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

Facility=MANAWA COM NUR CTR, MANAWA, 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++
02/09/2011 COMPLAINT 50.065(3)(b) , "COMPLETE BACKGROUND CHECK PROCESS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 03/09/2011 NO APPEAL ON RECORD
06/07/2011 FULL/COMPLAINT 50.065(3)(b) , "COMPLETE BACKGROUND CHECK PROCESS " CLASS C DEFICIENCY CORRECTED 07/07/2011 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=MANITOWOC HEALTH CARE CENTER, MANITOWOC, 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++
04/07/2011 FULL 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 05/07/2011 NO APPEAL ON RECORD
04/07/2011 FULL 50.04(2)(h) , "LICENSING & REGULATION OF NURSING HOMES " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 05/07/2011 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=MANORCARE HEALTH SERVICES, 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++
01/13/2011 FULL 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 02/13/2011 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=MANORCARE HEALTH SERVICES-KENOSHA, 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++
01/05/2011 COMPLAINT 132.60(2)(d) , "RESIDENT CARE/DIET ACCEPTANCE " CLASS B DEFICIENCY CORRECTED 01/25/2011 NO APPEAL ON RECORD
01/05/2011 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 01/25/2011 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=MANORCARE HEALTH SERVICES-PEWAUKEE, WAUKESHA, 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++
09/15/2011 FULL 132.60(8)(b) , "UPDATING OF CARE PLANS " CLASS B DEFICIENCY   NO APPEAL ON RECORD
09/15/2011 FULL 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " 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=MANORCARE HEALTH SERVICES-PLATTEVILLE, PLATTEVILLE, 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++
11/10/2010 COMPLAINT 132.51(2)(c) , "ADMISSIONS/DESTRUCTIVE RESIDENTS " CLASS B DEFICIENCY CORRECTED 12/10/2010 NO APPEAL ON RECORD
04/11/2011 FULL/COMPLAINT 132.45(5)(k) , "MEDICAL RECORDS-CONTENT-CONSENT " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 05/15/2011 NO APPEAL ON RECORD
04/11/2011 FULL/COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 05/15/2011 NO APPEAL ON RECORD
04/11/2011 FULL/COMPLAINT 132.60(1)(c)4 , "RESIDENT CARE/BASIC NRSG CARE " CLASS B DEFICIENCY CORRECTED 05/15/2011 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=MANORCARE HEALTH SERVICES-SHAWANO, SHAWANO, 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++
10/21/2010 COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 11/21/2010 NO APPEAL ON RECORD
10/21/2010 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 11/21/2010 NO APPEAL ON RECORD
06/14/2011 COMPLAINT 50.09(1)(k) , "Abuse and Restraints " CLASS B DEFICIENCY CORRECTED 07/03/2011 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=MAPLE LANE HEALTH AND REHAB, SHAWANO, 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++
03/29/2011 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 04/29/2011 APPEALED: 04/26/2011

*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=MAPLE RIDGE HEALTH AND REHABILITATION CENTER, 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++
11/02/2010 COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS A DEFICIENCY   NO APPEAL ON RECORD
06/01/2011 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 06/01/2011 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=MAPLEWOOD 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++
05/05/2011 FULL/COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 06/03/2011 NO APPEAL ON RECORD
05/05/2011 FULL/COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 06/03/2011 NO APPEAL ON RECORD
05/05/2011 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " 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=MARSHFIELD CARE CENTER, MARSHFIELD, 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++
10/06/2010 COMPLAINT 50.09(1)(L) , "Care " CLASS B DEFICIENCY CORRECTED 10/21/2010 APPEALED: 10/25/2010
09/27/2011 FULL/COMPLAINT 50.065(6)(am) , "Four Year Caregiver Background Requirement " 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=MARYWOOD CONV CTR, WAUSAU, 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++
06/22/2011 COMPLAINT 132.60(1)(c)4 , "RESIDENT CARE/BASIC NRSG CARE " CLASS B DEFICIENCY CORRECTED 06/16/2011 APPEALED: 07/07/2011
07/29/2011 FULL 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 08/30/2011 APPEALED: 08/18/2011

*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=MAYO CLINIC HEALTH SYSTEM-OAKRIDGE, INC, OSSEO, 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++
09/06/2011 FULL/COMPLAINT 132.71(7)(d) , "OXYGEN/SUPPLIES CHANGED EVERY 5 DAYS " 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=MAYO CLINIC HLTH SYSTEM CHIPPEWA VALLEY-MAPLEWOOD, 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++
07/21/2011 COMPLAINT 50.09(1)(L) , "Care " CLASS B DEFICIENCY CORRECTED 07/15/2011 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=MAYVILLE NUR REHAB CTR, MAYVILLE, 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++
12/07/2010 COMPLAINT 132.41(1) , "ADMINISTRATOR " CLASS B DEFICIENCY CORRECTED 01/10/2011 NO APPEAL ON RECORD
12/07/2010 COMPLAINT 132.60(1)(c)4 , "RESIDENT CARE/BASIC NRSG CARE " CLASS A DEFICIENCY CORRECTED 01/10/2011 NO APPEAL ON RECORD
12/07/2010 COMPLAINT 132.60(8)(b) , "UPDATING OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 01/10/2011 NO APPEAL ON RECORD
07/08/2011 FULL/COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 08/10/2011 APPEALED: 07/29/2011
07/08/2011 FULL/COMPLAINT 132.60(5)(a)1 , "RESIDENT CARE/ORDERS " CLASS B DEFICIENCY CORRECTED 08/10/2011 APPEALED: 07/29/2011
07/08/2011 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 08/10/2011 APPEALED: 07/29/2011

*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=MELLEN MANOR, MELLEN, 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++
03/03/2011 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 04/03/2011 APPEALED: 03/21/2011

*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=MEMORIAL NURSING AND REHAB CENTER, MEDFORD, 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++
02/24/2011 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 01/29/2011 NO APPEAL ON RECORD
06/16/2011 FULL/COMPLAINT 50.065(2)(bm) , "OUT OF STATE BACKGROUND CHECKS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 07/16/2011 APPEALED: 07/05/2011
06/16/2011 FULL/COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 07/16/2011 APPEALED: 07/05/2011
06/16/2011 FULL/COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 07/14/2011 APPEALED: 07/05/2011
06/16/2011 FULL/COMPLAINT 132.60(1)(c)2 , "RESIDENT CARE/BASIC NRSG CARE " CLASS B DEFICIENCY CORRECTED 07/14/2011 APPEALED: 07/05/2011

*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=MENOMONEE FALLS HCC, MENOMONEE FALLS, 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++
02/03/2011 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 02/03/2011 NO APPEAL ON RECORD
05/13/2011 COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 05/17/2011 NO APPEAL ON RECORD
08/08/2011 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=MERCY MANOR TRANS CTR, JANESVILLE, 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++
03/23/2011 FULL 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 04/23/2011 APPEALED: 04/18/2011

*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=MERCY MEDICAL CTR SUBACUTE, OSHKOSH, 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++
10/26/2010 FULL 50.04(2)(h) , "LICENSING & REGULATION OF NURSING HOMES " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED 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=MERCY RES AND REHAB 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++
02/14/2011 FULL/COMPLAINT 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 12/06/2010 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=MIDDLETON VILLAGE NUR REHAB, MIDDLETON, 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++
10/27/2010 COMPLAINT 132.60(2)(a) , "RESIDENT CARE/NOURISHMENT-DIETS " CLASS B DEFICIENCY CORRECTED 11/30/2010 APPEALED: 11/19/2010
10/27/2010 COMPLAINT 50.09(1)(L) , "Care " CLASS B DEFICIENCY CORRECTED 11/30/2010 DISMISSED
01/20/2011 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 01/21/2011 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=MILLWAY CARE AND REHABILITATION CENTER, 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++
09/14/2011 FULL/COMPLAINT 132.84(17)(d) , "NEW CONSTRUCTION PLANS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED   NO APPEAL ON RECORD
09/14/2011 FULL/COMPLAINT 132.83(1) , "MAINTENANCE " 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=MILWAUKEE COUNTY MHC REHAB CEN, 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++
03/29/2011 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 04/27/2011 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=MINERAL POINT CARE CTR, MINERAL POINT, 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++
03/02/2011 FULL/COMPLAINT 132.60(3)(a) , "RESIDENT CARE/NOTIFICATION OF CHANGE " CLASS B DEFICIENCY CORRECTED 04/19/2011 APPEALED: 03/21/2011
03/02/2011 FULL/COMPLAINT 132.60(5)(d)2 , "RESIDENT CARE/ADM OF MEDS " CLASS B DEFICIENCY CORRECTED 04/19/2011 APPEALED: 03/21/2011
03/02/2011 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 04/19/2011 APPEALED: 03/21/2011

*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=MITCHELL MANOR, 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++
06/30/2011 FULL/COMPLAINT 50.09(1)(L) , "Care " CLASS B DEFICIENCY CORRECTED 07/30/2011 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=MONROE MNR NUR REHAB, MONROE, 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++
12/07/2010 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 01/07/2011 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=MONTELLO CARE CENTER, MONTELLO, 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++
06/24/2011 FULL/COMPLAINT 50.065(2)(bm) , "OUT OF STATE BACKGROUND CHECKS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 07/24/2011 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=MORNINGSIDE HEALTH CTR, SHEBOYGAN, 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++
01/06/2011 FULL/COMPLAINT 50.065(2)(b)intro , "ENTITY BACKGROUND CHECK REQUIREMENTS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 02/06/2011 NO APPEAL ON RECORD
01/06/2011 FULL/COMPLAINT 50.065 (4m) (c) , "COMPLETE BACKGROUND INFORMATION DISCLOSURE " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 02/06/2011 NO APPEAL ON RECORD
01/06/2011 FULL/COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY CORRECTED 02/06/2011 NO APPEAL ON RECORD
01/06/2011 FULL/COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 02/06/2011 NO APPEAL ON RECORD
01/06/2011 FULL/COMPLAINT 132.83(1) , "MAINTENANCE " CLASS B DEFICIENCY CORRECTED 02/06/2011 NO APPEAL ON RECORD
01/06/2011 FULL/COMPLAINT 50.09(1)(k) , "Abuse and Restraints " CLASS B DEFICIENCY CORRECTED 02/06/2011 NO APPEAL ON RECORD
06/27/2011 COMPLAINT 50.065(2)(bm) , "OUT OF STATE BACKGROUND CHECKS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 07/27/2011 NO APPEAL ON RECORD
06/27/2011 COMPLAINT 50.065(6)(am) , "Four Year Caregiver Background Requirement " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 07/27/2011 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=MULDER HEALTH CARE FACILITY, WEST SALEM, 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++
07/14/2011 FULL 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 09/21/2011 APPEALED: 08/03/2011
07/14/2011 FULL 132.62(3) , "NURSING ASSIGNMENTS " CLASS B DEFICIENCY CORRECTED 09/21/2011 APPEALED: 08/03/2011
07/14/2011 FULL 132.72(1) , "HOUSEKEEPING " CLASS B DEFICIENCY CORRECTED 09/21/2011 APPEALED: 08/03/2011
07/14/2011 FULL 132.60(1)(c)5 , "FACILITY SHALL PROVIDE PAIN ASSESSMNT/TREATMT" CLASS B DEFICIENCY CORRECTED 09/21/2011 APPEALED: 08/03/2011
07/14/2011 FULL 50.09(1)(L) , "Care " CLASS B DEFICIENCY CORRECTED 09/21/2011 APPEALED: 08/03/2011
09/21/2011 REVISIT 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=MUSKEGO HEALTH CARE CENTER, MUSKEGO, 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++
04/05/2011 FULL/COMPLAINT 50.04(2)(h) , "LICENSING & REGULATION OF NURSING HOMES " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED 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.