Meadowbrook Manor
Bolingbrook, Illinois · CCN 145710
60 surveys since 2011, 15 of them producing a finding at harm level or worse.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
- Citations on record
- 191
- Surveys
- 60
- Harm or worse
- 15
- Immediate jeopardy
- 1
Findings at the most serious level CMS records.
Older surveys no longer in CMS’s monthly file or on Care Compare. They are shown here.
The facility
- Certified beds
- 298
- Ownership
- For profit - Corporation
- Chain
- Independent
- County
- Will
- Medicare-certified since
- 1991
CMS ratings
- Overall
- 2
- Health inspection
- 2
- Staffing
- 2
- Quality measures
- 3
CMS’s own Five-Star ratings.
Compared with similar facilities
Since 2021, this facility recorded somewhat fewer weighted findings than its peer group.
Weighted by harm level, against 232 for-profit facilities with 128 or more beds in Illinois.
Last survey on record
Jul 31, 2025
466 days ago.
Counts surveys with at least one finding. A clean survey leaves no record here, so the real gap may be shorter.
Staffing
| Measure | This facility | Peer median |
|---|---|---|
| Nurse hours per resident day | 3.47 | 3.12 |
| Registered-nurse hours per resident day | 0.79 | — |
| Annual nurse turnover | 52.1% | 43.2% |
As reported by the facility to CMS, beside the peer-group median.
Enforcement
- Fines
- $160,635 across 3 penalties
Federal civil money penalties and remedies as CMS currently publishes them. Amounts may still be under appeal.
Severity of recent findings
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J11.9% | K— | L— |
| Actual harm | G35.7% | H— | I— |
| No harm, potential for more than minimal | D2649.1% | E1630.2% | F611.3% |
| No harm, potential for minimal | A— | B— | C11.9% |
Most frequently cited here
In CMS’s current monthly file.
- F6777×
Provide care and assistance to perform activities of daily living for any resident who is unable.
- F6895×
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- F6003×
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- F6103×
Respond appropriately to all alleged violations.
- F6863×
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
In the surveyor’s words
From the most serious findings on record at Meadowbrook Manor, in the surveyor’s own words.
- Immediate jeopardy, isolatedF600Feb 21, 2025
Based on interviews and record review, the facility failed to protect residents from sexual abuse from a housekeeper (V4). This failure resulted in R1 and R2 being sexually abused by V4 on January 25, 2025. This applies to 2 of 3 residents (R1 and R2) reviewed for abuse in the sample of 22. This resulted in Immediate Jeopardy. The Immediate Jeopardy began on January 25, 2025 when R2 reported to the facility that she was sexually assaulted by V4. V1 (Administrator), V3 (acting Director of Nursing) and V15 (Part-time Nursing Consultant) were notified of the Immediate Jeopardy on February 18, 2025 at 10:37 AM. […]
- Actual harm, isolatedF689Jul 11, 2025
Based on interviews and record reviews, the facility failed to implement safety interventions and provide supervision to prevent two residents from injury. These failures resulted in R2 sustaining a laceration and a displaced bilateral nasal bone fracture and acute fracture of the bony nasal septum and R3 sustaining a head laceration requiring 5 staples and being admitted to the hospital. This applies to 2 of 6 residents (R2 and R3) reviewed for falls in a sample of 12. The findings include:1.R2's records showed that she was a [AGE] year-old female admitted to the facility on [DATE], with diagnoses including dementia, psychosis, restlessness and agitation. R2's record showed that on 5/29/25, R2 fell from her bed. […]
- Actual harm, isolatedF600Jun 11, 2025
Based on interview and record review, the facility failed to protect the residents' right to be free from neglect when the facility failed to ensure medications were obtained and hospice orders were followed for 2 (R1, R2) residents, admitted to the facility for a hospice respite stay. This failure resulted in R1 experiencing seizures after not receiving anticonvulsant medications and requiring hospitalization. This applies to 2 of 4 residents (R1, R2) reviewed for neglect in the sample of 8. The findings include: 1. The EMR (Electronic Medical Record) shows R1 was admitted to the facility on [DATE] for a respite stay. The EMR continues to show R1 was transferred to the local hospital on May 23, 2025 due to experiencing a seizure at the facility. R1 did not return to the facility. […]
- Actual harm, isolatedF760Jun 11, 2025
Based on interview and record review, the facility failed to ensure a hospice resident, admitted to the facility for a respite stay, was administered anticonvulsant medication and insulin as shown on the hospice records and provided by the resident's family. This failure resulted in R1 experiencing seizures after not receiving anticonvulsant medications and requiring hospitalization. This applies to 1 of 4 residents (R1) reviewed for medication administration in the sample of 8. The findings include: The EMR (Electronic Medical Record) shows R1 was admitted to the facility on [DATE] for a respite stay. The EMR continues to show R1 was transferred to the local hospital on May 23, 2025 due to experiencing a seizure at the facility. R1 did not return to the facility. […]
- Actual harm, isolatedF689Jan 29, 2023
Based on observation, interview and record review, the facility failed to ensure that a safety measure was implemented by not providing adequate assistance for a resident requiring total assistance with two-person assist during transfer using mechanical transfer lift device. Based on observation, interview and record review the facility failed to follow R1's physician orders and treatment plan. That requires R1 to be transferred using the mechanical lift and two-person transfer. This failure resulted in R1 sustaining an acute displaced comminuted fracture of the left tibia. This applies to 1 of 3 residents (R1) reviewed for transfers with use of mechanical transfer lift device. […]
Read 31 findings in full →The most serious and the most recent: 31 of 191 on record.
Every survey on record
FindingsAt actual harm or above
- Jul 31, 2025Standard13 findings
- Jul 11, 2025Complaint1 finding · 1 harm
- Jun 11, 2025Complaint3 findings · 2 harm
- Apr 15, 2025Complaint1 finding
- Feb 21, 2025Complaint2 findings · 1 harm
- Jan 8, 2025Complaint2 findings
- Dec 18, 2024Complaint1 finding
- Nov 19, 2024Complaint1 finding
Show the 52 earlier surveys
- Oct 10, 2024Complaint5 findings
- Jun 27, 2024Standard10 findings
- May 8, 2024Complaint1 finding
- Mar 18, 2024Complaint1 finding
- Feb 23, 2024Complaint2 findings
- Nov 6, 2023Complaint1 finding
- Sep 14, 2023Standard9 findings
- Jan 29, 2023Complaint1 finding · 1 harm
- Dec 8, 2022Standard7 findings
- Jun 2, 2022Complaint2 findings · 1 harm
- Nov 18, 2021Standard4 findings
- Jan 20, 2021Infection control1 finding
- Dec 23, 2020Infection control1 finding
- Oct 16, 2020Standard7 findings
- Aug 31, 2020Complaint1 finding
- Sep 3, 2019Complaint1 finding
- Jun 11, 2019Complaint2 findings · 1 harm
- Apr 10, 2019Standard11 findings
- Mar 13, 2019Complaint1 finding
- Dec 7, 2018Complaint1 finding
- Jun 21, 2018Complaint1 finding
- Jun 7, 2018Standard10 findings
- May 10, 2018Complaint1 finding
- Feb 14, 2018Complaint1 finding
- Oct 18, 2017Complaint4 findings · 1 harm
- Aug 22, 2017Complaint1 finding
- Jul 19, 2017Complaint4 findings
- Jul 5, 2017Complaint3 findings
- May 26, 2017Standard and complaint11 findings
- Apr 5, 2017Complaint1 finding
- Feb 7, 2017Complaint2 findings
- Dec 12, 2016Complaint1 finding
- Nov 9, 2016Complaint1 finding
- Aug 11, 2016Complaint1 finding
- Jul 19, 2016Complaint2 findings
- Apr 21, 2016Standard6 findings
- Feb 4, 2016Complaint1 finding
- Oct 14, 2015Complaint3 findings
- Jul 2, 2015Standard7 findings
- Nov 14, 2014Complaint1 finding
- Sep 3, 2014Complaint1 finding
- May 1, 2014Standard6 findings
- Nov 15, 2013—7 findings
- Oct 18, 2013—1 finding
- May 23, 2013—11 findings
- Mar 7, 2013—1 finding · 1 harm
- Nov 30, 2012—2 findings
- Feb 23, 2012—1 finding · 1 harm
- Jan 4, 2012—1 finding · 1 harm
- Sep 6, 2011—3 findings · 2 harm
- Mar 30, 2011—1 finding · 1 harm
- Mar 15, 2011—1 finding · 1 harm
Surveys that found no deficiencies are not in CMS’s files and do not appear here.
Comparable facilities
The nearest facilities to this one in the same peer group, by weighted findings.
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