Heritage Lakeside
Inspection Findings
F-Tag F0609
F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Resident Mistreatment, Neglect, and Abuse Report was submitted to the state survey agency on 09/12/2025 at 5:25 PM by the Administrator (ADM). The report indicated that a family member had reported that Resident #1's wallet was missing. The report revealed the resident's family member had indicated there was no cash in the wallet, but there was a state identification card and social security card in the wallet.A Misconduct Incident Report submitted to the state survey agency on 9/19/2025 at 10:33 AM indicated the facility was notified that Resident #1 was missing a wallet that included a state identification card and a social security card. The report and investigation indicated that facility staff had searched for the wallet but had not located the wallet. The report indicated that law enforcement had not been contacted or involved.During an interview on 10/20/2025 at 1:58 PM, the SSD stated investigating allegations of abuse, neglect, or misappropriation was a group effort. The SSD stated that anything that could be reportable should be reported to the ADM and Director of Nursing (DON).During a follow-up interview on 10/20/2025 at 3:05 PM, the SSD stated if someone reported missing money she would report it as an allegation of misappropriation, but missing money is managed differently than other missing items that were not necessarily reportable. The SSD stated it was the ADM who determined if something was reportable. The SSD stated that Resident #1 was sometimes cognitively aware but became confused later in the day.During
an interview on 10/20/2025 at 3:16 PM, the ADM confirmed that she was the Abuse Coordinator for the facility. The ADM stated that the SSD notified her of missing items. The ADM stated if it was clothing or candy or something that was easily replaceable, she replaced these types of items. The ADM stated that if money was missing, she reported it as misappropriation and contacted the police. The ADM stated that initially, since there was no money in the wallet, she did not feel it rose to the level of misappropriation. The ADM stated that during a care conference on 09/11/2025, the family had voiced additional concerns related to the missing identification (The concern about the missing social security card was mentioned in the RP's email dated 09/02/2025), so the ADM decided it should be reported and further investigated.During a follow-up interview with the ADM on 10/20/2025 at 4:25 PM, the ADM stated that the allegation had not been reported to the police because there was no specific person or suspect to report.
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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
10/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Heritage Lakeside
1016 Lakeshore Dr Rice Lake, WI 54868
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-Tag F0610
F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
missing wallet. LPN E stated Resident #1 had not reported a missing wallet to her, and no one had asked her about a missing wallet.During an interview on 10/20/2025 at 11:00 AM, Certified Nurse Aide (CNA) A confirmed she had worked with Resident #1. CNA A stated she was not aware that Resident #1 had a missing wallet. CNA A stated that no one had asked her about a missing wallet.During an interview on 10/20/2025 at 11:03 AM, CNA B confirmed she had worked with Resident #1. CNA B stated she had never seen Resident #1 with a wallet, and Resident #1 had not reported a missing wallet to her. CNA B stated that no one had asked her about a missing wallet.During an interview on 10/20/2025 at 11:10 AM, CNA C confirmed that she had worked with Resident #1. CNA C stated Resident #1 had never complained about missing wallet. CNA C stated no one ever interviewed her about a missing wallet.During an interview on 10/20/2025 at 11:14 AM, Trained Medication Aide (TMA) D confirmed she had worked with Resident #1.
TMA D stated Resident #1 had not reported anything missing to her. TMA D stated that no one had interviewed her about a missing wallet.During an interview on 10/20/2025 at 1:43 PM, CNA F confirmed that she had worked with Resident #1. CNA F stated Resident #1 had not reported anything missing to her.
CNA F stated that no one had interviewed her about a missing wallet.During an interview on 10/20/2025 at 1:58 PM, the SSD stated investigating allegations of abuse, neglect, or misappropriation was a group effort.
The SSD stated she worked with the Administrator to determine who to interview and what questions to ask.During an interview on 10/20/2025 at 3:16 PM, the Administrator stated she expected the facility investigation to include interviews with other residents and staff.
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HERITAGE LAKESIDE in RICE LAKE, 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 RICE LAKE, 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 HERITAGE LAKESIDE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.