Inspection visit
Health inspection
4 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 4 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
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 treat a resident in a dignified manner by
ensuring a resident's urinary drainage bag was covered while in common areas for one of three residents
(R15) reviewed for catheters in the sample of 18.
The findings include:
On 09/06/22 at 10:29 AM, R15 was in her high back wheelchair in a common area during an exercise
activity. R15's urinary drainage bag was visible and hanging to right of resident on the chair. The catheter
tubing came down through R15's right pant leg.
At 12:30 PM, R15 was in the high back chair seated at a dining room table. The dining room was full of
residents. R15's urinary drainage bag remained visible and attached to her chair.
On 09/08/22 at 08:37 AM, V10 MDS (Minimum Data Set) Coordinator said the purpose of a privacy bag is
for dignity. It's meant to preserve the patient's privacy. Everyone doesn't need to know that R15 has an
indwelling urinary catheter. Resident's with catheters should have a privacy bag even if they are in their
room.
R15's 9/7/22 face sheet showed a [AGE] year old female with diagnosis of encephalopathy palliative care,
Type 2 diabetes, heart failure, hypertension, psychosis, vascular dementia, glaucoma, hemiplegia and
hemiparesis, dysphagia, cerebral infarction and neuromuscular dysfunction of the bladder.
R15's undated indwelling catheter care plan showed to use a privacy bag at all times.
R15's 6/30/22 facility assessment showed total dependence of two plus persons for transfers, toilet use,
and bathing. This assessment showed R15 required extensive assistance of two plus persons for bed
mobility, and extensive assistance of one plus person for dressing and personal hygiene.
The Illinois Department on Aging's Resident Rights for people in long term care facilities showed your
medical and personal care are private.
The facility's 9/29/19 Dignity Policy showed each resident shall be cared for in a manner that promotes and
enhances quality of life, dignity, respect, and individuality. Staff shall promote, maintain, and protect resident
privacy, including bodily privacy during assistance with personal care and during treatment procedures.
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 5
Event ID:
146173
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
146173
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/08/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs at Monarch Landing, The
2308 North Route 59
Naperville, IL 60563
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 0803
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
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.
Based on observation, interview, and record review the facility failed to ensure residents were served menu
items from the dietitian approved spreadsheet to meet the resident's nutritional needs. This applies to all 74
residents residing in the facility.
The findings include:
The Resident Census and Condition Report (Federal Form 672) shows that on 9/6/22, the facility housed
74 residents.
The Spreadsheet for Tuesday's lunch includes tilapia, bowtie pasta, kale salad and pear halves for the
resident's on a general diet. The Spreadsheet shows pureed tilapia, bowtie pasta, green beans and pears
for the resident's on a pureed diet.
On 9/6/22 at 10:31 AM, V6 (Cook) pureed the noon meal. V6 pureed fish and green beans.
On 9/6/22 at 12:20 PM, V8 (Cook) did not have bowtie pasta on the steam table to be served. V8 served
R4, R7, R15, R25 and R62 the prepared pureed meal. V8 stated, They are getting fish, mashed potatoes
and peas. R4, R7, R15, R25 and R62 did not receive pureed pears or any dessert substitute.
On 9/07/22 at 2:15 PM, V6 said that the spreadsheet showed that the residents were supposed to get
bowtie pasta with the noon meal on 9/6/22 but the menu that was printed for the residents didn't include it.
V6 said that she just went off of the menu and not the spreadsheet when she prepared the meal so no
bowtie pasta was prepared. V6 said that the pureed desserts are usually done by the cooks on the unit. V6
said that she does not know why it was not done yesterday but the resident's on a pureed diet should have
received a dessert.
On 9/7/22 at 2:27 PM, V1 (Administrator) said that Diet Spreadsheets are reviewed by the dietician. V1 said
that the spreadsheets should be followed to ensure that the residents receive the appropriate amount of
nutrition daily. V1 said that the noodles were not transcribed over to the menu but the staff should have
followed the spreadsheet. V1 said that dessert should have been pureed by the kitchen and served to the
residents on a pureed diet.
The facility's Menus Policy dated 4/3/19 shows, Menus will be planned that meet the nutritional needs of
residents in accordance with the recommended dietary allowances of the Food and Nutrition Board Menus
will provide a variety of foods from the basic daily food groups.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146173
If continuation sheet
Page 2 of 5
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
146173
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/08/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs at Monarch Landing, The
2308 North Route 59
Naperville, IL 60563
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
Residents Affected - Many
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 food was stored and served
in a sanitary manner, dishes were cleaned under sanitary conditions, and food temperatures were taken to
prevent foodborne illnesses for all 74 residents residing in the facility.
The findings include:
The Resident Census and Condition Report (Federal Form 672) shows that on 9/6/22, the facility housed
74 residents.
1. On 9/6/22 at 10:15 AM, there were multiple opened food items in the dry storage area that were not
dated with the date opened. These food items include: baking powder, lime gelatin, marshmallows, noodles,
strawberry gelatin, brown sugar, 2 bags of pecans and sunflower kernels. A bag of pecans and a box of
sunflower kernels were not sealed closed. There was a bag of white chocolate chips that were dated, Use
by 2/22.
On 9/6/22 at 10:15 AM, V1 (Administrator) said that all food should be labeled with the open date once it is
opened. V2 said that it is important to know since different types of foods are only good for a certain
amount of time after opening.
The facility's undated Dining and Nutrition packet shows, When a product comes in, it needs to be labeled
with the following: item name, day it was made or opened, shelf life of the product ., use by date, and
employees name (Person that made the item or opened it).
2. On 9/6/22 at 10:44 AM, V9 (Dietary Aide) was hand washing pots and pans before putting them into the
dishwasher. With the same gloves on, V9 went to the clean side of the dishwasher, wiped her gloves off
with a hand towel and proceeded to put away clean pots and pans.
On 9/6/22 at 1:30 PM, V1 (Administrator) said that staff should perform hand hygiene before touching clean
dishes when they are using the dishwasher.
The facility's Dishwashing Machine Use Policy dated 4/3/19 shows, Wash hands before and after running
the dishwashing machine and during the process.
The facility's Dining and Nutrition booklet shows, When putting away clean dishes, wash hands, put on
gloves, then put them away.
3. On 9/6/22 at 12:07 PM, V7 (Cook) was serving the noon meal on the 2nd floor. V7 had a beard with no
beard restraint on. At 12:20 PM, V8 (Cook) was serving the noon meal on the 3rd floor. V8 had a beard with
no beard restraint on.
On 9/7/22 at 2:15 PM, V6 (Cook) said that hairnets should be worn at all times. V6 said that if a staff
member has a beard, they should wear a beard net at all times to ensure that hair does not get into the
food.
The facility's Preventing Foodborne Illness-Employee Hygiene and Sanitary Practice Policy dated 4/3/19
shows, Hair nets or caps and/or beard restraints must be worn to keep hair from contacting
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146173
If continuation sheet
Page 3 of 5
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
146173
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/08/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs at Monarch Landing, The
2308 North Route 59
Naperville, IL 60563
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
exposed food, clean equipment, utensils and linens.
Level of Harm - Minimal harm
or potential for actual harm
4. The facility's 2nd floor Steam Table Temperature Logbook shows that food temperatures were not taken
on 9/2/22 for the lunch and dinner meal, 9/3 for the lunch meal and 9/5 for lunch and dinner meal. The log
book did not have a sheet for 9/4/22.
Residents Affected - Many
The facility's Dining and Nutrition Booklet shows, Temperature control of food is important to prevent
foodborne illnesses. All hot food in the warming pantries must be above 140 degrees Fahrenheit Food
Temperature Logs will be kept in every warming pantry and country kitchen in a binder. You will record what
food you are testing, the time and the temperature.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146173
If continuation sheet
Page 4 of 5
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
146173
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/08/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs at Monarch Landing, The
2308 North Route 59
Naperville, IL 60563
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 socially distance residents who are on droplet
isolation while in the dining room. This applies to two residents (R19, R21) outside the sample reviewed for
infection control. This has the potential to affect all 74 residents in the facility.
Residents Affected - Many
The findings include:
The facility face sheet for R19 shows diagnosis to include dementia. The facility assessment dated [DATE]
shows moderate cognitive impairment.
The facility face sheet for R21 shows diagnosis to include Parkinson's Disease and dementia. The facility
assessment dated [DATE] shows her to be cognitively intact.
On 9/6/2022 at the noon meal, R19 was observed sitting next to another resident at a table in the dining
room. The two residents were not sitting six feet away from each other.
On 9/7/2022 during breakfast, R21 was observed sitting at the same dining room table across from another
resident. The residents were not sitting six feet from each other.
On 9/7/2022 at the noon meal, R19 and R21 were observed sitting at a dining room table with one other
resident. The residents were not sitting six feet away from each other.
The Physician order sheet dated September 2022 for R19 and R21 shows an order for droplet isolation.
On 9/06/22 at 11:40 AM, V3 Infection Preventionist said, currently due to an outbreak, all residents not up
to date are on isolation for 10 days starting on 9/3. For the resident who can not maintain isolation due to
safety reasons, they should be 6 ft apart from anyone at all times and mask as much as possible/tolerable.
If seen next to a resident, staff should re-direct from other residents. Try and have them eat in room but if
they can not for safety reasons, I would prefer them to eat in the living room socially distanced from others
and not in the dining room.
The facility list of residents currently on isolation include R19 and R21 for not being up to date on
COVID-19 vaccinations.
The facility care plan for R19 shows risk for exposure to COVID-19 and to maintain social distancing,
including dining and recreation services. The intervention for not complying with droplet precautions shows
she may come out of her room during meals while observing social isolation.
The facility care plan for R21 shows risk for exposure to COVID-19 and to maintain social distancing,
including dining and recreation services. The intervention for inability to comply with precautions due to
safety reasons the resident may come out of her room for meals while observing social distancing.
The facility policy with a revision date of 5/31/22 shows residents who are not up to date with COVID-19
vaccinations are restricted to their rooms, even if testing is negative .they do not participate in group
activities.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146173
If continuation sheet
Page 5 of 5
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Back to topCitations
4 citations recorded*CMS
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.
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
F803 - Menus and nutritional adequacy
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.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F880 - Infection Control
Provide and implement an infection prevention and control program.
FAQ · About this visit
Common questions about this visit
What happened during the September 8, 2022 survey of SPRINGS AT MONARCH LANDING, THE?
This was a inspection survey of SPRINGS AT MONARCH LANDING, THE on September 8, 2022. The surveyor cited 4 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at SPRINGS AT MONARCH LANDING, THE on September 8, 2022?
Yes, 4 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.