Rock River Nursing & Rehab
430 Wilcox St, Fort Atkinson, WI 53538Map
Medicare/Medicaid certified87 certified beds~21 residents/dayFor profit - Corporation
What Special Focus status means moreless
CMS keeps a short national list of nursing homes with the most persistent serious problems — the Special Focus Facility (SFF) program. SFF homes get inspected about twice as often and must improve or face termination from Medicare/Medicaid. 'SFF candidate' means the home qualifies for the list but isn't on it yet (the list has limited slots per state). Some SFF homes do graduate and improve; the designation means CMS is watching closely right now.
What to do with this: ask the administrator where the home is in the SFF process and what the improvement plan is. Verify status at medicare.gov/care-compare.
Last standard health inspection: December 4, 2025
Rock River Nursing & Rehab is a 87-bed for-profit, corporation-owned nursing home in Fort Atkinson, Jefferson County, Wisconsin, serving an average of 21 residents per day. As of CMS data processed June 1, 2026, its overall rating is not available. CMS does not rate this facility because of a history of serious quality issues — it is in the Special Focus Facility program.
CMS star ratings
CMS scores every nursing home 1–5 stars overall, built from three sub-ratings. moreless
Medicare inspects and measures every certified nursing home, then rolls the results into a 1–5 star overall rating. It combines three parts: health inspections, staffing, and quality measures. Five stars means much better than average — it does not mean perfect. One star means much worse than average — it does not mean every shift is bad. Stars are a screening tool, not a verdict. They can lag reality by months, and they can't see things like how kind the aides are or how the building smells at 7am.
What to do with this: use stars to build a shortlist, then visit in person. Nothing on this site replaces walking the halls.
Health-inspection stars are graded on a curve within each state — never compare stars across state lines. moreless
CMS sets health-inspection star cutoffs separately for each state: roughly the top 10% of homes in a state get 5 stars, the bottom 20% get 1 star, no matter how the state compares to others. That means a 4-star home in one state and a 4-star home in another state may have very different inspection records. The stars tell you how a home compares to its neighbors, not to the whole country. That's why this site shows your state's median next to each star rating — and never a national star comparison.
What to do with this: compare stars only between homes in the same state. To compare across states, use staffing hours — those are real numbers, not curves.
Not all three sub-ratings are equally hard to game: inspections are the most objective, quality measures the least. moreless
The three sub-ratings come from different sources. Health inspections are done on-site by trained state surveyors who show up mostly unannounced — the most objective signal. Staffing comes from payroll records that facilities must submit and CMS audits — quite reliable. Quality measures are partly self-reported by the facility from its own resident assessments — useful, but the facility grades some of its own homework.
What to do with this: when sub-ratings disagree, weigh the inspection star most and the quality-measure star least.
Staffing
Reported hours per resident per day, from payroll records. Hours, unlike stars, can be compared across states.
Hours per resident per day: total staff hours worked, divided by the number of residents. moreless
If a home reports 3.5 total nursing hours per resident per day, that's all nursing staff time across 24 hours — roughly one caregiver-hour every 7 hours per resident, spread across day, evening, and night shifts. On a real floor it decides whether call lights get answered in 5 minutes or 25, whether someone has time to help with dinner, and whether night shift is one aide for a hall or two. Unlike star ratings, hours are actual numbers, so they CAN be compared across state lines.
What to do with this: compare a home's hours to the state and national medians shown, and ask the facility how the hours split across day, evening, and night shifts.
RN (registered nurse) hours
LPN (licensed practical nurse) hours
Nurse aide hours
Total nursing hours
CMS also adjusts these numbers for how sick each home’s residents are — a home with sicker residents needs more staff for the same star. This home’s case-mix-adjusted total: 4.76 (US median, adjusted: 3.78).
CMS also adjusts staffing numbers for how sick each home's residents are. moreless
A home full of short-term rehab patients needs different staffing than a home caring for people with advanced dementia or ventilators. Case-mix adjustment estimates how many hours a home's particular residents need, then scales the reported hours so homes can be compared fairly. A home with sicker residents needs more staff for the same star. This page shows reported (raw payroll) numbers and compares them only to other reported numbers — like with like.
What to do with this: if a home's reported hours look low, check whether its residents may simply need less care — and ask the facility directly.
Staff turnover
Total nursing staff turnover: 76.8% · WI median: 46.3% · RN turnover: 83.3% (WI median: 36.4%)
The share of nursing staff who left within the year. Lower is steadier. moreless
Total nursing staff turnover is the percentage of the home's nurses and aides who stopped working there during the year. Around half of nursing-home staff leaving annually is sadly common in this industry. High turnover means residents are cared for by people who don't know them — which matters enormously for dementia care, pain management, and noticing the small changes that catch problems early. Low turnover usually means staff are treated well enough to stay.
What to do with this: when you visit, ask aides how long they've worked there. Long-tenured aides are the best sign a building has.
Inspections & deficiencies
The last 3 inspection cycles, from CMS’s federal health-survey file. State-only citations and fire-safety surveys are not included — an empty list means nothing federal is in this file, not that nothing ever happened.
Each deficiency gets a letter A–L: how severe it was × how widespread it was. moreless
Surveyors grade every deficiency on a grid. Severity runs from 'potential for minimal harm' up to 'immediate jeopardy to resident health or safety.' Scope runs from isolated (one or a few residents) to pattern to widespread. A and B are paperwork-level; D–F caused no actual harm but had the potential; G–I caused actual harm; J, K, and L mean immediate jeopardy — the most serious finding a surveyor can make. Most citations nationally are D–E.
What to do with this: scan for G or higher. One J/K/L tells you more than ten D's.
Standard surveys are routine; complaint surveys happen because someone reported a problem. moreless
A standard survey is the routine top-to-bottom inspection every home gets on a recurring cycle. A complaint survey happens because a resident, family member, or staff member reported something to the state — surveyors come specifically to investigate it. Infection-control surveys focus on practices like hand hygiene and isolation procedures. A deficiency found during a complaint survey means someone cared enough to report it and a surveyor confirmed enough to cite it.
What to do with this: note which deficiencies came from complaints — they show you what residents and families actually experienced.
The F-number on each deficiency is CMS's code for which federal requirement was violated. moreless
Every federal nursing-home requirement has a tag number. F0686, for example, is the pressure-ulcer requirement; F0600 is freedom from abuse. The tag tells you exactly which rule was broken, and the description next to it is CMS's own plain-language summary of that rule. The same tag appearing across multiple inspections is a pattern worth noticing.
What to do with this: if the same tag repeats across surveys, ask the facility what changed since the last citation.
This data shows federal health surveys only — state-only citations and fire-safety surveys aren't included. moreless
CMS's public deficiency file contains federal health-survey citations. It does not include citations issued under state-only rules, fire-safety (Life Safety Code) surveys, or anything older than three inspection cycles. A facility with no rows here may still have state citations or fire-safety findings. 'No deficiencies in this file' never means 'no violations ever.'
What to do with this: for the full picture, check your state health department's site and medicare.gov/care-compare, which shows fire-safety results separately.
118 deficiencies across the last 3 inspection cycles, in CMS’s federal health-survey file:
- Quality of Life and Care: 29
- Resident Rights: 24
- Pharmacy Service: 13
- Nutrition and Dietary: 10
- Freedom from Abuse, Neglect, and Exploitation: 9
- Nursing and Physician Services: 8
- Administration: 8
- Infection Control: 8
- Resident Assessment and Care Planning: 7
- Environmental: 2
February 6, 2026Complaint surveyTag F0609D — no actual harm, potential for more than minimal harm, isolated
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Deficient, Provider has date of correction · corrected March 10, 2026
December 4, 2025Standard + Complaint surveyTag F0610D — no actual harm, potential for more than minimal harm, isolated
Respond appropriately to all alleged violations.
Deficient, Provider has date of correction · corrected January 13, 2026
December 4, 2025Standard surveyTag F0656D — no actual harm, potential for more than minimal harm, isolated
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Deficient, Provider has date of correction · corrected January 13, 2026
December 4, 2025Standard surveyTag F0756D — no actual harm, potential for more than minimal harm, isolated
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Deficient, Provider has date of correction · corrected January 13, 2026
July 23, 2025Complaint surveyTag F0689K — immediate jeopardy to resident health or safety, pattern
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Deficient, Provider has date of correction · corrected August 28, 2025
July 23, 2025Complaint surveyTag F0732C — no actual harm, potential for minimal harm, widespread
Post nurse staffing information every day.
Deficient, Provider has date of correction · corrected August 28, 2025
July 23, 2025Complaint surveyTag F0745D — no actual harm, potential for more than minimal harm, isolated
Provide medically-related social services to help each resident achieve the highest possible quality of life.
Deficient, Provider has date of correction · corrected August 28, 2025
July 23, 2025Complaint surveyTag F0942D — no actual harm, potential for more than minimal harm, isolated
Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.
Deficient, Provider has date of correction · corrected August 28, 2025
July 23, 2025Complaint surveyTag F0943D — no actual harm, potential for more than minimal harm, isolated
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
Deficient, Provider has date of correction · corrected August 28, 2025
July 23, 2025Complaint surveyTag F0944D — no actual harm, potential for more than minimal harm, isolated
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
Deficient, Provider has date of correction · corrected August 28, 2025
Show 108 more deficiencies
July 23, 2025Complaint surveyTag F0949E — no actual harm, potential for more than minimal harm, pattern
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
Deficient, Provider has date of correction · corrected August 28, 2025
April 17, 2025Standard surveyTag F0553D — no actual harm, potential for more than minimal harm, isolated
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard + Complaint surveyTag F0604D — no actual harm, potential for more than minimal harm, isolated
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Complaint surveyTag F0610D — no actual harm, potential for more than minimal harm, isolated
Respond appropriately to all alleged violations.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard surveyTag F0655D — no actual harm, potential for more than minimal harm, isolated
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard surveyTag F0684J — immediate jeopardy to resident health or safety, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard surveyTag F0686G — actual harm, isolated
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard surveyTag F0689G — actual harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard + Complaint surveyTag F0725F — no actual harm, potential for more than minimal harm, widespread
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard surveyTag F0757D — no actual harm, potential for more than minimal harm, isolated
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard surveyTag F0758D — no actual harm, potential for more than minimal harm, isolated
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard + Complaint surveyTag F0880F — no actual harm, potential for more than minimal harm, widespread
Provide and implement an infection prevention and control program.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard + Complaint surveyTag F0882F — no actual harm, potential for more than minimal harm, widespread
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard + Complaint surveyTag F0883D — no actual harm, potential for more than minimal harm, isolated
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Deficient, Provider has date of correction · corrected May 23, 2025
April 17, 2025Standard surveyTag F0926E — no actual harm, potential for more than minimal harm, pattern
Have policies on smoking.
Deficient, Provider has date of correction · corrected May 23, 2025
January 15, 2025Complaint surveyTag F0580D — no actual harm, potential for more than minimal harm, isolated
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0584E — no actual harm, potential for more than minimal harm, pattern
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0610D — no actual harm, potential for more than minimal harm, isolated
Respond appropriately to all alleged violations.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0684J — immediate jeopardy to resident health or safety, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Deficient, Provider has date of correction · corrected May 23, 2025
January 15, 2025Complaint surveyTag F0689D — no actual harm, potential for more than minimal harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0726D — no actual harm, potential for more than minimal harm, isolated
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0730F — no actual harm, potential for more than minimal harm, widespread
Observe each nurse aide's job performance and give regular training.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0755J — immediate jeopardy to resident health or safety, isolated
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0759D — no actual harm, potential for more than minimal harm, isolated
Ensure medication error rates are not 5 percent or greater.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0837F — no actual harm, potential for more than minimal harm, widespread
Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0842D — no actual harm, potential for more than minimal harm, isolated
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0941F — no actual harm, potential for more than minimal harm, widespread
Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0942D — no actual harm, potential for more than minimal harm, isolated
Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0943D — no actual harm, potential for more than minimal harm, isolated
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0944F — no actual harm, potential for more than minimal harm, widespread
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0945D — no actual harm, potential for more than minimal harm, isolated
Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0946F — no actual harm, potential for more than minimal harm, widespread
Provide training in compliance and ethics.
Deficient, Provider has date of correction · corrected February 13, 2025
January 15, 2025Complaint surveyTag F0949F — no actual harm, potential for more than minimal harm, widespread
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
Deficient, Provider has date of correction · corrected February 13, 2025
September 11, 2024Complaint surveyTag F0552D — no actual harm, potential for more than minimal harm, isolated
Ensure that residents are fully informed and understand their health status, care and treatments.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0553D — no actual harm, potential for more than minimal harm, isolated
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0558D — no actual harm, potential for more than minimal harm, isolated
Reasonably accommodate the needs and preferences of each resident.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0559D — no actual harm, potential for more than minimal harm, isolated
Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0563D — no actual harm, potential for more than minimal harm, isolated
Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0580D — no actual harm, potential for more than minimal harm, isolated
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0584E — no actual harm, potential for more than minimal harm, pattern
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0657D — no actual harm, potential for more than minimal harm, isolated
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0660D — no actual harm, potential for more than minimal harm, isolated
Plan the resident's discharge to meet the resident's goals and needs.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0676D — no actual harm, potential for more than minimal harm, isolated
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0677D — no actual harm, potential for more than minimal harm, isolated
Provide care and assistance to perform activities of daily living for any resident who is unable.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0684D — no actual harm, potential for more than minimal harm, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0689D — no actual harm, potential for more than minimal harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0699D — no actual harm, potential for more than minimal harm, isolated
Provide care or services that was trauma informed and/or culturally competent.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0725E — no actual harm, potential for more than minimal harm, pattern
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0726E — no actual harm, potential for more than minimal harm, pattern
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0745D — no actual harm, potential for more than minimal harm, isolated
Provide medically-related social services to help each resident achieve the highest possible quality of life.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0755E — no actual harm, potential for more than minimal harm, pattern
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0758D — no actual harm, potential for more than minimal harm, isolated
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0759D — no actual harm, potential for more than minimal harm, isolated
Ensure medication error rates are not 5 percent or greater.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0814C — no actual harm, potential for minimal harm, widespread
Dispose of garbage and refuse properly.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0880D — no actual harm, potential for more than minimal harm, isolated
Provide and implement an infection prevention and control program.
Deficient, Provider has date of correction · corrected October 18, 2024
September 11, 2024Complaint surveyTag F0925F — no actual harm, potential for more than minimal harm, widespread
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Deficient, Provider has date of correction · corrected October 18, 2024
July 24, 2024Complaint surveyTag F0837F — no actual harm, potential for more than minimal harm, widespread
Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility.
Deficient, Provider has date of correction · corrected August 15, 2024
June 12, 2024Complaint surveyTag F0580D — no actual harm, potential for more than minimal harm, isolated
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Deficient, Provider has date of correction · corrected July 16, 2024
June 12, 2024Complaint surveyTag F0585D — no actual harm, potential for more than minimal harm, isolated
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Deficient, Provider has date of correction · corrected July 16, 2024
June 12, 2024Complaint surveyTag F0660D — no actual harm, potential for more than minimal harm, isolated
Plan the resident's discharge to meet the resident's goals and needs.
Deficient, Provider has date of correction · corrected July 16, 2024
June 12, 2024Complaint surveyTag F0684D — no actual harm, potential for more than minimal harm, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Deficient, Provider has date of correction · corrected July 16, 2024
June 12, 2024Complaint surveyTag F0686G — actual harm, isolated
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Deficient, Provider has date of correction · corrected October 21, 2024
June 12, 2024Complaint surveyTag F0687D — no actual harm, potential for more than minimal harm, isolated
Provide appropriate foot care.
Deficient, Provider has date of correction · corrected July 16, 2024
June 12, 2024Complaint surveyTag F0880D — no actual harm, potential for more than minimal harm, isolated
Provide and implement an infection prevention and control program.
Deficient, Provider has date of correction · corrected July 16, 2024
April 25, 2024Standard surveyTag F0578D — no actual harm, potential for more than minimal harm, isolated
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard + Complaint surveyTag F0610D — no actual harm, potential for more than minimal harm, isolated
Respond appropriately to all alleged violations.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard surveyTag F0623D — no actual harm, potential for more than minimal harm, isolated
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard surveyTag F0625E — no actual harm, potential for more than minimal harm, pattern
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard surveyTag F0656D — no actual harm, potential for more than minimal harm, isolated
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard + Complaint surveyTag F0678J — immediate jeopardy to resident health or safety, isolated
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
Past Non-Compliance · corrected April 9, 2024
April 25, 2024Standard + Complaint surveyTag F0686G — actual harm, isolated
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Deficient, Provider has date of correction · corrected October 21, 2024
April 25, 2024Standard surveyTag F0689E — no actual harm, potential for more than minimal harm, pattern
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard surveyTag F0692D — no actual harm, potential for more than minimal harm, isolated
Provide enough food/fluids to maintain a resident's health.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard surveyTag F0725F — no actual harm, potential for more than minimal harm, widespread
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard surveyTag F0742D — no actual harm, potential for more than minimal harm, isolated
Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard + Complaint surveyTag F0755D — no actual harm, potential for more than minimal harm, isolated
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard surveyTag F0758D — no actual harm, potential for more than minimal harm, isolated
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard surveyTag F0761D — no actual harm, potential for more than minimal harm, isolated
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard + Complaint surveyTag F0807D — no actual harm, potential for more than minimal harm, isolated
Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard + Complaint surveyTag F0812E — no actual harm, potential for more than minimal harm, pattern
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Deficient, Provider has date of correction · corrected May 23, 2024
April 25, 2024Standard + Complaint surveyTag F0880D — no actual harm, potential for more than minimal harm, isolated
Provide and implement an infection prevention and control program.
Deficient, Provider has date of correction · corrected July 16, 2024
March 7, 2024Complaint surveyTag F0677D — no actual harm, potential for more than minimal harm, isolated
Provide care and assistance to perform activities of daily living for any resident who is unable.
Deficient, Provider has date of correction · corrected March 19, 2024
March 7, 2024Complaint surveyTag F0697D — no actual harm, potential for more than minimal harm, isolated
Provide safe, appropriate pain management for a resident who requires such services.
Deficient, Provider has date of correction · corrected March 19, 2024
February 21, 2024Complaint surveyTag F0684D — no actual harm, potential for more than minimal harm, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Deficient, Provider has date of correction · corrected March 12, 2024
December 12, 2023Complaint surveyTag F0572E — no actual harm, potential for more than minimal harm, pattern
Give residents a notice of rights, rules, services and charges.
Deficient, Provider has date of correction · corrected January 12, 2024
December 12, 2023Complaint surveyTag F0580D — no actual harm, potential for more than minimal harm, isolated
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Deficient, Provider has date of correction · corrected January 12, 2024
December 12, 2023Complaint surveyTag F0678D — no actual harm, potential for more than minimal harm, isolated
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
Deficient, Provider has date of correction · corrected January 12, 2024
December 12, 2023Complaint surveyTag F0689D — no actual harm, potential for more than minimal harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Deficient, Provider has date of correction · corrected March 12, 2024
December 12, 2023Complaint surveyTag F0804D — no actual harm, potential for more than minimal harm, isolated
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Deficient, Provider has date of correction · corrected January 12, 2024
December 12, 2023Complaint surveyTag F0812F — no actual harm, potential for more than minimal harm, widespread
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Deficient, Provider has date of correction · corrected January 12, 2024
October 16, 2023Complaint surveyTag F0550D — no actual harm, potential for more than minimal harm, isolated
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0554D — no actual harm, potential for more than minimal harm, isolated
Allow residents to self-administer drugs if determined clinically appropriate.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0583D — no actual harm, potential for more than minimal harm, isolated
Keep residents' personal and medical records private and confidential.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0584E — no actual harm, potential for more than minimal harm, pattern
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0585E — no actual harm, potential for more than minimal harm, pattern
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0604D — no actual harm, potential for more than minimal harm, isolated
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0684D — no actual harm, potential for more than minimal harm, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0689G — actual harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Deficient, Provider has date of correction · corrected March 12, 2024
October 16, 2023Complaint surveyTag F0725E — no actual harm, potential for more than minimal harm, pattern
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0759E — no actual harm, potential for more than minimal harm, pattern
Ensure medication error rates are not 5 percent or greater.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0760D — no actual harm, potential for more than minimal harm, isolated
Ensure that residents are free from significant medication errors.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0804F — no actual harm, potential for more than minimal harm, widespread
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0805E — no actual harm, potential for more than minimal harm, pattern
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0810D — no actual harm, potential for more than minimal harm, isolated
Provide special eating equipment and utensils for residents who need them and appropriate assistance.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0812F — no actual harm, potential for more than minimal harm, widespread
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0814F — no actual harm, potential for more than minimal harm, widespread
Dispose of garbage and refuse properly.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0825E — no actual harm, potential for more than minimal harm, pattern
Provide or get specialized rehabilitative services as required for a resident.
Deficient, Provider has date of correction · corrected November 10, 2023
October 16, 2023Complaint surveyTag F0880D — no actual harm, potential for more than minimal harm, isolated
Provide and implement an infection prevention and control program.
Deficient, Provider has date of correction · corrected November 10, 2023
Fines & penalties
CMS can fine a home or stop paying for new admissions. Shown per CMS's current data window (~3 years) — not all-time. moreless
When deficiencies are serious or aren't fixed, CMS can impose a fine (a civil money penalty) or a payment denial — refusing to pay for new Medicare/Medicaid admissions until the home fixes the problem. Payment denials hit harder than most fines because they stop revenue. CMS's public dataset covers a rolling window of roughly the last three years, so the totals here are recent history, not an all-time record. Many facilities have no penalties in the window — that's common, not remarkable.
What to do with this: a recent large fine deserves a direct question on your visit — what happened, and what changed?
Fines: 2 totaling $136,384 · Payment denials: 3 — per CMS data (rolling ~3-year window).
| Date | Type | Amount / length |
|---|---|---|
| July 23, 2025 | Payment Denial | 36 days, from July 23, 2025 |
| April 25, 2024 | Fine | $119,141 |
| April 25, 2024 | Payment Denial | 150 days, from May 24, 2024 |
| October 16, 2023 | Fine | $17,243 |
| October 16, 2023 | Payment Denial | 126 days, from November 14, 2023 |
Ownership & chain
Who actually owns and controls the facility — individuals, companies, and their stakes. moreless
Nursing homes are often owned through layers: an operating company, a property company, management companies, and individual investors with percentage stakes. CMS publishes who holds 5%-or-greater interests and who has operational control. Ownership matters because it sets the budget: research has linked some ownership structures, especially certain chains and investment vehicles, to lower staffing. That's a pattern across the industry, not a verdict on any one building.
What to do with this: know who owns the home before you sign anything, and ask the administrator who actually sets the staffing budget.
Part of Bedrock Healthcare (9 facilities). Chain average overall rating: 1.4★.
Most US nursing homes belong to a chain. The chain's average rating is context for this home's rating. moreless
A chain is a group of facilities sharing an owner or operator. Chains share budgets, policies, and management practices, so a chain's average rating tells you something about the company behind the building. A home rating well above its chain's average may have an unusually strong local team; one below it may be the chain's neglected building. Either way, the chain sets the constraints the local staff work within.
What to do with this: if the chain average is low, ask the administrator what this building does differently.
| Owner / manager | Role | Stake | Since |
|---|---|---|---|
| Chopp, Martin (Individual) | 5% or greater indirect ownership interest | 20% | 10/01/2019 |
| Chopp, Pnina (Individual) | 5% or greater indirect ownership interest | 60% | 10/01/2019 |
| Chopp, Solomon (Individual) | 5% or greater indirect ownership interest | 20% | 10/01/2019 |
| Brewer, Anthony (Individual) | Adp of the snf | NOT APPLICABLE | 07/08/2025 |
| Chopp, Martin (Individual) | Adp of the snf | NOT APPLICABLE | 10/01/2019 |
| Chopp, Pnina (Individual) | Adp of the snf | NOT APPLICABLE | 10/01/2019 |
| Chopp, Solomon (Individual) | Adp of the snf | NOT APPLICABLE | 10/01/2019 |
| Opal Healthcare Wi LLC (Organization) | Adp of the snf | NOT APPLICABLE | 03/31/2025 |
| Brewer, Anthony (Individual) | Operational/managerial control | NOT APPLICABLE | 07/08/2025 |
| Chopp, Martin (Individual) | Operational/managerial control | NOT APPLICABLE | 10/01/2019 |
| Chopp, Pnina (Individual) | Operational/managerial control | NOT APPLICABLE | 10/01/2019 |
| Chopp, Solomon (Individual) | Operational/managerial control | NOT APPLICABLE | 10/01/2019 |
| Opal Healthcare Wi LLC (Organization) | Operational/managerial control | NOT APPLICABLE | 10/01/2019 |
| Ramanujam, Sandeep (Individual) | Operational/managerial control | NOT APPLICABLE | 02/01/2024 |
Nearby facilities in Jefferson County
Most families compare 2–3 homes. Same county, sorted by overall rating:
Visiting? Go in with questions.
Built from this facility’s own CMS data — bring them on the tour.
- CMS lists this facility as a Special Focus Facility — ask where the home is in the program and what the improvement plan is.
- Their total nursing staff turnover (76.8%) is above the WI median (46.3%) — ask how long the aides on your person's unit have worked there.
- CMS data shows 2 fines totaling $136,384 in its current data window — ask what the citations were for and what changed afterward.
- Their weekend total nurse staffing (4.06/resident/day) is lower than their overall figure (4.69) — ask who covers weekends and how shifts are filled when someone calls out.
- Their last standard health inspection was December 4, 2025 — ask what's improved since then.
- CMS records that this facility has a resident council — ask to speak with a council member before deciding.
- They have 87 certified beds and serve an average of 21 residents per day — ask which unit your person would be on and who staffs it overnight.
Data: Centers for Medicare & Medicaid Services (data.cms.gov), processing date June 1, 2026. This site is not affiliated with CMS or any government agency.