2020 3rd Quarterly Report

The Illinois Department of Public Health has initiated action, as indicated, against the following facilities which have been determined to be in violation of the Nursing Home Care Act, or has recommended decertification to the Director of the Department of Healthcare and Family Service, or the Secretary of the United States Department of Health and Human Services for violations in relation to patient care, pursuant to Titles XVIII and XIX of the Federal Social Security Act.

FACILITY ADDRESS: 2833 North Nordica Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60634

DOCKET NUMBER: NH 20-C0214

LICENSEE INFO: Norwegian Lutheran Bethesda Home Association
LICENSEE ADDRESS: 6016 North Nina Ave
LICENSEE CITY, STATE, ZIP: Chicago, IL 60631
Survey Date – 07/28/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 14500 South Manistee
FACILITY CITY, STATE, ZIP: Burnham, IL 60633

DOCKET NUMBER: NH 20-C0188

LICENSEE INFO: River Oaks Healthcare & Rehabilitation Center, LLC
LICENSEE ADDRESS: 5151 Church Street
LICENSEE CITY, STATE, ZIP: Skokie, IL 60044
Survey Date – 06/26/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 5400 West 87^th Street
FACILITY CITY, STATE, ZIP: Burbank, IL 60459

DOCKET NUMBER: NH 20-C0227

LICENSEE INFO: Burbank Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 08/24/2020

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b) and 300.1210c). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b).

A fine of $500.00

FACILITY ADDRESS: 4314 South Wabash Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60653

DOCKET NUMBER: NH 20-S0193

LICENSEE INFO: Laureate Chicago Operations, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street. Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 07/14/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010d)e)h), 300.1210b), 300.1210c), 300.1210d)3)6), 300.1220b)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 850 East Second Street
FACILITY CITY, STATE, ZIP: El Paso, IL 61738

DOCKET NUMBER: NH 20-C0205

LICENSEE INFO: El Paso HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 07/24/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210c)3), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 900 West Race Street
FACILITY CITY, STATE, ZIP: Ridgway, IL 62979

DOCKET NUMBER: NH 20-C0218

LICENSEE INFO: Gallatin Manor, LLC
LICENSEE ADDRESS: 900 W. Race Street
LICENSEE CITY, STATE, ZIP: Ridgway, IL 62979
Survey Date – 07/29/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c)3), 300.1210d)6), 300.3240a), and 300.3240f). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a).

A fine of $25,000.00.

FACILITY ADDRESS: 21020 Kostner Avenue
FACILITY CITY, STATE, ZIP: Matteson, IL 60443

DOCKET NUMBER: NH 20-C0191

LICENSEE INFO: Generations at Applewood, LLC
LICENSEE ADDRESS: 6840 N. Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 07/01/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 760 McHenry Road
FACILITY CITY, STATE, ZIP: Wheeling, IL 60090

DOCKET NUMBER: NH 20-C0203

LICENSEE INFO: Harbor House of Wheeling IV, LLC
LICENSEE ADDRESS: 191 N. Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 07/02/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.1130). A fine of $1,100.00

FACILITY ADDRESS: 727 North 17^th Street
FACILITY CITY, STATE, ZIP: Belleville, IL 62226

DOCKET NUMBER: NH 20-C0210

LICENSEE INFO: Belleville Behavioral Health & Nursing Center, LLC
LICENSEE ADDRESS: 600 S. 2^nd Street, Ste 104
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 07/31/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), 300.1220b)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 107 South Lincoln
FACILITY CITY, STATE, ZIP: Smithton, IL 62285

DOCKET NUMBER: NH 20-C0208

LICENSEE INFO: Park Haven Nursing & Rehabilitation Center, LLC
LICENSEE ADDRESS: 600 S. 2^nd Street, Ste 104
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 07/17/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 12450 Walker Road
FACILITY CITY, STATE, ZIP: Lemont, IL 60539

DOCKET NUMBER: NH 20-C0194

LICENSEE INFO: Lemont Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 07/07/2020

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.3240b) and 300.3240e). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.3240e).

A fine of $500.00

FACILITY ADDRESS: 2320 South Lawndale Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60623

DOCKET NUMBER: NH 20-S0201

LICENSEE INFO: Little Village Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 5750 Old Orchard Road Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 07/01/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 222 North Hammes Avenue
FACILITY CITY, STATE, ZIP: Joliet, IL 60435

DOCKET NUMBER: NH 20-C0202

LICENSEE INFO: Parc Joliet Nursing, LLC
LICENSEE ADDRESS: 6302 N. Monticello Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60659
Survey Date – 08/05/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)2), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 1010 West 95^th Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60643

DOCKET NUMBER: NH 20-C0221

LICENSEE INFO: Southpoint Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 07/31/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.690a)b)c), 300.1040c)d), 300.1210a)b), 300.1210d)6), 300.1810c)3), and 300.3240c)d)f). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.690, 300.1210b), 300.1210d)6) and 300.3240d).

A fine of $25,000.00

FACILITY ADDRESS: 3311 South Michigan Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60616

DOCKET NUMBER: NH 20-C0228

LICENSEE INFO: Laureate Southview Operations, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 07/30/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 767 30^th Street
FACILITY CITY, STATE, ZIP: Rock Island, IL 61201

DOCKET NUMBER: NH 20-C0209

LICENSEE INFO: St. Anthony’s Nursing and Rehabilitation Center. L.L.C.
LICENSEE ADDRESS: 150 N, Riverside Place, Ste 3000
LICENSEE CITY, STATE, ZIP: Chicago, IL 60601
Survey Date – 07/30/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)5), 300.1220b)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 4600 North Frontage Road
FACILITY CITY, STATE, ZIP: Hillside, IL 61062

DOCKET NUMBER: NH 20-C0226

LICENSEE INFO: Symphony Aria, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 07/14/2020

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.696. This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.696. A fine of $500.00

FACILITY ADDRESS: 3400 South Indiana
FACILITY CITY, STATE, ZIP: Chicago, IL 60616

DOCKET NUMBER: NH 20-S0206

LICENSEE INFO: Symphony Bronzeville Park, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 08/04/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)3)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 7750 South Shore Drive
FACILITY CITY, STATE, ZIP: Chicago, IL 60649

DOCKET NUMBER: NH 20-C0187

LICENSEE INFO: Waterfront Terrace, Inc.
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 08/18/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210d)2). A fine of $1,100.00