Gundersen St. Elizabeth's: Infection Control Failure - MN
Federal health inspectors cited the Wabasha nursing home on June 10 for failing to provide and implement its infection prevention and control program, a deficiency that carries the potential for more than minimal harm to residents even when no one has been hurt yet.
No one documented as harmed. That part is true. But the facility has also filed no plan of correction.
The citation falls under what federal regulators classify as a scope and severity level D, meaning the problem was isolated rather than widespread, and no actual harm was recorded at the time inspectors were on-site. That framing can make a finding sound minor. It is not a guarantee that it stays that way.
Infection control failures in long-term care settings carry consequences that can move fast. Nursing home residents are among the most medically vulnerable people in any community. Many are elderly, immunocompromised, or recovering from surgery or illness. A lapse in infection prevention protocol that goes unaddressed in a facility housing that population is not a paperwork problem.
The specific breakdown inspectors identified at Gundersen St. Elizabeth's was straightforward in its regulatory language: the facility failed to provide and implement an infection prevention and control program. What that means in practice, what exactly inspectors observed on the floor, which protocols were absent or ignored, is not detailed in the public record. The inspection narrative does not describe a specific incident, a specific resident, or a specific staff member. It describes a system that was not working.
What is documented is that the facility knew. Inspectors cited the deficiency. The facility received notice. And as of the date of this report, Gundersen St. Elizabeth's has submitted no plan of correction to address what was found.
That absence matters. A plan of correction is not a formality. It is the mechanism by which a facility tells regulators, and the public, what went wrong, who is responsible for fixing it, and by what date the problem will be resolved. Without one, there is no timeline. There is no accountability structure. There is no way for a resident's family to know whether the conditions that prompted the citation have changed.
Gundersen St. Elizabeth's Care Center is a long-term care facility in Wabasha, a small city on the Mississippi River in southeastern Minnesota. It operates under the Gundersen Health System name, a regional health network based in La Crosse, Wisconsin. The facility serves residents who, in many cases, have no other option for care. They cannot leave because a compliance form was not filed. They remain in the building whether the infection control program is running or not.
The June 10 inspection was a standard health survey, the routine federal process by which nursing homes are evaluated for compliance with Medicare and Medicaid requirements. Deficiencies identified during these surveys become part of the facility's public record and factor into its federal star rating. A level D finding, isolated and without documented harm, sits at the lower end of the severity scale. Facilities receive citations at this level regularly. Most file plans of correction within weeks.
Gundersen St. Elizabeth's has not.
There is a version of this story where the citation is resolved quietly, the plan of correction is filed late, and the infection control program is brought into compliance before anyone is hurt. That outcome is still possible. It has not happened yet.
What has happened is that inspectors walked into a nursing home, found that its infection prevention and control program was not being implemented, wrote it up, and left. The residents in that building went on living there. The facility went on operating. And the plan for making it right remains, as of this writing, unwritten.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Gundersen St Elizabeth's Care Center from 2026-06-10 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: August 5, 2026 · Our methodology
GUNDERSEN ST ELIZABETH'S CARE CENTER in WABASHA, MN was cited for violations during a health inspection on June 10, 2026.
But the facility has also filed no plan of correction.
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.