F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to ensure a resident who was contact isolation
was allowed to leave her own room. This applies to 1 of 31 residents (R143) reviewed for resident rights in
the sample of 31.
The findings include:
R143's face sheet shows she is a [AGE] year old female, with diagnoses including type 2 diabetes,
fibromyalgia, generalized anxiety, chronic pain, restless leg syndrome, major depression, and urinary tract
infection (UTI).
R143's Urinalysis Culture Report, dated 4/29/25, shows Klebsiella pneumonia (MDRO).
R143's Physician Order Sheets shows orders on 5/1/25 for Isolation: Contact Precautions: E Coli Urine.
On 5/12/25 at 9:42 AM, R143 said last week she was placed on isolation for seven days for a urinary tract
infection. At first, the staff said she could leave the room as long as she washed her hands. Then they
changed their mind and said she had to stay in her room with the door closed, the last four to five days of
her isolation. When she asked the staff why she couldn't leave they responded, It's (Facility) policy. She
spoke to several staff including V4 (Assistant Administrator) and V8 (previous Director of Nursing-DON).
R143 said, They did this so they could exert their power over me. It was rude, barbaric, and controlling.
R143 said she is independent with cares, ambulates and toilets herself. She was compliant with hand
washing, but they did not let me leave my room. R143 said she carries a small bottle of hand sanitizer with
her and they told her no, she could not leave the room.
On 5/13/25 at 7:49 AM, V7 (Unit Manager) said R143 was on contact isolation and could not leave her
room. If they are on contact or droplet precautions residents remain in their room until the isolation time is
discontinued. (R143) was upset she could not leave her room.
On 5/13/25 at 9:03 AM, V6, Registered Nurse (RN), said, (R143) is very independent, and she is alert and
oriented. She was moved to a private room and placed on isolation for Klebsiella (MDRO-multi drug
resistant organism). (R143) was upset she could not leave her room, she does not like to be alone.
Residents who are on contact isolation should remain in their room until isolation is completed, and practice
hand hygiene when leaving the room.
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 8
Event ID:
145259
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145259
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/14/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Park Strathmoor
5668 Strathmoor Drive
Rockford, IL 61107
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
On 5/13/25 at 11:02 AM, V4 (Assistant Administrator) said R143 was on isolation, and she was told R143
could not leave her room. (R143) was asking why she couldn't leave her room, and the nurse on A wing
said she has to stay in room. She notified V8 (previous Director of Nursing-DON) about R143's isolation
concern.
On 5/13/25 at 12:43 PM, V8 (previous Director of Nursing-DON) said, (R143) was on contact isolation and
was not allowed to leave her room. She was educated on hand hygiene and educated to stay in her room.
(R143) was independent, she could toilet herself, she could wash her hands and use appropriate infection
control measures. We really wanted to make sure the organism was contained, and told (R143) she needed
to remain in her room.
On 5/13/25 at 10:25 AM, V14 (Corporate RN) said, If a resident is on contact isolation for an UTI, they can
leave their room if they perform hand hygiene on their own, and as long as they are not touching other
residents or residents food.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145259
If continuation sheet
Page 2 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145259
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/14/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Park Strathmoor
5668 Strathmoor Drive
Rockford, IL 61107
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0693
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and
provide appropriate care for a resident with a feeding tube.
Based on observation, interview, and record review, the facility failed to set a resident's tube feeding pump
to the Dietitian's recommended infusion setting for 1 of 4 residents (R30) reviewed for tube feedings in the
sample of 31.
The findings include:
R30's Face Sheet, printed on 5/12/25, indicated R1 had a gastrostomy (tube feeding).
On 5/12/25 at 11:00 AM, R30 was in bed connected to her tube feeding. The tube feeding pump showed an
infusion rate of 55 milliliters (ml) per hour. The pump indicated the total volume to be infused was 1100 ml.
On 5/13/25 at 8:28 AM, R30 was in bed, connected to her tube feeding. The tube feeding pump showed an
infusion rate of 55 ml per hour. The pump indicated the total volume to be infused was 1100 ml.
R30's Order Summary Report, dated 5/12/25, showed two orders for R30's tube feeding. One order was for
a rate of 55 ml per hour, with a total volume of 1100 ml. The second order was for a rate of 60 ml per hour,
with a total volume of 1200 ml. Both orders had a start date of 5/6/25.
R30's Medication Administration Record for May 2025 showed, on 5/6/25 - 5/11/25, R30's tube feeding
pump was infusing at 55 ml per hour, with a total infused volume of 1100 ml, and at 60 ml per hour with a
total infused volume of 1200 ml.
R30's Progress Notes, dated 5/12/25, 5/11/25, 5/10/25, 5/9/25, and 5/8/25, showed the tube feeding was
infusing at a rate of 55 ml per hour, with a total volume of 1100 ml.
On 5/13/25 at 8:28 AM, V12 (Registered Nurse) looked at R30's tube feeding orders and said, That's not
right. V12 confirmed there were two tube feeding orders, and she would need to contact the Dietitian for
clarification. V12 added there should only be one order.
R30's Nutrition note, dated 5/1/25 entered by V13 (Dietitian), showed R30's previous weight loss was
related to fluid and current weight loss was undesirable. The recommendation was to increase the tube
feeding rate to 60 ml per hour, with a total infusion rate of 1200 ml, to increase caloric intake and promote
weight stability.
On 5/13/25 at 10:17 AM, V13 said R30 had weight loss that was fluid related, and on 5/1/25 she
recommended to increasing R30's tube feeding rate to 60 ml per hour, with a total volume of 1200 ml to
maintain R30's weight. V13 confirmed R30's tube feeding rate should be at 60 ml per hour, with a total
volume 1200 ml.
R30's Care Plan, with an initiated date of 2/6/25, showed R30 required tube feeding. Listed under
interventions was to administer tube feeding as ordered.
The facility's Enteral Nutritional Feeding, dated 9/2020, showed to verify orders for feeding.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145259
If continuation sheet
Page 3 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145259
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/14/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Park Strathmoor
5668 Strathmoor Drive
Rockford, IL 61107
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, interview, and record review, the facility failed to ensure dietary aides handled
dishware in a manner to prevent cross-contamination.
Residents Affected - Many
This failure has the potential to affect all 156 residents in the facility,
The findings include:
The facility's Long-Term Care Facility Application for Medicare and Medicaid form, dated 5/12/25, showed a
resident census of 156.
On 5/12/25 at 9:05 AM, V16, Dietary Aide, placed a rack of dirty cups into the facility's dishwasher. After
placing the cups into the dishwasher, V16 immediately walked over to a rack of clean pots, and began
placing the pots on a kitchen shelf. V16 did not wash her hands after loading the dirty cups into the
dishwasher. V16 wore no gloves.
On 5/12/25 at 9:15 AM, V15, Dietary Aide, placed dirty breakfast dishes on a shelf by a kitchen sink. At
9:16 AM, V15 walked over to a rack of clean food trays, and placed the trays on a kitchen cart. V15 did not
wash his hands after handling the dirty breakfast dishes. V15 wore no gloves.
On 5/13/25 at 12:07 PM, V17, Certified Dietary Manager (CDM), stated, Staff should not be touching clean
dishes after touching anything dirty to avoid cross-contamination. Staff should wash their hands when they
are dirty and prior to touching clean dishes.
The facility's Cross Contamination policy, dated 8/2018, showed, The Food & Nutrition Services staff will
employ measures to prevent cross contamination . to reduce the risk of food borne illness . Practice good
hand hygiene, hand washing, and glove use .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145259
If continuation sheet
Page 4 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145259
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/14/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Park Strathmoor
5668 Strathmoor Drive
Rockford, IL 61107
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to perform hand hygiene and change gloves in a
manner to prevent cross contamination for one of 31 residents (R94) reviewed for infection control in the
sample of 31.
Residents Affected - Few
The findings include:
R94's admission Record, dated 5/13/25, shows he was admitted to the facility on [DATE], with diagnoses
including Alzheimer's Disease, narcolepsy, anemia, adult failure to thrive, dementia, and history of falling.
R94's Care Plan, initiated 10/1/21, shows R94 experiences bladder incontinence and is incontinent of
bowel.
On 5/12/25 at 10:42 AM, V22, Certified Nursing Assistant (CNA), transferred R94 onto the toilet. R94
urinated and had a large bowel movement in the toilet. R94 used toilet paper to wipe the stool from R94's
buttocks multiple times. V22 then pulled up R94's clean incontinence brief and R94's clean pants. R94 then
flushed the toilet and pushed R94's wheelchair in front of the sink. V22 did not perform hand hygiene, nor
did she wash her hands.
On 5/13/25 at 10:27 AM, V14, Corporate Registered Nurse, said, Staff should change their gloves when
they are dirty. Gloves should be changed prior to touching anything clean.
The facility's Hand Hygiene Policy, dated October 2024, shows, It is the policy of the facility that hand
hygiene is to be performed to reduce the potential spread of pathogens. There are two methods for hand
hygiene: Alcohol based hand sanitizer (ABHS) is the preferred method of use in most clinical situation.
ABHS should be used: When caring for a resident, when moving from a soiled body site to a clean body
site of the same resident.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145259
If continuation sheet
Page 5 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145259
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/14/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Park Strathmoor
5668 Strathmoor Drive
Rockford, IL 61107
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0883
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to screen residents for and offer the influenza vaccine to
residents during influenza season; failed to screen residents for and offer the pneumococcal vaccine to
residents upon admission; and failed to administer the pneumococcal vaccine to a resident who consented
to receive the vaccine. These failures apply to 5 of 5 residents (R84, R137, R144, R145, R360) reviewed for
influenza and pneumococcal vaccines in the sample of 31.
Residents Affected - Some
The findings include:
1. R84's admission record showed R84 was admitted to the facility on [DATE].
R84's consent for the pneumococcal vaccine, dated 9/3/24, showed R84 consented to receive a
pneumococcal vaccine.
On 5/13/25 at 11:47 AM, V8, Infection Preventionist, stated R84 had never received a pneumococcal
vaccine in the facility.
2. R137's admission record showed R137 was admitted to the facility on [DATE].
R137's immunization record, dated 5/13/25, showed no documentation R137 was ever screened for or
educated on the influenza or pneumococcal vaccines. The record showed no documentation R137 ever
received either vaccine.
3. R144's admission record showed R144 was admitted to the facility on [DATE].
R144's immunization record, dated 5/13/25, showed no documentation R144 was ever screened for or
educated on the influenza or pneumococcal vaccines. The record showed no documentation R144 ever
received either vaccine.
4. R145's admission record showed R145 was admitted to the facility on [DATE].
R145's immunization record, dated 5/13/25, showed no documentation R145 was ever screened for or
educated on the influenza or pneumococcal vaccines. The record showed no documentation R145 ever
received either vaccine.
5. R360's admission record showed R360 was admitted to the facility on [DATE].
R360's immunization record, dated 5/13/25, showed no documentation R360 was ever screened for or
educated on the influenza or pneumococcal vaccines. The record showed no documentation R360 ever
received either vaccine.
On 5/13/25 at 11:47 AM, V8, Infection Preventionist, stated the facility had no documentation to support
R137, R144, R145, and R360 had ever been screened for, educated on, or offered the influenza or
pneumococcal vaccines while in the facility. V8 stated all residents should be screened for and offered the
influenza vaccine from October-March annually. V8 stated all residents should be screened for and offered
the pneumococcal vaccine upon admission to the facility by nursing staff.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145259
If continuation sheet
Page 6 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145259
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/14/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Park Strathmoor
5668 Strathmoor Drive
Rockford, IL 61107
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0883
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
The facility's Influenza Vaccination policy, dated 12/14/2023, showed, The facility follows recommendations
of the Center of Disease Control and Prevention (CDC) and Advisory Committee on Immunization
Practices (ACIP) for influenza vaccinations to be offered October 1 through March 31 annually unless the
immunization is medically contraindicated; the resident is already immunized; or after the provision of
education on risks and benefits is reviewed with the resident/and or responsible party or chooses to refuse
. All new admissions will be offered the influenza vaccine during October 1st through March 31st unless
ordered otherwise or has already received the influenza vaccine .
The facility's Pneumococcal Vaccination policy dated 12/2023 showed, It is the policy of this facility that
residents will be offered immunization against pneumococcal disease in accordance with The Advisory
Committee on Immunization Practices (ACIP) recommendations .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145259
If continuation sheet
Page 7 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145259
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/14/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Park Strathmoor
5668 Strathmoor Drive
Rockford, IL 61107
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0887
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
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.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to screen residents for, educate them on, or offer the
COVID-19 vaccine/booster to residents upon admission to the facility for 3 of 5 residents (R137, R144,
R145) reviewed for the COVID-19 vaccination in the sample of 31.
The findings include:
1. R137's admission record showed R137 was admitted to the facility on [DATE].
R137's immunization record, dated 5/13/25, showed no documentation R137 was ever screened for,
educated on, or offered the COVID-19 vaccine/booster. The record showed no documentation R137 ever
received the vaccine.
2. R144's admission record showed R144 was admitted to the facility on [DATE].
R144's immunization record, dated 5/13/25, showed no documentation R144 was ever screened for,
educated on, or offered the COVID-19 vaccine/booster. The record showed no documentation R144 ever
received the vaccine.
3. R145's admission record showed R145 was admitted to the facility on [DATE].
R145's immunization record, dated 5/13/25, showed no documentation R145 was ever screened for,
educated on, or offered the COVID-19 vaccine/booster. The record showed no documentation R145 ever
received the vaccine.
On 5/13/25 at 11:47 AM, V8, Infection Preventionist, stated the facility had no documentation to support
R137, R144, and R145 had ever been screened for, educated on, or offered the COVID-19 vaccine/booster
while in the facility. V8 stated all residents should be screened for and offered the COVID-19 vaccine upon
admission to the facility by nursing staff.
The facility's COVID-19 Vaccinations policy, dated 2/2025, showed, When recommended vaccines are
available, the facility will ensure COVID-19 vaccines are readily accessible to both residents and staff . The
residents medical record includes documentation that indicates, at a minimum the following: a. That the
resident or resident representative was provided education regarding the benefits and potential risks
associated with the COVID-19 vaccine: and b. Each dose of COVID-19 vaccine administered to the
resident; or c. If the resident did not receive the COVID-19 vaccine due to medical contraindications or
refusal .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145259
If continuation sheet
Page 8 of 8