2 health deficiencies
Top issue: Nutrition and Dietary (1 deficiency)
5 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Shabbona, IL
4-star overall rating with 4-star inspections with $39,635 in total fines with 2 recent health deficiencies with 5 fire-safety deficiencies in the latest cycle
409 West Comanche Road, Shabbona, IL
(815) 824-2194
Overall
4 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
3 / 5
RN + nurse staffing
Quality measures
2 / 5
Resident outcomes and process measures
Quick facts
Beds
91
Certified beds
Average residents
53
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1980-10-01
CMS approved date
Coverage
Medicare + Medicaid
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
RN hours / resident day
0.62
Registered nurse staffing · state 0.73 · national 0.68
LPN hours / resident day
0.51
Licensed practical nurse staffing · state 0.64 · national 0.87
Aide hours / resident day
2.71
Nurse aide staffing · state 2.13 · national 2.35
Total nurse hours
3.84
All reported nurse hours · state 3.49 · national 3.89
Licensed hours
1.13
RN + LPN hours · state 1.36 · national 1.54
Weekend hours
3.08
Weekend nurse staffing · state 3.09 · national 3.43
Weekend RN hours
0.46
Weekend registered nurse coverage · state 0.56 · national 0.47
Physical therapist
0.06
Reported PT staffing · state 0.05 · national 0.07
Adjusted RN hours
0.57
CMS adjusted RN staffing hours
Adjusted total hours
3.47
CMS adjusted total nurse staffing hours
Case-mix index
1.51
Higher values indicate more complex resident acuity
RN turnover
14%
Annual RN turnover · state 44% · national 45%
Total nurse turnover
42%
Annual nurse turnover · state 46% · national 46%
SNF VBP
Program rank
2,613
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
48.74
Composite VBP score used to determine payment impact.
Payment multiplier
1.0025
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
7.14
Baseline 18.09% · Performance 18.12% · Measure score 7.14 · Achievement 7.14 · Improvement 0
Healthcare-associated infections
2.86
Baseline 6.24% · Performance 6.98% · Measure score 2.86 · Achievement 2.86 · Improvement 0
Total nurse turnover
6.28
Baseline 55.10% · Performance 38.00% · Measure score 6.28 · Achievement 6.28 · Improvement 5.15
Adjusted total nurse staffing
3.21
Baseline 3.07 hours · Performance 3.99 hours · Measure score 3.21 · Achievement 3.21 · Improvement 2.90
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.02% |
10.72%
0.7 pts better
|
No Different than the National Rate · Eligible stays 59 · Observed rate 8.47% · Lower 95% interval 6.48% |
| Discharge to community | 41.49% |
50.57%
9.1 pts worse
|
No Different than the National Rate · Eligible stays 35 · Observed rate 31.43% · Lower 95% interval 29.31% |
| Medicare spending per beneficiary | 1.23 |
1.02
0.2 pts worse
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 32 · Denominator 32 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 32 |
| Discharge self-care score | 29.17% |
53.69%
24.5 pts worse
|
Numerator 7 · Denominator 24 |
| Discharge mobility score | 37.5% |
50.94%
13.4 pts worse
|
Numerator 9 · Denominator 24 |
| Pressure ulcers or injuries, new or worsened | 3.13% |
2.29%
0.8 pts worse
|
Numerator 1 · Denominator 32 · Adjusted rate 2.25% |
| Healthcare-associated infections requiring hospitalization | 6.98% |
7.12%
0.1 pts better
|
No Different than the National Rate · Eligible stays 30 · Observed rate 6.67% · Lower 95% interval 3.53% |
| Staff COVID-19 vaccination coverage | 7.84% |
8.2%
0.4 pts worse
|
Numerator 8 · Denominator 102 |
| Staff flu vaccination coverage | 24.14% |
42%
17.9 pts worse
|
Numerator 35 · Denominator 145 |
| Discharge function score | 41.67% |
56.45%
14.8 pts worse
|
Numerator 10 · Denominator 24 |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 9 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 11 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | Not Available |
25.2%
|
Numerator Not Available · Denominator 19 · Too few residents or stays to report publicly. |
Quality measures
| 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 1.7 · Expected 1.8 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 2.1 |
2.3
0.2 pts better
|
1.8
0.3 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.1 · Observed 2.0 · Expected 1.6 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 97.3% |
89.6%
7.7 pts better
|
93.4%
3.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 95.7% · Q3 97.9% · Q4 96.0% · 4Q avg 97.3% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 74.0% |
91.6%
17.6 pts worse
|
95.5%
21.5 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 74.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 2.2% |
3.3%
1.1 pts better
|
3.3%
1.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 2.1% · Q3 4.2% · Q4 2.0% · 4Q avg 2.2% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
50.3%
50.3 pts better
|
11.4%
11.4 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 who lose too much weight | 3.0% |
6.5%
3.5 pts better
|
5.4%
2.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 2.9% · Q4 7.9% · 4Q avg 3.0% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 9.4% |
18.5%
9.1 pts better
|
19.6%
10.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 6.5% · Q2 11.4% · Q3 11.4% · Q4 7.9% · 4Q avg 9.4% |
| Percentage of long-stay residents who received an antipsychotic medication | 23.3% |
22.8%
0.5 pts worse
|
16.7%
6.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 25.0% · Q2 24.0% · Q3 20.8% · Q4 23.3% · 4Q avg 23.3% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 1.6% |
0.1%
1.5 pts worse
|
0.1%
1.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.4% · Q2 2.1% · Q3 0.0% · Q4 2.0% · 4Q avg 1.6% |
| Percentage of long-stay residents whose ability to walk independently worsened | 21.4% |
17.2%
4.2 pts worse
|
16.3%
5.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 16.4% · Q2 27.1% · Q3 23.9% · Q4 18.0% · 4Q avg 21.4% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 17.8% |
15.0%
2.8 pts worse
|
14.9%
2.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.7% · Q2 20.0% · Q3 26.5% · Q4 16.7% · 4Q avg 17.8% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.3% |
1.1%
0.2 pts worse
|
1.0%
0.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 2.5% · Q3 2.4% · Q4 0.0% · 4Q avg 1.3% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 1.1% |
1.7%
0.6 pts better
|
1.7%
0.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.5% · Q2 0.0% · Q3 0.0% · Q4 2.0% · 4Q avg 1.1% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 13.7% |
21.3%
7.6 pts better
|
19.8%
6.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 15.1% · Q2 13.8% · Q3 15.4% · Q4 10.9% · 4Q avg 13.7% |
| Percentage of long-stay residents with pressure ulcers | 3.1% |
5.2%
2.1 pts better
|
5.1%
2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.2% · Q2 2.1% · Q3 4.8% · Q4 3.1% · 4Q avg 3.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 89.4% |
68.8%
20.6 pts better
|
81.7%
7.7 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 71.4% · Q3 91.3% · Q4 100.0% · 4Q avg 89.4% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 23.7% |
14.0%
9.7 pts worse
|
12.0%
11.7 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 23.7% · Observed 21.4% · Expected 10.1% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
2.3%
2.3 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 34.1% |
26.2%
7.9 pts worse
|
23.9%
10.2 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 34.1% · Observed 32.1% · Expected 22.5% · Used in QM five-star |
Survey summary
Top issue: Nutrition and Dietary (1 deficiency)
5 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Top issue: Quality of Life and Care (4 deficiencies)
6 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Top issue: Quality of Life and Care (6 deficiencies)
4 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Fire safety
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2024-10-25
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-10-25
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2024-10-25
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2024-10-25
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2024-10-25
Fire Safety
Establish roles under a Waiver declared by secretary.
Corrected 2023-10-13
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-10-13
Fire Safety
Have exits that are accessible at all times.
Corrected 2023-10-13
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2023-10-13
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2023-10-13
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2023-10-13
Fire Safety
Establish staff and initial training requirements.
Corrected 2022-08-23
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2022-08-22
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2022-08-22
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2022-08-22
Inspection history
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-10-16
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-10-16
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2024-08-12
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2024-04-09
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-12-22
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2023-10-06
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-10-06
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 2023-10-06
Health
Provide and implement an infection prevention and control program.
Corrected 2023-10-06
Health
Provide and implement an infection prevention and control program.
Corrected 2022-08-17
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2022-08-17
Health
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Corrected 2022-08-17
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2022-08-17
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 2022-08-17
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2022-08-17
Health
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected 2022-08-17
Penalties and ownership
Fine · fine $16,263
Fine
Fine · fine $11,358
Fine
Fine · fine $12,014
Fine
Payment Denial · denial start 2023-10-11 · 2 days
2 day denial
5% Or Greater Direct Ownership Interest · Individual
5% Or Greater Direct Ownership Interest · Individual
Operational/Managerial Control · Individual
Corporate Officer · Individual
Operational/Managerial Control · Individual
Corporate Officer · Individual
Operational/Managerial Control · Organization
Operational/Managerial Control · Individual
Corporate Officer · Individual
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