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

Facility=RENNES HEALTH AND REHAB CENTER- APPLETON, 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++
10/26/2010 FULL 50.04(2)(h) , "LICENSING & REGULATION OF NURSING HOMES " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 11/16/2010 NO APPEAL ON RECORD
01/18/2011 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 01/24/2011 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=RENNES HEALTH AND REHAB CENTER-DEPERE, DE PERE, 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++
02/04/2011 FULL/COMPLAINT 132.83(1) , "MAINTENANCE " CLASS B DEFICIENCY CORRECTED 03/03/2011 NO APPEAL ON RECORD
02/04/2011 FULL/COMPLAINT 132.84(4)(a)-(c) , "RESIDENT AND STAFF COMMUNICATION " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED CORRECTED 03/03/2011 NO APPEAL ON RECORD
06/29/2011 COMPLAINT 132.60(8)(c) , "IMPLEMENTATION OF CARE PLANS " CLASS B DEFICIENCY CORRECTED 06/30/2011 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=RENNES HEALTH AND REHAB CENTER-WESTON, WESTON, 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 50.065(2)(b)intro , "ENTITY BACKGROUND CHECK REQUIREMENTS " CLASS C DEFICIENCY -- CORRECTION ORDER SERVED 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=RICE LAKE CONV CTR, RICE LAKE, 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++
05/11/2011 FULL/COMPLAINT 132.45(5)(c)4.b , "MEDICAL RECORDS-CONTENT-NURSING " CLASS C DEFICIENCY CORRECTED 06/13/2011 NO APPEAL ON RECORD
05/11/2011 FULL/COMPLAINT 50.09(1)(L) , "Care " CLASS B DEFICIENCY 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=RIDGEWOOD CARE CTR, RACINE, 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++
04/08/2011 FULL 132.51(2)(b) , "ADMISSIONS/COMMUNICABLE DISEASE " CLASS B DEFICIENCY CORRECTED 05/03/2011 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=ROLLING HILLS REHAB CTR, SPARTA, 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++
07/29/2011 FULL/COMPLAINT 132.60(1)(b) , "RESIDENT CARE/DECUBITI PREVENTION " CLASS B DEFICIENCY   APPEALED: 08/19/2011

*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=RUSK CTY MEM HSPTL NH, LADYSMITH, 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++
11/03/2010 FULL 132.60(1) , "RESIDENT CARE/INDIVIDUAL CARE " CLASS B DEFICIENCY CORRECTED 12/03/2010 NO APPEAL ON RECORD
11/03/2010 FULL 50.09(1)(L) , "Care " CLASS B DEFICIENCY CORRECTED 12/03/2010 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.