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

Facility=CAMEO CARE CTR, 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++
11/15/2010 COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 01/06/2011 DISMISSED
11/15/2010 COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 01/06/2011 DISMISSED
11/15/2010 COMPLAINT 132.60(8)(b) , "UPDATING OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 01/06/2011 DISMISSED
09/15/2011 COMPLAINT 132.60(1)(c)4 , "RESIDENT CARE/BASIC NRSG CARE " CLASS B DEFICIENCY   APPEALED: 09/30/2011

*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=CAPITOL LAKES HEALTH CENTER, MADISON, SOUTHERN REGION (CONTACT: Kristy Pecosky, (608) 266-8633)*

Survey
Exit Date		 Survey Type Wisconsin
Administrative
Code Cited		 Class Code Revisit
Survey Result		 Status
of Appeal++
10/06/2010 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 11/05/2010 NO APPEAL ON RECORD
05/10/2011 FULL/COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 05/31/2011 APPEALED: 05/26/2011
05/10/2011 FULL/COMPLAINT 132.60(5)(a)1 , "RESIDENT CARE/ORDERS " CLASS A DEFICIENCY CORRECTED 05/31/2011 APPEALED: 05/26/2011

*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=CHIPPEWA MANOR NURSING HOME, CHIPPEWA FALLS, 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++
08/18/2011 FULL 132.60(8)(b) , "UPDATING OF CARE PLANS " CLASS B DEFICIENCY   APPEALED: 09/16/2011

*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=CHRISTIAN HOME AND REHAB CTR, WAUPUN, SOUTHERN REGION (CONTACT: Kristy Pecosky, (608) 266-8633)*

Survey
Exit Date		 Survey Type Wisconsin
Administrative
Code Cited		 Class Code Revisit
Survey Result		 Status
of Appeal++
12/14/2010 FULL/COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 01/06/2011 DISMISSED
12/14/2010 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 01/14/2011 DISMISSED

*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=CLAIREMONT NURSING AND REHAB, EAU CLAIRE, 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++
02/03/2011 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " 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=CLAIRIDGE HOUSE, KENOSHA, 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++
10/18/2010 FULL/COMPLAINT 132.51(2)(b) , "ADMISSIONS/COMMUNICABLE DISEASE " CLASS B DEFICIENCY CORRECTED 11/18/2010 DISMISSED
08/25/2011 FULL 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.


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

Facility=COLFAX HEALTH AND REHABILITATION CENTER, COLFAX, 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++
08/19/2011 FULL 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY   APPEALED: 09/12/2011
08/19/2011 FULL 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY   APPEALED: 09/14/2011
08/19/2011 FULL 132.60(1)(c)2 , "RESIDENT CARE/BASIC NRSG CARE " CLASS B DEFICIENCY   APPEALED: 09/14/2011

*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=COLONY OAKS CARE CTR, 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++
11/22/2010 COMPLAINT 50.065(2)(bm) , "OUT OF STATE BACKGROUND CHECKS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 12/07/2010 NO APPEAL ON RECORD
11/22/2010 COMPLAINT 50.065(3)(b) , "COMPLETE BACKGROUND CHECK PROCESS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 12/07/2010 NO APPEAL ON RECORD
02/16/2011 FULL/COMPLAINT 50.04(2)(h) , "LICENSING & REGULATION OF NURSING HOMES " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 03/16/2011 NO APPEAL ON RECORD
05/24/2011 COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 06/01/2011 NO APPEAL ON RECORD
08/05/2011 FULL/COMPLAINT 50.065(2)(bm) , "OUT OF STATE BACKGROUND CHECKS " CLASS C DEFICIENCY CORRECTED 08/31/2011 NO APPEAL ON RECORD
08/05/2011 FULL/COMPLAINT 50.065 (4m) (c) , "COMPLETE BACKGROUND INFORMATION DISCLOSURE " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 08/31/2011 NO APPEAL ON RECORD
08/05/2011 FULL/COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 08/31/2011 NO APPEAL ON RECORD
08/05/2011 FULL/COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 08/31/2011 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=CONGREGATIONAL HOME, BROOKFIELD, 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++
01/21/2011 FULL 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 02/21/2011 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=CORNELL AREA CARE CTR, CORNELL, 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++
10/26/2010 FULL 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 11/24/2010 NO APPEAL ON RECORD
10/26/2010 FULL 50.09(1)(L) , "Care " CLASS B DEFICIENCY CORRECTED 11/24/2010 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=CREST VIEW NURSING HOME, NEW LISBON, 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++
07/21/2011 FULL 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 08/21/2011 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=CUMBERLAND MEM HSPTL ECU, CUMBERLAND, 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++
02/18/2011 FULL/COMPLAINT 132.51(2)(b) , "ADMISSIONS/COMMUNICABLE DISEASE " CLASS B DEFICIENCY CORRECTED 03/14/2011 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.