Marquardt Memorial Manor
Inspection Findings
F-Tag F0578
F 0578 Level of Harm - Minimal harm or potential for actual harm
denied asking if APS-F was aware that Resident R1 requested an advocate or representative. NHA-A stated APS-F made it clear that Resident R1 was Resident R1's own decision maker. SW-E and NHA-A indicated no further action had been taken to fulfill Resident R1's request to complete a new POA document.
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
10/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Marquardt Memorial Manor
1020 Hill St Watertown, WI 53098
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 F0609
F 0609
10/6/25 and stated if the allegation was reported sooner, DON-B would have initiated an investigation.
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
10/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Marquardt Memorial Manor
1020 Hill St Watertown, WI 53098
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 F0880
F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
should be worn: a. When the potential for splash-back of contaminated blood/body fluids exists. b. In accordance with CDC guidance. On 10/6/25, Surveyor reviewed Resident R1's medical record. Resident R1 was admitted to
the facility on [DATE REDACTED] and had diagnoses including spina bifida, paraplegia, anxiety disorder, rectocele, neuromuscular dysfunction of bladder, neurogenic bowel, rentention of urine, severe sepsis, and stage 4 pressure ulcer of the sacral region. Resident R1's Minimum Data Set (MDS) assessment, dated 8/6/25, had a Brief
Interview for Mental Status (BIMS) score of 14 out of 15 which indicated Resident R1's cognition was intact. Resident R1 was responsible for Resident R1's healthcare decisions.On 10/6/25 at 10:00 AM, Surveyor observed LPN-C and CNA-D complete wound care for Resident R1 who was on EBP as indicated by a sign posted near Resident R1's door. LPN-C and CNA-D entered Resident R1's room without donning gowns. LPN-C brought a treatment cart into the room and placed a gauze package, a bottle of wound cleanser, and bandage scissors on Resident R1's bedside table. LPN-C did not disinfect the table or place a barrier between the supplies and the table surface. LPN-C and CNA-D then donned gloves. During the provision of wound care, LPN-C and CNA-D's clothing was in contact with Resident R1's environment, including Resident R1's bed linens. During the observation, LPN-C removed gloves and did not sanitize hands after completing the soiled portion of wound care. LPN-C then put a clean dressing on Resident R1's wound and donned a glove on the left hand. LPN-C's bare right hand was in contact with Resident R1's skin, linens, and environment while using a roll of tape. LPN-C put two dressing packages on Resident R1's bedside table that were not used. LPN-C retrieved clean gloves from the treatment cart and did not complete hand hygiene
after removing the left glove. LPN-C placed clean gloves on Resident R1's bedside table, donned a glove on the right hand, and assisted Resident R1 onto the left side. LPN-C removed a used absorbent pad, removed the right glove, unrolled tape, and stuck the tape to a second bedside table. LPN-C donned a clean glove, put a dressing
on Resident R1's wound, and taped the dressing in place. LPN-C then moved Resident R1's electronic tablet, put a clean brief
on Resident R1, assisted Resident R1 onto the right side, taped the dressing in place, and fastened Resident R1's brief. LPN-C then removed the glove, sanitized hands, and put a clean sheet over Resident R1. On 10/6/25 at 10:59 AM, LPN-C rolled
the treatment cart from Resident R1's room to the nurses' station. LPN-C donned gloves and disinfected the bandage scissors, wound cleanser, and top of the cart with hydrogen peroxide-based wipes.On 10/6/25 at 11:03 AM, Surveyor interviewed LPN-C who thought gowns were worn during wound care and stated LPN-C was nervous. LPN-C verified the treatment cart is used for all residents and stated LPN-C sanitizes the cart after
it leaves each room. LPN-C was not aware of the sanitizing product's dwell time (amount of time that a disinfecting product needs to stay wet on an item in order to properly disinfect) of one minute. LPN-C verified LPN-C put the bandage scissors and wound cleanser in the cart before ensuring a minute had passed. LPN-C verified Resident R1's wound care items were in the treatment cart and stated LPN-C should have put the items in a treatment bag. Surveyor and LPN-C verified the EBP sign outside Resident R1's door indicated staff shoud wear a gown and gloves during high-contact resident care, including wound care. LPN-C stated LPN-C should have worn a gown because Resident R1 had an open wound and a Foley catheter.On 10/6/25 at approximately 11:30 AM, Surveyor interviewed CNA-D. When asked if CNA-D wears a gown during cares for Resident R1, CNA-D stated, Sometimes, sometimes not. CNA-D then stated, We just forgot to put one on, I think.
On 10/6/25 at 3:00 PM, Surveyor interviewed Director of Nursing (DON)-B who veriifed LPN-C and CNA-D should have worn gowns during wound care for Resident R1. DON-B also indicated LPN-C should have taken the amount of gauze needed and placed the gauze on a clean surface with a barrier. When Surveyor informed DON-B of missed hand hygiene opportunities and cross-contamination of wound care products, clothing, and the environment, DON-B stated DON-B had educated staff on infection control. DON-B verified items used in Resident R1's room should not be used on other residents, including the tape or gauze.
Event ID:
Facility ID:
If continuation sheet
Marquardt Memorial Manor in WATERTOWN, 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 WATERTOWN, 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 Marquardt Memorial Manor or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.