01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-12-22 | 4 | 2025-12-22 | 5 |
| Cycle 2 | 2024-08-15 | 11 | 2024-08-15 | 5 |
| Cycle 3 | 2023-04-19 | 19 | 2023-04-19 | 7 |
CMS CCN 5256602026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
St Dominic Villa
2375 Sinsinawa Rd · Hazel Green, WI 53811 · Grant County
Certified beds62CMS provider file
Recent citation rows51current CMS citation release
Penalty rows4current 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
51 rows in the current release
6 rows carry G–L scope/severity codes; 4 carry J–L. 10 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-12-22 · HEALTHF0700Severity J · isolated immediate jeopardy
Quality of Life and Care Deficiencies
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Correction field: Deficient, Provider has date of correction · 2026-01-232025-12-22 · 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 · 2026-01-232025-12-22 · 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 · 2026-01-232025-12-22 · 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 · 2026-01-232025-12-22 · FIREK0223Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Correction field: Deficient, Provider has date of correction · 2026-01-222025-12-22 · FIREK0351Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install an approved automatic sprinkler system.
Correction field: Deficient, Provider has date of correction · 2026-01-222025-12-22 · FIREK0521Severity E · pattern; 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 · 2026-01-222025-12-22 · FIREK0912Severity E · pattern; 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 · 2026-01-222025-12-22 · FIREK0923Severity E · pattern; 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 · 2026-01-222024-08-15 · FIREE0039Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Correction field: Deficient, Provider has date of correction · 2024-09-162024-08-15 · 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 · 2024-09-162024-08-15 · HEALTHF0607Severity E · pattern; 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 · 2024-09-162024-08-15 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
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 · 2024-09-162024-08-15 · HEALTHF0686Severity J · isolated immediate jeopardy
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 · 2024-09-162024-08-15 · 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 · 2024-11-012024-08-15 · HEALTHF0729Severity D · isolated; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Verify that a nurse aide has been trained; and if they haven't worked as a nurse aide for 2 years, receive retraining.
Correction field: Deficient, Provider has date of correction · 2024-09-162024-08-15 · 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 · 2024-09-162024-08-15 · HEALTHF0760Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2024-09-162024-08-15 · 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 · 2024-09-162024-08-15 · 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 · 2024-09-162024-08-15 · HEALTHF0882Severity F · widespread; potential for more than minimal harm
Infection Control Deficiencies
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Correction field: Deficient, Provider has date of correction · 2024-09-162024-08-15 · FIREK0223Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Correction field: Deficient, Provider has date of correction · 2024-09-162024-08-15 · 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 · 2024-09-162024-08-15 · 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 · 2024-09-1603 / 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 |
|---|---|---|---|
| 2024-08-15 | Fine | $49,823 | 0 |
| 2024-08-15 | Payment Denial | $0 | 49 |
| 2023-10-06 | Fine | $79,644 | 0 |
| 2023-10-06 | Payment Denial | $0 | 119 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- SOUTHWEST HEALTH CENTER INCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/10/2020
- SWR1 INCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/10/2020
- THE HILLS AT CORTLAND RIDGE, INC.Organization · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 06/10/2020
- MAUTHE, MATTHEWIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/10/2020
- ROGERS, DOUGIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/01/2020
- ROSEMEYER, JOSEPHIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 11/01/2024
- SMITH, KENNETHIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 11/01/2024
- SOOKOCHOFF, JESSEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/01/2020
- MARKS, JULIEIndividual · CORPORATE OFFICERNOT APPLICABLE · since 06/09/2025
- MAUTHE, MATTHEWIndividual · CORPORATE OFFICERNOT APPLICABLE · since 06/10/2020
- ILLUMINUS INCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/10/2020
- BRUNER, JOSHUAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/06/2024
- DROESZLER, ZACHARYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/01/2024
- MARKS, JULIEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/09/2025
- MAUTHE, MATTHEWIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/10/2020
- ILLUMINUS INCOrganization · ADP OF THE SNFNOT APPLICABLE · since 10/17/2025
- BRUNER, JOSHUAIndividual · ADP OF THE SNFNOT APPLICABLE · since 04/25/2025
- DROESZLER, ZACHARYIndividual · ADP OF THE SNFNOT APPLICABLE · since 08/01/2024
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 hours3.81per resident day
RN hours0.72per resident day
Weekend nurse hours3.56per resident day
Staff turnover45.2%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.