2020 4th 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: 1001 East Pells Street
FACILITY CITY, STATE, ZIP: Paxton, IL 60957

DOCKET NUMBER: NH 20-C0258

LICENSEE INFO: Accolade Healthcare of the Heartland, LLC
LICENSEE ADDRESS: 1901 E. Golf Road, Ste 950A
LICENSEE CITY, STATE, ZIP: Schaumburg, IL 60173
Survey Date – 08/26/2020

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), 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 $2,200.00

FACILITY ADDRESS: 450 Fulton Street
FACILITY CITY, STATE, ZIP: Paxton, IL 60957

DOCKET NUMBER: NH 20-C0261

LICENSEE INFO: Accolade Healthcare of Paxton Senior Living, LLC
LICENSEE ADDRESS: 1900 E. Golf Road, Ste 950A
LICENSEE CITY, STATE, ZIP: Schaumburg, IL 60173
Survey Date – 08/24/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c)1), 300.1630d), 300.3220f) 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 $25,000.00

FACILITY ADDRESS: 550 South Mulford Avenue
FACILITY CITY, STATE, ZIP: Rockford, IL 61108

DOCKET NUMBER: NH 20-C0251

LICENSEE INFO: Alden – Alma Nelson Manor, Inc.
LICENSEE ADDRESS: 4200 West Peterson Avenue, Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 08/20/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 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 $2,200.00

FACILITY ADDRESS: 1545 Barrington Road
FACILITY CITY, STATE, ZIP: Hoffman Estates, IL 60169

DOCKET NUMBER: NH 20-C0248

LICENSEE INFO: Alden-Poplar Creek Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Ave. Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 08/18/2020

Type AA 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: 803 Royal Drive
FACILITY CITY, STATE, ZIP: McHenry, IL 60050

DOCKET NUMBER: NH 20-S0340

LICENSEE INFO: Alden Terrace of McHenry Rehabilitation and Health Care Ctr, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Avenue, Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 09/30/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210d)3), 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 $2,200.00

FACILITY ADDRESS: 304 S.W. 12^th Street
FACILITY CITY, STATE, ZIP: Aledo, IL 61231

DOCKET NUMBER: NH 20-C0263

LICENSEE INFO: Aledo HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 08/21/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)1), 300.1210d)2), and 300.1210d)3). 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). A fine of $25,000.00

FACILITY ADDRESS: 4900 N. Barnard
FACILITY CITY, STATE, ZIP: Chicago, IL 60625

DOCKET NUMBER: NH 20-C0274

LICENSEE INFO: Ambassador Nursing and Rehabilitation
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 09/11/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)2), 300.1210d)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) and 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 555 West Carpenter Road
FACILITY CITY, STATE, ZIP: Springfield, IL 62702

DOCKET NUMBER: NH 20-C0215

LICENSEE INFO: Aperion Care Capitol, LLC
LICENSEE ADDRESS: 208 S. La Salle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 08/10/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.610c)1), 300.1620f), 300.3240a), and 300.3300t). 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

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010g)3), 300.1010h), 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 $2,200.00

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), 300.1220b)7), 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

Total Fine $29,400.00

FACILITY ADDRESS: 490 West 16^th Place
FACILITY CITY, STATE, ZIP: Chicago, Heights, IL 60411

DOCKET NUMBER: NH 20-C0280

LICENSEE INFO: Riviera Care Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 08/27/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210d)3), 300.1210d)6), 300.3100d)2), 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: 300.1210d)6), 300.3100d)2), and 300.3240a). A fine of $25,000.00.

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210d)3), 300.1210d)6), 300.3100d)2), 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: 300.1210d)6), 300.3100d)2), and 300.3240a). A fine of $25,000.00.

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210d)3), 300.1220b)2)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 $2,200.00

Total Fines $52,200.00

FACILITY ADDRESS: 14325 South Blackstone
FACILITY CITY, STATE, ZIP: Dolton, IL 60419

DOCKET NUMBER: NH 20-C0222

LICENSEE INFO: Dolton Nursing & Rehab, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 08/07/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.1210b), 300.1210d)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) and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 9401 South Ridgeland Avenue
FACILITY CITY, STATE, ZIP: Oak Lawn, IL 60453

DOCKET NUMBER: NH 20-C0232

LICENSEE INFO: Concord Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
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), 300.1010h), 300.1210b), 300.1210d)3), 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 $2,200.00

FACILITY ADDRESS: 1300 North Greenwood Street
FACILITY CITY, STATE, ZIP: Spring Valley, IL 61362

DOCKET NUMBER: NH 20-C0253

LICENSEE INFO: Aperion Care Spring Valley, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 08/20/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 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: 1300 North Greenwood Street
FACILITY CITY, STATE, ZIP: Spring Valley, IL 61362

DOCKET NUMBER: NH 20-S0325

LICENSEE INFO: Aperion Care Spring Valley, LLC
LICENSEE ADDRESS: 208 So. LaSalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 09/30/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c)2), 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: 1512 West Fargo
FACILITY CITY, STATE, ZIP: Chicago, IL 60626

DOCKET NUMBER: NH 20-S0343

LICENSEE INFO: Arbour Health Care Center, Ltd.
LICENSEE ADDRESS: 191 N. Wacker Drive, Suite 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 10/09/2020

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: 1701 North Bowman
FACILITY CITY, STATE, ZIP: Danville, IL 61832

DOCKET NUMBER: NH 20-S0317

LICENSEE INFO: Danville Operations, LLC
LICENSEE ADDRESS: 600 South Second Street, Suite 404
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 10/08/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1220b)3), 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). A fine of $25,000.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.615e), 300.625c)1), 300.625c)2), 300.625f)4), and 300.625j). 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: 300.615e), 300.625c), 300.625f), and 300.625j). A fine of $2,200.00

Total fine $27,200.00

FACILITY ADDRESS: 1136 North Mill Street
FACILITY CITY, STATE, ZIP: Naperville, IL 60563

DOCKET NUMBER: NH 20-C0237

LICENSEE INFO: Arista Healthcare, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 07/02/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.3240a), 300.3240b), 300.3240d), 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: 300.3240a) and 300.3240d). A fine of $2,200.00

FACILITY ADDRESS: 901 South Austin Boulevard
FACILITY CITY, STATE, ZIP: Chicago, IL 60644

DOCKET NUMBER: NH 20-C0267

LICENSEE INFO: The Austin Oasis, LLC
LICENSEE ADDRESS: 4711 Gold Road, Street 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 09/01/2020

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), 300.1210d)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) and 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 901 South Austin Boulevard
FACILITY CITY, STATE, ZIP: Chicago, IL 60644

DOCKET NUMBER: NH 20-C0352

LICENSEE INFO: The Austin Oasis, LLC
LICENSEE ADDRESS: 4711 Golf Rd, Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 10/26/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1010i), 300.1210b), 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 $25,000.00

FACILITY ADDRESS: 1666 RFD Checker Road
FACILITY CITY, STATE, ZIP: Long Grove, IL 60047

DOCKET NUMBER: NH 20-C0189

LICENSEE INFO: Long Grove PAC, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 08/19/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b). 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). A fine of $2,200.00

FACILITY ADDRESS: 601 North Morgan
FACILITY CITY, STATE, ZIP: Bement, IL 61813

DOCKET NUMBER: NH 20-C0296

LICENSEE INFO: Bement HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 09/17/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210d)5), 300.1620a), 300.2210a)8), 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: 6909 West North Avenue
FACILITY CITY, STATE, ZIP: Oak Park, IL 60302

DOCKET NUMBER: NH 20-C0375

LICENSEE INFO: Berkeley Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 321 N. Clark Street, Suite 2800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60654
Survey Date – 10/22/2020

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), 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 $2,200;00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)6), 300.1210c), 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

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210d)3), 300.1220b)2), 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) and 300.3240a). A fine of $2,200.00

Total fine $6,600.00

FACILITY ADDRESS: 6301 Humbert Road
FACILITY CITY, STATE, ZIP: Godfrey, IL 62035

DOCKET NUMBER: NH 20-S0254

LICENSEE INFO: Beverly Farm Foundation
LICENSEE ADDRESS: 190 South LaSalle Street, Ste 3700
LICENSEE CITY, STATE, ZIP: Chicago, IL 60603
Survey Date – 08/24/2020

Type B violation for violating one or more of the following sections of the Code: 350.1060e) and 350.3220f). A fine of $1,100.00

FACILITY ADDRESS: 228 Briarbrook Drive
FACILITY CITY, STATE, ZIP: East Peoria, IL 61611

DOCKET NUMBER: NH 20-C0240

LICENSEE INFO: Progressive Housing, Inc.
LICENSEE ADDRESS: 20180 Governors Dr. Ste 300
LICENSEE CITY, STATE, ZIP: Olympia Fields, IL 60461
Survey Date – 08/07/2020

Type B violation for violating one or more of the following sections of the Code: 350.670. A fine of $550.00.

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

DOCKET NUMBER: NH 20-C0249

LICENSEE INFO: Burbank Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 08/19/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.690a), 300.1210b), 300.1210d)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: 300.690a), 300.1210b), and 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 751 North Oak Street
FACILITY CITY, STATE, ZIP: Carlinville, IL 62626

DOCKET NUMBER: NH 20-C0324

LICENSEE INFO: Carlinville Rehabilitation and Health Care Center, LLC
LICENSEE ADDRESS: 412 E. Lawrence Avenue
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 09/16/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c), 300.1210d)6), 300.1220b)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), 300.1210d)6), and 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 1660 South Mulford Road
FACILITY CITY, STATE, ZIP: Rockford, IL 61108

DOCKET NUMBER: NH 20-C0295

LICENSEE INFO: Rockford NH, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 09/17/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)2), 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

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.690b), 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: 300.690, 300.1210b), 300.1210d)6), and 300.3240a). A fine of $2,200.00

Total fine $27,200.00

FACILITY ADDRESS: 1660 South Mulford Road
FACILITY CITY, STATE, ZIP: Rockford, IL 61108

DOCKET NUMBER: NH 20-C0349

LICENSEE INFO: Rockford NH LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 10/27/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.3240a), 300.3240b), and 300.3240e). 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) and 300.3240e). A fine of $2,200.00

FACILITY ADDRESS: 601 West Lincoln Avenue
FACILITY CITY, STATE, ZIP: Caseyville, IL 62232

DOCKET NUMBER: NH 20-C0288

LICENSEE INFO: Caseyville Nursing & Rehabilitation Center, Inc
LICENSEE ADDRESS: 7434 N. Skokie Blvd
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 09/02/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)4), 300.1210d)4)B), 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: 302 Burwash Avenue
FACILITY CITY, STATE, ZIP: Savoy, IL 61874

DOCKET NUMBER: NH 20-C0341

LICENSEE INFO: Champaign Urbana Nursing and Rehab, LP
LICENSEE ADDRESS: 5750 Old Orchard Rd, Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 09/23/2020

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: 1507 7^th Street
FACILITY CITY, STATE, ZIP: Lincoln, IL 62656

DOCKET NUMBER: NH 20-S0327

LICENSEE INFO: Christian Homes, Inc.
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 10/01/2020

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), 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 $2,200.00

FACILITY ADDRESS: 625 E. Monroe Street
FACILITY CITY, STATE, ZIP: Cuba, IL 61427

DOCKET NUMBER: NH 20-C0318

LICENSEE INFO: County of Fulton
LICENSEE ADDRESS: P.O. Box 226, 100 N. Main Street
LICENSEE CITY, STATE, ZIP: Lewistown, IL 61542
Survey Date – 10/08/2020

Type B 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 $2,200.00

FACILITY ADDRESS: 1635 East 154^th Street
FACILITY CITY, STATE, ZIP: Dolton, IL 60419

DOCKET NUMBER: NH 20-C0250

LICENSEE INFO: Countryside Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 W. Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 08/20/2020

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), 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: 13301 South Central Avenue
FACILITY CITY, STATE, ZIP: Crestwood, IL 60418

DOCKET NUMBER: NH 20-S0300 & NH 20-C0301

LICENSEE INFO: Laureate Crestwood Operations, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 09/29/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)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

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), 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 $2,200.00

Total fine $27,200.00

FACILITY ADDRESS: 4505 S. Drexel Blvd
FACILITY CITY, STATE, ZIP: Chicago, IL 60653

DOCKET NUMBER: NH 20-C0211

LICENSEE INFO: The Estates of Hyde Park, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 08/05/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010g)3), 300.1210b), 300.1210d)2)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.

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010g)4), 300.1210b), 300.1210d)2)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) and 300.3240a). A fine of $2,200.00’

Total Fines: $27,200.00

FACILITY ADDRESS: 701 Shadwell Avenue
FACILITY CITY, STATE, ZIP: Flora, IL 62839

DOCKET NUMBER: NH 20-C0353

LICENSEE INFO: Petersen Health Network, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 10/23/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)2), 300.3220f), 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 $25,000.00

FACILITY ADDRESS: 321 Arnold Avenue
FACILITY CITY, STATE, ZIP: Rockford, IL 61108

DOCKET NUMBER: NH 20-C0264 & NH 20-S0247

LICENSEE INFO: Forest City Rehab and Nursing Center, LLC
LICENSEE ADDRESS: 4711 Golf Rd, Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 08/18/2020

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: 7733 West Grand Avenue
FACILITY CITY, STATE, ZIP: Elmwood Park, IL 60707

DOCKET NUMBER: NH 20-C0217

LICENSEE INFO: Generations at Elmwood Park, Inc.
LICENSEE ADDRESS: 6840 N. Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 08/25/2020

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), and 300.1210b). 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: 5600 N. Glen Elm Drive
FACILITY CITY, STATE, ZIP: Peoria, IL 61614

DOCKET NUMBER: NH 20-C0310

LICENSEE INFO: Generations at Peoria, LLC
LICENSEE ADDRESS: 6840 N. Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 10/07/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 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 $25,000.00

FACILITY ADDRESS: 2545 24^th Street
FACILITY CITY, STATE, ZIP: Rock Island, IL 61201

DOCKET NUMBER: NH 20-S0293 & NH 20-C0294

LICENSEE INFO: Generations at Rock Island, LLC
LICENSEE ADDRESS: 6840 North Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 09/16/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d2)3), 3001630d), 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

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

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)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) and 300.3240a). A fine of $2,200.00

A total fine $52,200.00

FACILITY ADDRESS: 6601 West Touhy
FACILITY CITY, STATE, ZIP: Niles, IL 60714

DOCKET NUMBER: NH 20-C0306

LICENSEE INFO: Grosse Pointe Manor, LLC
LICENSEE ADDRESS: 191 North Wacker Dr, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 09/17/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)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 $2,200.00

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

Total fine $4,400.00

FACILITY ADDRESS: 1601 North Farnsworth Avenue
FACILITY CITY, STATE, ZIP: Aurora, IL 60505

DOCKET NUMBER: NH 20-C0271

LICENSEE INFO: Aurora PAC, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 09/10/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 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 $25,000.00

FACILITY ADDRESS: 15600 South Honore Street
FACILITY CITY, STATE, ZIP: Harvey, IL 60426

DOCKET NUMBER: NH 20-C0231

LICENSEE INFO: Heather Health Care Center, Inc
LICENSEE ADDRESS: 4200 W. Peterson Ave., Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 07/17/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1035a)3), 300.1035a)4), 300.1035a)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: 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 873 Grove Street
FACILITY CITY, STATE, ZIP: Jacksonville, IL 62650

DOCKET NUMBER: NH 20-C0307

LICENSEE INFO: Barton W. Stone-Jacksonville, LLC
LICENSEE ADDRESS: 115 W. Jefferson St, Ste 401
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 09/15/2020

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: 1225 Woodland Drive
FACILITY CITY, STATE, ZIP: Mt. Zion, IL 62549

DOCKET NUMBER: NH 20-C0262

LICENSEE INFO: Heritage Manor – Mt. Zion, LLC
LICENSEE ADDRESS: 115 W. Jefferson Street, Ste 400
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 08/31/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 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: 300.1210d)6), and 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 900 North Rutledge Street
FACILITY CITY, STATE, ZIP: Springfield, IL 62702

DOCKET NUMBER: NH 20-C0245

LICENSEE INFO: Rutledge Joint Ventures, LLC
LICENSEE ADDRESS: 202 N. Center
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 08/17/2020

Type B 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 $2,200.00

FACILITY ADDRESS: 1450 26^th Street
FACILITY CITY, STATE, ZIP: Highland, IL 62249

DOCKET NUMBER: NH 20-C0378

LICENSEE INFO: Highland Care and Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 10/23/2020

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), 300.1220b)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: 910 West Polk Avenue
FACILITY CITY, STATE, ZIP: Charleston, IL 61920

DOCKET NUMBER: NH 20-C0224

LICENSEE INFO: Hilltop Care and Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 08/12/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 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) and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 910 West Polk Avenue
FACILITY CITY, STATE, ZIP: Charleston, IL 61920

DOCKET NUMBER: NH 20-C0309

LICENSEE INFO: Hilltop Care and Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 10/01/2020

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: 3523 Wickenhauser
FACILITY CITY, STATE, ZIP: Alton, IL 62002

DOCKET NUMBER: NH 20-C0238

LICENSEE INFO: Alton Rehabilitation and Nursing Center, LLC
LICENSEE ADDRESS: 600 S 2^nd Street. Suite 104
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 08/03/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 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: 3523 Wickenhauser
FACILITY CITY, STATE, ZIP: Alton, IL 62002

DOCKET NUMBER: NH 20-C0333

LICENSEE INFO: Alton Rehabilitation and Nursing Center, LLC
LICENSEE ADDRESS: 600 S. 2^nd Street, Ste 104
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 10/01/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 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 $2,200.00

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

DOCKET NUMBER: NH 20-C0328

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 – 09/30/2020

Type B 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 $2,200.00

FACILITY ADDRESS: 4101 Lake Cook Road
FACILITY CITY, STATE, ZIP: Northbrook, IL 60062

DOCKET NUMBER: NH 20-C0220

LICENSEE INFO: Northbrook NH, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 08/06/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)2), 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 $2,200.00

FACILITY ADDRESS: 900 Centennial Drive
FACILITY CITY, STATE, ZIP: East Peoria, IL 61611

DOCKET NUMBER: NH 20-C0259

LICENSEE INFO: East Peoria, NH, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 08/28/2020

Type AA violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210d)2), 300.1210d)3), 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 $50,000.00

FACILITY ADDRESS: 10300 Southwest Highway
FACILITY CITY, STATE, ZIP: Chicago Ridge, IL 60415

DOCKET NUMBER: NH 20-C0354 & NH 20-S0355

LICENSEE INFO: Lexington Health Care Center of Chicago Ridge, Inc
LICENSEE ADDRESS: 665 West North Avenue
LICENSEE CITY, STATE, ZIP: Lombard, IL 60148
Survey Date – 10/23/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), and 300.1210d)6). 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 300.1210d)6). A fine of $2,200.00

FACILITY ADDRESS: 14601 South John Humphrey Dr
FACILITY CITY, STATE, ZIP: Orland Park, IL 60462

DOCKET NUMBER: NH 20-C0273

LICENSEE INFO: Lexington Health Care Center od Orland Park, Inc.
LICENSEE ADDRESS: 665 West North Avenue
LICENSEE CITY, STATE, ZIP: Lombard, IL 60148
Survey Date – 09/09/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210d)3)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 $2,200.00

FACILITY ADDRESS: 2081 North Main Street
FACILITY CITY, STATE, ZIP: Canton, IL 61520

DOCKET NUMBER: NH 20-C0338

LICENSEE INFO: The Loft Rehabilitation and Nursing of Canton, LLC
LICENSEE ADDRESS: 55 W Monroe St, Ste 2400
LICENSEE CITY, STATE, ZIP: Chicago, IL 60603
Survey Date – 09/22/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 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 $2,200.00

FACILITY ADDRESS: 510 Broadway
FACILITY CITY, STATE, ZIP: Normal, IL 61761

DOCKET NUMBER: NH 20-C0358

LICENSEE INFO: The Loft Rehabilitation and Nursing of Normal, LLC
LICENSEE ADDRESS: 55 W. Monroe Street, Ste 2400
LICENSEE CITY, STATE, ZIP: Chicago, IL 60603
Survey Date – 10/27/2020

Type B 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 $2,200.00

FACILITY ADDRESS: 1 Park Lane West
FACILITY CITY, STATE, ZIP: Clinton, IL 61727

DOCKET NUMBER: NH 20-S0346

LICENSEE INFO: Residential Alternative of Illinois, Inc.
LICENSEE ADDRESS: 285 South Farnharm Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 09/10/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1830a), 300.1830b), 300.1830c), 300.3210a), 300.3210f), 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: 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 6955 State Route 162
FACILITY CITY, STATE, ZIP: Maryville, IL 62062

DOCKET NUMBER: NH 20-C0255

LICENSEE INFO: UDI#2, LLC
LICENSEE ADDRESS: 285 S. Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 08/24/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b)4), 300.1210b)5), 300.1210d)6), 300.1220a), 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: 2121 South 9^th Street
FACILITY CITY, STATE, ZIP: Mattoon, IL 61938

DOCKET NUMBER: NH 20-C0290

LICENSEE INFO: Mattoon Manor, LLC
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 09/15/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c), 300.1210d)2), 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 $2,200.00

FACILITY ADDRESS: 2121 South 9^th Street
FACILITY CITY, STATE, ZIP: Mattoon, IL 61938

DOCKET NUMBER: NH 20-C0312

LICENSEE INFO: Mattoon Manor, LLC
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 10/14/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.3210f), 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: 5905 West Washington
FACILITY CITY, STATE, ZIP: Chicago, IL 60644

DOCKET NUMBER: NH 20-C0216

LICENSEE INFO: Mayfield Care Center, LLC
LICENSEE ADDRESS: 1900 E. Golf Rd, Ste 940
LICENSEE CITY, STATE, ZIP: Schaumburg, IL 60173
Survey Date – 08/18/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)4)5), 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

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.690b). No Fine

FACILITY ADDRESS: 901 North Main
FACILITY CITY, STATE, ZIP: Normal, IL 61761

DOCKET NUMBER: NH 20-C0266

LICENSEE INFO: McLean County
LICENSEE ADDRESS: 115 E. Washington Street, Rm 401
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61702
Survey Date – 09/01/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), and 300.1210d)6). 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 300.1210d)6). A fine of $25,000.00

FACILITY ADDRESS: 2299 Metropolis Street
FACILITY CITY, STATE, ZIP: Metropolis, IL 62960

DOCKET NUMBER: NH 20-C0289

LICENSEE INFO: Metropolis Health Care Center
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 09/04/2020

Type AA violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 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 $50,000.00

FACILITY ADDRESS: 831 North Batavia Avenue
FACILITY CITY, STATE, ZIP: Batavia, IL 60510

DOCKET NUMBER: NH 20-S0362 & NH 20-C0363

LICENSEE INFO: Covenant Health Care Center, Inc.
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 10/22/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)3), 300.1035c)1)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 $25,000.00

FACILITY ADDRESS: #5 Doctor’s Park Road
FACILITY CITY, STATE, ZIP: Mount Vernon, IL 62864

DOCKET NUMBER: NH 20-C0292

LICENSEE INFO: Petersen Management Company, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 09/15/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)7), 300.1210b), 300.1210d)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), 300.696, and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 525 South Macon Street
FACILITY CITY, STATE, ZIP: Moweaqua, IL 62550

DOCKET NUMBER: NH 20-C0212

LICENSEE INFO: Moweaqua Rehabilitation & Health Care Center, LLC
LICENSEE ADDRESS: 412 E. Lawrence Avenue
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 08/06/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 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 $2,200.00

FACILITY ADDRESS: 525 South Macon Street
FACILITY CITY, STATE, ZIP: Moweaqua, IL 62550

DOCKET NUMBER: NH 20-S0357

LICENSEE INFO: Moweaqua Rehabilitation & Health Care Center, LLC
LICENSEE ADDRESS: 412 E. Lawrence Avenue
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 10/26/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)6), 300.696c)7), 300.1210d)3), 300.1220b)1), 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: 300.696 and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 612 East Davie Street, P.O. Box 88
FACILITY CITY, STATE, ZIP: Anna, IL 62906

DOCKET NUMBER: NH 20-C0265

LICENSEE INFO: Mulberry Manor, Inc.
LICENSEE ADDRESS: 158 E. Vienna Street, P.O. Box 88
LICENSEE CITY, STATE, ZIP: Anna, IL 62906
Survey Date – 08/27/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 350.620a), 350.760a), 350.760c)7), 350.1223a), 350.1230b), 350.1230d)2), and 350.3240a). A fine of $10,000.00

FACILITY ADDRESS: 612 East Davie Street, Box 88
FACILITY CITY, STATE, ZIP: Anna, IL 62906

DOCKET NUMBER: NH 20-C0367

LICENSEE INFO: Mulberry Manor, Inc.
LICENSEE ADDRESS: 158 E. Vienna Street, P.O. Box 88
LICENSEE CITY, STATE, ZIP: Anna, IL 62906
Survey Date – 10/19/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 350.620a) 350.1210, 350.1230b)6)7), 350.1230d)1), and 350.3240a). A fine of $10,000.00

FACILITY ADDRESS: 505 Stevens Street
FACILITY CITY, STATE, ZIP: Nokomis, IL 62075

DOCKET NUMBER: NH 20-C0275

LICENSEE INFO: Petersen Health Network, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 09/15/2020

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), 300.2900/300.3100 d)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), 300.1210d)6), and 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 9525 South Mayfield
FACILITY CITY, STATE, ZIP: Oaklawn, IL 60453

DOCKET NUMBER: NH 20-C0322

LICENSEE INFO: Oak Lawn Respiratory and Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 10/08/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)2), 300.1210d)5), 300.1620a), 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 $2,200.00

FACILITY ADDRESS: 3800 North California
FACILITY CITY, STATE, ZIP: Chicago, IL 60618

DOCKET NUMBER: NH 20-C0308

LICENSEE INFO: Paul House & Health Care Center, LLC
LICENSEE ADDRESS: 6500 North Hamlin Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 09/17/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)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: 6141 North Pulaski
FACILITY CITY, STATE, ZIP: Chicago, IL 60646

DOCKET NUMBER: NH 20-C0342

LICENSEE INFO: Peterson Park Associates, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 10/08/2020

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), 300.1210d)3), 300.1220b)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: 350 West South First Street
FACILITY CITY, STATE, ZIP: Red Bud, IL 62278

DOCKET NUMBER: NH 20-C0272

LICENSEE INFO: Red Bud Illinois Hospital Company, L.L.C.
LICENSEE ADDRESS: 201 So. LaSalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 09/11/2020

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: 350 West South First Street
FACILITY CITY, STATE, ZIP: Red Bud, IL 62278

DOCKET NUMBER: NH 20-C0287

LICENSEE INFO: Red Bud Illinois Hospital Company, L.L.C.
LICENSEE ADDRESS: 201 So. LaSalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 08/07/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 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 $2,200.00

FACILITY ADDRESS: 120 West Main
FACILITY CITY, STATE, ZIP: Albion, IL 62806

DOCKET NUMBER: NH 20-C0305

LICENSEE INFO: Rest Haven Manor, Inc.
LICENSEE ADDRESS: Box 511 11^th @ State Street
LICENSEE CITY, STATE, ZIP: Lawrenceville, IL 62439
Survey Date – 09/18/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 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: 900 North Third Street
FACILITY CITY, STATE, ZIP: Rochelle, IL

DOCKET NUMBER: NH 20-C0239

LICENSEE INFO: Petersen Health Network, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 08/07/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) and 300.3220f). 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). A fine of $25,000.00

FACILITY ADDRESS: 3615 16^th Street
FACILITY CITY, STATE, ZIP: Zion, IL 60099

DOCKET NUMBER: NH 20-S0361

LICENSEE INFO: Slovak American Charitable Association
LICENSEE ADDRESS: 3521 16^th Street
LICENSEE CITY, STATE, ZIP: Zion, IL 60099
Survey Date – 10/27/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1220b)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: 430 South 30^th Avenue
FACILITY CITY, STATE, ZIP: East Moline, IL 61244

DOCKET NUMBER: NH 20-C0283

LICENSEE INFO: Allure of Moline, LLC
LICENSEE ADDRESS: 2711 W. Howard Street
LICENSEE CITY, STATE, ZIP: Chicago, IL 60645
Survey Date – 08/27/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 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 $2,200.00

FACILITY ADDRESS: 1901 North 13^th Street
FACILITY CITY, STATE, ZIP: Herrin, IL 62948

DOCKET NUMBER: NH 20-C0241

LICENSEE INFO: Shawnee Senior Living, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 08/12/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210c), 300.1210d)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 $2,200.00

FACILITY ADDRESS: 1901 North 13^th Street
FACILITY CITY, STATE, ZIP: Herrin, IL 62948

DOCKET NUMBER: NH 20-S0291 & NH 20-C0303

LICENSEE INFO: Shawnee Senior Living, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 09/15/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.696a), 300.696b), 300.696c)2), 300.696c)7), 300.1210b), 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: 300.696, 300.1210b), and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 1111 W. North 12^th Street
FACILITY CITY, STATE, ZIP: Shelbyville, IL 62565

DOCKET NUMBER: NH 20-C0388

LICENSEE INFO: UDI #3, L.L.C.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 10/27/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a),300.696a), 300.696b), 300.696c)7), 300.696d)1), 300.1210b), 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: 300.696, 300.1210b), and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 19000 South Halsted Street
FACILITY CITY, STATE, ZIP: Homewood, IL 60430

DOCKET NUMBER: NH 20-C0243

LICENSEE INFO: South Suburban Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 West Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 08/14/2020

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: 19000 South Halsted Street
FACILITY CITY, STATE, ZIP: Homewood, IL 60430

DOCKET NUMBER: NH 20-C0244

LICENSEE INFO: South Suburban Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 West Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 08/17/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h). A fine of $1,100.00

FACILITY ADDRESS: 900 E. Ninth Street, P.O. Box 843
FACILITY CITY, STATE, ZIP: Metropolis, IL 62960

DOCKET NUMBER: NH 20-S0234

LICENSEE INFO: Southgate Health Care, Inc.
LICENSEE ADDRESS: 900 E. 9^th Street
LICENSEE CITY, STATE, ZIP: Metropolis, IL 62960
Survey Date – 08/12/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)5), 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: 1010 West 95^th Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60643

DOCKET NUMBER: NH 20-C0311

LICENSEE INFO: Southpoint Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 10/08/2020

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: 1251 East Richton Road
FACILITY CITY, STATE, ZIP: Crete, IL 60417

DOCKET NUMBER: NH 20-C0337

LICENSEE INFO: St. James Wellness Rehab and Villas, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 09/21/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)5), 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: 3900 Stearns Avenue
FACILITY CITY, STATE, ZIP: Granite City, IL 62040

DOCKET NUMBER: NH 20-C0269

LICENSEE INFO: Stearns Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 901 S. 2^nd Street Ste 201
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 09/04/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)2), 300.696c)6), 300.696c)7), 300.1020a), 300.1020b), 300.1020c), 300.1210b), 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: 300.696, 300.1210b), and 300.3240a). A fine of $25,000.00

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)2), 300.1210d)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) and 300.3240a). A fine of $25,000.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210d)3), 300.2040d), 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

Total fines $52,000.00

FACILITY ADDRESS: 3900 Stearns Avenue
FACILITY CITY, STATE, ZIP: Granite City, IL 62040

DOCKET NUMBER: NH 20-C0316

LICENSEE INFO: Stearns Nursing and Rehabilitation Center, L.L.C.
LICENSEE ADDRESS: 901 S. 2^nd Street, Ste 201
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 10/09/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)3), 300.1220b)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), 300.1210d)6), and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 2946 South Walnut Road
FACILITY CITY, STATE, ZIP: Freeport, IL 61032

DOCKET NUMBER: NH 20-M0344 & NH 20-M0345

LICENSEE INFO: Stephenson County Board of Supervisors
LICENSEE ADDRESS: 50 W. Douglas St, Ste 1002
LICENSEE CITY, STATE, ZIP: Freeport, IL 31032
Survey Date – 10/26/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.696a), 300.696c)2), 300.696c)7), 300.1020a), 300.1020b), 300.1210b), 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: 300.696, 300.1210b), and 300.3240a). A fine of $25,000.00

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210d)2), 300.1210d)3), 300.1210d)5), 300.3210o) 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: 300.1210d)5) and 300.3240a). A fine of $25,000.00

Total fine $50,000.00

FACILITY ADDRESS: 418 Washington Street
FACILITY CITY, STATE, ZIP: Quincy, IL 62301

DOCKET NUMBER: NH 20-M0286

LICENSEE INFO: Sunset Home
LICENSEE ADDRESS: 625 Vermont Street
LICENSEE CITY, STATE, ZIP: Quincy, IL 62301
Survey Date – 10/20/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.670k), 300.696a), 300.696c)7), 300.1020a), 300.1020b), and 300.1020c). 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: 300.696. A fine of $25,000.00

FACILITY ADDRESS: 2940 West 87^th Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60652

DOCKET NUMBER: NH 20-C0246

LICENSEE INFO: Symphony Beverly, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 08/18/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.3240a), 300.3240b), 300.3240c), 300.3240d), 300.3240e), 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: 300.3240a), 300.3240d), and 300.3240e). A fine of $2,200.00

FACILITY ADDRESS: 4600 North Frontage Road
FACILITY CITY, STATE, ZIP: Hillside, IL 60162

DOCKET NUMBER: NH 20-C0372

LICENSEE INFO: Symphony Aria, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 10/09/2020

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), 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: 10935 S. Halsted Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60628

DOCKET NUMBER: NH 20-C0270

LICENSEE INFO: Symphony Park South, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 09/08/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.3240a), 300.3240b), and 300.3240d). 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) and 300.3240d). A fine of $2,200.00.

FACILITY ADDRESS: 2330 West Galena Blvd
FACILITY CITY, STATE, ZIP: Aurora, IL 60506

DOCKET NUMBER: NH 20-C0277

LICENSEE INFO: Symphony Countryside, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 10/09/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1010i), 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: 600 South Houston
FACILITY CITY, STATE, ZIP: Taylorville, IL 62568

DOCKET NUMBER: NH 20-C0302

LICENSEE INFO: Palladian Taylorville SNF, LLC
LICENSEE ADDRESS: 600 S. Second Street, Ste 104
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 09/30/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210d)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: 300.3240a). A fine of $25,000.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: : 300.610a), 300.1210d)2), 300.1210d)5), 300.1230d)1), 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: 300.1210d)5) and 300.3240a). A fine of $2,200.00

Total fine $27,200.00

FACILITY ADDRESS: 850 E. US Highway 45
FACILITY CITY, STATE, ZIP: Mundelein, IL 60060

DOCKET NUMBER: NH 20-C0257

LICENSEE INFO: Thrive Lake County, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 08/26/2020

Type B 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 $2,200.00

FACILITY ADDRESS: 2220 State Street
FACILITY CITY, STATE, ZIP: Pekin, IL 61554

DOCKET NUMBER: NH 20-C0242

LICENSEE INFO: Petersen Health Operations, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 08/14/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1610a)1. A fine of $1,100.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.3300s)and 300.3300t). A fine of $1,100.00

Total fines $2,200.00

FACILITY ADDRESS: 759 Kane Street
FACILITY CITY, STATE, ZIP: South Elgin, IL 60177

DOCKET NUMBER: NH 20-C0268

LICENSEE INFO: Tower Hill Rehabilitation, LLC
LICENSEE ADDRESS: 7434 Skokie Blvd
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 09/03/2020

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: 310 Eads Avenue
FACILITY CITY, STATE, ZIP: Paris, IL 61944

DOCKET NUMBER: NH 20-S0297 & NH 20-C0298

LICENSEE INFO: Twin HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 09/21/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.696a), 300.696b), 300.696c)7), 300.1210b), 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: 300.696, 300.1210b), and 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 1095 University Drive
FACILITY CITY, STATE, ZIP: Edwardsville, IL 62025

DOCKET NUMBER: NH 20-C0326

LICENSEE INFO: University Care Center, LLC
LICENSEE ADDRESS: 111 North Ottawa Street
LICENSEE CITY, STATE, ZIP: Joliet, IL 60432
Survey Date – 10/01/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1035a)1), 300.1035e), 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: 500 South Art Bartell Road
FACILITY CITY, STATE, ZIP: Urbana, IL 61802

DOCKET NUMBER: NH 20-C0334

LICENSEE INFO: University Rehabilitation Center of C-U, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 10/13/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696b), 300.696c)7), 300.1210b), 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: 300.696, 300.1210b), and 300.3240a). A fine of $2,200.00

FACILITY ADDRESS: 1500 West Northmoor Road
FACILITY CITY, STATE, ZIP: Peoria, IL 61614

DOCKET NUMBER: NH 20-S0320

LICENSEE INFO: Peoria NH, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 10/15/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.696a), 300.696c)7), and 300.696d). 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: 300.696. A fine $2,200.00

FACILITY ADDRESS: 2773 Skokie Valley Road
FACILITY CITY, STATE, ZIP: Highland Park, IL 60035

DOCKET NUMBER: NH 20-C0219

LICENSEE INFO: Warren Barr North Shore, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 07/30/2020

Type B 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 $2,200.00

FACILITY ADDRESS: 6700 North Damen
FACILITY CITY, STATE, ZIP: Chicago, IL 60645

DOCKET NUMBER: NH 20-C0282

LICENSEE INFO: Warren Park Health and Living Center, LLC
LICENSEE ADDRESS: 6700 North Damen Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60645
Survey Date – 09/03/2020

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) 300.3240a), 300.3240d), 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), 300.3240a), and 300.3240d) . A fine of $25,000.00

FACILITY ADDRESS: 1201 Newcastle Road
FACILITY CITY, STATE, ZIP: Washington, IL 61571

DOCKET NUMBER: NH 20-C0223

LICENSEE INFO: Washington Senior Living, LLC
LICENSEE ADDRESS: 2200 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 08/06/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210a), 300.1210b), 300.1210d)3), 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 $2,200.00

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

DOCKET NUMBER: NH 20-C0330

LICENSEE INFO: Waterfront Terrace, Inc.
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 10/27/2020

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: 2901 South Wolf Road
FACILITY CITY, STATE, ZIP: Westchester, IL 60154

DOCKET NUMBER: NH 20-C0204

LICENSEE INFO: SSC Westchester Operating Company, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 08/18/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.3240a), 300.3240b), and 300.3240e). 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) and 300.3240e). A fine of $2,200.00

FACILITY ADDRESS: 1700 White Street
FACILITY CITY, STATE, ZIP: Mount Vernon, IL 62864

DOCKET NUMBER: NH 20-C0276

LICENSEE INFO: Petersen Management Company, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 09/16/2020

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210d)2), 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) and 300.3240a). A fine of $25,000.00

FACILITY ADDRESS: 2155 West Pierce
FACILITY CITY, STATE, ZIP: Chicago, IL 60622

DOCKET NUMBER: NH 20-C0313

LICENSEE INFO: R.REM, Inc.
LICENSEE ADDRESS: 6500 N. Hamilin Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 10/15/2020

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