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

Facility=HALES CORNERS CARE CTR, HALES CORNERS, 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++
03/17/2011 FULL 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 04/17/2011 APPEALED: 04/15/2011
03/17/2011 FULL 50.09(1)(L) , "Care " CLASS B DEFICIENCY CORRECTED 04/17/2011 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=HARBOR HAVEN HEALTH & REHABILITATION, 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++
03/04/2011 FULL/COMPLAINT 132.51(2)(b) , "ADMISSIONS/COMMUNICABLE DISEASE " CLASS B DEFICIENCY CORRECTED 04/01/2011 APPEALED: 03/29/2011
03/04/2011 FULL/COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 04/01/2011 APPEALED: 03/29/2011
03/04/2011 FULL/COMPLAINT 132.84(4)(a)-(c) , "RESIDENT AND STAFF COMMUNICATION " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 04/04/2011 APPEALED: 03/29/2011
03/04/2011 FULL/COMPLAINT 50.09(1)(L) , "Care " CLASS B DEFICIENCY CORRECTED 04/01/2011 APPEALED: 03/29/2011

*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=HEARTLAND COUNTRY VILLAGE, BLACK EARTH, 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++
05/03/2011 FULL 132.60(3)(a) , "RESIDENT CARE/NOTIFICATION OF CHANGE " CLASS B DEFICIENCY CORRECTED 06/03/2011 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=HERITAGE OF ELMWOOD NH, ELMWOOD, 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++
11/23/2010 COMPLAINT 132.45(5)(c)4.b , "MEDICAL RECORDS-CONTENT-NURSING " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 12/15/2010 DISMISSED
11/23/2010 COMPLAINT 132.51(2)(c) , "ADMISSIONS/DESTRUCTIVE RESIDENTS " CLASS B DEFICIENCY CORRECTED 01/15/2011 APPEALED: 12/27/2010
04/14/2011 FULL 132.44(1)(a) , "EMPLOYE DEVELOPMENT " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED UNCORRECTED AT REVISIT NO APPEAL ON RECORD
04/14/2011 FULL 132.83(7)(a)2 , "HOT WATER TEMPERATURE " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED 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=HETZEL CARE NURSING & REHABILITATION CENTER LLC, BLOOMER, 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++
02/17/2011 FULL/COMPLAINT 132.41(2)(b) , "ADMINISTRATOR-SMALL HOMES " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED NO APPEAL ON RECORD
02/17/2011 FULL/COMPLAINT 132.41(4)(d) , "ADMINISTRATOR-NOTICE OF CHANGE " 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=HIGHLAND HEIGHTS HEALTHCARE 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++
03/09/2011 COMPLAINT 132.60(1)(c)5 , "FACILITY SHALL PROVIDE PAIN ASSESSMNT/TREATMT" CLASS B DEFICIENCY CORRECTED 03/25/2011 APPEALED: 03/22/2011
04/27/2011 COMPLAINT 132.60(5)(a)1 , "RESIDENT CARE/ORDERS " CLASS B DEFICIENCY CORRECTED 05/13/2011 APPEALED: 05/05/2011
07/22/2011 FULL/COMPLAINT 50.065(2)(bb) , "DETERMINE FINAL DISPOSITION OF CHARGE " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 08/20/2011 APPEALED: 08/17/2011
07/22/2011 FULL/COMPLAINT 50.065(2)(d) , "MAINTAIN BACKGROUND INFORMATION " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 08/20/2011 APPEALED: 08/17/2011
07/22/2011 FULL/COMPLAINT 132.41(1) , "ADMINISTRATOR " CLASS B DEFICIENCY CORRECTED 08/20/2011 APPEALED: 08/17/2011
07/22/2011 FULL/COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 08/20/2011 APPEALED: 08/17/2011
07/22/2011 FULL/COMPLAINT 132.65(2) , "OBTAINING MEDS FROM LICENSED PHARMACY " CLASS B DEFICIENCY CORRECTED 08/20/2011 APPEALED: 08/17/2011

*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=HILLVIEW HEALTH CARE CTR, LA CROSSE, 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++
10/21/2010 COMPLAINT 132.44(1)(b) , "TRAINING-ASSIGNMENTS " CLASS B DEFICIENCY CORRECTED 11/25/2010 APPEALED: 11/16/2010
10/21/2010 COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 11/25/2010 APPEALED: 11/16/2010
10/21/2010 COMPLAINT 132.60(1)(c)4 , "RESIDENT CARE/BASIC NRSG CARE " CLASS B DEFICIENCY CORRECTED 11/25/2010 APPEALED: 11/16/2010
10/21/2010 COMPLAINT 132.72(1) , "HOUSEKEEPING " CLASS B DEFICIENCY CORRECTED 11/25/2010 APPEALED: 11/16/2010
10/21/2010 COMPLAINT 132.84(4)(d) , "RESIDENT AND STAFF COMMUNICATIONS " CLASS B DEFICIENCY CORRECTED 11/25/2010 APPEALED: 11/16/2010

*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=HOMESTEAD CARE CENTER, LLC, NEW HOLSTEIN, 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++
10/01/2010 FULL 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 11/01/2010 DISMISSED
10/01/2010 FULL 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 11/01/2010 DISMISSED
04/06/2011 COMPLAINT 132.65(6)(b)1 , "STORAGE OF MEDICATIONS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 05/06/2011 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=HOMME HOME FOR THE AGING, WITTENBERG, 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++
03/18/2011 FULL/COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 04/18/2011 NO APPEAL ON RECORD
08/15/2011 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 08/16/2011 NO APPEAL ON RECORD
09/09/2011 COMPLAINT 132.51(2)(c) , "ADMISSIONS/DESTRUCTIVE RESIDENTS " 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=HOSPITALITY NUR REHAB CTR, 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++
04/14/2011 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 05/14/2011 NO APPEAL ON RECORD
06/15/2011 FULL/COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 07/08/2011 NO APPEAL ON RECORD
08/08/2011 FULL/COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 08/31/2011 NO APPEAL ON RECORD
08/08/2011 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 08/31/2011 NO APPEAL ON RECORD
08/08/2011 FULL/COMPLAINT 132.72(1) , "HOUSEKEEPING " 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.