Not rated by CMS — ratings are suppressed for new or low-volume facilities.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Hearthstone Manor during CMS and state inspections, most recent first.
The facility failed to assess and treat pressure injuries for two residents, leading to a necrotic area on one resident's heel and an untreated open area on another's buttocks. The wound nurse was unaware of the injuries due to a lack of communication and documentation, contrary to facility policy requiring immediate assessment and treatment.
Two residents experienced significant weight loss due to the facility's failure to implement dietary recommendations and provide necessary nutritional supplements. One resident, with Alzheimer's and dysphagia, did not consistently receive prescribed health shakes, while another resident with Parkinson's and depression had discrepancies between dietary recommendations and physician orders. The deficiencies were due to miscommunication and lack of coordination among staff.
The facility failed to follow professional standards by not allowing cookware to air-dry after washing in the three-compartment sink. Instead, a cook was observed using paper towels to dry food processor components and other kitchen items. This practice was confirmed by a registered dietitian as not being standard practice, and it contradicts the facility's policy, which requires air drying. This deficiency could potentially affect all 33 residents in the facility.
The facility did not provide the correct 4-ounce portion of pureed lemon baked chicken for residents on pureed diets. The Food Service Director used a #10 scoop, providing only 3 ounces, instead of the required #8 scoop. This was confirmed by the Registered Dietitian, indicating a failure to follow the recipe, which could potentially lead to weight loss for the residents.
A resident's ability to ambulate diminished due to the facility's failure to provide restorative care. Despite being discharged from therapy with a home exercise program, the resident complained of not being walked and having to remain in a wheelchair. Staff interviews revealed that no restorative program was in place, and the facility had not conducted range of motion or walking exercises outside of therapy sessions for over a year.
A resident developed open areas on the right buttocks, which were observed by a CNA and reported to an LPN. The LPN, aware of the condition, did not notify the Wound Nurse or the physician, assuming it was the Wound Nurse's responsibility. The Wound Nurse was not informed until later and emphasized the need for timely skin assessments and treatments, as per facility policy.
The facility failed to provide pneumonia vaccinations to two residents, despite having policies in place to ensure immunizations are offered upon admission. One resident had a physician's order for the Prevnar20 vaccine, but it was never administered, while another resident had no documentation of being offered additional pneumonia vaccinations since their last recorded dose in 2003.
Failure to Assess and Treat Pressure Injuries
Penalty
Summary
The facility failed to properly assess and provide pressure-relieving interventions for a resident's left heel pressure injury, which progressed to a necrotic area. Initially, the resident had an intact fluid-filled blister on the left heel, but there were no further wound assessments documented after the initial observation. The wound nurse admitted to not having seen the wound since it was a blister and only applied a protective foam dressing. Upon later examination, the wound had developed into a necrotic area, and there was an additional open area on the left inner bunion with visible drainage on the compression socks. The care plan for the resident included monitoring and documenting the wound, but these actions were not effectively carried out. Another resident, identified as high risk for pressure injuries, was found to have an open area on the left buttocks without any dressing. A CNA noticed the open area and informed an LPN, who did not take further action, assuming it was the wound nurse's responsibility. The wound nurse was unaware of the pressure injury until it was brought to attention during the survey. The facility's policy requires nurses to assess, notify the physician, and obtain treatment orders for any new pressure injuries immediately, which was not followed in this case.
Failure to Provide Nutritional Supplements Leads to Resident Weight Loss
Penalty
Summary
The facility failed to implement dietary recommendations and provide nutritional supplements to residents experiencing significant weight loss. Resident 19, diagnosed with Alzheimer's dementia, Parkinson's, and dysphagia, experienced a 5.9% weight loss in one month and an 11.28% weight loss over three months. Despite dietary notes indicating the need for supplements such as supercereal and health shakes, these were not consistently provided. Observations revealed that Resident 19's meal trays often lacked the prescribed health shakes, and there was confusion among staff regarding who was responsible for providing these supplements. Resident 23, with diagnoses including Parkinson's Disease, Chronic Kidney Disease, and Major Depression, experienced a 9.37% weight loss over three months. The dietary notes recommended nutritional supplements and health shakes, but there was a discrepancy between the dietary recommendations and the physician's orders. The dietician noted that health shakes were not being provided as intended, and the care plan for Resident 23 did not address the weight loss or the need for supplements. The deficiencies were primarily due to a lack of communication and coordination between the dietary staff, nursing staff, and the kitchen. There was a misunderstanding about the responsibility for providing nutritional supplements, leading to residents not receiving the necessary dietary interventions to address their weight loss. This lack of implementation of dietary recommendations contributed to the significant weight loss observed in the residents.
Improper Drying of Cookware in Facility Kitchen
Penalty
Summary
The facility failed to ensure that cookware was air-dried after being washed in the three-compartment sink, which is a deviation from professional standards. During an observation, a cook was seen washing and rinsing food processor components and other kitchen items, then drying them with paper towels instead of allowing them to air dry. This practice was confirmed by a registered dietitian, who stated that it is not the standard of practice to dry items with paper towels. The facility's policy, dated 2019, clearly states that dishes should be air-dried on dish racks and not dried with towels. This failure has the potential to affect all 33 residents residing in the facility.
Failure to Provide Correct Portion Size for Pureed Diets
Penalty
Summary
The facility failed to provide a 4-ounce portion of pureed lemon baked chicken at lunch for four residents on pureed diets. On the specified date, the Food Service Director used a yellow handle scoop, equivalent to a #10 scoop, which provides only 3 ounces, instead of the required #8 scoop that provides 4 ounces. This discrepancy was observed during meal service and confirmed by the Registered Dietitian, who stated that the recipe should have been followed. The failure to use the correct scoop size could potentially lead to weight loss for the residents involved.
Failure to Provide Restorative Care for Ambulation
Penalty
Summary
The facility failed to provide restorative care to a resident, identified as R31, to ensure their ability to ambulate did not diminish. R31's medical records indicated that they had the ability to move their upper and lower extremities against gravity and could ambulate with a rolling walker. Despite being discharged from skilled therapy with a home exercise program (HEP) and a functional maintenance program recommended, the resident complained of not being walked and having to sit in a wheelchair all the time. The care plan noted a self-care deficit related to various health issues, requiring extensive assistance from staff for movement. Interviews with facility staff revealed that no residents were receiving range of motion or walking exercises outside of therapy sessions. The Director of Nursing admitted that a restorative program had not been in place for over a year, and the Director of Therapy confirmed that the facility had not had a restorative program since 2019. The Physical Therapy Assistant mentioned walking with the resident once upon request but indicated that there was no structured program to support ongoing ambulation. The lack of a restorative program was attributed to the company's policy, which did not require such programming.
Failure to Assess and Treat Facility-Acquired Skin Condition
Penalty
Summary
The facility failed to assess and obtain treatments for a facility-acquired skin condition for one resident, identified as R21, who was reviewed for skin conditions. On the specified date, a Certified Nursing Assistant (CNA) observed several open areas on R21's right buttocks while providing incontinence care. The CNA reported this to the Licensed Practical Nurse (LPN), who acknowledged awareness of the open areas but did not take any action, assuming it was the responsibility of the Wound Nurse. The LPN did not notify the Wound Nurse or the physician about the skin condition. The Wound Nurse later confirmed that she was not informed of R21's new skin irritations until that day. The Wound Nurse noted that R21 had a history of developing moisture-associated skin disorder (MASD) and emphasized that nurses should have initiated a skin assessment and obtained treatments promptly. The facility's policy on skin integrity management requires the charge nurse to complete an incident report and notify the physician and resident of any skin alterations, which was not followed in this case.
Failure to Provide Pneumonia Vaccinations to Residents
Penalty
Summary
The facility failed to ensure pneumonia vaccinations were offered or provided to two residents, R27 and R23, as part of their immunization protocol. R27 was admitted to the facility with no record of receiving a pneumonia vaccination, despite having a physician's order to receive the Prevnar20 vaccine. The facility had obtained consent from R27's representative for the vaccination, but it was never administered. This oversight was confirmed by the facility's administrator, who acknowledged that the pneumonia vaccine was not provided to R27. Similarly, R23's immunization records indicated that the last known Pneumococcal Polysaccharide Vaccine (PPSV23) was administered in 2003, with no documentation showing that R23 was offered or provided any additional pneumonia vaccinations after admission to the facility. The facility's policy requires that all residents be screened upon admission for their immunization status and that consent for vaccinations be obtained within seven days of admission. However, the facility was unable to provide evidence that these procedures were followed for R23.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 130 citations issued within 25 miles in the last 12 months — including the 4 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Woodstock
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| La Bella Of Woodstock | 0.3 mi | — | 12 | 0 |
| Valley Hi Nursing Home | 4.3 mi | — | 1 | 0 |
| Crystal Pines Rehab & Hcc | 7.3 mi | — | 4 | 0 |
| Fair Oaks Health Care Center | 7.5 mi | — | 2 | 0 |
| Ignite Medical Mchenry | 8 mi | — | 3 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Hearthstone Manor.
100% money-back within 48 hours.
Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.