Amberwood Care Centre

Name: Amberwood Care Centre
Address: 2313 NORTH ROCKTON AVENUE, Rockford, IL, 61103, US
Telephone: 8159642200

2313 North Rockton Avenue, Rockford, IL 61103 · Winnebago County · 135 certified beds · avg 122 residents/day · certified since Nov 1, 1996

Part of chain: CITADEL HEALTHCARE (14 facilities, chain avg rating 3.2★)

4/5

Health inspection rating (on-site)

Serious findings on record

Fines, last 3 years

2.41

Nurse hours/resident/day (adjusted)

What health inspectors found (on-site government inspections — the most independent evidence available)

Health inspection rating: ★★★★☆4/5 · CMS overall rating: 3/5

The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.

All citations in the current public record (41)

CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.

Date	Severity	What the facility was cited for
Feb 25, 2026	D · Potential for harm, one-off	The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint
Oct 27, 2025	D · Potential for harm, one-off	The facility did not provide proper foot care for residents. Foot care includes routine care like nail trimming and attention to foot problems, which matter greatly for older adults. · from a complaint
Jul 3, 2025	E · Potential for harm, repeated	The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs. · from a complaint
Jul 1, 2025	F · Potential for harm, facility-wide	The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. · from a complaint
May 14, 2025	D · Potential for harm, one-off	The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint
Jan 10, 2025	D · Potential for harm, one-off	The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. · from a complaint
Sep 11, 2024	E · Potential for harm, repeated	The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs.
Sep 11, 2024	D · Potential for harm, one-off	The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.
Sep 11, 2024	D · Potential for harm, one-off	The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving.
Sep 11, 2024	D · Potential for harm, one-off	The facility did not provide the care needed to maintain or improve residents' movement and flexibility — such as range-of-motion exercises — leading to avoidable decline.
Sep 11, 2024	D · Potential for harm, one-off	The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Sep 11, 2024	D · Potential for harm, one-off	The facility did not provide appropriate care related to bladder and bowel needs — including care for residents who use catheters and steps to prevent urinary tract infections.
Sep 11, 2024	D · Potential for harm, one-off	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.
Jun 15, 2024	F · Potential for harm, facility-wide	The facility's menus did not meet residents' nutritional needs, or were not prepared in advance, followed as written, kept up to date, or reviewed by a dietician. · from a complaint
Jan 11, 2024	D · Potential for harm, one-off	The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. · from a complaint
Nov 16, 2023	D · Potential for harm, one-off	The facility did not keep residents' personal and medical information private and confidential. · from a complaint
Nov 16, 2023	D · Potential for harm, one-off	The facility did not keep residents free from significant medication errors — such as giving the wrong drug, the wrong dose, or missing a critical medication. · from a complaint
Sep 16, 2023	D · Potential for harm, one-off	The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint
Aug 30, 2023	D · Potential for harm, one-off	The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs. · from a complaint
Jun 29, 2023	E · Potential for harm, repeated	The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Jun 29, 2023	D · Potential for harm, one-off	The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights.
Jun 29, 2023	D · Potential for harm, one-off	The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own.
Jun 29, 2023	D · Potential for harm, one-off	The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.
Jun 29, 2023	D · Potential for harm, one-off	The facility did not provide appropriate care related to bladder and bowel needs — including care for residents who use catheters and steps to prevent urinary tract infections.
Jun 29, 2023	D · Potential for harm, one-off	The facility used feeding tubes without a valid medical reason or the resident's agreement, or did not provide proper care to residents who have feeding tubes.
Jun 29, 2023	D · Potential for harm, one-off	The facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it.
Jun 29, 2023	D · Potential for harm, one-off	The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist.
Jun 29, 2023	D · Potential for harm, one-off	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not keep residents' personal and medical information private and confidential.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not honor residents' right to voice complaints without discrimination or retaliation, or did not have a working complaint process that resolves issues promptly.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not provide proper foot care for residents. Foot care includes routine care like nail trimming and attention to foot problems, which matter greatly for older adults.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not provide appropriate care related to bladder and bowel needs — including care for residents who use catheters and steps to prevent urinary tract infections.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not safely and appropriately administer IV fluids (fluids given through a vein) for residents who needed them.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not provide safe and appropriate pain management for a resident who needed it.
Apr 6, 2022	D · Potential for harm, one-off	The facility's medication error rate was 5 percent or higher — meaning too many doses were given incorrectly, such as the wrong drug, dose, or time.
Apr 6, 2022	D · Potential for harm, one-off	The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards.

Inspection trend by year

Citations from standard inspections stayed about the same across the last two inspection cycles (9 → 7).

Year	Citations	Worst severity that year
2022	13	D
2023	13	E
2024	9	F
2025	5	F
2026	1	D

Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.

Fines and enforcement (last 3 years)

No fines or payment denials in the published 3-year window.

Nurse staffing (from payroll records, adjusted for how much care residents need)

Measure	This facility	Illinois avg	U.S. avg	Where it stands
Total nurse staffing (hours per resident per day)	2.41	2.99	3.95	bottom 30% in Illinois; bottom 3% in the U.S.
Registered Nurse hours	0.27	0.63	0.69	bottom 13% in Illinois; bottom 7% in the U.S.
Weekend total nurse staffing	2.25	2.67	3.50	bottom 38% in Illinois; bottom 4% in the U.S.
Weekend RN hours (not acuity-adjusted)	0.30	0.56	0.48	bottom 21% in Illinois; bottom 32% in the U.S.
Total nursing staff turnover (%)	28.4	44.5	45.8	top 13% in Illinois; top 12% in the U.S.
RN turnover (%)	23.1	41.8	42.9	top 20% in Illinois; top 18% in the U.S.

Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 3.23, RN 0.37, weekend 3.00. Staffing rating: 1/5.

Self-reported quality measures

Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.

Quality measures rating: 4/5 · long-stay residents: 4/5 · short-stay residents: 3/5

Who owns this facility

For profit - Limited Liability company

Owner / manager	Type	Role	Stake	Since
Todd Stern 2015 Trust	Organization	5% or Greater Direct Ownership Interest	10%	12/30/2021
Graf, Marcella	Individual	Operational/Managerial Control	NOT APPLICABLE	08/03/2018
Graf, Marcella	Individual	ADP of the SNF	NOT APPLICABLE	08/03/2018
Labak, Sandra	Individual	Operational/Managerial Control	NOT APPLICABLE	04/08/2025
Labak, Sandra	Individual	ADP of the SNF	NOT APPLICABLE	04/08/2025
Logan, Julie	Individual	Operational/Managerial Control	NOT APPLICABLE	01/06/2023
Logan, Julie	Individual	ADP of the SNF	NOT APPLICABLE	01/06/2023
Ripstein, Kenneth	Individual	Operational/Managerial Control	NOT APPLICABLE	12/30/2021
Stern, Todd	Individual	Individual Is an Owner, Partner or Trustee of Any ADP of the SNF	NOT APPLICABLE	04/08/2025

Questions to ask on your visit

Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.

"What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
"How is routine foot care handled here, and does a podiatrist visit regularly?"
"Can we tour the resident rooms, bathrooms, and common areas today, including areas not on the usual tour route?"
"What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
"When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
"How does your pharmacist review residents' medications, and how quickly can you fill new or urgent prescriptions?"
"How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
"How do you prevent bedsores for residents who can't move themselves, and how often are at-risk residents repositioned?"
"What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
"Can I see the results and plan of correction from your most recent state inspection?"

Nearby facilities (within 20 miles)

Facility	Distance	City	Overall	Inspection	Flags
Mercyhealth Javon Bea Hospital -SNF	0.0 mi	Rockford, IL	★★★★☆	5/5
Willows Health Center	1.5 mi	Rockford, IL	★★★☆☆	3/5
Rock River Health Care	1.8 mi	Rockford, IL	★★★☆☆	3/5
Avira Health Pavilion	2.0 mi	Loves Park, IL	★★★★☆	4/5
River Bluff Nursing Home	2.1 mi	Rockford, IL	★★☆☆☆	2/5
Pa Peterson at the Citadel	2.3 mi	Rockford, IL	★☆☆☆☆	2/5	abuse
The Citadel at Saint Anne Place	3.5 mi	Rockford, IL	★☆☆☆☆	1/5
Fairhaven Christian Ret Center	3.6 mi	Rockford, IL	★★★☆☆	3/5
Alpine Fireside Health Center	3.7 mi	Rockford, IL	★★★☆☆	3/5
Alden Park Strathmoor	5.0 mi	Rockford, IL	★☆☆☆☆	2/5
Forest City Rehab & Nrsg Ctr	5.1 mi	Rockford, IL	★☆☆☆☆	1/5
Alden Debes Rehab & HCC	5.5 mi	Rockford, IL	★☆☆☆☆	2/5	abuse

Compare this facility with the 3 closest →

All facilities in Rockford →

Facility data as of CMS processing date 2026-08-01. CCN 145908.

The Care File

Visit checklist — Amberwood Care Centre

2313 North Rockton Avenue, Rockford, IL 61103 · 8159642200

Health inspection rating 4/5 · CMS overall 3/5· Fines (3y): $0

Questions for the administrator:

☐ "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
☐ "How is routine foot care handled here, and does a podiatrist visit regularly?"
☐ "Can we tour the resident rooms, bathrooms, and common areas today, including areas not on the usual tour route?"
☐ "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
☐ "When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
☐ "How does your pharmacist review residents' medications, and how quickly can you fill new or urgent prescriptions?"
☐ "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
☐ "How do you prevent bedsores for residents who can't move themselves, and how often are at-risk residents repositioned?"
☐ "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
☐ "Can I see the results and plan of correction from your most recent state inspection?"

While you're there, notice:

☐ Smell and cleanliness in hallways, not just the lobby
☐ How staff speak to residents; call lights answered promptly
☐ Residents up, dressed, and engaged (visit mealtimes and a weekend if you can)

Data: CMS Provider Data Catalog, version 2026-08-01 · CCN 145908 · Verify at medicare.gov/care-compare · Printed from The Care File (thecarefile.com)