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Public Record

Sandwich Living & Rehab Center

Nursing HomeSandwich, ILCMS 146133
83 citations on record

From CMS

Facility profile

CMS overall rating
1 / 5

*CMS Five-Star

Certified beds
63

*CMS

Avg. residents per day
28

*CMS

Inspection record

On record from CMS

Citations on record
83

*CMS

Inspections on file
18

*CMS

Last inspection
2026-03-04

*CMS

Citations

83 citations on record

Each deficiency cited on a CMS health inspection of this facility, sourced from the federal record. Open a report for the raw CMS Scope and Severity grade on each finding.

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

  • 0690Generalpotential for harm

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

  • 0689Generalpotential for harm

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

  • 0921Generalpotential for harm

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

  • 0690Generalpotential for harm

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

  • 0692Seriousactual harm

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

  • 0689Generalpotential for harm

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

  • 0755Generalpotential for harm

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

  • 0759Generalpotential for harm

    Ensure medication error rates are not 5 percent or greater.

  • 0842Generalpotential for harm

    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

  • 0880Generalpotential for harm

    Provide and implement an infection prevention and control program.

  • 0686Seriousactual harm

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

  • 0584Generalpotential for harm

    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.

  • 0580Generalpotential for harm

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

  • 0600Seriousactual harm

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

  • 0684Generalpotential for harm

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

  • 0686Generalpotential for harm

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

  • 0689Generalpotential for harm

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

  • 0600Generalpotential for harm

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

  • 0658Generalpotential for harm

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

  • 0684Generalpotential for harm

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

  • 0684Generalpotential for harm

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

  • 0812Generalpotential for harm

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

  • 0602Generalpotential for harm

    Protect each resident from the wrongful use of the resident's belongings or money.

  • 0610Generalpotential for harm

    Respond appropriately to all alleged violations.

  • 0755Generalpotential for harm

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

  • 0803Generalpotential for harm

    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.

  • 0805Seriousimmediate jeopardy

    Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.

  • 0921Generalpotential for harm

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

  • 0607Generalpotential for harm

    Develop and implement policies and procedures to prevent abuse, neglect, and theft.

  • 0684Generalpotential for harm

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

  • 0686Generalpotential for harm

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

  • 0690Generalpotential for harm

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

  • 0695Generalpotential for harm

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

  • 0725Generalpotential for harm

    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

  • 0727Generalpotential for harm

    Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

  • 0755Generalpotential for harm

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

  • 0812Generalpotential for harm

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

  • 0880Generalpotential for harm

    Provide and implement an infection prevention and control program.

  • 0883Generalpotential for harm

    Develop and implement policies and procedures for flu and pneumonia vaccinations.

  • 0026Generalpotential for harm

    Establish roles under a Waiver declared by secretary.

  • 0692Seriousactual harm

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

  • 0690Seriousactual harm

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

  • 0686Seriousactual harm

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

  • 0684Generalpotential for harm

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

  • 0600Seriousimmediate jeopardy

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

  • 0689Seriousimmediate jeopardy

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

  • 0835Seriousactual harm

    Administer the facility in a manner that enables it to use its resources effectively and efficiently.

  • 0689Generalpotential for harm

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

  • 0745Seriousactual harm

    Provide medically-related social services to help each resident achieve the highest possible quality of life.

  • 0584Generalpotential for harm

    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.

  • 0553Generalpotential for harm

    Allow resident to participate in the development and implementation of his or her person-centered plan of care.

  • 0550Generalpotential for harm

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

  • 0675Seriousactual harm

    Honor each resident's preferences, choices, values and beliefs.

  • 0755Generalpotential for harm

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

  • 0580Generalpotential for harm

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

  • 0725Generalpotential for harm

    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

  • 0755Generalpotential for harm

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

  • 0835Generalpotential for harm

    Administer the facility in a manner that enables it to use its resources effectively and efficiently.

  • 0686Generalpotential for harm

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

  • 0698Generalpotential for harm

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

  • 0745Seriousactual harm

    Provide medically-related social services to help each resident achieve the highest possible quality of life.

  • 0691Generalpotential for harm

    Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.

  • 0584Generalpotential for harm

    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.

  • 0943Generalpotential for harm

    Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

  • 0004Generalpotential for harm

    Develop and maintain an Emergency Preparedness Program (EP).

  • 0015Generalpotential for harm

    Address subsistence needs for staff and patients.

  • 0022Generalpotential for harm

    Establish policies and procedures for sheltering.

  • 0039Generalpotential for harm

    Conduct testing and exercise requirements.

  • 0561Generalpotential for harm

    Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

  • 0577Generalno actual harm

    Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.

  • 0584Generalpotential for harm

    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.

  • 0600Generalpotential for harm

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

  • 0604Generalpotential for harm

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

  • 0606Generalpotential for harm

    Not hire anyone with a finding of abuse, neglect, exploitation, or theft.

  • 0727Generalpotential for harm

    Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

  • 0755Generalpotential for harm

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

  • 0758Generalpotential for harm

    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.

  • 0773Generalpotential for harm

    Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.

  • 0880Generalpotential for harm

    Provide and implement an infection prevention and control program.

  • 0882Generalpotential for harm

    Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.

  • 0883Generalpotential for harm

    Develop and implement policies and procedures for flu and pneumonia vaccinations.

  • 0887Generalpotential for harm

    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.

  • 0921Generalpotential for harm

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

Inspection findings

What the surveyors documented

The verbatim CMS Form 2567 statement of deficiencies for each survey, straight from the federal record. Open a report for the full findings and plan of correction.

  • Inspection2 deficiencies

    F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on…

    Read full statement of deficiencies
  • Inspection9 deficiencies

    F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. Based on observation, interview and…

    Read full statement of deficiencies
  • Inspection5 deficiencies

    F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT…

    Read full statement of deficiencies
  • Inspection2 deficiencies

    F 0600 Level of Harm - Minimal harm or potential for actual harm Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Based on observation, interview, and record review the facility failed to ensure resident's were free…

    Read full statement of deficiencies
  • Inspection1 deficiency

    F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 document…

    Read full statement of deficiencies
  • Inspection1 deficiency

    F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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…

    Read full statement of deficiencies
  • Inspection7 deficiencies

    F 0602 Protect each resident from the wrongful use of the resident's belongings or money. 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 prevent the…

    Read full statement of deficiencies
  • Inspection13 deficiencies

    F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. 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…

    Read full statement of deficiencies

Showing the 8 most recent surveys with findings. 6 earlier surveys are also on record.

FAQ

Questions and answers

What is Sandwich Living & Rehab Center?
Sandwich Living & Rehab Center is a Medicare- and Medicaid-certified nursing home in Sandwich, IL, tracked by the Centers for Medicare & Medicaid Services (CMS). Its CMS Certification Number (CCN) is 146133.
What is the CMS rating for Sandwich Living & Rehab Center?
Sandwich Living & Rehab Center has a CMS overall rating of 1 out of 5 stars. CMS rates nursing homes on health inspections, staffing, and quality measures.
How many beds does Sandwich Living & Rehab Center have?
Sandwich Living & Rehab Center is certified for 63 beds. It serves an average of 28 residents per day.
How many citations does Sandwich Living & Rehab Center have?
Sandwich Living & Rehab Center has 83 citations on record from CMS health inspections, each tied to a federal deficiency tag.
When was Sandwich Living & Rehab Center last inspected?
Sandwich Living & Rehab Center was last inspected on March 4, 2026. CMS surveys nursing homes about once a year and after complaints.
What can I do if I have concerns about care at this facility?
Start by raising the concern with the facility administrator or director of nursing. Every state also runs a free long-term care ombudsman program that advocates for residents and families; the federal Eldercare Locator at eldercare.acl.gov can connect you with yours. Complaints about quality of care can also be filed with your state survey agency.

*Sourced from the Centers for Medicare & Medicaid Services (CMS). See the official record on CMS Care Compare. If you believe any information is inaccurate, report it here.

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