01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-03-12 | 9 | 2026-03-12 | 0 |
| Cycle 2 | 2024-11-14 | 17 | 2024-11-14 | 4 |
| Cycle 3 | 2023-09-07 | 3 | 2023-09-07 | 4 |
CMS CCN 5254472026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Hillside Manor
803 S University Ave · Beaver Dam, WI 53916 · Dodge County
Certified beds115CMS provider file
Recent citation rows37current CMS citation release
Penalty rows3current 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
37 rows in the current release
3 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.
2026-03-12 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Deficient, Provider has date of correction · 2026-04-042026-03-12 · HEALTHF0677Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2026-04-042026-03-12 · HEALTHF0686Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2026-04-042026-03-12 · HEALTHF0689Severity D · isolated; 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 · 2026-04-042026-03-12 · HEALTHF0694Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2026-04-042026-03-12 · HEALTHF0759Severity E · pattern; 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 · 2026-04-042026-03-12 · HEALTHF0804Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Correction field: Deficient, Provider has date of correction · 2026-04-042026-03-12 · 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 · 2026-04-042026-03-12 · 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 · 2026-04-042025-07-21 · HEALTHF0684Severity J · isolated immediate jeopardy
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-07-22 · complaint2025-07-21 · HEALTHF0689Severity D · isolated; 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 · 2025-07-22 · complaint2025-07-21 · HEALTHF0712Severity D · isolated; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Ensure that the resident and his/her doctor meet face-to-face at all required visits.
Correction field: Deficient, Provider has date of correction · 2025-07-24 · complaint2025-06-24 · HEALTHF0585Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2025-07-24 · complaint2025-06-24 · HEALTHF0610Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Deficient, Provider has date of correction · 2025-07-24 · complaint2024-11-14 · FIREE0004Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop and maintain an Emergency Preparedness Program (EP).
Correction field: Deficient, Provider has date of correction · 2024-12-312024-11-14 · HEALTHF0557Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Correction field: Deficient, Provider has date of correction · 2024-12-312024-11-14 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Deficient, Provider has date of correction · 2024-12-31 · complaint2024-11-14 · 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 · 2024-12-312024-11-14 · HEALTHF0689Severity G · isolated actual 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 · 2024-12-31 · complaint2024-11-14 · HEALTHF0756Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Correction field: Deficient, Provider has date of correction · 2024-12-312024-11-14 · 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 · 2024-12-312024-11-14 · 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 · 2024-12-312024-11-14 · HEALTHF0761Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2024-12-312024-11-14 · HEALTHF0804Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Correction field: Deficient, Provider has date of correction · 2024-12-3103 / 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 |
|---|---|---|---|
| 2026-03-12 | Fine | $45,220 | 0 |
| 2025-06-24 | Fine | $148,132 | 0 |
| 2024-11-14 | Payment Denial | $0 | 20 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- MCHS HOSPITALS INCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 05/01/2019
- MARSHFIELD CLINIC HEALTH SYSTEM INCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 05/01/2019
- SANFORDOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 01/01/2025
- BALTUS, JOHNIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/04/2016
- FERNANDEZ, EDWARDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 09/08/2023
- HOERNEMAN, BRIANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 09/01/2023
- KLEBE, SAMANTHAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 09/08/2023
- MATHISON, DOUGLASIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/15/2020
- NEWCOMB, EVERETTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 09/13/2024
- PROCCI, LINDAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/14/2025
- SMITH, DENNISIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/14/2025
- BALTUS, JOHNIndividual · CORPORATE OFFICERNOT APPLICABLE · since 09/08/2023
- FERNANDEZ, EDWARDIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2025
- HOERNEMAN, BRIANIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/04/2023
- KLEBE, SAMANTHAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2025
- POPPEN, JEFFREYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 06/12/2025
- MCHS HOSPITALS INCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/01/2019
- BUSWELL CLEARY, LINDSEYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/02/2023
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 hours3.88per resident day
RN hours1.10per resident day
Weekend nurse hours3.32per resident day
Staff turnover50.0%CMS reported field
06 / LOCAL RECORDS
Open the Beaver Dam ledger →