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Complaint Investigation

Fair View Nursing And Rehabilitation Center

Inspection Date: September 24, 2025
Total Violations 2
Facility ID 525437
Location MAUSTON, WI
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Inspection Findings

F-Tag F0609

Freedom from Abuse, Neglect, and Exploitation Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

interviewed DON B (Director of Nursing). Surveyor asked DON B about the reporting requirements for abuse allegations. DON B stated, it is 24 hours if no immediate danger or physical injury. Police should be notified immediately and if not reported timely re-education to staff on the abuse policy. Surveyor asked DON B when she was educated on abuse reporting requirements. DON B stated, I was verbally educated by the NHA (Nursing Home Administrator) on 9/15/25 but did not sign the education sheet until today.On 9/24/25 at 2:15 PM, Surveyor interviewed NHA A . Surveyor asked NHA A about reporting of abuse allegations. NHA A stated, 2-hour reporting is required if there is serious bodily injury. This report was a unique situation where they approached each other and were hand holding. Surveyor discussed SOM (State Operations Manual) reporting requirements with NHA A. Surveyor asked NHA A about the facility policies indicate 2-hour reporting for serious bodily injury. NHA A stated, this is what our policy states.

Surveyor asked NHA A when she started education with staff on the reporting requirements. NHA A stated that she had given education to the RN and DON but did not document that education.The facility failed to report an abuse allegation within 2-hours.

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Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Fair View Nursing and Rehabilitation Center

1050 Division St Mauston, WI 53948

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

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F-Tag F0656

Resident Assessment and Care Planning Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Based on record review and staff interview the facility did not develop and implement a Comprehensive Resident Centered Care Plan for 1 of 4 residents reviewed (R 2). Resident R2's medical record indicated Resident R1 had occasional sexual inappropriate behaviors. Resident R2's comprehensive care plan does not include a care plan for sexual inappropriate behaviors.Evidenced by:The facility's Multidisciplinary Plan of Care Policy, undated, includes in part the following: D. The comprehensive plan of care is maintained in the electronic medical

record (EMR) and is updated to reflect the resident's current status and goals. It will be reviewed at minimum quarterly and per resident need. Resident R2 was admitted to the facility 9/12/24. Resident R2's diagnosis include dementia, history of stroke, osteoarthritis and diabetes. Resident R2's most recent MDS (Minimum Data Set) with and ARD (Assessment Reference Date) of 8/28/25, includes, in part, the following: Resident R1 usually understands, is usually understood and has severe cognitive impairment. Resident R1's Interdisciplinary Notes includes, in part,

the following:9/11/25, 10:07 AM, Care Plan Conference, What staff attended meeting: Care Plan reviewed by each IDT (Interdisciplinary Team) prior to Care Conference attended by RN G (Registered Nurse), .

Annual . FM H (Family Member) apologized for pt's (patient's) occasional sexual inappropriateness .On 9/24/25 at 2:10 PM Surveyor interviewed RN G. RN G stated she was responsible for updating care plans

after Care Plan Conferences. Surveyor asked RN G if she had attended Resident R2's Care Plan Conference on 9/11/25. RN G stated yes she did. Surveyor asked RN G if she had updated Resident R2's Care Plan to include the concerns for sexual inappropriateness. RN G and surveyor reviewed Resident R2's Care Plan. RN G stated no she had not updated Resident R1's Care Plan to include concerns of sexual inappropriateness or interventions when Resident R2 was sexually inappropriate. RN G stated she should have updated Resident R2's Care Plan to include the concerns with sexual inappropriateness. RN G stated she would update Resident R2's Care Plan right away.

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📋 Inspection Summary

FAIR VIEW NURSING AND REHABILITATION CENTER in MAUSTON, WI inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in MAUSTON, WI, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from FAIR VIEW NURSING AND REHABILITATION CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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