01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-07-31 | 13 | 2024-06-27 | 8 |
| Cycle 2 | 2024-06-27 | 26 | 2023-09-14 | 7 |
| Cycle 3 | 2023-09-14 | 14 | 2022-12-08 | 14 |
CMS CCN 1457102026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Meadowbrook Manor
431 West Remington Boulevard · Bolingbrook, IL 60440 · Will County
Certified beds298CMS provider file
Recent citation rows82current CMS citation release
Penalty rows3current 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
82 rows in the current release
4 rows carry G–L scope/severity codes; 1 carry J–L. 16 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-07-31 · HEALTHF0677Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-31 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-31 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-31 · HEALTHF0689Severity D · isolated; potential for more than minimal 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 · 2025-08-012025-07-31 · HEALTHF0700Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-31 · 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 · 2025-08-012025-07-31 · HEALTHF0761Severity E · pattern; potential for more than minimal harm
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.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-31 · HEALTHF0791Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide or obtain dental services for each resident.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-31 · HEALTHF0803Severity E · pattern; potential for more than minimal harm
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.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-31 · 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 · 2025-08-012025-07-31 · HEALTHF0880Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-31 · HEALTHF0883Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-31 · HEALTHF0887Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-11 · 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 · 2025-07-12 · complaint2025-06-11 · HEALTHF0600Severity G · isolated actual 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 · 2025-06-16 · complaint2025-06-11 · HEALTHF0757Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2025-06-16 · complaint2025-06-11 · HEALTHF0760Severity G · isolated actual harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2025-06-16 · complaint2025-04-15 · HEALTHF0677Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2025-04-18 · complaint2025-02-21 · HEALTHF0600Severity J · isolated immediate jeopardy
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 · 2025-03-06 · complaint2025-02-21 · HEALTHF0610Severity F · widespread; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Deficient, Provider has date of correction · 2025-03-06 · complaint2025-01-08 · HEALTHF0677Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2025-01-22 · complaint2025-01-08 · HEALTHF0725Severity E · pattern; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Correction field: Deficient, Provider has date of correction · 2025-01-22 · complaint2024-12-18 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2024-12-30 · complaint2024-11-19 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2024-11-29 · complaint03 / 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 |
|---|---|---|---|
| 2025-07-11 | Fine | $16,790 | 0 |
| 2025-06-11 | Fine | $13,299 | 0 |
| 2025-02-21 | Fine | $130,546 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- DESCENDANTS S CORP FBO ASHLEY MARIA DIMASOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST7% · since 07/11/1989
- DESCENDANTS S CORP TRUST FBO SASHA EVA DIMASOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST7% · since 07/11/1989
- DESCENDANTS S CORP TRUST FBO SEAN WILLIAM DIMASOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST7% · since 07/11/1989
- DOROTHY VANGEL QSS TRUSTOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST8% · since 07/11/1989
- JAFARI, KIANOOSHIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST13% · since 07/11/1989
- JAFARI, ROBERTIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST25% · since 07/11/1989
- JAFARI, SOUSSANIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST13% · since 07/11/1989
- VANGEL, DOROTHYIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST10% · since 07/11/1989
- VANGEL, NICHOLASIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST10% · since 07/11/1989
- JAFARI, KIANOOSHIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 07/11/1989
- KOSHY, ELIZABETHIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 12/03/2018
- JAFARI, KIANOOSHIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/11/1989
- VANGEL, CHRISTOPHERIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/11/1989
- VANGEL, DOROTHYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/11/1989
- VANGEL, NICHOLASIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/11/1989
- KOSHY, ELIZABETHIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/03/2018
- VANGEL, CHRISTOPHERIndividual · CORPORATE OFFICERNOT APPLICABLE · since 07/11/1989
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 hours3.47per resident day
RN hours0.79per resident day
Weekend nurse hours3.00per resident day
Staff turnover52.1%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.