01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-04-22 | 19 | 2026-04-22 | 3 |
| Cycle 2 | 2025-01-09 | 20 | 2025-01-09 | 14 |
| Cycle 3 | 2023-10-16 | 5 | 2023-10-16 | 8 |
CMS CCN 5256882026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Wi Veterans Home-Boland Hall
21425 E Spring St · Union Grove, WI 53182 · Racine County
Certified beds158CMS provider file
Recent citation rows69current CMS citation release
Penalty rows8current 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
69 rows in the current release
9 rows carry G–L scope/severity codes; 6 carry J–L. 14 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-04-22 · 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 · 2026-05-212026-04-22 · 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 · 2026-05-212026-04-22 · 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 · 2026-05-212026-04-22 · HEALTHF0883Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Correction field: Deficient, Provider has date of correction · 2026-05-212026-04-22 · 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 · 2026-05-282026-04-22 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2026-06-102026-04-22 · 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 · 2026-05-282025-12-03 · 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 · 2025-12-30 · complaint2025-12-03 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2025-12-30 · complaint2025-12-03 · 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 · 2025-12-30 · complaint2025-12-03 · 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 · 2025-12-30 · complaint2025-12-03 · 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 · 2025-12-30 · complaint2025-10-01 · 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 · 2025-11-18 · complaint2025-10-01 · HEALTHF0600Severity J · isolated immediate jeopardy
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Deficient, Provider has date of correction · 2025-11-18 · complaint2025-10-01 · HEALTHF0610Severity E · pattern; 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 · 2025-11-18 · complaint2025-10-01 · HEALTHF0627Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
Correction field: Deficient, Provider has date of correction · 2025-11-18 · complaint2025-10-01 · HEALTHF0675Severity K · pattern of immediate jeopardy
Quality of Life and Care Deficiencies
Honor each resident's preferences, choices, values and beliefs.
Correction field: Deficient, Provider has date of correction · 2025-11-18 · complaint2025-10-01 · HEALTHF0685Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Assist a resident in gaining access to vision and hearing services.
Correction field: Deficient, Provider has date of correction · 2025-11-18 · complaint2025-10-01 · HEALTHF0689Severity K · pattern of 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: Deficient, Provider has date of correction · 2025-11-18 · complaint2025-10-01 · HEALTHF0745Severity J · isolated immediate jeopardy
Quality of Life and Care Deficiencies
Provide medically-related social services to help each resident achieve the highest possible quality of life.
Correction field: Deficient, Provider has date of correction · 2025-11-18 · complaint2025-10-01 · HEALTHF0941Severity F · widespread; potential for more than minimal harm
Administration Deficiencies
Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.
Correction field: Deficient, Provider has date of correction · 2025-11-18 · complaint2025-10-01 · HEALTHF0944Severity F · widespread; potential for more than minimal harm
Administration Deficiencies
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
Correction field: Deficient, Provider has date of correction · 2025-11-18 · complaint2025-06-12 · HEALTHF0600Severity J · isolated immediate jeopardy
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Deficient, Provider has date of correction · 2025-07-02 · complaint2025-06-12 · HEALTHF0742Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.
Correction field: Deficient, Provider has date of correction · 2025-11-18 · complaint03 / 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 |
|---|---|---|---|
| 2025-06-12 | Fine | $10,358 | 0 |
| 2025-06-12 | Fine | $10,358 | 0 |
| 2025-06-12 | Fine | $17,345 | 0 |
| 2025-06-12 | Fine | $157,053 | 0 |
| 2025-06-12 | Payment Denial | $0 | 144 |
| 2025-03-26 | Fine | $73,190 | 0 |
| 2025-03-26 | Payment Denial | $0 | 27 |
| 2023-10-16 | Fine | $12,870 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- STATE OF WISCONSINOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 03/27/2006
- PARKER, JAMESIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 04/22/2012
- SERVATIUS, TAMMYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/14/2025
- STATE OF WISCONSINOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/27/2006
- BEAUMONT, LAURENIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 09/22/2025
- PARKER, JAMESIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/22/2012
- SERVATIUS, TAMMYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/14/2025
- SIDHU, SARFRAZIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/21/2022
- STATE OF WISCONSINOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/27/2006
- BEAUMONT, LAURENIndividual · ADP OF THE SNFNOT APPLICABLE · since 09/22/2025
- PARKER, JAMESIndividual · ADP OF THE SNFNOT APPLICABLE · since 04/22/2012
- SERVATIUS, TAMMYIndividual · ADP OF THE SNFNOT APPLICABLE · since 10/14/2025
- SIDHU, SARFRAZIndividual · ADP OF THE SNFNOT APPLICABLE · since 05/21/2022
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 hours6.03per resident day
RN hours1.96per resident day
Weekend nurse hours5.56per resident day
Staff turnover51.4%CMS reported field
06 / LOCAL RECORDS
Open the Union Grove ledger →