Quarterly Report July - September 2015

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: Alden Estates of Orland Park
FACILITY ADDRESS: 16450 South 97th Ave
FACILITY CITY, STATE, ZIP: Orland Park, IL 60462
DOCKET NUMBER: 15-C0413
LICENSEE INFO: Alden-Orland Park Rehab and Health Care Center, Inc
LICENSEE ADDRESS: 4200 W Peterson Ave, Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 8/5/15
Type B violation for violating one or more sections: 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 following sections of the Code with a high risk designation: 300.1210b) and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Alden Long Grove Rehab & HCC
FACILITY ADDRESS: Box 2308, RFD Old Hicks Rd
FACILITY CITY, STATE, ZIP: Long Grove, IL 60047
DOCKET NUMBER: 15-C0356
LICENSEE INFO: Alden- Long Grove Rehab And Health Care Center, Inc
LICENSEE ADDRESS: 4200 W. Petersen Ave, Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 7/9/15
Type B violation for violating one or more sections: 300.610a), 300.1210b), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Alden Town Manor Rehab and HCC
FACILITY ADDRESS: 6120 West Ogden
FACILITY CITY, STATE, ZIP: Cicero, IL 60804
DOCKET NUMBER: 15-C0401
LICENSEE INFO: Alden- Town Manor Rehab and Health Care Center, Inc
LICENSEE ADDRESS: 4200 W. Peterson Ave., Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 8/12/15
Type C violation for violating one or more sections: 300.610a), 300.1010h), 300.1210b), 300.1210d)5), and 300.3240a). No fine.
 
FACILITY NAME: Aperion Care Center
FACILITY ADDRESS: 2650 North Monroe Street
FACILITY CITY, STATE, ZIP: Decatur, IL 62526
DOCKET NUMBER: 15-S0015 & 15-S0106
LICENSEE INFO: Lincoln Rehabilitation Center, LLC
LICENSEE ADDRESS: 8131 Monticello Avenue
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 12-11-14
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Arba Care Center of Bloomington
FACILITY ADDRESS: 1509 N. Calhoun St.
FACILITY CITY, STATE, ZIP: Bloomington, IL 61701
DOCKET NUMBER: 15-C0329
LICENSEE INFO: Arba Care Center of Bloomington, LLC
LICENSEE ADDRESS: 134 N McLean Blvd
LICENSEE CITY, STATE, ZIP: Elgin, IL 60123
Survey Date – 6/30/15
Type B violation for violating one or more sections: 300.610a), 300.1210a), 300.1210b), 300.1210d)6), 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 following sections of the Code with a high risk
designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Belhaven Nursing and Rehab Center
FACILITY ADDRESS: 11401 South Oakley Ave
FACILITY CITY, STATE, ZIP: Chicago, IL 60643
DOCKET NUMBER: 15-C0376
LICENSEE INFO: Belhaven Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 150 Fencl Ln
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 7/23/15
Type B violation for violating one or more sections: 300.3300a)b)c)1). No fine.
 
FACILITY NAME: Bethany Home
FACILITY ADDRESS: 4950 North Ashland
FACILITY CITY, STATE, ZIP: Chicago, IL 60640
DOCKET NUMBER: 15-S0400
LICENSEE INFO: Bethany Homes and Methodist Hospital
LICENSEE ADDRESS: 5015 N. Paulina St
LICENSEE CITY, STATE, ZIP: Chicago, IL 60640
Survey Date -
Type B violation for violating one or more sections: 330.1155a)4)c). No fine.
 
FACILITY NAME: Brentwood North NC & Rehab Center
FACILITY ADDRESS: 3705 Deerfield Rd
FACILITY CITY, STATE, ZIP: Riverwoods, IL 60015
DOCKET NUMBER: NH 15-S0373
LICENSEE INFO: Brentwood North Healthcare and Rehab Centre, Inc
LICENSEE ADDRESS: 191 N. Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 7/16/15
Type A violation for violating one or more sections: 300.1210b), 300.1210d)6), 300.3130c)3)4)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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a) For a total fine of $25,000.00.
 
FACILITY NAME: Brentwood North HC & Rehab Centre
FACILITY ADDRESS: 3705 Deerfield Rd
FACILITY CITY, STATE, ZIP: Riverwoods, IL 60015
DOCKET NUMBER: 15-C0350
LICENSEE INFO: Brentwood North Healthcare and Rehab Centre, Inc
LICENSEE ADDRESS: 191 n Wacker Dr. Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 7/1/15
Type A violation for violating one or more sections: 300.1210a), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $25,000.00.
 
FACILITY NAME: Brentwood Sub Acute Healthcare Center
FACILITY ADDRESS: 5400 West 87th St
FACILITY CITY, STATE, ZIP: Burbank, IL 60459
DOCKET NUMBER: 15-S0418
LICENSEE INFO: Brentwood Operating Company, LLC
LICENSEE ADDRESS: 208 S LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 7/31/15
Type B violation for violating one or more sections: 300.1010h), 300.1210a), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)5), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Bria of Geneva
FACILITY ADDRESS: 1101 East State Street
FACILITY CITY, STATE, ZIP: Geneva, IL 60134
DOCKET NUMBER: 15-S0332
LICENSEE INFO: Geneva Nursing and Rehab Center, LLC
LICENSEE ADDRESS: 4711 Golf Rd., Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 6/24/15
1. Type B violation for violating one or more sections: 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a).For a total fine of $2,200.00.

2. Type B violation for violating one or more sections: 300.610a), 300.1210b), 300.1210c), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)5), and 300.3240a).For a total fine of $2,200.00.

 
FACILITY NAME: Buckingham Pavilion
FACILITY ADDRESS: 2625 West Touhy Ave
FACILITY CITY, STATE, ZIP: Chicago, IL 60645
DOCKET NUMBER: 15-S0372
LICENSEE INFO: Buckingham Pavilion
LICENSEE ADDRESS: 191 N Wacker Dr., Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 7/16/15
Type B violation for violating one or more sections: 300.1210b), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Burgin Manor of Olney, Inc
FACILITY ADDRESS: 900 East Scott Street
FACILITY CITY, STATE, ZIP: Olney, IL 62450
DOCKET NUMBER: 15-S0315
LICENSEE INFO: Burgin Manor of Olney, Inc
LICENSEE ADDRESS: 858 Sunnyhill Lane
LICENSEE CITY, STATE, ZIP: Columbia, IL 62236
Survey Date – 2-11-15
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: California Gardens Nursing and Rehab Center
FACILITY ADDRESS: 2820 South California Blvd
FACILITY CITY, STATE, ZIP: Chicago, IL 60608
DOCKET NUMBER: 15-C0344, 15-S0345
LICENSEE INFO: California Gardens Corp
LICENSEE ADDRESS: 191 North Wacker Dr., Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60608
Survey Date – 6-16-15
Type B violation for violating one or more sections: 300.1210b), 300.1210d)2), 300.1210d)3), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Chicago Ridge Nursing Center
FACILITY ADDRESS: 10602 Southwest Highway
FACILITY CITY, STATE, ZIP: Chicago Ridge, IL 60415
DOCKET NUMBER: 15-C0384
LICENSEE INFO: BM of Chicago Ridge, LLC
LICENSEE ADDRESS: 8170 N McCormick Blvd., Ste 219
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 7/29/15
Type B violation for violating one or more sections: 300.1810a)b). No fine.
 
FACILITY NAME: Clark-Lindsey Village
FACILITY ADDRESS: 101 West Windsor Rd
FACILITY CITY, STATE, ZIP: Urbana, IL 61071
DOCKET NUMBER: 15-S0416
LICENSEE INFO: Clark-Lindsey Village, Inc
LICENSEE ADDRESS: 1729 Georgetown Dr
LICENSEE CITY, STATE, ZIP: Champaign, IL 61821
Survey Date – 9/2/15
Type B violation for violating one or more sections: 300.610a), 300.1210b), 300.1210d)6), and 300.3240a). No fine.
 
FACILITY NAME: Clayton Residential Home
FACILITY ADDRESS: 2026 North Clark St
FACILITY CITY, STATE, ZIP: Chicago, IL 60093
DOCKET NUMBER: 15-S0090
LICENSEE INFO: Clayton Residential Home, Inc
LICENSEE ADDRESS: 465 Central Ave, Ste 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Clayton Residential Home
FACILITY ADDRESS: 2026 North Clark St.
FACILITY CITY, STATE, ZIP: Chicago, IL 60093
DOCKET NUMBER: 15-S0349
LICENSEE INFO: Clayton residential Home, Inc
LICENSEE ADDRESS: 465 Central Ave. Ste 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
Survey Date – 7/9/15
Type B violation for violating one or more sections: 300.1210d)1) and 300.696a)c)7). No fine.
 
FACILITY NAME: Covenant Healthcare Center
FACILITY ADDRESS: 2155 Pfingsten Rd
FACILITY CITY, STATE, ZIP: Northbrook, IL 60062
DOCKET NUMBER: 15-S0215
LICENSEE INFO: Covenant Healthcare Center, Inc
LICENSEE ADDRESS: 2155 Pfingsten Rd
LICENSEE CITY, STATE, ZIP: Northbrook, IL 60062
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Decatur Manor Healthcare
FACILITY ADDRESS: 1016 West Pershing Road
FACILITY CITY, STATE, ZIP: Decatur, IL 62526
DOCKET NUMBER: 14-S0430
LICENSEE INFO: Decatur Manor Healthcare, LLC
LICENSEE ADDRESS: 6840 N Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 9-4-14
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Dixie Manor Sheltered Care
FACILITY ADDRESS: 15535 Dixie Highway
FACILITY CITY, STATE, ZIP: Harvey, IL 60426
DOCKET NUMBER: 15-S0399
LICENSEE INFO: Dixie Manor Sheltered Care, Inc
LICENSEE ADDRESS: 15535 Dixie Highway
LICENSEE CITY, STATE, ZIP: Harvey, IL 60426
Survey Date – 8/26/15
Type C violation for violating one or more sections: 330.790a), 330.790b), 330.790c)1)2)3), 330.1510a)2), 330.1950c)1)2)3), 330.1950d)1)2)3)4)5)6)7)8)9)10)11), 330.1950e), 330.1950f), and 330.1950g)1)2). No fine.
 
FACILITY NAME: Dobson Plaza
FACILITY ADDRESS: 120 Dodge Avenue
FACILITY CITY, STATE, ZIP: Evanston, IL 60202
DOCKET NUMBER: 14-C0436
LICENSEE INFO: Dobson Plaza Nursing & Rehab Center, LLC
LICENSEE ADDRESS: 191 Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 9-3-14
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Eastview Terrace
FACILITY ADDRESS: 100 Eastview Place
FACILITY CITY, STATE, ZIP: Sullivan, IL 61951
DOCKET NUMBER: 15-S0341
LICENSEE INFO: Petersen Health Care, Inc
LICENSEE ADDRESS: 830 West Trailcreek Dr.
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 7/15/15
Type B violation for violating one or more sections: 300.1230k). No fine.
 
FACILITY NAME: Elmhurst Extended Care Center
FACILITY ADDRESS: 200 East Lake St
FACILITY CITY, STATE, ZIP: Elmhurst, IL 60126
DOCKET NUMBER: 15-S0302
LICENSEE INFO: SBNB, Inc
LICENSEE ADDRESS: 200 East Lake St
LICENSEE CITY, STATE, ZIP: Elmhurst, IL 60126
Survey Date – 6/9/15
Type A violation for violating one or more sections: 300.1010h), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $25,000.00.
 
FACILITY NAME: Estates of Hyde Park
FACILITY ADDRESS: 4505 S. Drexel Blvd
FACILITY CITY, STATE, ZIP: Chicago, IL 60653
DOCKET NUMBER: 15-C0337
LICENSEE INFO: The Estates of Hyde Park, LLC
LICENSEE ADDRESS: 4711 Golf Rd., Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date -7/1/15
Type B violation for violating one or more sections: 300.1010h), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)5), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Fairview Nursing Plaza
FACILITY ADDRESS: 321 Arnold Avenue
FACILITY CITY, STATE, ZIP: Rockford, IL 61108
DOCKET NUMBER: 13-s0531
LICENSEE INFO: Fairview Nursing Plaza, Inc
LICENSEE ADDRESS: 6840 N Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 11-13-13
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Farmer City Rehab & Health CR
FACILITY ADDRESS: 404 Brookview Drive
FACILITY CITY, STATE, ZIP: Farmer City, IL 61842
DOCKET NUMBER: 15-C0288
LICENSEE INFO: Petersen Health Care – Farmer City, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 6-10-15
Type B violation for violating one or more sections of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.1230d)2) and 300.1230k). No Fine.
 
FACILITY NAME: Flora Gardens Care Center
FACILITY ADDRESS: 701 Shadwell Ave
FACILITY CITY, STATE, ZIP: Flora, IL 62839
DOCKET NUMBER: 15-S0346
LICENSEE INFO: Petersen Health Network, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Dr
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 7/30/15
Type B violation for violating one or more sections: 300.610a), 300.690a), 300.1210b), 300.3240a), 300.3240d), 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 following sections of the Code with a high risk designation: 300.690a), 300.1210b), 300.3240a), 300.3240d), and 300.3240e). For a total fine of $2,200.00.
 
FACILITY NAME: Forest City Rehab & Nrsg Ctr
FACILITY ADDRESS: 321 Arnold Avenue
FACILITY CITY, STATE, ZIP: Rockford, IL 61108
DOCKET NUMBER: 15-C0305
LICENSEE INFO: Forest City Rehab & Nursing Center, LLC
LICENSEE ADDRESS: 4711 Golf Rd Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date - 6-1-15
Type B violation(s) for violating one or more sections of the Act and the Skilled Nursing and Intermediate Care Facilities: 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). For a fine of $2,200.00.
 
FACILITY NAME: Gilman Healthcare Center
FACILITY ADDRESS: 1390 South Crescent St
FACILITY CITY, STATE, ZIP: Gilman, IL 60938
DOCKET NUMBER: 15-C0352
LICENSEE INFO: Gilman Healthcare Center, LLC
LICENSEE ADDRESS: 4711 Golf Rd., Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 6/25/15
Type B violation for violating one or more sections: 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Gilman Healthcare Center
FACILITY ADDRESS: 1390 South Cresent St
FACILITY CITY, STATE, ZIP: Gilman, IL 60938
DOCKET NUMBER: 15-S0422
LICENSEE INFO: Gilman Healthcare Center, LLC
LICENSEE ADDRESS: 4711 Golf Rd, Ste. 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 8/27/15
Type B violation for violating one or more sections: 300.1210a), 300.1210b), 300.1210d)1), 300.d)3), 300.1620a), 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 following sections of the Code with a high risk designation: 300.1210b) and 300.3240a). For a total fine of $2,200.00.

Type B violation of an occurrence for violating the following section of the code: 300.615f). No fine.

Type B violation of an occurrence for violating the following section of the code: 300.625c)1) and 300.625c)2). No fine.

 
FACILITY NAME: Glenview Terrace and Nursing Center
FACILITY ADDRESS: 1511 Greenwood Rd
FACILITY CITY, STATE, ZIP: Glenview, IL 60025
DOCKET NUMBER: 15-S0338
LICENSEE INFO: Glenview Terrace Nursing Center
LICENSEE ADDRESS: 6633 North Lincoln Ave
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 6/17/15
Type B violation for violating one or more sections: 300.610a), 300.1210b), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Glenwood Health Care and Rehab
FACILITY ADDRESS: 19330 South Cottage Grove
FACILITY CITY, STATE, ZIP: Glenwood, IL 60425
DOCKET NUMBER: 15-C0313
LICENSEE INFO: Glenwood Healthcare & Rehab, Inc
LICENSEE ADDRESS: 5750 Old Orchard Rd., Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 6/10/15
Type A violation for violating one or more sections: 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 following sections of the Code with a high risk designation: 300.1210b) and 300.3240a). For a total fine of $25,000.00.
 
FACILITY NAME: Glenwood Healthcare and Rehab
FACILITY ADDRESS: 19330 South Cottage Grove
FACILITY CITY, STATE, ZIP: Glenwood, IL 60425
DOCKET NUMBER: 15-C0394, 15-S0395
LICENSEE INFO: Glenwood Healthcare & Rehab, Inc
LICENSEE ADDRESS: 5750 Old Orchard Rd, Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 8/6/15
Type A violation for violating one or more sections: 300.610a), 300.1210a), 300.1210b), 300.1210d)5), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $25,000.00.
 
FACILITY NAME: Grasmere Place
FACILITY ADDRESS: 4621 North Sheridan
FACILITY CITY, STATE, ZIP: Chicago, IL 60640
DOCKET NUMBER: 15-C0357
LICENSEE INFO: Grasmere Place, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 8/5/15
Type C violation for violating one or more sections: 300.1630d). No fine.
 
FACILITY NAME: Greenfields of Geneva
FACILITY ADDRESS: 0N801 Friendship Way
FACILITY CITY, STATE, ZIP: Geneva, IL 60134
DOCKET NUMBER: 15-C0319
LICENSEE INFO: Friendship Village of Mill Creek, NFP
LICENSEE ADDRESS: 10 S. LaSalle, Ste 2880
LICENSEE CITY, STATE, ZIP: Chicago, IL 60603
Survey Date – 6/18/15
Type A violation for violating one or more sections: 300.610a), 300.1210b)5), 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 following sections of the Code with a high risk designation: 300.1210b)5), 300.1210d)6), and 300.3240a). For a total fine of
$27,200.00.
 
FACILITY NAME: Heartland of Champaign
FACILITY ADDRESS: 309 East Springfield
FACILITY CITY, STATE, ZIP: Champaign, IL 61820
DOCKET NUMBER: 15-C0378
LICENSEE INFO: Heartland of Champaign IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 7/14/15
Type A violation for violating one or more sections: 300.1210b), 300.1210d)3), 300.1220d)6), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $25,000.00.
 
FACILITY NAME: Heartland of Normal
FACILITY ADDRESS: 510 Broadway
FACILITY CITY, STATE, ZIP: Normal, IL
DOCKET NUMBER: 15-S0412
LICENSEE INFO: Heartland of Normal IL, LLC
LICENSEE ADDRESS: 208 S LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 8/20/15
Type B violation for violating one or more sections: 300.610a), 300.1010h), 300.1210b)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 following sections of the Code with a high risk designation: 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Highland Healthcare Center
FACILITY ADDRESS: 1450-26th St
FACILITY CITY, STATE, ZIP: Highland, IL 62249
DOCKET NUMBER: 15-C0392
LICENSEE INFO: Covenant Care Midwest, Inc
LICENSEE ADDRESS: 2015 W. Main St, #11
LICENSEE CITY, STATE, ZIP: Carbondale, IL 62901
Survey Date – 7/15/15
Type B violation for violating one or more sections: 300.3300a)b)c)1)A)B)C). No fine.
 
FACILITY NAME: Hillsboro Rehab & HCC
FACILITY ADDRESS: 1300 East Tremont St
FACILITY CITY, STATE, ZIP: Hillsboro, IL 62049
DOCKET NUMBER: 15-S0397
LICENSEE INFO: Hillsboro Rehab and Health Care Center, LLC
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 8/19/15
Type A violation for violating one or more sections: 300.610a), 300.1035a)3), 300.1035a)4), 300.1035b)2), 300.1210a), 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 following sections of the Code with a high risk designation: 300.1210b) and 300.3240a). For a total fine of $25,000.00.
 
FACILITY NAME: Holy Family Villa
FACILITY ADDRESS: 12220 South Cook Road
FACILITY CITY, STATE, ZIP: Palos Heights, IL 60464
DOCKET NUMBER: 15-S0153
LICENSEE INFO: Holy Family Villa
LICENSEE ADDRESS: 721 N LaSalle St
LICENSEE CITY, STATE, ZIP: Chicago, IL 60654
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Illini Restorative Care
FACILITY ADDRESS: 1455 Hospital Rd
FACILITY CITY, STATE, ZIP: Silvis, IL 61282
DOCKET NUMBER: 15-S0340
LICENSEE INFO: Genesis Health System
LICENSEE ADDRESS: 801 Illini Dr.
LICENSEE CITY, STATE, ZIP: Silvis, IL 61282
Survey Date – 7/6/15
Type B violation for violating one or more sections: 300.610a), 300.1630c), 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 following sections of the Code with a high risk designation: 300.3240a).. For a total fine of $2,200.00.
 
FACILITY NAME: Lake Shore Healthcare & Rehab
FACILITY ADDRESS: 7200 North Sheridan Road
FACILITY CITY, STATE, ZIP: Chicago, IL 60626
DOCKET NUMBER: 14-C0314
LICENSEE INFO: Lake Shore Healthcare & Rehabilitation Centre, LLC
LICENSEE ADDRESS: 4600 West Touhy Avenue #200
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 6-12-14
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Lena Living Center
FACILITY ADDRESS: 1010 South Logan Street
FACILITY CITY, STATE, ZIP: Lena, IL 61048
DOCKET NUMBER: NH 15-C0284
LICENSEE INFO: Lena Living Center, L.L.C.
LICENSEE ADDRESS: One IBM Plaza, Ste 3000
LICENSEE CITY, STATE, ZIP: Chicago, IL 60611
Survey Date – 6-8-2015
Type B violation for violating one or more sections: 300.1210b) and 300.1210d)6). No Fine.
 
FACILITY NAME: Leroy Manor
FACILITY ADDRESS: 509 South Buck Rd
FACILITY CITY, STATE, ZIP: Leroy, IL 61752
DOCKET NUMBER: 15-S0390
LICENSEE INFO: UDI #4, LLC
LICENSEE ADDRESS: 285 South Farnham St
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 8/5/15
Type B violation for violating one or more sections: 300.670c). No fine.
 
FACILITY NAME: Lexington of Elmhurst
FACILITY ADDRESS: 420 West Butterfield Rd
FACILITY CITY, STATE, ZIP: Elmhurst, IL 60126
DOCKET NUMBER: 15-S0362
LICENSEE INFO: Lexington Healthcare Center of Elmhurst, Inc
LICENSEE ADDRESS: 665 West North Ave
LICENSEE CITY, STATE, ZIP: Lombard, IL 60148
Survey Date – 7/24/15
1. Type B violation for violating one or more sections: 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00.

2. Type B violation of an occurrence for violating the following sections of the code: 300.625a). No fine.

 
FACILITY NAME: Lexington of LaGrange
FACILITY ADDRESS: 4735 Willow Springs Rd
FACILITY CITY, STATE, ZIP: LaGrange, IL 60525
DOCKET NUMBER: 15-S0343
LICENSEE INFO: Lexington Health Care Center of LaGrange, Inc
LICENSEE ADDRESS: 665 West North Ave.
LICENSEE CITY, STATE, ZIP: Lombard, IL 60148
Survey Date – 7-13-15
Type C violation for violating one or more sections: 300.610a), 300.1210a)b)d)6), 300.1220b)3), and 300.3240a)b). No fine.
 
FACILITY NAME: Lexington of Streamwood
FACILITY ADDRESS: 815 East Irving Park Road
FACILITY CITY, STATE, ZIP: Streamwood, IL 60107
DOCKET NUMBER: 15-S0308
LICENSEE INFO: Lexington Health Care Center of Streamwood. Inc
LICENSEE ADDRESS: 665 West North Avenue
LICENSEE CITY, STATE, ZIP: Lombard, IL 60148
Survey Date – 5-29-15
Type B violation(s) for violating one or more sections of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.1210b), 300.1210b)3), 300.1210b)4), 300.1210b)4)A)B)C)D), 300.1210d)5), 300.3240a). No fine.
 
FACILITY NAME: Lexington of Streamwood
FACILITY ADDRESS: 815 East Irving Park Rd
FACILITY CITY, STATE, ZIP: Streamwood, IL 60107
DOCKET NUMBER: 15-S0353
LICENSEE INFO: Lexington Health Care Center of Streamwood, Inc.
LICENSEE ADDRESS: 665 West North Avenue
LICENSEE CITY, STATE, ZIP: Lombard, IL 60184
Survey Date – 6/24/15
Type B violation for violating one or more sections: 300.610a), 300.690a)b), 300.1010h), 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 following sections of the Code with a high risk designation: 300.690a)b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Lydia Healthcare
FACILITY ADDRESS: 13901 South Lydia
FACILITY CITY, STATE, ZIP: Robbins, IL 60472
DOCKET NUMBER: 15-C0380
LICENSEE INFO: Lydia Healthcare I, LLC
LICENSEE ADDRESS: 13901 S Lydia Ave
LICENSEE CITY, STATE, ZIP: Robbins, IL 60472
Survey Date – 8/18/15
Type B violation for violating one or more sections: 300.690b)c). No fine.
 
FACILITY NAME: Magnolia Manor Sheltered Care H
FACILITY ADDRESS: 1100 Grant
FACILITY CITY, STATE, ZIP: Eldorado, IL 62930
DOCKET NUMBER: 15-S0348
LICENSEE INFO: John Zink
LICENSEE ADDRESS: 150 South Route 45, PO Box 250
LICENSEE CITY, STATE, ZIP: Louisville, IL 62858
Survey Date – 7/16/15
Type B violation for violating one or more sections: 330.2000. No fine.
 
FACILITY NAME: Manor Court of Maryville
FACILITY ADDRESS: 6955 State Route 162
FACILITY CITY, STATE, ZIP: Maryville, IL 62062
DOCKET NUMBER: 15-C0389
LICENSEE INFO: UDI #2, LLC
LICENSEE ADDRESS: 285 S. Farnham St
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 7/24/15
Type B violation for violating one or more sections: 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 following sections of the Code with a high risk designation:300.1210b) and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Manorcare of Arlington Heights
FACILITY ADDRESS: 715 West Central Road
FACILITY CITY, STATE, ZIP: Arlington Hts, IL 60005
DOCKET NUMBER: 15-C0292
LICENSEE INFO: Manorcare Health Services, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date - 6-9-15
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)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). For a Fine of $2,200.00.
 
FACILITY NAME: Manorcare of South Holland
FACILITY ADDRESS: 2145 East 170th St
FACILITY CITY, STATE, ZIP: South Holland, IL 60473
DOCKET NUMBER: 15-C0404, 15-S0405
LICENSEE INFO: Manor Care of South Holland IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 7/31/15
Type B violation for violating one or more sections: 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)5), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Marigold Rehabilitation HCC
FACILITY ADDRESS: 275 East Carl Sandburg Drive
FACILITY CITY, STATE, ZIP: Galesburg, IL 61401
DOCKET NUMBER: NH 15-C0281
LICENSEE INFO: Petersen Health Network, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Dr.
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 5-16-2015
Type B violation for violating one or more sections: 300.1230b), 300.1230d)1)2), 300.1230L)1)2)3)4)5)6). No fine.
 
FACILITY NAME: Mason Point
FACILITY ADDRESS: One Masonic Way
FACILITY CITY, STATE, ZIP: Sullivan, IL 61951
DOCKET NUMBER: 15-S0290
LICENSEE INFO: Petersen Health Care VII, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date - 6-10-15
Type C violation(s) for violating one or more sections of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.1230k). No fine.
 
FACILITY NAME: Mason Point
FACILITY ADDRESS: One Masonic Way
FACILITY CITY, STATE, ZIP: Sullivan, IL 61951
DOCKET NUMBER: 15-S0342
LICENSEE INFO: Petersen Health Care VII, LLC
LICENSEE ADDRESS: 830 W Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 7/1/15
Type B violation for violating one or more sections: 300.1210b), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00
 
FACILITY NAME: Mclean County Nursing Home
FACILITY ADDRESS: 901 North Main
FACILITY CITY, STATE, ZIP: Normal, IL 61761
DOCKET NUMBER: 15-S0339
LICENSEE INFO: Mclean County
LICENSEE ADDRESS: 202 N. Main, RM 205, PO Box 2400
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61702
Survey Date – 7/9/15
Type B violation for violating one or more sections: 300.610a), 300.1210a), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00
 
FACILITY NAME: Meadows
FACILITY ADDRESS: 3250 South Plum Grove Rd
FACILITY CITY, STATE, ZIP: Rolling Meadows, IL 60008
DOCKET NUMBER: 15-C0039
LICENSEE INFO: Meadows Sheltered care, Inc
LICENSEE ADDRESS: 3250 S Plum Grove Rd
LICENSEE CITY, STATE, ZIP: Rolling Meadows, IL 60008
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Meadows Mennonite Home
FACILITY ADDRESS: 24588 Church Street
FACILITY CITY, STATE, ZIP: Chenoa, IL 61726
DOCKET NUMBER: 15-S0306
LICENSEE INFO: Meadows Mennonite Retirement Community Association, Inc
LICENSEE ADDRESS: 24588 Church Street
LICENSEE CITY, STATE, ZIP: Chenoa, IL 61726
Survey Date - 6/09/15
Type B violation(s) of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.610a), 300.1210a), 300.1210b)5), 300.1210d)6), 300.1210b)2), 300.1210b)3), 300.3240a), 300.7020b)2). No fine.
 
FACILITY NAME: Neighbors Rehabilitation Center
FACILITY ADDRESS: 811 West 2nd St
FACILITY CITY, STATE, ZIP: Byron, IL 61010
DOCKET NUMBER: 14-C162
LICENSEE INFO: Neighbors Rehabilitation Center, LLC
LICENSEE ADDRESS: 6840 N Lincoln Ave
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Meadows Mennonite Home
FACILITY ADDRESS: 24588 Church St
FACILITY CITY, STATE, ZIP: Chenoa, IL 61726
DOCKET NUMBER: 15-C0386
LICENSEE INFO: Meadows Mennonite Retirement Community Association, Inc
LICENSEE ADDRESS: 24588 Church St
LICENSEE CITY, STATE, ZIP: Chenoa, IL 61726
Survey Date – 8/6/15
Type B violation for violating one or more sections: 300.610a), 300.1210d)1), 300.1210d)2), 300.1620a), 300.1630c), 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 following sections of the Code with a high risk designation: 300.3240a). For a total fine of $2,200.00
 
FACILITY NAME: Newman Rehab & Health Care Ctr
FACILITY ADDRESS: 418 South Memorial Park Drive
FACILITY CITY, STATE, ZIP: Newman, IL 61942
DOCKET NUMBER: 15-S0314
LICENSEE INFO: Petersen Health & Wellness, LLC
LICENSEE ADDRESS: 830 W Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, Il 61614
Survey Date – 6-25-15
One or more Type B violation(s) for violating one or more sections of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.670c),300.1230k), and 300.2010a)1). No fine.
 
FACILITY NAME: Paris Health Care Center
FACILITY ADDRESS: 1011 North Main St
FACILITY CITY, STATE, ZIP: Paris, IL 61944
DOCKET NUMBER: 15-S0420
LICENSEE INFO: Paris Health Care Center Investors, LLC
LICENSEE ADDRESS: 8170 N McCormick Blvd., Ste 219
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 8/14/15
Type B violation for violating one or more sections: 300.7060a). No fine.
 
FACILITY NAME: Paxton Healthcare and Rehab
FACILITY ADDRESS: 1240 North Market St
FACILITY CITY, STATE, ZIP: Paxton, IL 60957
DOCKET NUMBER: 15-S0361
LICENSEE INFO: Paxton Healthcare and Rehab, LLC
LICENSEE ADDRESS: 8170 McCormick Blvd
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 7/10/15
1. Type B violation for violating one or more sections: 300.1210a), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00

2. Type B violation of an occurrence for violating the following section of the code: 300.690b)c). No fine.

3. Type B violation of an occurrence for violating the following section of the code: 300.3100d)2). No fine.

 
FACILITY NAME: Pekin Manor
FACILITY ADDRESS: 1520 El Camino Drive
FACILITY CITY, STATE, ZIP: Pekin, IL 61554
DOCKET NUMBER: 15-C0309
LICENSEE INFO: UDI #10
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date - 6-11-15
Type B violation(s) of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.610a), 300.1210b), 300.1210d)6), 300.3240a). No fine.
 
FACILITY NAME: Presence Pine View Care Center
FACILITY ADDRESS: 611 Allen Lane
FACILITY CITY, STATE, ZIP: St. Charles, IL 60174
DOCKET NUMBER: 15-S0415
LICENSEE INFO: Presence Life Connections
LICENSEE ADDRESS: 9223 West Saint Francis Rd
LICENSEE CITY, STATE, ZIP: Frankfort, IL 60423
Survey Date – 8/21/15
Type B violation for violating one or more sections: 300.690a), 300.1210b), 300.3240a), 300.3240b), 300.3240c), 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 following sections of the Code with a high risk designation: 300.1210b), 300.3240a), 300.3240d). For a total fine of $2,200.00.
 
FACILITY NAME: Presence St. Joseph Center
FACILITY ADDRESS: 659 East Jefferson St.
FACILITY CITY, STATE, ZIP: Freeport, IL 61032
DOCKET NUMBER: 15-S0393
LICENSEE INFO: Presence Life Connections
LICENSEE ADDRESS: 9223 West Saint Francis Rd
LICENSEE CITY, STATE, ZIP: Frankfort, IL 60423
Survey Date – 7/21/15
Type B violation for violating one or more sections: 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Presence Villa Franciscan
FACILITY ADDRESS: 210 North Springfield Avenue
FACILITY CITY, STATE, ZIP: Joliet, IL 60435
DOCKET NUMBER: 14-C0471
LICENSEE INFO: Presence Life Connection
LICENSEE ADDRESS: 9223 West Saint Francis Road
LICENSEE CITY, STATE, ZIP: Frankfort, IL 60423
Survey Date – 10-7-14
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Presence Villa Franciscan
FACILITY ADDRESS: 210 North Springfield Avenue
FACILITY CITY, STATE, ZIP: Joliet, IL 60435
DOCKET NUMBER: 14-C0472
LICENSEE INFO: Presence Life Connection
LICENSEE ADDRESS: 9223 West Saint Francis Road
LICENSEE CITY, STATE, ZIP: Frankfort, IL 60423
Survey Date – 10-17-14
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Riverwood Rehab
FACILITY ADDRESS: 430 South 30th Ave
FACILITY CITY, STATE, ZIP: East Moline, IL 61244
DOCKET NUMBER: 15-S0335
LICENSEE INFO: Riverwood Rehab, LLC
LICENSEE ADDRESS: 8131 N Monticello
LICENSEE CITY, STATE, ZIP: Skokie, IL 61244
Survey Date – 7/17/15
Type B violation for violating one or more sections: 300.1230b), 300.1230d)1)2), 300.1230e), 300.1230h), 300.1230i), 300.1230j)1)5), 300.1230k), and 300.1230)1)2)3). No Fine.
 
FACILITY NAME: Rock Island Nsg & Rehab Ctr
FACILITY ADDRESS: 2545 24th Street
FACILITY CITY, STATE, ZIP: Rock Island, IL 61201
DOCKET NUMBER: 15-C0294
LICENSEE INFO: Rock Island Nursing & Rehab Center, LLC
LICENSEE ADDRESS: 6840 North Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
 
 
FACILITY NAME: St. Paul’s Home
FACILITY ADDRESS: 1021 West E. St.
FACILITY CITY, STATE, ZIP: Belleville, IL 62220
DOCKET NUMBER: 15-S0396
LICENSEE INFO: St. Paul’s Home
LICENSEE ADDRESS: 23 Public Square #300
LICENSEE CITY, STATE, ZIP: Belleville, IL 62220
Survey Date – 8/26/15
Type C violation for violating one or more sections: 300.610a), 300.1210b), 300.1210d)3), and 300.3240a). No fine.
 
FACILITY NAME: St. Paul’s Home
FACILITY ADDRESS: 1021 West E. St.
FACILITY CITY, STATE, ZIP: Belleville, IL 62220
DOCKET NUMBER: 15-C0382
LICENSEE INFO: St Paul’s Home for the Aged
LICENSEE ADDRESS: 23 Public Square #300
LICENSEE CITY, STATE, ZIP: Belleville, IL 62220
Survey Date – 7/13/15
Type B violation for violating one or more sections: 300.610a), 300.1210b), 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)5), and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Skokie Meadows Nrsg Center #2
FACILITY ADDRESS: 4600 West Golf Road
FACILITY CITY, STATE, ZIP: Skokie, IL 60076
DOCKET NUMBER: 15-S0017
LICENSEE INFO: Skokie Meadows Nursing Centers II, LLC
LICENSEE ADDRESS: 9615 North Knox Avenue
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 12-8-14
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: South Lawn Sheltered Care
FACILITY ADDRESS: 512 South Franklin
FACILITY CITY, STATE, ZIP: Bunker Hill, IL 62014
DOCKET NUMBER: 15-C0327
LICENSEE INFO: South Lawn Sheltered Care, Inc
LICENSEE ADDRESS: RR 1, Route 159, PO Box H
LICENSEE CITY, STATE, ZIP: Bunker Hill, IL 62014
Survey Date – 7/2/15
Type B violation for violating one or more sections: 330.920d), 330.715a)c), and 330.725c)1)2)e)f)3)A)B)j)k)n)q). No fine.
 
FACILITY NAME: Southpoint Nrsg & Rehab Ctr
FACILITY ADDRESS: 1010 West 95th Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60643
DOCKET NUMBER: 15-S0325
LICENSEE INFO: Southpoint Nrsg & Rehabilitation Center, LLC
LICENSEE ADDRESS: 150 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 6-11-15
Type B violation(s) of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.615. No fine.
 
FACILITY NAME: Springs at Crystal Lake
FACILITY ADDRESS: 1000 East Brighton
FACILITY CITY, STATE, ZIP: Crystal Lake, IL
DOCKET NUMBER: 15-C0331
LICENSEE INFO: The Springs at Crystal Lake, LLC
LICENSEE ADDRESS: 191 N. Wacker Dr., Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 6/30/15
Type C violation for violating one or more sections: 300.1210a), 300.1210c), 300.1210d)5), 300.1220b)3), and 300.3240a). No fine.
 
FACILITY NAME: Stephenson Nursing Center
FACILITY ADDRESS: 2946 South Walnut Rd
FACILITY CITY, STATE, ZIP: Freeport, IL 61032
DOCKET NUMBER: 15-C0351
LICENSEE INFO: Stephenson County Board of Supervisors
LICENSEE ADDRESS: 50 W. Douglas St., Ste 1002
LICENSEE CITY, STATE, ZIP: Freeport, IL 61032
Survey Date – 7/29/15
Type B violation for violating one or more sections: 300.690b) and 300.690c). No fine.
 
FACILITY NAME: Sterling Pavilion
FACILITY ADDRESS: 105 East 23rd Street
FACILITY CITY, STATE, ZIP: Sterling, IL 61081
DOCKET NUMBER: 15-S0291
LICENSEE INFO: Sterling Pavilion, Ltd
LICENSEE ADDRESS: 191 North Wacker Dr. Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 6-9-15
1. Type B violation for violating one or more sections: 300.610a), 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 following sections of the Code with a high risk designation: 300.1210d)5) and 300.3240a). For a total fine of $2,200.00.
2. Type B violation for violating one or more sections: 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 following sections of the Code with a high risk designation: 300.1210d)6), 300.1210b)5) and 300.3240a). For a total fine of $2,200.00.
3. Type B violation for violating one or more sections: 300.1010h), 300.1210b, 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 following sections of the Code with a high risk designation: 300.1210b and 300.3240a). For a total fine of $2,200.00.
 
FACILITY NAME: Sterling Pavilion
FACILITY ADDRESS: 105 East 23rd St
FACILITY CITY, STATE, ZIP: Sterling, IL 61081
DOCKET NUMBER: 15-S0383
LICENSEE INFO: Sterling Pavilion, LTD
LICENSEE ADDRESS: 191 North Wacker Dr., Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 8/6/15
Type B violation for violating one or more sections: 300.1210d)5). No fine.
 
FACILITY NAME: Sunset Rehabilitation & Hlth C
FACILITY ADDRESS: 129 South 1st Avenue
FACILITY CITY, STATE, ZIP: Canton, IL 61520
DOCKET NUMBER: 15-S0289
LICENSEE INFO: Sunset Home
LICENSEE ADDRESS: 625 Vermont Street
LICENSEE CITY, STATE, ZIP: Quincy, IL 62301
Survey Date – 6-24-15
Type B violation(s) of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300:300.696A)C)2)7) and 300.2100. No fine.
 
FACILITY NAME: Swansea Rehab & Health Care Center
FACILITY ADDRESS: 1405 North Second Street
FACILITY CITY, STATE, ZIP: Swansea, IL 62226
DOCKET NUMBER: 14-C0333
LICENSEE INFO: Petersen Health Care II, Inc
LICENSEE ADDRESS: 830 West Trailcreek Dr
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.
 
FACILITY NAME: Symphony of Evanston Healthcare
FACILITY ADDRESS: 820 Foster St
FACILITY CITY, STATE, ZIP: Evanston, IL 60201
DOCKET NUMBER: 15-S0381
LICENSEE INFO: Symphony of Evanston Healthcare, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Dr
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 7/16/15
Type B violation for violating one or more sections: 300.7060a) and 300.615e). No fine.
 
FACILITY NAME: Thorton Heights Terrace
FACILITY ADDRESS: 160 West 10th St.
FACILITY CITY, STATE, ZIP: Chicago Heights, IL 60411
DOCKET NUMBER: 15-S0410
LICENSEE INFO: Thorton Heights Terrace, LTD
LICENSEE ADDRESS: 465 Central Ave, Ste 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
Survey Date – 8/13/15
Type B violation for violating one or more sections: 300.690b)c), 300.695a)3)b)c)1)2), and 300.3240d)f), No fine.
 
FACILITY NAME: Timber Point Healthcare Center
FACILITY ADDRESS: 205 East Spring Street
FACILITY CITY, STATE, ZIP: Camp Point, IL 62320
DOCKET NUMBER: 15-S0316
LICENSEE INFO: Timber Point Healthcare Center, Inc
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 6-25-15
Type B violation(s) of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.615, 300.625, 300.690. No fine.
 
FACILITY NAME: Tri-State Nursing & Rehab Ctr
FACILITY ADDRESS: 2500 East 175th Street
FACILITY CITY, STATE, ZIP: Lansing, IL 60438
DOCKET NUMBER: 15-S0303
LICENSEE INFO: Tri-State Nursing & Rehabilitation Center, Inc
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 6-4-15
Type B violation(s) of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.610a), 300.1210b), 300.1210d), 300.3240a). No fine.
 
FACILITY NAME: Twin Lakes Rehab & Health Care
FACILITY ADDRESS: 310 Eads Ave
FACILITY CITY, STATE, ZIP: Paris, IL 61944
DOCKET NUMBER: 15-S0322
LICENSEE INFO: Petersen Health Care II, Inc
LICENSEE ADDRESS: 830 W Trailcreek Dr
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 6/26/15
4. Type B violation for violating one or more sections: 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 following sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). For a total fine of $2,200.00

5. Type B Violation of an occurrence for violating the following section of the Code: 300.690a), 300.690b), and 300.690c). No Fine.

 
FACILITY NAME: Warren Barr Lincolnshire
FACILITY ADDRESS: 150 Jamestown Lane
FACILITY CITY, STATE, ZIP: Lincolnshire, IL 60069
DOCKET NUMBER: 15-C0333
LICENSEE INFO: Lincolnshire Living and Rehab Center, LLC
LICENSEE ADDRESS: 7040 N. Ridgeway
LICENSEE CITY, STATE, ZIP: Lincolnshire, IL 60712
Survey Date – 6/15/15
Type B violation for violating one or more sections: 300.1210b), 300.1210d)6), and 300.3240a). No Fine.
 
FACILITY NAME: Warren Barr Lincolnshire
FACILITY ADDRESS: 150 Jamestown Lane
FACILITY CITY, STATE, ZIP: Lincolnshire, IL 60069
DOCKET NUMBER: 15-S0411
LICENSEE INFO: Lincolnshire Living and Rehab Center, LLC
LICENSEE ADDRESS: 7040 N Ridgeway
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 8/18/15
Type B violation for violating one or more sections: 300.610a), 300.1210a), 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 following sections of the Code with a high risk designation: 300.1210b) and 300.3240a) For a total fine of $2,200.00
 
FACILITY NAME: Waverly Place of Stockton
FACILITY ADDRESS: 501 Front Street
FACILITY CITY, STATE, ZIP: Stockton, IL 61085
DOCKET NUMBER: 15-C0355
LICENSEE INFO: Waverly Place of Stockton, LLC
LICENSEE ADDRESS: 2711 W Howard Street
LICENSEE CITY, STATE, ZIP: Chicago, IL 60645
Survey Date – 6/11/15
Type B violation for violating one or more sections: 300.610a), 300.1010H), 300.1210B)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 following sections of the Code with a high risk designation: 300.1210d)5), and 300.3240a). For a total fine of $2,200.00
 
FACILITY NAME: West Chicago Terrace Nursing Home
FACILITY ADDRESS: 928 Joliet Rd
FACILITY CITY, STATE, ZIP: West Chicago, IL 60185
DOCKET NUMBER: 15-S0375
LICENSEE INFO: WCT Care, LLC
LICENSEE ADDRESS: 1S443 Summitt Ave, Ste. 204
LICENSEE CITY, STATE, ZIP: Oakbrook Terrace, IL 60181
Survey Date – 7/30/15
Type C violation for violating one or more sections: 300.690b)c). No Fine.
 
FACILITY NAME: Westchester Health & Rehab Ctr
FACILITY ADDRESS: 2901 South Wolf Road
FACILITY CITY, STATE, ZIP: Westchester, IL 60154
DOCKET NUMBER: 15-C0283
LICENSEE INFO: SSC Westchester Operating Company, LLC
LICENSEE ADDRESS: 208 South LaSalle St, suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 6-3-15
Type B violation(s) of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.610a)< 300.1210b), 300.1210c), 300.1210d)6), 300.3240a). No Fine.
 
FACILITY NAME: Winchester House
FACILITY ADDRESS: 1125 North Milwaukee Avenue
FACILITY CITY, STATE, ZIP: Libertyville, IL 60048
DOCKET NUMBER: 15-C0323
LICENSEE INFO: County of Lake
LICENSEE ADDRESS: 18 North County Street
LICENSEE CITY, STATE, ZIP: Waukegan, IL 60085
Survey Date – 6-3-15
Type B violation(s) of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.1210b), 300.1210c), 300.1210d)6), 300.1220b)3), 300.3240a). No Fine.
 
FACILITY NAME: Woodbridge Nursing Pavilion
FACILITY ADDRESS: 2242 North Kedzie
FACILITY CITY, STATE, ZIP: Chicago, IL 60647
DOCKET NUMBER: 15-C0320
LICENSEE INFO: Woodbridge Nursing Pavilion, LTD
LICENSEE ADDRESS: 191 North Wacker Dr. ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 6-25-15
Type B violation(s) of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.1210a), 300.1210b), 300.1210c)3), 300.1210d)5). No fine.
 
FACILITY NAME: Watseka Rehab & Health Care Center
FACILITY ADDRESS: 715 East Raymond Road
FACILITY CITY, STATE, ZIP: Watseka, IL 60970
DOCKET NUMBER: NH 15-S0285
LICENSEE INFO: Peterson Health Care II, Inc.
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 5-26-2015
Type B violation(s) of the Act and the Skilled Nursing and Intermediate Care Facilities Code, 77 ILL Adm. Code 300: 300.1210b), 300.1210d)2), 300.1210d)6), 300.3240a). No Fine.