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2020 1st Quarterly Report

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

FACILITY NAME: Alden Estates of Barrington

FACILITY ADDRESS: 1420 South Barrington Road
FACILITY CITY, STATE, ZIP: Barrington, IL 60010

DOCKET NUMBER: NH 19-C0559

LICENSEE INFO: Alden Estates of Barrington, Inc
LICENSEE ADDRESS: 4200 West Peterson Avenue, Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646

Survey Date – 10/17/2019
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)3), 300.1220b)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00

FACILITY NAME: Alden Estates of Northmoor

FACILITY ADDRESS: 5831 North Northwest Highway
FACILITY CITY, STATE, ZIP: Chicago, IL 60631

DOCKET NUMBER: NH 19-C0254

LICENSEE INFO: Alden Northmoor Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 West Peterson Avenue, Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60645

Survey Date – 04/23/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.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 20-C0063

LICENSEE INFO: Alden Orland Park Rehabilitation & Health Care Center, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Avenue, Suite 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646

Survey Date – 01/15/2020
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c)1), 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: Alden Town Manor Rehab & HCC

FACILITY ADDRESS: 6120 West Ogden
FACILITY CITY, STATE, ZIP: Cicero, IL 60804

DOCKET NUMBER: NH 18-C0539

LICENSEE INFO: Alden Town Manor Rehabilitation and Health Care Center, Inc.
LICENSEE ADDRESS: 4200 W. Peterson Avenue, Suite 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646

Survey Date – 11/09/2018
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: All American Nursing Home

FACILITY ADDRESS: 5448 North Broadway Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60640

DOCKET NUMBER: NH 20-S0086

LICENSEE INFO: Zikainim, Inc.
LICENSEE ADDRESS: 191 North Wacker Drive, Suite 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606

Survey Date – 01/15/2020
Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.690a), 300.690b), and 300.690c). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.690
A fine of $500.00.

FACILITY NAME: Allure of Geneseo

FACILITY ADDRESS: 704 South Illinois Street
FACILITY CITY, STATE, ZIP: Geneseo, IL 61254

DOCKET NUMBER: NH 20-C0025

LICENSEE INFO: Allure of Geneseo, LLC
LICENSEE ADDRESS: 2711 West Howard Street
LICENSEE CITY, STATE, ZIP: Chicago, IL 60645

Survey Date – 11/21/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), and 300.1210d)5). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)5). A fine of $2,200.

FACILITY NAME: Amberwood Care Center

FACILITY ADDRESS: 2313 North Rockton Avenue
FACILITY CITY, STATE, ZIP: Rockford, IL 61103

DOCKET NUMBER: NH 20-C0048

LICENSEE INFO: Amberwood Healthcare Centre, LLC
LICENSEE ADDRESS: 8140 River Drive
LICENSEE CITY, STATE, ZIP: Morton Grove, IL 60053

Survey Date – 01/02/2020
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)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00

FACILITY NAME: Aperion Care Bloomington

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

DOCKET NUMBER: NH 19-C0415

LICENSEE INFO: Aperion Care Bloomington, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 07/11/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Aperion Care Cairo

FACILITY ADDRESS: 2001 Cedar Street
FACILITY CITY, STATE, ZIP: Cairo, IL 62914

DOCKET NUMBER: NH 19-C0315
NH 19-S0335

LICENSEE INFO: Aperion Care Cairo, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 05/23/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Aperion Care Cairo

FACILITY ADDRESS: 2001 Cedar Street
FACILITY CITY, STATE, ZIP: Cairo, IL 62914

DOCKET NUMBER: NH 19-C0429

LICENSEE INFO: Aperion Care Cairo, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 08/01/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Aperion Care International

FACILITY ADDRESS: 4815 South Western Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60609

DOCKET NUMBER: NH 19-S0548
NH 19-C0549

LICENSEE INFO: International Nursing & Rehab Center, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 11/14/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)5), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $2,200.00

FACILITY NAME: Aperion Care Spring Valley

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

DOCKET NUMBER: NH 20-S0099

LICENSEE INFO: Aperion Care Spring Valley, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 01/16/2020
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210c)3), 300.1210d)6), 300.3220f), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a).
A fine of $2,200.00

FACILITY NAME: Aperion Care Wilmington

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

DOCKET NUMBER: NH 19-S0351

LICENSEE INFO: Island City Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 06/26/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Apostolic Christian Home

FACILITY ADDRESS: 1102 West Randolph, P.O. Box 530
FACILITY CITY, STATE, ZIP: Roanoke, IL 61561

DOCKET NUMBER: NH 19-C0578

LICENSEE INFO: Apostolic Christian Home of Roanoke, Illinois, Inc.
LICENSEE ADDRESS: 1102 West Randolph
LICENSEE CITY, STATE, ZIP: Roanoke, IL 61561

Survey Date – 10/31/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 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 300.3240e).
A fine of $25,000.00

FACILITY NAME: Arden Courts of Elk Grove

FACILITY ADDRESS: 1940 Nerge Road
FACILITY CITY, STATE, ZIP: Elk Grove, IL 60007

DOCKET NUMBER: NH 19-S0560

LICENSEE INFO: Arden Courts of Elk Grove Village IL, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 11/13/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.1710a)b). A fine of $1,100.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.780a)b)c) and 300.4240a)b)c). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.780 and 330.4240a). A fine of $2,200.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.1155b)c)e)2). No fine

Type C violation of an occurrence for violating one or more of the following sections of the Code: 330.790a)c)1). This instance in accordance with 330.282f) i) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 330.790). A fine $500.00

Administrative Warning for violating the following section of the Code: 330.1160c)d).

Total Fines $3,800.00

FACILITY NAME: Arden Courts of Palos Heights

FACILITY ADDRESS: 7880 W. College Drive
FACILITY CITY, STATE, ZIP: Palos Heights, IL 60463

DOCKET NUMBER: NH 20-C0041

LICENSEE INFO: Arden Courts of Palos Heights IL, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 12/03/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.710a), 330.780b), 330.780c), and 330.4240)f). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.780. A fine of $2,200.00

FACILITY NAME: Auburn Rehab & HCC

FACILITY ADDRESS: 304 Maple Avenue
FACILITY CITY, STATE, ZIP: Auburn, IL 62615

DOCKET NUMBER: NH 20-S0071

LICENSEE INFO: Auburn Nursing and Rehabilitation Center, L.L.C.
LICENSEE ADDRESS: 412 East Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 12/23/2019
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)5), 300.1210c), 300.1210d)6), 300.1450, 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: Bella Terra Wheeling

FACILITY ADDRESS: 730 West Hintz Road
FACILITY CITY, STATE, ZIP: Wheeling, IL 60090

DOCKET NUMBER: NH 19-C0518

LICENSEE INFO: Wheeling Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 3450 Oakton Street
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076

Survey Date – 10/17/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1620a), and 300.1630c). A fine of $12,500.00

FACILITY NAME: Bethany Rehab & HCC

FACILITY ADDRESS: 3298 Resource Parkway
FACILITY CITY, STATE, ZIP: DeKalb, IL 60115

DOCKET NUMBER: NH 20-S0016

LICENSEE INFO: Bethany Health, LLC
LICENSEE ADDRESS: 412 E. Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 12/11/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Bria of Belleville

FACILITY ADDRESS: 150 North 27^th Street
FACILITY CITY, STATE, ZIP: Belleville, IL 62226

DOCKET NUMBER: NH 19-S0353

LICENSEE INFO: Belleville Healthcare & Rehabilitation Center, Inc.
LICENSEE ADDRESS: 465 Central Avenue Suite 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093

Survey Date – 06/07/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Bria of Belleville

FACILITY ADDRESS: 150 North 27^th Street
FACILITY CITY, STATE, ZIP: Belleville, IL 62226

DOCKET NUMBER: NH 20-C0044

LICENSEE INFO: Belleville Healthcare & Rehabilitation Center, Inc.
LICENSEE ADDRESS: 465 Central Avenue, Suite 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093

Survey Date – 12/12/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Bria of Belleville

FACILITY ADDRESS: 150 North 27^th Street
FACILITY CITY, STATE, ZIP: Belleville, IL 62226

DOCKET NUMBER: NH 20-C0043

LICENSEE INFO: Belleville Healthcare & Rehabilitation Center, Inc.
LICENSEE ADDRESS: 465 Central Avenue, Suite 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093

Survey Date – 12/04/2019
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: Bria of Palos Hills

FACILITY ADDRESS: 10426 South Roberts
FACILITY CITY, STATE, ZIP: Palos Hills, IL 60465

DOCKET NUMBER: NH 19-C0395

LICENSEE INFO: Palos Hills Healthcare, LLC
LICENSEE ADDRESS: 5151 Church Street
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077

Survey Date – 07/09/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Bridge Care Suites, The

FACILITY ADDRESS: 3089 Old Jacksonville Road
FACILITY CITY, STATE, ZIP: Springfield, IL 62704

DOCKET NUMBER: NH 20-C0030

LICENSEE INFO: OJCC, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 11/25/2019
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: Bridgeview Health Care Center

FACILITY ADDRESS: 8100 South Harlem Avenue
FACILITY CITY, STATE, ZIP: Bridgeview, IL 60455

DOCKET NUMBER: NH 20-S0003

LICENSEE INFO: Bridgeview Health Care Center, LTD
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606

Survey Date – 11/20/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Bridgeway Senior Living

FACILITY ADDRESS: 111 East Washington Street
FACILITY CITY, STATE, ZIP: Bensenville, IL 60106

DOCKET NUMBER: NH 19-C0590

LICENSEE INFO: Bridgeway Senior Living, LLC
LICENSEE ADDRESS: 5750 Old Orchard Road, Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077

Survey Date – 11/15/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b)4), 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: Chicago Ridge Nursing Center

FACILITY ADDRESS: 10602 Southwest Highway
FACILITY CITY, STATE, ZIP: Chicago, IL 60415

DOCKET NUMBER: NH 19-C0573

LICENSEE INFO: BM of Chicago Ridge, LLC
LICENSEE ADDRESS: 6500 North Hamlin
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712

Survey Date – 11/13/2019
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: Clark Lindsey Village

FACILITY ADDRESS: 101 West Windsor Road
FACILITY CITY, STATE, ZIP: Urbana, IL 61801

DOCKET NUMBER: NH 20-S0073

LICENSEE INFO: Clark Lindsey Village, Inc.
LICENSEE ADDRESS: 2110 Boudreau Drive
LICENSEE CITY, STATE, ZIP: Urbana, IL 61801

Survey Date – 01/14/2020
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210c), and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine of $2,200.00

FACILITY NAME: Clark Manor

FACILITY ADDRESS: 7433 North Clark Street
FACILITY CITY, STATE, ZIP: Chicago, IL 60626

DOCKET NUMBER: NH 20-S0015

LICENSEE INFO: Clark Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 3450 Oakton Street
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076

Survey Date – 11/14/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 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: Collinsville Rehabilitation & Health C

FACILITY ADDRESS: 614 North Summit
FACILITY CITY, STATE, ZIP: Collinsville, IL 62234

DOCKET NUMBER: NH 20-C0052

LICENSEE INFO: Petersen Health Business, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614

Survey Date – 01/08/2020
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: Countryside Nrsg & Rehab Ctr

FACILITY ADDRESS: 1635 East 154^th Street
FACILITY CITY, STATE, ZIP: Dolton, IL 60419

DOCKET NUMBER: NH 19-C0306

LICENSEE INFO: Countryside Nursing & Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 W. Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202

Survey Date – 05/15/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Countryside Nrsg & Rehab Ctr

FACILITY ADDRESS: 1635 East 15^th Street
FACILITY CITY, STATE, ZIP: Dolton, IL 60419

DOCKET NUMBER: NH 20-C0062

LICENSEE INFO: Countryside Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 2201 West Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202

Survey Date – 01/03/2020
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)5), 300.1210d)6), and 300.1220b)3). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Elevate Care Waukegan

FACILITY ADDRESS: 2222 14^th Street
FACILITY CITY, STATE, ZIP: Waukegan, IL 60085

DOCKET NUMBER: NH 20-S0038

LICENSEE INFO: Elevate Care Waukegan, LLCC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60064

Survey Date – 12/19/2019
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: Eden Village Care Center

FACILITY ADDRESS: 400 South Station Road
FACILITY CITY, STATE, ZIP: Glen Carbon, IL 62034

DOCKET NUMBER: NH 20-C0069

LICENSEE INFO: Eden Retirement Center, Inc.
LICENSEE ADDRESS: 400 South Station Road
LICENSEE CITY, STATE, ZIP: Glen Carbon, IL 62034

Survey Date – 01/13/2020
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Elevate Senior Living

FACILITY ADDRESS: 16300 Louis Avenue
FACILITY CITY, STATE, ZIP: South Holland, IL 60473

DOCKET NUMBER: NH 20-C0070

LICENSEE INFO: GS Healthcare, LLC
LICENSEE ADDRESS: 333 Knightsbridge Pkwy, Suite 210
LICENSEE CITY, STATE, ZIP: Lincolnshire, IL 60069

Survey Date – 12/13/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.1145a), 330.1145d), and 330.4240a). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.4240a). A fine of $2,200.00

FACILITY NAME: Exceptional Care & Training Center

FACILITY ADDRESS: 2601 Woodlawn Road
FACILITY CITY, STATE, ZIP: Sterling, IL 61081

DOCKET NUMBER: NH 20-C0050

LICENSEE INFO: Hoosier Care, Inc.
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 12/02/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 390.620a) 390.1010a), and 390.3240a). The fine was doubled in this instance in accordance with 390.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 390.1010 and 390.3240. A fine of $20,000.00

FACILITY NAME: Fair Havens Senior Living

FACILITY ADDRESS: 1790 South Fairview Avenue
FACILITY CITY, STATE, ZIP: Decatur, IL 62521

DOCKET NUMBER: NH 20-S0056

LICENSEE INFO: Fair Havens Senior Living, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202

Survey Date – 01/08/2020
Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)1) and 300.1620a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b). A fine of $25,000.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.696a), 300.696c)2), 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 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.3240a), 300.3240b), 300.3240c), 300.3240d), and 300.3240e). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1230). A fine of $500.00

Total Fines: $27,700.00

FACILITY NAME: Friendship Manor Health Care

FACILITY ADDRESS: 485 South Friendship Drive
FACILITY CITY, STATE, ZIP: Nashville, IL 62263

DOCKET NUMBER: NH 20-S0031

LICENSEE INFO: Friendship Manor Group, LLC
LICENSEE ADDRESS: 485 South Friendship Drive
LICENSEE CITY, STATE, ZIP: Nashville, IL 62263

Survey Date – 11/22/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b)5) 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: Generations at Applewood

FACILITY ADDRESS: 21020 Kostner Avenue
FACILITY CITY, STATE, ZIP: Matteson, IL 60443

DOCKET NUMBER: NH 18-C0451

LICENSEE INFO: Generations at Applewood, LLC
LICENSEE ADDRESS: 6840 North Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712

Survey Date – 09/05/2018
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Generations at Riverview

FACILITY ADDRESS: 500 Centennial Drive
FACILITY CITY, STATE, ZIP: East Peoria, IL 61611

DOCKET NUMBER: NH 19-C0571

LICENSEE INFO: Generations at Riverview, LLC
LICENSEE ADDRESS: 6840 N. Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712

Survey Date – 10/29/2019
Type AA violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $50,000.00

FACILITY NAME: Generations Oakton Pavilion

FACILITY ADDRESS: 1660 Oakton Place
FACILITY CITY, STATE, ZIP: Des Plaines, IL 60018

DOCKET NUMBER: NH 20-C0011

LICENSEE INFO: Generations at Oakton Pavilion, LLC
LICENSEE ADDRESS: 6840 N. Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712

Survey Date – 11/27/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b) and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Golfview Development Center

FACILITY ADDRESS: 9555 West Golf Road
FACILITY CITY, STATE, ZIP: Des Plaines, IL 60016

DOCKET NUMBER: NH 19-C0138

LICENSEE INFO: Golfview Development Center, Inc.
LICENSEE ADDRESS: 111 Wacker Drive, 44^th FL
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606

Survey Date – 02/04/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Greentree of Bradley Rehab

FACILITY ADDRESS: 650 North Kinzie
FACILITY CITY, STATE, ZIP: Bradley, IL 60915

DOCKET NUMBER: NH 19-C0264

LICENSEE INFO: River North of Bradley Health & Rehabilitation Center, LLC
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606

Survey Date – 04/10/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Grove of Fox Valley, The

FACILITY ADDRESS: 1601 N. Farnsworth Avenue
FACILITY CITY, STATE, ZIP: Aurora, IL 60505

DOCKET NUMBER: NH 19-C0298

LICENSEE INFO: Aurora PAC, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 06/06/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Grove of St. Charles

FACILITY ADDRESS: 611 Allen Lane
FACILITY CITY, STATE, ZIP: St. Charles, IL 60174

DOCKET NUMBER: NH 19-S0326

LICENSEE INFO: St. Charles Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 3450 Oakton Street
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076

Survey Date – 06/12/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Harbor House

FACILITY ADDRESS: 760 McHenry Road
FACILITY CITY, STATE, ZIP: Wheeling, IL 60090

DOCKET NUMBER: NH 19-S0561

LICENSEE INFO: Harbor House of Wheeling IV, LLC
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606

Survey Date – 10/16/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 330.710a), 330.720b), 330.3370d), and 330.4240a). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.4240a). A fine of $25,000.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.710a), 330.715)a)b), 330.910a), 330.920a)f), 330.1310a), 330.1310b)2), 330.1310c)1), 330.1310g), and 300.1310j). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.715)a)b).
A fine of $2,200.00

Type C violation of an occurrence for violating one or more of the following sections of the Code: 330.710a), 330.720b), 330.1120a), 330.1145a),d), 330.1520a)b), 330.3720b)7), 330.4210a), and 330.4240a). This instance in accordance with 330.282f) i) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 330.4240a). A fine of $500.00 Total Fines $27,700.00

FACILITY NAME: Harmony Nursing and Rehab Center

FACILITY ADDRESS: 3919 West Foster Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60625

DOCKET NUMBER: NH 19-C0523

LICENSEE INFO: Harmony Nursing and Rehabilitation Center, Inc.
LICENSEE ADDRESS: 6633 North Lincoln Avenue
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712

Survey Date – 09/24/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Heather Health Care Center

FACILITY ADDRESS: 15600 South Honore Street
FACILITY CITY, STATE, ZIP: Harvey, IL 60426

DOCKET NUMBER: NH 19-C0591

LICENSEE INFO: Heather Health Care Center, Inc.
LICENSEE ADDRESS: 4200 West Peterson Avenue, Ste 140
LICENSEE CITY, STATE, ZIP: Chicago, IL 60646

Survey Date – 11/13/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)2) and 300.3240a). 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 $25,000.00

FACILITY NAME: Heritage Health Carlinville

FACILITY ADDRESS: 1200 University Avenue
FACILITY CITY, STATE, ZIP: Carlinville, IL 62626

DOCKET NUMBER: NH 19-C0586

LICENSEE INFO: Heritage Manor – Carlinville, LLC
LICENSEE ADDRESS: 115 W. Jefferson, Suite 401
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701

Survey Date – 11/06/2019
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)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), and 300.3240a). A fine of $25,000.00.

FACILITY NAME: Heritage Health Carlinville

FACILITY ADDRESS: 1200 University Avenue
FACILITY CITY, STATE, ZIP: Carlinville, IL 62626

DOCKET NUMBER: NH 19-C0586

LICENSEE INFO: Heritage Health Carlinville, LLC
LICENSEE ADDRESS: 115 West Jefferson, Suite 401
LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701

Survey Date – 11/06/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Hickory Nursing Pavilion

FACILITY ADDRESS: 9246 South Roberts Road
FACILITY CITY, STATE, ZIP: Hickory Hills, IL 60457

DOCKET NUMBER: NH 20-C0027

LICENSEE INFO: Hickory Nursing Pavilion, Inc.
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606

Survey Date – 12/27/2019
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: Hickory Nursing Pavilion

FACILITY ADDRESS: 9246 South Roberts Road
FACILITY CITY, STATE, ZIP: Hickory Hills, IL 60457

DOCKET NUMBER: NH 20-S0028

LICENSEE INFO: Hickory Nursing Pavilion, Inc.
LICENSEE ADDRESS: 191 N. Wacker Drive, Suite 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606

Survey Date – 12/11/2019
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)6), 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), 300.1210d)6) and 300.3240a). A fine of $25,000.00

FACILITY NAME: Hilltop Skilled Nursing & Rehab

FACILITY ADDRESS: 910 West Polk Avenue
FACILITY CITY, STATE, ZIP: Charleston, IL 61920

DOCKET NUMBER: NH 20-S0034

LICENSEE INFO: Hilltop Care and Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 12/05/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a) and 300.1210d)5). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210d)5).
A fine of $2,200.00

FACILITY NAME: Hitz Memorial Home

FACILITY ADDRESS: 201 Belle Street, P.O. Box 79
FACILITY CITY, STATE, ZIP: Alhambra, IL 62001

DOCKET NUMBER: NH 19-S0519

LICENSEE INFO: Hitz Memorial Home
LICENSEE ADDRESS: 201 Belle Street, P.O. Box 79
LICENSEE CITY, STATE, ZIP: Alhambra, IL 62001

Survey Date – 10/28/2019
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: Illinois Veteran’s Home Anna

FACILITY ADDRESS: 792 North Main Street
FACILITY CITY, STATE, ZIP: Anna, IL 62906

DOCKET NUMBER: NH 20-C0004

LICENSEE INFO: Illinois Department of Veteran’s Affair
LICENSEE ADDRESS: 833 South Spring Street, P.O. Box 19432
LICENSEE CITY, STATE, ZIP: Springfield, IL 62794

Survey Date – 11/20/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 340.1440a), 340.1505a), 340.1505b) and 340.1505e). 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: 340.1440a), 340.1505b) and 340.1505e). A fine of $2,200.00

FACILITY NAME: Integrity HC of Alton

FACILITY ADDRESS: 3523 Wickenhauser
FACILITY CITY, STATE, ZIP: Alton, IL 62002

DOCKET NUMBER: NH 20-C0032

LICENSEE INFO: Alton Rehabilitation and Nursing Center, LLC
LICENSEE ADDRESS: 2015 North Main Street, Suite 111
LICENSEE CITY, STATE, ZIP: Carbondale, IL 62901

Survey Date – 11/22/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 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 $2,200.00

FACILITY NAME: Integrity HC of Belleville

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

DOCKET NUMBER: NH 20-C0006

LICENSEE INFO: Belleville Behavioral Health & Nursing Center, LLC
LICENSEE ADDRESS: 2015 W. Main Street, Suite 111
LICENSEE CITY, STATE, ZIP: Carbondale, IL 62901

Survey Date – 12/17/2019
Type AA violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)2) and 300.1210d)3). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b). A fine of $50,000.00

FACILITY NAME: Integrity HC of Smithton

FACILITY ADDRESS: 107 South Lincoln
FACILITY CITY, STATE, ZIP: Smithton, IL 62285

DOCKET NUMBER: NH 20-S0029

LICENSEE INFO: Park Haven Nursing & Rehabilitation Center, LLC
LICENSEE ADDRESS: 2015 West Main Street, Suite 111
LICENSEE CITY, STATE, ZIP: Carbondale, IL 62901

Survey Date – 11/26/2019
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: Jacksonville Skilled Nursing & Rehab

FACILITY ADDRESS: 1517 West Walnut Street
FACILITY CITY, STATE, ZIP: Jacksonville, IL 62650

DOCKET NUMBER: NH 19-C0570

LICENSEE INFO: Jacksonville Care & Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 11/27/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)5), 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: Jennings Terrace

FACILITY ADDRESS: 275 South LaSalle
FACILITY CITY, STATE, ZIP: Aurora, IL 60505

DOCKET NUMBER: NH 20-S0035
NH 20-C0036

LICENSEE INFO: Jennings Terrace
LICENSEE ADDRESS: 1320 North Route 59
LICENSEE CITY, STATE, ZIP: Naperville, IL 60563

Survey Date – 12/12/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.4240a). The fine was doubled in this instance in accordance with 330.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 330.4240a). A fine of $2,200.00

FACILITY NAME: Lewis Memorial Christian Vlg

FACILITY ADDRESS: 3400 West Washington Street
FACILITY CITY, STATE, ZIP: Springfield, IL 62711

DOCKET NUMBER: NH 19-S0440

LICENSEE INFO: Lewis Memorial Christian Village
LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 08/05/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Loft Rehab and Nursing of Normal

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

DOCKET NUMBER: NH 19-C0593

LICENSEE INFO: The Loft Rehabilitation and Nursing of Normal, LLC
LICENSEE ADDRESS: 55 West Monroe Street, Suite 2400
LICENSEE CITY, STATE, ZIP: Chicago, IL 60603

Survey Date – 12/12/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)5), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5), and 300.3240a). A fine of $2,200.00

FACILITY NAME: Manor Court of Maryville

FACILITY ADDRESS: 6955 State Route 162
FACILITY CITY, STATE, ZIP: Maryville, IL 62062

DOCKET NUMBER: NH 19-C0579

LICENSEE INFO: UD #2, LLC
LICENSEE ADDRESS: 285 S. Farnham Street
LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401

Survey Date – 11/18/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b)5), 300.1210d)6), 300.1220b)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00

FACILITY NAME: Marshall Rehab & Nursing

FACILITY ADDRESS: 410 North Second Street
FACILITY CITY, STATE, ZIP: Marshall, IL 62441

DOCKET NUMBER: NH 19-S0585

LICENSEE INFO: Marshall Rehabilitation and Nursing, LLC
LICENSEE ADDRESS: 615 West Webb Street
LICENSEE CITY, STATE, ZIP: Carmi, IL 62821

Survey Date – 11/13/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.686a)F)1)2)3)4)5), 300.686b), 300.686c), 300.686d), and 300.686e)1)2)3), The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.686). A fine $2,200.00

FACILITY NAME: Mosaic of Lakeshore , The

FACILITY ADDRESS: 7200 North Sheridan Road
FACILITY CITY, STATE, ZIP: Chicago, IL 60626

DOCKET NUMBER: NH 19-C0567
NH 19-S0568

LICENSEE INFO: Lake Shore Healthcare & Rehabilitation Centre, LLC
LICENSEE ADDRESS: 4600 W. Touhy Avenue. #200
LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712

Survey Date – 11/07/2019
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 $2,200.00

FACILITY NAME: Niles Nrsg & Rehab Center

FACILITY ADDRESS: 9777 Greenwood Avenue
FACILITY CITY, STATE, ZIP: Niles, IL 60714

DOCKET NUMBER: NH 19-S0551
NH 19-C0552

LICENSEE INFO: Niles Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 240 Fencl Lane
LICENSEE CITY, STATE, ZIP: Hillside, IL 60162

Survey Date – 10/24/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.1220b)2). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Palm Terrace of Mattoon

FACILITY ADDRESS: 1000 Palm Avenue
FACILITY CITY, STATE, ZIP: Mattoon, IL 61938

DOCKET NUMBER: NH 19-C0547

LICENSEE INFO: Petersen Management Company, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614

Survey Date – 10/23/2019
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)3), 300.1610a)1), 300.1620a), 300.1630e), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Parents and Friends of the SLC

FACILITY ADDRESS: 1450 Caseyville Avenue
FACILITY CITY, STATE, ZIP: Swansea, IL 62226

DOCKET NUMBER: NH 20-S0033

LICENSEE INFO: Parents and Friends of the Specialized Living Center
LICENSEE ADDRESS: 1450 Caseyville Avenue
LICENSEE CITY, STATE, ZIP: Swansea, IL 62226

Survey Date – 10/22/2019
Type B violation for violating one or more of the following sections of the Code: 350.1060e), 350.1210), 350.1220j), 350.1230b)7), 350.1230d)1), 350.1230d)2), and 350.3240a). A fine of $750.00

Type B violation for violating one or more of the following sections of the Code: 350.1210, 350.1220j), 350.1230b), and 350.3240a). A fine $750.00

Total Fine $1,500.00

FACILITY NAME: Park Place of Belvidere

FACILITY ADDRESS: 1701 5^th Avenue
FACILITY CITY, STATE, ZIP: Belvidere, IL 61008

DOCKET NUMBER: NH 19-C0274

LICENSEE INFO: The Gardens of Belvidere, LLC
LICENSEE ADDRESS: 8140 McCormick Blvd, Suite 131
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076

Survey Date – 05/14/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Pearl Pavilion

FACILITY ADDRESS: 900 South Kiwanis Drive
FACILITY CITY, STATE, ZIP: Freeport, IL 61032

DOCKET NUMBER: NH 19-C0564

LICENSEE INFO: Pearl Pavilion, LLC
LICENSEE ADDRESS: 4711 Gold Road, Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076

Survey Date – 11/13/2019
Type AA violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)2), 300.1210d)3), 300.3220f), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), and 300.3240a). A fine of $50,000

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) 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 $75,000.00

FACILITY NAME: Piper City Rehab & Living Center

FACILITY ADDRESS: 600 South Maple Street, P.O. Box 68
FACILITY CITY, STATE, ZIP: Piper City, IL 60959

DOCKET NUMBER: NH 19-S0563

LICENSEE INFO: Midwest Health Operations, LLC
LICENSEE ADDRESS: 830 W. Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614

Survey Date – 11/04/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.695b)3), 300.1210b), 300.3240a), 300.3240b), 300.3240c), 300.3240d), and 300.3240f). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.695b), 300.1210b), 300.3240a), and 300.3240d). A fine of $25,000.00

FACILITY NAME: Prairie Oasis

FACILITY ADDRESS: 16000 Wabash Avenue
FACILITY CITY, STATE, ZIP: South Holland, IL 60473

DOCKET NUMBER: NH 20-S0017
NH 20-C0022

LICENSEE INFO: Prairie Oasis, LLC
LICENSEE ADDRESS: 4711 Golf Road, Suite 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076

Survey Date – 11/25/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b) and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Presence Our Lady of Victory

FACILITY ADDRESS: 20 Briarcliff Lane
FACILITY CITY, STATE, ZIP: Bourbonnais, IL 60914

DOCKET NUMBER: NH 19-S0537

LICENSEE INFO: Presence Life Connections
LICENSEE ADDRESS: 18927 Hickory Creek Drive, Ste 300
LICENSEE CITY, STATE, ZIP: Mokena, IL 60448

Survey Date – 11/08/2019
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: Renaissance Care Center

FACILITY ADDRESS: 1675 East Ash Street
FACILITY CITY, STATE, ZIP: Canton, IL 61520

DOCKET NUMBER: NH 20-C0012
NH 20-S0013

LICENSEE INFO: Renaissance Care Center, Inc.
LICENSEE ADDRESS: 5750 Old Orchard Road, Ste 420
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077

Survey Date – 11/20/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1035a)4)5), 300.1210b). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b). A fine of $25,000.00

FACILITY NAME: River View Rehab Center

FACILITY ADDRESS: 50 North Jane
FACILITY CITY, STATE, ZIP: Elgin, IL 60123

DOCKET NUMBER: NH 20-C0007

LICENSEE INFO: River View Rehab Center, LLC
LICENSEE ADDRESS: 4711 Golf Road, Ste 200
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076

Survey Date – 11/12/2019
Type AA violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)2)3)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $50,000.00

FACILITY NAME: Rosewood Care Center Inverness

FACILITY ADDRESS: 1800 Colonial Parkway
FACILITY CITY, STATE, ZIP: Inverness, IL 60067

DOCKET NUMBER: NH 19-S0205

LICENSEE INFO: Bravo Care of Inverness, Inc.
LICENSEE ADDRESS: 412 East Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 03/01/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Rosewood Care Center of Joliet

FACILITY ADDRESS: 3401 Hennepin Drive
FACILITY CITY, STATE, ZIP: Joliet, IL 60431

DOCKET NUMBER: NH 19-C0221

LICENSEE INFO: Bravo Care of Joliet, Inc.
LICENSEE ADDRESS: 412 East Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 03/22/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Rosewood Care Center Joliet

FACILITY ADDRESS: 3401 Hennepin Drive
FACILITY CITY, STATE, ZIP: Joliet, IL 60431

DOCKET NUMBER: NH 20-S0054

LICENSEE INFO: Bravo Care of Joliet, Inc.
LICENSEE ADDRESS: 412 East Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 01/03/2020
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: Rosewood Care Center of Peoria

FACILITY ADDRESS: 1500 West Northmoor Road
FACILITY CITY, STATE, ZIP: Peoria, IL 61614

DOCKET NUMBER: NH 19-S0143

LICENSEE INFO: Bravo Care of Peoria, Inc.
LICENSEE ADDRESS: 412 East Lawrence Street
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 02/21/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Rosewood Care Center of Peoria

FACILITY ADDRESS: 1500 West Northmoor Road
FACILITY CITY, STATE, ZIP: Peoria, IL 61614

DOCKET NUMBER: NH 19-C0150

LICENSEE INFO: Bravo Care of Peoria, Inc.
LICENSEE ADDRESS: 412 East Lawrence Street
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 03/06/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Rosewood Care Ctr St. Charles

FACILITY ADDRESS: 850 Dunham Road
FACILITY CITY, STATE, ZIP: St. Charles, IL 60174

DOCKET NUMBER: NH 20-S0066

LICENSEE INFO: Bravo Care of St. Charles, Inc.
LICENSEE ADDRESS: 412 East Lawrence
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

FACILITY NAME: Sandwich Rehab & HCC

FACILITY ADDRESS: 902 East Arnold Street
FACILITY CITY, STATE, ZIP: Sandwich, IL 60548

DOCKET NUMBER: NH 19-S0572

LICENSEE INFO: Petersen Health Business, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614

Survey Date – 11/21/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b)5), 300.1210c), 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: Sharon Health Care Pines

FACILITY ADDRESS: 3614 North Rochelle
FACILITY CITY, STATE, ZIP: Peoria, IL 61604

DOCKET NUMBER: NH 19-S0417

LICENSEE INFO: Sharon Health Care Pines, Inc.
LICENSEE ADDRESS: 465 Central Avenue, Suite 100
LICENSEE CITY, STATE, ZIP: Northfield, IL 60093

Survey Date – 07/29/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: South Holland Manor Health & Rehab

FACILITY ADDRESS: 2145 East 170^th Street
FACILITY CITY, STATE, ZIP: South Holland, IL 60473

DOCKET NUMBER: NH 19-C0211

LICENSEE INFO: South Holland Manor HRC, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202

Survey Date – 03/28/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: South Holland Manor Health & Rehab

FACILITY ADDRESS: 2145 East 170^th Street
FACILITY CITY, STATE, ZIP: South Holland, IL 60473

DOCKET NUMBER: NH 20-C0008

LICENSEE INFO: South Holland Manor HRC, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202

Survey Date – 11/27/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210c), and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Spring Creek

FACILITY ADDRESS: 777 Draper Avenue
FACILITY CITY, STATE, ZIP: Joliet, IL 60432

DOCKET NUMBER: NH 20-C0057

LICENSEE INFO: Spring Creek SNF, LLC
LICENSEE ADDRESS: 6302 North Monticello Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60659

Survey Date – 01/02/2020
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: Springs at Crystal Lake

FACILITY ADDRESS: 1000 East Brighton
FACILITY CITY, STATE, ZIP: Crystal Lake, IL 60012

DOCKET NUMBER: NH 18-C0445

LICENSEE INFO: The Springs at Crystal Lake, LLC
LICENSEE ADDRESS: 191 North Wacker Drive, Suite 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606

Survey Date – 10/01/2018
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Springs at Monarch Landing

FACILITY ADDRESS: 2308 N. Route 59
FACILITY CITY, STATE, ZIP: Naperville, IL 60563

DOCKET NUMBER: NH 20-C0045

LICENSEE INFO: Monarch Landing OPCO (SL-VII), LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 12/17/2019
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: Squire’s Sheltered Care Home

FACILITY ADDRESS: 2601 North California
FACILITY CITY, STATE, ZIP: Chicago, IL 60647

DOCKET NUMBER: NH 19-C0588
NH 19-S0589

LICENSEE INFO: Fellowship House, Inc.
LICENSEE ADDRESS: 2601 North California Avenue
LICENSEE CITY, STATE, ZIP: Chicago, IL 60647

Survey Date – 11/21/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.710a), 330.3970f), 330.3990j), and 300.3 A fine of $1,100.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.1520b), 330.1520c)1), 330.1710b), 330.1720a)4), 330.1720b), and 330.1720c)1)2)3)B)4)5)6).
A fine of $1,100.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 330.2000). A fine of $1,100.00

Total Fines $3,300.00

FACILITY NAME: St. Anthony’s Nsg & Rehab Ctr

FACILITY ADDRESS: 767 30^th Street
FACILITY CITY, STATE, ZIP: Rock Island, IL 61201

DOCKET NUMBER: NH 19-S0558

LICENSEE INFO: St. Anthony’s Nursing and Rehabilitation Center, L.L.C.
LICENSEE ADDRESS: 150 North Riverside Pl. Ste 3000
LICENSEE CITY, STATE, ZIP: Chicago, IL 60601

Survey Date – 10/25/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)5), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5), and 300.3240a). A fine of $2,200.00

FACILITY NAME: Stephenson Nursing Center

FACILITY ADDRESS: 2946 S. Walnut Road
FACILITY CITY, STATE, ZIP: Freeport, IL 61032

DOCKET NUMBER: NH 19-S0025

LICENSEE INFO: Stephenson County Board of Supervisors
LICENSEE ADDRESS: 50 W. Douglas Street, Suite 1002
LICENSEE CITY, STATE, ZIP: Freeport, IL 61032

Survey Date – 12/14/2018
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Symphony at Midway

FACILITY ADDRESS: 4437 South Cicero
FACILITY CITY, STATE, ZIP: Chicago, IL 60632

DOCKET NUMBER: NH 20-C0060
NH 20-S0061

LICENSEE INFO: Symphony Midway, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 12/10/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)6), 300.2900d)2), 300.3100d)2), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00

FACILITY NAME: Taylorville Skld Nur & Rehab

FACILITY ADDRESS: 800 McAdam Drive
FACILITY CITY, STATE, ZIP: Taylorville, IL 62568

DOCKET NUMBER: NH 19-C0592

LICENSEE INFO: Taylorville Skilled Nursing & Rehab, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 10/16/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Taylorville Skld Nur & Rehab

FACILITY ADDRESS: 800 McAdam Drive
FACILITY CITY, STATE, ZIP: Taylorville, IL 62568

DOCKET NUMBER: NH 20-S0055

LICENSEE INFO: Taylorville Skilled Nursing & Rehab, LLC
LICENSEE ADDRESS: 208 South LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 12/20/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $25,000.00

FACILITY NAME: Terrace Nursing Home

FACILITY ADDRESS: 1615 Sunset Avenue
FACILITY CITY, STATE, ZIP: Waukegan, IL 60087

DOCKET NUMBER: NH 19-C0505

LICENSEE INFO: TN Care, LLC
LICENSEE ADDRESS: 1S443 Summitt Avenue, STE 204
LICENSEE CITY, STATE, ZIP: Oakbrook Terrace, IL 60181

Survey Date – 10/17/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 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: 300.1210b) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Timbercreek Rehab & Healthcare Center

FACILITY ADDRESS: 2220 State Street
FACILITY CITY, STATE, ZIP: Pekin, IL 61554

DOCKET NUMBER: NH 20-C0009

LICENSEE INFO: Petersen Health Operations, LLC
LICENSEE ADDRESS: 830 West Trailcreek Drive
LICENSEE CITY, STATE, ZIP: Peoria, IL 61614

Survey Date – 11/27/2019
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: Tri-State Village Nursing & Rehab

FACILITY ADDRESS: 2500 East 175^th Street
FACILITY CITY, STATE, ZIP: Lansing, IL 60438

DOCKET NUMBER: NH 19-C0557

LICENSEE INFO: Tri-State Village Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814
LICENSEE CITY, STATE, ZIP: Chicago, IL 60604

Survey Date – 10/29/2019
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: Uptown Healthcare Center

FACILITY ADDRESS: 4920 North Kenmore
FACILITY CITY, STATE, ZIP: Chicago, IL 60640

DOCKET NUMBER: NH 19-S0091

LICENSEE INFO: Uptown Health Center, LLC
LICENSEE ADDRESS: 5215 Old Orchard Road, Ste 960
LICENSEE CITY, STATE, ZIP: Skokie, IL 60077

Survey Date – 01/17/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Villa at South Holland, The

FACILITY ADDRESS: 16300 Wausau Street
FACILITY CITY, STATE, ZIP: South Holland, IL 60473

DOCKET NUMBER: NH 19-C0581

LICENSEE INFO: The Villa at South Holland, LLC
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606

Survey Date – 11/13/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6), and 300.3240a). A fine $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 19-S0219

LICENSEE INFO: Warren Barr North Shore, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 04/23/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Warren Barr North Shore

FACILITY ADDRESS: 2773 Skokie Valley Road
FACILITY CITY, STATE, ZIP: Highland Park, IL 60035

DOCKET NUMBER: NH 19-C0285

LICENSEE INFO: Warren Barr North Shore, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 05/29/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Warren Barr South Loop

FACILITY ADDRESS: 1725 South Wabash Avenue
FACILITY CITY, STATE, ZIP: Chicago, IL 60616

DOCKET NUMBER: NH 20-C0094

LICENSEE INFO: South Loop Skilled Nursing Facility, LLC
LICENSEE ADDRESS: 801 Adlai Stevenson Drive
LICENSEE CITY, STATE, ZIP: Springfield, IL 62703

Survey Date – 01/03/2020
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.1210d)6). A fine of $2,200.00

FACILITY NAME: Washington Senior Living

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

DOCKET NUMBER: NH 19-S0569

LICENSEE INFO: Washington Senior Living, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202

Survey Date – 11/07/2019
Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 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 $2,200.00

FACILITY NAME: Washington Senior Living

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

DOCKET NUMBER: NH 19-S0569

LICENSEE INFO: Washington Senior Living, LLC
LICENSEE ADDRESS: 2201 Main Street
LICENSEE CITY, STATE, ZIP: Evanston, IL 60202

Survey Date – 11/07/2019
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: White Hall Nursing & Rehab Center

FACILITY ADDRESS: 620 West Bridgeport Street
FACILITY CITY, STATE, ZIP: White Hall, IL 62092

DOCKET NUMBER: NH 19-S0582
NH 19-C0583

LICENSEE INFO: White Hall Nursing and Rehabilitation Center, LLC
LICENSEE ADDRESS: 901 S. 2^nd Street, Suite 201
LICENSEE CITY, STATE, ZIP: Springfield, IL 62704

Survey Date – 12/02/2019
Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)5), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)2)4), 300.1220b)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

Total Fine: $27,200.00

FACILITY NAME: Willow Crest Nursing Pavilion

FACILITY ADDRESS: 515 North Main Street
FACILITY CITY, STATE, ZIP: Sandwich, IL 60548

DOCKET NUMBER: NH 18-C0416

LICENSEE INFO: Willow Crest Nursing Pavilion, LTD
LICENSEE ADDRESS: 191 North Wacker Drive, Ste 1800
LICENSEE CITY, STATE, ZIP: Chicago, IL 60606

Survey Date – 08/08/2018
FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

FACILITY NAME: Windsor Estates Nsg & Rehab

FACILITY ADDRESS: 18300 South Lavergne
FACILITY CITY, STATE, ZIP: Country Club Hills, IL 60478

DOCKET NUMBER: NH 20-S0077

LICENSEE INFO: McAllister Nursing and Rehab, LLC
LICENSEE ADDRESS: 9100 Karlov Avenue
LICENSEE CITY, STATE, ZIP: Skokie, IL 60076

Survey Date – 01/09/2020
Type B violation of an occurrence for violating one or more of the following sections of the Code: 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