Integrity Hc of Carbondale
On Medicare Special Focus status, a serious quality warning. Visit in person and ask tough questions before deciding.
based on 32 Google reviews
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Quality Concerns Identified
Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.
- Special Focus Facility (under heightened CMS scrutiny)
- Abuse citation on record
- Low overall rating (1/5 stars)
- Low staffing rating (2/5 stars)
- Above-median deficiencies (32 vs median 11.0)
- High staff turnover (69%)
- High RN turnover (89%)
Bottom 25% in IL · Critically understaffed (RN) · Above recommended total nurse staffing · Worst in INTEGRITY HEALTHCARE COMMUNITIES chain · $199,594 in fines · Special Focus Facility (CMS) · Abuse citation
What this means for your family
While the facility has a specialized TBI unit that some families find beneficial, the recurring reports of unsanitary conditions and neglect are significant red flags. We strongly recommend conducting an unannounced visit to inspect the cleanliness of the rooms and observing staff interactions before making a decision.
Google Reviews
Google Reviews
32 reviews on Google“Integrity HC of Carbondale receives highly polarized feedback, with some families praising the TBI unit and friendly staff, while others report severe neglect and unsanitary conditions. Critical concerns include cleanliness issues, poor communication regarding medical orders, and allegations of staff negligence. Potential families should be aware of the stark contrast between positive experiences in specialized units and reports of systemic failures in basic care.”
Quality Themes
Tap a score for detailsStrengths
- Specialized TBI (Traumatic Brain Injury) unit
- Friendly and compassionate nursing staff
- Recent facility renovations
Concerns
- Unsanitary conditions and cleanliness issues (mentioned by 4 reviewers)
- Neglect and poor quality of care (mentioned by 4 reviewers)
- Poor communication and follow-through on medical orders (mentioned by 2 reviewers)
Rating Trends
Tap a year to see what changed
Distribution · 54 analyzed
How They Respond to Reviews
Questions for Your Tour
- 1I noticed you have a specialized TBI unit; how does the care plan for those residents differ from the rest of the facility?
- 2With the recent renovations, what specific improvements have been made to the dining areas and resident rooms?
- 3How does the nursing team ensure that all medical orders and medication changes are communicated clearly to both the residents and their families?
- 4What specific protocols do you have in place to maintain high standards of cleanliness and sanitation throughout the facility?
- 5Can you tell me about the daily activities and social programs available to help residents stay engaged with one another?
- 6In the event of a medical emergency during the night, what is the immediate process for notifying the family and coordinating care?
Personalized based on this facility's data
Key Review Excerpts
“New traumatic head injury wing is top notch.”
“While it's not a photo of "State of the Art" cutting edge technology, perfect food or 100% sterility, I have found most of the staff to be caring and careful with my aunt.”
“Had to give management the exact same doctors orders at least 4 times post surgery before the staff even came close to following orders when my grandmother was there.”
Quality Measures
Quality Measures
Resident outcomes compared with national, state, and local averages · 17 measures
10
measures
4
measures
3
measures
Residents with depression symptoms
Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.
Residents on anti-anxiety or sleep medication
Residents who lost too much weight
Residents whose bladder or bowel control got worse
Residents whose walking got worse
Residents vaccinated for pneumonia
Short-stay residents vaccinated for the flu
Short-stay residents vaccinated for pneumonia
Short-stay residents newly given antipsychotics
US average from Medicare published data
Inspection History
Medicare Inspection History
3-year lookback · Medicare 2026
This facility has serious recurring problems with families filing numerous complaints about resident safety, food service, and medication management. Recent deficiencies include resident abuse protection failures, medication errors, inadequate nutrition/food safety, and accident hazards. While the facility corrects violations when cited, the pattern of 37 complaint-triggered deficiencies across multiple surveys suggests ongoing care quality issues that prompt families to report concerns to authorities.
Oct 9, 2025Complaint4
Resident Rights Deficiencies
Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
Sep 10, 2025Complaint4
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Aug 27, 2025Complaint5
Nursing and Physician Services Deficiencies
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary Deficiencies
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.
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
Jul 23, 2025Complaint5
Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
Nutrition and Dietary Deficiencies
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Feb 25, 2025Complaint1
Egress Deficiencies
Install proper backup exit lighting.
Feb 10, 2025Routine17
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Egress Deficiencies
Have properly located and lighted "Exit" signs.
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Smoke Deficiencies
Provide properly protected cooking facilities.
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Resident Rights Deficiencies
Keep residents' personal and medical records private and confidential.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Resident Assessment and Care Planning Deficiencies
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Quality of Life and Care Deficiencies
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Federal Penalties
Fine
Oct 9, 2025
$101,500
Fine
Jul 23, 2025
$99,119
Payment Denial
Jul 23, 2025
40-day denial
Fine
Dec 19, 2024
$203,153
Payment Denial
Dec 19, 2024
64-day denial
Ownership & Operations
Who Operates This Facility
Integrity Hc of Carbondale
for profit
Chain Affiliation
Integrity Healthcare Communities
5 facilities nationwide
Chain avg rating: 2.0/5 · Rank 4 of 5 (Worst)
Ownership & Management
Key personnel
Contact
Get in Touch
Contact this facility directly and verify the details that matter most to your family.
References & Resources
Medicare Care Compare
Official Medicare quality ratings, inspections & staffing data
Google Maps
Photos, directions & neighborhood info
Google Reviews
32 reviews from families & visitors
Official Website
Visit integrityhcc.com
Medicare data downloads
Original nursing home datasets
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Safer Alternatives Nearby
Based on current clinical data, we identified 1 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.