Inspection Reports for Villas of Holly Brook & Reflections Springfield

IL, 62711

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Deficiencies per Year

4 3 2 1 0
2024
2025
Severe High Moderate Low Unclassified
Inspection Report Plan of Correction Deficiencies: 0 Nov 17, 2025
Visit Reason
The survey was conducted following a facility reported incident IL198460 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 and administrative codes during this survey.
Inspection Report Complaint Investigation Deficiencies: 2 Sep 25, 2025
Visit Reason
The inspection was conducted as an original investigation of Complaint 2548917/IL197576 and a facility reported incident investigation related to an incident on 08-10-25/IL197469.
Findings
The facility failed to revise service plans to address resident falls and implement fall prevention interventions for two residents (R1 and R3) after falls. Additionally, the facility failed to implement interventions specified in the service plan for one resident (R2) at risk for falls, resulting in harm including a vertebral compression fracture.
Complaint Details
Original investigation of Complaint 2548917/IL197576 found no findings. The complaint investigation focused on falls and related service plan deficiencies for residents R1, R2, and R3.
Severity Breakdown
Type 2 Violation: 2
Deficiencies (2)
DescriptionSeverity
Failed to revise care plans to address resident falls and interventions following falls for two residents (R1 and R3).Type 2 Violation
Failed to implement interventions specified in the Service Plan for one resident (R2) at risk for falls.Type 2 Violation
Report Facts
Fall Investigation Dates: 3 Severity of Injuries: 1
Employees Mentioned
NameTitleContext
E1Executive DirectorVerified no staff member was present to assist resident R2 during fall and confirmed injury details.
E2Wellness DirectorConfirmed service plans for residents R1 and R3 were not revised after falls and no new fall prevention interventions were implemented.
Inspection Report Complaint Investigation Deficiencies: 0 May 1, 2025
Visit Reason
The visit was conducted as an original complaint investigation #IL190757.
Findings
The establishment 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.
Complaint Details
Original complaint investigation #IL190757; establishment found in compliance.
Inspection Report Annual Inspection Deficiencies: 0 Feb 10, 2025
Visit Reason
Annual Licensure Survey and Incident Report Investigation 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
No violations were cited during the annual licensure survey or the incident report investigation. The establishment was found to be in compliance with applicable assisted living regulations.
Inspection Report Plan of Correction Deficiencies: 0 Dec 17, 2024
Visit Reason
The document is a plan of correction following an incident investigation at the assisted living facility.
Findings
The incident investigation could not be substantiated and no violations were cited. The facility was found to be in compliance with the applicable Illinois Assisted Living and Shared Housing regulations.
Complaint Details
Incident cannot be substantiated.
Inspection Report Complaint Investigation Deficiencies: 0 Nov 11, 2024
Visit Reason
The inspection was conducted as an incident report investigation related to a complaint identified as IL 179713.
Findings
The allegation could not be substantiated and no violations were cited. The facility was found to be in compliance with the applicable Illinois Assisted Living and Shared Housing regulations.
Complaint Details
Allegation cannot be substantiated. No violations cited.

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