Quarterly Report July - Sept 2018

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The Illinois Department of Public Health has initiated action, as indicated, against the following facilities which have been determined to be in violation of the Nursing Home Care Act, or has recommended decertification to the Director of the Department of Healthcare and Family Service, or the Secretary of the United States Department of Health and Human Services for violations in relation to patient care, pursuant to Titles XVIII and XIX of the Federal Social Security Act. FACILITY NAME: Alden Estates of Naperville FACILITY ADDRESS: 1525 South Oxford Lane FACILITY CITY, STATE, ZIP: Naperville, IL 60565 DOCKET NUMBER: NH 18-S0368 NH 18-C0369 LICENSEE INFO: Alden Estates of Naperville, Inc. LICENSEE ADDRESS: 4200 W. Peterson Avenue, Suite 140 LICENSEE CITY, STATE, ZIP: Chicago, IL 60646 Survey Date – 07/20/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210c) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00. Total Fines $4,400.00. FACILITY NAME: Alden Estates of Orland Park FACILITY ADDRESS: 16450 South 97th Avenue FACILITY CITY, STATE, ZIP: Orland Park, IL 60462 DOCKET NUMBER: NH 18-C0295 LICENSEE INFO: Alden Orland Park Rehabilitation and Health Care Center, Inc. LICENSEE ADDRESS: 4200 W. Peterson Avenue, Suite 140 LICENSEE CITY, STATE, ZIP: Chicago, IL 60646 Survey Date – 06/13/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

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FACILITY NAME: Alden Park Strathmoor FACILITY ADDRESS: 5668 Strathmoor Drive FACILITY CITY, STATE, ZIP: Rockford, IL 61107 DOCKET NUMBER: NH 18-C0353 LICENSEE INFO: Alden Park Strathmoor, Inc. LICENSEE ADDRESS: 4200 West Peterson Avenue, Suite 140 LICENSEE CITY, STATE, ZIP: Chicago, IL 60646 Survey Date – 06/02/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Alden Terrace of McHenry Rehab FACILITY ADDRESS: 803 Royal Drive FACILITY CITY, STATE, ZIP: McHenry, IL 60050 DOCKET NUMBER: NH 18-S0345 LICENSEE INFO: Alden Terrace of McHenry Rehabilitation & Health Care Center Inc LICENSEE ADDRESS: 4200 West Peterson Avenue, Suite 140 LICENSEE CITY, STATE, ZIP: Chicago, IL 60646 Survey Date – 07/30/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210c), 300.1210d)3), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

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FACILITY NAME: Alden Valley Ridge Rehab & HCC FACILITY ADDRESS: 275 East Army Trail Road FACILITY CITY, STATE, ZIP: Bloomingdale, IL 60108 DOCKET NUMBER: NH 18-S0367 LICENSEE INFO: Alden Valley Ridge Rehabilitation and Health Care Center, Inc. LICENSEE ADDRESS: 4200 W. Peterson Avenue, Suite 140 LICENSEE CITY, STATE, ZIP: Chicago, IL 60646 Survey Date – 07/20/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210d)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00. Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.690a), 300.1210a), 300.1210b), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. Total fines $4,400.00.

FACILITY NAME: All American Nursing Home FACILITY ADDRESS: 5448 North Broadway Street FACILITY CITY, STATE, ZIP: Chicago, IL 60640 DOCKET NUMBER: NH 18-C0363 LICENSEE INFO: Zikainim, Inc. LICENSEE ADDRESS: 191 North Wacker Drive, Suite 1800 LICENSEE CITY, STATE, ZIP: Chicago, IL 60606 Survey Date – 08/01/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210d)6) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

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FACILITY NAME: Ambassador Nsg & Rehab Center FACILITY ADDRESS: 4900 North Bernard FACILITY CITY, STATE, ZIP: Chicago, IL 60625 DOCKET NUMBER: NH 18-S0337 LICENSEE INFO: Ambassador Nursing and Rehabilitation II, LLC LICENSEE ADDRESS: 240 Fencl Lane LICENSEE CITY, STATE, ZIP: Hillside, IL 60162 Survey Date – 07/26/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) 300.1210d)3) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $500.00. FACILITY NAME: Aperion Care Capitol FACILITY ADDRESS: 555 West Carpenter Road FACILITY CITY, STATE, ZIP: Springfield, IL 62702 DOCKET NUMBER: NH 18-S0365 LICENSEE INFO: Aperion Care Capitol, LLC LICENSEE ADDRESS: 2018 S. LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 07/16/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Aperion Care Galesburg FACILITY ADDRESS: 1145 Frank Street FACILITY CITY, STATE, ZIP: Galesburg, IL 61401 DOCKET NUMBER: NH 18-C0314 LICENSEE INFO: River Crossing Rehab, LLC LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 06/14/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b) 300.1210d)5), 300.1220b)2) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $500.00.

Quarterly Report July - Sept 2018

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FACILITY NAME: Aperion Care Litchfield FACILITY ADDRESS: 1024 East Tyler FACILITY CITY, STATE, ZIP: Litchfield, IL 62056 DOCKET NUMBER: NH 18-S0344 LICENSEE INFO: Litchfield Care Center, LLC LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 08/03/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010e), 300.1210b)3), 300.1210d)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00. Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a) 300.1210b)2) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $500.00 Total Fines of $2,700.00 FACILITY NAME: Aperion Care Marseilles FACILITY ADDRESS: 578 West Commercial Street FACILITY CITY, STATE, ZIP: Marseilles, IL 61341 DOCKET NUMBER: NH 18-S0272 LICENSEE INFO: Aperion Care Marseilles, LLC LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 05/18/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

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FACILITY NAME: Aperion Care Spring Valley FACILITY ADDRESS: 1300 North Greenwood Street FACILITY CITY, STATE, ZIP: Spring Valley, IL 61362 DOCKET NUMBER: NH 18-C0378 LICENSEE INFO: Aperion Care Spring Valley, LLC LICENSEE ADDRESS: 208 S. LaSalle Street. Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 07-31-2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Aperion Care Wilmington FACILITY ADDRESS: 555 West Kahler FACILITY CITY, STATE, ZIP: Wilmington, IL 60481 DOCKET NUMBER: NH 18-C0305 LICENSEE INFO: Island City Rehabilitation Center, LLC LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 06/22/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) 300.1210d)1)2)3)5), 300.1620a) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $500.00. FACILITY NAME: Auburn Rehab & HCC FACILITY ADDRESS: 304 Maple Avenue FACILITY CITY, STATE, ZIP: Auburn, IL 62615 DOCKET NUMBER: NH 18-C0332 LICENSEE INFO: Auburn Nursing and Rehabilitation Center. L.L.C. LICENSEE ADDRESS: 412 East Lawrence LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 07/12/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

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FACILITY NAME: Avantara Park Ridge FACILITY ADDRESS: 1601 North Western Avenue FACILITY CITY, STATE, ZIP: Park Ridge, IL 60068 DOCKET NUMBER: NH 18-S0284 LICENSEE INFO: Avantara Park Ridge, LLC LICENSEE ADDRESS: 1601 North Western Avenue LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 05/25/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b) 300.1210d)6) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $500.00.

FACILITY NAME: Avondale Estates of Elgin FACILITY ADDRESS: 1754-1760 Capital Street FACILITY CITY, STATE, ZIP: Elgin, IL 60124 DOCKET NUMBER: NH 18-S0321 LICENSEE INFO: Avondale Estates of Elgin, LLC LICENSEE ADDRESS: 7366 N. Lincoln Avenue, Suite 206 LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712 Survey Date – 06/21/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210a), 300.1210b)4), 300.1210d)3), 300.1220b)3) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $500.00. FACILITY NAME: Beacon Hill FACILITY ADDRESS: 2400 South Finley Road FACILITY CITY, STATE, ZIP: Lombard, IL 60148 DOCKET NUMBER: NH 18-S0350 LICENSEE INFO: Lifespan Communities, Inc. LICENSEE ADDRESS: 118 W. Edwards Street, Suite 200 LICENSEE CITY, STATE, ZIP: Springfield, IL 62704 Survey Date – 08/09/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.3100d)2). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.3100d)2). A fine of $500.00.

Quarterly Report July - Sept 2018

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FACILITY NAME: Beecher Manor Nsg & Rehab FACILITY ADDRESS: 1201 Dixie Highway FACILITY CITY, STATE, ZIP: Beecher, IL 60401 DOCKET NUMBER: NH 18-S0270 LICENSEE INFO: Beecher Manor Nursing and Rehabilitation Center, LLC LICENSEE ADDRESS: 2201 West Main Street LICENSEE CITY, STATE, ZIP: Evanston, IL 60202 Survey Date – 05/17/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Bement Health Care Center FACILITY ADDRESS: 601 North Morgan FACILITY CITY, STATE, ZIP: Bement, IL 61813 DOCKET NUMBER: NH 18-S0292 LICENSEE INFO: Petersen Health Quality, LLC LICENSEE ADDRESS: 830 W. Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 06/19/2018 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00. FACILITY NAME: Bloomington Rehabilitation & HCC FACILITY ADDRESS: 1925 South Main Street FACILITY CITY, STATE, ZIP: Bloomington, IL 61701 DOCKET NUMBER: NH 18-C0276 LICENSEE INFO: Petersen Health Operations, LLC LICENSEE ADDRESS: 1925 South Main Street LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 06/20/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1230b)d)1)2)j)5)k)l)1)2)3)4)5). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1230). A fine of $500.00.

Quarterly Report July - Sept 2018

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FACILITY NAME: Bloomington Rehabilitation & HCC FACILITY ADDRESS: 1925 South Main Street FACILITY CITY, STATE, ZIP: Bloomington, IL 61701 DOCKET NUMBER: NH 18-C0277 LICENSEE INFO: Petersen Health Operations, LLC LICENSEE ADDRESS: 1925 South Main Street LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 06/20/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1230b)d)1)2)j)5)k)l)1)2)3)4)5). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1230). A fine of $500.00. FACILITY NAME: Bria of Cahokia FACILITY ADDRESS: 3354 Jerome Lane FACILITY CITY, STATE, ZIP: Cahokia, IL 62206 DOCKET NUMBER: NH 18-C0304 LICENSEE INFO: Atrium Health Care & Rehab Center of Cahokia, LLC LICENSEE ADDRESS: 465 Central Avenue #100 LICENSEE CITY, STATE, ZIP: Northfield, IL 60093 Survey Date – 06/20/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h) and 300.1210b). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b). A fine of $2,200.00.

Quarterly Report July - Sept 2018

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FACILITY NAME: Bria of Forest Edge FACILITY ADDRESS: 8001 South Western Avenue FACILITY CITY, STATE, ZIP: Chicago, IL 60620 DOCKET NUMBER: NH 18-C0371 LICENSEE INFO: Forest Edge Healthcare & Rehabilitation Center, LLC LICENSEE ADDRESS: 5151 Church Street LICENSEE CITY, STATE, ZIP: Skokie, IL 60077 Survey Date – 07/24/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)3), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. Type 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. Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.690a. This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.690a). A fine of $500.00 Total Fines of $4,900.00. FACILITY NAME: Bria of River Oaks FACILITY ADDRESS: 14500 South Manistee FACILITY CITY, STATE, ZIP: Burnham. IL 60633 DOCKET NUMBER: NH 18-S0343 LICENSEE INFO: River Oaks Healthcare & Rehabilitation Center, LLC LICENSEE ADDRESS: 5151 Church Street LICENSEE CITY, STATE, ZIP: Skokie, IL 60044 Survey Date – 07/13/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), 300.1220b)3)and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

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FACILITY NAME: Briar Place Nursing FACILITY ADDRESS: 6800 West Joliet Street FACILITY CITY, STATE, ZIP: Indian Head Park, IL 60525 DOCKET NUMBER: NH 18-C0253 LICENSEE INFO: Briar Place Nursing, LLC LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 05/15/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210c), 300.1210d)6), 300.1810c)5)D), 300.1810e), 300.1810f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: British Home, The FACILITY ADDRESS: 8700 West 31st Street FACILITY CITY, STATE, ZIP: Brookfield, IL 60513 DOCKET NUMBER: NH 18-C0341 LICENSEE INFO: The British Home for Retired Men and Women LICENSEE ADDRESS: 31st Street & McCormick Avenue LICENSEE CITY, STATE, ZIP: Brookfield, IL 60513 Survey Date – 07/10/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Caseyville Nursing & Rehab Ctr FACILITY ADDRESS: 601 West Lincoln Avenue FACILITY CITY, STATE, ZIP: Caseyville, IL 62232 DOCKET NUMBER: NH 18-C0362 LICENSEE INFO: Caseyville Nursing & Rehabilitation Center, Inc. LICENSEE ADDRESS: 7434 N. Skokie Blvd LICENSEE CITY, STATE, ZIP: Skokie, IL 60077 Survey Date – 07/18/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)3), 300.1210d)5), 300.1220b)2) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

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FACILITY NAME: Champaign County Nursing Home FACILITY ADDRESS: 500 South Art Bartell Drive FACILITY CITY, STATE, ZIP: Urbana, IL 61802 DOCKET NUMBER: NH 18-C0339 LICENSEE INFO: Champaign County Board LICENSEE ADDRESS: 1776 East Washington Street LICENSEE CITY, STATE, ZIP: Urbana, IL 61802 Survey Date – 07/25/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1230b), 300.1230d)1)2), 300.1230j)5), 300.1230k) and 300.1230l)1)2)3)4). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1230). A fine of $500.00.

FACILITY NAME: Champaign Urbana Nrsg & Rehab FACILITY ADDRESS: 302 Nurwash Avenue FACILITY CITY, STATE, ZIP: Savoy, IL 61874 DOCKET NUMBER: NH 18-C0315 LICENSEE INFO: Champaign Urbana Nursing and Rehab, LP LICENSEE ADDRESS: 5750 Old Orchard Road, Suite 420 LICENSEE CITY, STATE, ZIP: Skokie, IL 60077 Survey Date – 06/22/2018 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.690b)c), 300.1210a), 300.1210b), 300.1210d)6), 300.2040b) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00. FACILITY NAME: City View Muticare Center FACILITY ADDRESS: 5825 West Cermak Road FACILITY CITY, STATE, ZIP: Cicero, IL 60804 DOCKET NUMBER: NH 18-C0335 LICENSEE INFO: City View Multicare Center, LLC LICENSEE ADDRESS: 240 Fencl Lane LICENSEE CITY, STATE, ZIP: Hillside, IL 60162 Survey Date – 07/13/2018 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

Quarterly Report July - Sept 2018

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FACILITY NAME: Community Care Center FACILITY ADDRESS: 4314 South Wabash Avenue FACILITY CITY, STATE, ZIP: Chicago, IL 60653 DOCKET NUMBER: NH 18-C0280 LICENSEE INFO: CC Care, LLC LICENSEE ADDRESS: 1S443 Summit Avenue, Suite 204 LICENSEE CITY, STATE, ZIP: Oakbrook Terrace, IL 60181 Survey Date – 05/23/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Covenant Health Care Center Northbrook FACILITY ADDRESS: 2155 Pfingsten Road FACILITY CITY, STATE, ZIP: Northbrook, IL 60062 DOCKET NUMBER: NH 18-S0320 LICENSEE INFO: Covenant Health Care Center, Inc. LICENSEE ADDRESS: 2155 Pfingsten Road LICENSEE CITY, STATE, ZIP: Northbrook, IL 60062 Survey Date – 06/27/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210c)3) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $500.00. FACILITY NAME: Edwardsville Nrsg & Rehab Ctr FACILITY ADDRESS: 401 St. Mary Drive FACILITY CITY, STATE, ZIP: Edwardsville, IL 62025 DOCKET NUMBER: NH 18-S0258 LICENSEE INFO: Edwardsville Care Center, LLC LICENSEE ADDRESS: 111 North Ottawa Street LICENSEE CITY, STATE, ZIP: Joliet, IL 60432 Survey Date – 05/04/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b)5), 300.1210c), 300.1210d)3), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

14

FACILITY NAME: Edwardsville Nursing and Rehab FACILITY ADDRESS: 401 St. Mary Drive FACILITY CITY, STATE, ZIP: Edwardsville, IL 62025 DOCKET NUMBER: NH 18-C0309 LICENSEE INFO: Edwardsville Care Center, LLC LICENSEE ADDRESS: 111 N. Ottawa Street LICENSEE CITY, STATE, ZIP: Joliet, IL 60432 Survey Date – 07/03/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210a), 300.1210b)4)5), 300.1210d)3)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Elmwood Nursing & Rehab Center FACILITY ADDRESS: 152 Wilma Drive FACILITY CITY, STATE, ZIP: Maryville, IL 62062 DOCKET NUMBER: NH 18-C0279 LICENSEE INFO: Elmwood Nursing & Rehabilitation Center, LLC LICENSEE ADDRESS: 2202 Main Street, Suite 180 LICENSEE CITY, STATE, ZIP: Evanston, IL 60202 Survey Date – 05/23/2018 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: Fair Havens Christian Village FACILITY ADDRESS: 1790 South Fairview Avenue FACILITY CITY, STATE, ZIP: Decatur, IL 62521 DOCKET NUMBER: NH 18-S0346 LICENSEE INFO: Fair Havens Christian Homes, Inc. LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 08/09/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b)5), 300.1210c), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

15

FACILITY NAME: Gilman Healthcare Center FACILITY ADDRESS: 1390 South Crescent Street FACILITY CITY, STATE, ZIP: Gilman, IL 60938 DOCKET NUMBER: NH 18-C0259 LICENSEE INFO: Gilman Healthcare Center, LLC LICENSEE ADDRESS: 4711 Golf Road, Suite 200 LICENSEE CITY, STATE, ZIP: Skokie, IL 60076 Survey Date – 05/21/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210d)2), 300.1210d)3) 300.1210d)5). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210d)5). A fine of $2,200.00. FACILITY NAME: Gilman Healthcare Center FACILITY ADDRESS: 1390 South Crescent Street FACILITY CITY, STATE, ZIP: Gilman, IL 60938 DOCKET NUMBER: NH 18-C0260 LICENSEE INFO: Gilman Healthcare Center, LLC LICENSEE ADDRESS: 4711 Golf Road, Suite 200 LICENSEE CITY, STATE, ZIP: Skokie, IL 60076 Survey Date – 06/06/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210c), and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210d)6). A fine of $2,200.00.

FACILITY NAME: Good Samaritan Prophets Riverview FACILITY ADDRESS: 310 Mosher Drive FACILITY CITY, STATE, ZIP: Prophetstown, IL 61277 DOCKET NUMBER: NH 18-S0349 LICENSEE INFO: Good Samaritan Society Prophets Riverview LICENSEE ADDRESS: 208 South LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 07/13/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.690a) and 300.690b). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.690. A fine of $500.00.

Quarterly Report July - Sept 2018

16

FACILITY NAME: Grove at the Lake, The FACILITY ADDRESS: 2534 Elim Avenue FACILITY CITY, STATE, ZIP: Zion, IL 60099 DOCKET NUMBER: NH 18-C0274 LICENSEE INFO: Grove at the Lake Skilled Nursing Facility, LLC LICENSEE ADDRESS: 801 Adlai Stevenson Drive LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 06/06/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Grove at the Lake, The FACILITY ADDRESS: 2534 Elim Avenue FACILITY CITY, STATE, ZIP: Zion, IL 60099 DOCKET NUMBER: NH 18-S0358 LICENSEE INFO: Grove at the Lake Skilled Nursing Facility, LLC LICENSEE ADDRESS: 801 Adlai Stevenson Drive LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 07/17/2018 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210c), 300.1210d)6), 300.1220b)2) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00.

FACILITY NAME: Grove of Skokie, The FACILITY ADDRESS: 90000 Lavergne Avenue FACILITY CITY, STATE, ZIP: Skokie, IL 60077 DOCKET NUMBER: NH 18-S0252 LICENSEE INFO: Skokie Skilled Nursing Facility, LLC LICENSEE ADDRESS: 801 Adlai Stevenson Drive LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 05/03/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b)3), 300.1220b)2)3), 300.1620a), 300.1620b), 300.1620c) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

17

FACILITY NAME: Havana Health Care Center FACILITY ADDRESS: 609 North Harpham Street FACILITY CITY, STATE, ZIP: Havana, IL 62644 DOCKET NUMBER: NH 18-C0359 LICENSEE INFO: Petersen Health Quality, LLC LICENSEE ADDRESS: 830 W. Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 07/13/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.3210a), 300.3210o), 300.3240a), 300.3300d), 300.3300f), 300.3300j), 300.3300k), 300.3300l), 300.3300m) and 300.3300n). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.3240a). A fine of $2,200.00. FACILITY NAME: Heartland of Canton FACILITY ADDRESS: 2081 N. Main Street FACILITY CITY, STATE, ZIP: Canton, IL 61520 DOCKET NUMBER: NH 18-S0257 LICENSEE INFO: Heartland of Canton II, LLC LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 05/24/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00. 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. Total Fines of $4,400.00.

Quarterly Report July - Sept 2018

18

FACILITY NAME: Heartland of Normal FACILITY ADDRESS: 510 Broadway FACILITY CITY, STATE, ZIP: Normal, IL 61761 DOCKET NUMBER: NH 18-S0256 LICENSEE INFO: Heartland of Normal LL, LLC LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 05/30/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)3), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Heritage Health Mt Sterling FACILITY ADDRESS: 435 Camden Road FACILITY CITY, STATE, ZIP: Mt. Sterling, IL 62353 DOCKET NUMBER: NH 18-C0364 LICENSEE INFO: Heritage Manor Mt Sterling, LLC LICENSEE ADDRESS: 115 W. Jefferson Street, Suite 400 LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701 Survey Date – 07/12/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00 FACILITY NAME: Hillcrest Retirement Village FACILITY ADDRESS: 1740 North Circuit Drive FACILITY CITY, STATE, ZIP: Round Lake Beach, IL 60073 DOCKET NUMBER: NH 18-C0322 LICENSEE INFO: Hillcrest Retirement Village, LTD LICENSEE ADDRESS: 30 S. Wacker Drive, Suite 2600 LICENSEE CITY, STATE, ZIP: Chicago, IL 60606 Survey Date – 06/27/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a),300.1210a), 300.1210b) 300.1210d)6) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $500.00.

Quarterly Report July - Sept 2018

19

FACILITY NAME: Illini Heritage Rehab & HC FACILITY ADDRESS: 1315 Curt Drive, P.O. Box 6179 FACILITY CITY, STATE, ZIP: Champaign, IL 61820 DOCKET NUMBER: NH 18-C0351 LICENSEE INFO: Petersen Health Care Illini, LLC LICENSEE ADDRESS: 830 W. Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 07/27/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Illini Restorative Care FACILITY ADDRESS: 1455 Hospital Road FACILITY CITY, STATE, ZIP: Silvis, IL 61282 DOCKET NUMBER: NH 18-C0306 LICENSEE INFO: Genesis Health System LICENSEE ADDRESS: 801 Illini Drive LICENSEE CITY, STATE, ZIP: Silvis, IL 61282 Survey Date – 06/06/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Imboden Creek Living Center FACILITY ADDRESS: 180 West Imboden FACILITY CITY, STATE, ZIP: Decatur, IL 62521 DOCKET NUMBER: NH 18-S0347 LICENSEE INFO: Living Centers, Inc. LICENSEE ADDRESS: 20 South Side Country Club LICENSEE CITY, STATE, ZIP: Decatur, IL 62521 Survey Date – 07/19/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210d)6), 300.1220b)7) and 300.3240a)b). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

20

FACILITY NAME: Integrity HC of Marion FACILITY ADDRESS: 1301 East DeYoung FACILITY CITY, STATE, ZIP: Marion, IL 62959 DOCKET NUMBER: NH 18-C0352 LICENSEE INFO: Marion Rehabilitation and Nursing Center, LLC LICENSEE ADDRESS: 2015 W. Main Street, Suite 111 LICENSEE CITY, STATE, ZIP: Carbondale, IL 62901 Survey Date – 07/17/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210a), 300.1210b), 300.1210d)2), 300.1210d)3), 300.1210d)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Jerseyville Nsg & Rehab Center FACILITY ADDRESS: 1001 South State Street FACILITY CITY, STATE, ZIP: Jerseyville, IL 62052 DOCKET NUMBER: NH 18-C0255 LICENSEE INFO: Helia Healthcare of Jerseyville, LLC LICENSEE ADDRESS: 118 W. Edwards Street, Suite 200 LICENSEE CITY, STATE, ZIP: Springfield, IL 62704 Survey Date – 06/01/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), 300.1220b)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Lakeview Rehab & Nursing Center FACILITY ADDRESS: 735 West Diversey FACILITY CITY, STATE, ZIP: Chicago, IL 60614 DOCKET NUMBER: NH 18-C0283 LICENSEE INFO: Lakeview Rehabilitation and Nursing Center, LLC LICENSEE ADDRESS: 735 West Diversey LICENSEE CITY, STATE, ZIP: Hillside, IL 60162 Survey Date – 05/24/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a),300.690b), 300.690c), 300.1210b) 300.1210d)6) and 300.3240A). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.690, 300.1210b), 300.1210d)6) and 300.3240a). A fine of $500.00.

Quarterly Report July - Sept 2018

21

FACILITY NAME: Lewis Memorial Christian Village FACILITY ADDRESS: 3400 West Washington FACILITY CITY, STATE, ZIP: Springfield, IL 62711 DOCKET NUMBER: NH 18-S0331 LICENSEE INFO: Lewis Memorial Christian Village LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 06/28/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c), 300.1210d)6), 300.1220b)2) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Lexington of Lake Zurich FACILITY ADDRESS: 900 South Rand Road FACILITY CITY, STATE, ZIP: Lake Zurich, IL 60047 DOCKET NUMBER: NH 18- S0356 LICENSEE INFO: Lexington Health Care Center of Lake Zurich, Inc. LICENSEE ADDRESS: 665 West North Avenue LICENSEE CITY, STATE, ZIP: Lombard, IL 60148 Survey Date – 08/02/2018 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: Lutheran Home, The FACILITY ADDRESS: 6901 North Galena Road FACILITY CITY, STATE, ZIP: Peoria, IL 61614 DOCKET NUMBER: NH 18-C0290 LICENSEE INFO: Lutheran Hillside Village, Inc. LICENSEE ADDRESS: 6901 North Galena Road LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 06/15/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) 300.1210d)5) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $500.00.

Quarterly Report July - Sept 2018

22

FACILITY NAME: Manor Court of Clinton FACILITY ADDRESS: 1 Park Lane West FACILITY CITY, STATE, ZIP: Clinton, IL 61727 DOCKET NUMBER: NH 18-S0377 LICENSEE INFO: Residential Alternatives of Illinois, Inc. LICENSEE ADDRESS: 285 South Farnham Street LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401 Survey Date – 08/01/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b)5), 300.1210c), 300.1210d)3), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Manor Court of Maryville FACILITY ADDRESS: 6955 State Route 162 FACILITY CITY, STATE, ZIP: Maryville, IL 62062 DOCKET NUMBER: NH 18-S0376 LICENSEE INFO: UDI #2, LLC LICENSEE ADDRESS: 285 S. Farnham Street LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401 Survey Date – 07/30/2018 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: Manorcare of Palos Heights East FACILITY ADDRESS: 7820 W. College Drive FACILITY CITY, STATE, ZIP: Palos Heights, IL 60463 DOCKET NUMBER: NH 18-C0375 LICENSEE INFO: Manor Care of Palos Heights IL, LLC LICENSEE ADDRESS: 208 S. LaSalle Street, Suite 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 07/25/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210c)3), 300.3220f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

Quarterly Report July - Sept 2018

23

FACILITY NAME: Maple Crossing at Amboy FACILITY ADDRESS: 15 West Wasson Road FACILITY CITY, STATE, ZIP: Amboy, IL 61310 DOCKET NUMBER: NH 18-S0303 LICENSEE INFO: Maple Crossing at Amboy, LLC LICENSEE ADDRESS: 7434 Skokie Blvd LICENSEE CITY, STATE, ZIP: Skokie, IL 60077 Survey Date – 07/05/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) 300.1210d)6), 300.1220b)3), 300.3240a) and 300.3240f). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $500.00. FACILITY NAME: Marigold Estates FACILITY ADDRESS: 3240 Barney Avenue FACILITY CITY, STATE, ZIP: Pekin, IL 61554 DOCKET NUMBER: NH 18-S0327 LICENSEE INFO: Patterson House, Inc. LICENSEE ADDRESS: 110 Southbrooke LICENSEE CITY, STATE, ZIP: Decatur, IL 62521 Survey Date – 07/17/2018 Type B violation for violating one or more of the following sections of the Code: 350.620a), 350.1060e), 350.3240a) and 350.3240f). A fine of $550.00. FACILITY NAME: Mercy Rehab and Care Center FACILITY ADDRESS: 100 Rosewood Village Drive FACILITY CITY, STATE, ZIP: Swansea, IL 62226 DOCKET NUMBER: NH 18-S0354 LICENSEE INFO: Mercy Rehab and Care Center, Inc. LICENSEE ADDRESS: 412 E. Lawrence LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 07/12/2018 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

Quarterly Report July - Sept 2018

24

FACILITY NAME: Park Point Healthcare & Rehab FACILITY ADDRESS: 1223 Edgewater Drive FACILITY CITY, STATE, ZIP: Morris, IL 60450 DOCKET NUMBER: NH 18-C0254 LICENSEE INFO: Park Pointe Healthcare & Rehabilitation Center, LLC LICENSEE ADDRESS: 1001 Warrenville Road, Suite 500 LICENSEE CITY, STATE, ZIP: Lisle, IL 60532 Survey Date – 06/15/2018 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: Parkway Manor FACILITY ADDRESS: 3116 Williamson County Pkwy FACILITY CITY, STATE, ZIP: Marion, IL 62959 DOCKET NUMBER: NH 18- C0291 LICENSEE INFO: UDI #1, LLC LICENSEE ADDRESS: 3116 Williamson County Pkwy LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401 Survey Date – 06/06/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b) 300.1210d)6) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $500.00. FACILITY NAME: Prairie City Rehab & HC FACILITY ADDRESS: 825 E. Main Street, R.R. #2, Box 97 FACILITY CITY, STATE, ZIP: Prairie City, IL 61470 DOCKET NUMBER: NH 18- C0268 LICENSEE INFO: Midwest Health Operations, LLC LICENSEE ADDRESS: 830 W.Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 05/12/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

25

FACILITY NAME: Presence Cor Mariae Center FACILITY ADDRESS: 3330 Maria Linden Drive FACILITY CITY, STATE, ZIP: Rockford, IL 61114 DOCKET NUMBER: NH 18-C0271 LICENSEE INFO: Presence Life Connections LICENSEE ADDRESS: 18927 Hickory Creek Drive, Suite 300 LICENSEE CITY, STATE, ZIP: Mokena, IL 60448 Survey Date – 06/06/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210d)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210d)5) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Presence Cor Mariae Center FACILITY ADDRESS: 3330 Maria Linden Drive FACILITY CITY, STATE, ZIP: Rockford, IL 61114 DOCKET NUMBER: NH 18-C0294 LICENSEE INFO: Presence Life Connections LICENSEE ADDRESS: 18927 Hickory Creek Drive, Suite 300 LICENSEE CITY, STATE, ZIP: Mokena, IL 60448 Survey Date – 06/25/2018 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210d)6) and 300.3240a). A fine of $25,000.00.

FACILITY NAME: Presence Heritage Village FACILITY ADDRESS: 901 North Entrance Avenue FACILITY CITY, STATE, ZIP: Kankakee, IL 60901 DOCKET NUMBER: NH 18-S0318 LICENSEE INFO: Presence Life Connections LICENSEE ADDRESS: 18927 Hickory Creek Drive, Suite 300 LICENSEE CITY, STATE, ZIP: Mokena, IL 60448 Survey Date – 06/28/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210c) and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210d)6). A fine of $2,200.00.

Quarterly Report July - Sept 2018

26

FACILITY NAME: Presence Villa Franciscan FACILITY ADDRESS: 210 North Springfield Avenue FACILITY CITY, STATE, ZIP: Joliet, IL 60435 DOCKET NUMBER: NH 18-C0275 LICENSEE INFO: Presence Life Connections LICENSEE ADDRESS: 18927 Hickory Creek Drive, Suite 300 LICENSEE CITY, STATE, ZIP: Mokena, IL 60448 Survey Date – 06/01/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210c), 300.1210d)3), 300.1210d)4), 300.1210d)5)A) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00. FACILITY NAME: River North of Bradley H & R FACILITY ADDRESS: 650 North Kinzie FACILITY CITY, STATE, ZIP: Bradley, IL 60915 DOCKET NUMBER: NH 18-C0250 LICENSEE INFO: River North of Bradley Health and Rehabilitation Center, LLC LICENSEE ADDRESS: 191 N. Wacker Drive, Suite 1800 LICENSEE CITY, STATE, ZIP: Chicago, IL 60606 Survey Date – 05/25/2018 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: River North of Bradley H & R FACILITY ADDRESS: 650 North Kinzie FACILITY CITY, STATE, ZIP: Bradley, IL 60915 DOCKET NUMBER: NH 18-C0302 LICENSEE INFO: River North of Bradley Health and Rehabilitation Center, LLC LICENSEE ADDRESS: 191 N. Wacker Drive, Suite 1800 LICENSEE CITY, STATE, ZIP: Chicago, IL 60606 Survey Date – 06/15/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)5), 300.3220f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

27

FACILITY NAME: River North Bradley H & R FACILITY ADDRESS: 650 North Kinzie FACILITY CITY, STATE, ZIP: Bradley, IL 60915 DOCKET NUMBER: NH 18-C0380 LICENSEE INFO: River North of Bradley Health and Rehabilitation Center, LLC LICENSEE ADDRESS: 191 N. Wacker Drive, Suite 1800 LICENSEE CITY, STATE, ZIP: Chicago, IL 60606 Survey Date – 07/27/2018 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210c)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210c2)3), 300.1210d)5), 300.3220f) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00. Total Fines $27,200.00

FACILITY NAME: Rochelle Gardens Care Center FACILITY ADDRESS: 1021 Caron Road FACILITY CITY, STATE, ZIP: Rochelle, IL 61068 DOCKET NUMBER: NH 18-S0298 LICENSEE INFO: Petersen Health Network, LLC. LICENSEE ADDRESS: 830 W. Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 06/12/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.690), 300.1210b), 300.1210d)6), 300.1220b)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

28

FACILITY NAME: Rosewood Care Center Iverness FACILITY ADDRESS: 1800 Colonial Parkway FACILITY CITY, STATE, ZIP: Iverness, IL 60067 DOCKET NUMBER: NH 18-C0329 LICENSEE INFO: Bravo Care of Iverness, Inc. LICENSEE ADDRESS: 412 East Lawrence LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 06/28/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) 300.1210c), 300.1210d)6) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $500.00. Total Fines $2,700.00/

FACILITY NAME: Salem Village Nursing & Rehab FACILITY ADDRESS: 1314 Rowell Avenue FACILITY CITY, STATE, ZIP: Joliet, IL 60433 DOCKET NUMBER: NH 18-C0311 LICENSEE INFO: Salem Village Nursing and Rehabilitation Center, LLC LICENSEE ADDRESS: 111 N. Ottawa Street LICENSEE CITY, STATE, ZIP: Joliet, IL 60432 Survey Date – 07/09/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)2)5) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00

Quarterly Report July - Sept 2018

29

FACILITY NAME: Sherman West Court FACILITY ADDRESS: 1950 Larkin Avenue FACILITY CITY, STATE, ZIP: Elgin, IL 60123 DOCKET NUMBER: NH 18-S0333 LICENSEE INFO: Sherman West Court LICENSEE ADDRESS: 3075 Highland Parkway, Suite 600 LICENSEE CITY, STATE, ZIP: Downers Grove, IL 60515 Survey Date – 07/03/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)3), 300.1220b)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)5), 300.1210c), 300.1210d)6), 300.3240a) and 300.3240d)2). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: , 300.1210b), 300.1210d)6), 300.3240a) and 300.3240d). A fine of $500.00. Total Fines $2,700.00 FACILITY NAME: South Lawn Sheltered Care FACILITY ADDRESS: 512 South Franklin FACILITY CITY, STATE, ZIP: Bunker Hill, IL 62014 DOCKET NUMBER: NH 18-S0288 LICENSEE INFO: South Lawn Sheltered Care, Inc. LICENSEE ADDRESS: R.R. 1 Route 159, P.O. Box H LICENSEE CITY, STATE, ZIP: Bunker Hill, IL 62014 Survey Date – 05/31/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 330.4240a)b)c)d)e). This instance in accordance with 330.282f) i) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 330.4240a)d)e). A fine of $500.00.

Quarterly Report July - Sept 2018

30

FACILITY NAME: South Suburban Rehab Center FACILITY ADDRESS: 19000 South Halsted Street FACILITY CITY, STATE, ZIP: Homewood, IL 60430 DOCKET NUMBER: NH 18-C0312 LICENSEE INFO: South Suburban Rehabilitation Center, LLC LICENSEE ADDRESS: 2201 West Main Street LICENSEE CITY, STATE, ZIP: Evanston, IL 60202 Survey Date – 06/22/2018 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210c), 300.1210d)6) 300.1220b)3) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.690, 300.1210b), 300.1210d)6) and 300.3240a). A fine of $500.00. FACILITY NAME: Symphony Evanston Healthcare FACILITY ADDRESS: 820 Foster Street FACILITY CITY, STATE, ZIP: Evanston, IL 60201 DOCKET NUMBER: NH 18-C0307 LICENSEE INFO: Symphony of Evanston Healthcare, LLC LICENSEE ADDRESS: 801 Adlai Stevenson Drive LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 06/15/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00 Type C violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) 300.1210d)6), 300.1220b)3) and 300.3240a). This instance in accordance with 300.282f) and j) of the Code is assessed a fine due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $500.00 Total Fines $2,700.00.

Quarterly Report July - Sept 2018

31

FACILITY NAME: Taylorville Care Center FACILITY ADDRESS: 600 South Houston FACILITY CITY, STATE, ZIP: Taylorville, IL 62568 DOCKET NUMBER: NH 18-S0313 LICENSEE INFO: Taylorville Care Center, Inc. LICENSEE ADDRESS: 1670 Essex Way, Suite B LICENSEE CITY, STATE, ZIP: O’Fallon, IL 62269 Survey Date – 06/22/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210d)5), 300.1220b)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00. Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b)2), 300.1210c), 300.1220b)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00. Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)6), 300.1220b)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00 Total Fines $6,600.00.

FACILITY NAME: Timber Point Healthcare FACILITY ADDRESS: 205 East Spring Street FACILITY CITY, STATE, ZIP: Camp Point, IL 62320 DOCKET NUMBER: NH 18-S0281 LICENSEE INFO: Timber Point Healthcare Center, Inc. LICENSEE ADDRESS: 2201 Main Street LICENSEE CITY, STATE, ZIP: Evanston, IL 60202 Survey Date – 06/07/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1620a), 300.1630c) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00.

Quarterly Report July - Sept 2018

32

FACILITY NAME: Victorian Village Hlth & Wellness FACILITY ADDRESS: 12525 W. Renaissance Circle FACILITY CITY, STATE, ZIP: Homer Glen, IL 60491 DOCKET NUMBER: NH 18-C0357 LICENSEE INFO: Rest Haven Illiana Christian Convalescent Home LICENSEE ADDRESS: 18601 N. Creek Drive LICENSEE CITY, STATE, ZIP: Tinley Park, IL 60477 Survey Date – 07/11/2018 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210c)1), 300.1210c)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.3240a). A fine of $2,200.00.