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2021 3rd Quarterly Report

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

FACILITY NAME: Adloff Place
FACILITY ADDRESS: 50 Adloff Lane
FACILITY CITY, STATE, ZIP: Springfield, IL 62703

DOCKET NUMBER: NH 21-C0404

LICENSEE INFO: Home and Environments for Living and Programs, Inc.
LICENSEE ADDRESS: 208 South LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/13/2021

Type B violation for violating one or more of the following sections of the Code: 350.620a), 350.1210b), 3501230d)1), and 350.3240a). A fine of $550.00

FACILITY NAME: Adloff Place
FACILITY ADDRESS: 50 Adloff Lane
FACILITY CITY, STATE, ZIP: Springfield, IL 62703

DOCKET NUMBER: NH 21-C0605

LICENSEE INFO: Home and Environments for Living and Programs, Inc.
LICENSEE ADDRESS: 208 South La Salle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 06/29/2021

Type B violation for violating one or more of the following sections of the Code: 350.620a), 350.1230d)2), and 350.31230d)3). A fine of $550.00

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

DOCKET NUMBER: NH 21-C0379

LICENSEE INFO: Alden Alma Nelson Manor, Inc.
LICENSEE ADDRESS: 4200 West Peterson Ave, #140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 05/10/2021

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

FACILITY NAME: Alden Des Plaines Rehab & HC
FACILITY ADDRESS: 1221 East Golf Road
FACILITY CITY, STATE, ZIP: Des Plaines, IL 60016

DOCKET NUMBER: NH 21-S0490

LICENSEE INFO: Alden Des Plaines Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 West Peterson Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 06/10/2021

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

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.690b) and 300.690c). 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

Total Fine: $2,700.00

FACILITY NAME: Alden Des Plaines Rehab & HC
FACILITY ADDRESS: 1221 East Golf Road
FACILITY CITY, STATE, ZIP: Des Plaines, IL 60016

DOCKET NUMBER: NH 21-C0494

LICENSEE INFO: Alden Des Plaines Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 West Peterson Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 06/03/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.3240a), and 300.3240b). The fine was doubled in this instance in accordance 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: Alden Lakeland Rehab & HCC
FACILITY ADDRESS: 820 West Lawrence
FACILITY CITY, STATE, ZIP: Chicago, IL 60640

DOCKET NUMBER: NH 21-S0520

LICENSEE INFO: Alden-Lakeland Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Avenue, #140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 07/09/2021

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a. No Fine

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

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b). A fine of $500.00

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1610a)1). No Fine

Total Fine: $1,000.00

FACILITY NAME: Alden Long Grove Rehab & HCC
FACILITY ADDRESS: Box 2308 RFD Old Hicks Road
FACILITY CITY, STATE, ZIP: Long Grove, IL 60047

DOCKET NUMBER: NH 21-S0449

LICENSEE INFO: Alden-Long Grove Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Ave, Suite 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 05/19/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), and 300.1210b). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.696 and 300.1210b). A fine of $2,200.00

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

DOCKET NUMBER: NH 21-C0380

LICENSEE INFO: Alden-Valley Ridge Rehabilitation and Health Care Center, Inc
LICENSEE ADDRESS: 4200 W. Peterson Ave, Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 04/25/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)5), 300.1210d)6), and 300.3240a). 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: Allure of Moline
FACILITY ADDRESS: 430 South 30^th Avenue
FACILITY CITY, STATE, ZIP: East Moline, IL 61244

DOCKET NUMBER: NH 21-S0373

LICENSEE INFO: Allure of Moline, LLC
LICENSEE ADDRESS: 2711 W. Howard Street
LICENSEE CITY, STATE, ZIP: Chicago, IL 60645
Survey Date – 04/23/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.650a), 300.650e), 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 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: Alpine Fireside Health Care
FACILITY ADDRESS: 3650 North Alpine Road
FACILITY CITY, STATE, ZIP: Rockford, IL 61114

DOCKET NUMBER: NH 21-S0311

LICENSEE INFO: Alpine Fireside Health Center, LTD
LICENSEE ADDRESS: 3650 N. Alpine Road
LICENSEE CITY, STATE, ZIP: Rockford, IL 61114
Survey Date – 04/09/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.790a). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.790). A fine of $2,200.00

FACILITY NAME: Aperion Care Forest Park
FACILITY ADDRESS: 8200 West Roosevelt Road
FACILITY CITY, STATE, ZIP: Forest Park, IL 60130

DOCKET NUMBER: NH 21-C0293

LICENSEE INFO: Berkshire Nursing & Rehab Center, LLC
LICENSEE ADDRESS: 208 So. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/02/2021

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

FACILITY NAME: Aperion Care Forest Park
FACILITY ADDRESS: 8200 West Roosevelt Road
FACILITY CITY, STATE, ZIP: Forest Park, IL 60130

DOCKET NUMBER: NH 21-S0439

LICENSEE INFO: Berkshire Nursing & Rehab Center, LLC
LICENSEE ADDRESS: 208 So LaSalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/27/2021

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

FACILITY NAME: Aperion Care Jacksonville
FACILITY ADDRESS: 1021 North Church Street
FACILITY CITY, STATE, ZIP: Jacksonville, IL 62650

DOCKET NUMBER: NH 21-C0534

LICENSEE INFO: North Church Nursing & Rehab, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street. Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 07/02/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)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: Aperion Care Lakeshore
FACILITY ADDRESS: 7200 North Sheridan Road
FACILITY CITY, STATE, ZIP: Chicago, IL 60626

DOCKET NUMBER: NH 21-C0524

LICENSEE INFO: Lake Shore Healthcare & Rehabilitation Centre, LLC
LICENSEE ADDRESS: 4600 W. Touhy Avenue #200
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 06/08/2021

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

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.690a), 300.690b), and 300.690c). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.690. A fine of $2,200.00

Total Fine: $27,200.00

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

DOCKET NUMBER: NH 21-S0489

LICENSEE INFO: Aperion Care Marseilles, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 06/11/2021

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)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $25,000.00

FACILITY NAME: Aperion Care Mascoutah
FACILITY ADDRESS: 901 North Tenth Street
FACILITY CITY, STATE, ZIP: Mascoutah, IL 62258

DOCKET NUMBER: NH 21-C0361

LICENSEE INFO: Aperion Care Mascoutah, LLC
LICENSEE ADDRESS: 208 S. LaSalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/30/2021

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.625a),300.625b), 300.625c)1)2), 300.625d), 300.625e), 300.625f), 300.6251)2)3)A)B)4), 300.625g), 300.625h), 300.625i), 300.625j), 300.625l), 300.625m), 300.625n), 300.625o), 300.625p), and 300.625q). 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: 300.625a),300.625b), 300.625c), 300.624f), 300.625j), 300.625l), 300.625n), and 300.625o). A fine of $500.00

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

DOCKET NUMBER: NH 21-C0354

LICENSEE INFO: Concord Nursing & Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/21/2021

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

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

DOCKET NUMBER: NH 21-C0445

LICENSEE INFO: Plum Grove Nursing & Rehab, LLC
LICENSEE ADDRESS: 208 So. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/27/2021

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

FACILITY NAME: Aperion Care West Chicago
FACILITY ADDRESS: 201 West North Avenue
FACILITY CITY, STATE, ZIP: West Chicago, IL 60185

DOCKET NUMBER: NH 21-S0327

LICENSEE INFO: Aperion Care West Chicago, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/16/2021

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

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

DOCKET NUMBER: NH 21-C0277

LICENSEE INFO: Island City Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 So. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/02/2021

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

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

DOCKET NUMBER: NH 21-S0278

LICENSEE INFO: Island City Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 So. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/20/2021

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

FACILITY NAME: Asbury Court Nursing & Rehab
FACILITY ADDRESS: 1750 Elmhurst Road
FACILITY CITY, STATE, ZIP: Des Plaines, IL 60018

DOCKET NUMBER: NH 21-S0367

LICENSEE INFO: Asbury Court Nursing & Rehabilitation, LLC
LICENSEE ADDRESS: 7040 N. Ridgeway
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 04/22/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a)b), 300.1210d)3), 300.1830a), and 300.3210f)g). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b). A fine of $2,200.00

FACILITY NAME: Ascension Casa Scalabrini
FACILITY ADDRESS: 480 North Wolf Road
FACILITY CITY, STATE, ZIP: Northlake, IL 60164

DOCKET NUMBER: NH 21-C0458

LICENSEE INFO: Presence Senior Services-Chicagoland
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/01/2021

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: Ascension Resurrection Place
FACILITY ADDRESS: 1001 North Greenwood Avenue
FACILITY CITY, STATE, ZIP: Park Ridge, IL 60068

DOCKET NUMBER: NH 21-C0387

LICENSEE INFO: Presence Senior Services-Chicagoland
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 05/04/2021

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

FACILITY NAME: Avantara Evergreen Park
FACILITY ADDRESS: 10124 South Kedzie
FACILITY CITY, STATE, ZIP: Evergreen Park, IL 60805

DOCKET NUMBER: NH 21-C0455

LICENSEE INFO: Evergreen Living & Rehab Center, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 05/27/2021

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

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), 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

Total Fine: $4,400.00

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

DOCKET NUMBER: NH 21-S0355

LICENSEE INFO: Lifespace Communities, Inc.
LICENSEE ADDRESS: 118 W. Edwards St., Ste 200
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 05/08/2021

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

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

DOCKET NUMBER: NH 21-C0527

LICENSEE INFO: Beecher Manor Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 West Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 06/10/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1035a)1), and 300.1035a)2). A fine of $12,500.00

FACILITY NAME: Belhaven Nursing & Rehab Ctr
FACILITY ADDRESS: 11401 South Oakley Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60643

DOCKET NUMBER: NH 21-C0421

LICENSEE INFO: Belhaven Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 05/04/2021

Type AA violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1035a)4), 300.1035a)5), 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 $25,000.00

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), 300.1210d)6), 300.1220b)3), and 300.3240f). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

Total Fine: $27,200.00

FACILITY NAME: Belhaven Nursing & Rehab Ctr
FACILITY ADDRESS: 11401 South Oakley Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60643

DOCKET NUMBER: NH 21-C0583 & NH 21-S0584

LICENSEE INFO: Belhaven Nursing & Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 07/09/2021

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

FACILITY NAME: Berkeley Nrsg & Rehab Center
FACILITY ADDRESS: 6909 West North Avenue
FACILITY CITY, STATE, ZIP: Oak Park, IL 60302

DOCKET NUMBER: NH 21-C0320

LICENSEE INFO: Berkeley Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 321 N. Clark Street, Suite 2800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60654
Survey Date – 04/28/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1610a), 300.1630a)2), and 300.1630e). A fine of $1,100.00

FACILITY NAME: Bethesda Rehab & Senior Care
FACILITY ADDRESS: 2833 North Nordica Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60634

DOCKET NUMBER: NH 21-C0466

LICENSEE INFO: Norwegian Lutheran Bethesda Home Association
LICENSEE ADDRESS: 6016 North Nina Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60631
Survey Date – 05/20/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1220b)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Beverly Farm Foundation
FACILITY ADDRESS: 6301 Humbert Road
FACILITY CITY, STATE, ZIP: Godfrey, IL 62035

DOCKET NUMBER: NH 21-C0417 & NH 21-S0418

LICENSEE INFO: Beverly Farm Foundation
LICENSEE ADDRESS: 190 South LaSalle St, Ste 3700
LICENSEE CITY, STATE, ZIP: Chicago, IL 60603
Survey Date – 04/22/2021

Type B violation for violating one or more of the following sections of the Code: 350.620a), 350.700a), 350.1210b) and 350.3240a). A fine of $1,100.00

Type B violation for violating one or more of the following sections of the Code: 350.1082a)3), 350.1082a)4), 350.1210b), 350.1230b)3), and 350.1230b)7). A fine of $1,100.00

Type B violation for violating one or more of the following sections of the Code: 350.1040b)1), 350.1210a), 350.1210b), 350.1420a), 350.1450a), 350.3220f), and 350.3220h)2). A fine of $1,100.00

Total Fine: $3,300.00

FACILITY NAME: Beverly Farm Foundation
FACILITY ADDRESS: 6301 Humbert Road
FACILITY CITY, STATE, ZIP: Godfrey, IL 62035

DOCKET NUMBER: NH 21-S0567

LICENSEE INFO: Beverly Farm Foundation
LICENSEE ADDRESS: 190 South LaSalle St, Ste 3700
LICENSEE CITY, STATE, ZIP: Chicago, IL 60603
Survey Date – 06/11/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 350.620a) 350.1210, 350.1220j), 350.1230d)1)2)3), and 350.3240a). A fine of $12,500.00

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

DOCKET NUMBER: NH 21-S0405

LICENSEE INFO: Briar Place Nursing, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/16/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.690a), 300.690b), 300.1210b), 300.1210c)3), 300.1210d)6), and 300.3240f). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $25,000.00

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), 300.1220b)2)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $25,000.00

Total Fine: $50,000.00

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

DOCKET NUMBER: NH 21-S0553

LICENSEE INFO: Briar Place Nursing, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 06/15/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.690a), 300.1210b), 300.1210c)3), 300.1210d)6), 300.3240a), and 300.3240f). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.690, 300.1210b), 300.1210d)6), and 300.3240a). A fine of $25,000.00

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

Total Fine: $27,200.00

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

DOCKET NUMBER: NH 21-C0554

LICENSEE INFO: Briar Place Nursing, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 06/15/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210c)3) 300.1210d)5), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5), and 300.3240a). A fine of $2,200.00

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

DOCKET NUMBER: NH 21-C0399

LICENSEE INFO: Burbank Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 04/27/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), and 300.1210d)2). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b). A fine of $25,000.00

FACILITY NAME: Care Center at Center Grove
FACILITY ADDRESS: 6277 Center Grove Road
FACILITY CITY, STATE, ZIP: Edwardsville, IL 62025

DOCKET NUMBER: NH 21-S0324

LICENSEE INFO: Edwardsville NH, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 04/20/2021

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

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)1), 300.1630e), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) 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: 300.610a), 300.1210a), 300.1210b)2)4)5), 300.1210d)2), 300.1220b)2)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

Total Fine: $77,200.00

FACILITY NAME: Cedar Ridge Health & Rehab Center
FACILITY ADDRESS: One Perryman Street
FACILITY CITY, STATE, ZIP: Lebanon, IL 62254

DOCKET NUMBER: NH 21-C0539

LICENSEE INFO: Cedar Ridge Care and Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 06/09/2021

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

DOCKET NUMBER: NH 21-C0322

LICENSEE INFO: Champaign Urbana Nursing and Rehab, LP
LICENSEE ADDRESS: 5750 Old Orchard Rd, Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 04/20/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)2)3)5), and 300.1220b)2). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)5). A fine of $2,200.00

FACILITY NAME: Charleston Rehab & Health CC
FACILITY ADDRESS: 716 Eighteenth Street
FACILITY CITY, STATE, ZIP: Charleston, IL 61920

DOCKET NUMBER: NH 21-C0513

LICENSEE INFO: Charleston HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/29/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.1220b)3). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Charter Sr Lvg Poplar Creek
FACILITY ADDRESS: 2150 West Golf Road
FACILITY CITY, STATE, ZIP: Hoffman Estates, IL 60169

DOCKET NUMBER: NH 21-S0508

LICENSEE INFO: S-H OPCO Hoffman Estates, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/08/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.4240a). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.4240a). A fine of $2,200.00

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

DOCKET NUMBER: NH 21-C0323

LICENSEE INFO: Diamond Development Co.
LICENSEE ADDRESS: 150 South State Rte 45. Box 250
LICENSEE CITY, STATE, ZIP: Louisville, IL 62858
Survey Date – 04/09/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.790c)1), and 330.790c)4). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.790). A fine of $2,200.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.2220a)1) and 330.2220a)3). No fine

Total Fine: $2,200.00

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

DOCKET NUMBER: NH 21-C0397

LICENSEE INFO: Diamond Development Co.
LICENSEE ADDRESS: 150 South State Rte 45, Box 250
LICENSEE CITY, STATE, ZIP: Louisville, IL 62858
Survey Date – 05/04/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.710 a), 330.1150 a), 330.1150 b)1), 330.1150 b)2), 330.1150 b)3), 330.1150 c), 330.1150 d)1), 330.1150d)2), 330.1150 d)3), 330.1150 d)4), 330.1150 d)5), 330.1150 d)6), 330.1150d)7), and 330.1150 e). A fine of $1,100.00

FACILITY NAME: Chestnut Corner S C
FACILITY ADDRESS: 905 West Chestnut St., Box #250
FACILITY CITY, STATE, ZIP: Louisville, IL 62858

DOCKET NUMBER: NH 21-C0475

LICENSEE INFO: Diamond Development Co.
LICENSEE ADDRESS: 150 South State Rte 45, Box 250
LICENSEE CITY, STATE, ZIP: Louisville, IL 62858
Survey Date – 06/11/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.911, 955.150a), 955.160a)6), 955.165a)1)B), and 955.165f). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.911. A fine of $2,200.00

FACILITY NAME: Children’s Habilitation Ctr
FACILITY ADDRESS: 121 West 154^th Street
FACILITY CITY, STATE, ZIP: Harvey, IL 60426

DOCKET NUMBER: NH 21-C0236

LICENSEE INFO: Children’s Habilitation Center, Inc.
LICENSEE ADDRESS: 121 West 154^th Street
LICENSEE CITY, STATE, ZIP: Harvey, IL 60426
Survey Date – 03/17/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 390.620a), 390.1040j) and 390.3240a). The fine was doubled in this instance in accordance with 390.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 340.1040) and 340.3240). A fine of $20,000.00

FACILITY NAME: City View Multicare Center
FACILITY ADDRESS: 5825 West Cermak Road
FACILITY CITY, STATE, ZIP: Cicero, IL 60804

DOCKET NUMBER: NH 21-S0536

LICENSEE INFO: City View Multicare Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 06/15/2021

FACILITY NAME: City View Multicare Center
FACILITY ADDRESS: 5825 West Cermak Road
FACILITY CITY, STATE, ZIP: Cicero, IL 60804

DOCKET NUMBER: NH 21-C0537

LICENSEE INFO: City View Multicare Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 07/01/2021

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

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010g)1), 300.1210a), 300.1210b), 300.1210d)6), and 300.7020a)2)F). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

Total Fine: $27,200.00

FACILITY NAME: Clark Lindsey Village
FACILITY ADDRESS: 101 West Windsor Road
FACILITY CITY, STATE, ZIP: Urbana, IL 61801

DOCKET NUMBER: NH 21-C0276

LICENSEE INFO: Clark Lindsey Village, Inc.
LICENSEE ADDRESS: 2110 Boudreau Drive
LICENSEE CITY, STATE, ZIP: Urbana, IL 61801
Survey Date – 04/07/2021

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

FACILITY NAME: Collins Square
FACILITY ADDRESS: 145 South Crosswell Avenue
FACILITY CITY, STATE, ZIP: Bradley, IL 60915

DOCKET NUMBER: NH 21-C0395

LICENSEE INFO: Pinnacle Opportunities, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 04/14/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 350.620a) 350.1210, 350.3240a), 350.3240b), 350.3240d), and 350.3240f). A fine of $6,250.00

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

DOCKET NUMBER: NH 21-S0443

LICENSEE INFO: Petersen Health Properties, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/03/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.3210a), 300.3240a), and 300.3240e). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.3240a) and 300.3240e). A fine of $2,200.00

FACILITY NAME: Doctors Nursing & Rehab Center
FACILITY ADDRESS: 1201 Hawthorn Road
FACILITY CITY, STATE, ZIP: Salem, IL 62881

DOCKET NUMBER: NH 21-C0442

LICENSEE INFO: Helia Healthcare of Salem, LLC
LICENSEE ADDRESS: 600 S. Second Street, Suite 104
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 06/02/2021

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

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

Total Fine: $4,400.00

FACILITY NAME: Du Page Care Center
FACILITY ADDRESS: 400 N County Farm Rd
FACILITY CITY, STATE, ZIP: Wheaton, IL 60187

DOCKET NUMBER: NH 21-C0440

LICENSEE INFO: DuPage County Board
LICENSEE ADDRESS: 421 County Farm Road
LICENSEE CITY, STATE, ZIP: Wheaton, IL 60187
Survey Date – 05/11/2021

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

FACILITY NAME: Eastview Terrace
FACILITY ADDRESS: 100 Eastview Place
FACILITY CITY, STATE, ZIP: Sullivan, IL 61951

DOCKET NUMBER: NH 21-C0314

LICENSEE INFO: Eastview HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Dr
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/31/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610c)4)c) 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: Eastview Terrace
FACILITY ADDRESS: 100 Eastview Place
FACILITY CITY, STATE, ZIP: Sullivan, IL 61951

DOCKET NUMBER: NH 21-S0356

LICENSEE INFO: Petersen Health Quality, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 04/29/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1630d), and 300.1630e) A fine of $1,100.00

FACILITY NAME: El Paso Health Care Center
FACILITY ADDRESS: 850 East Second Street
FACILITY CITY, STATE, ZIP: El Paso, IL 61738

DOCKET NUMBER: NH 21-S0469

LICENSEE INFO: El Paso HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 05/27/2021

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)3), 300.1210d)6), 300.1220b)2)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $2,200.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210c)3), 300.1210d)6), 300.1220b)2)3), and 300.3240a). . The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $2,200.00

Total Fine: $4,400.00

FACILITY NAME: Elevate Care Irving Park
FACILITY ADDRESS: 4340 N. Keystone
FACILITY CITY, STATE, ZIP: Chicago, IL 60641

DOCKET NUMBER: NH 21-C0297

LICENSEE INFO: Elevate Care Irving Park, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/01/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.690b), 300.690c), 300.1010h), 300.1210b), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.690, 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: 300.610a), 300.1210b), and 300.1210d)1). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b). A fine of $2,200.00

Total Fine: $27,200.00

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

DOCKET NUMBER: NH 21-S0307

LICENSEE INFO: Fair Havens Senior Living, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 04/12/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 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: Fair Haven Senior Living
FACILITY ADDRESS: 1790 South Fairview Avenue
FACILITY CITY, STATE, ZIP: Decatur, IL 62521

DOCKET NUMBER: NH 21-C0428

LICENSEE INFO: Fair Havens Senior Living, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 05/19/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)4), 300.1210d)2), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Fair Haven Senior Living
FACILITY ADDRESS: 1979 South Fairview Avenue
FACILITY CITY, STATE, ZIP: Decatur, IL 62521

DOCKET NUMBER: NH 21-S0486

LICENSEE INFO: Fair Havens Senior Living, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 06/23/2021

Type B 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 300.1220b)3). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.690, 300.1210b), and 300.1210d)6). A fine of $2,200.00

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

DOCKET NUMBER: NH 21-C0517

LICENSEE INFO: Fair Haven Senior Living, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 07/06/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.2900d)2), 300.3100d)2), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00

FACILITY NAME: Fair Oaks Rehab & HCC
FACILITY ADDRESS: 1515 Blackhawk
FACILITY CITY, STATE, ZIP: South Beloit, IL 61080

DOCKET NUMBER: NH 21-S0339

LICENSEE INFO: Fair Oaks Rehabilitation and Health Care Center, LLC
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 04/14/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)2), 300.696c)6), and 300.1210b). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.696 and 300.1210b). A fine of $2,200.00

FACILITY NAME: Fairhaven Christian Ret Center
FACILITY ADDRESS: 3470 North Alpine Road
FACILITY CITY, STATE, ZIP: Rockford, IL 61114

DOCKET NUMBER: NH 21-S0459

LICENSEE INFO: Fairhaven Christian Retirement Center
LICENSEE ADDRESS: 3470 North Alpine Road
LICENSEE CITY, STATE, ZIP: Rockford, IL 61114
Survey Date – 06/17/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610c)4)C) 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: Fargo Health Care Center
FACILITY ADDRESS: 1512 West Fargo Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60626

DOCKET NUMBER: NH 21-S0425

LICENSEE INFO: Fargo Health Care Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/30/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.696a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.696. A fine of $2,200.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b)1), 300.1210b)4), 300.1210d)4)A), and 300.1210d)4)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). A fine of $2,200.00

Total Fine: $4,400.00

FACILITY NAME: Farmington County Manor
FACILITY ADDRESS: 701 South Main Street
FACILITY CITY, STATE, ZIP: Farmington, IL 61531

DOCKET NUMBER: NH 21-S0451

LICENSEE INFO: American Health Corp.
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/16/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 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: Flanagan Rehab & HCC
FACILITY ADDRESS: 201 East Falcon Highway
FACILITY CITY, STATE, ZIP: Flanagan, IL 61740

DOCKET NUMBER: NH 21-C0503 & NH 21-S0504

LICENSEE INFO: Flanagan HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Dr
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/10/2021

Type A 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 $25,000.00

FACILITY NAME: Flora Rehab & Health Care Ctr
FACILITY ADDRESS: 232 Given Street
FACILITY CITY, STATE, ZIP: Flora, IL 62839

DOCKET NUMBER: NH 21-S0492

LICENSEE INFO: Petersen Management Company, LLC
LICENSEE ADDRESS: 830 Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/18/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 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: Forest City Rehab & Nrsg Ctr
FACILITY ADDRESS: 321 Arnold Avenue
FACILITY CITY, STATE, ZIP: Rockford, IL 61108

DOCKET NUMBER: NH 21-S0468

LICENSEE INFO: Forest City Rehab and Nursing Center, LLC
LICENSEE ADDRESS: 4711 Golf Road, Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 05/27/2021

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)2)3), 300.1210d)6), 300.1220b)2)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), 300.1210d)6), and 300.3240a). A fine of $2,200.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c), 300.1210d)6), 300.1220b)2)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $2,200.00

Total Fine: $4,400.00

FACILITY NAME: Friendship Village Schaumburg
FACILITY ADDRESS: 350 West Schaumburg Road
FACILITY CITY, STATE, ZIP: Schaumburg, IL 60194

DOCKET NUMBER: NH 21-S0514

LICENSEE INFO: Evangelical Retirement Homes of Greater Chicago, Incorporation
LICENSEE ADDRESS: 350 West Schaumburg Road
LICENSEE CITY, STATE, ZIP: Schaumburg, IL 60194
Survey Date – 06/16/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)7), 300.1020a), and 300.1020b). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.696. A fine of $25,000.00

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

Total Fine: $27,200.00

FACILITY NAME: Generations at Elmwood Park
FACILITY ADDRESS: 7733 West Grand Avenue
FACILITY CITY, STATE, ZIP: Elmwood Park, IL 60707

DOCKET NUMBER: NH 21-C0467

LICENSEE INFO: Generations at Elmwood Park, Inc.
LICENSEE ADDRESS: 6840 N. Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 05/21/2021

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

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

DOCKET NUMBER: NH 21-S0349

LICENSEE INFO: Generations at Rock Island, LLC
LICENSEE ADDRESS: 6840 North Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 04/16/2021

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

FACILITY NAME: Glenview Terrace Nursing Ctr
FACILITY ADDRESS: 1511 Greenwood Road
FACILITY CITY, STATE, ZIP: Glenview, IL 60025

DOCKET NUMBER: NH 21-C0457

LICENSEE INFO: Glenview Terrace Nursing Center
LICENSEE ADDRESS: 6633 North Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 05/17/2021

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

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

DOCKET NUMBER: NH 21-C0450

LICENSEE INFO: Good Samaritan Pontiac
LICENSEE ADDRESS: 1225 S. Ewing Drive
LICENSEE CITY, STATE, ZIP: Pontiac, IL 61764
Survey Date – 06/04/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.610c)4)a), 300.1210b), and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.1210d)6). A fine of $25,000.00

FACILITY NAME: Granite Nsg & Rehab Center
FACILITY ADDRESS: 3500 Century Drive
FACILITY CITY, STATE, ZIP: Granite City, IL 62040

DOCKET NUMBER: NH 21-C0535

LICENSEE INFO: Granite Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 901 S. 2^nd Street Ste 201
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 06/17/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)1), 300.1630e), and 300.3220f). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b). A fine of $25,000.00

FACILITY NAME: Greenville Nursing & Rehab
FACILITY ADDRESS: 400 East Hillview Avenue
FACILITY CITY, STATE, ZIP: Greenville, IL 62246

DOCKET NUMBER: NH 21-C0429

LICENSEE INFO: Greenville Nursing & Rehabilitation Center, LLC
LICENSEE ADDRESS: 215 E. Locust Street
LICENSEE CITY, STATE, ZIP: Harrisburg, IL 62946
Survey Date – 05/28/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 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: Grove of Skokie, The
FACILITY ADDRESS: 9000 Lavergne Avenue
FACILITY CITY, STATE, ZIP: Skokie, IL 60077

DOCKET NUMBER: NH 21-S0388

LICENSEE INFO: Skokie Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 04/30/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.3240a). 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: Hawthorne Inn of Danville
FACILITY ADDRESS: 3222 Independence Drive
FACILITY CITY, STATE, ZIP: Danville, IL 61832

DOCKET NUMBER: NH 21-C0340

LICENSEE INFO: Residential Alternatives of Illinois, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 04/07/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)2), and 300.1210d)5). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.1210d)5). A fine of $25,000.00

FACILITY NAME: Heartland of Henry
FACILITY ADDRESS: 1650 Indian Town Road
FACILITY CITY, STATE, ZIP: Henry, IL 61537

DOCKET NUMBER: NH 21-C0306

LICENSEE INFO: Heartland of Henry IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/19/2021

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

FACILITY NAME: Heartland of Moline
FACILITY ADDRESS: 833 Sixteenth Ave
FACILITY CITY, STATE, ZIP: Moline, IL 61265

DOCKET NUMBER: NH 21-S0493

LICENSEE INFO: Heartland of Moline IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 06/10/2021

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

FACILITY NAME: Heartland Senior Living
FACILITY ADDRESS: 101 Trowbridge Road
FACILITY CITY, STATE, ZIP: Neoga, IL 62447

DOCKET NUMBER: NH 21-S0394 & NH 21-C0444

LICENSEE INFO: Heartland Senior Living, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 04/22/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.1220b)2). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.1210d)6). A fine of $25,000.00

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

Total Fine: $27,200.00

FACILITY NAME: Helia Healthcare of Belleville
FACILITY ADDRESS: 40 North 64^th Street
FACILITY CITY, STATE, ZIP: Belleville, IL 62223

DOCKET NUMBER: NH 21-C0384

LICENSEE INFO: Helia Healthcare of Belleville, LLC
LICENSEE ADDRESS: 600 S. Second Street, Suite 104
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 04/22/2021

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

FACILITY NAME: Helia Healthcare of Belleville
FACILITY ADDRESS: 40 North 64^th Street
FACILITY CITY, STATE, ZIP: Belleville, IL 62223

DOCKET NUMBER: NH 21-C0472

LICENSEE INFO: Helia Healthcare of Belleville, LLC
LICENSEE ADDRESS: 600 S. Second Street, Suite 104
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 05/12/2021

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

FACILITY NAME: Heritage Health El Paso
FACILITY ADDRESS: 555 E. Clay
FACILITY CITY, STATE, ZIP: El Paso, IL 61738

DOCKET NUMBER: NH 21-S0549

LICENSEE INFO: Heritage Manor El Paso, LLC
LICENSEE ADDRESS: 202 N. Center
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 06/09/2021

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

FACILITY NAME: Ignite Medical McHenry
FACILITY ADDRESS: 550 Ridgeway Drive
FACILITY CITY, STATE, ZIP: McHenry, IL 60050

DOCKET NUMBER: NH 21-S0345

LICENSEE INFO: TCO JV, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 04/29/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.2090a) and 300.2090b). A fine of $1,100.00

FACILITY NAME: IL Veteran’s Home at Quincy
FACILITY ADDRESS: 1707 North 12^th Street
FACILITY CITY, STATE, ZIP: Quincy, IL 62301

DOCKET NUMBER: NH 21-S0495

LICENSEE INFO: Illinois Department of Veterans’ Affairs
LICENSEE ADDRESS: 1707 North 12^th Street
LICENSEE CITY, STATE, ZIP: Springfield, IL 62794
Survey Date – 03/27/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 340.1505b)5). The fine was doubled in this instance in accordance with 340.1245i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 340.1505b)5). A fine of $2,200.00

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

DOCKET NUMBER: NH 21-C0479

LICENSEE INFO: Belleville Behavioral Health & Nursing Center, LLC
LICENSEE ADDRESS: 600 S. 2^nd Street Ste 104
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 05/27/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)3), 300.1210d)6), and 300.1220b)3). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

Total Fine: $4,400.00

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

DOCKET NUMBER: NH 21-C0414

LICENSEE INFO: Marion Rehabilitation and Nursing Center, LLC
LICENSEE ADDRESS: 600 S. 2^nd Street, Ste 104
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 05/27/2021

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.615e), 300.625c)1), and 300.625c)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: 300.615)e) and 300.625)c). A fine of $500.00

FACILITY NAME: Jacksonville Skilled Nur & Rehab
FACILITY ADDRESS: 1517 West Walnut Street
FACILITY CITY, STATE, ZIP: Jacksonville, IL 62650

DOCKET NUMBER: NH 21-S0465

LICENSEE INFO: Jacksonville Care & Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/25/2021

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

FACILITY NAME: Kensington Place Nrsg & Rehab
FACILITY ADDRESS: 3405 South Michigan Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60616

DOCKET NUMBER: NH 21-S0368

LICENSEE INFO: Kensington Place Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 04/20/2021

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

FACILITY NAME: Kewanee Care Home
FACILITY ADDRESS: 144 Junior Avenue
FACILITY CITY, STATE, ZIP: Kewanee, IL 61443

DOCKET NUMBER: NH 21-S0296

LICENSEE INFO: Kewanee HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Dr
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 04/01/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b)4), 300.1210c), 300.1210d)1)3), and 300.1210d)5). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)5). A fine of $2,200.00

FACILITY NAME: Lakefront Nursing & Rehab Ctr
FACILITY ADDRESS: 7618 North Sheridan Road
FACILITY CITY, STATE, ZIP: Chicago, IL 60626

DOCKET NUMBER: NH 21-C0523

LICENSEE INFO: Lakefront Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/07/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.690a), 300.690b), 300.690c), 300.3210o), 300.3240a), 300.3240b), 300.3240c), 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 sections of the Code with a high-risk designation: 300.690, 300.1210d)6), 300.3240a), 300.3240d), and 300.3240d). A fine of $25,000.00

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

DOCKET NUMBER: NH 21-C0360

LICENSEE INFO: Lakeview Rehabilitation and Nursing Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 05/07/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b)5), 300.1210c), and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.1210d)6). A fine of $25,000.00

FACILITY NAME: Lena Living Center
FACILITY ADDRESS: 1010 South Logan Street
FACILITY CITY, STATE, ZIP: Lena, IL 61048

DOCKET NUMBER: NH 21-C0522

LICENSEE INFO: Lena Living Center, LLC
LICENSEE ADDRESS: 150 N. Riverside Plaza, #3000
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 06/09/2021

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

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)1), 300.1210d2), 300.1210d)5), 300.1220b)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b), 300.1210d)5), and 300.3240a). A fine of $25,000.00

Total Fine: $50,000.00

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

DOCKET NUMBER: NH 21-C0338

LICENSEE INFO: Lewis Memorial Christian Village
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/02/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.1220b)2)3). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.1210d)6). A fine of $25,000.00

FACILITY NAME: Lincoln Village Healthcare
FACILITY ADDRESS: 2202 North Kickapoo Street
FACILITY CITY, STATE, ZIP: Lincoln, IL 62656

DOCKET NUMBER: NH 21-C0551

LICENSEE INFO: Lincoln Village Healthcare Center, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 06/24/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)2), and 300.1220b)2). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b). A fine of $25,000.00

FACILITY NAME: Linton Terrace
FACILITY ADDRESS: 330 Linton Avenue
FACILITY CITY, STATE, ZIP: Wood River, IL 62095

DOCKET NUMBER: NH 21-S0427

LICENSEE INFO: Community Living Options, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 04/28/2021

Type B violation for violating one or more of the following sections of the Code: 350.610a), 350.670f)3), 350.1060a), 350.1086b), and 350.1610e). A fine of $550.00

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

DOCKET NUMBER: NH 21-C0525

LICENSEE INFO: Residential Alternatives of Illinois, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 06/07/2021

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

FACILITY NAME: Manor Court of Freeport
FACILITY ADDRESS: 2170 West Navajo Drive
FACILITY CITY, STATE, ZIP: Freeport, IL 61032

DOCKET NUMBER: NH 21-S0337

LICENSEE INFO: Residential Alternatives of Illinois, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 04/08/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)2), 300.1210d)5), 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: Manor Court of Freeport
FACILITY ADDRESS: 2170 West Navajo Drive
FACILITY CITY, STATE, ZIP: Freeport, IL 61032

DOCKET NUMBER: NH 21-S0545

LICENSEE INFO: Residential Alternatives of Illinois, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 06/23/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210d)1), 300.1610a)1)j), 300.1620a), 300.1640a)f)h), and 300.3220f). A fine of $12,500.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1220b)2), 300.1220d)1)2), 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 sections of the Code with a high risk designation: 300.1210b), 300.3240a), 300.3240d), and 300.3240e). A fine of $2,200.00

Total Fine: $14,700.00

FACILITY NAME: Manor Court of Peoria
FACILITY ADDRESS: 6900 North Stalworth Drive
FACILITY CITY, STATE, ZIP: Peoria, IL 61615

DOCKET NUMBER: NH 21-C0505

LICENSEE INFO: Residential Alternatives of Illinois, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 06/25/2021

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

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

DOCKET NUMBER: NH 21-C0471

LICENSEE INFO: Manor Care of Palos Heights IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/07/2021

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

FACILITY NAME: Marshall Rehab & Nursing
FACILITY ADDRESS: 410 Second Street
FACILITY CITY, STATE, ZIP: Marshall, IL 62441

DOCKET NUMBER: NH 21-S0392

LICENSEE INFO: Marshall Rehabilitation and Nursing, LLC
LICENSEE ADDRESS: 615 W. Webb Street
LICENSEE CITY, STATE, ZIP: Carmi, IL 62821
Survey Date – 05/14/2021

FACILITY NAME: Mason City Area Nursing Home
FACILITY ADDRESS: 520 North Price Avenue, Box 32
FACILITY CITY, STATE, ZIP: Mason City, IL 62664

DOCKET NUMBER: NH 21-C0452

LICENSEE INFO: Mason City Area Nursing Home Association, Inc.
LICENSEE ADDRESS: 520 North Price Avenue, Box 52
LICENSEE CITY, STATE, ZIP: Mason City, IL 62664
Survey Date – 05/27/2021

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

FACILITY NAME: Meadows
FACILITY ADDRESS: 3250 South Plum Grove Road
FACILITY CITY, STATE, ZIP: Meadows, IL 60008

DOCKET NUMBER: NH 21-S0484

LICENSEE INFO: Meadows Sheltered Care, Inc.
LICENSEE ADDRESS: 3250 S. Plum Grove Road
LICENSEE CITY, STATE, ZIP: Rolling Meadows, IL 60008
Survey Date – 06/04/2021

Type B violation for violating one or more of the following sections of the Code: 350.620a), 350.1210a), 350.1230b), 350.1230d)1), 350.3240a), 350.3420b), and 350.3240e). A fine of $750.00

FACILITY NAME: Midway Neurological /Rehab Ctr
FACILITY ADDRESS: 8540 South Harlem Avenue
FACILITY CITY, STATE, ZIP: Bridgeview, IL 60455

DOCKET NUMBER: NH 21-C0433

LICENSEE INFO: Midway Neurological and Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 05/04/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b)4)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 $25,000.00

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

Total Finer: $50,000.00

FACILITY NAME: Midway Neurological / Rehab Center
FACILITY ADDRESS: 8540 South Harlem Avenue
FACILITY CITY, STATE, ZIP: Bridgeview, IL 60455

DOCKET NUMBER: NH 21-C0515

LICENSEE INFO: Midway Neurological and Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 06/24/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b)4), 300.1210b)5), and 300.1210b)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). A fine of $25,000.00

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.690b), and 300.690c). 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

Total Fine: $25,500.00

FACILITY NAME: New Athens Home for the Aged
FACILITY ADDRESS: 203 South Johnson Street
FACILITY CITY, STATE, ZIP: New Athens, IL 62264

DOCKET NUMBER: NH 21-S0365

LICENSEE INFO: New Athens Home for the Aged
LICENSEE ADDRESS: 203 South Johnson Street
LICENSEE CITY, STATE, ZIP: New Athens, IL 62264
Survey Date – 04/23/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.2930c)4)5)6), and 300.2930A)B). A fine of $1,100.00

FACILITY NAME: Park Place
FACILITY ADDRESS: 205 Park Avenue
FACILITY CITY, STATE, ZIP: Pana, IL 62557

DOCKET NUMBER: NH 21-S0348

LICENSEE INFO: Progressive Housing, Inc.
LICENSEE ADDRESS: 20180 Governors Dr, Ste 300
LICENSEE CITY, STATE, ZIP: Olympia Fields, IL 60461
Survey Date – 04/12/2021

Type B violation for violating one or more of the following sections of the Code: 350.620a) 350.1210b), 350.1420a), 350.1430e), 350.1440a), 350.1840b), 350.1840e), and 350.3240a A fine of $550.00

FACILITY NAME: Park View Rehab Center
FACILITY ADDRESS: 5888 North Ridge
FACILITY CITY, STATE, ZIP: Chicago, IL 60660

DOCKET NUMBER: NH 21-C0512

LICENSEE INFO: Park View Rehab Center, LLC
LICENSEE ADDRESS: 191 N. Wacker Drive Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 06/20/2021

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

FACILITY NAME: Parkshore Estates Nrsg & Rehab
FACILITY ADDRESS: 6125 South Kenwood
FACILITY CITY, STATE, ZIP: Chicago, IL 60637

DOCKET NUMBER: NH 21-C0477 & NH 21-S0478

LICENSEE INFO: Parkshore Estates Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 06/03/2021

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

FACILITY NAME: Parkview Home Freeport
FACILITY ADDRESS: 1234 South Park Boulevard
FACILITY CITY, STATE, ZIP: Freeport, IL 61032

DOCKET NUMBER: NH 21-C0312 & NH 21-S0313

LICENSEE INFO: Parkview Home of Freeport, Illinois, Inc.
LICENSEE ADDRESS: 1234 South Park Boulevard
LICENSEE CITY, STATE, ZIP: Freeport, IL 61032
Survey Date – 04/01/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 330.790a). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 330.790). A fine of $25,000.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.1510a). A fine of $1,100.00

Total Fine: $28,300.00

FACILITY NAME: Pine Acres Rehab & Living Ctr
FACILITY ADDRESS: 1212 South Second Street
FACILITY CITY, STATE, ZIP: DeKalb, IL 60115

DOCKET NUMBER: NH 21-S0422

LICENSEE INFO: Pine Acres Rehab & Living Center, LLC
LICENSEE ADDRESS: 191 North Wacker Dr., Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 05/21/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)7), and 300.1020a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.696). A fine of $2,200.00

FACILITY NAME: Pinecrest Manor
FACILITY ADDRESS: 414 South Wesley Avenue
FACILITY CITY, STATE, ZIP: Mount Morris, IL 61054

DOCKET NUMBER: NH 21-S0544

LICENSEE INFO: Brethren Home
LICENSEE ADDRESS: 414 South Wesley Avenue
LICENSEE CITY, STATE, ZIP: Mount Morris, IL 61054
Survey Date – 06/10/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696b), 300.696c)2)7), and 300.1210b). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.696 and 300.1210b). A fine of $2,200.00

FACILITY NAME: Pleasant View Rehab & HCC
FACILITY ADDRESS: 500 North Jackson Street
FACILITY CITY, STATE, ZIP: Morrison, IL 61270

DOCKET NUMBER: NH 21-S0406

LICENSEE INFO: Pleasant View HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 05/24/2021

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

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

DOCKET NUMBER: NH 21-S0561

LICENSEE INFO: Prairie City, HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 07/08/2021

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), 300.1210d)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: Promedica Skilled Nursing Home HM
FACILITY ADDRESS: 940 Maple Avenue
FACILITY CITY, STATE, ZIP: Homewood, IL 60430

DOCKET NUMBER: NH 21-C0533

LICENSEE INFO: Manor Care of Homewood IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 06/17/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1030b), 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 $25,000.00

Total Fine: $50.000.00

FACILITY NAME: Randolph County Care Center
FACILITY ADDRESS: 312 West Belmont Street
FACILITY CITY, STATE, ZIP: Sparta, IL 62286

DOCKET NUMBER: NH 21-C0350

LICENSEE INFO: Randolph County Board
LICENSEE ADDRESS: #1 Taylor Street
LICENSEE CITY, STATE, ZIP: Chester, IL 62233
Survey Date – 04/27/2021

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

FACILITY NAME: Regency Care
FACILITY ADDRESS: 2120 W. Washington St
FACILITY CITY, STATE, ZIP: Springfield, IL 62702

DOCKET NUMBER: NH 21-S0423

LICENSEE INFO: Rutledge – Regency Operations, LLC
LICENSEE ADDRESS: 202 N. Center Street
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 05/05/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)6)7), 300.1020a), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.696) and 300.3240a). A fine of $25,000.00

FACILITY NAME: River Crossing of Edwardsville
FACILITY ADDRESS: 6277 Center Grove Road
FACILITY CITY, STATE, ZIP: Edwardsville, IL 62025

DOCKET NUMBER: NH 21-C0408

LICENSEE INFO: Edwardsville NH, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 05/25/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)1), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00

FACILITY NAME: River Crossing of Moline
FACILITY ADDRESS: 7300 34^th Avenue
FACILITY CITY, STATE, ZIP: Moline, IL 61265

DOCKET NUMBER: NH 21-S0424

LICENSEE INFO: Moline NH LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 05/20/2021

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

Total Fine: $50,000.00

FACILITY NAME: River View Rehab Center
FACILITY ADDRESS: 50 North Jane
FACILITY CITY, STATE, ZIP: Elgin, IL 60123

DOCKET NUMBER: NH 21-C0526

LICENSEE INFO: River View Rehab Center, LLC
LICENSEE ADDRESS: 4711 Golf Road, Suite 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 06/16/2021

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

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

DOCKET NUMBER: NH 21-C0364

LICENSEE INFO: Petersen Health Network, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Dr
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 04/23/2021

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

FACILITY NAME: Rock Falls Rehab & & Hlth Care C
FACILITY ADDRESS: 430 Martin Road
FACILITY CITY, STATE, ZIP: Rock Falls, IL 61071

DOCKET NUMBER: NH 21-S0431

LICENSEE INFO: Petersen Health & Wellness, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 05/20/2021

FACILITY NAME: Rock River Health Care
FACILITY ADDRESS: 707 West Riverside Boulevard
FACILITY CITY, STATE, ZIP: Rockford, IL 61103

DOCKET NUMBER: NH 21-S0419

LICENSEE INFO: Rock River Health Care, LLC
LICENSEE ADDRESS: 4711 Golf Road, Suite 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 05/14/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)7), 300.1020a)b), 300.675b)1)A)B)C)D)E), and 300.675b)4). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.696). A fine of $2,200.00

FACILITY NAME: Rolling Hills Manor
FACILITY ADDRESS: 3615 16^th Street
FACILITY CITY, STATE, ZIP: Zion, IL 60099

DOCKET NUMBER: NH 21-S0390

LICENSEE INFO: Slovak American Charitable Association
LICENSEE ADDRESS: 3521 16^th Street
LICENSEE CITY, STATE, ZIP: Zion, IL 60099
Survey Date – 05/04/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.696a) and 300.696c)7). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.696). A fine of $25,000.00

FACILITY NAME: Seminary Manor
FACILITY ADDRESS: 2345 North Seminary Street
FACILITY CITY, STATE, ZIP: Galesburg, IL 61401

DOCKET NUMBER: NH 21-C0286

LICENSEE INFO: UDI #7, LLC
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 03/31/2021

Type B 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). The fine was doubled in this instance in accordance 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: Seminary Manor
FACILITY ADDRESS: 2345 North Seminary Street
FACILITY CITY, STATE, ZIP: Galesburg, IL 61401

DOCKET NUMBER: NH 21-C0315

LICENSEE INFO: UDI # 7, LLC
LICENSEE ADDRESS: 285 South Farnharm Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 04/12/2021

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

FACILITY NAME: Sharon Health Care Pines
FACILITY ADDRESS: 3614 North Rochelle
FACILITY CITY, STATE, ZIP: Peoria, IL 61604

DOCKET NUMBER: NH 21-C0521

LICENSEE INFO: Sharon Health Care Pines, Inc.
LICENSEE ADDRESS: 465 Central Avenue, Suite 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
Survey Date – 06/17/2021

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

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

DOCKET NUMBER: NH 21-S0343

LICENSEE INFO: Sharon Health Care Willows, Inc.
LICENSEE ADDRESS: 465 Central Avenue, Suite 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
Survey Date – 04/29/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696c)2), 300.1210a), 300.1210d)2)3), 300.1210d)5), 300.1220b)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210d)5), and 300.3240a). A fine of $2,200.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), 300.1220b)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $2,200.00

Total Fine: $4,400.00

FACILITY NAME: Sheridan Village Nrsg & Rhb
FACILITY ADDRESS: 5838 North Sheridan Road
FACILITY CITY, STATE, ZIP: Chicago, IL 60660

DOCKET NUMBER: NH 21-C0559

LICENSEE INFO: Sheridan Village Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 5009 Oakton Street
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 07/02/2021

FACILITY NAME: South Holland Manor Hth & Rhb
FACILITY ADDRESS: 2145 East 170^th Street
FACILITY CITY, STATE, ZIP: South Holland, IL 60473

DOCKET NUMBER: NH 21-C0430

LICENSEE INFO: South Holland Manor HRC, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 05/07/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 30.3240a). A fine of $2,200.00

FACILITY NAME: Southgate Health Care Center
FACILITY ADDRESS: 900 E. Ninth St., P.O. Box 843
FACILITY CITY, STATE, ZIP: Metropolis, IL 62960

DOCKET NUMBER: NH 21-C0378

LICENSEE INFO: Southgate Health Care, Inc.
LICENSEE ADDRESS: 900 E. 9^th Street
LICENSEE CITY, STATE, ZIP: Metropolis, IL 62960
Survey Date – 04/06/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b)3), 300.1220b)2), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00

FACILITY NAME: Southpoint Nrsg & Rehab Ctr
FACILITY ADDRESS: 1010 West 95^th Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60643

DOCKET NUMBER: NH 21-C0376

LICENSEE INFO: Southpoint Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162
Survey Date – 04/29/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)2), 300.1620a), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), and 300.3240a). A fine of $2,200.00

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

DOCKET NUMBER: NH 21-S0538

LICENSEE INFO: Laureate Southview Operations, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 06/24/2021

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

FACILITY NAME: Sparta Terrace
FACILITY ADDRESS: 1501 Melmar
FACILITY CITY, STATE, ZIP: Sparta, IL 62286

DOCKET NUMBER: NH 21-S0321

LICENSEE INFO: Progressive Housing, Inc.
LICENSEE ADDRESS: 20180 Governors Dr., Ste 300
LICENSEE CITY, STATE, ZIP: Olympia Fields, IL 60461
Survey Date – 04/09/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 350.620a) 350.1040b)1), 350.1210b), 350.1230b)3), 350.1230d)3), 350.1840b)e), 350.3220f), and 350.3240a). A fine of $6,250.00

FACILITY NAME: Sparta Terrace
FACILITY ADDRESS: 1501 Melmar
FACILITY CITY, STATE, ZIP: Sparta, IL 62286

DOCKET NUMBER: NH 21-C0415 & NH 21-S0416

LICENSEE INFO: Progressive Housing, Inc.
LICENSEE ADDRESS: 20180 Governors Dr., Ste 300
LICENSEE CITY, STATE, ZIP: Olympia Fields, IL 60461
Survey Date – 05/28/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 350.620a), 350.700a), 350.1210, 350.1220j), 350.1230b)7), 350.1230d)1)2)3), 350.3210o). and 350.3240a). A fine of $6,250.00

FACILITY NAME: Squire’s Sheltered Care Home
FACILITY ADDRESS: 2601 North California
FACILITY CITY, STATE, ZIP: Chicago, IL 60647

DOCKET NUMBER: NH 21-S0377

LICENSEE INFO: Fellowship House, Inc.
LICENSEE ADDRESS: 180 N. LaSalle Street, Ste 3300
LICENSEE CITY, STATE, ZIP: Chicago, IL 60601
Survey Date – 04/30/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.1155 a)3, 330.1155 a)4), 330.1155 b), 330.1155 c), 330.1155 d), 330.1155e)2), 330.1155 e)3), 330.1520a), and 330.1520 b). A fine of $1,100.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.1160 a), 330.1160 b), 330.1160 c), 330.1160 d), 330.510b), and 330.1510a)1). A fine of $1,100.00

Type C violation of an occurrence for violating one or more of the following sections of the Code: 330.4240 c), 330.4240 d), 330.4240 e), and 330.911. 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: 330.4240d) and 330.4240e). A fine of $500.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.790a), 330.790b), and 330.790c)1). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.790). A fine of $2,200.00

Total Fine: $4,900.00

FACILITY NAME: St. Anthony’s Nsg & Rehab Ctr
FACILITY ADDRESS: 767 30^th Street
FACILITY CITY, STATE, ZIP: Rock Island, IL 61201

DOCKET NUMBER: NH 21-S0574

LICENSEE INFO: St. Anthony’s Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 150 N. Riverside Place, Ste 3000
LICENSEE CITY, STATE, ZIP: Chicago, IL 60601
Survey Date – 06/22/2021

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

FACILITY NAME: St. Patrick’s Residence
FACILITY ADDRESS: 1400 Brookdale Road
FACILITY CITY, STATE, ZIP: Naperville, IL 60563

DOCKET NUMBER: NH 21-C0369

LICENSEE INFO: Saint Patrick’s Residence
LICENSEE ADDRESS: 1400 Brookdale Road
LICENSEE CITY, STATE, ZIP: Naperville, IL 60563
Survey Date – 05/04/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)5), 300.1210c), and 3001210d)6)). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Stephenson Nursing Center
FACILITY ADDRESS: 2946 South Walnut Road
FACILITY CITY, STATE, ZIP: Freeport, IL 61032

DOCKET NUMBER: NH 21-S0407

LICENSEE INFO: Stephenson County Board of Supervisors
LICENSEE ADDRESS: 50 West Douglas St., Ste 1002
LICENSEE CITY, STATE, ZIP: Freeport, IL 61032
Survey Date – 05/12/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)6)7), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.696) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Sullivan Rehab & Hlth Care Ctr
FACILITY ADDRESS: 11 Hawthorne Lane
FACILITY CITY, STATE, ZIP: Sullivan, IL 61951

DOCKET NUMBER: NH 21-C0509 & NH 21-S0510

LICENSEE INFO: Sullivan HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/17/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b)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 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: Sunny Acres Nursing Home
FACILITY ADDRESS: 19130 Sunny Acres Road
FACILITY CITY, STATE, ZIP: Petersburg, IL 62675

DOCKET NUMBER: NH 21-C0461 & NH 21-S0462

LICENSEE INFO: Menard County
LICENSEE ADDRESS: 102 S 7^th Street, P.O. Box 464
LICENSEE CITY, STATE, ZIP: Petersburg, IL 62675
Survey Date – 05/27/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)2)3)5), and 300.1220b)2)3). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)5). A fine of $2,200.00

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

DOCKET NUMBER: NH 21-S0485

LICENSEE INFO: Petersen Health Junction, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/01/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696b), 300.696c)2), 300.696c)7), and 300.1210b). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.696 and 300.1210b). A fine of $2,200.00

FACILITY NAME: Swansea Rehab & Hlth Care Ctr
FACILITY ADDRESS: 1405 North Second Street
FACILITY CITY, STATE, ZIP: Swansea, IL 62226

DOCKET NUMBER: NH 21-C0382

LICENSEE INFO: Swansea HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 05/05/2021

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

FACILITY NAME: Swansea Rehab & Hlth Care Ctr
FACILITY ADDRESS: 1405 North Second Street
FACILITY CITY, STATE, ZIP: Swansea, IL 62226

DOCKET NUMBER: NH 21-C0506

LICENSEE INFO: Swansea HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/01/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)5), and 300.1220b)3). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), and 300.1210d)5). A fine of $2,200.00

FACILITY NAME: Symphony at the Tillers
FACILITY ADDRESS: 4390 Route 71
FACILITY CITY, STATE, ZIP: Oswego, IL 60543

DOCKET NUMBER: NH 21-C0491

LICENSEE INFO: Symphony Oswego, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/10/2021

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

FACILITY NAME: Symphony Encore
FACILITY ADDRESS: 2829 South California Blvd
FACILITY CITY, STATE, ZIP: Chicago, IL 60608

DOCKET NUMBER: NH 21-S0352

LICENSEE INFO: Symphony of California Gardens, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 04/16/2021

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.625b), 300.625c)1)2), and 300.625f)1). 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: 300.625b), 300.625c), and 300.625f). A fine of $500.00

Total Fine: $2,700.00

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

DOCKET NUMBER: NH 21-C0579

LICENSEE INFO: Symphony Bronzeville Park, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/18/2021

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

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1010g)1), 300.1620c), and 300.1630b). A fine of $12,500.00

Total Fine: $37,500.00

FACILITY NAME: Symphony of Buffalo Grove
FACILITY ADDRESS: 150 North Weiland
FACILITY CITY, STATE, ZIP: Buffalo Grove, IL 60089

DOCKET NUMBER: NH 21-C0482

LICENSEE INFO: Symphony Buffalo Grove, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/24/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)5), 300.120c), 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: Symphony of Chicago West
FACILITY ADDRESS: 5130 West Jackson Blvd
FACILITY CITY, STATE, ZIP: Chicago, IL 60644

DOCKET NUMBER: NH 21-C0507

LICENSEE INFO: Symphony Jackson Square, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/16/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)1), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00

FACILITY NAME: Symphony of South Shore
FACILITY ADDRESS: 2425 East 71^st Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60649

DOCKET NUMBER: NH 21-C0499

LICENSEE INFO: Symphony South Shore, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/08/2021

FACILITY NAME: Thrive of Fox Valley
FACILITY ADDRESS: 4020 E. New York Street
FACILITY CITY, STATE, ZIP: Aurora, IL 60504

DOCKET NUMBER: NH 21-S0375

LICENSEE INFO: IH Fox Valley OPCO, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/19/2021

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a),300.696c)2), and 300.1210b). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.696 and 300.1210b). A fine of $500.00

FACILITY NAME: Thrive of Lake County
FACILITY ADDRESS: 850 E. US Highway 45
FACILITY CITY, STATE, ZIP: Mundelein, IL 60060

DOCKET NUMBER: NH 21-S0396

LICENSEE INFO: Transitional Care of Lake County, LLC
LICENSEE ADDRESS: 208 S. LaSalle St., Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/28/2021

FACILITY NAME: Torrence Place
FACILITY ADDRESS: 2601 22 3^rd Street
FACILITY CITY, STATE, ZIP: Sauk Village, IL 60411

DOCKET NUMBER: NH 21-S0398

LICENSEE INFO: Pioneer Concepts, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 04/08/2021

Type B violation for violating one or more of the following sections of the Code: 350.620a), 350.1080a), 350.1082a)1), 350.1082a)2), 350.1082a)3), 350.1082a)4), 350.1082e), 350.1082h), 350.1082i), 350.1210b), and 350.3240a). A fine of $550.00

FACILITY NAME: Trinity Living Center #1
FACILITY ADDRESS: 3360 Ugland Drive
FACILITY CITY, STATE, ZIP: Joliet, IL 60432

DOCKET NUMBER: NH 21-S0541

LICENSEE INFO: Trinity Services, Inc.
LICENSEE ADDRESS: 71 North Chicago Street
LICENSEE CITY, STATE, ZIP: Joliet, IL 60431
Survey Date – 06/17/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 350.620a) 350.700a), 350.1210b), 350.1230b)7), 350.1230d)1)2)3), 350.3220f), and 350.3240a). A fine of $6,250.00

FACILITY NAME: Twin Lakes Rehab & Health Care
FACILITY ADDRESS: 310 Eads Avenue
FACILITY CITY, STATE, ZIP: Paris, IL 61944

DOCKET NUMBER: NH 21-S0366

LICENSEE INFO: Twin HCO, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 04/23/2021

FACILITY NAME: Union County Hospital LTC
FACILITY ADDRESS: 521 North Main Street
FACILITY CITY, STATE, ZIP: Anna, IL 62906

DOCKET NUMBER: NH 21-S0370

LICENSEE INFO: Anna Hospital Corporation
LICENSEE ADDRESS: 208 S. LaSalle St. Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/06/2021

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

DOCKET NUMBER: NH 21-C0328

LICENSEE INFO: University Rehabilitation Center of C-U, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/08/2021

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

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1230b)1), 300.1230e), and 300.3240)a). The fine was doubled in this instance in accordance 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), 300.1230), and 300.3240)a). A fine of $2,200.00

Total Fine: $4,400.00

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

DOCKET NUMBER: NH 21-C0400 & NH 21-S0401

LICENSEE INFO: University Rehabilitation Center of C-U, LLC
LICENSEE ADDRESS: 208 S. LaSalle St, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/06/2021

Total Fine: $4,400.00

FACILITY NAME: University Rehab at Northmoor
FACILITY ADDRESS: 1500 West Northmoor Road
FACILITY CITY, STATE, ZIP: Peoria, IL 61614

DOCKET NUMBER: NH 21-S0393

LICENSEE INFO: Peoria, NH LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 05/06/2021

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

Total Fine: $4,400.00

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

DOCKET NUMBER: NH 21-S0480

LICENSEE INFO: Rest Haven Illiana Christian Convalescent Home
LICENSEE ADDRESS: 18601 N. Creek Drive
LICENSEE CITY, STATE, ZIP: Tinley Park, IL 60477
Survey Date – 06/24/2021

FACILITY NAME: Villa at Windsor Park, The
FACILITY ADDRESS: 2649 East 75^th Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60649

DOCKET NUMBER: NH 21-C0357

LICENSEE INFO: The Villa at Windsor Park Nursing and Rehab Center, LLC
LICENSEE ADDRESS: 191 N. Wacker Dr., Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 04/15/2021

FACILITY NAME: Warren Barr Orland Park
FACILITY ADDRESS: 14601 John Humphry Drive
FACILITY CITY, STATE, ZIP: Orland Park, IL 60462

DOCKET NUMBER: NH 21-C0578

LICENSEE INFO: Orland Park Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 3450 Oakton Street
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 07/01/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210d)1), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Watseka Rehab & Hlth Care Ctr
FACILITY ADDRESS: 715 East Raymond Road
FACILITY CITY, STATE, ZIP: Watseka, IL 60970

DOCKET NUMBER: NH 21-C0601

LICENSEE INFO: Watseka HCO, LLC
LICENSEE ADDRESS: 830 Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 06/22/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)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: Waverly Place of Stockton
FACILITY ADDRESS: 501 Front Street
FACILITY CITY, STATE, ZIP: Stockton, IL 61085

DOCKET NUMBER: NH 21-S0275

LICENSEE INFO: Waverly Place of Stockton, LLC
LICENSEE ADDRESS: 2711 W. Howard Street
LICENSEE CITY, STATE, ZIP: Chicago, IL 60645
Survey Date – 04/02/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b)5), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $25,000.00

FACILITY NAME: Westminster Village
FACILITY ADDRESS: 2025 East Lincoln Street
FACILITY CITY, STATE, ZIP: Bloomington, IL 61701

DOCKET NUMBER: NH 21-C0341

LICENSEE INFO: Westminster Village, Inc.
LICENSEE ADDRESS: 2025 E Lincoln Street
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 04/22/2021

FACILITY NAME: Westmont Manor Hlth & Rhb
FACILITY ADDRESS: 512 East Ogden Avenue
FACILITY CITY, STATE, ZIP: Westmont, IL 60559

DOCKET NUMBER: NH 21-C0473

LICENSEE INFO: Westmont Manor HRC, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 06/16/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)1), 300.1630e), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Westmont Manor Hlth & Rhb
FACILITY ADDRESS: 512 East Ogden Avenue
FACILITY CITY, STATE, ZIP: Westmont, IL 60559

DOCKET NUMBER: NH 21-C0511

LICENSEE INFO: Westmont Manor HRC, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 06/04/2021

‘Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)2), 300.1210d)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00

FACILITY NAME: White Hall Nsg & Rehab Center
FACILITY ADDRESS: 620 West Bridgeport Street
FACILITY CITY, STATE, ZIP: White Hall, IL 62092

DOCKET NUMBER: NH 21-S0463

LICENSEE INFO: White Hall Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 901 S. 2^nd Street, Suite 201
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 06/15/2021

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

Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b) 300.1210d)3) and 300.1220b)3). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b). A fine of $500.00

Total Fine: $4,900.00

FACILITY NAME: Whitehall North
FACILITY ADDRESS: 300 Waukegan Road
FACILITY CITY, STATE, ZIP: Deerfield, IL 60015

DOCKET NUMBER: NH 21-S0426

LICENSEE INFO: Whitehall North, LLC
LICENSEE ADDRESS: 6633 North Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 05/12/2021

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)2), and 300.696c)7). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.696. A fine of $2,200.00

FACILITY NAME: Winning Wheels
FACILITY ADDRESS: 701 East 3^rd Street
FACILITY CITY, STATE, ZIP: Prophetstown, IL 61277

DOCKET NUMBER: NH 21-S0530

LICENSEE INFO: Winning Wheels, Inc.
LICENSEE ADDRESS: 701 East Third Street
LICENSEE CITY, STATE, ZIP: Prophetstown, IL 61277
Survey Date – 06/30/2021

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)3), 300.1210d)6), and 300.3240a). 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: Windsor Estates Nsg & Rehab
FACILITY ADDRESS: 18300 South Lavergne
FACILITY CITY, STATE, ZIP: Country Club Hills, IL 60478

DOCKET NUMBER: NH 21-C0453

LICENSEE INFO: McAllister Nursing and Rehab, LLC
LICENSEE ADDRESS: 180 N. LaSalle Ste, Ste 3300
LICENSEE CITY, STATE, ZIP: Chicago, IL 60601
Survey Date – 05/27/2021

2021 3rd Quarterly Report

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2021 3rd Quarterly Report

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