St Joseph Residence
Inspection Findings
F-Tag F0609
F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Based on staff interview and record review, the facility failed to develop and/or implement policies and procedures for ensuring the reporting of a reasonable suspicion of a crime in accordance with section 1150B of the Act for 2 residents (R) (Resident R1 and Resident R2) of 8 sampled residents.On 6/27/25, Resident R1 and Resident R2 were struck by Family Member (FM)-C) in the dining room. FM-C aggressively grabbed at Resident R1, pulled Resident R1 in, and hit Resident R1 in the mid-section with a closed fist. FM-C also slapped Resident R2 on the right hand, grabbed Resident R2's left hand, and pulled Resident R2's wheelchair toward FM-C. The facility did not notify local law enforcement of the abuse.Findings include:The facility's Abuse Prevention and Response policy, revised 1/1/25, indicates: 1.
Upon receipt of an allegation or report of an incident, the licensed staff and/or Social Services will .1.3 Contact the police department if there is a suspected crime against a resident. (The facility's policy did not include examples of crimes that should be reported, including but not limited to assault and battery, and did not indicate the facility consulted with local law enforcement to discuss what to report or not report.)On 8/15/25, Surveyor reviewed a facility-reported incident that indicated FM-C was in the dining room with Resident R1 and Resident R2 on 6/27/25 and became upset when Resident R1 did not eat beans that FM-C brought from home. The investigation indicated Certified Nursing Assistant (CNA)-D witnessed FM-C aggressively grab at Resident R1, pull Resident R1 in, and swing at Resident R1's mid-section with a closed fist. Staff also witnessed FM-C swat at and hit Resident R2's right hand, grab Resident R2's left hand, and pull Resident R2's wheelchair toward FM-C as Resident R2 attempted to roll away. Staff removed Resident R1 and Resident R2 from FM-C's vicinity following the incidents.The facility completed resident interviews, psychosocial assessments, and psychosocial monitoring on 6/27/25. The facility also completed psychosocial monitoring for Resident R1 and Resident R2 for 3 days post-incident. Nursing Home Administrator (NHA)-A spoke to FM-C about the incidents which did not appear to have affected Resident R1 or Resident R2. On 8/15/25 at 10:34 AM, Surveyor interviewed NHA-A who indicated Resident R1 and Resident R2's [NAME] of Attorney (POA) did not want to proceed with charges regarding the incidents. NHA-A did not feel the abuse should be reported to local law enforcement. NHA-A also confirmed the facility had not had a formal discussion with local law enforcement to determine what local law enforcement wanted the facility to report and/or what was considered a crime.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
ST JOSEPH RESIDENCE in NEW LONDON, WI inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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 NEW LONDON, 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 ST JOSEPH RESIDENCE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.