient, Provider has date of correction (February 21, 2025)

February 15, 2024 — 3 citations

Citations issued on February 15, 2024
TagWhat the surveyor checksStatus
K-0133Install a two-hour-resistant firewall separation.Deficient, Provider has date of correction (February 22, 2024)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (February 22, 2024)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (March 20, 2024)

December 19, 2022 — 3 citations

Citations issued on December 19, 2022
TagWhat the surveyor checksStatus
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (January 14, 2023)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (January 14, 2023)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (January 14, 2023)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.