Meadowbrook Manor - Naperville
MEADOWBROOK MANOR - NAPERVILLE in NAPERVILLE, IL — inspection on September 3, 2025.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
incontinence care during her shift and repositioned her at 11:55 with the physical therapist.On 9/2/25
brief for over two hours.On 9/2/25 at 3:18 PM, V9 RN (Registered Nurse) stated R1 was on antibiotics
wound or UTI prior to or on admission.On 9/2/25 at 4:50 PM, V3 Wound Nurse stated there was no documentation of a coccyx pressure wound on 8/27/25 when R1 was admitted to the facility. V3 stated there was no documentation of a coccyx pressure wound was in R1's hospital discharge records. V3 stated she discovered and documented R1's wounds on 8/29/25 during the skin assessment. V3 stated the coccyx wound measured 2.0 cm (centimeters)x 0.2 cm x 0.2cm. V3 stated R1 is obese and unable to reposition without the assistance of two staff members. R1 is incontinent of bowel and bladder moisture is a contributing factor to skin break down. V3 stated nursing staff is responsible for repositioning and providing incontinence care for R1.On 9/2/25 at 6:17 PM, V1 Administrator stated should not need to call their family members to obtain staff assistance.The facility policy Wound Care Prevention dated April 2025 states, all residents will receive appropriate care to decrease the risk of skin break down.
The nursing department will review all new admissions / readmissions to put a plan in place for the prevention based on the resident's activity level, comorbidities, mental status, risk assessment and other pertinent information.
Clean skin at time of soiling and at routine intervals.The facility policy Incontinence Care dated April 2025 states, incontinence care is provided to keep residents as dry comfortable and odor free as possible. It also helps in preventing skin breakdown.
145874 09/03/2025
Meadowbrook Manor - Naperville 720 Raymond Drive Naperville, IL 60563
she sometimes has 17 to 20 residents to care for. V7 stated sometimes she is unable to complete like
Some residents aren't happy when they're not showered when it's scheduled.On 9/2/25 at 3:50 PM,
is staffing shortage and no one picks up it's expected the CNAs working will make up the shortage.On 9/2/25 at 4:26 PM, V4 Scheduler stated if there is a staffing shortage the managers and restorative aids should fill in and assist but aren't taking a full team. V4 stated she was a CNA able to fill in on the floor if needed.On 9/3/25 at 3:50 PM, V4 Scheduler stated staff are to initial on the schedule when they work. A check mark by nursing staff names mean they did not initial but they were working and accounted for. If there is no initial or check mark by the staff name that means they called off.
Names that are lined out means that staff member was reassigned to another unit. V4 stated the staffing ratios for the 1st floor AM and PM shifts should have 3-4 nurses and 4-5 CNAs.
The 1st floor night shift should have 2 nurses and 3 CNAs.
The 2nd floor AM and PM shifts should have 3 nurses and 5-6 CNAs.
The Night shift 2nd floor should have 2 nurses and 4 CNAs.
The 3rd floor AM and PM shifts should have 2 nurses and 3 CNAs.
The 3rd floor night shift should have 1 nurse and 2 CNAs.
The memory care unit AM and PM should have 1 nurse and 2-3 CNAs.
The memory care unit night shift should have 1 nurse and 2 CNAs.The staffing schedule for August 2025 and September to date were reviewed.
The facility had 22 shifts that worked with less than the required number of nurses or CNAs as determined by the facility for August 2025.On 9/2/25 at 6:17 PM, V1 Administrator stated there was no facility policy for staffing.
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.