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Nursing HomeMedicaid Investigative

Fair Oaks Rehab & Healthcare

Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.

1515 Blackhawk Boulevard, South Beloit, IL 6108078 bedsLicensed & Active
2/5
Medicare
Inspection
Quality
Staffing
Google rating
4.4/5

based on 111 Google reviews

5
4
3
2
1
Fair Oaks Rehab & Healthcare Nursing Home in South Beloit, IL — Street View
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3/ 10
moderate Risk

Quality Concerns Identified

Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.

  • Low staffing rating (2/5 stars)
  • High staff turnover (64%)
  • High RN turnover (67%)

Top 25% in IL · Below recommended RN staffing · Chain outperformer · $22,139 in fines

Source: Medicare data

What this means for your family

Fair Oaks is frequently praised for its therapy department and clean, welcoming environment. However, because multiple families have reported serious concerns regarding neglect and communication, we strongly advise you to conduct an unannounced visit and speak directly with current residents' families to verify current staffing levels and care quality.

Google Reviews

Google Reviews

111 reviews on Google
Fair Oaks Rehab & Healthcare receives highly polarized feedback, with many families praising the facility as a warm, clean, and welcoming environment with a strong therapy department. However, a significant number of critical reviews allege serious neglect, including understaffing, poor communication, and failures in basic hygiene and medication management. Families considering this facility should weigh the positive experiences of many against these recurring, serious allegations of substandard care.

Quality Themes

Tap a score for details
Food6.0Staff5.0Clean8.0Activities9.0Meds2.0MemoryN/AComms4.0ValueN/A

Strengths

  • Highly regarded physical and occupational therapy department
  • Clean and well-maintained facility
  • Warm and welcoming atmosphere
  • Responsive and professional management team

Concerns

  • Severe understaffing leading to slow response times and neglect (mentioned by 7 reviewers)
  • Poor communication regarding medical status and care plans (mentioned by 4 reviewers)
  • Basic hygiene and personal care failures (showering/bathing) (mentioned by 3 reviewers)
  • Medication management issues (mentioned by 2 reviewers)

Rating Trends

Tap a year to see what changed

234'16(1)'18(2)'20(4)'22(27)'24(8)'26(9)

Distribution · 113 analyzed

5
91
4
6
3
0
2
2
1
14
13 reviews posted between Jun 30, 2025Jul 2, 2025 · 13 were 5-star
13 reviews posted between Dec 22, 2022Dec 23, 2022 · 13 were 5-star

How They Respond to Reviews

83%response rate

This facility actively engages with reviewer feedback.

Questions for Your Tour

  • 1I noticed your management team is very active in responding to feedback online; how do you use that family input to improve daily care and communication?
  • 2Given the current staffing levels, what specific protocols do you have in place to ensure residents receive timely assistance with personal hygiene and bathing?
  • 3Could you walk me through your process for keeping families updated on changes in a resident's medical status or care plan?
  • 4With your strong reputation for physical and occupational therapy, how do you integrate those services into the daily schedule to keep residents active and engaged?
  • 5What steps are currently being taken to ensure accuracy and consistency in medication management for residents?
  • 6In the event of an urgent medical concern, what is the standard procedure for notifying the family and coordinating with the resident's primary physician?

Personalized based on this facility's data


Key Review Excerpts

The main issue my wife and I had was the lack of communication regarding her progress, procedures for appeals and how insurance reviews and discharge worked.

Family member of rehab patient · 2023☆☆☆☆

My mother was there less then 24 hours and fell on the floor layed there for mins before found..received phone call saying she was at the hospital thought brushing or bone but I never expected to walk in the emergency room and see my mother in that condition

Family member of resident · 2020☆☆☆☆

I have been at this facility for a little over a month, amd it is straight up 4 star plus. Never does a request go unanswered. Food is good. Therapy is excellent top notch.

Rehab patient · 2024★★★★
Source: 111 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.75hrs
OK
Registered nurses for medical care
Total Nursing
3.39hrs
83%
All nurses + aides combined
Staff Turnover
56%
Lower is better (< 30% = good)
RN Turnover
63%
Lower is better (< 30% = good)

Total nursing hours are below minimum, though RN coverage is adequate. This may mean fewer aides for daily tasks like bathing and mobility.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 17 measures

Medicare Rating
2/ 5
Better Than Avg

6

measures

Worse Than Avg

6

measures

Mixed Results

5

measures

Long-Stay Residents
😔

Residents with depression symptoms

↓ Lower is better
This Facility21.1%
Mixed vs Avgs
Here
21.1%
US
12.1%
IL
52.5%
Winnebago
15.7%

Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.

💊

Residents on antipsychotic medication

↓ Lower is better
This Facility11.8%
Better than Avg
Here
11.8%
US
15.4%
IL
21.8%
Winnebago
19.1%
🚶

Residents whose walking got worse

↓ Lower is better
This Facility22.7%
Worse than Avg
Here
22.7%
US
15.3%
IL
15.9%
Winnebago
18.5%
🚿

Residents whose bladder or bowel control got worse

↓ Lower is better
This Facility25.4%
Worse than Avg
Here
25.4%
US
19.4%
IL
21.1%
Winnebago
24.9%
⚖️

Residents who lost too much weight

↓ Lower is better
This Facility9.5%
Worse than Avg
Here
9.5%
US
5.3%
IL
6.6%
Winnebago
4.7%
💉

Residents vaccinated for pneumonia

↑ Higher is better
This Facility94.6%
Mixed vs Avgs
Here
94.6%
US
93.4%
IL
90.0%
Winnebago
95.6%
Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility63.8%
Mixed vs Avgs
Here
63.8%
US
79.7%
IL
63.1%
Winnebago
81.3%
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility81.8%
Mixed vs Avgs
Here
81.8%
US
81.8%
IL
69.0%
Winnebago
87.3%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility2.6%
Worse than Avg
Here
2.6%
US
1.6%
IL
2.4%
Winnebago
1.3%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

9deficiencies
2penalties
Near state avg (12.0)
12 complaint-triggered
$22,139 in fines

Families have filed 19 complaints triggering federal investigations, with recurring issues in medication management, pressure ulcer care, and abuse/neglect reporting that persist across multiple years. Recent complaints in 2025 and 2024 involved serious concerns including inadequate emergency response, medication errors, and failure to provide proper daily care assistance, indicating ongoing care quality problems that have not been consistently resolved despite facility corrections.

Mar 10, 2026Complaint
2
0600Immediate jeopardy · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

0880Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

Dec 12, 2025Complaint
1
0677Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

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

Jun 9, 2025Complaint
1
0760Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure that residents are free from significant medication errors.

Feb 11, 2025Complaint
2
0678Immediate jeopardy · IsolatedResolved (past non-compliance)

Quality of Life and Care Deficiencies

Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.

0684Actual harm · IsolatedCorrected

Quality of Life and Care Deficiencies

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

Nov 12, 2024Complaint
1
0755Potential for harm · PatternResolved (past non-compliance)

Pharmacy Service Deficiencies

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

Oct 28, 2024Complaint
2
0677Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

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

0806Potential for harm · IsolatedCorrected

Nutrition and Dietary Deficiencies

Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

Federal Penalties

Fine

Feb 11, 2025

$8,161

Fine

Feb 11, 2025

$14,373

Ownership & Operations

Who Operates This Facility

Owner / Operator

Fair Oaks Rehab & Healthcare

Organization Type

for profit

Chain Affiliation

Chain Name

Tutera Senior Living & Health Care

Chain Size

26 facilities nationwide

Chain avg rating: 2.2/5 · Rank 3 of 25

Ownership & Management

Owners

Jct Investments, LLC

Owner · Organization

Tutera Investments, LLC

Owner · Organization

Joseph Charles Tutera 2013 Family Irrevociable Trust Agreement

Owner (parent company) · Organization

Marian Olander Tutera 2020 Mrtl Tr

Owner (parent company) · Organization

Tutera, Joseph

Owner (parent company)

Tutera, Marian

Owner (parent company)

Flanagan, Michael

Individual is an Owner, Partner or Trustee of Any Adp of the Snf

Key personnel

Bloom, RandallOfficer / DirectorBrooks, KileyOfficer / DirectorWalnut Creek Management Company LLCManagerBloom, RandallManagerBrooks, KileyManager
Source: Medicare provider data

Contact

Get in Touch

Contact this facility directly and verify the details that matter most to your family.

References & Resources

EveryPlace is a research directory. Facility information is compiled from public sources — Medicare.gov, state licensing portals, Google Places, and publicly available street-level imagery. Listings do not constitute endorsement, recommendation, or advertisement, and we do not accept payment for placement. Families should verify all details directly with the facility and the original sources linked above before making any care decisions. See our Research Policy for our editorial standards, correction process, and image-removal policy.

Safer Alternatives Nearby

Based on current clinical data, we identified 6 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.

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