2021 2nd 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 NAME: Accolade Healthcare Danville
FACILITY ADDRESS: 801 North Logan Avenue
FACILITY CITY, STATE, ZIP: Danville, IL 61832

DOCKET NUMBER: NH 21-S0117

LICENSEE INFO: Accolade Healthcare of Danville, LLC
LICENSEE ADDRESS: 1900 E. Golf Rd, Ste 950A
LICENSEE CITY, STATE, ZIP: Schaumburg, IL 60173
Survey Date – 01/27/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)4), and 300.1220b)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 $2,200.00

FACILITY NAME: Alden Debes Rehab & HCC
FACILITY ADDRESS: 550 South Mulford Avenue
FACILITY CITY, STATE, ZIP: Rockford, IL 61108

DOCKET NUMBER: NH 21-S0263

LICENSEE INFO: Alden Alma Nelson Manor, Inc.
LICENSEE ADDRESS: 4200 West Peterson Ave., #140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 03/18/2021

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), 300.2900d)2), and 300.3100d)2). 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), 300.2900d)2), and 300.3100d)2). A fine of $2,200.00

FACILITY NAME: Alden Estates of Northmoor
FACILITY ADDRESS: 5831 North Northwest Highway
FACILITY CITY, STATE, ZIP: Chicago, IL 60631

DOCKET NUMBER: NH 21-C0290

LICENSEE INFO: Alden-Northmoor Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Ave, Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60645
Survey Date – 03/10/2021

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), and 300.1210d)5). 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)5). A fine of $2,200.00

FACILITY NAME: Alden Poplar Creek Rehab & HCC
FACILITY ADDRESS: 1545 Barrington Road
FACILITY CITY, STATE, ZIP: Hoffman Estates, IL 60169

DOCKET NUMBER: NH 21-S0260

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 – 03/10/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c), 300.1020a), 300.1020b), 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 $2,200.00

FACILITY NAME: Aledo Rehab & Health Care Ctr
FACILITY ADDRESS: 304 SW 12th Street
FACILITY CITY, STATE, ZIP: Aledo, IL 61231

DOCKET NUMBER: NH 21-S0205

LICENSEE INFO: Petersen Health Group, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 02/25/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210a), and 300.1210d)2)3)5). 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). A fine of $2,200.00

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

Total Fine: $4,400.00

FACILITY NAME: All American Nursing Home
FACILITY ADDRESS: 5448 North Broadway Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60640

DOCKET NUMBER: NH 21-C0219

LICENSEE INFO: Zikainim, Inc.
LICENSEE ADDRESS: 191 North Wacker Dr., Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 03/09/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1220b)2), 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

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

DOCKET NUMBER: NH 21-C0174

LICENSEE INFO: Riviera Care Center, LLC
LICENSEE ADDRESS: 208 So. LaSalle St
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 01/26/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c), 300.1210d)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 NAME: Aperion Care Chicago Heights
FACILITY ADDRESS: 490 West 16th Place
FACILITY CITY, STATE, ZIP: Chicago Heights, IL 60411

DOCKET NUMBER: NH 21-C0256

LICENSEE INFO: Riviera Care Center, LLC
LICENSEE ADDRESS: 208 So. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/26/2021

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

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

DOCKET NUMBER: NH 21-S0203

LICENSEE INFO: Dolton Nursing & Rehab, LLC
LICENSEE ADDRESS: 208 So. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 02/11/2021

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 NAME: Aperion Care Highwood
FACILITY ADDRESS: 50 Pleasant Avenue
FACILITY CITY, STATE, ZIP: Highwood, IL 60040

DOCKET NUMBER: NH 21-S0292

LICENSEE INFO: Highland Park Nursing and Rehab Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/18/2021

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

FACILITY NAME: Aperion Care Plum Grove
FACILITY ADDRESS: 24 South Plum Grove Road
FACILITY CITY, STATE, ZIP: Palatine, IL 60067

DOCKET NUMBER: NH 21-C0216

LICENSEE INFO: Plum Grove Nursing and Rehab, LLC
LICENSEE ADDRESS: 208 So. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 02/18/2021

Type A 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)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 NAME: Aperion Care Princeton
FACILITY ADDRESS: 515 Bureau Valley Parkway
FACILITY CITY, STATE, ZIP: Princeton, IL 61356

DOCKET NUMBER: NH 21-S0270

LICENSEE INFO: Aperion Care Princeton, LLC
LICENSEE ADDRESS: 208 S Lasalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/12/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210b)4), and 300.1210b)5). 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 NAME: Aperion Care West Ridge
FACILITY ADDRESS: 6450 N. Ridge Blvd
FACILITY CITY, STATE, ZIP: Chicago, IL 60626

DOCKET NUMBER: NH 21-C0169

LICENSEE INFO: Aperion Care West Ridge, LLC
LICENSEE ADDRESS: 208 S. LaSalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 01/22/2021

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), 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 NAME: Arcadia Care Clifton
FACILITY ADDRESS: 1190 E. 2900 North Rd
FACILITY CITY, STATE, ZIP: Clifton, IL 60927

DOCKET NUMBER: NH 21-C0176

LICENSEE INFO: Clifton Operations, LLC
LICENSEE ADDRESS: 4655 W. Chase Ave
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 02/18/2021

Type B 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), 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

FACILITY NAME: Arcadia of Danville
FACILITY ADDRESS: 1701 North Bowman
FACILITY CITY, STATE, ZIP: Danville, IL 61832

DOCKET NUMBER: NH 21-C0237

LICENSEE INFO: Danville Operations, LLC
LICENSEE ADDRESS: 600 South Second St, Suite 404
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 03/16/2021

Type B 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), 300.1210d)3), and 300.1210d)5). 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)5). A fine of $2,200.00

FACILITY NAME: Arden Courts of Palos Heights
FACILITY ADDRESS: 7880 W. College Drive
FACILITY CITY, STATE, ZIP: Palos Heights, IL 60463

DOCKET NUMBER: NH 21-C0160

LICENSEE INFO: Arden Courts of Palos Heights IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 01/25/2021

Type C violation of an occurrence for violating one or more of the following sections of the Code: 330.4240a) and 330.4240b). This instance in accordance with 330.282f) i) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 330.4240a). A fine of $500.00

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

DOCKET NUMBER: NH 21-C0224

LICENSEE INFO: Arista Healthcare, LLC
LICENSEE ADDRESS: 208 S. LaSalle St, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 12/03/2020

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), 300.1210b), 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 NAME: Arista Healthcare
FACILITY ADDRESS: 1136 North Mill Street
FACILITY CITY, STATE, ZIP: Naperville, IL 60563

DOCKET NUMBER: NH 21-C0268

LICENSEE INFO: Arista Healthcare, LLC
LICENSEE ADDRESS: 208 S Lasalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/11/2021

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 300.1210d)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 $2,200.00

FACILITY NAME: Ascension Nazarathville Place
FACILITY ADDRESS: 300 North River Road
FACILITY CITY, STATE, ZIP: Des Plaines, IL 60016

DOCKET NUMBER: NH 21-C0284

LICENSEE INFO: Presence Senior Services Chicagoland
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 03/20/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.3210f), 300.3210g), 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 NAME: Ascension Saint Anne Place
FACILITY ADDRESS: 4405 Highcrest Road
FACILITY CITY, STATE, ZIP: Rockford, IL 61107

DOCKET NUMBER: NH 21-C0126

LICENSEE INFO: Presence Life Connections
LICENSEE ADDRESS: 18927 Hickory Creek Dr. Suite 300
LICENSEE CITY, STATE, ZIP: Mokena, IL 60448
Survey Date – 01/25/2021

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 NAME: Ascension Saint Benedict
FACILITY ADDRESS: 6930 West Touhy Avenue
FACILITY CITY, STATE, ZIP: Niles, IL 60714

DOCKET NUMBER: NH 21-S0252

LICENSEE INFO: Presence Senior Services-Chicagoland
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 03/05/2021

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), 300.1210d)5), 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), 300.1210d)5), and 300.3240a). A fine of $2,200.00

FACILITY NAME: Auburn Rehab & HCC
FACILITY ADDRESS: 304 Maple Avenue
FACILITY CITY, STATE, ZIP: Auburn, IL 62615

DOCKET NUMBER: NH 21-C0232

LICENSEE INFO: Auburn Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 02/17/2021

Type B 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 300.1220b)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) and 300.1210d)6). A fine of $2,200.00

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

DOCKET NUMBER: NH 21-S0184

LICENSEE INFO: The Austin Oasis, LLC
LICENSEE ADDRESS: 4711 Golf Road, Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 02/11/2021

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 NAME: Autumn Meadows of Cahokia
FACILITY ADDRESS: 2 Annable Court
FACILITY CITY, STATE, ZIP: Cahokia, IL 62206

DOCKET NUMBER: NH 21-S0175

LICENSEE INFO: Cahokia Nursing & Rehabilitation Center, Inc
LICENSEE ADDRESS: 7434 North Skokie Blvd
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 02/11/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.610c)4)A), 300.625k), 300.690, 300.1210b)5), 300.1210c), 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 NAME: Bethany Rehab & HCC
FACILITY ADDRESS: 3298 Resource Parkway
FACILITY CITY, STATE, ZIP: DeKalb, IL 60115

DOCKET NUMBER: NH 21-S0279

LICENSEE INFO: Bethany Health, LLC
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 03/17/2021

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

FACILITY NAME: Bria of Cahokia
FACILITY ADDRESS: 3354 Jerome Lane
FACILITY CITY, STATE, ZIP: Cahokia, IL 62206

DOCKET NUMBER: NH 21-S0267

LICENSEE INFO: Atrium Hlth Care & Rehab Ctr of Cahokia, LLC
LICENSEE ADDRESS: 465 Central Avenue #100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
Survey Date – 03/26/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.690a), 300.1010i), 300.1210b)4), 300.1210d)3), 300.1210d)6), and 300.1810)c). 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), and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Briar Place Nursing
FACILITY ADDRESS: 6800 West Joliet
FACILITY CITY, STATE, ZIP: Indian Head Park, IL 60525

DOCKET NUMBER: NH 21-C0195

LICENSEE INFO: Briar Place Nursing, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 01/25/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210c), 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 NAME: Carriage Rehab & Healthcare
FACILITY ADDRESS: 1660 South Mulford Road
FACILITY CITY, STATE, ZIP: Rockford, IL 61108

DOCKET NUMBER: NH 21-S0246

LICENSEE INFO: Rockford NH, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 02/19/2021

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

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b)1) and 300.1210b)2). 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

Total Fine: $4,400.00

FACILITY NAME: Casey Healthcare Center
FACILITY ADDRESS: 100 N.E. 15th
FACILITY CITY, STATE, ZIP: Casey, IL 62420

DOCKET NUMBER: NH 21-S0189

LICENSEE INFO: Casey HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Dr
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 01/21/2021

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 NAME: Caseyville Nursing & Rehab Ctr
FACILITY ADDRESS: 601 West Lincoln Avenue
FACILITY CITY, STATE, ZIP: Caseyville, IL 62232

DOCKET NUMBER: NH 21-S0281

LICENSEE INFO: Caseyville Nursing & Rehabilitation Center, Inc.
LICENSEE ADDRESS: 7434 N. Skokie Blvd
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 03/02/2021

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)6), 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

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 300.1220b)2). 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

Total Fine: $4,400.00

FACILITY NAME: Champaign Urbana Nrsg & Rehab
FACILITY ADDRESS: 302 Burwash Avenue
FACILITY CITY, STATE, ZIP: Savoy, IL 61874

DOCKET NUMBER: NH 21-C0319

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 – 03/29/2021

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), 300.1210d)6), and 300.1220b)2)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) and 300.1210d)6). 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)3), 300.1210d)5), and 300.1220b)2)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) and 300.1210d)5). A fine of $25,000.00

Total Fine: $50,000.00

FACILITY NAME: Chestnut Corner SC
FACILITY ADDRESS: 905 West Chestnut St, Box 250
FACILITY CITY, STATE, ZIP: Louisville, IL 62858

DOCKET NUMBER: NH 21-C0178

LICENSEE INFO: Diamond Development Co.
LICENSEE ADDRESS: 150 South State Rte 45, Box 250
LICENSEE CITY, STATE, ZIP: Louisville, IL 62858
Survey Date – 02/11/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.720b), 330.720e)1), and 330.720e)3). A fine of $1,100.00

FACILITY NAME: Christian Nursing Home
FACILITY ADDRESS: 1507 7^th Street
FACILITY CITY, STATE, ZIP: Lincoln, IL 62656

DOCKET NUMBER: NH 21-C0188

LICENSEE INFO: Christian Homes, Inc.
LICENSEE ADDRESS: 208 S. LaSalle St. Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 02/05/2021

Type B 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)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 NAME: Citadel of Glenview, The
FACILITY ADDRESS: 1700 East Lake Avenue
FACILITY CITY, STATE, ZIP: Glenview, IL 60025

DOCKET NUMBER: NH 21-C0228

LICENSEE INFO: The Citadel of Glenview, LLC
LICENSEE ADDRESS: 191 N. Wacker Dr, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 01/04/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.680a), 300.680c), 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 NAME: Claridge Healthcare Center
FACILITY ADDRESS: 700 Jenkisson
FACILITY CITY, STATE, ZIP: Lake Bluff, IL 60044

DOCKET NUMBER: NH 21-S0251

LICENSEE INFO: Claridge Operations, LLC
LICENSEE ADDRESS: 325 N. Wells, 9^th Floor
LICENSEE CITY, STATE, ZIP: Chicago, IL 60610
Survey Date – 03/03/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 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 NAME: Claridge Healthcare Center
FACILITY ADDRESS: 700 Jenkisson
FACILITY CITY, STATE, ZIP: Lake Bluff, IL 60044

DOCKET NUMBER: NH 21-S0283

LICENSEE INFO: Claridge Operations, L.L.C.
LICENSEE ADDRESS: 325 N. Wells, 9^th Floor
LICENSEE CITY, STATE, ZIP: Chicago, IL 60610
Survey Date – 03/10/2021

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 NAME: Clearbrook Center
FACILITY ADDRESS: 3201 West Campbell Street
FACILITY CITY, STATE, ZIP: Rolling Meadows, IL 60008

DOCKET NUMBER: NH 21-S0210

LICENSEE INFO: Clearbrook
LICENSEE ADDRESS: 1835 West Central Road
LICENSEE CITY, STATE, ZIP: Arlington Heights, IL 60005
Survey Date – 01/27/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 350.620a) 350.1210, 350.1220k), 350.1230b), 350.1230d)2)3), and 350.3240a). A fine of $10,000.00

FACILITY NAME: Countryview Care Center Macomb
FACILITY ADDRESS: 400 West Grant Street
FACILITY CITY, STATE, ZIP: Macomb, IL 61455

DOCKET NUMBER: NH 21-C0191

LICENSEE INFO: Petersen Health Properties, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 01/29/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 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 NAME: Crestwood Terrace
FACILITY ADDRESS: 13301 South Central Avenue
FACILITY CITY, STATE, ZIP: Crestwood, IL 60418

DOCKET NUMBER: NH 21-C0244

LICENSEE INFO: Laureate Crestwood Operations, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 02/05/2021

Type AA 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)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 $50,000.00

FACILITY NAME: DeKalb County Rehab & Nursing
FACILITY ADDRESS: 2600 North Annie Glidden Road
FACILITY CITY, STATE, ZIP: DeKalb, IL 60115

DOCKET NUMBER: NH 21-C0144 & NH 21-S0145

LICENSEE INFO: The County of DeKalb
LICENSEE ADDRESS: 200 North Main Street
LICENSEE CITY, STATE, ZIP: Sycamore, IL 60178
Survey Date – 01/22/2021

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), 300.1210b), 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 NAME: Effingham Rehab & Health C Ctr
FACILITY ADDRESS: 1610 North Lakewood Drive
FACILITY CITY, STATE, ZIP: Effingham, IL 62401

DOCKET NUMBER: NH 21-C0111

LICENSEE INFO: Effingham HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Dr
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 01/27/2021

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

FACILITY NAME: Estates of Hyde Park
FACILITY ADDRESS: 4505 S. Drexel Blvd
FACILITY CITY, STATE, ZIP: Chicago, IL 60653

DOCKET NUMBER: NH 21-C0148

LICENSEE INFO: The Estates of Hyde Park, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 01/25/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)3), 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 NAME: Fair Oaks Rehab & HCC
FACILITY ADDRESS: 1515 Blackhawk
FACILITY CITY, STATE, ZIP: South Beloit, IL 61080

DOCKET NUMBER: NH 21-C0171

LICENSEE INFO: Fair Oaks Rehabilitation and Heath Care Center, LLC
LICENSEE ADDRESS: 412 E Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 02/09/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 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 NAME: Fox River Rehab & Healthcare
FACILITY ADDRESS: 2355 Royal Blvd
FACILITY CITY, STATE, ZIP: Elgin, IL 60123

DOCKET NUMBER: NH 21-C0217

LICENSEE INFO: Elgin NH, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 02/18/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b)4), 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 NAME: Galena Stauss Nursing Home
FACILITY ADDRESS: 215 Summit Street
FACILITY CITY, STATE, ZIP: Galena, IL 61036

DOCKET NUMBER: NH 21-S0289

LICENSEE INFO: Midwest Medical Center
LICENSEE ADDRESS: 100 Park Avenue, P.O. Box 1389
LICENSEE CITY, STATE, ZIP: Rockford, IL 61105
Survey Date – 03/22/2021

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), and 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: 300.696) and 300.1210b). A fine of $2,200.00

FACILITY NAME: Gilman Health Care Center
FACILITY ADDRESS: 1390 South Cresent Street
FACILITY CITY, STATE, ZIP: Gilman, IL 60938

DOCKET NUMBER: NH 21-S0300

LICENSEE INFO: Gilman Healthcare Center
LICENSEE ADDRESS: 4711 Golf Rd, Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 03/25/2021

FACILITY NAME: Good Samaritan Pontiac
FACILITY ADDRESS: 1225 S. Ewing Drive
FACILITY CITY, STATE, ZIP: Pontiac, IL 61764

DOCKET NUMBER: NH 21-C0193

LICENSEE INFO: Good Samaritan Pontiac
LICENSEE ADDRESS: 1225 S. Ewing Drive
LICENSEE CITY, STATE, ZIP: Pontiac, IL 61764
Survey Date – 03/25/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 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 NAME: Granite Nsg & Rehab Center
FACILITY ADDRESS: 3500 Century Drive
FACILITY CITY, STATE, ZIP: Granite City, IL 62040

DOCKET NUMBER: NH 21-C0303

LICENSEE INFO: Granite Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 901 S. 2nd Street, Ste 201
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 03/25/2021

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

FACILITY NAME: Helia Healthcare of Energy
FACILITY ADDRESS: 210 East College, P.O. Box 519
FACILITY CITY, STATE, ZIP: Energy, IL 62933

DOCKET NUMBER: NH 21-C0172

LICENSEE INFO: Helia Healthcare of Energy, LLC
LICENSEE ADDRESS: 118 W. Edwards St., Ste 210
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 01/27/2021

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), 300.1210a), and 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: 300.696. A fine of $25,000.00

FACILITY NAME: Heritage Health-Dwight
FACILITY ADDRESS: 300 East Mazon Avenue
FACILITY CITY, STATE, ZIP: Dwight, IL 60420

DOCKET NUMBER: NH 21-S0269

LICENSEE INFO: Heritage Manor-Dwight, LLC
LICENSEE ADDRESS: 115 West Jefferson, Ste 404
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 03/11/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 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 NAME: Heritage Health Gillespie
FACILITY ADDRESS: 7588 Staunton Road
FACILITY CITY, STATE, ZIP: Gillespie, IL 62033

DOCKET NUMBER: NH 21-S0280

LICENSEE INFO: Heritage Manor- Gillespie, LLC
LICENSEE ADDRESS: 115 West Jefferson St., Ste 401
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 03/17/2021

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

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

Total Fine: $4,400.00

FACILITY NAME: Heritage Health Normal
FACILITY ADDRESS: 509 N. Adelaide
FACILITY CITY, STATE, ZIP: Normal, IL 61761

DOCKET NUMBER: NH 21-C0182 & NH 21-S0183

LICENSEE INFO: Heritage Health Normal, LLC
LICENSEE ADDRESS: 115 W Jefferson St., Ste 401
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 02/04/2021

Type A 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), and 300.1220b)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) and 300.1210d)6). A fine of $25,000.00

FACILITY NAME: Hickorypoint Christian Village
FACILITY ADDRESS: 565 West Marion Avenue
FACILITY CITY, STATE, ZIP: Forsyth, IL 62535

DOCKET NUMBER: NH 21-S0240

LICENSEE INFO: Fair Haven Christian Homes, Inc.
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 02/05/2021

FACILITY NAME: Highland Health Care Center
FACILITY ADDRESS: 1450 26^th Street
FACILITY CITY, STATE, ZIP: Highland, IL 62249

DOCKET NUMBER: NH 21-C0167

LICENSEE INFO: Highland Care and Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 01/26/2021

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 NAME: Hillcrest Home
FACILITY ADDRESS: 14688 Illinois Highway 82
FACILITY CITY, STATE, ZIP: Geneseo, IL 61254

DOCKET NUMBER: NH 21-S0229

LICENSEE INFO: Henry County
LICENSEE ADDRESS: 307 W. Center
LICENSEE CITY, STATE, ZIP: Cambridge, IL 61238
Survey Date – 02/24/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)6) and 300.1220b)2). 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 NAME: Hilltop Skilled Nsg & Rehab
FACILITY ADDRESS: 910 West Polk Avenue
FACILITY CITY, STATE, ZIP: Charleston, IL 61920

DOCKET NUMBER: NH 21-C0259

LICENSEE INFO: Hilltop Care and Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/10/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210c), 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

FACILITY NAME: Hope Creek Nursing & Rehab
FACILITY ADDRESS: 4343 Kennedy Drive
FACILITY CITY, STATE, ZIP: East Moline, IL 61244

DOCKET NUMBER: NH 21-C0253

LICENSEE INFO: Hope Creek Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 5683 N. Lincoln Ave
LICENSEE CITY, STATE, ZIP: Chicago, IL 60659
Survey Date – 02/26/2021

FACILITY NAME: IL Veterans’ Home at LaSalle
FACILITY ADDRESS: 1015 O’Connor Ave
FACILITY CITY, STATE, ZIP: LaSalle, IL 61301

DOCKET NUMBER: NH 21-S0266

LICENSEE INFO: Illinois Department of Veterans’ Affairs
LICENSEE ADDRESS: 1015 O’Connor Ave
LICENSEE CITY, STATE, ZIP: Springfield, IL 62794
Survey Date – 03/26/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 340.1300a), 340.1440a), 340.1440b), and 340.1440e). The fine was doubled in this instance in accordance with 340.1245i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 340.1440a)and 340.1440e). A fine of $2,200.00

FACILITY NAME: Integrity HC of Marion
FACILITY ADDRESS: 1301 East DeYoung
FACILITY CITY, STATE, ZIP: Marion, IL 62959

DOCKET NUMBER: NH 21-C0185

LICENSEE INFO: Marion Rehabilitation and Nursing Center, LLC
LICENSEE ADDRESS: 600 S. 2^nd Street, Ste 104
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 02/22/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), and 300.1210d)2). 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 NAME: Kensington Place Nrsg & Rehab
FACILITY ADDRESS: 3405 South Michigan Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60616

DOCKET NUMBER: NH 21-C0262

LICENSEE INFO: Kensington Place Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 03/09/2021

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.690a), 300.690b), 300.690c), 300.1210a), 300.1210b) 300.1210d)3), 300.1210d)4)A), 300.3240a), and 300.3240b). 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: 300.690, 300.1210b), and 300.3240a). A fine of $500.00

FACILITY NAME: Landmark of Des Plaines Rehab
FACILITY ADDRESS: 9300 Ballard Road
FACILITY CITY, STATE, ZIP: Des Plaines, IL 60016

DOCKET NUMBER: NH 21-C0168

LICENSEE INFO: Landmark of Des Plaines Rehabilitation Center, LLC
LICENSEE ADDRESS: 5683 North Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60659
Survey Date – 02/16/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.690c), 300.1210c), 300.1210d)6), and 300.1220b)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: 300.690), 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Landmark of Des Plaines Rehab
FACILITY ADDRESS: 9300 Ballard Road
FACILITY CITY, STATE, ZIP: Des Plaines, IL 60016

DOCKET NUMBER: NH 21-C0222

LICENSEE INFO: Landmark of Des Plaines Rehabilitation Center, LLC
LICENSEE ADDRESS: 5683 North Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60659
Survey Date – 03/12/2021

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

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210d)1), and 300.1620a). A fine of $12,500.00

Total Fine: $37,500.00

FACILITY NAME: Landmark of Richton Park
FACILITY ADDRESS: 22660 South Cicero Ave
FACILITY CITY, STATE, ZIP: Richton Park, IL 60471

DOCKET NUMBER: NH 21-C0196

LICENSEE INFO: Landmark of Richton Park Rehabilitation and Nursing Center, LLC
LICENSEE ADDRESS: 5683 N. Lincoln Ave
LICENSEE CITY, STATE, ZIP: Chicago, IL 60659
Survey Date – 02/10/2021

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), 300.1210d)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 $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), 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

Total fines: $50,000.00

FACILITY NAME: Landmark of Richton Park
FACILITY ADDRESS: 22660 South Cicero Ave
FACILITY CITY, STATE, ZIP: Richton Park, IL 60471

DOCKET NUMBER: NH 21-S0301

LICENSEE INFO: Landmark of Richton Park Rehabilitation and Nursing Center, LLC
LICENSEE ADDRESS: 5683 N Lincoln Ave
LICENSEE CITY, STATE, ZIP: Chicago, IL 60659
Survey Date – 03/26/2021

FACILITY NAME: Lewis Memorial Christian Vlg
FACILITY ADDRESS: 3400 West Washington
FACILITY CITY, STATE, ZIP: Springfield, IL 62711

DOCKET NUMBER: NH 21-C0302

LICENSEE INFO: Lewis Memorial Christian Village
LICENSEE ADDRESS: 208 S Lasalle Ste, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/16/2021

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 300.1220b)2)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) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Lincolnshire Assisted Liv Ctr
FACILITY ADDRESS: 170 Jamestown Lane
FACILITY CITY, STATE, ZIP: Lincolnshire, IL 60069

DOCKET NUMBER: NH 21-S0335

LICENSEE INFO: Lincolnshire Assisted Living Center, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 03/30/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.1110f) and 330.1110g). A fine of $1,100.00

Type C violation of an occurrence for violating one or more of the following sections of the Code: 330.790a) and 330.790c). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.790). A fine of $500.00

Total Fine: $1,600.00

FACILITY NAME: Loft Rehabilitation & Nursing
FACILITY ADDRESS: 700 N. Main Street
FACILITY CITY, STATE, ZIP: Eureka, IL 61530

DOCKET NUMBER: NH 21-S0255

LICENSEE INFO: The Loft Rehabilitation & Nursing, LLC
LICENSEE ADDRESS: 191 N. Wacker Drive, Suite 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 02/18/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 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 NAME: Lutheran Home for the Aged
FACILITY ADDRESS: 800 West Oakton Street
FACILITY CITY, STATE, ZIP: Arlington Hts, IL 60004

DOCKET NUMBER: NH 21-S0291

LICENSEE INFO: Lutheran Home for the Aged, Inc.
LICENSEE ADDRESS: 800 W. Oakton Street
LICENSEE CITY, STATE, ZIP: Arlington Hts, IL 60004
Survey Date – 03/09/2021

FACILITY NAME: Lutheran Home for the Aged
FACILITY ADDRESS: 800 West Oakton Street
FACILITY CITY, STATE, ZIP: Arlington Hts, IL 60004

DOCKET NUMBER: NH 21-C0334

LICENSEE INFO: Lutheran Home for the Aged, Inc.
LICENSEE ADDRESS: 800 W. Oakton St
LICENSEE CITY, STATE, ZIP: Arlington Hghts, IL 60004
Survey Date – 03/29/2021

Type AA 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 300.1220b)2). 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 $50,000.00

FACILITY NAME: Manorcare of Arlington Heights
FACILITY ADDRESS: 715 West Central Road
FACILITY CITY, STATE, ZIP: Arlington Hts, IL 60005

DOCKET NUMBER: NH 21-S0254

LICENSEE INFO: Manorcare Health Services, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/03/2021

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

FACILITY NAME: Manorcare of Oak Lawn West
FACILITY ADDRESS: 6300 West 95^th Street
FACILITY CITY, STATE, ZIP: Oak Lawn, IL 60453

DOCKET NUMBER: NH 21-C0204

LICENSEE INFO: Manor Care of Oak Lawn (West) IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/01/2021

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

FACILITY NAME: Manorcare of Palos Hts East
FACILITY ADDRESS: 7850 W. College Drive
FACILITY CITY, STATE, ZIP: Palos Heights, IL 60463

DOCKET NUMBER: NH 21-S0194

LICENSEE INFO: Manor Care of Palos Heights IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 01/21/2021

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), and 300.1220b)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) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: McLeansboro Rehab & Hlth C Ctr
FACILITY ADDRESS: 405 West Carpenter
FACILITY CITY, STATE, ZIP: McLeansboro, IL 62859

DOCKET NUMBER: NH 21-S0177

LICENSEE INFO: McLeansboro HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 02/11/2021

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

FACILITY NAME: Moweaqua Rehab & HCC
FACILITY ADDRESS: 525 South Macon Street
FACILITY CITY, STATE, ZIP: Moweaqua, IL 62550

DOCKET NUMBER: NH 21-C0143

LICENSEE INFO: Moweaqua Rehabilitation & Health Care Center, LLC
LICENSEE ADDRESS: 412 E. Lawrence Avenue
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 01/29/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 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 NAME: Mulberry Manor
FACILITY ADDRESS: 612 East Davie Street, Box 88
FACILITY CITY, STATE, ZIP: Anna, IL 62906

DOCKET NUMBER: NH 21-S0333

LICENSEE INFO: Mulberry Manor, Inc.
LICENSEE ADDRESS: 158 E. Vienna St., P.O. Box 88
LICENSEE CITY, STATE, ZIP: Anna, IL 62906
Survey Date – 03/25/2021

Type B violation for violating one or more of the following sections of the Code: 350.620a), 350.1080a), 350.1082a)1)2)3)4), 350.1082e), 350.1082h), 350.1082i), and 350.3240a). A fine of $1,100.00

FACILITY NAME: Nature Trail Health Care Ctr
FACILITY ADDRESS: 1001 South 34^th Street
FACILITY CITY, STATE, ZIP: Mount Vernon, IL 62864

DOCKET NUMBER: NH 21-C0190

LICENSEE INFO: SSC Mount Vernon Operating Co., LLC
LICENSEE ADDRESS: 208 South LaSalle St, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 01/27/2021

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 NAME: North Aurora Care Center
FACILITY ADDRESS: 310 Banbury Road
FACILITY CITY, STATE, ZIP: North Aurora, IL 60542

DOCKET NUMBER: NH 21-S0165

LICENSEE INFO: North Aurora HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 02/01/2021

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

FACILITY NAME: Oak Crest
FACILITY ADDRESS: 2944 Greenwood Acres
FACILITY CITY, STATE, ZIP: DeKalb, IL 60115

DOCKET NUMBER: NH 21-S0242

LICENSEE INFO: DeKalb Area Retirement Center
LICENSEE ADDRESS: 2944 Greenwood Acres Dr
LICENSEE CITY, STATE, ZIP: DeKalb, IL 60115
Survey Date – 03/02/2021

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

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b)5). 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). No fine

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.675a)1)2) and 300.675b)1)3). No fine

FACILITY NAME: Palos Heights Rehabilitation
FACILITY ADDRESS: 13259 South Central Avenue
FACILITY CITY, STATE, ZIP: Crestwood, IL 60418

DOCKET NUMBER: NH 21-C0179 & NH 21-S0180

LICENSEE INFO: Palos Heights Rehabilitation, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 01/29/2021

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)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 NAME: Pearl Pavilion
FACILITY ADDRESS: 900 South Kiwanis Drive
FACILITY CITY, STATE, ZIP: Freeport, IL 61032

DOCKET NUMBER: NH 21-C0206

LICENSEE INFO: Pearl Pavilion, LLC
LICENSEE ADDRESS: 4711 Golf Road, Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076-
Survey Date – 03/03/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 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 NAME: Pleasant Meadows Senior Living
FACILITY ADDRESS: 400 West Washington
FACILITY CITY, STATE, ZIP: Chrisman, IL 61924

DOCKET NUMBER: NH 21-C0208

LICENSEE INFO: Pleasant Meadows Senior Living, LLC
LICENSEE ADDRESS: 5750 Old Orchard Rd, Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 03/03/2021

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)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 $25,000.00

FACILITY NAME: Prairie Creek Village
FACILITY ADDRESS: 2530 North Monroe
FACILITY CITY, STATE, ZIP: Decatur, IL 62526

DOCKET NUMBER: NH 21-C0231

LICENSEE INFO: Prairie Creek Village, LLC
LICENSEE ADDRESS: 6840 N. Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 02/17/2021

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 NAME: Prairie Creek Village
FACILITY ADDRESS: 2530 North Monroe
FACILITY CITY, STATE, ZIP: Decatur, IL 62526

DOCKET NUMBER: NH 21-C0245

LICENSEE INFO: Prairie Creek Village, LLC
LICENSEE ADDRESS: 6840 N. Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 02/26/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210d)1), 300.1210d)3), 300.1610a)1), 300.1630e). 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 NAME: River Crossing of St Charles
FACILITY ADDRESS: 850 Dunham Road
FACILITY CITY, STATE, ZIP: St Charles, IL 60174

DOCKET NUMBER: NH 21-C0353

LICENSEE INFO: St Charles NH LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 03/30/2021

Type AA 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)6) and 300.1220b)2). 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 $50,000.00

FACILITY NAME: Rochelle Rehab & Healthcare Cr
FACILITY ADDRESS: 900 North Third Street
FACILITY CITY, STATE, ZIP: Rochelle, IL 61068

DOCKET NUMBER: NH 21-C0209

LICENSEE INFO: Petersen Health Network, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 02/02/2021

Type AA 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)4)A), 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 $50,000.00

FACILITY NAME: Rochelle Rehab & Healthcare Cr
FACILITY ADDRESS: 900 North Third Street
FACILITY CITY, STATE, ZIP: Rochelle, IL 61068

DOCKET NUMBER: NH 21-S0274

LICENSEE INFO: Petersen Health Network, LLC
LICENSEE ADDRESS: 830 W Trailcreek Dr
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/12/2021

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 NAME: Rock River Gardens
FACILITY ADDRESS: 3601 Sixteenth Avenue
FACILITY CITY, STATE, ZIP: Sterling, IL 61081

DOCKET NUMBER: NH 21-S0247

LICENSEE INFO: Midwest Health Operations, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 02/16/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)2)7), 300.1210b), and 300.1220b)1)2). 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 300.1210b). A fine of $2,200.00

FACILITY NAME: Rushville Nursing & Rehab Ctr
FACILITY ADDRESS: 135 South Morgan Street
FACILITY CITY, STATE, ZIP: Rushville, IL 62681

DOCKET NUMBER: NH 21-C0234

LICENSEE INFO: Rushville Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 02/24/2021

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), 300.1220b)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 NAME: Sharon Health Care Willows
FACILITY ADDRESS: 3520 North Rochelle
FACILITY CITY, STATE, ZIP: Peoria, IL 61604

DOCKET NUMBER: NH 21-M0225

LICENSEE INFO: Sharon Health Care Willows, Inc.
LICENSEE ADDRESS: 465 Central Avenue, Suite 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
Survey Date – 01/06/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.696a), 300.696c), 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 NAME: Sharon Health Care Willows
FACILITY ADDRESS: 3520 North Rochelle
FACILITY CITY, STATE, ZIP: Peoria, IL 61604

DOCKET NUMBER: NH 21-M0226

LICENSEE INFO: Sharon Health Care Willows, Inc.
LICENSEE ADDRESS: 465 Central Avenue, Suite 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
Survey Date – 12/15/2020

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a)c), 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 NAME: Sheldon Health Care Center
FACILITY ADDRESS: 170 West Concord
FACILITY CITY, STATE, ZIP: Sheldon, IL 60966

DOCKET NUMBER: NH 21-C0282

LICENSEE INFO: Petersen Health Enterprises, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 12/31/2020

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), 300.1210b), 300.1220b), 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 NAME: Sunset Rehabilitation & Hlth C
FACILITY ADDRESS: 129 South 1^st Avenue
FACILITY CITY, STATE, ZIP: Canton, IL 61520

DOCKET NUMBER: NH 21-S0142

LICENSEE INFO: Petersen Health Junction, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 01/21/2021

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), and 300.1210d)2). 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 NAME: Symphony of Bronzeville
FACILITY ADDRESS: 3400 South Indiana
FACILITY CITY, STATE, ZIP: Chicago, IL 60616

DOCKET NUMBER: NH 21-C0173

LICENSEE INFO: Symphony Bronzeville Park, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 02/05/2021

FACILITY NAME: Symphony of Bronzeville
FACILITY ADDRESS: 3400 South Indiana
FACILITY CITY, STATE, ZIP: Chicago, IL 60616

DOCKET NUMBER: NH 21-C0207

LICENSEE INFO: Symphony Bronzeville Park, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 02/16/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210d)1), 300.1210d)2), 300.1810c)3), 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: 300.3240a). A fine of $25,000.00

FACILITY NAME: Symphony of Bronzeville
FACILITY ADDRESS: 3400 South Indiana
FACILITY CITY, STATE, ZIP: Chicago, IL 60616

DOCKET NUMBER: NH 21-C0218

LICENSEE INFO: Symphony Bronzeville Park, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 03/11/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210c), 300.1210d)1), 300.1210d)2), 300.1210d)3), 300.1620a), and 300.1620a)2). 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 NAME: Symphony of Bronzeville
FACILITY ADDRESS: 3400 South Indiana
FACILITY CITY, STATE, ZIP: Chicago, IL 60616

DOCKET NUMBER: NH 21-C0257 & NH 21-S0258

LICENSEE INFO: Symphony Bronzeville Park, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 03/18/2021

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)1), and 300.1220b)2). 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 NAME: Symphony of Morgan Park
FACILITY ADDRESS: 10935 S. Halsted Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60628

DOCKET NUMBER: NH 21-C0241

LICENSEE INFO: Symphony Park South, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 02/26/2021

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

FACILITY NAME: Taylorville Skld Nur & Rehab
FACILITY ADDRESS: 800 McAdam Drive
FACILITY CITY, STATE, ZIP: Taylorville, IL 62568

DOCKET NUMBER: NH 21-C0264

LICENSEE INFO: Taylorville Skilled Nursing & Rehab, LLC
LICENSEE ADDRESS: 208 S Lasalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/16/2021

FACILITY NAME: Terrace Nursing Home, The
FACILITY ADDRESS: 1615 Sunset Avenue
FACILITY CITY, STATE, ZIP: Waukegan, IL 60087

DOCKET NUMBER: NH 21-S0233

LICENSEE INFO: TN Care, LLC
LICENSEE ADDRESS: 1S443 Summitt Avenue, Ste 204
LICENSEE CITY, STATE, ZIP: Oakbrook Terrace, IL 60181
Survey Date – 02/23/2021

FACILITY NAME: Three Crowns Park
FACILITY ADDRESS: 2323 McDaniel Avenue
FACILITY CITY, STATE, ZIP: Evanston, IL 60201

DOCKET NUMBER: NH 21-C0220

LICENSEE INFO: Three Crowns Park
LICENSEE ADDRESS: 2323 McDaniel Avenue
LICENSEE CITY, STATE, ZIP: Evanston, IL 60201
Survey Date – 02/22/2021

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a) and 300.696c)2). 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 NAME: Tower Hill Healthcare Center
FACILITY ADDRESS: 759 Kane Street
FACILITY CITY, STATE, ZIP: South Elgin, IL 60177

DOCKET NUMBER: NH 21-C0186

LICENSEE INFO: Tower Hill Rehabilitation, LLC
LICENSEE ADDRESS: 759 Kane St
LICENSEE CITY, STATE, ZIP: South Elgin, IL 60177
Survey Date – 02/08/2021

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 NAME: University Nsg & Rehab Center
FACILITY ADDRESS: 1095 University Drive
FACILITY CITY, STATE, ZIP: Edwardsville, IL 62025

DOCKET NUMBER: NH 21-S0211

LICENSEE INFO: University Care Center, LLC
LICENSEE ADDRESS: 111 North Ottawa Street
LICENSEE CITY, STATE, ZIP: Joliet, IL 60432
Survey Date – 01/27/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)4), 300.1210c)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 NAME: University Nsg & Rehab Center
FACILITY ADDRESS: 1095 University Drive
FACILITY CITY, STATE, ZIP: Edwardsville, IL 62025

DOCKET NUMBER: NH 21-C0212

LICENSEE INFO: University Care Center, LLC
LICENSEE ADDRESS: 111 North Ottawa Street
LICENSEE CITY, STATE, ZIP: Joliet, IL 60432
Survey Date – 02/03/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a) and 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 NAME: University Rehab
FACILITY ADDRESS: 500 South Art Bartell Road
FACILITY CITY, STATE, ZIP: Urbana, IL 61802

DOCKET NUMBER: NH 21-C0161 & NH 21-S0162

LICENSEE INFO: University Rehabilitation Center of C-U, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 01/27/2021

FACILITY NAME: University Rehab
FACILITY ADDRESS: 500 South Art Bartell Road
FACILITY CITY, STATE, ZIP: Urbana, IL 61802

DOCKET NUMBER: NH 21-C0197

LICENSEE INFO: University Rehabilitation Center of C-U, LLC
LICENSEE ADDRESS: 208 S. LaSalle St, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 02/03/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.3300d), 300.3300e), 300.3300f), 300.3300g), 300.3300j), 300.3300l). 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 NAME: University Rehab
FACILITY ADDRESS: 500 South Art Bartell Road
FACILITY CITY, STATE, ZIP: Urbana, IL 61802

DOCKET NUMBER: NH 21-C0221

LICENSEE INFO: University Rehabilitation Center of C-U, LLC
LICENSEE ADDRESS: 208 S Lasalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/11/2021

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

FACILITY NAME: University Rehab
FACILITY ADDRESS: 500 South Art Bartell Road
FACILITY CITY, STATE, ZIP: Urbana, IL 61802

DOCKET NUMBER: NH 21-C0223

LICENSEE INFO: University Rehabilitation Center of C-U, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 02/18/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.3240a), 300.3300d), 300.3300e), 300.3300e)1), 300.3300e)2), 300.3300e)3), 300.3300e)4), 300.3300e)5), 300.3300f), 300.3300g), 300.3300j), 300.3300l)). 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 NAME: Vandalia Rehab & Health Care C
FACILITY ADDRESS: 1500 West St. Louis Avenue
FACILITY CITY, STATE, ZIP: Vandalia, IL 62471

DOCKET NUMBER: NH 21-C0271

LICENSEE INFO: Vandalia HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/24/2021

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), and 300.1220b)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 $2,200.00

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

DOCKET NUMBER: NH 21-C0273

LICENSEE INFO: Waterfront Terrace, Inc.
LICENSEE ADDRESS: 191 North Wacker Dr., Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 03/26/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), and 300.1220)b)7). A fine of $12,500.00

FACILITY NAME: West Suburban Nsg & Rehab Ctr
FACILITY ADDRESS: 311 Edgewater Drive
FACILITY CITY, STATE, ZIP: Bloomingdale, IL 60108

DOCKET NUMBER: NH 21-C0213

LICENSEE INFO: West Suburban Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 01/25/2021

Type A 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 $25,000.00

FACILITY NAME: West Suburban Nsg & Rehab Ctr
FACILITY ADDRESS: 311 Edgewater Drive
FACILITY CITY, STATE, ZIP: Bloomingdale, IL 60108

DOCKET NUMBER: NH 21-C0243

LICENSEE INFO: West Suburban Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside. IL 60162
Survey Date – 03/04/2021

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)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

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

Total Fine $4,000.00

2021 2nd Quarterly Report

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2021 2nd Quarterly Report

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