3rd Quarter Report July-September 2018

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 Naperville
FACILITY ADDRESS: 1525 South Oxford Lane
FACILITY CITY, STATE, ZIP: Naperville, IL 60565

DOCKET NUMBER: NH 18-S0368 & NH 18-C0369

LICENSEE INFO: Alden Estates of Naperville, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Avenue, Suite 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 07/20/2018

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

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

Total Fines $4,400.00.

FACILITY NAME: Alden Estates of Orland Park
FACILITY ADDRESS: 16450 South 97^th Avenue
FACILITY CITY, STATE, ZIP: Orland Park, IL 60462

DOCKET NUMBER: NH 18-C0295

LICENSEE INFO: Alden Orland Park Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Avenue, Suite 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 06/13/2018

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

FACILITY NAME: Alden Park Strathmoor
FACILITY ADDRESS: 5668 Strathmoor Drive
FACILITY CITY, STATE, ZIP: Rockford, IL 61107

DOCKET NUMBER: NH 18-C0353

LICENSEE INFO: Alden Park Strathmoor, Inc.
LICENSEE ADDRESS: 4200 West Peterson Avenue, Suite 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 06/02/2018

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)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: Alden Terrace of McHenry Rehab
FACILITY ADDRESS: 803 Royal Drive
FACILITY CITY, STATE, ZIP: McHenry, IL 60050

DOCKET NUMBER: NH 18-S0345

LICENSEE INFO: Alden Terrace of McHenry Rehabilitation & Health Care Center Inc
LICENSEE ADDRESS: 4200 West Peterson Avenue, Suite 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 07/30/2018

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

FACILITY NAME: Alden Valley Ridge Rehab & HCC
FACILITY ADDRESS: 275 East Army Trail Road
FACILITY CITY, STATE, ZIP: Bloomingdale, IL 60108

DOCKET NUMBER: NH 18-S0367

LICENSEE INFO: Alden Valley Ridge Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Avenue, Suite 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 07/20/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210d)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00.

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

Total fines $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 18-C0363

LICENSEE INFO: Zikainim, Inc.
LICENSEE ADDRESS: 191 North Wacker Drive, Suite 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 08/01/2018

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

FACILITY NAME: Ambassador Nsg & Rehab Center
FACILITY ADDRESS: 4900 North Bernard
FACILITY CITY, STATE, ZIP: Chicago, IL 60625

DOCKET NUMBER: NH 18-S0337

LICENSEE INFO: Ambassador Nursing and Rehabilitation II, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 07/26/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) 300.1210d)3) and 300.3240a). 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) and 300.3240a). A fine of $500.00.

FACILITY NAME: Aperion Care Capitol
FACILITY ADDRESS: 555 West Carpenter Road
FACILITY CITY, STATE, ZIP: Springfield, IL 62702

DOCKET NUMBER: NH 18-S0365

LICENSEE INFO: Aperion Care Capitol, LLC
LICENSEE ADDRESS: 2018 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 07/16/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Aperion Care Galesburg
FACILITY ADDRESS: 1145 Frank Street
FACILITY CITY, STATE, ZIP: Galesburg, IL 61401

DOCKET NUMBER: NH 18-C0314

LICENSEE INFO: River Crossing Rehab, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 06/14/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b) 300.1210d)5), 300.1220b)2) and 300.3240a). 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), 300.1210d)5) and 300.3240a). A fine of $500.00.

FACILITY NAME: Aperion Care Litchfield
FACILITY ADDRESS: 1024 East Tyler
FACILITY CITY, STATE, ZIP: Litchfield, IL 62056

DOCKET NUMBER: NH 18-S0344

LICENSEE INFO: Litchfield Care Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 08/03/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010e), 300.1210b)3), 300.1210d)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00.

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a) 300.1210b)2) and 300.3240a). 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) and 300.3240a). A fine of $500.00

Total Fines of $2,700.00

FACILITY NAME: Aperion Care Marseilles
FACILITY ADDRESS: 578 West Commercial Street
FACILITY CITY, STATE, ZIP: Marseilles, IL 61341

DOCKET NUMBER: NH 18-S0272

LICENSEE INFO: Aperion Care Marseilles, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/18/2018

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

DOCKET NUMBER: NH 18-C0378

LICENSEE INFO: Aperion Care Spring Valley, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street. Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 07-31-2018

FACILITY NAME: Aperion Care Wilmington
FACILITY ADDRESS: 555 West Kahler
FACILITY CITY, STATE, ZIP: Wilmington, IL 60481

DOCKET NUMBER: NH 18-C0305

LICENSEE INFO: Island City Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 06/22/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) 300.1210d)1)2)3)5), 300.1620a) and 300.3240a). 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), 300.1210d)5) and 300.3240a). A fine of $500.00.

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

DOCKET NUMBER: NH 18-C0332

LICENSEE INFO: Auburn Nursing and Rehabilitation Center. L.L.C.
LICENSEE ADDRESS: 412 East Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 07/12/2018

FACILITY NAME: Avantara Park Ridge
FACILITY ADDRESS: 1601 North Western Avenue
FACILITY CITY, STATE, ZIP: Park Ridge, IL 60068

DOCKET NUMBER: NH 18-S0284

LICENSEE INFO: Avantara Park Ridge, LLC
LICENSEE ADDRESS: 1601 North Western Avenue
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 05/25/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b) 300.1210d)6) and 300.3240a). 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), 300.1210d)6) and 300.3240a). A fine of $500.00.

FACILITY NAME: Avondale Estates of Elgin
FACILITY ADDRESS: 1754-1760 Capital Street
FACILITY CITY, STATE, ZIP: Elgin, IL 60124

DOCKET NUMBER: NH 18-S0321

LICENSEE INFO: Avondale Estates of Elgin, LLC
LICENSEE ADDRESS: 7366 N. Lincoln Avenue, Suite 206
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 06/21/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210a), 300.1210b)4), 300.1210d)3), 300.1220b)3) and 300.3240a). 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) and 300.3240a). A fine of $500.00.

FACILITY NAME: Beacon Hill
FACILITY ADDRESS: 2400 South Finley Road
FACILITY CITY, STATE, ZIP: Lombard, IL 60148

DOCKET NUMBER: NH 18-S0350

LICENSEE INFO: Lifespan Communities, Inc.
LICENSEE ADDRESS: 118 W. Edwards Street, Suite 200
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 08/09/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.3100d)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: 300.3100d)2). A fine of $500.00.

FACILITY NAME: Beecher Manor Nsg & Rehab
FACILITY ADDRESS: 1201 Dixie Highway
FACILITY CITY, STATE, ZIP: Beecher, IL 60401

DOCKET NUMBER: NH 18-S0270

LICENSEE INFO: Beecher Manor Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 West Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 05/17/2018

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

FACILITY NAME: Bement Health Care Center
FACILITY ADDRESS: 601 North Morgan
FACILITY CITY, STATE, ZIP: Bement, IL 61813

DOCKET NUMBER: NH 18-S0292

LICENSEE INFO: Petersen Health Quality, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/19/2018

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: Bloomington Rehabilitation & HCC
FACILITY ADDRESS: 1925 South Main Street
FACILITY CITY, STATE, ZIP: Bloomington, IL 61701

DOCKET NUMBER: NH 18-C0276

LICENSEE INFO: Petersen Health Operations, LLC
LICENSEE ADDRESS: 1925 South Main Street
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/20/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1230b)d)1)2)j)5)k)l)1)2)3)4)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: 300.1230). A fine of $500.00.

FACILITY NAME: Bloomington Rehabilitation & HCC
FACILITY ADDRESS: 1925 South Main Street
FACILITY CITY, STATE, ZIP: Bloomington, IL 61701

DOCKET NUMBER: NH 18-C0277

LICENSEE INFO: Petersen Health Operations, LLC
LICENSEE ADDRESS: 1925 South Main Street
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/20/2018

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

DOCKET NUMBER: NH 18-C0304

LICENSEE INFO: Atrium Health Care & Rehab Center of Cahokia, LLC
LICENSEE ADDRESS: 465 Central Avenue #100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
Survey Date – 06/20/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h) 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: Bria of Forest Edge
FACILITY ADDRESS: 8001 South Western Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60620

DOCKET NUMBER: NH 18-C0371

LICENSEE INFO: Forest Edge Healthcare & Rehabilitation Center, LLC
LICENSEE ADDRESS: 5151 Church Street
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 07/24/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)3), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.690a. 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: 300.690a). A fine of $500.00

Total Fines of $4,900.00.

FACILITY NAME: Bria of River Oaks
FACILITY ADDRESS: 14500 South Manistee
FACILITY CITY, STATE, ZIP: Burnham. IL 60633

DOCKET NUMBER: NH 18-S0343

LICENSEE INFO: River Oaks Healthcare & Rehabilitation Center, LLC
LICENSEE ADDRESS: 5151 Church Street
LICENSEE CITY, STATE, ZIP: Skokie, IL 60044
Survey Date – 07/13/2018

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

DOCKET NUMBER: NH 18-C0253

LICENSEE INFO: Briar Place Nursing, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/15/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210c), 300.1210d)6), 300.1810c)5)D), 300.1810e), 300.1810f) 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: British Home, The
FACILITY ADDRESS: 8700 West 31^st Street
FACILITY CITY, STATE, ZIP: Brookfield, IL 60513

DOCKET NUMBER: NH 18-C0341

LICENSEE INFO: The British Home for Retired Men and Women
LICENSEE ADDRESS: 31^st Street & McCormick Avenue
LICENSEE CITY, STATE, ZIP: Brookfield, IL 60513
Survey Date – 07/10/2018

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

DOCKET NUMBER: NH 18-C0362

LICENSEE INFO: Caseyville Nursing & Rehabilitation Center, Inc.
LICENSEE ADDRESS: 7434 N. Skokie Blvd
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 07/18/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)3), 300.1210d)5), 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)5) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Champaign County Nursing Home
FACILITY ADDRESS: 500 South Art Bartell Drive
FACILITY CITY, STATE, ZIP: Urbana, IL 61802

DOCKET NUMBER: NH 18-C0339

LICENSEE INFO: Champaign County Board
LICENSEE ADDRESS: 1776 East Washington Street
LICENSEE CITY, STATE, ZIP: Urbana, IL 61802
Survey Date – 07/25/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1230b), 300.1230d)1)2), 300.1230j)5), 300.1230k) and 300.1230l)1)2)3)4). 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: 300.1230). A fine of $500.00.

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

DOCKET NUMBER: NH 18-C0315

LICENSEE INFO: Champaign Urbana Nursing and Rehab, LP
LICENSEE ADDRESS: 5750 Old Orchard Road, Suite 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 06/22/2018

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.690b)c), 300.1210a), 300.1210b), 300.1210d)6), 300.2040b) 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: City View Muticare Center
FACILITY ADDRESS: 5825 West Cermak Road
FACILITY CITY, STATE, ZIP: Cicero, IL 60804

DOCKET NUMBER: NH 18-C0335

LICENSEE INFO: City View Multicare Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 07/13/2018

FACILITY NAME: Community Care Center
FACILITY ADDRESS: 4314 South Wabash Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60653

DOCKET NUMBER: NH 18-C0280

LICENSEE INFO: CC Care, LLC
LICENSEE ADDRESS: 1S443 Summit Avenue, Suite 204
LICENSEE CITY, STATE, ZIP: Oakbrook Terrace, IL 60181
Survey Date – 05/23/2018

Type B 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 $2,200.00.

FACILITY NAME: Covenant Health Care Center Northbrook
FACILITY ADDRESS: 2155 Pfingsten Road
FACILITY CITY, STATE, ZIP: Northbrook, IL 60062

DOCKET NUMBER: NH 18-S0320

LICENSEE INFO: Covenant Health Care Center, Inc.
LICENSEE ADDRESS: 2155 Pfingsten Road
LICENSEE CITY, STATE, ZIP: Northbrook, IL 60062
Survey Date – 06/27/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210c)3) and 300.3240a). 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) and 300.3240a). A fine of $500.00.

FACILITY NAME: Edwardsville Nrsg & Rehab Ctr
FACILITY ADDRESS: 401 St. Mary Drive
FACILITY CITY, STATE, ZIP: Edwardsville, IL 62025

DOCKET NUMBER: NH 18-S0258

LICENSEE INFO: Edwardsville Care Center, LLC
LICENSEE ADDRESS: 111 North Ottawa Street
LICENSEE CITY, STATE, ZIP: Joliet, IL 60432
Survey Date – 05/04/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b)5), 300.1210c), 300.1210d)3), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Edwardsville Nursing and Rehab
FACILITY ADDRESS: 401 St. Mary Drive
FACILITY CITY, STATE, ZIP: Edwardsville, IL 62025

DOCKET NUMBER: NH 18-C0309

LICENSEE INFO: Edwardsville Care Center, LLC
LICENSEE ADDRESS: 111 N. Ottawa Street
LICENSEE CITY, STATE, ZIP: Joliet, IL 60432
Survey Date – 07/03/2018

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)4)5), 300.1210d)3)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Elmwood Nursing & Rehab Center
FACILITY ADDRESS: 152 Wilma Drive
FACILITY CITY, STATE, ZIP: Maryville, IL 62062

DOCKET NUMBER: NH 18-C0279

LICENSEE INFO: Elmwood Nursing & Rehabilitation Center, LLC
LICENSEE ADDRESS: 2202 Main Street, Suite 180
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 05/23/2018

FACILITY NAME: Fair Havens Christian Village
FACILITY ADDRESS: 1790 South Fairview Avenue
FACILITY CITY, STATE, ZIP: Decatur, IL 62521

DOCKET NUMBER: NH 18-S0346

LICENSEE INFO: Fair Havens Christian Homes, Inc.
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 08/09/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 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: Gilman Healthcare Center
FACILITY ADDRESS: 1390 South Crescent Street
FACILITY CITY, STATE, ZIP: Gilman, IL 60938

DOCKET NUMBER: NH 18-C0259

LICENSEE INFO: Gilman Healthcare Center, LLC
LICENSEE ADDRESS: 4711 Golf Road, Suite 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 05/21/2018

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). 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.

FACILITY NAME: Gilman Healthcare Center
FACILITY ADDRESS: 1390 South Crescent Street
FACILITY CITY, STATE, ZIP: Gilman, IL 60938

DOCKET NUMBER: NH 18-C0260

LICENSEE INFO: Gilman Healthcare Center, LLC
LICENSEE ADDRESS: 4711 Golf Road, Suite 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 06/06/2018

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

FACILITY NAME: Good Samaritan Prophets Riverview
FACILITY ADDRESS: 310 Mosher Drive
FACILITY CITY, STATE, ZIP: Prophetstown, IL 61277

DOCKET NUMBER: NH 18-S0349

LICENSEE INFO: Good Samaritan Society Prophets Riverview
LICENSEE ADDRESS: 208 South LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 07/13/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.690a) and 300.690b). 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. A fine of $500.00.

FACILITY NAME: Grove at the Lake, The
FACILITY ADDRESS: 2534 Elim Avenue
FACILITY CITY, STATE, ZIP: Zion, IL 60099

DOCKET NUMBER: NH 18-C0274

LICENSEE INFO: Grove at the Lake Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/06/2018

FACILITY NAME: Grove at the Lake, The
FACILITY ADDRESS: 2534 Elim Avenue
FACILITY CITY, STATE, ZIP: Zion, IL 60099

DOCKET NUMBER: NH 18-S0358

LICENSEE INFO: Grove at the Lake Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 07/17/2018

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210c), 300.1210d)6), 300.1220b)2) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00.

FACILITY NAME: Grove of Skokie, The
FACILITY ADDRESS: 90000 Lavergne Avenue
FACILITY CITY, STATE, ZIP: Skokie, IL 60077

DOCKET NUMBER: NH 18-S0252

LICENSEE INFO: Skokie Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 05/03/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b)3), 300.1220b)2)3), 300.1620a), 300.1620b), 300.1620c) 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: Havana Health Care Center
FACILITY ADDRESS: 609 North Harpham Street
FACILITY CITY, STATE, ZIP: Havana, IL 62644

DOCKET NUMBER: NH 18-C0359

LICENSEE INFO: Petersen Health Quality, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 07/13/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.3210a), 300.3210o), 300.3240a), 300.3300d), 300.3300f), 300.3300j), 300.3300k), 300.3300l), 300.3300m) and 300.3300n). 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: Heartland of Canton
FACILITY ADDRESS: 2081 N. Main Street
FACILITY CITY, STATE, ZIP: Canton, IL 61520

DOCKET NUMBER: NH 18-S0257

LICENSEE INFO: Heartland of Canton II, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/24/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00.

Total Fines of $4,400.00.

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

DOCKET NUMBER: NH 18-S0256

LICENSEE INFO: Heartland of Normal LL, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/30/2018

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) 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: Heritage Health Mt Sterling
FACILITY ADDRESS: 435 Camden Road
FACILITY CITY, STATE, ZIP: Mt. Sterling, IL 62353

DOCKET NUMBER: NH 18-C0364

LICENSEE INFO: Heritage Manor Mt Sterling, LLC
LICENSEE ADDRESS: 115 W. Jefferson Street, Suite 400
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 07/12/2018

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). 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: Hillcrest Retirement Village
FACILITY ADDRESS: 1740 North Circuit Drive
FACILITY CITY, STATE, ZIP: Round Lake Beach, IL 60073

DOCKET NUMBER: NH 18-C0322

LICENSEE INFO: Hillcrest Retirement Village, LTD
LICENSEE ADDRESS: 30 S. Wacker Drive, Suite 2600
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 06/27/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a),300.1210a), 300.1210b) 300.1210d)6) and 300.3240a). 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), 300.1210d)6) and 300.3240a). A fine of $500.00.

FACILITY NAME: Illini Heritage Rehab & HC
FACILITY ADDRESS: 1315 Curt Drive, P.O. Box 6179
FACILITY CITY, STATE, ZIP: Champaign, IL 61820

DOCKET NUMBER: NH 18-C0351

LICENSEE INFO: Petersen Health Care Illini, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 07/27/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Illini Restorative Care
FACILITY ADDRESS: 1455 Hospital Road
FACILITY CITY, STATE, ZIP: Silvis, IL 61282

DOCKET NUMBER: NH 18-C0306

LICENSEE INFO: Genesis Health System
LICENSEE ADDRESS: 801 Illini Drive
LICENSEE CITY, STATE, ZIP: Silvis, IL 61282
Survey Date – 06/06/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210d)6) 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: Imboden Creek Living Center
FACILITY ADDRESS: 180 West Imboden
FACILITY CITY, STATE, ZIP: Decatur, IL 62521

DOCKET NUMBER: NH 18-S0347

LICENSEE INFO: Living Centers, Inc.
LICENSEE ADDRESS: 20 South Side Country Club
LICENSEE CITY, STATE, ZIP: Decatur, IL 62521
Survey Date – 07/19/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210d)6), 300.1220b)7) and 300.3240a)b). 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: Integrity HC of Marion
FACILITY ADDRESS: 1301 East DeYoung
FACILITY CITY, STATE, ZIP: Marion, IL 62959

DOCKET NUMBER: NH 18-C0352

LICENSEE INFO: Marion Rehabilitation and Nursing Center, LLC
LICENSEE ADDRESS: 2015 W. Main Street, Suite 111
LICENSEE CITY, STATE, ZIP: Carbondale, IL 62901
Survey Date – 07/17/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210a), 300.1210b), 300.1210d)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: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Jerseyville Nsg & Rehab Center
FACILITY ADDRESS: 1001 South State Street
FACILITY CITY, STATE, ZIP: Jerseyville, IL 62052

DOCKET NUMBER: NH 18-C0255

LICENSEE INFO: Helia Healthcare of Jerseyville, LLC
LICENSEE ADDRESS: 118 W. Edwards Street, Suite 200
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 06/01/2018

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: Lakeview Rehab & Nursing Center
FACILITY ADDRESS: 735 West Diversey
FACILITY CITY, STATE, ZIP: Chicago, IL 60614

DOCKET NUMBER: NH 18-C0283

LICENSEE INFO: Lakeview Rehabilitation and Nursing Center, LLC
LICENSEE ADDRESS: 735 West Diversey
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 05/24/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a),300.690b), 300.690c), 300.1210b) 300.1210d)6) and 300.3240A). 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), 300.1210d)6) and 300.3240a). A fine of $500.00.

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

DOCKET NUMBER: NH 18-S0331

LICENSEE INFO: Lewis Memorial Christian Village
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 06/28/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c), 300.1210d)6), 300.1220b)2) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Lexington of Lake Zurich
FACILITY ADDRESS: 900 South Rand Road
FACILITY CITY, STATE, ZIP: Lake Zurich, IL 60047

DOCKET NUMBER: NH 18- S0356

LICENSEE INFO: Lexington Health Care Center of Lake Zurich, Inc.
LICENSEE ADDRESS: 665 West North Avenue
LICENSEE CITY, STATE, ZIP: Lombard, IL 60148
Survey Date – 08/02/2018

FACILITY NAME: Lutheran Home, The
FACILITY ADDRESS: 6901 North Galena Road
FACILITY CITY, STATE, ZIP: Peoria, IL 61614

DOCKET NUMBER: NH 18-C0290

LICENSEE INFO: Lutheran Hillside Village, Inc.
LICENSEE ADDRESS: 6901 North Galena Road
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/15/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) 300.1210d)5) and 300.3240a). 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), 300.1210d)5) and 300.3240a). A fine of $500.00.

FACILITY NAME: Manor Court of Clinton
FACILITY ADDRESS: 1 Park Lane West
FACILITY CITY, STATE, ZIP: Clinton, IL 61727

DOCKET NUMBER: NH 18-S0377

LICENSEE INFO: Residential Alternatives of Illinois, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 08/01/2018

FACILITY NAME: Manor Court of Maryville
FACILITY ADDRESS: 6955 State Route 162
FACILITY CITY, STATE, ZIP: Maryville, IL 62062

DOCKET NUMBER: NH 18-S0376

LICENSEE INFO: UDI #2, LLC
LICENSEE ADDRESS: 285 S. Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 07/30/2018

FACILITY NAME: Manorcare of Palos Heights East
FACILITY ADDRESS: 7820 W. College Drive
FACILITY CITY, STATE, ZIP: Palos Heights, IL 60463

DOCKET NUMBER: NH 18-C0375

LICENSEE INFO: Manor Care of Palos Heights IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 07/25/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210c)3), 300.3220f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Maple Crossing at Amboy
FACILITY ADDRESS: 15 West Wasson Road
FACILITY CITY, STATE, ZIP: Amboy, IL 61310

DOCKET NUMBER: NH 18-S0303

LICENSEE INFO: Maple Crossing at Amboy, LLC
LICENSEE ADDRESS: 7434 Skokie Blvd
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 07/05/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) 300.1210d)6), 300.1220b)3), 300.3240a) and 300.3240f). 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), 300.1210d)6) and 300.3240a). A fine of $500.00.

FACILITY NAME: Marigold Estates
FACILITY ADDRESS: 3240 Barney Avenue
FACILITY CITY, STATE, ZIP: Pekin, IL 61554

DOCKET NUMBER: NH 18-S0327

LICENSEE INFO: Patterson House, Inc.
LICENSEE ADDRESS: 110 Southbrooke
LICENSEE CITY, STATE, ZIP: Decatur, IL 62521
Survey Date – 07/17/2018

Type B violation for violating one or more of the following sections of the Code: 350.620a), 350.1060e), 350.3240a) and 350.3240f). A fine of $550.00.

FACILITY NAME: Mercy Rehab and Care Center
FACILITY ADDRESS: 100 Rosewood Village Drive
FACILITY CITY, STATE, ZIP: Swansea, IL 62226

DOCKET NUMBER: NH 18-S0354

LICENSEE INFO: Mercy Rehab and Care Center, Inc.
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 07/12/2018

FACILITY NAME: Park Point Healthcare & Rehab
FACILITY ADDRESS: 1223 Edgewater Drive
FACILITY CITY, STATE, ZIP: Morris, IL 60450

DOCKET NUMBER: NH 18-C0254

LICENSEE INFO: Park Pointe Healthcare & Rehabilitation Center, LLC
LICENSEE ADDRESS: 1001 Warrenville Road, Suite 500
LICENSEE CITY, STATE, ZIP: Lisle, IL 60532
Survey Date – 06/15/2018

FACILITY NAME: Parkway Manor
FACILITY ADDRESS: 3116 Williamson County Pkwy
FACILITY CITY, STATE, ZIP: Marion, IL 62959

DOCKET NUMBER: NH 18- C0291

LICENSEE INFO: UDI #1, LLC
LICENSEE ADDRESS: 3116 Williamson County Pkwy
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 06/06/2018

FACILITY NAME: Prairie City Rehab & HC
FACILITY ADDRESS: 825 E. Main Street, R.R. #2, Box 97
FACILITY CITY, STATE, ZIP: Prairie City, IL 61470

DOCKET NUMBER: NH 18- C0268

LICENSEE INFO: Midwest Health Operations, LLC
LICENSEE ADDRESS: 830 W.Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 05/12/2018

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: Presence Cor Mariae Center
FACILITY ADDRESS: 3330 Maria Linden Drive
FACILITY CITY, STATE, ZIP: Rockford, IL 61114

DOCKET NUMBER: NH 18-C0271

LICENSEE INFO: Presence Life Connections
LICENSEE ADDRESS: 18927 Hickory Creek Drive, Suite 300
LICENSEE CITY, STATE, ZIP: Mokena, IL 60448
Survey Date – 06/06/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 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: Presence Cor Mariae Center
FACILITY ADDRESS: 3330 Maria Linden Drive
FACILITY CITY, STATE, ZIP: Rockford, IL 61114

DOCKET NUMBER: NH 18-C0294

LICENSEE INFO: Presence Life Connections
LICENSEE ADDRESS: 18927 Hickory Creek Drive, Suite 300
LICENSEE CITY, STATE, ZIP: Mokena, IL 60448
Survey Date – 06/25/2018

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

FACILITY NAME: Presence Heritage Village
FACILITY ADDRESS: 901 North Entrance Avenue
FACILITY CITY, STATE, ZIP: Kankakee, IL 60901

DOCKET NUMBER: NH 18-S0318

LICENSEE INFO: Presence Life Connections
LICENSEE ADDRESS: 18927 Hickory Creek Drive, Suite 300
LICENSEE CITY, STATE, ZIP: Mokena, IL 60448
Survey Date – 06/28/2018

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

FACILITY NAME: Presence Villa Franciscan
FACILITY ADDRESS: 210 North Springfield Avenue
FACILITY CITY, STATE, ZIP: Joliet, IL 60435

DOCKET NUMBER: NH 18-C0275

LICENSEE INFO: Presence Life Connections
LICENSEE ADDRESS: 18927 Hickory Creek Drive, Suite 300
LICENSEE CITY, STATE, ZIP: Mokena, IL 60448
Survey Date – 06/01/2018

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)3), 300.1210d)4), 300.1210d)5)A) 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: River North of Bradley H & R
FACILITY ADDRESS: 650 North Kinzie
FACILITY CITY, STATE, ZIP: Bradley, IL 60915

DOCKET NUMBER: NH 18-C0250

LICENSEE INFO: River North of Bradley Health and Rehabilitation Center, LLC
LICENSEE ADDRESS: 191 N. Wacker Drive, Suite 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 05/25/2018

FACILITY NAME: River North of Bradley H & R
FACILITY ADDRESS: 650 North Kinzie
FACILITY CITY, STATE, ZIP: Bradley, IL 60915

DOCKET NUMBER: NH 18-C0302

LICENSEE INFO: River North of Bradley Health and Rehabilitation Center, LLC
LICENSEE ADDRESS: 191 N. Wacker Drive, Suite 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 06/15/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)5), 300.3220f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: River North Bradley H & R
FACILITY ADDRESS: 650 North Kinzie
FACILITY CITY, STATE, ZIP: Bradley, IL 60915

DOCKET NUMBER: NH 18-C0380

LICENSEE INFO: River North of Bradley Health and Rehabilitation Center, LLC
LICENSEE ADDRESS: 191 N. Wacker Drive, Suite 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 07/27/2018

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

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210c2)3), 300.1210d)5), 300.3220f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00.

Total Fines $27,200.00

FACILITY NAME: Rochelle Gardens Care Center
FACILITY ADDRESS: 1021 Caron Road
FACILITY CITY, STATE, ZIP: Rochelle, IL 61068

DOCKET NUMBER: NH 18-S0298

LICENSEE INFO: Petersen Health Network, LLC.
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/12/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.690), 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: Rosewood Care Center Iverness
FACILITY ADDRESS: 1800 Colonial Parkway
FACILITY CITY, STATE, ZIP: Iverness, IL 60067

DOCKET NUMBER: NH 18-C0329

LICENSEE INFO: Bravo Care of Iverness, Inc.
LICENSEE ADDRESS: 412 East Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/28/2018

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

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) 300.1210c), 300.1210d)6) and 300.3240a). 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), 300.1210d)6) and 300.3240a). A fine of $500.00.

Total Fines $2,700.00

FACILITY NAME: Salem Village Nursing & Rehab
FACILITY ADDRESS: 1314 Rowell Avenue
FACILITY CITY, STATE, ZIP: Joliet, IL 60433

DOCKET NUMBER: NH 18-C0311

LICENSEE INFO: Salem Village Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 111 N. Ottawa Street
LICENSEE CITY, STATE, ZIP: Joliet, IL 60432
Survey Date – 07/09/2018

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)2)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Sherman West Court
FACILITY ADDRESS: 1950 Larkin Avenue
FACILITY CITY, STATE, ZIP: Elgin, IL 60123

DOCKET NUMBER: NH 18-S0333

LICENSEE INFO: Sherman West Court
LICENSEE ADDRESS: 3075 Highland Parkway, Suite 600
LICENSEE CITY, STATE, ZIP: Downers Grove, IL 60515
Survey Date – 07/03/2018

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)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 C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)5), 300.1210c), 300.1210d)6), 300.3240a) and 300.3240d)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: , 300.1210b), 300.1210d)6), 300.3240a) and 300.3240d). A fine of $500.00.

Total Fines $2,700.00

FACILITY NAME: South Lawn Sheltered Care
FACILITY ADDRESS: 512 South Franklin
FACILITY CITY, STATE, ZIP: Bunker Hill, IL 62014

DOCKET NUMBER: NH 18-S0288

LICENSEE INFO: South Lawn Sheltered Care, Inc.
LICENSEE ADDRESS: R.R. 1 Route 159, P.O. Box H
LICENSEE CITY, STATE, ZIP: Bunker Hill, IL 62014
Survey Date – 05/31/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 330.4240a)b)c)d)e). 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)d)e). A fine of $500.00.

FACILITY NAME: South Suburban Rehab Center
FACILITY ADDRESS: 19000 South Halsted Street
FACILITY CITY, STATE, ZIP: Homewood, IL 60430

DOCKET NUMBER: NH 18-C0312

LICENSEE INFO: South Suburban Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 West Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 06/22/2018

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210c), 300.1210d)6) 300.1220b)3) and 300.3240a). 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), 300.1210d)6) and 300.3240a). A fine of $500.00.

FACILITY NAME: Symphony Evanston Healthcare
FACILITY ADDRESS: 820 Foster Street
FACILITY CITY, STATE, ZIP: Evanston, IL 60201

DOCKET NUMBER: NH 18-C0307

LICENSEE INFO: Symphony of Evanston Healthcare, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/15/2018

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) 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 C 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). 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), 300.1210d)6) and 300.3240a). A fine of $500.00

Total Fines $2,700.00.

FACILITY NAME: Taylorville Care Center
FACILITY ADDRESS: 600 South Houston
FACILITY CITY, STATE, ZIP: Taylorville, IL 62568

DOCKET NUMBER: NH 18-S0313

LICENSEE INFO: Taylorville Care Center, Inc.
LICENSEE ADDRESS: 1670 Essex Way, Suite B
LICENSEE CITY, STATE, ZIP: O’Fallon, IL 62269
Survey Date – 06/22/2018

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

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)2), 300.1210c), 300.1220b)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00.

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)6), 300.1220b)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00

Total Fines $6,600.00.

FACILITY NAME: Timber Point Healthcare
FACILITY ADDRESS: 205 East Spring Street
FACILITY CITY, STATE, ZIP: Camp Point, IL 62320

DOCKET NUMBER: NH 18-S0281

LICENSEE INFO: Timber Point Healthcare Center, Inc.
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 06/07/2018

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

FACILITY NAME: Victorian Village Hlth & Wellness
FACILITY ADDRESS: 12525 W. Renaissance Circle
FACILITY CITY, STATE, ZIP: Homer Glen, IL 60491

DOCKET NUMBER: NH 18-C0357

LICENSEE INFO: Rest Haven Illiana Christian Convalescent Home
LICENSEE ADDRESS: 18601 N. Creek Drive
LICENSEE CITY, STATE, ZIP: Tinley Park, IL 60477
Survey Date – 07/11/2018

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

3rd Quarter Report July-September 2018

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3rd Quarter Report July-September 2018

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