Rivers Edge Nursing And Rehab

F 0609

facility did not report an allegation of abuse to the state agency and law enforcement for 1 of 5 investigations reviewed.

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

12/01/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Rivers Edge Nursing and Rehab

1000 N. Wisconsin Ave.

Muscoda, WI 53573

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 0610

Respond appropriately to all alleged violations.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review the facility failed to ensure that all alleged violations are thoroughly investigated and report the results of all investigations to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of

the incident, and if the alleged violation is verified appropriate corrective action must be taken this affected 1 (Resident R12) of 5 investigations reviewed. Resident R12 reported an allegation of abuse. The facility did not complete a thorough investigation.Evidenced by:The facility policy, Abuse/Neglect/Exploitation, no date, states, in part;.A. An immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect or exploitation occur. Resident R12 was admitted to the facility on [DATE REDACTED], with a diagnoses including Bipolar disorder (chronic mental health condition), antisocial personality disorder (mental health condition persistent pattern of disregard for and violation of the rights of others), kidney disease, and diabetes. Resident R12's most recent MDS (Minimum Data Set) with ARD (Assessment Reference Date) of 8/4/25, indicates Resident R12 has a BIMS (Brief Interview for Mental Status) score of 12 indicating Resident R12 is moderately cognitively impaired. Resident R12 has an activated power of attorney. Nursing Home Administrator A (NHA) timeline states, in part;.9/19/25 Registered Nurse Care Coordinator from hospital called to voice a concern over a recent concern that was voiced. Resident R12 was taken to the ER and told a nurse there that our nurse had threw him on the bed. NHA A told RN Care Coordinator that she would follow up and report back to her what was found. On 9/29/25 at 10:44AM, Nursing Home Administrator A (NHA) indicated the hospital care coordinator called NHA A on 9/19/25 to report a concern that Resident R12 had voiced when Resident R12 was at ER on [DATE REDACTED]. NHA A indicated Resident R12 told hospital staff that the night nurse threw Resident R12 on the bed. NHA A indicated

she talked to the nurse and Certified Nursing Assistant (CNA) that was working with Resident R12 that night. The statements matched so NHA A did not investigate further. NHA A indicated she talked with Resident R12 as well and Resident R12 did not have any concerns, feels safe at the facility, and could not remember any incident that had occurred. On 9/30/25 at 11:03AM, Hospital Manager G indicated she did call and report Resident R12's allegation of abuse to Nursing Home Administrator A (NHA) on 9/19/25. Hospital Manager G indicated it was reported that Resident R12 told staff that the nurse at the facility threw him on the bed. Hospital Manager G indicated NHA A followed back up and reported that she talked to the nurse and Certified Nursing Assistant that worked with Resident R12 that night. On 9/30/25 at 12:21PM, Nursing Home Administrator A indicated she did not interview other residents and staff. NHA A indicated Resident R12 stating he was thrown on the bed could be an allegation of abuse and should be thoroughly investigated. The facility did not complete a thorough investigation for 1 of 5 investigations reviewed.

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

12/01/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Rivers Edge Nursing and Rehab

1000 N. Wisconsin Ave.

Muscoda, WI 53573

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 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review, the facility failed to develop a person-centered comprehensive care plan to meet personal preferences and goals, or address the resident's medical, physical, mental and psychosocial needs for 1 or 16 sampled residents (Resident R1).Resident R1 displayed behaviors of making sexual remarks to a staff member and the facility failed to develop a behavior care plan with goals and interventions related to Resident R1's behavior.Evidenced by:Facility policy, titled Comprehensive Care Plan, dated 3/1/23, includes: . it is the policy of the facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessments.Resident R1 admitted to the facility on [DATE REDACTED]. His most recent MDS (Minimum Data Set) with ARD (Assessment Reference Date) of 7/18/25, indicates Resident R1 is severely cognitively impaired with

a BIMS (Brief Interview for Mental Status) score of 8 out of 15.On 09/25/25 at 9:59 AM LPN O (Licensed Practical Nurse) indicated there was an incident on 9/1/25 at 8:00 PM in which Resident R1 and another resident were making sexual remarks to her and threatening to sexually assault her. The police came and arrested

the other resident and he has not been back to the facility.Resident R1's Comprehensive Care Plan, reviewed 9/25/25, initiated 3/28/24, does not include goals or interventions related to inappropriate sexual behaviors.On 9/25/25 at 3:09 PM NHA A (Nursing Home Administrator) indicated Resident R1 was involved in an incident that occurred on 9/1/25 around 8:00 PM in the shared gathering room. NHA A indicated staff reported to NHA A that Resident R1 was making sexual remarks to LPN O and verbalizing a desire of sexual misconduct with LPN O. NHA A indicated other residents and staff were in the room while this was happening. NHA A indicated the facility did not add interventions or goals in Resident R1's care plan related to this behavior. NHA A indicated the facility is not monitoring Resident R1 for inappropriate sexual comments to staff or other residents, but they should be.

Event ID:

Facility ID:

If continuation sheet