01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-01-14 | 7 | 2026-01-14 | 7 |
| Cycle 2 | 2024-10-16 | 24 | 2024-10-16 | 17 |
| Cycle 3 | 2023-10-18 | 8 | 2023-10-18 | 12 |
CMS CCN 5254882026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Meadowbrook At Black River Falls
1311 Tyler St · Black River Falls, WI 54615 · Jackson County
Certified beds45CMS provider file
Recent citation rows75current CMS citation release
Penalty rows5current 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
75 rows in the current release
3 rows carry G–L scope/severity codes; 2 carry J–L. 14 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-01-14 · HEALTHF0605Severity E · pattern; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Correction field: Deficient, Provider has date of correction · 2026-02-142026-01-14 · HEALTHF0628Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Correction field: Deficient, Provider has date of correction · 2026-02-142026-01-14 · HEALTHF0645Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
PASARR screening for Mental disorders or Intellectual Disabilities
Correction field: Deficient, Provider has date of correction · 2026-02-142026-01-14 · HEALTHF0756Severity E · pattern; 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 · 2026-02-142026-01-14 · 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 · 2026-02-142026-01-14 · HEALTHF0880Severity F · widespread; 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 · 2026-02-142026-01-14 · FIREK0321Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2026-02-112026-01-14 · FIREK0346Severity C · widespread; potential for minimal harm
Smoke Deficiencies
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
Correction field: Deficient, Provider has date of correction · 2026-02-112026-01-14 · FIREK0355Severity F · widespread; 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 · 2026-02-112026-01-14 · FIREK0712Severity C · widespread; potential for minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2026-02-112026-01-14 · FIREK0741Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Correction field: Deficient, Provider has date of correction · 2026-02-112026-01-14 · FIREK0761Severity F · widespread; 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 · 2026-02-112026-01-14 · FIREK0918Severity C · widespread; potential for minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2026-02-112025-10-22 · 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 · 2025-12-11 · complaint2025-04-01 · HEALTHF0740Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
Correction field: Deficient, Provider has date of correction · 2025-04-23 · complaint2025-01-22 · 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 · 2025-02-16 · complaint2025-01-22 · HEALTHF0760Severity G · isolated actual harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2025-03-24 · complaint2025-01-22 · 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 · 2025-02-16 · complaint2024-12-18 · HEALTHF0732Severity C · widespread; potential for minimal harm
Nursing and Physician Services Deficiencies
Post nurse staffing information every day.
Correction field: Deficient, Provider has date of correction · 2024-12-23 · complaint2024-12-18 · HEALTHF0801Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
Correction field: Deficient, Provider has date of correction · 2024-12-23 · complaint2024-12-18 · 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 · 2024-12-23 · complaint2024-12-18 · 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 · 2024-12-23 · complaint2024-10-16 · 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 · 2025-01-052024-10-16 · FIREE0013Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop Emergency Preparedness policies and procedures.
Correction field: Deficient, Provider has date of correction · 2024-12-3003 / 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 |
|---|---|---|---|
| 2025-01-22 | Fine | $56,898 | 0 |
| 2025-01-22 | Payment Denial | $0 | 32 |
| 2024-10-16 | Fine | $17,250 | 0 |
| 2024-07-10 | Fine | $34,190 | 0 |
| 2024-07-10 | Payment Denial | $0 | 36 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- VANDER VELDEN, BARBARAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/01/2019
- LINDEMANN, MITULIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/01/2019
- SYNERGY SENIOR CARE LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2019
- FILLA, LAURIANNIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/16/2024
- LINDEMANN, MITULIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2019
- MAHAN, MICHAELIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/23/1997
- PUKSHANSKY, ROSTISLAVIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2019
- OCONTO FALLS NURSING AND REHAB LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 06/28/2022
- REINHART BOERNER VAN DEUREN S.C.Organization · ADP OF THE SNFNOT APPLICABLE · since 12/01/2019
- ROTH & CO, LLPOrganization · ADP OF THE SNFNOT APPLICABLE · since 12/01/2019
- SYNERGY SENIOR CARE LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/03/2025
- WIPFLI LLPOrganization · ADP OF THE SNFNOT APPLICABLE · since 12/01/2019
- FILLA, LAURIANNIndividual · ADP OF THE SNFNOT APPLICABLE · since 12/16/2024
- LINDEMANN, MITULIndividual · ADP OF THE SNFNOT APPLICABLE · since 12/01/2019
- MAHAN, MICHAELIndividual · ADP OF THE SNFNOT APPLICABLE · since 01/23/1997
- MASLOVSKY, BORISIndividual · ADP OF THE SNFNOT APPLICABLE · since 12/01/2019
- PUKSHANSKY, ROSTISLAVIndividual · ADP OF THE SNFNOT APPLICABLE · since 12/01/2019
- VANDER VELDEN, BARBARAIndividual · ADP OF THE SNFNOT APPLICABLE · since 12/01/2019
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 hours4.14per resident day
RN hours0.98per resident day
Weekend nurse hours3.86per resident day
Staff turnover66.0%CMS reported field
06 / LOCAL RECORDS
Open the Black River Falls ledger →