Burlington Health & Rehab: Dietary Failures - WI
R2 sat in the dining room eating pot roast, mashed potatoes and a dinner roll for lunch on December 21. Her plate had no vegetables. She told inspectors she wasn't served any vegetables because the only option was carrots, which she doesn't eat.
"There is no different vegetable," R2 said. "They used to have a whole list of things but they don't have that anymore. We eat what they bring us."
The facility's own policy requires alternatives to be "immediately available if the primary menu or selections for a particular meal are not to a resident's liking." But the Food Services Manager confirmed to inspectors that no alternate vegetables or starches were served with meals.
R23 told the Resident Council that the alternative menu "disappeared about a month ago." When she asked why, staff informed her it was too complicated for kitchen workers. R18 said the facility added one new alternative, but it was meaningless — "if they were being served a chop salad the alternative would be a Caesar salad or a hamburger for a hamburger."
Staff doesn't offer alternatives when residents want something other than the main meal, R18 said.
The Registered Dietician told inspectors she expected alternates of equal nutritive value to be available for each meal. She also expected menus to be posted where residents could access them. The Food Services Manager confirmed the Always Available Menu was supposed to be posted next to daily menus throughout the facility and in each resident's room.
Residents receiving special diets got no alternatives either, despite the facility's written policy promising immediate availability of meal choices.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Burlington Health and Rehabilitation Center from 2025-12-22 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: August 9, 2026 · Our methodology
Burlington Health and Rehabilitation Center in BURLINGTON, WI was cited for violations during a health inspection on December 22, 2025.
R2 sat in the dining room eating pot roast, mashed potatoes and a dinner roll for lunch on December 21.
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.