Alpine Care Of Zion

Penalties

• Aug 13, 2025 — IDPH fine (Nursing Home Care Act) ($500)
• Aug 8, 2025 — Fine ($13,142)
• Aug 8, 2025 — IDPH fine (Nursing Home Care Act) ($25,000)
• Aug 5, 2024 — IDPH fine (Nursing Home Care Act) ($50,000)
• Jul 15, 2024 — Fine ($30,014)
• Sep 27, 2023 — Fine ($29,432)
• Sep 27, 2023 — Payment Denial · payment denial 7 days

Inspection findings

1. Apr 13, 2026 Health · 1 finding
   • Not serious Scope/severity D Complaint

     F0600 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

     Corrected Apr 19, 2026 · CMS health inspection

2. Mar 27, 2026 Health · 2 findings
   • Not serious Scope/severity D Complaint

     F0677 Quality of Life and Care Deficiencies

     Provide care and assistance to perform activities of daily living for any resident who is unable.

     Corrected Mar 30, 2026 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Mar 30, 2026 · CMS health inspection

3. Dec 5, 2025 Health · 1 finding
   • Not serious Scope/severity D Complaint

     F0686 Quality of Life and Care Deficiencies

     Provide appropriate pressure ulcer care and prevent new ulcers from developing.

     Corrected Dec 8, 2025 · CMS health inspection

4. Nov 14, 2025 Health · 1 finding
   • Not serious Scope/severity E Complaint

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Nov 15, 2025 · CMS health inspection

5. Sep 22, 2025 Health · 1 finding
   • Not serious Scope/severity D Complaint

     F0627 Resident Rights Deficiencies

     Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.

     Corrected Oct 1, 2025 · CMS health inspection

6. Aug 13, 2025 Health · 6 findings
   • Not serious Scope/severity D

     F0604 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.

     Corrected Aug 14, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0677 Quality of Life and Care Deficiencies

     Provide care and assistance to perform activities of daily living for any resident who is unable.

     Corrected Aug 14, 2025 · CMS health inspection

   • Not serious Scope/severity E

     F0761 Pharmacy Service Deficiencies

     Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

     Corrected Aug 14, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0806 Nutrition and Dietary Deficiencies

     Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

     Corrected Aug 14, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Aug 14, 2025 · CMS health inspection

   • Not serious Scope/severity C

     Type C Illinois Nursing Home Care Act violation

     Type C: less than minimal harm (1-132). Sections of the Illinois Administrative Code cited: 300.615f). 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: 300.615f).

     Statement of deficiencies (PDF)

7. Aug 8, 2025 Health · 2 findings
   • Serious Scope/severity G Complaint

     F0684 Quality of Life and Care Deficiencies

     Provide appropriate treatment and care according to orders, resident’s preferences and goals.

     Corrected Aug 9, 2025 · CMS health inspection

   • Serious Scope/severity A

     Type A Illinois Nursing Home Care Act violation

     Type A: substantial probability of death or serious harm, or actual harm (1-129). Sections of the Illinois Administrative Code cited: 300.1210b) and 300.1210d)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: 300.1210b).

     Statement of deficiencies (PDF)

8. Dec 17, 2024 Health · 1 finding
   • Not serious Scope/severity D Complaint

     F0580 Resident Rights Deficiencies

     Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

     Corrected Dec 18, 2024 · CMS health inspection

9. Aug 5, 2024 Health · 2 findings
   • Serious Scope/severity J Complaint

     F0684 Quality of Life and Care Deficiencies

     Provide appropriate treatment and care according to orders, resident’s preferences and goals.

     Corrected Aug 6, 2024 · CMS health inspection

   • Serious Scope/severity AA

     Type AA Illinois Nursing Home Care Act violation

     Type AA: proximately caused a resident's death (210 ILCS 45/1-128.5). Sections of the Illinois Administrative Code cited: 300.610a), 300.1210b), and 300.1210d)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: 300.1210b).

     Statement of deficiencies (PDF)

10. Jul 19, 2024 Fire Safety · 27 findings
    • Not serious Scope/severity F

      E0004 Emergency Preparedness Deficiencies

      Develop and maintain an Emergency Preparedness Program (EP).

      Corrected Aug 6, 2024 · CMS fire safety

    • Not serious Scope/severity F

      E0006 Emergency Preparedness Deficiencies

      Conduct risk assessment and an All-Hazards approach.

      Corrected Aug 6, 2024 · CMS fire safety

    • Not serious Scope/severity F

      E0015 Emergency Preparedness Deficiencies

      Address subsistence needs for staff and patients.

      Corrected Aug 6, 2024 · CMS fire safety

    • Not serious Scope/severity F

      E0022 Emergency Preparedness Deficiencies

      Establish policies and procedures for sheltering.

      Corrected Aug 6, 2024 · CMS fire safety

    • Not serious Scope/severity F

      E0024 Emergency Preparedness Deficiencies

      Establish policies and procedures for volunteers.

      Corrected Aug 6, 2024 · CMS fire safety

    • Not serious Scope/severity F

      E0041 Emergency Preparedness Deficiencies

      Implement emergency and standby power systems.

      Corrected Aug 6, 2024 · CMS fire safety

    • Not serious Scope/severity D

      F0550 Resident Rights Deficiencies

      Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

      Corrected Jul 23, 2024 · CMS health inspection

    • Not serious Scope/severity E

      F0565 Resident Rights Deficiencies

      Honor the resident's right to organize and participate in resident/family groups in the facility.

      Corrected Jul 23, 2024 · CMS health inspection

    • Not serious Scope/severity D

      F0684 Quality of Life and Care Deficiencies

      Provide appropriate treatment and care according to orders, resident’s preferences and goals.

      Corrected Aug 6, 2024 · CMS health inspection

    • Not serious Scope/severity D

      F0689 Quality of Life and Care Deficiencies

      Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

      Corrected Jul 23, 2024 · CMS health inspection

    • Not serious Scope/severity D

      F0690 Quality of Life and Care Deficiencies

      Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

      Corrected Jul 23, 2024 · CMS health inspection

    • Not serious Scope/severity D

      F0692 Quality of Life and Care Deficiencies

      Provide enough food/fluids to maintain a resident's health.

      Corrected Jul 23, 2024 · CMS health inspection

    • Not serious Scope/severity D

      F0698 Quality of Life and Care Deficiencies

      Provide safe, appropriate dialysis care/services for a resident who requires such services.

      Corrected Jul 23, 2024 · CMS health inspection

    • Not serious Scope/severity D

      F0755 Pharmacy Service Deficiencies

      Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

      Corrected Jul 23, 2024 · CMS health inspection

    • Not serious Scope/severity D

      F0803 Nutrition and Dietary Deficiencies

      Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

      Corrected Jul 23, 2024 · CMS health inspection

    • Not serious Scope/severity E

      F0880 Infection Control Deficiencies

      Provide and implement an infection prevention and control program.

      Corrected Jul 23, 2024 · CMS health inspection

    • Not serious Scope/severity E

      K0161 Construction Deficiencies

      Use approved construction type or materials.

      Corrected Aug 6, 2024 · CMS fire safety

    • Not serious Scope/severity E

      K0211 Egress Deficiencies

      Keep aisles, corridors, and exits free of obstruction in case of emergency.

      Corrected Aug 5, 2024 · CMS fire safety

    • Not serious Scope/severity F

      K0311 Smoke Deficiencies

      Have an enclosure around a vertical opening shaft.

      Corrected Nov 7, 2024 · CMS fire safety

    • Not serious Scope/severity E

      K0321 Smoke Deficiencies

      Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

      Corrected Aug 6, 2024 · CMS fire safety

    • Not serious Scope/severity F

      K0345 Smoke Deficiencies

      Have approved installation, maintenance and testing program for fire alarm systems.

      Corrected Aug 7, 2024 · CMS fire safety

    • Not serious Scope/severity F

      K0351 Smoke Deficiencies

      Install an approved automatic sprinkler system.

      Corrected Aug 6, 2024 · CMS fire safety

    • Not serious Scope/severity F

      K0353 Smoke Deficiencies

      Inspect, test, and maintain automatic sprinkler systems.

      Corrected Aug 6, 2024 · CMS fire safety

    • Not serious Scope/severity E

      K0374 Smoke Deficiencies

      Install smoke barrier doors that can resist smoke for at least 20 minutes.

      Corrected Aug 6, 2024 · CMS fire safety

    • Not serious Scope/severity F

      K0915 Gas, Vacuum, and Electrical Systems Deficiencies

      Have proper power supply for life support equipment.

      Corrected Aug 7, 2024 · CMS fire safety

    • Not serious Scope/severity F

      K0918 Gas, Vacuum, and Electrical Systems Deficiencies

      Have generator or other power source capable of supplying service within 10 seconds.

      Corrected Aug 14, 2024 · CMS fire safety

    • Not serious Scope/severity E

      K0920 Gas, Vacuum, and Electrical Systems Deficiencies

      Ensure proper usage of power strips and extension cords.

      Corrected Aug 7, 2024 · CMS fire safety

11. Jul 15, 2024 Health · 2 findings
    • Not serious Scope/severity D Complaint

      F0695 Quality of Life and Care Deficiencies

      Provide safe and appropriate respiratory care for a resident when needed.

      Corrected Jul 20, 2024 · CMS health inspection

    • Not serious Scope/severity E Complaint

      F0921 Environmental Deficiencies

      Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

      Corrected Jul 20, 2024 · CMS health inspection

12. Jan 8, 2024 Health · 2 findings
    • Not serious Scope/severity D Complaint

      F0677 Quality of Life and Care Deficiencies

      Provide care and assistance to perform activities of daily living for any resident who is unable.

      Corrected Jan 10, 2024 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0880 Infection Control Deficiencies

      Provide and implement an infection prevention and control program.

      Corrected Jan 10, 2024 · CMS health inspection

13. Dec 28, 2023 Health · 2 findings
    • Not serious Scope/severity D Complaint

      F0686 Quality of Life and Care Deficiencies

      Provide appropriate pressure ulcer care and prevent new ulcers from developing.

      Corrected Dec 29, 2023 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0880 Infection Control Deficiencies

      Provide and implement an infection prevention and control program.

      Corrected Jan 10, 2024 · CMS health inspection

14. Sep 27, 2023 Health · 21 findings
    • Not serious Scope/severity D Complaint

      F0573 Resident Rights Deficiencies

      Let each resident or the resident's legal representative access or purchase copies of all the resident's records.

      Corrected Sep 29, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0677 Quality of Life and Care Deficiencies

      Provide care and assistance to perform activities of daily living for any resident who is unable.

      Corrected Sep 29, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0684 Quality of Life and Care Deficiencies

      Provide appropriate treatment and care according to orders, resident’s preferences and goals.

      Corrected Sep 29, 2023 · CMS health inspection

    • Serious Scope/severity G

      F0686 Quality of Life and Care Deficiencies

      Provide appropriate pressure ulcer care and prevent new ulcers from developing.

      Corrected Oct 27, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0689 Quality of Life and Care Deficiencies

      Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

      Corrected Sep 29, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0755 Pharmacy Service Deficiencies

      Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

      Corrected Sep 29, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0758 Pharmacy Service Deficiencies

      Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

      Corrected Sep 29, 2023 · CMS health inspection

    • Not serious Scope/severity E

      F0759 Pharmacy Service Deficiencies

      Ensure medication error rates are not 5 percent or greater.

      Corrected Oct 27, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0760 Pharmacy Service Deficiencies

      Ensure that residents are free from significant medication errors.

      Corrected Sep 29, 2023 · CMS health inspection

    • Not serious Scope/severity F

      F0812 Nutrition and Dietary Deficiencies

      Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

      Corrected Oct 27, 2023 · CMS health inspection

    • Not serious Scope/severity E

      F0880 Infection Control Deficiencies

      Provide and implement an infection prevention and control program.

      Corrected Sep 29, 2023 · CMS health inspection

    • Not serious Scope/severity E

      K0211 Egress Deficiencies

      Keep aisles, corridors, and exits free of obstruction in case of emergency.

      Corrected Oct 3, 2023 · CMS fire safety

    • Not serious Scope/severity F

      K0311 Smoke Deficiencies

      Have an enclosure around a vertical opening shaft.

      CMS fire safety

    • Not serious Scope/severity F

      K0345 Smoke Deficiencies

      Have approved installation, maintenance and testing program for fire alarm systems.

      Corrected Oct 3, 2023 · CMS fire safety

    • Not serious Scope/severity E

      K0355 Smoke Deficiencies

      Properly select, install, inspect, or maintain portable fire extinguishes.

      Corrected Oct 3, 2023 · CMS fire safety

    • Not serious Scope/severity E

      K0363 Smoke Deficiencies

      Install corridor and hallway doors that block smoke.

      Corrected Oct 3, 2023 · CMS fire safety

    • Not serious Scope/severity F

      K0511 Services Deficiencies

      Have properly installed electrical wiring and gas equipment.

      Corrected Oct 3, 2023 · CMS fire safety

    • Not serious Scope/severity F

      K0531 Services Deficiencies

      Have elevators that firefighters can control in the event of a fire.

      Corrected Oct 4, 2023 · CMS fire safety

    • Not serious Scope/severity E

      K0541 Services Deficiencies

      Install properly constructed and protected linen or trash chutes.

      Corrected Oct 3, 2023 · CMS fire safety

    • Not serious Scope/severity F

      K0918 Gas, Vacuum, and Electrical Systems Deficiencies

      Have generator or other power source capable of supplying service within 10 seconds.

      Corrected Oct 24, 2023 · CMS fire safety

    • Not serious Scope/severity D

      K0920 Gas, Vacuum, and Electrical Systems Deficiencies

      Ensure proper usage of power strips and extension cords.

      Corrected Oct 3, 2023 · CMS fire safety

15. Aug 3, 2023 Health · 3 findings
    • Not serious Scope/severity D Complaint

      F0658 Resident Assessment and Care Planning Deficiencies

      Ensure services provided by the nursing facility meet professional standards of quality.

      Corrected Aug 4, 2023 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0690 Quality of Life and Care Deficiencies

      Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

      Corrected Aug 4, 2023 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0880 Infection Control Deficiencies

      Provide and implement an infection prevention and control program.

      Corrected Aug 4, 2023 · CMS health inspection

16. Oct 19, 2022 Fire Safety · 2 findings
    • Not serious Scope/severity F

      E0004 Emergency Preparedness Deficiencies

      Develop and maintain an Emergency Preparedness Program (EP).

      Corrected Nov 3, 2022 · CMS fire safety

    • Not serious Scope/severity F

      E0041 Emergency Preparedness Deficiencies

      Implement emergency and standby power systems.

      Corrected Nov 3, 2022 · CMS fire safety

Owners and managers (as published by CMS)

• SHABAT, MENACHEM — operational/managerial control, NOT APPLICABLE, since 05/03/2017
• SHABAT, MENACHEM — adp of the snf, NOT APPLICABLE, since 05/03/2017
• SHABAT, MENACHEM — managing control - governing body, NOT APPLICABLE, since 05/03/2017
• STANGEL, JULIE — adp of the snf, NOT APPLICABLE, since 11/06/2015
• STANGEL, JULIE — operational/managerial control, NOT APPLICABLE, since 11/06/2015
• WOIKE, TOM — adp of the snf, NOT APPLICABLE, since 01/01/2024
• WOIKE, TOM — operational/managerial control, NOT APPLICABLE, since 01/01/2024
• DOROS GENERATION TRUST U/A/D 1/3/12 — adp of the snf, NOT APPLICABLE, since 11/01/2015
• DOROS GENERATION TRUST U/A/D 1/3/12 — 5% or greater direct ownership interest, 50%, since 05/03/2017
• GPN FAMILY TRUST U/A/D 4/28/08 — adp of the snf, NOT APPLICABLE, since 11/06/2015
• GPN FAMILY TRUST U/A/D 4/28/08 — 5% or greater direct ownership interest, 50%, since 05/03/2017
• GROVE AT THE LAKE REALTY, LLC — adp of the snf, NOT APPLICABLE, since 11/06/2015
• GROVE AT THE LAKE REALTY, LLC — 5% or greater security interest, NOT APPLICABLE, since 11/06/2015
• LEGACY HEALTHCARE FINANCIAL SERVICES LLC — operational/managerial control, NOT APPLICABLE, since 11/06/2015
• LEGACY HEALTHCARE FINANCIAL SERVICES LLC — adp of the snf, NOT APPLICABLE, since 11/17/2025
• ROTH & CO, LLP — adp of the snf, NOT APPLICABLE, since 01/01/2024
• VNB NEW YORK LLC — 5% or greater security interest, NOT APPLICABLE, since 03/07/2025
• VNB NEW YORK LLC — operational/managerial control, NOT APPLICABLE, since 03/07/2025