Wisconsin Rapids Health Services

In the surveyor’s words

From the most serious findings on record at Wisconsin Rapids Health Services, in the surveyor’s own words.

• Immediate jeopardy, isolatedF686Nov 6, 2024

  Based on observation, interview and record review, the facility did not ensure 2 of 4 residents (R) reviewed for pressure injuries (PI) (R151 and R32) received care consistent with professional standards of practice to prevent the development of a new pressure injury and promote healing of existing PIs. R151 was admitted to the facility with a sacral PI and was assessed to be at risk for PI development. R151 developed one unstageable PI on 10/16/24 and three unstageable PIs on 10/18/24. R151's care plan for PI interventions was not developed until 10/18/24 and not updated until 10/23/24 with interventions to off-load pressure areas to R151's bilateral lower extremities and sacral wound. […]

• Immediate jeopardy, isolatedF678Feb 29, 2024

  Based on staff interview and record review, the facility did not ensure code status was determined for 1 Resident (R) (R1) of 2 sampled residents which led to the failure to perform cardiopulmonary resuscitation (CPR) for the resident after the resident was found pulseless and non-breathing (PNB). R1's Power of Attorney for Healthcare (POAHC) document indicated R1 wished to be resuscitated. On [DATE], staff did not initiate resuscitation efforts when R1 was found PNB. R1 passed away at the facility on [DATE]. The facility's failure to ensure code status was determined and perform CPR when R1 was found PNB created a finding of Immediate Jeopardy (IJ) which began on [DATE]. The State Agency (SA) notified Nursing Home Administrator (NHA)-A of the immediate jeopardy on [DATE] at 4:46 PM. […]

• Immediate jeopardy, isolatedF684Jan 24, 2024

  Based on staff interview and record review, the facility did not ensure care and treatment in accordance with professional standards of practice was provided for 1 Resident (R) (R1) of 9 sampled residents. R1 experienced a change in condition, including altered mental status, on the [DATE] AM shift. The facility did not complete an appropriate assessment or notify a physician. EMS (Emergency Medical Services) was notified at 8:50 PM when R1 was found unresponsive. R1 was transferred to the hospital and passed away on [DATE]. The facility's failure to complete an appropriate assessment and timely notify a physician for a resident who experienced a change in condition created a finding of immediate jeopardy that began on [DATE]. […]

• Actual harm, isolatedF686Jan 28, 2021

  Based on interviews and record reviews, the facility did not ensure 1 of 3 residents reviewed for Pressure Injuries (R1) received care consistent with current standards of practice in the prevention, assessment and treatment of [REDACTED]. R1 was admitted without any skin impairments. He was then hospitalized and a pressure injury was discovered in the Emergency Department (ED). Following the hospitalization , there was only one comprehensive nursing assessment of the pressure injury until he was seen by a wound doctor and the wound required debridement. Following the debridement, again, there were no comprehensive nursing assessments of the wound to ensure staff were monitoring for progress or deterioration. […]

• No harm, potential for more than minimal, widespreadF812Feb 25, 2026

  Based on observation, staff and resident interview, and record review, the facility did not ensure food was stored, prepared, and served in a safe and sanitary manner. This practice had the potential to affect 35 of 36 residents residing in the facility (one resident received nutrition via tubefeeding.)Staff did not complete appropriate hand hygiene.Documentation logs for parts per million (PPM) of the sanitizing solution were not completed correctly.Staff did not follow safe food cooling protocols.Food was not served at an appropriate temperature.Findings include:On 2/23/26 at 9:40 AM, Surveyor and Account Manager (AM)-E began an initial kitchen tour. […]