01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-05-07 | 1 | 2026-05-07 | 4 |
| Cycle 2 | 2025-03-12 | 2 | 2025-03-12 | 7 |
| Cycle 3 | 2024-02-14 | 4 | 2024-02-14 | 3 |
CMS CCN 5253832026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
American Lutheran Home-Mondovi
200 Memorial Dr · Mondovi, WI 54755 · Buffalo County
Certified beds35CMS provider file
Recent citation rows21current CMS citation release
Penalty rows0current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
21 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 3 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-05-07 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2026-06-012026-05-07 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2026-06-012026-05-07 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2026-06-012026-05-07 · FIREK0363Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2026-06-012026-05-07 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2026-06-012025-03-12 · FIREE0006Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct risk assessment and an All-Hazards approach.
Correction field: Deficient, Provider has date of correction · 2025-04-242025-03-12 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2025-04-022025-03-12 · HEALTHF0758Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2025-04-022025-03-12 · FIREK0132Severity D · isolated; potential for more than minimal harm
Construction Deficiencies
Meet requirements for outpatient facilities located next to inpatient facilities separated by fire resistive construction.
Correction field: Deficient, Provider has date of correction · 2025-04-242025-03-12 · FIREK0222Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Correction field: Deficient, Provider has date of correction · 2025-04-242025-03-12 · FIREK0331Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Construct fire resistant interior walls.
Correction field: Deficient, Provider has date of correction · 2025-04-242025-03-12 · FIREK0353Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-04-242025-03-12 · FIREK0912Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have power receptacles that are properly grounded.
Correction field: Deficient, Provider has date of correction · 2025-04-242025-03-12 · FIREK0920Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Correction field: Deficient, Provider has date of correction · 2025-04-242024-02-14 · HEALTHF0689Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2024-03-062024-02-14 · HEALTHF0759Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2024-03-062024-02-14 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2024-03-062024-02-14 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2024-03-062024-02-14 · FIREK0293Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Have properly located and lighted "Exit" signs.
Correction field: Deficient, Provider has date of correction · 2024-03-082024-02-14 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2024-03-082024-02-14 · FIREK0923Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have proper medical gas storage and administration areas.
Correction field: Deficient, Provider has date of correction · 2024-03-0803 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- ERICKSON, JOANNEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2023
- GROSSIER, STEPHANYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- LARSON, DAVIDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2021
- LARSON, LINDAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/28/2025
- LEE, RITAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2018
- REID, ANITAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2023
- DUHR, AMYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/17/2020
- LARSON, JAMIEIndividual · CORPORATE OFFICERNOT APPLICABLE · since 08/24/2021
- GRACE LUTHERAN FOUNDATION, INC.Organization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2000
- DUHR, AMYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/17/2020
- HUNGERFORD, KEVINIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/01/2025
- LARSON, JAMIEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/24/2021
- LILYQUIST, JENNYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/26/2017
- LISOWSKI, TONYAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/12/2016
- RICH, TREVORIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/26/2024
- TANDE, CHELSEAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/26/2022
- GRACE LUTHERAN FOUNDATION, INC.Organization · ADP OF THE SNFNOT APPLICABLE · since 03/04/2025
- BERG, MATTHEWIndividual · ADP OF THE SNFNOT APPLICABLE · since 07/01/2016
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours3.79per resident day
RN hours1.10per resident day
Weekend nurse hours3.53per resident day
Staff turnover20.0%CMS reported field
06 / LOCAL RECORDS
Open the Wisconsin ledger →Other published facilities nearby
No second facility in the same city met the directory rule.