Rivers Edge Nursing and Rehab: Wound Care Failures - WI
The resident, identified in inspection records only as R5, had wounds documented across at least four separate body sites by mid-July 2025. A wound on the left lateral hip measured 3.2 centimeters long, 1.0 centimeter wide, and 2.0 centimeters deep on July 14. That depth figure matters: two centimeters of tunneling means the wound had begun burrowing beneath the skin's surface, a sign of serious deterioration. By July 7, the same wound had already been tunneling, recorded at 3.2 x 0.7 x 0.5 centimeters. By July 21, the measurements had shifted to 0.5 x 0.5 x 0.1, though the wound's trajectory over those weeks had already drawn federal scrutiny serious enough to warrant an immediate jeopardy finding, the most severe classification available to inspectors.
Immediate jeopardy means inspectors concluded the facility's failures had placed residents in a situation where serious injury, harm, or death was likely unless something changed immediately.
R5 also had wounds on the left posterior shoulder, the right second toe, and the right great toe, all documented in mid-July. The shoulder wound measured 2.5 x 1.5 centimeters on July 14. Both toe wounds were small but present and being tracked.
Physician orders for R5 dated July 5 called for wound care every day shift on the left posterior shoulder and on the right foot. The instructions were specific: cleanse the wound with wound cleanser, pat dry, paint with betadine, leave open to air. A July 7 order added wound care for the left lateral hip, this time with packing, calling for iodoform gauze packing strips or sterile gauze, fluffed, then covered with a bordered island dressing, also every day shift.
Those orders were in place. The wounds were documented. The measurements were being recorded. And still, by July 31, a physician assistant came to see R5 and documented the reason for the visit as anemia and multiple wounds. That same day, a referral went out to a wound care clinic specifically for the left hip wound with tunneling.
The referral came nearly a month after the tunneling was first documented.
On August 8, wound care orders were revised: instead of daily treatment, staff would now clean and dress the hip wound three times per week, on Mondays, Wednesdays, and Fridays, using a Mepilex dressing.
The inspection that produced these findings was a complaint inspection, meaning someone, a resident, a family member, or a staff member, contacted regulators before inspectors arrived. The complaint inspection was completed August 25, 2025.
What the records show is a resident with wounds on four parts of their body, physician orders calling for daily wound care, and a tunneling hip wound that required an outside clinic referral a month after the tunneling appeared. The facility's own documentation captured the wound measurements at each stage. The numbers are in the record. The orders are in the record. The gap between them is what inspectors found.
R5's situation, as captured in the inspection documents, is one of accumulation. One wound became two, became four. A tunnel opened beneath the skin of the hip. A physician assistant arrived to discuss advanced directives alongside the wounds. A wound care clinic was eventually called. The federal government classified what happened to this resident as an immediate threat to health and safety.
The inspection report does not say whether R5's wounds healed.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Rivers Edge Nursing and Rehab from 2025-08-25 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: July 2, 2026 · Our methodology
Rivers Edge Nursing and Rehab in Muscoda, WI was cited for violations during a health inspection on August 25, 2025.
The resident, identified in inspection records only as R5, had wounds documented across at least four separate body sites by mid-July 2025.
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.