Goldwater Care Bloomington
On Medicare Special Focus status, a serious quality warning. Visit in person and ask tough questions before deciding.
based on 27 Google reviews
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Quality Concerns Identified
Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.
- Special Focus Facility (under heightened CMS scrutiny)
- Low overall rating (1/5 stars)
- Low staffing rating (1/5 stars)
- Above-median deficiencies (19 vs median 11.0)
- High staff turnover (62%)
Bottom 25% in IL · Below recommended RN staffing · Worst in GOLDWATER CARE chain · $237,807 in fines · Special Focus Facility (CMS)
What this means for your family
While Goldwater Care has received praise for its hospice and rehabilitation outcomes, the recent reports of medication errors and medical neglect are serious red flags. If you are considering this facility, we strongly advise you to conduct an unannounced visit and specifically ask about their current nurse-to-patient ratios and medication administration protocols.
Google Reviews
Google Reviews
27 reviews on Google“Goldwater Care Bloomington receives highly polarized feedback, with some families praising the compassionate hospice and rehabilitation staff, while others report severe concerns regarding medical negligence and administrative transparency. Several reviewers highlight a lack of consistent nursing care and issues with medication administration, suggesting significant variability in the quality of care provided.”
Quality Themes
Tap a score for detailsStrengths
- Compassionate hospice care
- Effective rehabilitation therapy
- Warm, family-oriented environment
- Helpful front-desk staff
Concerns
- Medication administration errors or delays (mentioned by 3 reviewers)
- Neglect or lack of basic nursing care (mentioned by 3 reviewers)
- Poor communication and administrative dishonesty (mentioned by 2 reviewers)
Rating Trends
Tap a year to see what changed
Distribution · 33 analyzed
How They Respond to Reviews
This facility rarely responds to reviews.
Questions for Your Tour
- 1Given the recent challenges with medication management, could you walk me through your current process for ensuring medications are administered accurately and on time?
- 2I noticed some feedback regarding communication; what is the standard protocol for keeping families updated on their loved one's health status or any changes in care?
- 3With the current staffing levels, how do you ensure that residents receive consistent attention for their daily hygiene and basic nursing needs?
- 4I see that the facility has a strong reputation for rehabilitation therapy; how do you integrate that care with the daily routine of residents who are not in active therapy?
- 5Could you describe the steps taken to maintain cleanliness and hygiene in the resident living areas, as this is a high priority for our family?
- 6What is your procedure for handling urgent medical concerns or emergencies, and how quickly can we expect to be notified if a situation arises?
Personalized based on this facility's data
Key Review Excerpts
“My mother was sent to Goldwater on hospice and they couldn't have been more compassionate, kind and patient. We feel extremely blessed that is where my mom spent the last several days of her life.”
“I wanted to like this facility and hoped it would be a good place for my father's rehab, but it was not. Nearly 2 weeks later, he was so sick, I had them call 911 and he went into cardiac arre”
“Horrible experience. My significant other was neglected when needing to use restroom..medications were not administered as ordered .. fell and no one arrived to assist..food terribly undesirable.”
Staffing
Staffing Hours
per resident/day · Medicare 2026Both RN and total nursing hours are below national benchmarks. This can mean less clinical attention per resident, so ask about their staffing plan.
Quality Measures
Quality Measures
Resident outcomes compared with national, state, and local averages · 17 measures
9
measures
6
measures
2
measures
Residents with depression symptoms
Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.
Residents who lost too much weight
Residents on antipsychotic medication
Residents vaccinated for the flu
Residents whose bladder or bowel control got worse
Residents whose walking got worse
Short-stay residents vaccinated for pneumonia
Short-stay residents vaccinated for the flu
Short-stay residents newly given antipsychotics
US average from Medicare published data
Inspection History
Medicare Inspection History
3-year lookback · Medicare 2026
This facility shows concerning patterns with recurring safety hazards and numerous family complaints over multiple years. The most frequent issues involve accident prevention and supervision, daily care assistance, and infection control protocols. While all 111 deficiencies have been officially corrected, the high volume of complaints (54 total) and persistent problems with resident safety suggest ongoing care quality challenges that families should carefully investigate before considering placement.
Sep 11, 2025Complaint1
Environmental Deficiencies
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Aug 17, 2025Complaint1
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Jul 28, 2025Complaint3
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
Apr 10, 2025Complaint2
Nursing and Physician Services Deficiencies
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Nursing and Physician Services Deficiencies
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Feb 26, 2025Routine24
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Emergency Preparedness Deficiencies
Establish staff and initial training requirements.
Egress Deficiencies
Install emergency lighting that can last at least 1 1/2 hours.
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Services Deficiencies
Install properly constructed and protected linen or trash chutes.
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper storage of liquid oxygen.
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Resident Assessment and Care Planning Deficiencies
Provide care by qualified persons according to each resident's written plan of care.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
Resident Assessment and Care Planning Deficiencies
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
Quality of Life and Care Deficiencies
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
Dec 31, 2024Complaint1
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Federal Penalties
Fine
Feb 26, 2025
$110,450
Payment Denial
Feb 26, 2025
15-day denial
Fine
Jun 21, 2024
$48,685
Payment Denial
Jun 21, 2024
5-day denial
Fine
Jan 23, 2024
$75,498
Payment Denial
Jan 23, 2024
21-day denial
Ownership & Operations
Who Operates This Facility
Goldwater Care Bloomington
for profit
Chain Affiliation
Goldwater Care
11 facilities nationwide
Chain avg rating: 1.4/5 · Rank 7 of 11 (Worst)
Ownership & Management
Owners
Katzenstein, Meir
Owner
Tversky, Aaron
Owner
David a Berkowitz Delta Trust
Owner · Organization
Key personnel
Contact
Get in Touch
Contact this facility directly and verify the details that matter most to your family.
References & Resources
Medicare Care Compare
Official Medicare quality ratings, inspections & staffing data
Google Maps
Photos, directions & neighborhood info
Google Reviews
27 reviews from families & visitors
Official Website
Visit goldwatercare.com
Medicare data downloads
Original nursing home datasets
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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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