01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-08-27 | 13 | 2024-10-30 | 9 |
| Cycle 2 | 2024-10-30 | 4 | 2023-09-28 | 8 |
| Cycle 3 | 2023-09-28 | 12 | 2022-07-28 | 8 |
CMS CCN 1457122026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Pavilion On Main Street, The
515 North Main · Sandwich, IL 60548 · De Kalb County
Certified beds113CMS provider file
Recent citation rows54current 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
54 rows in the current release
4 rows carry G–L scope/severity codes; 0 carry J–L. 7 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-10-09 · 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 · 2025-10-10 · complaint2025-09-18 · 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 · 2025-09-26 · complaint2025-09-18 · HEALTHF0755Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has date of correction · 2025-11-11 · complaint2025-08-27 · HEALTHF0584Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Correction field: Deficient, Provider has date of correction · 2025-09-232025-08-27 · HEALTHF0677Severity D · isolated; 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 · 2025-09-232025-08-27 · 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 · 2025-09-232025-08-27 · 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 · 2025-09-232025-08-27 · HEALTHF0692Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
Correction field: Deficient, Provider has date of correction · 2025-09-232025-08-27 · 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 · 2025-09-232025-08-27 · HEALTHF0803Severity F · widespread; 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 · 2025-09-232025-08-27 · HEALTHF0804Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Correction field: Deficient, Provider has date of correction · 2025-09-232025-08-27 · 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 · 2025-09-232025-08-27 · HEALTHF0880Severity D · isolated; 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 · 2025-09-232025-07-23 · HEALTHF0880Severity F · widespread; 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 · 2025-08-05 · complaint2025-07-23 · 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 · 2025-08-05 · complaint2024-10-30 · HEALTHF0755Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has date of correction · 2024-11-112024-10-30 · HEALTHF0812Severity E · pattern; 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 · 2024-11-112024-10-30 · FIREK0225Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Have stairways and smokeproof enclosures used as exits that meet safety requirements.
Correction field: Waiver has been granted2024-10-30 · FIREK0281Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Install proper backup exit lighting.
Correction field: Deficient, Provider has date of correction · 2024-12-132024-10-30 · 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 · 2024-12-132024-10-30 · FIREK0341Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install a fire alarm system that can be heard throughout the facility.
Correction field: Deficient, Provider has date of correction · 2024-12-132024-10-30 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2024-12-132024-10-30 · 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 · 2024-12-132024-10-30 · FIREK0531Severity E · pattern; potential for more than minimal harm
Services Deficiencies
Have elevators that firefighters can control in the event of a fire.
Correction field: Waiver has been granted03 / 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 |
|---|---|---|---|
| 2025-08-27 | Fine | $52,234 | 0 |
| 2025-08-27 | Payment Denial | $0 | 48 |
| 2023-09-28 | Fine | $41,649 | 0 |
| 2023-09-28 | Payment Denial | $0 | 9 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- ILANA D AARON TRUST C/U MAURICE AARON 2014 FAMILY GIFT TRUSTOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST12% · since 12/19/2022
- ILANA D AARON TRUST C/U MAURICE AARON 2014 LEGACY GIFT TRUSTOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST9% · since 12/19/2022
- GOLDSTEIN, SHIMONIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/01/2023
- GRAF, MARCELLAIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/19/2022
- GROSS, SHOSHANAIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/01/2023
- KROLL, GABRIELIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/01/2023
- PROCTOR, KATHERINEIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/01/2023
- RIPSTEIN, KENNETHIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/01/2023
- AARON, JONATHANIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 12/19/2022
- AARON, JONATHANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/19/2022
- GRAF, MARCELLAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/19/2022
- MCDONALD, NANCYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/22/2024
- ROBIN, JASONIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/01/2023
- STERN, TODDIndividual · INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFNOT APPLICABLE · since 11/10/2025
- MCDONALD, NANCYIndividual · ADP OF THE SNFNOT APPLICABLE · since 04/22/2024
- ROBIN, JASONIndividual · ADP OF THE SNFNOT APPLICABLE · since 07/01/2023
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 hours2.98per resident day
RN hours0.72per resident day
Weekend nurse hours2.71per resident day
Staff turnover34.7%CMS reported field
06 / LOCAL RECORDS
Open the Sandwich ledger →