Avantara Joliet: Missing Wound Care Documentation - IL
Federal inspectors found multiple missing signatures on treatment records for a resident with incontinence-associated dermatitis who required zinc oxide ointment applications every shift from July through October 2025.
The resident, identified as R123, was admitted with a displaced hip fracture, malnutrition, and lung cancer. Skin assessments in June documented 3-centimeter dermatitis on the buttocks from incontinence. A physician ordered staff to cleanse the area with soap and water and apply zinc oxide ointment every shift starting July 2.
But treatment records for July, August, September, and October showed repeated gaps where nurses failed to sign indicating the treatment was completed.
"If the ETAR was not signed, the treatment was considered not completed," Director of Nursing V2 told inspectors on December 23. The facility's own policy requires nurses to sign electronic treatment records to document all care was provided as ordered.
The wound care certified nurse confirmed that nurses must sign the records to show treatments were done. She said the zinc oxide remained ordered even after the dermatitis healed as a preventative measure.
A certified nursing assistant told inspectors the resident "occasionally experienced skin irritation to the buttocks."
The facility's skin care policy, dated July 3, 2025, requires prompt identification and appropriate treatment of residents with skin breakdown, along with complete documentation of all assessments and treatments.
The resident was discharged home on October 17, 2025, after a stay that lasted several months. Federal inspectors classified the violation as causing minimal harm to few residents during their December 24 complaint investigation.
The missing documentation meant administrators had no way to verify whether ordered wound care was actually provided to prevent infection and further skin deterioration.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Avantara Joliet from 2025-12-24 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
Avantara Joliet in JOLIET, IL was cited for violations during a health inspection on December 24, 2025.
The resident, identified as R123, was admitted with a displaced hip fracture, malnutrition, and lung cancer.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.