2nd Quarter Report April-June 2017

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: A. Merkle C Knipprath N.H.
FACILITY ADDRESS: 1190 E. 2900 North Road
FACILITY CITY, STATE, ZIP: Clifton, IL 60927

DOCKET NUMBER: NH 17-S0273

LICENSEE INFO: Arthur Merkle –Clara Knipprath Nursing Home
LICENSEE ADDRESS: 18927 Hickory Creek Drive, Suite 300
LICENSEE CITY, STATE, ZIP: Mokena, IL 60448
Survey Date – 04/27/2017

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: Addison Rehab and Living Center
FACILITY ADDRESS: 1754-1760 Capital Street
FACILITY CITY, STATE, ZIP: Elgin, IL 60124

DOCKET NUMBER: NH 17-S0187

LICENSEE INFO: Addison Rehabilitation ad Living Center, LLC
LICENSEE ADDRESS: 2920 W. Coyle Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60645
Survey Date – 04/05/2017

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

Type C violation for violating one or more sections: 300.2100. No fine

FACILITY NAME: Addolorata Villa
FACILITY ADDRESS: 555 McHenry Road
FACILITY CITY, STATE, ZIP: Wheeling, IL 60090

DOCKET NUMBER: NH 17-S0237

LICENSEE INFO: Franciscan Communities, Inc.
LICENSEE ADDRESS: 208 South LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/07/2017

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

DOCKET NUMBER: NH 17-S0208

LICENSEE INFO: Home and Environments for Living and Programs, Inc.
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 02/15/2017

Type B violation for violating one or more of the following sections of the Code: 350.620a), 350.1230d)1) and 350.3240a). A fine of $550.00.

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

DOCKET NUMBER: NH 17-S0254

LICENSEE INFO: Aperion Care Bloomington, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/20/2017

Type B violation for violating one or more sections: 300.4030o). No fine

Administrative Warning for violating the following section of the Code: 300.1230b)d)j)k)l)

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

DOCKET NUMBER: NH 17-S0257

LICENSEE INFO: Berkshire Nursing & Rehab Center, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/21/2017

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

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

DOCKET NUMBER: NH 17-S0220

LICENSEE INFO: Riviera Care Center, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/06/2017

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

FACILITY NAME: Arden Courts of Northbrook
FACILITY ADDRESS: 3240 Milwaukee Avenue
FACILITY CITY, STATE, ZIP: Northbrook, IL 60062

DOCKET NUMBER: NH 17-S0236

LICENSEE INFO: Arden Courts of Northbrook, IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 04/05/2017

Type B violation for violating one or more sections: 330.790a)c)1)4). No fine

Type B violation for violating one or more sections: 330.1950b)1). No fine

Administrative Warning for violating the following section of the Code: 330.1990a).

Type B violation for violating one or more sections: 330.1940f). No fine

FACILITY NAME: Bayside Terrace
FACILITY ADDRESS: 1100 South Lewis Avenue
FACILITY CITY, STATE, ZIP: Waukegan, IL 60085I

DOCKET NUMBER: NH 17-C0185

LICENSEE INFO: Bayside Terrace, Inc.
LICENSEE ADDRESS: 600 Central Avenue, Suite 380
LICENSEE CITY, STATE, ZIP: Highland Park, IL 60035
Survey Date – 03/27/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.3240a), 300.3240b), 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: Belmont Village Oak Park
FACILITY ADDRESS: 1035 Madison Street
FACILITY CITY, STATE, ZIP: Oak Park, IL 60302

DOCKET NUMBER: NH 17-C0161

LICENSEE INFO: Belmont Village Oak Park Tenant, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL, 62703
Survey Date – 03/20/2017

Type B violation for violating one or more sections: 330.710a)b)c)2). No fine

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

DOCKET NUMBER: NH 17-S0170

LICENSEE INFO: Petersen Health Operations, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/21/2017

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: Calhoun Nursing & Rehab Center
FACILITY ADDRESS: 1 Myrtle Lane
FACILITY CITY, STATE, ZIP: Hardin, IL 62047

DOCKET NUMBER: NH 17-C0147

LICENSEE INFO: Calhoun Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 901 S. 2^nd Street, Suite 201
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 02/24/2017

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.

FACILITY NAME: Calumet City Terrace
FACILITY ADDRESS: 1380 River Drive
FACILITY CITY, STATE, ZIP: Calumet City, IL 60409

DOCKET NUMBER: NH 16-S0300

LICENSEE INFO: Pioneer Concepts, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 06/16/2016

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

FACILITY NAME: Charleston Rehab and Health Care Center
FACILITY ADDRESS: 716 Eighteenth Street
FACILITY CITY, STATE, ZIP: Charleston, IL 61920

DOCKET NUMBER: NH 17-S0157

LICENSEE INFO: Petersen Health Network, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/01/2017

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 300.3240a). 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: Christian Nursing Home
FACILITY ADDRESS: 1507 7^th Street
FACILITY CITY, STATE, ZIP: Lincoln, IL 62656

DOCKET NUMBER: NH 17-S0192

LICENSEE INFO: Christian Homes, Inc
LICENSEE ADDRESS: 200 N. Postville Drive
LICENSEE CITY, STATE, ZIP: Lincoln, IL 62656
Survey Date – 03/16/2017

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

Administrative Warning for violating the following section of the Code: 300.1230j)5)k).

FACILITY NAME: Chicago Ridge Nursing Center
FACILITY ADDRESS: 10602 Southwest Highway
FACILITY CITY, STATE, ZIP: Chicago Ridge, IL 60415

DOCKET NUMBER: NH 17-C0197

LICENSEE INFO: BM of Chicago Ridge, LLC
LICENSEE ADDRESS: 6500 N. Hamlin
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 03/27/2017

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

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

DOCKET NUMBER: NH 17-C0276

LICENSEE INFO: CC Care, LLC
LICENSEE ADDRESS: 1S443 Summit Avenue, Suite 204
LICENSEE CITY, STATE, ZIP: Oak Brook Terrace, IL 60181
Survey Date – 04/28/2017

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

DOCKET NUMBER: NH 17-S0272

LICENSEE INFO: Covenant Health Care Center, Inc.
LICENSEE ADDRESS: 2155 Pfingsten Road
LICENSEE CITY, STATE, ZIP: Northbrook, IL 60062
Survey Date – 05/25/2017

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

FACILITY NAME: Covenant Hlth Cr Ctr-Batavia
FACILITY ADDRESS: 831 North Batavia Avenue
FACILITY CITY, STATE, ZIP: Batavia, IL 60510

DOCKET NUMBER: NH 17-C0277

LICENSEE INFO: Covenant Health Care Center, Inc.
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 05/11/2017

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

DOCKET NUMBER: NH 17-S0234

LICENSEE INFO: Danville Care Center, LTD
LICENSEE ADDRESS: 5750 Old Orchard Road, Suite 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077
Survey Date – 04/07/2017

Administrative Warning for violating the following section of the Code: 300.1230b), 300.1230d)1)2), 300.1230j)5), and 300.1230l)1)2)3)4)5)6).

Type B violation for violating one or more sections: 300.2010a)1) and 300.330. No fine

Administrative Warning for violating the following section of the Code: 300.3060b)2)

Administrative Warning for violating the following section of the Code: 300.3060e)1)C)

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

DOCKET NUMBER: NH 17-C0133

LICENSEE INFO: Danville Care Center, LTD
LICENSEE ADDRESS: 5750 Old Orchard Road, Suite 420
LICENSEE CITY, STATE, ZIP: Danville, IL 60077
Survey Date – 02/11/2017

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

FACILITY NAME: Daystar Nursing & Rehab Center
FACILITY ADDRESS: 2001 Cedar Street
FACILITY CITY, STATE, ZIP: Cairo, IL 62914

DOCKET NUMBER: NH 17-S0191

LICENSEE INFO: Daystar Nursing & Rehabilitation Center, LLC
LICENSEE ADDRESS: 2202 Main Street, Suite 180
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 03/03/2017

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

DOCKET NUMBER: NH 17-C0204

LICENSEE INFO: Du Page County Board
LICENSEE ADDRESS: 421 County Farm Road
LICENSEE CITY, STATE, ZIP: Wheaton, IL 60187
Survey Date – 03/24/2017

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: Effingham Rehab & Health Care Center
FACILITY ADDRESS: 1610 North Lakewood Drive
FACILITY CITY, STATE, ZIP: Effingham, IL 62401

DOCKET NUMBER: NH 17-S0199

LICENSEE INFO: Petersen Health Care VII, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/16/2017

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

Type B violation for violating one or more sections: 300.661. No fine

Administrative Warning for violating the following section of the Code 300.680a)c).

Administrative Warning for violating the following section of the Code 300.696a)c)2)7).

Administrative Warning for violating the following section of the Code 300.1060c)d).

Administrative Warning for violating the following section of the Code 300.1410a)g)h)1)2)3)4)5)6)7)8)9).

Administrative Warning for violating the following section of the Code 300.1620a).

Type C violation for violating one or more sections: 300.2220a)1). No fine

FACILITY NAME: Elizabeth Nursing Home
FACILITY ADDRESS: 540 Pleasant Street
FACILITY CITY, STATE, ZIP: Elizabeth, IL 61028

DOCKET NUMBER: NH 17-S0249

LICENSEE INFO: Elizabeth Nursing Home, Inc.
LICENSEE ADDRESS: 540 Pleasant Street
LICENSEE CITY, STATE, ZIP: Elizabeth, IL 61028
Survey Date – 04/12/2017

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

Type B violation for violating one or more sections: 300.661. No fine

Type C violation for violating one or more sections: 300.686b). No fine

FACILITY NAME: Evergreen Nursing & Rehab Center
FACILITY ADDRESS: 1115 North Wenthe
FACILITY CITY, STATE, ZIP: Effingham, IL 62401

DOCKET NUMBER: NH 17-C0178

LICENSEE INFO: Evergreen Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 1625 S. 6^th Street
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 03/16/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1620c), 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: Forest City Rehab & Nursing Center
FACILITY ADDRESS: 321 Arnold Avenue
FACILITY CITY, STATE, ZIP: Rockford, IL 61108

DOCKET NUMBER: NH 17-C0247

LICENSEE INFO: Forest City Rehab and Nursing Center, LLC
LICENSEE ADDRESS: 4711 Golf Road, Suite 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 04/06/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.2210b)8), 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: Harmony Nursing & Rehab Center
FACILITY ADDRESS: 3919 West Forest Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60625

DOCKET NUMBER: NH 17-C0163

LICENSEE INFO: Harmony Nursing and Rehabilitation Center, Inc.
LICENSEE ADDRESS: 6633 North Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712
Survey Date – 03/02/2017

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: Havana Health Care Center
FACILITY ADDRESS: 609 North Harpham Street
FACILITY CITY, STATE, ZIP: Havana, IL 62644

DOCKET NUMBER: NH 17-S0263

LICENSEE INFO: Petersen Health Quality, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 04/20/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1220b)3), 300.3240a) and 300.3300d)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) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Heartland of Decatur
FACILITY ADDRESS: 444 W. Harrison Street
FACILITY CITY, STATE, ZIP: Decatur, IL 62526

DOCKET NUMBER: NH 16-C0448

LICENSEE INFO: Heartland of Decatur, IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 08/29/2016

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

FACILITY NAME: Heddington Oaks
FACILITY ADDRESS: 2223 West Heading Avenue
FACILITY CITY, STATE, ZIP: Peoria, IL 61604

DOCKET NUMBER: NH 17-S0267

LICENSEE INFO: Peoria County Board
LICENSEE ADDRESS: 324 Main Street, Room 502
LICENSEE CITY, STATE, ZIP: Peoria, IL 61602
Survey Date – 03/29/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1010i) 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: Helia Healthcare of Belleville
FACILITY ADDRESS: 40 North 64^th Street
FACILITY CITY, STATE, ZIP: Belleville, IL 62223

DOCKET NUMBER: NH 17-C0179

LICENSEE INFO: Helia Healthcare of Belleville, LLC
LICENSEE ADDRESS: 118 W. Edwards Street, Suite 200
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 03/09/2017

FACILITY NAME: Hillside Rehab & Care Center
FACILITY ADDRESS: 1308 Game Farm Road
FACILITY CITY, STATE, ZIP: Yorkville, IL 60560

DOCKET NUMBER: NH 17-S0195

LICENSEE INFO: Helia Healthcare of Yorkville, LLC
LICENSEE ADDRESS: 118 W. Edwards Street, Suite 200
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 03/17/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 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: Hope Creek Care Center
FACILITY ADDRESS: 4343 Kennedy Drive
FACILITY CITY, STATE, ZIP: East Moline, IL 61244

DOCKET NUMBER: NH 17-S0155

LICENSEE INFO: Rock Island County
LICENSEE ADDRESS: 1504 Third Avenue
LICENSEE CITY, STATE, ZIP: Rock Island, IL 61201
Survey Date – 03/02/2017

FACILITY NAME: Illinois Knights Templar Home
FACILITY ADDRESS: 450 Fulton Street, P.O. Box 49
FACILITY CITY, STATE, ZIP: Paxton, IL 60957

DOCKET NUMBER: NH 17-S0175

LICENSEE INFO: Illinois Knights Templar Home
LICENSEE ADDRESS: 115 W. Jefferson Street, Suite 401
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 03/09/2017

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)3), 300.1210d)5), 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)5) and 300.3240a). A fine of $2,200.00.

Type B violation of an occurrence for violating the following section of the Code: 300.670k)1)2)3)- No fine

Type B violation of an occurrence for violating the following section of the Code: 300.1230b)d)1)2)j)5)k)l)1)2)3)4)5)6)- No fine

Type B violation of an occurrence for violating the following section of the Code: 300.3260c)- No fine

FACILITY NAME: Illinois Veterans’ Home - Anna
FACILITY ADDRESS: 792 North Main Street
FACILITY CITY, STATE, ZIP: Anna, IL 62906

DOCKET NUMBER: NH 17-S0213

LICENSEE INFO: Illinois Department of Veterans’ Affairs
LICENSEE ADDRESS: 833 S. Spring Street, Box 19432
LICENSEE CITY, STATE, ZIP: Springfield, IL 62794
Survey Date – 04/06/2017

Type B violation for violating one or more sections: 340.1320. No fine

FACILITY NAME: IL Veterans’ Home at Manteno
FACILITY ADDRESS: One Veterans Drive
FACILITY CITY, STATE, ZIP: Manteno, IL 60950

DOCKET NUMBER: NH 17-C0092

LICENSEE INFO: Illinois Department of Veterans’ Affairs
LICENSEE ADDRESS: 833 South Spring Street, Box 19432
LICENSEE CITY, STATE, ZIP: Springfield, IL 62794
Survey Date – 02/08/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 340.1505b)5), 340.1505g) and 340.1300a). 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) and 340.1505g). A fine of $2,200.00.

FACILITY NAME: IL Veterans’ Home at Manteno
FACILITY ADDRESS: One Veterans’ Drive
FACILITY CITY, STATE, ZIP: Manteno, IL 60950

DOCKET NUMBER: NH 17-C0239

LICENSEE INFO: Illinois Department of Veterans’ Affairs
LICENSEE ADDRESS: One Veterans’ Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62794
Survey Date – 04/21/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 340.1500)c. A fine of $1,100.00.

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

DOCKET NUMBER: NH 17-C0229

LICENSEE INFO: Belleville Behavioral Health & Nursing Center, LLC
LICENSEE ADDRESS: 2015 West Main Street, Suite 111
LICENSEE CITY, STATE, ZIP: Carbondale, IL 62901
Survey Date – 03/30/2017

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

FACILITY NAME: Joliet Terrace Nursing Center
FACILITY ADDRESS: 2230 McDonough Street
FACILITY CITY, STATE, ZIP: Joliet, IL 60436

DOCKET NUMBER: NH 17-S0280

LICENSEE INFO: JT Care, LLC
LICENSEE ADDRESS: 1S443 Summit Avenue, Ste 204
LICENSEE CITY, STATE, ZIP: Oakbrook Terrace, IL 60181
Survey Date – 05/19/2017

Type B violation for violating one or more sections: 300.625b) and 300.3240a. No fine

FACILITY NAME: King Home
FACILITY ADDRESS: 1555 Oak Avenue
FACILITY CITY, STATE, ZIP: Evanston, IL 60201

DOCKET NUMBER: NH 17-S0184

LICENSEE INFO: Westminster Place
LICENSEE ADDRESS: 3200 Grant Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60201
Survey Date – 04/05/2017

Type B violation of an occurrence for violating the following section of the Code: 330.1510a)g)- No fine

Administrative Warning for violating the following section of the Code: 330.3130c)d)e).

FACILITY NAME: Lebanon Care Center
FACILITY ADDRESS: 1201 North Alton
FACILITY CITY, STATE, ZIP: Lebanon, IL 62254

DOCKET NUMBER: NH 17-S0201

LICENSEE INFO: Petersen Health Group, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/24/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code:300.1010h), 300.1210b), 300.1210d)6), 300.1220b)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: Lena Living Center
FACILITY ADDRESS: 1010 South Logan Street
FACILITY CITY, STATE, ZIP: Lena, IL 61048

DOCKET NUMBER: NH 17-S0278

LICENSEE INFO: Lena Living Center, L.L.C.
LICENSEE ADDRESS: 161 N. St, Ste 4200
LICENSEE CITY, STATE, ZIP: Chicago, IL 60601
Survey Date – 05/04/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.3240a), 300.3240b), 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.

FACILITY NAME: Leroy Manor
FACILITY ADDRESS: 509 South Buck Road, P.O. Box 149
FACILITY CITY, STATE, ZIP: Leroy, IL 61752

DOCKET NUMBER: NH 17-S0177

LICENSEE INFO: UDI #4, LLC
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 03/17/2017

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: Lexington Health Care Center Lombard
FACILITY ADDRESS: 2100 South Finley Road
FACILITY CITY, STATE, ZIP: Lombard, IL 60148

DOCKET NUMBER: NH 17-C0154

LICENSEE INFO: Lexington Health Care Center of Lombard, Inc.
LICENSEE ADDRESS: 665 W. North Avenue
LICENSEE CITY, STATE, ZIP: Lombard, IL 60148
Survey Date – 02/17/2017

FACILITY NAME: Lexington of Chicago Ridge
FACILITY ADDRESS: 10300 Southwest Highway
FACILITY CITY, STATE, ZIP: Chicago Ridge, IL 60415

DOCKET NUMBER: NH 17-C0269

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 – 04/26/2017

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)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: Lincolnshire Assisted Lvg Ctr
FACILITY ADDRESS: 170 Jamestown Lane
FACILITY CITY, STATE, ZIP: Lincolnshire, IL 60069

DOCKET NUMBER: NH 17-S0160

LICENSEE INFO: Lincolnshire Assisted Living Center, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 03/16/2017

Type C violation for violating one or more sections: 330.1155(a)2))3)4)c)d). No fine

Type B violation for violating one or more sections: 330.4220f). No fine

Administrative Warning for violating the following section of the Code: 330.2000.

FACILITY NAME: Lydia Healthcare
FACILITY ADDRESS: 13901 South Lydia
FACILITY CITY, STATE, ZIP: Robbins, IL 60472

DOCKET NUMBER: NH 17-C0253

LICENSEE INFO: Lydia Healthcare I, LLC
LICENSEE ADDRESS: 13901 S. Lydia Avenue
LICENSEE CITY, STATE, ZIP: Robbins, IL 60472
Survey Date – 05/16/2017

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

FACILITY NAME: Mado Healthcare – Douglas Park
FACILITY ADDRESS: 1550 South Albany
FACILITY CITY, STATE, ZIP: Chicago, IL 60623

DOCKET NUMBER: NH 17-C0274

LICENSEE INFO: Sacred Heart Home Incorporated
LICENSEE ADDRESS: 1541 North Wells Street
LICENSEE CITY, STATE, ZIP: Chicago, IL 60610
Survey Date – 05/03/2017

Type AA violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.625b), 300.625f)4), 300.625j), 300.625m), 300.1210a), 300.1210b), 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: 300.625b), 300.625j), 300.1210b), 300.1210d)6) and 300.3240a). A fine of $50,000.00.

FACILITY NAME: Mado Healthcare-Old Town
FACILITY ADDRESS: 1121 North Orleans
FACILITY CITY, STATE, ZIP: Chicago, IL 60610

DOCKET NUMBER: NH 17-C0245

LICENSEE INFO: Margaret Manor, Inc.
LICENSEE ADDRESS: 1541 North Wells Street
LICENSEE CITY, STATE, ZIP: Chicago, IL 60610
Survey Date – 05/18/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210d)2), and 300.3220f. A fine of $1,100.00.

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

DOCKET NUMBER: NH 17-C0228

LICENSEE INFO: UDI #2, LLC
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 04/20/2017

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

FACILITY NAME: Manor Court of Peru
FACILITY ADDRESS: 3230 Becker Drive
FACILITY CITY, STATE, ZIP: Peru, IL 61354

DOCKET NUMBER: NH 17-S0233

LICENSEE INFO: Residential Alternatives of Illinois, Inc.
LICENSEE ADDRESS: 285 South Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401
Survey Date – 04/27/2017

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

FACILITY NAME: Manorcare of Westmont
FACILITY ADDRESS: 512 East Ogden Avenue
FACILITY CITY, STATE, ZIP: Westmont, IL 60559

DOCKET NUMBER: NH 17-S0139

LICENSEE INFO: Manor Care of Westmont, IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 02/09/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1220b)2), 300.1620a), 300.1630c) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

Type C violation of an occurrence for violating the following section of the Code: 300.615e). No fine

FACILITY NAME: Manorcare of Westmont
FACILITY ADDRESS: 512 East Ogden Avenue
FACILITY CITY, STATE, ZIP: Westmont, IL 60559

DOCKET NUMBER: NH 17-C0205

LICENSEE INFO: Manor Care of Westmont, IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604
Survey Date – 03/09/2017

FACILITY NAME: Meadowood
FACILITY ADDRESS: Second and Commerce
FACILITY CITY, STATE, ZIP: Grayville, IL 62844

DOCKET NUMBER: NH 17-S0260

LICENSEE INFO: Bonum, Inc.
LICENSEE ADDRESS: 11^th & State, P.O. Box 511
LICENSEE CITY, STATE, ZIP: Lawrenceville, IL 62439
Survey Date – 05/04/2017

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

DOCKET NUMBER: NH 16-S0407

LICENSEE INFO: Meadows Sheltered Care, Inc.
LICENSEE ADDRESS: 3250 South Plum Grove Road
LICENSEE CITY, STATE, ZIP: Rolling Meadows, IL 60008
Survey Date – 08/09/2016

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

FACILITY NAME: Meadows Mennonite Home
FACILITY ADDRESS: 24588 Church Street
FACILITY CITY, STATE, ZIP: Chenoa, IL 61726

DOCKET NUMBER: NH 16-C0438

LICENSEE INFO: Meadows Mennonite Retirement Community Association, Inc.
LICENSEE ADDRESS: 24588 Church Street
LICENSEE CITY, STATE, ZIP: Chenoa, IL 61726
Survey Date – 08/19/2016

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

FACILITY NAME: Meadows Mennonite Home
FACILITY ADDRESS: 24588 Church Street
FACILITY CITY, STATE, ZIP: Chenoa, IL 61726

DOCKET NUMBER: NH 17-C0216

LICENSEE INFO: Meadows Mennonite Retirement Community Association, Inc.
LICENSEE ADDRESS: 24588 Church Street
LICENSEE CITY, STATE, ZIP: Chenoa, IL 61726
Survey Date – 03/28/2017

Type A 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 $25,000.00.

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

DOCKET NUMBER: NH 17-C0180

LICENSEE INFO: Midway Neurological and Rehabilitation Center, LLC
LICENSEE ADDRESS: 150 Fenel Lane
LICENSEE CITY, STATE, ZIP: Bridgeview, IL 60162
Survey Date – 03/15/2017

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: Morton Terrace H & R Centre
FACILITY ADDRESS: 191 East Queenwood Road
FACILITY CITY, STATE, ZIP: Morton, IL 61550

DOCKET NUMBER: NH 17-C0243

LICENSEE INFO: Morton Terrace Healthcare & Rehabilitation Centre, LLC
LICENSEE ADDRESS: 161 N. Clark Street, Suite 4200
LICENSEE CITY, STATE, ZIP: Chicago, IL 60601
Survey Date – 04/18/2017

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $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 17-S0279

LICENSEE INFO: Morton Terrace Healthcare and Rehabilitation Centre, LLC
LICENSEE ADDRESS: 161 N. Clark Street, Ste 4200
LICENSEE CITY, STATE, ZIP: Chicago, IL 60601
Survey Date – 05/12/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.625n), 300.625p), 300.625q), 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: 300.625n), 300.1210b) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Mulberry Manor
FACILITY ADDRESS: 612 East Davie Street, Box 88
FACILITY CITY, STATE, ZIP: Anna, IL 62906

DOCKET NUMBER: NH 17-S0173

LICENSEE INFO: Mulberry Manor, Inc.
LICENSEE ADDRESS: 158 East Vienna Street, P.O. Box 88
LICENSEE CITY, STATE, ZIP: Anna, IL 62906
Survey Date – 02/16/2017

Type A violation of an occurrence for violating one or more of the following sections of the Code: 350.620a) 350.1210, 350.1220j), 350.1230b)6)7), 350.1230c), 350.1230d)1)2), 350.3220f), 350.3240a), 350.3240b), 350.3240d) and 350.3240f). A fine of $10,000.00.

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

DOCKET NUMBER: NH 17-C0166

LICENSEE INFO: Petersen Health Operations, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/07/2017

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

FACILITY NAME: North Logan Healthcare Center
FACILITY ADDRESS: 801 North Logan Avenue
FACILITY CITY, STATE, ZIP: Danville, IL 61832

DOCKET NUMBER: NH 17-S0265

LICENSEE INFO: North Logan Health Care Center Investors, L.L.C.
LICENSEE ADDRESS: 8170 North McCormick Blvd, Suite 219
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 05/19/2017

Type B violation for violating one or more sections: 300.625c)1). No fine

Type B violation for violating one or more sections: 300.661 and 955.165a)1)b)c). No fine

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

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

DOCKET NUMBER: NH 17-S0224

LICENSEE INFO: DeKalb Area Retirement Center
LICENSEE ADDRESS: 2944 Greenwood Acres Drive
LICENSEE CITY, STATE, ZIP: DeKalb, IL 60115
Survey Date – 04/04/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 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: Oak Hill
FACILITY ADDRESS: 623 Hamacher Street
FACILITY CITY, STATE, ZIP: Waterloo, IL 62298

DOCKET NUMBER: NH 17-S0196

LICENSEE INFO: County of Monroe
LICENSEE ADDRESS: 100 South Main Street
LICENSEE CITY, STATE, ZIP: Waterloo, IL 62298
Survey Date – 03/03/2017

FACILITY NAME: Paxton Healthcare and Rehab
FACILITY ADDRESS: 1240 North Market Street
FACILITY CITY, STATE, ZIP: Paxton, IL 60957

DOCKET NUMBER: NH 17-C0120

LICENSEE INFO: Paxton Healthcare and Rehab, LLC
LICENSEE ADDRESS: 2202 Main Street, Suite 180
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 01/25/2017

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

FACILITY NAME: Pleasant Hill Village
FACILITY ADDRESS: 1010 West North Street
FACILITY CITY, STATE, ZIP: Girard, IL 62640

DOCKET NUMBER: NH 17-C0250

LICENSEE INFO: Brethren Home of Girard, Illinois
LICENSEE ADDRESS: 1010 West North Street
LICENSEE CITY, STATE, ZIP: Girard, IL 62640
Survey Date – 04/13/2017

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

Total fines of $27,200.00.

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

DOCKET NUMBER: NH 17-C0146

LICENSEE INFO: Petersen Health Business, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 02/28/2017

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1010i), 300.1210b)4)5), 300.1210d)3)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: Prairie City Rehab & HC
FACILITY ADDRESS: 825 East Main Street, R.R.#2, Box 97
FACILITY CITY, STATE, ZIP: Prairie City, IL 61470

DOCKET NUMBER: NH 17-S0238

LICENSEE INFO: Midwest Health Operations, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 05/04/2017

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

DOCKET NUMBER: NH 17-C0168

LICENSEE INFO: Rutledge-Regency Operations, LLC
LICENSEE ADDRESS: 202 N. Center Street
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 03/04/2017

FACILITY NAME: Regency Care of Morris
FACILITY ADDRESS: 1095 Twilight Drive
FACILITY CITY, STATE, ZIP: Morris, IL 60450

DOCKET NUMBER: NH 17-C0268

LICENSEE INFO: Morris SNF Management, LLC
LICENSEE ADDRESS: 1315 West Lawrence Avenue
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704
Survey Date – 05/30/2017

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), 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: Rivershores Health & Rehab Center
FACILITY ADDRESS: 578 W. Commercial Street
FACILITY CITY, STATE, ZIP: Marseilles, IL 61341

DOCKET NUMBER: NH 17-S0214

LICENSEE INFO: Rivershores Healthcare and Rehabilitation Centre, LLC
LICENSEE ADDRESS: 161 N. Clark Street, Suite 4200
LICENSEE CITY, STATE, ZIP: Chicago, IL 60601
Survey Date – 03/30/2017

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: Rosary Hill Home
FACILITY ADDRESS: 9000 West 81^st Street
FACILITY CITY, STATE, ZIP: Justice, IL 60458

DOCKET NUMBER: NH 17-S0190

LICENSEE INFO: Dominican Sisters of Chicago
LICENSEE ADDRESS: 9000 West 81^st Street
LICENSEE CITY, STATE, ZIP: Justice, IL 60458
Survey Date – 04/07/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1030a)1)2)3)4)5)b)c)d). A fine of $1,100.00.

FACILITY NAME: Rosewood Care Center Galesburg
FACILITY ADDRESS: 1250 W. Carl Sandburg Drive
FACILITY CITY, STATE, ZIP: Galesburg, IL 61401

DOCKET NUMBER: NH 17-C0183

LICENSEE INFO: Bravo Care of Galesburg, Inc.
LICENSEE ADDRESS: 412 East Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 03/02/2017

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: Rosewood Care Center of Peoria
FACILITY ADDRESS: 1500 W. Northmoor Road
FACILITY CITY, STATE, ZIP: Peoria, IL 61614

DOCKET NUMBER: NH 17-S0251 & NH 17-C0252

LICENSEE INFO: Bravo Care of Peoria, Inc.
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 04/13/2017

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 300.3240a). 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: Sauk Valley Senior Living
FACILITY ADDRESS: 1000 Dixon Avenue
FACILITY CITY, STATE, ZIP: Rock Falls, IL 61071

DOCKET NUMBER: NH 17-C0167

LICENSEE INFO: Midwest Health Operations, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/01/2017

Type B violation for violating one or more sections: 300.670a) and 300.670i)2). No fine

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

DOCKET NUMBER: NH 17-C0156

LICENSEE INFO: Sharon Health Care Elms, Inc.
LICENSEE ADDRESS: 465 Central Avenue, Suite 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
Survey Date – 03/08/2017

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.

Administrative Warning for violating the following sections of the Code: 300.690c). No fine

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

DOCKET NUMBER: NH 17-S0171

LICENSEE INFO: Sharon Health Care Willows, Inc.
LICENSEE ADDRESS: 465 Central Avenue, Suite 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093
Survey Date – 03/01/2017

FACILITY NAME: Sheldon Health Care Center
FACILITY ADDRESS: 170 West Concord
FACILITY CITY, STATE, ZIP: Sheldon, IL 60966

DOCKET NUMBER: NH 17-S0255

LICENSEE INFO: Petersen Health Enterprises, L.L.C.
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 05/03/2017

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

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

DOCKET NUMBER: NH 17-C0158

LICENSEE INFO: SV Care, LLC
LICENSEE ADDRESS: 1S433 Summitt Avenue, Suite 204
LICENSEE CITY, STATE, ZIP: Oakbrook Terrace, IL 60181
Survey Date – 02/06/2017

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

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

DOCKET NUMBER: NH 17-C0172

LICENSEE INFO: SV Care, LLC
LICENSEE ADDRESS: 1S433 Summitt Avenue, Suite 204
LICENSEE CITY, STATE, ZIP: Oakbrook Terrace, IL 60181
Survey Date – 03/28/2017

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.

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.615e), 300.615f) and 300.615j) The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.615e) and 300.615f). A fine of $2,200.00.

Total Fines $4,400.00.

FACILITY NAME: Spring Creek Nrsg & Rehab Ctr
FACILITY ADDRESS: 777 Draper Avenue
FACILITY CITY, STATE, ZIP: Joliet, IL 60432

DOCKET NUMBER: NH 17-C0227

LICENSEE INFO: Spring Creek Nursing & Rehab Center, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202
Survey Date – 03/27/2017

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

DOCKET NUMBER: NH 16-C0328

LICENSEE INFO: St. Paul’s Home
LICENSEE ADDRESS: 23 Public Square #300
LICENSEE CITY, STATE, ZIP: Belleville, IL 62220
Survey Date – 06/20/2016

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

FACILITY NAME: Sterling Pavilion
FACILITY ADDRESS: 105 East 23^rd Street
FACILITY CITY, STATE, ZIP: Sterling, IL 61081

DOCKET NUMBER: NH 17-S0231

LICENSEE INFO: Sterling Pavilion, LTD
LICENSEE ADDRESS: 191 North Wacker Drive, Suite 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 04/26/2017

Type B violation for violating one or more sections: 300.661. No fine

Administrative Warning for violating the following section of the Code: 300.1610k) and 300.16101).

Administrative Warning for violating the following section of the Code: 300.615e) and 300.615f).

FACILITY NAME: Sunset Home
FACILITY ADDRESS: 418 Washington Street
FACILITY CITY, STATE, ZIP: Quincy, IL 62301

DOCKET NUMBER: NH 16-S0387

LICENSEE INFO: Sunset Home
LICENSEE ADDRESS: 625 Vermont Street
LICENSEE CITY, STATE, ZIP: Quincy, IL 62301
Survey Date – 08/10/2016

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

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

DOCKET NUMBER: NH 17-C0258

LICENSEE INFO: Symphony Bronzeville Park
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 04/28/2017

Type B violation for violating one or more sections: 300.3300c)1)A)B)C)D), 300.3300d), 300.3300j), and 300.3300v)1)2). No fine

FACILITY NAME: Symphony of Morgan Park
FACILITY ADDRESS: 10935 S. Halsted Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60628

DOCKET NUMBER: NH 17-C0140

LICENSEE INFO: Symphony Park South, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 02/08/2017

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

DOCKET NUMBER: NH 17-C0246

LICENSEE INFO: Symphony Oswego, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703
Survey Date – 04/06/2017

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

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

DOCKET NUMBER: NH 17-S0244

LICENSEE INFO: TN Care, LLC
LICENSEE ADDRESS: 1S443 Summitt Avenue, Suite 204
LICENSEE CITY, STATE, ZIP: Oakbrook Terrace, IL 60181
Survey Date – 05/10/2017

FACILITY NAME: The Admiral at the Lake
FACILITY ADDRESS: 933 West Foster Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60640

DOCKET NUMBER: NH 17-S0181

LICENSEE INFO: The Admiral at the Lake
LICENSEE ADDRESS: 933 West Foster Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60640
Survey Date – 03/06/2017

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

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

Total Fines $4,400.00.

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

DOCKET NUMBER: NH 17-S0281

LICENSEE INFO: The Iroquois Memorial Hospital and Resident Home
LICENSEE ADDRESS: 123 S. 4^th Street
LICENSEE CITY, STATE, ZIP: Watseka, IL 60970
Survey Date – 05/25/2017

Type B violation for violating one or more sections: 300.661 and 955.165a)1)b)c). No fine

Type B violation for violating one or more sections: 300.6`5e)f). No fine

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

DOCKET NUMBER: NH 17-S0182

LICENSEE INFO: Lutheran Hillside Village, Inc.
LICENSEE ADDRESS: 6901 N. Galena Road
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 03/09/2017

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1620a) and 300.1630b). A fine of $1,100.00.

Type B violation of an occurrence for violating the following section of the Code: 300.625j)5)- No fine

Administrative Warning for violating the following section of the Code: 300.740e).

Administrative Warning for violating the following section of the Code: 300.7050d)e).

Administrative Warning for violating the following section of the Code: 300.615e)f).

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

DOCKET NUMBER: NH 17-C0212

LICENSEE INFO: Veracare Brentwood, LLC
LICENSEE ADDRESS: 6312 N. Central Park Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60659
Survey Date – 04/04/2017

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

Type B violation for violating one or more sections: 300.3300)3)4)5)f)g)y). No fine

FACILITY NAME: Washington Christian Village
FACILITY ADDRESS: 1201 Newcastle Road
FACILITY CITY, STATE, ZIP: Washington, IL 61571

DOCKET NUMBER: NH 17-C0144

LICENSEE INFO: Christian Homes, Inc.
LICENSEE ADDRESS: 200 North Potsville Road
LICENSEE CITY, STATE, ZIP: Lincoln, IL 62656
Survey Date – 02/08/2017

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), 300.1210d)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.

Type A 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 $25,000.00.

Total fines of $50,000.00.

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

DOCKET NUMBER: NH 17-S0206

LICENSEE INFO: Warren Barr North Shore
LICENSEE ADDRESS: 3450 Oakton Street
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076
Survey Date – 03/28/2017

Type B violation for violating one or more sections: 300.615e), 300.615f), 300.625c)1), and 300.625e). No fine

Type B violation for violating one or more sections: 300.625c)1)e). No fine

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

DOCKET NUMBER: NH 17-S0202

LICENSEE INFO: Waterford Terrace, Inc.
LICENSEE ADDRESS: 191 N. Wacker Drive, Suite 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606
Survey Date – 03/16/2017

Type B violation for violating one or more sections: 300.661. No fine

FACILITY NAME: Wentworth Rehab & HCC
FACILITY ADDRESS: 201 West 69^th Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60621

DOCKET NUMBER: NH 16-S0466

LICENSEE INFO: Wentworth Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 West Peterson Avenue, Suite 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 09/12/2016

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

FACILITY NAME: Wentworth Rehab & HCC
FACILITY ADDRESS: 201 West 69^th Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60621

DOCKET NUMBER: NH 17-S0145

LICENSEE INFO: Wentworth Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Avenue, Suite 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646
Survey Date – 02/09/2017

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), 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.

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.670a), 300.670c)1)2)3), 300.670d), 300.1210b) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00.

Total fines of $50,000.00.

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

DOCKET NUMBER: NH 17-S0248

LICENSEE INFO: Westminster Village, Inc.
LICENSEE ADDRESS: 2025 East Lincoln Street
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701
Survey Date – 05/11/2017

Type C violation for violating one or more sections: 300.650d), 300.650g) and 965.165a)1)B)2). No fine

Type B violation for violating one or more sections: 300.1010h). No fine

Type B violation for violating one or more sections: 300.1620a) and 300.1620c). No fine

Type B violation for violating one or more sections: 300.1810b) and 300.1810c)3). No fine

Type B violation for violating one or more sections: 300.2040b), 300.2040c) and 300.2040e). No fine

FACILITY NAME: Willow Rose Rehab & Health
FACILITY ADDRESS: 410 Fletcher
FACILITY CITY, STATE, ZIP: Jerseyville, IL 62052

DOCKET NUMBER: NH 17-C0225

LICENSEE INFO: Petersen Health Network, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614
Survey Date – 04/11/2017

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

2nd Quarter Report April-June 2017

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2nd Quarter Report April-June 2017

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