2nd Quarter Report April-June 2016

FACILITY NAME: Abington of Glenview
FACILITY ADDRESS: 3901 Glenview Road
FACILITY CITY, STATE, ZIP: Glenview, IL 60025

DOCKET NUMBER: NH 16-S0146

LICENSEE INFO: Glen Ridge Associates II Limited Partnership
LICENSEE ADDRESS: 3901 Glenview Road
LICENSEE CITY, STATE, ZIP: Glenview, IL 60025
Survey Date – 02/04/2016

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

FACILITY NAME: Alden Alma Nelson Manor
FACILITY ADDRESS: 550 South Mulford Avenue
FACILITY CITY, STATE, ZIP: Rockford, IL 61108

DOCKET NUMBER: NH 14-S0371 & NH 14-C0372

LICENSEE INFO: Alden Alma Nelson Manor, Inc.
LICENSEE ADDRESS: 4200 West Peterson
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 08/01/2014

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Alden Alma Nelson Manor
FACILITY ADDRESS: 550 South Mulford Avenue
FACILITY CITY, STATE, ZIP: Rockford, IL 61108

DOCKET NUMBER: NH 15-C0264

LICENSEE INFO: Alden Alma Nelson Manor, Inc.
LICENSEE ADDRESS: 4200 West Peterson
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 05/05/2015

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Alden Alma Nelson Manor
FACILITY ADDRESS: 550 South Mulford Avenue
FACILITY CITY, STATE, ZIP: Rockford, IL 61108

DOCKET NUMBER: NH 15-S0296

LICENSEE INFO: Alden Alma Nelson Manor, Inc.
LICENSEE ADDRESS: 4200 West Peterson
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 06/11/2015

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

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

DOCKET NUMBER: NH 15-C0413

LICENSEE INFO: Alden-Orland Park Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Ave., Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 08/05/2015

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Aperion Care Bloomington
FACILITY ADDRESS: 1509 North Calhoun Street
FACILITY CITY, STATE, ZIP: Bloomington, IL 61701

DOCKET NUMBER: NH 16-S0137

LICENSEE INFO: Aperion Care Bloomington, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 03/08/2016

Type B violation for violating one or more sections: 300.670k)1)2)3). No fine

Type B violation for violating one or more sections: 300.3260c). No fine

FACILITY NAME: Aperion Care of Bloomington
FACILITY ADDRESS: 1509 North Calhoun Street
FACILITY CITY, STATE, ZIP: Bloomington, IL 61701

DOCKET NUMBER: NH 16-S0187

LICENSEE INFO: Aperion Care Bloomington, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 04/25/2016

Type B violation for violating one or more sections: 300.3260c). No fine.

FACILITY NAME: Applewood Rehabilitation Center
FACILITY ADDRESS: 21020 Kostner Avenue
FACILITY CITY, STATE, ZIP: Matteson, IL 60443

DOCKET NUMBER: NH 14-S0504 & NH 14-C0505

LICENSEE INFO: Applewood Rehabilitation Center, LLC
LICENSEE ADDRESS: 6840 N. Lincoln Ave
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 09/25/2014

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Aria Post Acute Care
FACILITY ADDRESS: 4600 North Frontage Road
FACILITY CITY, STATE, ZIP: Hillside, IL 60162

DOCKET NUMBER: NH 16-S0140

LICENSEE INFO: Symphony Aria, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 02/18/2016

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

FACILITY NAME: Bellwood Developmental Center
FACILITY ADDRESS: 105 Eastern Avenue
FACILITY CITY, STATE, ZIP: Bellwood, IL 60104

DOCKET NUMBER: NH 16-C0169

LICENSEE INFO: Bellwood Nursing Center, LLC
LICENSEE ADDRESS: 5750 Old Orchard Rd, Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 03/01/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 350.620a), 350.760a), 350.760c)7), 350.1210 and 350.3240a). A fine of $750.00.

FACILITY NAME: Brentwood North HC & Rehab Ctr
FACILITY ADDRESS: 3705 Deerfield Rd
FACILITY CITY, STATE, ZIP: Riverwoods, Illinois 60015

DOCKET NUMBER: NH 16-S0246

LICENSEE INFO: Brentwood North Healthcare and Rehabilitation Centre, Inc.
LICENSEE ADDRESS: 191 North Wacker Dr. Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, Illinois 60606
Survey Date – 05/19/2016

Type B violation for violating one or more sections: 300.615e), 300.615f), 300.615g). No fine

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

DOCKET NUMBER: NH 15-C0456

LICENSEE INFO: Champaign County Board
LICENSEE ADDRESS: 1776 East Washington Street
LICENSEE CITY, STATE, ZIP: Urbana, IL 61802
Survey Date – 09/15/2015

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

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

DOCKET NUMBER: NH 16-S0195

LICENSEE INFO: Champaign County Board
LICENSEE ADDRESS: 1776 East Washington Street
LICENSEE CITY, STATE, ZIP: Urbana, IL 61802
Survey Date – 03/30/2016

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: 300.1210d)6) and 300.3240a). 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 16-S0154

LICENSEE INFO: Petersen Health Network, LLC
LICENSEE ADDRESS: 832 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/02/2016

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: Chester Rehab and Nrsg Center
FACILITY ADDRESS: 770 State Street
FACILITY CITY, STATE, ZIP: Chester, IL 62233

DOCKET NUMBER: NH 16-C0153

LICENSEE INFO: Chester Rehabilitation and Nursing Center, LLC
LICENSEE ADDRESS: 8170 N. McCormick Blvd, Ste 219
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 03/08/2016

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: Citadel Care Center - Kankakee
FACILITY ADDRESS: 900 West River Place
FACILITY CITY, STATE, ZIP: Kankakee, IL 60901

DOCKET NUMBER: NH 16-S0190

LICENSEE INFO: Citadel Care Center – Kankakee, LLC
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 04/22/2016

Type B violation for violating one or more sections: 300.1620a), 300.1630a)1)b). No fine

Administrative Warning for violating the following section of the Code: 300.2050g)1)A)B)C). No fine.

Administrative Warning for violating the following section of the Code: 300.2860c)2). No fine.

FACILITY NAME: Collinsville Rehab & Health CC
FACILITY ADDRESS: 614 North Summit
FACILITY CITY, STATE, ZIP: Collinsville, IL 62234

DOCKET NUMBER: NH 16-C0231

LICENSEE INFO: Petersen Health Business, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61624
Survey Date – 04/07/2016

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)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: Community Nursing & Rehab Ctr.
FACILITY ADDRESS: 1136 North Mill Street
FACILITY CITY, STATE, ZIP: Naperville, IL 60563

DOCKET NUMBER: NH 16-S0149

LICENSEE INFO: Community Nursing & Rehabilitation Center, L.L.C.
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 03/09/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)5), 300.2220f) and 300.3240a). The fine was doubled in this instance in accordance with 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: Concordia Village Care Center
FACILITY ADDRESS: 4101 West Isles Avenue
FACILITY CITY, STATE, ZIP: Springfield, IL 62711

DOCKET NUMBER: NH 16-C0193

LICENSEE INFO: Lutheran Senior Services
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 62711
Survey Date – 03/30/2016

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

FACILITY NAME: Continental Nsg & Rehab Ctr.
FACILITY ADDRESS: 5336 North Western Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60625

DOCKET NUMBER: NH 16-C0180

LICENSEE INFO: Continental Nursing and Rehabilitation, LLC
LICENSEE ADDRESS: 8170 North McCormick Blvd, Ste 219
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 03/11/2016

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), 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: Country Health
FACILITY ADDRESS: 2304 C.R. 3000 N.
FACILITY CITY, STATE, ZIP: Gifford, IL 61847

DOCKET NUMBER: NH 16-C0217

LICENSEE INFO: Country Health, Inc.
LICENSEE ADDRESS: 115 W. Jefferson St., Ste 401
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 04/14/2016

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

FACILITY NAME: Crossroads Care Ctr-Woodstock
FACILITY ADDRESS: 309 McHenry Avenue
FACILITY CITY, STATE, ZIP: Woodstock, IL 60098

DOCKET NUMBER: NH 16-C0226

LICENSEE INFO: Crossroads Care Center of Woodstock, LLC
LICENSEE ADDRESS: 5750 Old Orchard Rd, Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 04/21/2016

Type B violation for violating one or more sections:300.1230b), 300.1230d), 300.1230e), 300.1230i). No fine

FACILITY NAME: Crystal Pines Rehab & HCC
FACILITY ADDRESS: 335 North Illinois Street
FACILITY CITY, STATE, ZIP: Crystal Lake, IL 60014

DOCKET NUMBER: NH 16-S0224

LICENSEE INFO: Crystal Pines Rehabilitation and Health Care Center, LLC
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 05/03/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a)4), 300.1210b), 300.1210d)2), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Danville Care Center
FACILITY ADDRESS: 1701 North Bowman
FACILITY CITY, STATE, ZIP: Danville, IL 61832

DOCKET NUMBER: NH 16-C0229

LICENSEE INFO: Danville Care Center, LTD
LICENSEE ADDRESS: 5759 Old Orchard Rd., Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 05/02/2016

Type B violation for violating one or more sections: 300.615e). No fine

Administrative Warning for violating the following section of the Code: 300.4090b)1)A). No fine

FACILITY NAME: Decatur Rehab & Health Care Ct.
FACILITY ADDRESS: 136 South Dipper Lane
FACILITY CITY, STATE, ZIP: Decatur, IL 62522

DOCKET NUMBER: NH 16-S0198

LICENSEE INFO: Petersen Health & Wellness, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 04/05/2016

Type B violation for violating one or more sections: 300.610a), 300.1210b)d)5), 300.1010h). No fine

FACILITY NAME: Douglas Nursing & Rehab Center
FACILITY ADDRESS: 3516 Powell Lane
FACILITY CITY, STATE, ZIP: Mattoon, IL 61938

DOCKET NUMBER: NH 16-S0260

LICENSEE INFO: Douglas Rehabilitation and Care Center, L.L.C.
LICENSEE ADDRESS: 1625 South 6^th Street
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 05/06/2016

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.

Administrative Warning for violating the following section of the Code: 300.2010a)1). No fine

Administrative Warning for violating the following section of the Code: 300.1230b), 300.1230d)1)2), 300.1230j)5), 300.1230k) and 300.1230l)1)2)3)4). No fine

FACILITY NAME: DuPage Convalescent Center
FACILITY ADDRESS: 400 North County Farm Road
FACILITY CITY, STATE, ZIP: Wheaton, IL 60187

DOCKET NUMBER: NH 16-C0255

LICENSEE INFO: Du Page County Board
LICENSEE ADDRESS: 421 County Farm Road
LICENSEE CITY, STATE, ZIP: Wheaton, IL 60187
Survey Date – 05/11/2016

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: Elm Brook Healthcare & Rehab
FACILITY ADDRESS: 127 West Diversey Avenue
FACILITY CITY, STATE, ZIP: Elmhurst, IL 60126

DOCKET NUMBER: NH 16-S0117

LICENSEE INFO: Elmbrook Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 7040 North Ridgeway Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 02/24/2016

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Frankfort Hlthcare & Rehab Ctr.
FACILITY ADDRESS: 2500 East St. Louis Street
FACILITY CITY, STATE, ZIP: West Frankfort, IL 62896

DOCKET NUMBER: NH 16-C0172

LICENSEE INFO: Frankfort Healthcare & Rehabilitation Center, L.L.C.
LICENSEE ADDRESS: 118 West Edwards Street, Ste 200
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 03/16/2016

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: Franklin Grove Living & Rehab
FACILITY ADDRESS: 502 North State Street
FACILITY CITY, STATE, ZIP: Franklin Grove, IL 61031

DOCKET NUMBER: NH 16-S0192

LICENSEE INFO: Franklin Grove Living & Rehabilitation Center, LLC
LICENSEE ADDRESS: 7434 Skokie Blvd
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 03/15/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)2), 300.1210d)5), 300.1220b)3), 300.1620a) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Friendship Manor
FACILITY ADDRESS: 1209 21^st Avenue
FACILITY CITY, STATE, ZIP: Rock Island, IL 61201

DOCKET NUMBER: NH 16-S0234

LICENSEE INFO: Friendship Manor, Inc.
LICENSEE ADDRESS: 329 18^th Street, Ste 300
LICENSEE CITY, STATE, ZIP: Rock Island, IL 61201
Survey Date – 04/18/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.690a)b)c), 300.1210b, and 300.3240a)b)d)e). The fine was doubled in this instance in accordance with 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)d)e). 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, 300.1220b)3)7), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00.

A total of both fines $4,400.00

FACILITY NAME: Glenlake Terrace Nursing & REH
FACILITY ADDRESS: 2222 West 14^th Street
FACILITY CITY, STATE, ZIP: Waukegan, IL 60085

DOCKET NUMBER: NH 16-C0156

LICENSEE INFO: Pinnacle, Inc.
LICENSEE ADDRESS: 191 N. Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 03/08/2016

Type B violation for violating one or more sections: 300.1210d)6). No fine

FACILITY NAME: Glenwood Healthcare & Rehab
FACILITY ADDRESS: 19330 South Cottage Grove
FACILITY CITY, STATE, ZIP: Glenwood, IL 60425

DOCKET NUMBER: NH 16-C0216

LICENSEE INFO: Glenwood Healthcare & Rehab, Inc.
LICENSEE ADDRESS: 5750 Old Orchard Rd, Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 03/24/2016

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

FACILITY NAME: Good Samaritan - Flanagan
FACILITY ADDRESS: 205 North Adams Street
FACILITY CITY, STATE, ZIP: Flanagan, IL 61740

DOCKET NUMBER: NH 16-S0151

LICENSEE INFO: Good Samaritan Home of Flanagan Illinois
LICENSEE ADDRESS: 205 North Adams Street
LICENSEE CITY, STATE, ZIP: Flanagan, IL 61740
Survey Date – 03/17/2016

Type B violation for violating one or more sections: 300.610a), 300.1210b), and 300.1210d)6). No fine

FACILITY NAME: Grove of Evanston L & R, The
FACILITY ADDRESS: 500 Asbury Avenue
FACILITY CITY, STATE, ZIP: Evanston, IL 60202

DOCKET NUMBER: NH 16-C0162

LICENSEE INFO: Evanston Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 7040 North Ridgeway Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 03/03/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), 300.3240a) and 300.2900d)2). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), 300.3240a) and 300.2900d)2). A fine of $25,000.00.

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

DOCKET NUMBER: NH 16-C0183

LICENSEE INFO: Heartland of Moline, IL, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/09/2016

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: Heartland of Peoria
FACILITY ADDRESS: 5660 Glen Elm Drive
FACILITY CITY, STATE, ZIP: Peoria, IL 61614

DOCKET NUMBER: NH 13-C0487

LICENSEE INFO: Heartland of Peoria, IL, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 10/10/2013

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

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

DOCKET NUMBER: NH 16-C0257

LICENSEE INFO: Helia Healthcare of Belleville, LLC
LICENSEE ADDRESS: 118 West Edwards Street, Ste 200
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 05/16/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1035)4)5), 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: Heritage Health - Carlinville
FACILITY ADDRESS: 1200 University Avenue
FACILITY CITY, STATE, ZIP: Carlinville, IL 62626

DOCKET NUMBER: NH 16-S0207

LICENSEE INFO: Heritage Manor-Carlinville, LLC
LICENSEE ADDRESS: 115 W. Jefferson, Ste 401
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 04/08/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210d)4), and 300.3240a). The fine was doubled in this instance in accordance with 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: Hillsboro Rehab & HCC
FACILITY ADDRESS: 1300 East Tremont Street
FACILITY CITY, STATE, ZIP: Hillsboro, IL 62049

DOCKET NUMBER: NH 15-S0397

LICENSEE INFO: Hillsboro Rehabilitation and Health Care Center, LLC
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 08/19/2015

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

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

DOCKET NUMBER: NH 16-S0253

LICENSEE INFO: Petersen Health Care- Illini, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 05/27/2016

Type B violation for violating one or more sections: 300.670c). No fine

Administrative Warning for violating the following section of the Code: 300.2010a)1). No fine

Administrative Warning for violating the following section of the Code: : 300.1230b), 300.1230d)1)2), 300.1230j)5), 300.1230k), 300.1230l). No fine

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

DOCKET NUMBER: NH 16-S0225

LICENSEE INFO: Genesis Health System
LICENSEE ADDRESS: 801 Illini Drive
LICENSEE CITY, STATE, ZIP: Silvis, IL 61282
Survey Date – 04/12/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)2), 300.3220f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00.

FACILITY NAME: Iroquois Resident Home, The
FACILITY ADDRESS: 200 Fairman Avenue
FACILITY CITY, STATE, ZIP: Watseka, IL 60970

DOCKET NUMBER: NH 16-S0263

LICENSEE INFO: The Iroquois Memorial Hospital and Resident Home
LICENSEE ADDRESS: 121 South 4^th Street
LICENSEE CITY, STATE, ZIP: Watseka, IL 60970
Survey Date – 06/09/2016

Type B violation for violating one or more sections: 300.650d). No fine

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

DOCKET NUMBER: NH 16-S0157

LICENSEE INFO: Kensington Place Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 8170 McCormick Blvd. Ste. 219
LICENSEE CITY, STATE, ZIP: Skokie, IL 60079
Survey Date – 02/29/2016

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: Lake Shore Healthcare & Rehab
FACILITY ADDRESS: 7200 North Sheridan Road
FACILITY CITY, STATE, ZIP: Chicago, IL 60626

DOCKET NUMBER: NH 16-C0174

LICENSEE INFO: Lake Shore Healthcare & Rehabilitation Centre, LLC
LICENSEE ADDRESS: 4600 West Touhy Avenue, #200
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 03/01/2016

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

FACILITY NAME: Lexington Hlth Cr Ctr-Lombard
FACILITY ADDRESS: 2100 South Finley Road
FACILITY CITY, STATE, ZIP: Lombard, Illinois 60148

DOCKET NUMBER: NH 16-C0239

LICENSEE INFO: Lexington Health Care Center of Lombard, Inc.
LICENSEE ADDRESS: 665 W. North Avenue
LICENSEE CITY, STATE, ZIP: Lombard, Illinois 60148
Survey Date – 05/11/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 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: Lexington of Chicago Ridge
FACILITY ADDRESS: 10300 Southwest Highway
FACILITY CITY, STATE, ZIP: Chicago Ridge, IL 60415

DOCKET NUMBER: NH 16-C0136

LICENSEE INFO: Lexington Health Care Center of Chicago Ridge, Inc.
LICENSEE ADDRESS: 665 West North Avenue
LICENSEE CITY, STATE, ZIP: Lombard, IL 60148
Survey Date – 03/16/2016

Type B violation for violating one or more sections: 300.695b)1)3) and 300.695c)1)4). No fine

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

DOCKET NUMBER: NH 15-C0098

LICENSEE INFO: Lewis Memorial Christian Village
LICENSEE ADDRESS: 200 North Postville Road
LICENSEE CITY, STATE, ZIP: Lincoln, IL 62656
Survey Date – 02/06/2015

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Life’s Journey Mattoon
FACILITY ADDRESS: 300 Lerna Road South
FACILITY CITY, STATE, ZIP: Mattoon, IL 61938

DOCKET NUMBER: NH 16-S0185

LICENSEE INFO: MAS Senior Living, LLC
LICENSEE ADDRESS: 70 West Madison St, Ste 3500
LICENSEE CITY, STATE, ZIP: Chicago, IL 60602
Survey Date – 04/19/2016

Type B violation for violating one or more sections: 330.1110a). No fine

FACILITY NAME: Life’s Journey Mattoon
FACILITY ADDRESS: 300 Lerna Road South
FACILITY CITY, STATE, ZIP: Mattoon, IL 61938

DOCKET NUMBER: NH 16-S0211

LICENSEE INFO: MAS Senior Living, LLC
LICENSEE ADDRESS: 70 West Madison St, Ste 3500
LICENSEE CITY, STATE, ZIP: Chicago, IL 60602
Survey Date – 04/19/2016

Type B violation for violating one or more sections: 330.715a), 330.715b). No fine

Type B violation for violating one or more sections: 330.720b). No fine

Type B violation for violating one or more sections: 330.770a), 330.770b)1)2)3), 330.770d), 330.770k)1)2). No fine

Type B violation for violating one or more sections: 330.1110a). No fine

Type B violation for violating one or more sections: 330.1155A)1)2)3)4)5). No fine

Type B violation for violating one or more sections: 330.1510a)1)4), 330.1510e)1), 330.1710g). No fine

Type B violation for violating one or more sections: 330.1990a), 330.1990b). No fine

Administrative Warning for violating the following section of the Code: 330.230a)2), 330230b)1), No fine

Administrative Warning for violating the following section of the Code:330.2000, 750.151a), 750.151b), 750.800e). No fine

Administrative Warning for violating the following section of the Code: 330.220d) 330.3060r). No fine

FACILITY NAME: Madison Terrace
FACILITY ADDRESS: 95 North Main
FACILITY CITY, STATE, ZIP: Wood River, IL 62095

DOCKET NUMBER: NH 16-S0209

LICENSEE INFO: Community Living Options, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 03/03/2016

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

FACILITY NAME: Magnolia Manor Shelter Care H
FACILITY ADDRESS: 1100 Grant
FACILITY CITY, STATE, ZIP: Eldorado, IL 62930

DOCKET NUMBER: NH 16-C0188

LICENSEE INFO: John Zink
LICENSEE ADDRESS: 150 South Route 45, Box 250
LICENSEE CITY, STATE, ZIP: Louisville, IL 62858
Survey Date – 04/15/2016

Type B violation for violating one or more sections: 330.790a)b), 330.1110f), 330.1130c). No fine

FACILITY NAME: Manorcare of Elk Grove Village
FACILITY ADDRESS: 1920 Nerge Road
FACILITY CITY, STATE, ZIP: Elk Grove Village, IL 60007

DOCKET NUMBER: NH 16-S0152

LICENSEE INFO: Manor Care of Elk Grove Village, IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 02/19/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210a), 300.1210b), 300.1210d)5), 300.1220b)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00

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

DOCKET NUMBER: NH 15-C0032

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 – 12/15/2014

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Manorcare of Palos Hts West
FACILITY ADDRESS: 11860 Southwest Highway
FACILITY CITY, STATE, ZIP: Palos Heights, IL 60463

DOCKET NUMBER: NH 16-C0265

LICENSEE INFO: Manor Care of Palos Heights (West) IL, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 05/10/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)1), 300.1210d)2), 300.1210d)3), and 300.3240a). The fine was doubled in this instance in accordance with 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: Mason Point
FACILITY ADDRESS: One Masonic Way
FACILITY CITY, STATE, ZIP: Sullivan, IL 61951

DOCKET NUMBER: NH 16-S0176

LICENSEE INFO: Petersen Health Care VII, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 02/05/2016

Type B violation for violating one or more sections:300.1230)k)l). No fine

Type B violation for violating one or more sections:300.3100d)2), 330.3620g), 330.3660b). No fine

FACILITY NAME: Midwest Rehab & Respiratory
FACILITY ADDRESS: 727 North 17^th Street
FACILITY CITY, STATE, ZIP: Belleville, IL 62226

DOCKET NUMBER: NH 16-C0194

LICENSEE INFO: Midwest Rehabilitation & Respiratory Center, LLC
LICENSEE ADDRESS: 8170 McCormick Blvd, Ste 219
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 03/16/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.670a), 300.670b)2)3), 300.670e), 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: Morton Terrace H & R Centre
FACILITY ADDRESS: 191 East Queenwood Road
FACILITY CITY, STATE, ZIP: Morton, IL 61550

DOCKET NUMBER: NH 16-S0203

LICENSEE INFO: Morton Terrace Healthcare and Rehabilitation Centre, LLC
LICENSEE ADDRESS: 4600 West Touhy Avenue, Ste 200
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 04/19/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1035a), 300.1035)2)3)4)5), 300.1210d)2), 300.3220f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.3240a). A fine of $25,000.00.

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

DOCKET NUMBER: NH 16-C0218

LICENSEE INFO: DeKalb Area Retirement Center
LICENSEE ADDRESS: 2944 Greenwood Acres Dr.
LICENSEE CITY, STATE, ZIP: DeKalb, IL 60115
Survey Date – 05/10/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.690b), 300.690c) 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: Palm Terrace of Mattoon
FACILITY ADDRESS: 1000 Palm Avenue
FACILITY CITY, STATE, ZIP: Mattoon, IL 61938

DOCKET NUMBER: NH 16-S0142

LICENSEE INFO: Petersen Management Company, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/17/2016

Type B violation for violating one or more sections: 300.1230b), 300.1230d), 300.1230j), 300.1230I, 300.1230k). No fine

FACILITY NAME: Piatt County Nursing Home
FACILITY ADDRESS: 1111 North State Street, P.O. Box 410
FACILITY CITY, STATE, ZIP: Monticello, IL 61856

DOCKET NUMBER: NH 16-S0252

LICENSEE INFO: Piatt County
LICENSEE ADDRESS: 101 West Washington Street, Room 107
LICENSEE CITY, STATE, ZIP: Monticello, IL 61856
Survey Date – 05/26/2016

Type B violation for violating one or more sections: 300.3100d)2). No fine

Administrative Warning for violating the following section of the Code: 300.7050d)e). No fine

Administrative Warning for violating the following section of the Code: 300.2010a)1), 300.330. No fine

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

DOCKET NUMBER: NH 16-C0247

LICENSEE INFO: Pine Acres Rehab & Living Center, L.L.C.
LICENSEE ADDRESS: 191 North Wacker Dr., Ste. 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 05/05/2016

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

DOCKET NUMBER: NH 16-S0011

LICENSEE INFO: Presence Life Connections
LICENSEE ADDRESS: 9223 West Saint Francis Road
LICENSEE CITY, STATE, ZIP: Frankfort, IL 60423
Survey Date – 11/19/2015

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Presence Pine View Care Center
FACILITY ADDRESS: 611 Allen Lane
FACILITY CITY, STATE, ZIP: St. Charles, IL 60174

DOCKET NUMBER: NH 15-S0415

LICENSEE INFO: Presence Life Connections
LICENSEE ADDRESS: 9223 West Saint Francis Road
LICENSEE CITY, STATE, ZIP: Frankfort, IL 60423
Survey Date – 08/21/2015

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

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

DOCKET NUMBER: NH 16-S0254

LICENSEE INFO: Presence Life Connections
LICENSEE ADDRESS: 18927 Hickory Creek Dr., Ste 300
LICENSEE CITY, STATE, ZIP: Mokena, IL 60448
Survey Date – 05/16/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1620a), 300.3220f), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a).A fine of $2,200.00.

FACILITY NAME: Providence Palos Heights
FACILITY ADDRESS: 13259 South Central Avenue
FACILITY CITY, STATE, ZIP: Palos Heights, IL 60463

DOCKET NUMBER: NH 16-C0212

LICENSEE INFO: Providence Operations, LLC
LICENSEE ADDRESS: 18601 N. Creek Drive, Ste. A
LICENSEE CITY, STATE, ZIP: Tinley Park, IL 60477
Survey Date – 04/04/2016

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

FACILITY NAME: Regency Rehabilitation Center
FACILITY ADDRESS: 6631 Milwaukee Avenue
FACILITY CITY, STATE, ZIP: Niles, IL 60714

DOCKET NUMBER: NH 14-S0427 & NH 14-C0428

LICENSEE INFO: Regency Rehabilitation Center, LLC
LICENSEE ADDRESS: 6840 N. Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 09/24/2014

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Resthave Home-Whiteside County
FACILITY ADDRESS: 408 Maple Avenue
FACILITY CITY, STATE, ZIP: Morrison, IL 61270

DOCKET NUMBER: NH 16-S0232

LICENSEE INFO: Resthave Home of Whiteside County, Illinois
LICENSEE ADDRESS: 408 Maple Avenue
LICENSEE CITY, STATE, ZIP: Morrison, IL 61270
Survey Date – 05/10/2016

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

FACILITY NAME: River Bluff Nursing Home
FACILITY ADDRESS: 4401 North Main Street
FACILITY CITY, STATE, ZIP: Rockford, IL 61103

DOCKET NUMBER: NH 15-C0517

LICENSEE INFO: Winnebago County
LICENSEE ADDRESS: 404 Elm Street. Room 504
LICENSEE CITY, STATE, ZIP: Rockford, IL 61101
Survey Date – 10/22/2015

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Rosewood Care Ctr-Edwardsville
FACILITY ADDRESS: 6277 Center Grove Rd
FACILITY CITY, STATE, ZIP: Edwardsville, IL 62025

DOCKET NUMBER: NH 16-S0238

LICENSEE INFO: Bravo Care of Edwardsville, Inc.
LICENSEE ADDRESS: 412 East Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 04/26/2016

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

FACILITY NAME: Rosewood Care Center of Moline
FACILITY ADDRESS: 7300 34^th Avenue
FACILITY CITY, STATE, ZIP: Moline, IL 61265

DOCKET NUMBER: NH 16-C0233

LICENSEE INFO: Bravo Care of Moline, Inc.
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 04/19/2016

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)2), 300.3220f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00.

FACILITY NAME: Rosewood Care Center of Moline
FACILITY ADDRESS: 7300 34^th Avenue
FACILITY CITY, STATE, ZIP: Moline, IL 61265

DOCKET NUMBER: NH 16-S0259

LICENSEE INFO: Bravo Care of Moline, Inc.
LICENSEE ADDRESS: 412 E, Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 06/01/2016

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

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

DOCKET NUMBER: NH 16-S0173

LICENSEE INFO: Rushville Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 03/16/2016

Type B violation for violating one or more sections: 300.3240b) No fine

FACILITY NAME: Sharon Health Care Elms
FACILITY ADDRESS: 3611 North Rochelle
FACILITY CITY, STATE, ZIP: Peoria, IL 61604

DOCKET NUMBER: NH 16-C0021

LICENSEE INFO: Sharon Health Care Elms, Inc.
LICENSEE ADDRESS: 465 Central Avenue, Ste 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
Survey Date – 12/17/2015

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Shelbyville Manor
FACILITY ADDRESS: 1111 West North 12^th Street
FACILITY CITY, STATE, ZIP: Shelbyville, IL 62565

DOCKET NUMBER: NH 16-S0186

LICENSEE INFO: UDI #3, L.L. C.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 04/22/2016

Type B violation for violating one or more sections: 300.670a), 300.670c)1)2)3). No fine

Type B violation for violating one or more sections: 300.690b), 300.690c). No fine

Administrative Warning for violating the following section of the Code: 300.1230k)1), 300.1230k)1)2)3)4). No fine

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

DOCKET NUMBER: NH 16-C0130

LICENSEE INFO: South Lawn Sheltered Care, Inc.
LICENSEE ADDRESS: R.R. #1 Route 159
LICENSEE CITY, STATE, ZIP: Bunker Hill, IL 62014
Survey Date – 02/02/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 330.720e)1),2),3),4), 330.710f)1)2) and 330.4240f). A fine of $12,500.00.

Administrative Warning for violating the following section of the Code: 330.710a), 330.710b), 330.710c)1)2)3)A)B)C)D)E)F)G), No fine

FACILITY NAME: St. Paul’s Home
FACILITY ADDRESS: 1021 West E. Street
FACILITY CITY, STATE, ZIP: Belleville, IL 62220

DOCKET NUMBER: NH 16-S0060

LICENSEE INFO: St. Paul’s Home
LICENSEE ADDRESS: 23 Public Square #300
LICENSEE CITY, STATE, ZIP: Belleville, IL 62220
Survey Date – 12/22/2015

FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Sunny Acres Nursing Home
FACILITY ADDRESS: 19130 Sunny Acres Road
FACILITY CITY, STATE, ZIP: Petersburg, IL 62675

DOCKET NUMBER: NH 16-C0236

LICENSEE INFO: Menard County
LICENSEE ADDRESS: Route 97, Sixth St., P.O. Box 465
LICENSEE CITY, STATE, ZIP: Petersburg, IL 62675
Survey Date – 04/27/2016

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

DOCKET NUMBER: NH 16-C0139

LICENSEE INFO: Petersen Health Care II, Inc.
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 01/19/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)2), 300.1210d)5), and 300.3240a). The fine was doubled in this instance in accordance with 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: Swansea Rehab & Hlth Care Ctr
FACILITY ADDRESS: 1405 North Second Street
FACILITY CITY, STATE, ZIP: Swansea, IL 62226

DOCKET NUMBER: NH 16-C0158

LICENSEE INFO: Petersen Health Care, IL, Inc.
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/08/2016

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)1), 300.1210d)2), 1210d)3) 300.1210d)5), 300.1220b)3), 300.1620a), 300.1630d), 300.3220f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Terraces at the Clare
FACILITY ADDRESS: 55 East Pearson Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60611

DOCKET NUMBER: NH 16-S0220

LICENSEE INFO: Chicago Senior Care, LLC
LICENSEE ADDRESS: 208 So. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/14/2016

Type B violation for violating one or more sections: 300.615e). No fine

Type B violation for violating one or more sections: 300.690b)c). No fine

FACILITY NAME: Timbercreek Rehab & Hlth C. Ctr
FACILITY ADDRESS: 2220 State Street
FACILITY CITY, STATE, ZIP: Pekin, IL 61554

DOCKET NUMBER: NH 16-C0165

LICENSEE INFO: Petersen Health Operations, L.L.C.
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 02/19/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)1), 300.1210d)2), 300.1620a), 300.3220f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Transitional Care of Arl Hts.
FACILITY ADDRESS: 1200 N. Arlington Heights Rd
FACILITY CITY, STATE, ZIP: Arlington Hts, IL 60004

DOCKET NUMBER: NH 16-S0214

LICENSEE INFO: Transitional Care Center of Arlington Heights, LLC
LICENSEE ADDRESS: 345 N. Canal St., #1208
LICENSEE CITY, STATE, ZIP: Chicago, IL 60062
Survey Date – 05/05/2016

Type B violation for violating one or more sections: 300.696c)2)6). No fine

Type B violation for violating one or more sections: 300.1210b)d)2). No fine

Type B violation for violating one or more sections: 300.2090b), 750.325b). No fine

FACILITY NAME: Trinity Living Center #3
FACILITY ADDRESS: 3360 Francis Lane
FACILITY CITY, STATE, ZIP: Joliet, IL 60432

DOCKET NUMBER: NH 16-C0240

LICENSEE INFO: Trinity Service, Inc.
LICENSEE ADDRESS: 71 North Chicago Street
LICENSEE CITY, STATE, ZIP: Joliet, IL 60431
Survey Date – 05/12/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 350.620a), 350.1210), 350.1220j), 350.3240a) and 350.3240c). A fine of $6,250.00.

FACILITY NAME: Villa at South Holland, The
FACILITY ADDRESS: 16300 Wausau Street
FACILITY CITY, STATE, ZIP: South Holland, IL 60473

DOCKET NUMBER: NH 16-C0191

LICENSEE INFO: The Villa at South Holland
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 03/16/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1030a)1), 300.1030a)2), 300.1030b), 300.1030c), 300.1030d), 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: Warren Barr Lincolnshire
FACILITY ADDRESS: 150 Jamestown Lane
FACILITY CITY, STATE, ZIP: Lincolnshire, IL 60069

DOCKET NUMBER: NH 16-C0208

LICENSEE INFO: Lincolnshire Living & Rehab Center, LLC
LICENSEE ADDRESS: 7040 N. Ridgeway
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 04/12/2016

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

FACILITY NAME: Warren Barr North Shore
FACILITY ADDRESS: 2773 Skokie Valley Road
FACILITY CITY, STATE, ZIP: Highland Park, IL 60035

DOCKET NUMBER: NH 16-C0215

LICENSEE INFO: Warren Barr North Shore, LLC
LICENSEE ADDRESS: 7040 N. Ridgeway Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 04/07/2016

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

FACILITY NAME: West Chicago Terrace NH
FACILITY ADDRESS: 928 Joliet Road
FACILITY CITY, STATE, ZIP: Chicago, IL 60185

DOCKET NUMBER: NH 16-C0184

LICENSEE INFO: WCT Care, LLC
LICENSEE ADDRESS: 1S443 Summit Avenue, Ste 204
LICENSEE CITY, STATE, ZIP: Oakbrook Terrace, IL 60181
Survey Date – 03/24/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.625k)o), 300.626c), 300.626d)2)3), 300.690a)b)c), 300.1210b) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.625k), 300.625o), 300.1210b) and 300.3240a). A fine of $25,000.00.

FACILITY NAME: Wesley Village
FACILITY ADDRESS: 1200 East Grant Street
FACILITY CITY, STATE, ZIP: Macomb, IL 61455

DOCKET NUMBER: NH 16-S0200

LICENSEE INFO: Wesley Village, Incorporated
LICENSEE ADDRESS: 1200 East Grant Street
LICENSEE CITY, STATE, ZIP: Macomb, IL 61455
Survey Date – 03/21/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 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: 300.1210b), 300.3240a) 300.3240d) and 3300.3240e). A fine of $25,000.00.

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

DOCKET NUMBER: NH 16-S0182

LICENSEE INFO: Westminister Village, IL
LICENSEE ADDRESS: 2025 East Lincoln Street
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 04/14/2016

Type B violation for violating one or more sections: 300.2080a). No fine

Type B violation for violating one or more sections: 300.3100d)7). No fine

Administrative Warning for violating the following section of the Code: 300.1230k), 300.1230l)4). No fine

FACILITY NAME: Willow Crest Nursing Pavilion
FACILITY ADDRESS: 515 North Main Street
FACILITY CITY, STATE, ZIP: Sandwich, IL 60548

DOCKET NUMBER: NH 16-S0223

LICENSEE INFO: Willow Crest Nursing Pavilion, LTD
LICENSEE ADDRESS: 191 North Wacker Dr. Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 04/19/2016

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), 300.2210b)2), 300.2920e), and 300.3240a). The fine was doubled in this instance in accordance with 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: Winchester House
FACILITY ADDRESS: 1125 North Milwaukee Avenue
FACILITY CITY, STATE, ZIP: Libertyville, IL 60048

DOCKET NUMBER: NH 16-S0143

LICENSEE INFO: Transitional Care of Lake County, LLC
LICENSEE ADDRESS: 1 N. LaSalle Street, Ste 1350
LICENSEE CITY, STATE, ZIP: Chicago, IL 60602
Survey Date – 03/17/2016

Type B violation for violating one or more sections: 300.696, 300.1210d)6), and 300.1650b). No fine

Type B violation for violating one or more sections: 300.1210d)6). No fine

Type B violation for violating one or more sections: 300.1650b). No fine

FACILITY NAME: Windmill Nursing Pavilion
FACILITY ADDRESS: 16000 South Wabash
FACILITY CITY, STATE, ZIP: South Holland, IL 60473

DOCKET NUMBER: NH 16-C0163

LICENSEE INFO: Windmill Nursing Pavilion, LTD
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 02/17/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010i), 300.1030a)1), 300.1035e) and 300.3240a). The fine was doubled in this instance in accordance 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.

Administrative Warning for violating the following section of the Code: 300.690b) and 300.690c). No fine

FACILITY NAME: Winston Manor CNV & Nursing
FACILITY ADDRESS: 2155 West Pierce
FACILITY CITY, STATE, ZIP: Chicago, IL 60622

DOCKET NUMBER: NH 16-S0219

LICENSEE INFO: RREM, Inc
LICENSEE ADDRESS: 6500 N. Hamlin Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 04/21/2016

Type B violation for violating one or more sections: 300.615e). No fine

Type B violation for violating one or more sections: 300.2820a)1)C). No fine