01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-03-21 | 2 | 2025-03-21 | 3 |
| Cycle 2 | 2024-05-16 | 12 | 2024-05-16 | 11 |
| Cycle 3 | 2023-04-28 | 9 | 2023-04-28 | 10 |
CMS CCN 1458662026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Hickory Vlg Nrsg & Rhb
9246 South Roberts Road · Hickory Hills, IL 60457 · Cook County
Certified beds74CMS provider file
Recent citation rows47current CMS citation release
Penalty rows4current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
47 rows in the current release
4 rows carry G–L scope/severity codes; 3 carry J–L. 13 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-06-17 · HEALTHF0921Severity F · widespread; potential for more than minimal harm
Environmental Deficiencies
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Correction field: Deficient, Provider has date of correction · 2025-07-02 · complaint2025-03-21 · HEALTHF0568Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.
Correction field: Deficient, Provider has date of correction · 2025-04-082025-03-21 · HEALTHF0644Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Correction field: Deficient, Provider has date of correction · 2025-04-082025-03-21 · FIREK0271Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Have exits that are accessible at all times.
Correction field: Deficient, Provider has date of correction · 2025-03-212025-03-21 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-06-102025-03-21 · FIREK0363Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2025-04-112025-02-07 · HEALTHF0689Severity J · isolated immediate jeopardy
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2025-02-08 · complaint2025-01-14 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
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.
Correction field: Deficient, Provider has date of correction · 2025-01-31 · complaint2025-01-14 · HEALTHF0689Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2025-01-31 · complaint2024-12-19 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
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.
Correction field: Deficient, Provider has date of correction · 2024-12-30 · complaint2024-09-25 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
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.
Correction field: Deficient, Provider has date of correction · 2024-10-22 · complaint2024-09-25 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2024-10-15 · complaint2024-09-25 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2024-10-15 · complaint2024-09-25 · HEALTHF0741Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents.
Correction field: Deficient, Provider has date of correction · 2024-10-15 · complaint2024-07-19 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
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.
Correction field: Deficient, Provider has date of correction · 2024-08-07 · complaint2024-05-16 · HEALTHF0759Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2024-06-072024-05-16 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2024-06-072024-05-16 · HEALTHF0882Severity F · widespread; potential for more than minimal harm
Infection Control Deficiencies
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Correction field: Deficient, Provider has date of correction · 2024-06-072024-05-16 · FIREK0222Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Correction field: Deficient, Provider has date of correction · 2024-06-072024-05-16 · FIREK0321Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2024-06-072024-05-16 · FIREK0324Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2024-06-072024-05-16 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Waiver has been granted · 2024-08-092024-05-16 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2024-06-072024-05-16 · FIREK0355Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Correction field: Deficient, Provider has date of correction · 2024-06-0703 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-01-14 | Fine | $131,763 | 0 |
| 2025-01-14 | Payment Denial | $0 | 1 |
| 2024-01-25 | Fine | $79,590 | 0 |
| 2023-11-02 | Fine | $139,319 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- WISSATI IRREVOCABLE TRUSTOrganization · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/01/2022
- LIPSHITZ, RITAIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/01/2022
- MASHIACH, RHONDAIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/01/2022
- MASHIACH, YAACOVIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/01/2022
- MASHIACH, YECHIELIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/01/2022
- MIDLAND STATES BANCORP INCOrganization · 5% OR GREATER SECURITY INTERESTNOT APPLICABLE · since 12/11/2024
- DAVEY, JENNIFERIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/01/2022
- GAUTAM, SAGUNIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/01/2022
- MASHIACH, YAACOVIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/01/2022
- MASHIACH, YECHIELIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/01/2022
- GRASSO, ALBERTIndividual · TRUSTEE OF THE SNFNOT APPLICABLE · since 07/01/2022
- MIRETZKY, STEVENIndividual · TRUSTEE OF THE SNFNOT APPLICABLE · since 07/01/2022
- JADE FINANCIAL SERVICES LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 07/01/2022
- DAVEY, JENNIFERIndividual · ADP OF THE SNFNOT APPLICABLE · since 07/01/2022
- GAUTAM, SAGUNIndividual · ADP OF THE SNFNOT APPLICABLE · since 07/01/2022
- LIPSHITZ, RITAIndividual · ADP OF THE SNFNOT APPLICABLE · since 07/01/2022
- MASHIACH, RHONDAIndividual · ADP OF THE SNFNOT APPLICABLE · since 07/01/2022
- MASHIACH, YAACOVIndividual · ADP OF THE SNFNOT APPLICABLE · since 07/01/2022
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours2.67per resident day
RN hours0.67per resident day
Weekend nurse hours2.05per resident day
Staff turnover27.9%CMS reported field
06 / LOCAL RECORDS
Open the Illinois ledger →Other published facilities nearby
No second facility in the same city met the directory rule.