Cycle 1
Health 2024-12-12 · Fire 2024-12-12
5 health deficiencies
Top issue: Quality of Life and Care (2 deficiencies)
6 fire-safety deficiencies
Top issue: Smoke (4 deficiencies)
Lake Forest, IL
Lake Forest Place
5-star overall rating with 4-star inspections with 5 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
1100 Pembridge Drive, Lake Forest, IL
(847) 604-6701
Overall
5 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
50
Certified beds
Average residents
47
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1999-09-23
CMS approved date
Coverage
Medicare
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
2.27
Registered nurse staffing · state 0.73 · national 0.68
LPN hours / resident day
0.34
Licensed practical nurse staffing · state 0.64 · national 0.87
Aide hours / resident day
2.92
Nurse aide staffing · state 2.13 · national 2.35
Total nurse hours
5.53
All reported nurse hours · state 3.49 · national 3.89
Licensed hours
2.61
RN + LPN hours · state 1.36 · national 1.54
Weekend hours
4.87
Weekend nurse staffing · state 3.09 · national 3.43
Weekend RN hours
1.80
Weekend registered nurse coverage · state 0.56 · national 0.47
Physical therapist
0.21
Reported PT staffing · state 0.05 · national 0.07
Adjusted RN hours
2.29
CMS adjusted RN staffing hours
Adjusted total hours
5.60
CMS adjusted total nurse staffing hours
Case-mix index
1.35
Higher values indicate more complex resident acuity
RN turnover
18%
Annual RN turnover · state 44% · national 45%
Total nurse turnover
27%
Annual nurse turnover · state 46% · national 46%
SNF VBP
Value-based purchasing
Program rank
1,478
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
56.41
Composite VBP score used to determine payment impact.
Payment multiplier
1.0115
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
1.68
Baseline 19.42% · Performance 20.65% · Measure score 1.68 · Achievement 1.68 · Improvement 0
Healthcare-associated infections
6.21
Baseline 4.55% · Performance 5.98% · Measure score 6.21 · Achievement 6.21 · Improvement 0
Total nurse turnover
7.07
Baseline 42.86% · Performance 34.78% · Measure score 7.07 · Achievement 7.07 · Improvement 3.98
Adjusted total nurse staffing
7.60
Baseline 4.75 hours · Performance 5.24 hours · Measure score 7.60 · Achievement 7.60 · Improvement 4.29
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.98% |
10.72%
0.7 pts better
|
No Different than the National Rate · Eligible stays 493 · Observed rate 8.32% · Lower 95% interval 7.88% |
| Discharge to community | 66.48% |
50.57%
15.9 pts better
|
Better than the National Rate · Eligible stays 505 · Observed rate 61.58% · Lower 95% interval 62.61% |
| Medicare spending per beneficiary | 0.84 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 96.54% |
95.27%
1.3 pts better
|
Numerator 251 · Denominator 260 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 260 |
| Discharge self-care score | 33.15% |
53.69%
20.5 pts worse
|
Numerator 59 · Denominator 178 |
| Discharge mobility score | 26.4% |
50.94%
24.5 pts worse
|
Numerator 47 · Denominator 178 |
| Pressure ulcers or injuries, new or worsened | 0.77% |
2.29%
1.5 pts better
|
Numerator 2 · Denominator 260 · Adjusted rate 0.7% |
| Healthcare-associated infections requiring hospitalization | 5.98% |
7.12%
1.1 pts better
|
No Different than the National Rate · Eligible stays 278 · Observed rate 4.32% · Lower 95% interval 4.08% |
| Staff COVID-19 vaccination coverage | 3.74% |
8.2%
4.5 pts worse
|
Numerator 13 · Denominator 348 |
| Staff flu vaccination coverage | 92.76% |
42%
50.8 pts better
|
Numerator 410 · Denominator 442 |
| Discharge function score | 29.78% |
56.45%
26.7 pts worse
|
Numerator 53 · Denominator 178 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 109 · Denominator 109 |
| Transfer of health information to patient | 99.09% |
96.28%
2.8 pts better
|
Numerator 109 · Denominator 110 |
| Resident COVID-19 vaccinations up to date | 35.04% |
25.2%
9.8 pts better
|
Numerator 41 · Denominator 117 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.8 |
2.0
0.2 pts better
|
1.9
0.1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.8 · Observed 1.3 · Expected 1.4 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.3 |
2.3
1 pts better
|
1.8
0.5 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.3 · Observed 1.0 · Expected 1.3 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
89.6%
10.4 pts better
|
93.4%
6.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 96.6% |
91.6%
5 pts better
|
95.5%
1.1 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 96.6% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 6.7% |
3.3%
3.4 pts worse
|
3.3%
3.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 7.7% · Q2 11.5% · Q3 6.2% · Q4 2.9% · 4Q avg 6.7% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 2.7% |
50.3%
47.6 pts better
|
11.4%
8.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 3.4% · Q4 5.7% · 4Q avg 2.7% |
| Percentage of long-stay residents who lose too much weight | 6.0% |
6.5%
0.5 pts better
|
5.4%
0.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 5.0% · Q3 13.6% · Q4 4.3% · 4Q avg 6.0% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 11.6% |
18.5%
6.9 pts better
|
19.6%
8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 10.0% · Q3 13.0% · Q4 12.5% · 4Q avg 11.6% |
| Percentage of long-stay residents who received an antipsychotic medication | 32.7% |
22.8%
9.9 pts worse
|
16.7%
16 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 32.7% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.1%
0.1 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 12.1% |
17.2%
5.1 pts better
|
16.3%
4.2 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 12.1% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 23.5% |
15.0%
8.5 pts worse
|
14.9%
8.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 23.5% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
1.1%
1.1 pts better
|
1.0%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.9% |
1.7%
0.8 pts better
|
1.7%
0.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.8% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.9% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 19.0% |
21.3%
2.3 pts better
|
19.8%
0.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 16.1% · Q2 15.5% · Q3 26.3% · Q4 17.7% · 4Q avg 19.0% |
| Percentage of long-stay residents with pressure ulcers | 4.3% |
5.2%
0.9 pts better
|
5.1%
0.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 5.2% · Q2 2.7% · Q3 4.2% · Q4 5.1% · 4Q avg 4.3% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 98.2% |
68.8%
29.4 pts better
|
81.7%
16.5 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 98.2% · Q2 96.8% · Q3 99.2% · Q4 99.1% · 4Q avg 98.2% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 11.6% |
14.0%
2.4 pts better
|
12.0%
0.4 pts better
|
Short Stay · 20240701-20250630 · Adjusted 11.6% · Observed 10.0% · Expected 9.6% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.5% |
2.3%
1.8 pts better
|
1.6%
1.1 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.9% · Q3 1.0% · Q4 0.0% · 4Q avg 0.5% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 95.0% |
63.0%
32 pts better
|
79.7%
15.3 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 95.0% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 30.7% |
26.2%
4.5 pts worse
|
23.9%
6.8 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 30.7% · Observed 25.9% · Expected 20.1% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-01-11 · Fire 2024-01-11
5 health deficiencies
Top issue: Quality of Life and Care (2 deficiencies)
7 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Cycle 3
Health 2023-03-08 · Fire 2023-03-08
3 health deficiencies
Top issue: Pharmacy Service (1 deficiency)
13 fire-safety deficiencies
Top issue: Emergency Preparedness (5 deficiencies)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-12-12
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2024-12-30
F · Potential for more than minimal harm
2024-12-12
K311 · Smoke Deficiencies
Fire Safety
Have an enclosure around a vertical opening shaft.
Corrected 2025-03-05
F · Potential for more than minimal harm
2024-12-12
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2025-02-11
F · Potential for more than minimal harm
2024-12-12
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2025-02-14
E · Potential for more than minimal harm
2024-12-12
K324 · Smoke Deficiencies
Fire Safety
Provide properly protected cooking facilities.
Corrected 2025-02-11
E · Potential for more than minimal harm
2024-12-12
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2025-01-17
F · Potential for more than minimal harm
2024-01-11
E26 · Emergency Preparedness Deficiencies
Fire Safety
Establish roles under a Waiver declared by secretary.
Corrected 2024-02-14
F · Potential for more than minimal harm
2024-01-11
E4 · Emergency Preparedness Deficiencies
Fire Safety
Develop and maintain an Emergency Preparedness Program (EP).
Corrected 2024-02-12
F · Potential for more than minimal harm
2024-01-11
K161 · Construction Deficiencies
Fire Safety
Use approved construction type or materials.
Corrected 2024-02-14
F · Potential for more than minimal harm
2024-01-11
K311 · Smoke Deficiencies
Fire Safety
Have an enclosure around a vertical opening shaft.
Not marked corrected
F · Potential for more than minimal harm
2024-01-11
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-02-14
F · Potential for more than minimal harm
2024-01-11
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2024-02-14
F · Potential for more than minimal harm
2024-01-11
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2024-02-15
F · Potential for more than minimal harm
2023-03-08
E15 · Emergency Preparedness Deficiencies
Fire Safety
Address subsistence needs for staff and patients.
Corrected 2023-05-03
F · Potential for more than minimal harm
2023-03-08
E22 · Emergency Preparedness Deficiencies
Fire Safety
Establish policies and procedures for sheltering.
Corrected 2023-05-03
F · Potential for more than minimal harm
2023-03-08
E32 · Emergency Preparedness Deficiencies
Fire Safety
Provide primary/alternate means for communication.
Corrected 2023-05-03
F · Potential for more than minimal harm
2023-03-08
E35 · Emergency Preparedness Deficiencies
Fire Safety
Provide family notifications of emergency plan.
Corrected 2023-05-10
F · Potential for more than minimal harm
2023-03-08
E41 · Emergency Preparedness Deficiencies
Fire Safety
Implement emergency and standby power systems.
Corrected 2023-05-03
F · Potential for more than minimal harm
2023-03-08
K311 · Smoke Deficiencies
Fire Safety
Have an enclosure around a vertical opening shaft.
Not marked corrected
F · Potential for more than minimal harm
2023-03-08
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-05-19
F · Potential for more than minimal harm
2023-03-08
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-04-08
F · Potential for more than minimal harm
2023-03-08
K711 · Miscellaneous Deficiencies
Fire Safety
Provide a written emergency evacuation plan.
Corrected 2023-04-08
F · Potential for more than minimal harm
2023-03-08
K914 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Corrected 2023-05-03
F · Potential for more than minimal harm
2023-03-08
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2023-05-03
E · Potential for more than minimal harm
2023-03-08
K324 · Smoke Deficiencies
Fire Safety
Provide properly protected cooking facilities.
Corrected 2023-05-19
E · Potential for more than minimal harm
2023-03-08
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2023-05-03
Inspection history
Recent health citations
D · Potential for more than minimal harm
2026-01-28
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2026-02-12
D · Potential for more than minimal harm
2025-08-13
F761 · Pharmacy Service Deficiencies
Health
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.
Corrected 2025-08-28
G · Actual harm
2025-02-27
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2025-03-07
F · Potential for more than minimal harm
2024-12-12
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-12-23
D · Potential for more than minimal harm
2024-12-12
F693 · Quality of Life and Care Deficiencies
Health
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.
Corrected 2024-12-23
D · Potential for more than minimal harm
2024-12-12
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-12-23
D · Potential for more than minimal harm
2024-08-14
F550 · Resident Rights Deficiencies
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2024-08-27
D · Potential for more than minimal harm
2024-08-14
F584 · Resident Rights Deficiencies
Health
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.
Corrected 2024-08-27
D · Potential for more than minimal harm
2024-05-08
F811 · Nutrition and Dietary Deficiencies
Health
Ensure that residents are assessed for appropriateness for a feeding assistant program, receive services as per their plan of care, and feeding assistants are trained and supervised.
Corrected 2024-05-17
D · Potential for more than minimal harm
2024-01-11
F690 · Quality of Life and Care Deficiencies
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2024-01-25
G · Actual harm
2023-03-08
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-03-22
D · Potential for more than minimal harm
2023-03-08
F661 · Resident Assessment and Care Planning Deficiencies
Health
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
Corrected 2023-03-22
D · Potential for more than minimal harm
2023-03-08
F761 · Pharmacy Service Deficiencies
Health
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.
Corrected 2023-03-22
Penalties and ownership
What sits behind the stars
Ownership
Lake Forest Place, LLC
5% Or Greater Direct Ownership Interest · Organization
Presbyterian Homes
5% Or Greater Indirect Ownership Interest · Organization
Abi-Antoun, Nadim
Operational/Managerial Control · Individual
Abi-Antoun, Nadim
Corporate Officer · Individual
Brault, James
Corporate Director · Individual
Denison, Charles
Corporate Director · Individual
Donnersberger, David
Corporate Director · Individual
Familara, Ceazar
W-2 Managing Employee · Individual
Green, Leslie
W-2 Managing Employee · Individual
Havrilka, Mark
Operational/Managerial Control · Individual
Havrilka, Mark
Corporate Officer · Individual
Heenan, Monica
Corporate Director · Individual
Hite, Elinor
Corporate Director · Individual
Kelly, Vincent
Corporate Director · Individual
Kirby, Michael
Corporate Director · Individual
Lincoln, Michael
Corporate Director · Individual
Marx, Dennie
Corporate Director · Individual
Mcafee, Thomas
Corporate Director · Individual
Mollman, Eric
Corporate Director · Individual
Noble, Paula
Corporate Director · Individual
Presbyterian Homes Manager LLC
Operational/Managerial Control · Organization
Seymour, Julie
Corporate Director · Individual
Swortzel, Todd
Operational/Managerial Control · Individual
Swortzel, Todd
Corporate Officer · Individual
Toledo, Mark
Corporate Director · Individual
Vanberkel, Carol
W-2 Managing Employee · Individual
Wetzel, Mark
Corporate Director · Individual
Nearby options
Other facilities in reach
#1
Claridge Healthcare Center
Lake Bluff, IL
1-star overall rating with 1-star inspections with Special Focus status with abuse icon flag with $262,807 in total fines with 33 recent health deficiencies with 8 fire-safety deficiencies in the latest cycle
#2
Warren Barr North Shore
Highland Park, IL
3-star overall rating with 3-star inspections with $24,397 in total fines with 8 recent health deficiencies with 9 fire-safety deficiencies in the latest cycle
#3
Avantara Libertyville
Libertyville, IL
3-star overall rating with 3-star inspections with $138,991 in total fines with 8 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
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