The group, Equip for Equality, found that illnesses at Alden Village North were improperly treated, doctors failed to return pages, lab results were ignored and internal investigations into deaths were superficial, incomplete or inaccurate.
Chicago-based Equip for Equality was able to begin its own inquiry because it is part of a nationwide network of advocacy groups granted broad powers by Congress to help protect people with disabilities.
The group spent weeks inside Alden, reviewing patient medical records and other documents unavailable to the Tribune. It filed its report with the state this month, and the Tribune obtained a copy last week through an open-records request.
In an interview, Deborah Kennedy, abuse investigation director for the group, said: "What we're seeing here is a culture within a nursing home that tolerated lackadaisical, substandard care for years."
The group's report said Alden routinely destroyed some evidence of medication errors, an action that "bears scrutiny for criminal negligence."
Alden Village North has been under fire since October, when a Tribune investigation revealed a pattern of death and neglect at the home. Since 2008, eight residents have died in cases resulting in state citations.
The articles sparked several actions, including Equip for Equality's probe and an announcement by state authorities this month that they would shut the home. Alden, a for-profit facility at 7464 N. Sheridan Road, appealed and remains open.
Equip for Equality said it determined about 20 Alden residents died since 2008, when the current operator, Floyd Schlossberg, took over. Kennedy said the watchdog group's investigators, which included staff with legal and health care backgrounds, examined 15 cases, finding all of them "troublesome."
Five deaths, she said, involved "particularly egregious" care and were not previously reported by the newspaper. She said that although it was difficult to say whether neglect caused the deaths, poor care likely contributed to the patients' decline in their final days or hours.
An Alden spokesman disputed the findings, saying the five residents "died because of medical conditions, not the care that was provided."
"We believe we provided appropriate, life-sustaining care to these residents and the Equip for Equality report does not tell the entire story," the spokesman wrote in an email. "Our residents are like family members to our staff, and we grieve whenever one of them passes."
Alden also challenged the group's statement that the facility, by destroying reports detailing medication errors, might have committed crimes.
"The information contained in medication error reports also is contained in the patient charts," the spokesman wrote. "Patient charts are always available, and it is now our policy to preserve the medication error reports as well."
Regarding the care provided to patients who died, the spokesman said Alden's corporate medical director was reviewing all deaths that occurred within the last three years. He also said Alden has hired consultants to improve death investigations and created a committee of outside medical experts who will examine care at the home and suggest improvements.
The spokesman also noted that although Equip for Equality's report called for a variety of changes at Alden, including a ban on new admissions, the report did not urge authorities to shut the home.
Equip for Equality officials said they submitted their report to regulators the same day the state announced it was taking steps to close the home. Zena Naiditch, president and CEO of Equip for Equality, said the report outlined only initial recommendations and that the group backs the state's effort to close the home.
"At some point, you have to put the welfare of the residents above the welfare of the owner and the staff," she said.
Besides operating Alden Village North, Schlossberg runs more than 20 nursing facilities in Illinois, primarily providing care for the elderly.
Alden Village North cares for about 90 people, primarily children and young adults, with severe developmental disabilities. The five deaths detailed in Equip for Equality's report involved residents who were 14, 18, 32, 36 and 48 years old.
Naiditch said Alden's troubles illustrate how Illinois allows facilities like Alden to police themselves. The state investigates a death only if a facility reports it, the public submits a tip or a regulator discovers an unexplained death during a routine inspection.
"We have vulnerable people in a for-profit system where the owners are being basically told, 'You tell us if you think this case warrants us investigating it because you've committed abuse or neglect,'" she said.
Equip for Equality asked the Illinois Department of Public Health to investigate all deaths at Alden Village North since 2008. A department spokeswoman said she could not confirm targets of future investigations but said the agency looks into all credible allegations of neglect associated with a death in a nursing facility.
In its report, Equip for Equality cites the 2009 death of a 14-year-old girl as an example of poor care. The teenager breathed with the aid of a ventilator, and her death certificate states she died of pneumonia.
But the report calls into question a series of decisions prior to her death.
Six weeks before she died, a lab report showed she had "heavy growth" of the bacteria Pseudomonas aeruginosa. The results were relayed to her doctor, but records do not show the teen was started on an antibiotic.
A week later, after a chest X-ray showed pneumonia, the doctor ordered that the girl be given Cipro and Zosyn, even though "the lab report specifically stated that Pseudomonas is resistant to both Cipro and Zosyn," according to Equip for Equality's report.
When the girl was hospitalized, a lab test again found Pseudomonas. This time, physicians placed her on Amikacin, and she became stable and returned to Alden. She was to remain on Amikacin for three more days.
But an Alden nurse recorded in her notes that the pharmacy called to say Amikacin was not available. Equip for Equality investigators found no records that the teen received any appropriate antibiotic for the next two days until she was started back on Amikacin.
A few days later, lab tests showed she still had a heavy growth of Pseudomonas. The results were again relayed to her doctor, but the physician did not order an antibiotic for two days. Three days after the order, the teen died.
"Alden's internal investigation of this matter made no mention of the failed and interrupted treatment of the bacterial infection that likely ultimately led to her death," Equip for Equality's report states. "The facility's failure to adequately treat this infection was significant and should have been noted and investigated further."
Alden's spokesman said the girl was seriously ill and died of natural causes. "We did all that we could for (her) and we were devastated by her loss," he wrote.