The nursing home failed to keep the area free of hazards and provide enough supervision to prevent accidents. Cited December 2025 — isolated incident, actual harm.
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F-Tag 689 — 42 CFR §483.25(d) — S/S: G
Nursing home report
ASBURY GARDENS NSG & REHAB
NORTH AURORA, IL · Medicare-certified · 75 beds
In good standing
For-profit
4 of 5 overall
ASBURY GARDENS NSG & REHAB has an overall rating of 4 out of 5 stars, with 4-star health inspection and staffing ratings but a lower 2-star quality measures rating. It had no fines in the last 24 months, and reported nurse staffing was 3.97 hours per resident per day versus the federal benchmark of 4.1.
Facility ratings
Health inspections
Staffing
3.9711 hrs/resident/day
Quality measures
Last inspection: January 16, 2026Penalties, last 24 months: $0
Federal guidance recommends at least 4.1 nursing hours per resident each day. This facility reports 3.9711.
Staffing detail
- Registered nurses
- 1.07
- Licensed practical nurses
- 0.40
- Nurse aides
- 2.50
- Weekend nursing
- 3.44
Hours per resident per day.
Total staff turnover: 57%
Registered nurse turnover: 33%
Resident outcomes
How often residents experience these outcomes, with the direction over the past year.
Long-stay residents on antipsychotic medication
11.3%Worsening
Residents with a fall causing major injury
2.6%Improving
Residents with pressure ulcers (bedsores)
2.4%Improving
Residents with a urinary tract infection
1.1%Worsening
Residents who lost too much weight
6.5%Improving
Residents who were physically restrained
0%Steady
Residents needing more help with daily activities
17.9%Improving
Residents whose ability to walk got worse
29.6%Steady
Show all measures
Long-stay residents on antianxiety or sleep medication
15.6%Improving
Short-stay residents newly given an antipsychotic
3.9%Improving
Residents with a long-term catheter
0%Steady
Residents with new or worsening incontinence
24.4%Improving
Residents with depressive symptoms
15.9%Worsening
Long-stay residents given the seasonal flu vaccine
100%Steady
Long-stay residents given the pneumonia vaccine
97.4%Worsening
Short-stay residents given the seasonal flu vaccine
93.6%Steady
Short-stay residents given the pneumonia vaccine
85%Improving
What the inspectors found
The home failed to make sure food was safely sourced, stored, prepared, and served according to professional standards. Cited January 2024 — widespread issue, potential for harm.
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F-Tag 812 — 42 CFR §483.60(i) — S/S: F
The nursing home failed to ensure a qualified person was assigned to oversee infection prevention and control. Cited January 2024 — widespread issue, potential for harm.
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F-Tag 882 — 42 CFR §483.80 — S/S: F
The nursing home failed to keep essential equipment working safely. Cited January 2024 — widespread issue, potential for harm.
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F-Tag 908 — 42 CFR §483.90 — S/S: F
The nursing home failed to keep its areas safe, easy to use, clean, and comfortable for residents, staff, and visitors. Cited January 2024 — widespread issue, potential for harm.
View the original federal record
F-Tag 921 — 42 CFR §483.90 — S/S: F
Recent history
- STAFFING
Reported nurse staffing was below the federal recommendation of 4.1 hours per resident per day.
- INSPECTION
Health inspection found 3 health deficiencies.
See what inspectors found
- INSPECTION
Health inspection found 1 health deficiency.
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- INSPECTION
Health inspection found 1 health deficiency.
See what inspectors found
Penalties & enforcement
On record with Medicare: 2 fines · $6,350 in total fines.
- $2,117
Federal fine
Aug 21, 2023
- $4,233
Federal fine
Jul 31, 2023
Operator & ownership
- Ownership
- For profit - Limited Liability company
- Occupancy
- 57.4 residents on an average day (77% of 75 beds)
- Resident voice
- Resident council
- Medicare history
- Certified for 11 years
Things at a nursing home change — inspections, staffing, ownership, news.
Source: Centers for Medicare & Medicaid Services — public records, updated monthly. GoodStanding presents official records with plain-language summaries. Always visit a facility in person.