Amethyst Health Of Wausau

F 0602 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

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

that approximately $300 was taken from the account BOM-D closed.On 10/31/25 at 10:05 AM, NHA-A contacted Surveyor via phone indicating that Owner-G's sister left a voicemail on 10/29 indicating that another resident's (Resident R13) family is questioning billing statement because it had doubled the normal price despite having fully paid through September. Also, Resident R12 is again questioning Resident R12's statement amounts, SW-E had reminded NHA-A that Resident R12 had concerns in the past. NHA-A indicated concerns that those payments may have been directed to the account BOM-D was utilizing. On 10/31/25 at 12:39 PM, Surveyor interviewed BOM-D who confirmed meeting with NHA-A and DOO-F on 10/22/25. BOM-D indicated I was told I needed to resign, that was pretty much my only option. BOM-D confirmed having a debit card for a business account that BOM-D was the authorized user of and confirmed closing the account. BOM-D had inconsistent answers in terms of how the money was spent and how the account came to be and would divert to other topics of conversation during interview.The facility's failure to respond to suspected misappropriation created a reasonable likelihood for serious harm which led to a finding of immediate jeopardy. The facility removed the jeopardy on 11/3/25, however, the deficient practice continues at a scope/severity of level E (potential for more than minimal harm/pattern) as the facility continues to implement the follow action plan:1. The NHA and member of a governing body conducted an audit of past residents' funds. Credits will be made to families who are owed. The NHA and member of the governing body reviewed the petty cash policy reviewed and implemented on 11/1/25.2. The Director of Nursing (DON), Social Service Director (SSD) and Minimum Data Set (MDS) nurse)/care plan nurse will review clinical documents to identify any negative outcome that may have resulted from the alleged deficiency. The following document were reviewed: NAR report, 24-hour summary, order report listing, incident report portal, transfer/discharge log, concern log and resident council minutes.3. The DON/ SSD/Nurses will complete assessment of all residents to identify any negative psychosocial outcomes or worsening of overall condition that may have resulted from the alleged deficiency. The attending physician/Nurse Practitioner (NP) of the resident will be notified of any negative findings.4. The NHA/SSD/DON will conduct interviews of interviewable residents to identify if they have any concern related to mishandling, misused and/or misappropriation of their funds. Any identified concern will be reported to the state agency and law enforcement, and investigation will be conducted. For residents who are not able to participate in the interviews, the NHA/SSD/DON will interview the resident representatives.5. The corporate BOM will also audit all residents' status of benefits (Medicaid and Managed Care) to identify any concern. An investigation will be conducted if any concern is identified. Any identified misappropriation of residents' funds and exploitation will be reported to the NHA, state agency and law enforcement.

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

11/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Amethyst Health of Wausau

1010 E Wausau Ave Wausau, WI 54403

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 0607

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Level of Harm - Minimal harm or potential for actual harm

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

record review and interview, the facility did not implement policy and procedures related to screening employees for a prior history of abuse, neglect, exploitation of residents, or misappropriation of resident property for 1 of 13 employees reviewed.The facility did not ensure their abuse policy was implemented when one employee's Background Information Disclosure (BID), Department of Justice Response (DOJ), and Government Findings report was not obtained before employee started working at facility, Registered Nurse (RN) H.This is evidenced by:Facility policy titled, Abuse, Neglect, Exploitation and Misappropriation Prevention Program, with a revised date of 04/2021, states in part: The resident abuse, neglect and exploitation prevention program consists of a facility-wide commitment and resource allocation to support

the following objectives: 4. Conduct employee background checks and no knowingly employ or otherwise engage an individual who has: a. been found guilty of abuse, neglect, exploitation, misappropriation of property, or mistreatment by a court of law; b. had a finding entered into the state nurse aide registry concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of their property; or c. a disciplinary action in effect against his or her professional license by a state licensure body as a result of finding of abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property.On 11/05/25, Surveyor reviewed 12 random staff Caregiver Background Check and Misconduct Reporting Compliance Check. RN H was hired on 08/22/23. Surveyor found no BID, Department of Justice (DOJ), or Government Findings report completed for RN H.On 11/05/25 at 1:10 PM, Surveyor interviewed Executive Director Assistant ([NAME]) I regarding completion of employees' BID, DOJ, and Government Findings report. [NAME] I stated that it was recently discovered that many personnel files were missing items and sweep was being done to determine which personnel files were missing items. Surveyor asked [NAME] I if any personnel files had been updated with the necessary paperwork yet. [NAME] I stated no and that currently it is just a list. Surveyor asked [NAME] I to provide a list of employees identified needing BID, DOJ, and Government Findings report. No additional documentation was provided to Surveyor by exit.On 11/05/25 at 1:30 PM, Surveyor interviewed Nursing Home Administrator (NHA) A regarding lack of RN H's BID, DOJ, and Government Findings report. NHA A stated apologies having just recently taking over at facility. NHA A stated that a sweep was being done and those without a background check will be removed from the schedule until their background check is completed.

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

11/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Amethyst Health of Wausau

1010 E Wausau Ave Wausau, WI 54403

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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

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

office.On 10/30/25 at 2:25 PM, Surveyor interviewed DOO-F who again indicated having no knowledge of financial concerns or issues at the facility. DOO-F also indicated not knowing BOM-D, as had only a couple interactions.On 10/30/25 at 3:07 PM, Surveyor again asked DOO-F in the presence of NHA-A if DOO-F was aware of any financial concerns at the facility, DOO-F again initially denied and then asked NHA-A if NHA-A was aware of anything at which time NHA-A indicated, Yes, we talked about this. DOO-F initially indicated not knowing what NHA-A meant and then admitted to knowing something about a bank account.On 10/30/25 at 4 PM, NHA-A provided Surveyor copies of the three checks that were scanned into Resident R3's medical record. Upon handing the checks to Surveyor, Surveyor asked if anything seemed unusual about the checks and NHA-A indicated, the signature is not Resident R3's handwriting.On 10/30/25 at 4:20 PM, NHA-A informed Surveyor that NHA-A had now contacted the police department about these concerns and will be submitting a report to the SA.On 10/30 and 10/31, Surveyor requested policies for accounts receivables and accounts payable; none were provided. On 11/3/25, NHA-C provided policies with an effective date of 11/2/25. The failure to report suspicion of misappropriation and/or exploitation of residents' funds created a reasonable likelihood for serious harm which led to a finding of immediate jeopardy. The facility removed the jeopardy on 11/3/25; however, the deficient practice continues at a scope/severity of level E (potential for more than minimal harm/pattern) as the facility continues to implement the following action plan:1. The DON/SSD (Social Service Director)/Nurses will complete assessment of all residents to identify any negative psychosocial outcomes or worsening of overall condition that may have resulted from

the alleged deficiency. The attending physician/NP (nurse practitioner) of the resident will be notified of any negative findings.2. The NHA (Nursing Home Administrator)/SSD/DON will conduct interviews of interviewable residents to identify if they have any concern related to mishandling, misused and/or misappropriation of their funds. Any identified concern will be reported to the state agency and law enforcement, and investigation will be conducted. For residents who are not able to participate in the interviews, the NHA (Nursing Home Administrator)/SSD/DON will interview the resident representatives.3.

The corporate business office manager will also audit all residents' status of benefits (Medicaid and Managed Care) to identify any concern. An investigation will be conducted if any concern is identified. Any identified misappropriation of residents' funds and exploitation will be reported to the NHA, state agency and law enforcement.4.The NHA/DON will provide training to the department heads (Activities, SSD, BOM business office manager, Dietary Manager, Therapy Director, Environmental Services and Maintenance staff) related to the intent of F-F609, facility policy related to Abuse, Neglect, Exploitation and Misappropriation, focusing on the reporting requirements and responsibility of the staff to misappropriation of resident property, and exploitation to the state agency and police department. The DON/NHA/trained department head will provide training to all staff about reporting allegations of abuse, neglect and misappropriation to the Administrator/DON immediately. The staff members who are not available will receive their education prior to starting their shift upon return to work.

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

11/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Amethyst Health of Wausau

1010 E Wausau Ave Wausau, WI 54403

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 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

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

identified concern will be reported to the state agency and law enforcement, and investigation will be conducted. For residents who are not able to participate in the interviews, the NHA (Nursing Home Administrator)/SSD/DON will interview the resident representatives.3. The corporate business office manager will also audit all residents' status of benefits (Medicaid and Managed Care) to identify any concern. An investigation will be conducted if any concern is identified. Any identified misappropriation of residents' funds and exploitation will be reported to the NHA, state agency and law enforcement.4. To identify any negative outcome, the DON/SSD (Social Service Director)/Nurses will complete assessment of all residents. The attending physician/NP (nurse practitioner) of the resident will be notified of any negative findings.5. The NHA will initiate the investigation while ensuring residents are protected from further misappropriation of property and exploitation.6. The Compliance consultant will provide training to the RDO (Regional Director of Operations), NHA, DON, and members of the governing body, related to the intent of F-F610, facility policy related investigation of allegations of Misappropriation of Resident Property and Exploitation and responsibility of the staff to assure thorough investigation and to implement measures to prevent further mishandling of finances and/or exploitation and to safeguard residents' finances.7. The NHA/DON will provide training to the department heads (Activities, SSD, BOM - business office manager, Dietary Manager, Therapy Director, Environmental Services and Maintenance staff) related to the intent of F-F610, facility policy related investigation of allegations of Misappropriation of Resident Property and Exploitation and responsibility of the staff to assure thorough investigation and to implement measures to prevent further mishandling of finances and/or exploitation and to safeguard residents' finances.8. The NHA/DON/trained department head will provide the staff with training about their responsibility to participate/cooperate with the administration when conducting an investigation. Staff who are not available will receive their education prior to starting their shift upon return to work

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

11/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Amethyst Health of Wausau

1010 E Wausau Ave Wausau, WI 54403

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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

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

needs), a replenishment check is requested. RFMS Petty Cash box is counted. Receipts, G/L log and count are sent to third-party billing office. Replenishment check is issued to facility. Replenishment check is then cashed at local bank. Funds are counted at facility by two employees. Funds are then placed back into the RFMS Petty Cash box.6. The policies and procedures related to administration of the facility will be reviewed by the NHA, DON, Medical Director and a representative of the governing body. The compliance consultant will provide the NHA, DON and members of the governing body training about administration of

the facility in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. It will be emphasized that the NHA and DON are accountable for all the programs and services in the facility to meet the needs of

the residents who reside in the facility. The Administrator and DON are accountable for planning, coordinating and managing all services, including protection of residents from misappropriation of property and exploitation, meeting the reporting and thorough investigation requirements of any allegation related to misappropriation of resident property and exploitation, and are responsible for the overall direction, coordination and evaluation of all care and services provided to the residents in the facility.7. The NHA/DON will provide training to the department heads (Activities, SSD, BOM - business office manager, Dietary Manager, Therapy Director, Environmental Services and Maintenance staff) about the intent of F-F835 and their responsibility to operate and manage the facility efficiently and effectively to ensure that the facility is administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain

the highest practicable physical, mental, and psychosocial well-being of each resident. The training will also include review of their responsibility to prevent abuse, including misappropriation of resident property and exploitation, identifying, investigating and protecting residents from allegations of abuse and exploitation that has the potential to cause serious injury, harm, impairment, or death.

Event ID:

Facility ID:

If continuation sheet