01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-06-11 | 3 | 2025-06-11 | 7 |
| Cycle 2 | 2024-05-15 | 9 | 2024-05-15 | 5 |
| Cycle 3 | 2023-04-19 | 2 | 2023-04-19 | 10 |
CMS CCN 5252742026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Edenbrook Of Fond Du Lac
265 S National Ave · Fond Du Lac, WI 54935 · Fond Du Lac County
Certified beds90CMS provider file
Recent citation rows36current CMS citation release
Penalty rows1current 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
36 rows in the current release
1 rows carry G–L scope/severity codes; 1 carry J–L. 7 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-06-11 · HEALTHF0552Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Ensure that residents are fully informed and understand their health status, care and treatments.
Correction field: Deficient, Provider has date of correction · 2025-07-032025-06-11 · HEALTHF0689Severity J · isolated immediate jeopardy
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: Past Non-Compliance · 2025-05-20 · complaint2025-06-11 · HEALTHF0755Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has date of correction · 2025-07-032025-06-11 · 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 · 2025-07-032025-06-11 · FIREK0324Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2025-06-202025-06-11 · 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 · 2025-08-152025-06-11 · FIREK0355Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Correction field: Deficient, Provider has date of correction · 2025-07-032025-06-11 · FIREK0372Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Correction field: Deficient, Provider has date of correction · 2025-07-032025-06-11 · FIREK0521Severity D · isolated; potential for more than minimal harm
Services Deficiencies
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Correction field: Deficient, Provider has date of correction · 2025-07-072025-06-11 · FIREK0711Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Provide a written emergency evacuation plan.
Correction field: Deficient, Provider has date of correction · 2025-10-202025-06-11 · FIREK0761Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2025-07-072025-05-06 · HEALTHF0690Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Correction field: Deficient, Provider has date of correction · 2025-05-29 · complaint2025-03-05 · 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 · 2025-04-03 · complaint2024-11-08 · 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 · 2024-12-06 · complaint2024-05-15 · HEALTHF0607Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Correction field: Deficient, Provider has date of correction · 2024-06-072024-05-15 · HEALTHF0644Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Correction field: Deficient, Provider has date of correction · 2024-06-172024-05-15 · HEALTHF0757Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2024-06-172024-05-15 · 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 · 2024-06-172024-05-15 · HEALTHF0880Severity E · pattern; 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 · 2024-06-172024-05-15 · FIREK0211Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Correction field: Deficient, Provider has date of correction · 2024-06-272024-05-15 · FIREK0222Severity E · pattern; 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 · 2024-06-272024-05-15 · FIREK0311Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Have an enclosure around a vertical opening shaft.
Correction field: Waiver has been granted · 2024-08-302024-05-15 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Waiver has been granted · 2024-09-302024-05-15 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Waiver has been granted · 2024-09-2503 / 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 |
|---|---|---|---|
| 2025-06-11 | Fine | $9,113 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- LIFSICS, CHANNIEIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST12% · since 11/01/2018
- POLSTEIN, MORDECHAIIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST18% · since 11/01/2018
- STESEL, MAXIMIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST49% · since 11/01/2018
- SEYLER, MIRIAHIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 11/01/2018
- WEBER, LISAIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 11/01/2018
- RICE, PAMELAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 03/01/2017
- POLSTEIN, MORDECHAIIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/01/2018
- SEYLER, MIRIAHIndividual · ADP OF THE SNFNOT APPLICABLE · since 03/26/2025
- WEBER, LISAIndividual · ADP OF THE SNFNOT APPLICABLE · since 03/26/2025
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 hours3.28per resident day
RN hours0.91per resident day
Weekend nurse hours3.00per resident day
Staff turnover51.4%CMS reported field
06 / LOCAL RECORDS
Open the Fond Du Lac ledger →Other published facilities nearby
Avina Of Fond Du Lac50 beds · CMS overall 2/562 citation rowsAvina On Division50 beds · CMS overall 1/571 citation rowsFond Du Lac Lutheran Home85 beds · CMS overall 3/589 citation rowsHarbor Haven Health & Rehabilitation85 beds · CMS overall 5/521 citation rowsSt Francis Home90 beds · CMS overall 3/547 citation rows