Careview Health And Rehab Of Minocqua

F 0678 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

[BLS], revised [DATE REDACTED], indicated: The facility's procedure for administering CPR shall incorporate the steps covered in the American Heart Association 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care or facility BLS training material. They include the following areas: 1. Check victim for responsiveness, breathing and pulse. 2. Shout for nearby help. 3. Activate emergency response system via mobile device (if appropriate) or designate staff member to call 911, then call resident's Attending Physician and the resident's family. 4. Call a code as designated by facility protocol. 5. Send someone to get AED and emergency equipment. 6. Check victim for pulse and respirations: No breathing, pulse not felt within 10 seconds, Start CPR . Use AED as soon as it is available.

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Facility ID:

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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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Careview Health and Rehab of Minocqua

9969 Old Hwy 70 Rd Minocqua, WI 54548

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)

F 0694

necessary to give intravenous fluids and electrolytes .

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

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

Event ID:

Facility ID:

If continuation sheet

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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Careview Health and Rehab of Minocqua

9969 Old Hwy 70 Rd Minocqua, WI 54548

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)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

8:03 AM, two hours and three minutes after the scheduled time10/02/25 11:00 AM doses were administered at 10:51 AM, two hours and 28 minutes after the previous doses10/03/25 6:00 AM doses were administered at 8:15 AM, two hours and 15 minutes after the scheduled time10/03/25 11:00 AM doses were administered at 11:01 AM, two hours and 46 minutes after the previous doses10/21/25 6:00 AM doses were administered at 8:37 AM, two hours and 37 minutes after the scheduled time10/21/25 11:00 AM doses were administered at 11:23 AM, two hours and 46 minutes after the previous doses10/22/25 6:00 AM doses were administered at 8:39 AM, two hours and 39 minutes after the scheduled time10/22/25 11:00 AM doses were administered at 10:55 AM, two hours and 16 minutes after

the previous dosesDuring an observation on 10/21/25 at 11:20 AM, CMA1 administered medications to Resident R5 to include:Buspirone 5 mg (11:00 AM) doseGabapentin 600 mg (11:00 AM) doseBoth medications were administered two hours and 43 minutes after the previous doses were documented as administered.During

an interview on 10/21/25 at 12:35 PM, CMA1 said that medications could be administered one hour before or one hour after the scheduled time unless it was a medication scheduled once a day in the morning, then

it could be administered between the hours of 6AM to 10AM. CMA1 stated she had not administered the early morning medications to Resident R2 and Resident R5 and denied reviewing the Medication Administration Record (MAR) for the time the last dose was given for a medication scheduled more than one time a day. CMA1 said that residents could have an adverse reaction if medications were given too close together.During an

interview on 10/21/25 at 4:18 PM, the Assistant Director of Nursing (ADON)1 indicated there was a four-hour window to pass medications in the morning. ADON1 said that she audited charts the day after admission to ensure that medications were entered correctly per the admission orders. ADON1 stated she did not audit when medications were administered.During an interview on 10/23/25 at 4:14 PM, the Director of Nursing (DON) stated the facility followed a liberalized medication administration timeframe that allowed flexibility when passing medications in convenient time windows, such as morning, midday, and evening.

The DON said that she was unsure how medications would be administered if a dose was scheduled for more than one time a day. The DON said that the nurses were responsible for making sure that they passed medications following the time range schedule or as instructed on the MAR.Record review of the facility's policy titled, Administering Medications, revised December 2009 indicated: Medications shall be administered in a safe and timely manner, and as prescribed. 3. Medications must be administered in accordance with the orders, including any required time frame. 9. Medications may not be prepared in advance and must be administered within one [1] hour of their prescribed time, unless otherwise specified [for example, before and after meal orders].

Event ID:

Facility ID:

If continuation sheet

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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Careview Health and Rehab of Minocqua

9969 Old Hwy 70 Rd Minocqua, WI 54548

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)

F 0760

Ensure that residents are free from significant medication errors.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, record reviews, and policy reviews, the facility failed to ensure Vancomycin (antibiotic used to treat serious bacterial infections) was administered as ordered resulting in two missed doses for one of five residents (Resident (R)1) reviewed for significant medication errors out of a total sample of 11 residents.

This failure had the potential to increase the risk of serious complications from untreated sepsis such as organ damage and/or death, especially in critically ill patients.Findings include:Review of Resident R1's admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 07/02/25 located under the MDS tab in the electronic medical record (EMR) revealed Resident R1 was admitted to the facility on [DATE REDACTED] with a diagnosis of gram-positive bacteremia (bacteria in the bloodstream). Resident R1 had a Brief Interview for Mental Status (BIMS) score of 10 out of 15, which indicated moderately impaired cognition. The MDS reflected that Resident R1 had an intravenous (IV) access placed and IV antibiotics administered within the last 14 days while Resident R1 was a resident at the facility.Review of Resident R1's undated hospital Discharge Summary located in the EMR under the Misc tab, revealed Resident R1 discharged from an acute care hospital. The discharge summary revealed Resident R1 received IV antibiotics during the hospital course (06/11/25 - 06/29/25). The discharge orders reflected vancomycin 750 milligrams (mg) IV daily over 30 minutes until July 15. The discharge orders did not include

the last date and time that Vancomycin was administered in the hospital prior to Resident R1's discharge to the facility.Record review of Resident R1's undated Clinical Physician Orders located in the EMR under the Orders tab, reflected an order entered on 06/29/25 for Vancomycin intravenous solution 750 mg/150 milliliter [ML]. Give 750 mg intravenously one time a day [Start date: 06/30/25 at 5:00 PM] related to bacteremia was digitally transmitted to the pharmacy. Review of Resident R1's Progress Notes located in the EMR under the Prog Note tab included electronic Medication Administration Record (eMAR) progress notes entered on 06/30/25 and 07/01/25 that indicated the Vancomycin was not available in the facility for administration to Resident R1. Additional documentation, dated 06/30/25, reflected communication with the pharmacy and the orders were refaxed

on 06/30/25 and the pharmacy indicated that the medication would be delivered that night.Review of Resident R1's June and July Medication Administration Record (MAR) located in the EMR under the Orders tab revealed vancomycin was not administered on 06/30/25 or 07/01/25. The first dose of vancomycin was administered

on 07/02/25.Review of Resident R1's July Medication Admin Audit Report provided on paper by the facility reflected vancomycin intravenous solution 750 mg/150 ML was administered by Registered Nurse (RN)2 at 07/02/25 at 4:24 PM and on 07/03/25 at 4:57 PM via the PICC line to the right upper arm.During a phone interview

on 10/20/25 at 2:45 PM, RN2 verified that she administered the medication on 07/02/25 and again on 07/03/25.During an interview on 10/22/25 at 10:52 AM, nurse practitioner (NP)1 stated he was unaware of

the missed doses of vancomycin. NP1 said that he entered an order on 07/01/25 for the pharmacy to schedule a vancomycin trough for dose monitoring. The NP said that he expected to be informed about a late/missed dose so that he could make changes as needed. The NP said that if he had been aware, he would have inquired as to why the delay, written a prescription for a local pharmacy if the facility pharmacy did not have the medication available or could not deliver it, and he would have added more days onto the length of treatment.Record review of the facility's policy titled, Administering Medications, revised December 2009 indicated: Medications shall be administered in a safe and timely manner, and as prescribed. 3. Medications must be administered in accordance with the orders, including any required time frame. 9. Medications may not be prepared in advance and must be administered within one (1) hour of their prescribed time, unless otherwise specified (for example, before and after meal orders).

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet

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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Careview Health and Rehab of Minocqua

9969 Old Hwy 70 Rd Minocqua, WI 54548

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)

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

of care and services . 3. To promote consistent facility systems and processes and appropriate practices in resident care . 4. To help identify negative outcomes relative to resident care and resolve them appropriately. The Quality Assessment and Assurance Committee advises the Administrator and owner and/or governing board [body]. The committee has the full authority to oversee the implementation of the Quality Assessment and Assurance Program, including, but not limited to identifying negative and positive outcomes of care and services. Review of the facility's policy titled, Quality Assessment and Assurance Plan, revised [DATE REDACTED], indicated: The primary purposes of the Quality Assessment and Assurance Plan are:

1. 1. To provide a means to identify and resolve present and potential negative outcomes related to resident

care and safety . 3. To provide a structure and process to correct identified quality deficiencies . 4. To establish and implement plans to correct deficiencies, and to monitor the effects of these action plans on resident outcome.

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Facility ID:

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