Inspection Reports for Villas of Holly Brook Collinsville
121 South Bluff Road, Collinsville, IL, 62234
Back to Facility ProfileInspection Report Summary
The most recent inspection on August 7, 2025, found the facility in compliance with applicable assisted living regulations and cited no deficiencies. Earlier inspections showed a generally compliant pattern, though a complaint investigation on September 20, 2024, identified deficiencies related to individualized fall prevention plans and monitoring for residents with dementia, which resulted in a fall and injury requiring emergency evaluation. Some complaints were substantiated without violations cited, while others were unsubstantiated. No fines, immediate jeopardy findings, or enforcement actions were listed in the available reports. The facility appears to have addressed prior issues through a plan of correction, and subsequent inspections have found no deficiencies, indicating improvement.
Deficiencies (last 2 years)
Deficiencies (over 2 years)
2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
43% better than Illinois average
Illinois average: 3.5 deficiencies/yearDeficiencies per year
4
3
2
1
0
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Aug 7, 2025
Visit Reason
Annual Licensure Survey to assess compliance with Part 295 Assisted Living and Shared Housing Establishment Administrative Code and 210 ILCS 9/1 Assisted Living and Shared Housing Act.
Findings
The establishment was found to be in compliance with the applicable assisted living regulations during this annual licensure survey.
Inspection Report
Deficiencies: 0
Date: Mar 12, 2025
Visit Reason
The inspection was conducted as a facility reported incident investigation related to an incident report dated IL186171.
Findings
The facility, Villas of Holly Brook Collinsville, was found to be in general compliance with the Requirements of the Assisted Living and Shared Housing Establishment Code for this survey.
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Feb 4, 2025
Visit Reason
The survey was conducted following a facility reported incident on 2025-01-15 to assess compliance with Part 295 Assisted Living and Shared Housing Establishment Administrative Code and 210 ILCS 9/1 Assisted Living and Shared Housing Act.
Findings
The Villas of Holly Brook Collinsville was found to be in compliance with the applicable assisted living regulations during this survey.
Report Facts
Incident date: Jan 15, 2025
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 12, 2024
Visit Reason
The inspection was conducted to investigate complaints #2449201/Il180696 and #2449189/IL180684 regarding the Villas of Hollybrook Collinsville.
Complaint Details
Complaint #2449201/Il180696 - The allegation cannot be substantiated. No violations cited. Complaint #2449189/IL180684 - Previously investigated 9/30/24-10/10/24 IL178730 - No violations cited.
Findings
The allegations in complaint #2449201/Il180696 could not be substantiated and no violations were cited. Complaint #2449189/IL180684 was previously investigated with no violations cited. The facility was found to be in compliance with Part 295 Assisted Living and Shared Housing Establishment Administrative Code and 210 ILCS 9/1 Assisted Living and Shared Housing Act.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Oct 10, 2024
Visit Reason
The inspection was conducted to investigate multiple allegations including falls, delay of care after falls, lack of staff, medication administration issues, and family notification following incidents.
Complaint Details
Fall allegation and allegation that resident was not getting medications were substantiated but no violations were cited. Allegations of delay of care after fall, lack of staff, delay in care post fall, and failure to notify family were not substantiated and no violations were cited.
Findings
Several allegations were investigated; some were substantiated but no violations were cited. The facility was found to be in general compliance with the Assisted Living and Shared Housing Establishment Code.
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Sep 20, 2024
Visit Reason
The inspection was conducted following substantiated and partially substantiated allegations regarding the facility's compliance with service plan requirements and Alzheimer's/dementia program regulations.
Complaint Details
Allegation IL177797 was substantiated with violations cited for Sections 295.4010 and 295.4060. Allegation IL177804 was partially substantiated with no violations cited.
Findings
The facility failed to develop individualized fall prevention plans for residents at risk of falls and did not ensure adequate monitoring and supervision to prevent falls during toileting for a resident with dementia, resulting in a fall and injury requiring ER evaluation.
Deficiencies (2)
Failure to ensure individualized/personalized fall prevention plans for residents at risk for falls.
Failure to ensure monitoring and supervision to prevent a fall during toilet use for a resident with dementia.
Report Facts
Cognitive Assessment FAST score: 6
Date of fall incident: Sep 9, 2024
Date of service plan update: Jul 8, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| E1 | Executive Director | Stated that direct care staff were reeducated regarding safety monitoring for residents with dementia. |
| E3 | Resident Assistant | Reported leaving resident unattended briefly during toileting leading to fall. |
| E4 | Resident Assistant | Reported assisting resident with walking and monitoring during toileting. |
| E5 | Resident Assistant | Reported staying with resident during toileting due to fall risk. |
| E2 | Stated resident should never be left unattended during toileting. |
Inspection Report
Plan of Correction
Deficiencies: 2
Date: Sep 20, 2024
Visit Reason
The document is a plan of correction submitted in response to a complaint survey conducted on 9/20/2024 regarding violations in service plans and Alzheimer's and dementia programs.
Complaint Details
The visit was complaint-related with a survey conducted on 9/20/2024. The plan of correction was submitted on 10/15/2024.
Findings
The plan of correction addresses deficiencies related to individualized fall prevention plans and safety risks for residents with Alzheimer's disease, with in-services completed by the Executive Director, Wellness Director, and Regional Nurse.
Deficiencies (2)
Failure to ensure individualized/personalized fall prevention plans for residents at risk for falls and those with actual falls.
Failure to identify and alleviate safety risks to residents with Alzheimer's disease.
Report Facts
Date of complaint survey: 9/20/2024
Date plan of correction submitted: 10/15/2024
Date final report received: 10/02/2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Executive Director | Participated in in-services related to service plan and safety monitoring. | |
| Wellness Director | Responsible for ensuring fall prevention plans and participated in in-services. | |
| Regional Nurse | Conducted in-services on service plan and fall risk prevention. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Aug 15, 2024
Visit Reason
The inspection was conducted in response to a facility reported incident dated 7-16-24, identified as IL176731, to investigate the allegation.
Complaint Details
The allegation was investigated and found to be unsubstantiated with no violations cited.
Findings
The allegation could not be substantiated and no violations were cited. The facility was found to be in compliance with Part 295 Assisted Living and Shared Housing Establishment Code for this survey.
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Aug 5, 2024
Visit Reason
Annual Licensure Survey conducted to assess compliance with the Assisted Living and Shared Housing Establishment Code.
Findings
No violations were cited. The facility was found to be in general compliance with the applicable regulatory requirements.
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