Stephenson Nursing Center
2946 South Walnut Road · Freeport, IL · 61032 · 8152356173
148 certified beds Government - County
Why this verdict
- Inspection record is far worse than the national median (deficiency count and severity).
- 4 citations involved actual harm to residents.
The complete Safety Report — $19
Everything on this page plus the full citation-by-citation history with inspector findings, the complete penalty record, staffing vs benchmarks, side-by-side nearby comparisons, and the printable tour checklist. One PDF, emailed in minutes, yours to keep and share with family.
Red flags
3 actual-harm citations in the most recent cycle
Inspectors found deficiencies that caused real harm to residents, beyond potential-harm paperwork findings.
Medicare/Medicaid payments were denied
CMS refused payment for new admissions for a period — one of its strongest enforcement tools.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 2 of 5 Inspections: 2 of 5 Staffing: 2 of 5 Quality measures: 3 of 5
| Total nurse hours / resident-day | 3.38 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.87 | 0.55–0.75 |
| Weekend hours / resident-day | 2.99 | ≈ weekday level |
| Nursing turnover / year | — | median 45% |
| Fines (3-yr window) | none |
Inspection citations (37 in the current record)
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Actual harm · G March 17, 2026 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected February 27, 2026 · Quality of Life and Care
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Actual harm · G June 4, 2025 · found via complaint
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Corrected June 20, 2025 · Resident Rights
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Actual harm · G May 27, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected June 2, 2025 · Quality of Life and Care
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Potential for harm · D April 3, 2025 · found via complaint
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected April 11, 2025 · Pharmacy Service
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Actual harm · G February 4, 2025
Provide safe, appropriate pain management for a resident who requires such services.
Corrected February 28, 2025 · Quality of Life and Care
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Potential for harm · E February 4, 2025
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Corrected March 7, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D February 4, 2025
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected February 28, 2025 · Quality of Life and Care
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Potential for harm · D February 4, 2025
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected February 28, 2025 · Quality of Life and Care
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Potential for harm · D February 4, 2025
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected February 28, 2025 · Quality of Life and Care
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Potential for harm · D February 4, 2025
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 February 28, 2025 · Quality of Life and Care
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Potential for harm · D February 4, 2025
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Corrected February 7, 2025 · Nutrition and Dietary
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Potential for harm · F February 4, 2025
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected February 7, 2025 · Nutrition and Dietary
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Potential for harm · F February 4, 2025
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Corrected February 28, 2025 · Nursing and Physician Services
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Potential for harm · D February 4, 2025 · found via complaint
Protect each resident from the wrongful use of the resident's belongings or money.
Corrected February 28, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D February 4, 2025 · found via complaint
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected February 28, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D February 4, 2025 · found via complaint
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected February 28, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D July 2, 2024 · found via complaint
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected July 19, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D July 2, 2024 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected July 19, 2024 · Quality of Life and Care
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Potential for harm · D April 30, 2024 · found via complaint
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected May 13, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D April 30, 2024 · found via complaint
Respond appropriately to all alleged violations.
Corrected May 13, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D January 18, 2024
Keep residents' personal and medical records private and confidential.
Corrected February 10, 2024 · Resident Rights
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Potential for harm · D January 18, 2024
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected March 7, 2024 · Quality of Life and Care
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Potential for harm · D January 18, 2024
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected February 10, 2024 · Quality of Life and Care
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Potential for harm · E January 18, 2024
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected February 10, 2024 · Pharmacy Service
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Potential for harm · E January 18, 2024
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Corrected February 10, 2024 · Nutrition and Dietary
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| February 4, 2025 | Payment Denial | 114 days |
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 145895 · certified since November 1, 1996. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.