St Joseph Residence: Failed to Report Family Assault - WI
The assault occurred on June 27 when Family Member C became upset that one resident wouldn't eat beans brought from home. A certified nursing assistant witnessed the family member aggressively grab at the first resident, pull them in, and swing at their midsection with a closed fist.
The same family member also swat at and hit a second resident's right hand, grabbed their left hand, and pulled their wheelchair closer as the resident attempted to roll away. Staff removed both residents from the area following the incidents.
Federal inspectors found the facility violated requirements for reporting suspected crimes against residents during their August 15 investigation. The nursing home's own abuse prevention policy, revised January 1, states staff must "contact the police department if there is a suspected crime against a resident."
But Nursing Home Administrator A told inspectors they didn't feel the abuse should be reported to local law enforcement. The administrator said the residents' power of attorney didn't want to proceed with charges regarding the incidents.
The facility's policy contained a critical gap. It failed to include examples of crimes that should be reported, such as assault and battery, and administrators had never consulted with local law enforcement to discuss what incidents to report.
Administrator A confirmed the facility had not had a formal discussion with local law enforcement to determine what they wanted the facility to report or what was considered a crime.
The inspection revealed a pattern of administrative decisions that prioritized family wishes over legal requirements. Despite witnessing what appeared to be clear physical assault, staff completed internal assessments and monitoring but avoided involving law enforcement entirely.
The facility did conduct resident interviews and psychosocial assessments on the day of the incident. Staff also provided psychosocial monitoring for both residents for three days following the assault. Administrator A spoke to Family Member C about the incidents.
According to the facility's investigation, the incidents did not appear to have affected either resident. But the administrative response focused entirely on internal procedures while ignoring the legal obligation to report suspected crimes.
The June 27 incident highlighted broader systemic problems with crime reporting at nursing homes. Federal law requires facilities to immediately report any reasonable suspicion of a crime to appropriate authorities, regardless of family preferences or perceived resident impact.
Physical assault constitutes a crime under Wisconsin law. The witnessed account described Family Member C using a closed fist to strike one resident and physically grabbing and hitting another resident who was attempting to move away.
The certified nursing assistant who witnessed the assault provided detailed observations of the family member's aggressive behavior. The staff member saw Family Member C pull one resident in before swinging at their midsection and observed the physical contact with the second resident's hands and wheelchair.
Staff intervention came only after the assault occurred. The facility removed both residents from Family Member C's vicinity following the incidents, but the response remained reactive rather than preventive.
The inspection found the facility failed to develop adequate policies for crime reporting. While the January policy revision included language about contacting police for suspected crimes, it lacked specificity about what constitutes reportable criminal behavior.
The policy gap left administrators without clear guidance about mandatory reporting requirements. The absence of examples or consultation with law enforcement created confusion about when to involve police in resident safety incidents.
Administrator A's decision not to report the assault reflected a misunderstanding of legal obligations. The administrator's reasoning centered on family preferences rather than regulatory requirements or criminal law.
The power of attorney's reluctance to pursue charges did not eliminate the facility's independent obligation to report suspected crimes. Federal regulations require immediate reporting regardless of family wishes or anticipated prosecution outcomes.
The facility's internal response demonstrated some awareness of the incident's seriousness. Staff conducted immediate assessments and maintained monitoring protocols for three days after the assault.
But the psychosocial assessments and monitoring protocols, while appropriate for care planning, could not substitute for required crime reporting. The facility treated a criminal matter as an internal care issue.
The administrator's conversation with Family Member C about the incidents represented another missed opportunity. Rather than addressing the criminal nature of the behavior, the discussion appeared focused on facility management rather than law enforcement referral.
The inspection revealed that St Joseph Residence lacked fundamental understanding of crime reporting requirements. The facility had never established communication protocols with local law enforcement or clarified reporting expectations.
This gap in law enforcement coordination left staff without guidance about distinguishing between care incidents and criminal behavior. The facility operated in isolation from the legal system designed to protect vulnerable residents.
The August inspection found the facility failed two residents by not reporting the suspected crimes. Both residents experienced physical assault while under the facility's care, and administrators chose not to involve appropriate authorities.
The violation carried minimal harm designation, but the failure to report suspected crimes creates ongoing risk for all residents. Without proper crime reporting, patterns of abuse may go undetected and unprosecuted.
Family Member C's behavior during the dining room incident demonstrated escalating aggression that warranted law enforcement attention. The closed-fist punch and forcible grabbing of residents attempting to escape suggested potential for future violence.
The facility's response prioritized maintaining family relationships over resident protection and legal compliance. This approach left both immediate victims and other residents vulnerable to unreported criminal behavior.
The inspection findings highlight the critical importance of clear crime reporting policies and law enforcement coordination. Nursing homes must recognize that their first obligation involves resident safety and legal compliance, not family preferences.
Administrator A's admission about lacking formal law enforcement discussions revealed systemic problems beyond this single incident. The facility operated without essential partnerships needed to protect residents from criminal behavior.
The June 27 assault occurred in a public area with staff witnesses, yet still went unreported to police. This suggests that less visible incidents might face even greater reporting failures at the facility.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for St Joseph Residence from 2025-08-15 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
St Joseph Residence in New London, WI was cited for violations during a health inspection on August 15, 2025.
The assault occurred on June 27 when Family Member C became upset that one resident wouldn't eat beans brought from home.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.