Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

ALLURE OF LAKE STOREY

GALESBURG, IL · 180 certified beds · Last Life Safety survey July 18, 2024

CMS Certification Number 145619 · first certified May 1989

Ownership

Operated by ALLURE HEALTHCARE SERVICES · For profit - Corporation

Ownership changed September 1, 2020 (change of ownership)to ALLURE OF LAKE STOREY LLC from APERION CARE GALESBURG NORTH

Citations on file

Rolling three-year window

Life Safety surveys

In the same window

Tags cited more than once

Across separate surveys

Inspection & testing records

Of the citations on file

Position within IL

37 citations — more than 90% of the 666 certified nursing homes in IL. Compared within IL rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Improvingfewer citations at the latest survey than at its earlier surveys in the window.

The latest survey found 6 citations; the earlier surveys in the window averaged 15.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

Well past the typical window (June 2025 to August 2025), and past the point by which nine in ten IL facilities have been surveyed. This facility’s last Life Safety survey was July 2024. Facilities in IL are typically surveyed 11–13 months after the last one (median 12), measured over 759 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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5 inspection-and-testing tags have been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Emergency preparedness

8 of the 37 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

2 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 37 Life Safety citations above. The Physical Environment Index

F-0880 Provide and implement an infection prevention and control program.
F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

How that compares

Citations on file over three years

Compared with the median facility in IL, and nationally. Surveyors differ markedly between states, so the IL figure is the meaningful one.

Citations on file over three years, compared
Measure	Citations
This facility	37
Median facility in IL	15
Median facility nationally	11

Survey history

Citations at each Life Safety survey

Citations at each Life Safety survey
Survey date	Citations
August 18, 2022	16
July 14, 2023	15
July 18, 2024	6

Most-cited tags

Most-cited tags at this facility

Most-cited tags at this facility
Tag	What the surveyor checks	Times cited	Last cited
K-0353	Inspect, test, and maintain automatic sprinkler systems.	3	2024-07-18
E-0037	Establish staff and initial training requirements.	2	2023-07-14
K-0712	Have simulated fire drills held at unexpected times.	2	2023-07-14
K-0918	Have generator or other power source capable of supplying service within 10 seconds.	2	2023-07-14
K-0111	Satisfy building requirements after a repair, renovation, modification, or change of user/occupancy.	2	2023-07-14
K-0930	Ensure proper storage of liquid oxygen.	2	2023-07-14
K-0761	To conduct inspection, testing and maintenance of fire doors by qualified individuals.	2	2023-07-14
K-0351	Install an approved automatic sprinkler system.	2	2024-07-18

What the citations cover

Citations by CMS category

Smoke Deficiencies 14
Emergency Preparedness Deficiencies 8
Gas, Vacuum, and Electrical Systems Deficiencies 5
Miscellaneous Deficiencies 5
Other 5

Citations by CMS category
Category	Citations
Smoke Deficiencies	14
Emergency Preparedness Deficiencies	8
Gas, Vacuum, and Electrical Systems Deficiencies	5
Miscellaneous Deficiencies	5
Egress Deficiencies	3
Construction Deficiencies	2

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

July 18, 2024 — 6 citations

Citations issued on July 18, 2024
Tag	What the surveyor checks	Status
E-0015	Address subsistence needs for staff and patients.	Deficient, Provider has date of correction (July 19, 2024)
E-0031	Provide emergency officials' contact information.	Deficient, Provider has date of correction (July 19, 2024)
K-0271	Have exits that are accessible at all times.	Deficient, Provider has date of correction (July 19, 2024)
K-0293	Have properly located and lighted "Exit" signs.	Deficient, Provider has date of correction (July 19, 2024)
K-0351	Install an approved automatic sprinkler system.	Deficient, Provider has date of correction (July 19, 2024)
K-0353	Inspect, test, and maintain automatic sprinkler systems.	Deficient, Provider has date of correction (July 25, 2024)

July 14, 2023 — 15 citations

Citations issued on July 14, 2023
Tag	What the surveyor checks	Status
E-0004	Develop and maintain an Emergency Preparedness Program (EP).	Deficient, Provider has date of correction (August 17, 2023)
E-0013	Develop Emergency Preparedness policies and procedures.	Deficient, Provider has date of correction (August 17, 2023)
E-0029	Develop a communication plan.	Deficient, Provider has date of correction (August 17, 2023)
E-0036	Establish emergency prep training and testing.	Deficient, Provider has date of correction (August 17, 2023)
E-0037	Establish staff and initial training requirements.	Deficient, Provider has date of correction (August 17, 2023)
K-0111	Satisfy building requirements after a repair, renovation, modification, or change of user/occupancy.	Deficient, Provider has date of correction (August 17, 2023)
K-0281	Install proper backup exit lighting.	Deficient, Provider has date of correction (August 17, 2023)
K-0321	Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.	Deficient, Provider has date of correction (August 17, 2023)
K-0345	Have approved installation, maintenance and testing program for fire alarm systems.	Waiver has been granted (November 21, 2023)
K-0351	Install an approved automatic sprinkler system.	Deficient, Provider has date of correction (August 17, 2023)
K-0353	Inspect, test, and maintain automatic sprinkler systems.	Waiver has been granted (November 21, 2023)
K-0712	Have simulated fire drills held at unexpected times.	Deficient, Provider has date of correction (August 17, 2023)
K-0761	To conduct inspection, testing and maintenance of fire doors by qualified individuals.	Deficient, Provider has date of correction (August 17, 2023)
K-0918	Have generator or other power source capable of supplying service within 10 seconds.	Deficient, Provider has date of correction (August 17, 2023)
K-0930	Ensure proper storage of liquid oxygen.	Deficient, Provider has date of correction (August 17, 2023)

August 18, 2022 — 16 citations

Citations issued on August 18, 2022
Tag	What the surveyor checks	Status
E-0037	Establish staff and initial training requirements.	Deficient, Provider has date of correction (October 22, 2022)
K-0111	Satisfy building requirements after a repair, renovation, modification, or change of user/occupancy.	Waiver has been granted (November 21, 2023)
K-0321	Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.	Deficient, Provider has date of correction (August 20, 2022)
K-0324	Provide properly protected cooking facilities.	Deficient, Provider has date of correction (October 22, 2022)
K-0345	Have approved installation, maintenance and testing program for fire alarm systems.	Waiver has been granted (November 21, 2023)
K-0346	Follow proper procedures when the fire alarm was out of service for more than 4 hours.	Deficient, Provider has date of correction (October 22, 2022)
K-0353	Inspect, test, and maintain automatic sprinkler systems.	Waiver has been granted (November 21, 2023)
K-0354	Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.	Deficient, Provider has date of correction (October 22, 2022)
K-0355	Properly select, install, inspect, or maintain portable fire extinguishes.	Deficient, Provider has date of correction (October 22, 2022)
K-0374	Install smoke barrier doors that can resist smoke for at least 20 minutes.	Deficient, Provider has date of correction (October 22, 2022)
K-0711	Provide a written emergency evacuation plan.	Deficient, Provider has date of correction (October 22, 2022)
K-0712	Have simulated fire drills held at unexpected times.	Deficient, Provider has date of correction (October 22, 2022)
K-0761	To conduct inspection, testing and maintenance of fire doors by qualified individuals.	Deficient, Provider has date of correction (October 22, 2022)
K-0913	Ensure operating rooms are properly protected and written records are maintained and available for inspection.	Deficient, Provider has date of correction (October 22, 2022)
K-0918	Have generator or other power source capable of supplying service within 10 seconds.	Deficient, Provider has date of correction (October 22, 2022)
K-0930	Ensure proper storage of liquid oxygen.	Deficient, Provider has date of correction (October 22, 2022)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.