Clark County Rehab: Abuse Cover-Up Reported - WI
Her reason, given to a surveyor the following October, was direct. She knew the report was late. She knew the state would cite the facility for that. So she decided not to report at all.
That admission is now part of a federal inspection record.
The sequence of events began on August 12, 2025, when Director of Nursing B, identified in inspection records only by that initial, was notified of an abuse allegation involving CNA F. She opened an investigation. One week later, on August 19, the facility concluded that abuse had occurred. CNA F was terminated.
No report went to the state. No Facility Reported Incident, the standard mechanism nursing homes use to notify Wisconsin regulators of abuse allegations, was ever submitted. There is no documentation in the inspection record showing that local law enforcement was contacted, either.
The facility did not report the allegation. It did not report the finding. It did not report the termination. It reported nothing.
On October 14, 2025, a surveyor sat down with DON B and asked about it directly. DON B's explanation was not that the incident had slipped through the cracks, not that there had been confusion about the process, not that someone else was supposed to handle it. The explanation was that she had weighed the consequences and made a calculation.
She told the surveyor that the report was late being brought to her attention, and that the state survey agency would give the facility a citation for reporting late. So she decided not to report.
That is the sentence that sits at the center of this inspection finding. A director of nursing, having confirmed that one of her staff members abused a resident in her care, chose silence over disclosure because disclosure would come with a penalty. The penalty for reporting late, in her assessment, was worse than not reporting at all.
It is worth being precise about what that reasoning requires. It requires believing that the purpose of mandatory abuse reporting is to protect the facility from citations, not to protect residents from harm. It requires treating a confirmed abuse finding as an administrative inconvenience rather than as information the state has a legal interest in receiving. And it requires deciding, unilaterally, that the regulatory system does not get to know what happened inside these walls.
CMS classified the violation as causing minimal harm or potential for actual harm, and noted that few residents were affected. That classification reflects the scope of the documented abuse incident itself. It does not reflect the significance of what DON B chose to do afterward.
The resident who was abused by CNA F is not named in the inspection record. Their diagnosis, their age, their condition at the time, the nature of the abuse — none of that appears in the publicly available inspection narrative. What is documented is that the facility confirmed the abuse occurred, that it acted swiftly enough to terminate the employee within a week, and that it then went silent.
The gap between August 19 and October 14 is nearly two months. For nearly two months, Wisconsin regulators had no idea that a resident at Clark County Rehabilitation had been abused, that an investigation had been completed, or that a CNA had been fired. They learned about it only when a surveyor arrived on a complaint inspection and started asking questions.
DON B did not dispute any of this during the interview. She did not claim the report had been filed and lost. She did not say she had misunderstood the reporting requirement. She explained her reasoning, and her reasoning was that reporting would cost the facility a citation.
Clark County Rehabilitation & Living Center sits on County Highway X in Owen, a small city in Clark County in north-central Wisconsin. Clark County is rural, with limited options for residents who need skilled nursing care. The facility operates under the county's name.
The inspection that produced this finding was a complaint inspection, meaning someone had raised a concern serious enough to trigger a visit. The inspection was completed October 15, 2025. The record was printed August 8, 2026.
There is no documentation in the inspection record of any corrective action taken between August 19, when the facility confirmed abuse and fired the CNA, and October 14, when the surveyor arrived. There is no record of the facility self-correcting its failure to report, no record of a late submission to the state, no record of outreach to law enforcement in the intervening weeks.
The inspection record does not indicate whether CNA F held certifications that would allow employment at another facility, or whether the termination was reported to the Wisconsin Nurse Aide Registry, which tracks abuse findings and is supposed to prevent aides with substantiated abuse findings from working in other care settings. Reporting to that registry is a separate requirement from the Facility Reported Incident process. The inspection record is silent on whether that step was taken.
What the record does show is a director of nursing who understood the reporting system well enough to know that late reports generate citations, and who used that knowledge not to file a timely report in the future but to justify filing no report at all. That is a specific kind of institutional failure. It is not negligence. It is not confusion. It is a decision.
The resident at the center of this case received no acknowledgment from the state for nearly two months after their abuse was confirmed. The people responsible for investigating abuse in Wisconsin nursing homes did not know to look at what had happened to them. The system that exists to track these incidents, to identify patterns, to flag facilities with abuse problems, had a gap in it, and the gap was put there on purpose.
DON B told the surveyor the state would have cited them for reporting late.
She was right. They would have. That citation would have been a small administrative mark on a facility record, the kind of thing that shows up in inspection histories and gets weighed against other findings when CMS calculates star ratings. It is not nothing. But it is, by any measure, less than what happened instead.
What happened instead is that a confirmed abuse finding went unreported for two months, local law enforcement was never notified, and the director of nursing sat across from a surveyor in October and explained her reasoning without apparent hesitation.
The resident who was abused by CNA F lived in this facility while all of that was happening.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Clark County Rehabilitation & Living Center from 2025-10-15 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 9, 2026 · Our methodology
CLARK COUNTY REHABILITATION & LIVING CENTER in OWEN, WI was cited for abuse-related violations during a health inspection on October 15, 2025.
Her reason, given to a surveyor the following October, was direct.
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.