Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=ALDEN ESTATES OF COUNTRYSIDE, INC, JEFFERSON, SOUTHEAST REGION (CONTACT: Carol Jean Rucker, (414) 227-4563)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
03/28/2011 FULL/COMPLAINT 50.065(2)(d) , "MAINTAIN BACKGROUND INFORMATION " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 04/20/2011 NO APPEAL ON RECORD
03/28/2011 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 04/20/2011 NO APPEAL ON RECORD

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.



Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=ALEXIAN VILLAGE OF MILWAUKEE, MILWAUKEE, SOUTHEAST REGION (CONTACT: Carol Jean Rucker, (414) 227-4563)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
10/27/2010 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 11/26/2010 NO APPEAL ON RECORD

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.



Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=ALGOMA LTC UNIT, ALGOMA, NORTHEAST REGION (CONTACT: Dolores Zwiers, (920) 983-3185)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
08/15/2011 FULL 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 09/14/2011 APPEALED: 09/01/2011

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.



Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=ALL ABOUT LIFE REHAB CTR, FOND DU LAC, NORTHEAST REGION (CONTACT: Dolores Zwiers, (920) 983-3185)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
01/26/2011 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 02/26/2011 NO APPEAL ON RECORD
04/15/2011 FULL 132.60(5)(a)1 , "RESIDENT CARE/ORDERS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 05/15/2011 NO APPEAL ON RECORD
05/17/2011 COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 05/20/2011 NO APPEAL ON RECORD

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.



Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=ALLIS CARE CENTER, WEST ALLIS, SOUTHEAST REGION (CONTACT: Carol Jean Rucker, (414) 227-4563)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
10/05/2010 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 10/05/2010 NO APPEAL ON RECORD
02/09/2011 FULL/COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 03/11/2011 NO APPEAL ON RECORD
02/09/2011 FULL/COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 03/11/2011 NO APPEAL ON RECORD
02/09/2011 FULL/COMPLAINT 132.83(1) , "MAINTENANCE " CLASS B DEFICIENCY CORRECTED 03/11/2011 NO APPEAL ON RECORD
02/09/2011 FULL/COMPLAINT 50.04(2)(h) , "LICENSING & REGULATION OF NURSING HOMES " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 03/11/2011 NO APPEAL ON RECORD
02/09/2011 FULL/COMPLAINT 50.09(1)(L) , "Care " CLASS B DEFICIENCY CORRECTED 03/11/2011 NO APPEAL ON RECORD

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.



Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=AMERICAN LUTHERAN HOME MONDOVI, MONDOVI, WESTERN REGION (CONTACT: Sherry Walters, (715) 836-4420)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
09/21/2011 FULL 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY   NO APPEAL ON RECORD

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.



Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=APPLETON HEALTH CARE CENTER, APPLETON, NORTHEAST REGION (CONTACT: Dolores Zwiers, (920) 983-3185)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
02/24/2011 COMPLAINT 132.51(2)(b) , "ADMISSIONS/COMMUNICABLE DISEASE " CLASS B DEFICIENCY CORRECTED 03/11/2011 APPEALED: 03/11/2011
04/27/2011 COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 05/19/2011 NO APPEAL ON RECORD
05/20/2011 FULL 50.04(2)(h) , "LICENSING & REGULATION OF NURSING HOMES " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 06/13/2011 NO APPEAL ON RECORD

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.



Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=ARCADIA NURSING HOME, ARCADIA, WESTERN REGION (CONTACT: Sherry Walters, (715) 836-4420)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
10/13/2010 FULL 132.65(6)(b)7 , "ACCESSIBILITY TO DRUGS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED   NO APPEAL ON RECORD
10/13/2010 FULL 132.71(7)(d) , "OXYGEN/SUPPLIES CHANGED EVERY 5 DAYS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED   NO APPEAL ON RECORD
03/03/2011 COMPLAINT 50.09(1)(k) , "Abuse and Restraints " CLASS B DEFICIENCY CORRECTED 03/03/2011 NO APPEAL ON RECORD

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.



Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=ASHLAND HEALTH AND REHAB CTR, ASHLAND, NORTHERN REGION (CONTACT: Jessica Radtke, (715) 365-2801)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
10/21/2010 FULL 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 11/21/2010 NO APPEAL ON RECORD

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.



Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=ASPIRUS PLEASANT VIEW, PHILLIPS, NORTHERN REGION (CONTACT: Jessica Radtke, (715) 365-2801)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
02/01/2011 COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 03/02/2011 NO APPEAL ON RECORD
05/05/2011 FULL/COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 06/20/2011 NO APPEAL ON RECORD

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.



Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=AUGUSTA AREA HOME, INC, AUGUSTA, WESTERN REGION (CONTACT: Sherry Walters, (715) 836-4420)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
01/12/2011 COMPLAINT 132.72(1) , "HOUSEKEEPING " CLASS B DEFICIENCY CORRECTED 02/12/2011 NO APPEAL ON RECORD
05/19/2011 FULL 132.44(1)(b) , "TRAINING-ASSIGNMENTS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 08/18/2011 NO APPEAL ON RECORD
05/19/2011 FULL 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY UNCORRECTED AT REVISIT NO APPEAL ON RECORD

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.



Wisconsin Nursing Homes: State Citations Issued from 10/01/2010 to 9/30/2011
Information is current as of 10/24/2011

Facility=AVANTI HEALTH AND REHABILITATION CENTER, LLC, MINOCQUA, NORTHERN REGION (CONTACT: Jessica Radtke, (715) 365-2801)*

Survey
Exit Date
Survey Type Wisconsin
Administrative
Code Cited
Class Code Revisit
Survey Result
Status
of Appeal++
08/23/2011 COMPLAINT 50.065(2)(bm) , "OUT OF STATE BACKGROUND CHECKS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED   NO APPEAL ON RECORD

*Please direct questions to the Bureau of Nursing Home Resident Care regional contact
noted above after the facility name and location.
++Appeal status is as of the last day of the reporting period, in this case September 30, 2011. Changes in the appeal status
occurring after that date will be noted in the updated Nursing Home State Citations Report generated the following quarter.