Bayshore Nursing & Rehab: 39 Deficiencies Cited - WI
One of those deficiencies was a citation under infection control rules covering COVID-19 vaccination. Inspectors found the facility had failed on three connected fronts: it had not properly educated residents and staff about COVID-19 vaccination, had not consistently offered the vaccine to eligible residents and staff after that education, and had not kept proper documentation of vaccination status for the people living and working inside its walls.
Inspectors classified the scope of the problem as widespread.
That word carries specific meaning in federal inspection language. A widespread finding means the failure was not isolated to one unit, one wing, or one staff member. It touched the facility broadly. And while inspectors documented no actual harm from this particular deficiency, they found the potential for more than minimal harm to residents, a threshold that matters in a building where the people most at risk from respiratory illness live in close quarters, share common spaces, and often cannot advocate for their own medical needs.
The vaccination documentation requirement exists because a nursing home cannot manage infection risk it cannot see. If a facility does not know which residents have been vaccinated, which have declined, and which were never offered the vaccine in the first place, it cannot make informed decisions about outbreak response, cohorting, or protective measures when a case is identified. The record is not a formality. It is the foundation for every decision that follows.
Bayshore reported a correction date of November 12, 2025, roughly six weeks after the inspection closed.
What the inspection report does not say is how long the documentation gaps had existed before inspectors arrived, how many residents and staff members were affected, or whether anyone inside the facility had flagged the problem before the September visit. The report does not say whether residents or their families were ever informed that vaccination records were incomplete or that the required education had not been delivered.
Thirty-nine deficiencies in a single inspection is a significant total. The COVID-19 vaccination citation was one piece of a much larger picture inspectors documented that day, though this report addresses only what was disclosed about that specific finding. The breadth of the citation list suggests the September 30 visit was not a routine check that turned up a stray paperwork error. It was an inspection that found problems across categories.
Nursing homes in Wisconsin, like those across the country, have operated through years of COVID-19 surges that killed tens of thousands of long-term care residents nationally. Vaccination programs inside those facilities were a central part of the public health response, and federal rules requiring education, vaccine offers, and documentation were put in place precisely because the population inside nursing homes faces severe risk from the virus. A widespread failure to meet those requirements, discovered in a complaint inspection in the fall of 2025, is not a relic of the early pandemic. It is a current finding about how a facility is running today.
The residents at Bayshore did not choose to live in a setting where infection spreads easily. Most of them had no alternative. They moved in because they needed a level of care they could not receive at home, and they depend on the people running the facility to manage the risks that come with congregate living. When a facility cannot document whether its own staff have been vaccinated, the residents absorbing that risk are the ones who had the least say in the matter.
Bayshore Nursing & Rehab told regulators it corrected the vaccination deficiency by November 12. Whether the correction addressed the underlying conditions that allowed the problem to become widespread in the first place is not something the inspection report resolves.
The 38 other deficiencies cited that same day remain part of the facility's public record.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Bayshore Nursing & Rehab from 2025-09-30 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 16, 2026 · Our methodology
Bayshore Nursing & Rehab in GLENDALE, WI was cited for violations during a health inspection on September 30, 2025.
One of those deficiencies was a citation under infection control rules covering COVID-19 vaccination.
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.