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Nursing home report card · Rockford, IL

The Citadel at Saint Anne Place

4405 Highcrest Road, Rockford, IL 61107

Call this home: (815) 229-1999

View this home on Medicare.gov ↗

Infection-control problems noted

Quick summary

Below-average Medicare rating

Overall rating is 1 of 5 stars. Its health-inspection rating is 1 of 5. Read the dated inspection findings and separate staffing and care ratings below.

Our summary of public Medicare records. It does not establish that this home harmed a particular resident. About this summary.

How recent is this information?
Medicare file prepared
Aug 1, 2026
Our record last updated
Oct 15, 2026
Last routine health inspection
Jun 5, 2025

These dates mean different things. A new file can include older inspections and staffing figures. Read about the dates.

Medicare ratings

One star is the lowest rating. Five stars is the highest. Ratings are a starting point—read the inspection findings too.

Overall rating
1out of 5

Combines inspection, staffing, and care measures.

Among the lowest Medicare ratings

Health inspections
1out of 5

Based on problems found during health inspections.

Among the lowest Medicare ratings

Nursing staff
2out of 5

Based on staffing levels and related measures.

Below-average Medicare rating

Health and care results
1out of 5

Based on reported health and care results.

Among the lowest Medicare ratings

What do the ratings and warnings mean?
Medicare ratings
One star is the lowest rating. Five stars is the highest. These are government ratings, not family reviews.
Inspection problems
Inspectors found that a home did not meet a care or safety rule. The official term is “deficiency.”
Abuse warning
Medicare has flagged the home because of abuse-related inspection findings. Read the findings and dates.
Nursing staff time
Average staff hours for each resident per day. This does not mean each resident gets that much one-to-one care.

Learn about the records and their limits →

At a glance

These numbers come from the records we have. Inspection problems are rules the home did not meet. The dates covered can differ.

Care and safety problems
44

Care, safety, and resident-rights issues on recent inspections

Fire-safety problems
0

Building, alarms, exits, and related safety citations

Reported fines
$123,556

Total fine amounts in the imported penalty records

Medicare file prepared
Aug 1, 2026

Medicare home ID: 145563

Inspection findings to read first

Start with these past findings. We show the most serious first, then the most recent. They do not describe the home’s condition today.

  • Caused actual harm · isolated case

    Nov 25, 2025 · Inspection rule 0684

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  • Caused actual harm · isolated case

    Jul 8, 2025 · Inspection rule 0684

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  • Caused actual harm · isolated case

    Jun 5, 2025 · Inspection rule 0686

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Read the inspection history →

Nursing staff time

These are average staff hours for each resident per day. They are not one-to-one bedside care. The file does not give the reporting period for each figure.

Registered nurses (RNs)
0.85hours per resident per day

about 51 minutes per resident per day

All nursing staff
3.42hours per resident per day

about 3 hr 25 min per resident per day

Registered nurse time on weekends
0.57hours per resident per day

about 34 minutes per resident per day

Latest inspection summary

A summary of the most recent routine inspections. You can open the dated findings below.

We do not have a routine inspection summary for this home. Check the dated findings below and the Medicare.gov record.

How this home compares

Compared with state and national averages. The numbers may cover different periods.

  • Overall CMS rating: 1 stars
  • Health inspection rating: 1 stars
  • Staffing rating: 2 stars
  • Registered nurse time per resident: 0.85 hours/day
  • Total nurse time per resident: 3.42 hours/day
See the dates used for these averages

Medicare file dates: this home Aug 1, 2026; Illinois averages Unavailable; U.S. averages Oct 1, 2026.

Other concerns in the records

These points may be worth asking about. They do not establish what happened to a particular resident. See our Terms of Use.

  • Overall star rating is 2 or lower
  • Health inspection rating is 2 stars or lower
  • Recent citations include infection-control problems
  • Inspectors have listed an unusually high number of problems
  • CMS has fined this home in the recent reporting period

How serious were the problems?

Inspectors rate each problem by how much harm it caused or could cause. We group the CMS letter codes into plain language.

  • Caused actual harm9 citations
  • Could have caused harm35 citations

Why inspectors showed up

Routine checks happen on a schedule. Complaint visits happen when someone reports a concern.

Complaints
0
Routine
44
Fire safety
0
Other
0

Who owns it

Names CMS lists as owners or managers · reported as Non profit - Church related.

  • We do not have individual owner names for this home.

Inspection history

Open a date to read what inspectors found. The harm labels explain how serious the problem was at the time.

June 23, 20261 finding
  • Quality of Life and Care problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0677 · code D

    Provide care and assistance to perform activities of daily living for any resident who is unable.

April 21, 20261 finding
  • Resident Rights problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0576 · code D

    Ensure residents have reasonable access to and privacy in their use of communication methods.

April 14, 20261 finding
  • Pharmacy Service problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0755 · code D

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

December 16, 20251 finding
  • Quality of Life and Care problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0689 · code D

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

November 25, 20255 findings
  • Quality of Life and Care problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0694 · code D

    Provide for the safe, appropriate administration of IV fluids for a resident when needed.

  • Pharmacy Service problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0755 · code D

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

  • Quality of Life and Care problems
    Caused actual harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0684 · code G

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  • Resident Rights problems
    Could have caused harm · pattern case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0550 · code E

    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

  • Quality of Life and Care problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0686 · code D

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

July 8, 20251 finding
  • Quality of Life and Care problems
    Caused actual harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0684 · code G

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

June 5, 202511 findings
  • Quality of Life and Care problems
    Caused actual harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0686 · code G

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

  • Quality of Life and Care problems
    Caused actual harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0689 · code G

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

  • Quality of Life and Care problems
    Caused actual harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0692 · code G

    Provide enough food/fluids to maintain a resident's health.

  • Nutrition and Dietary problems
    Could have caused harm · widespread case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0812 · code F

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

  • Infection Control problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0880 · code D

    Provide and implement an infection prevention and control program.

  • Pharmacy Service problems
    Could have caused harm · pattern case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0755 · code E

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

  • Nutrition and Dietary problems
    Could have caused harm · pattern case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0805 · code E

    Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.

  • Resident Rights problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0550 · code D

    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

  • Quality of Life and Care problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0695 · code D

    Provide safe and appropriate respiratory care for a resident when needed.

  • Nursing and Physician Services problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0725 · code D

    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

  • Quality of Life and Care problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0684 · code D

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

April 29, 20251 finding
  • Quality of Life and Care problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0689 · code D

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

August 7, 20247 findings
  • Infection Control problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0880 · code D

    Provide and implement an infection prevention and control program.

  • Pharmacy Service problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0761 · code D

    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.

  • Pharmacy Service problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0759 · code D

    Ensure medication error rates are not 5 percent or greater.

  • Quality of Life and Care problems
    Caused actual harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0686 · code G

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

  • Quality of Life and Care problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0689 · code D

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

  • Pharmacy Service problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0755 · code D

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

  • Pharmacy Service problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0758 · code D

    Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is…

July 17, 20241 finding
  • Quality of Life and Care problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0689 · code D

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

April 3, 20241 finding
  • Pharmacy Service problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0760 · code D

    Ensure that residents are free from significant medication errors.

March 13, 20242 findings
  • Pharmacy Service problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0755 · code D

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

  • Quality of Life and Care problems
    Could have caused harm · isolated case
    Inspection type and official rule codes

    Routine health inspection · CMS tag 0697 · code D

    Provide safe, appropriate pain management for a resident who requires such services.

Fines & penalties

These fines appear in Medicare’s records. A listed amount does not tell us whether it has been paid.

  • Fine · Nov 25, 2025$38,786
  • Fine · Jun 5, 2025$44,372
  • Payment Denial · Jun 5, 2025Unavailable
  • Fine · Aug 7, 2024$13,309
  • Fine · Feb 21, 2024$14,050
  • Fine · Nov 15, 2023$13,039

Related topics

Questions about The Citadel at Saint Anne Place

What is The Citadel at Saint Anne Place's Medicare star rating?
As of August 1, 2026, The Citadel at Saint Anne Place in Rockford, Illinois has an overall CMS rating of 1 out of 5 stars. Other CMS scores: health inspection 1 of 5, staffing 2 of 5, quality measures 1 of 5. These are CMS ratings based on inspection, staffing, and quality information, not consumer reviews.
Has The Citadel at Saint Anne Place been fined?
As of August 1, 2026, the imported penalty records list $123,556 in reported fines for The Citadel at Saint Anne Place. The individual penalty dates can differ from the Medicare file date; a listed fine does not establish that it was paid.
Does The Citadel at Saint Anne Place have a Medicare abuse warning?
No. The current CMS Care Compare extract does not show an abuse warning icon for The Citadel at Saint Anne Place in Rockford, Illinois.
How does The Citadel at Saint Anne Place compare with other nursing homes in Illinois?
Its overall CMS rating is 1 out of 5. A rating comparison is withheld because a matching source date or a usable rating is missing. Use the Illinois report card and dated inspection history for context; inspection totals alone are not a like-for-like performance comparison.

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