Mulder Health Care Facility
MULDER HEALTH CARE FACILITY in WEST SALEM, WI — inspection on September 16, 2025.
Found 4 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
CNA G stated, Do you want me to help?? and the resident said, That's fine.
Staff pulled the covers
you want my help or not? CNA G continued to hold onto R4's arm to turn her to assist with putting
situation was not deescalating.On 09/16/25 at 10:30 AM, Surveyor interviewed Licensed Practical Nurse (LPN) F, who stated she was in the hall when she was called to R4's room. LPN F stated that when she entered the room R4's eyes were watering, and she was visibly trembling. LPN F stated CNA G was speaking aggressively and was not appropriate. LPN F stated she asked CNA G to leave a couple of times before she did. LPN F stated that CNA G got really close to R4's face and asked her if she wanted her to leave, and R4 responded that, Yes she wanted her to leave. CNA G responded fine, and then left.
When asked if she noticed anything with R4's wrist, LPN F stated the arm was slightly red, near the wrist.
When asked if R4 was upset, while she continued with the cares, LPN F stated that R4 calmed as soon as CNA G left the room.
When asked if she felt CNA G was abusive to R4, LPN G responded, Yes. LPN F stated she called the Director of Nursing (DON) right away to report the incident and began to gather statements for an investigation. LPN F stated she was surprised that CNA G was not removed from the building during the investigation. LPN F stated that CNA G continued to work the rest of the night shift on the 100 hall.
525209 09/16/2025
Mulder Health Care Facility 713 Leonard St N West Salem, WI 54669
Review of the facility self-report indicates it was reported to the state on 09/12/2025.
The self-report indicates the incident occurred on 09/09/25.
525209 09/16/2025
Mulder Health Care Facility 713 Leonard St N West Salem, WI 54669
resist. CNA D stated I went to grab the nurse because the situation was not deescalating.On
were watering, and she was visibly trembling. LPN F stated CNA G was speaking aggressively and
stated that CNA G got really close to R4's face and asked her if she wanted her to leave, and R4 responded that, Yes she wanted her to leave. CNA G responded, Fine, and then left.
When asked if she noticed anything with R4's wrist, LPN F stated the arm was slightly red, near the wrist.
When asked if R4 was upset, while she continued with the cares, LPN F stated that R4 calmed as soon as CNA G left the room.
When asked if she felt CNA G was abusive to R4, LPN G responded, Yes. LPN F stated she called the Director of Nursing (DON) right away to report the incident and began to gather statements for an investigation. LPN F stated she was surprised that CNA G was not removed from the building during the investigation. LPN F stated that CNA G continued to work the rest of the night shift on the 100 hall.Review of LPN F's witness statement dated 09/09/25 states in part, Nurse called to resident room by CNA D stating CNA G and R4 were arguing.
The nurse walked into CNA G demanding resident roll. R4 had a look of fear and distress, so the nurse immediately asked CNA G to leave. CNA G told resident she's got it and she will continue cares.
The nurse said no I'll take over. To which the CNA G responded no I got it.
This nurse then said in a stern voice, You need to leave now.
CNA G then turned to resident, leaning in inches from her face, and kept repeating, Do you want me to leave [R4]? This nurse repeated herself for the third time asking CNA G to leave as well as resident stating again that she would like CNA G to leave.
This nurse then repeated to CNA to leave. CNA finally left and continued to talk aggressively to R4 on her way out.
Nurse reported incident to DON within 30 minutes of interaction.On 09/15/25 at 4:19 PM, Surveyor interviewed Nursing Home Administrator (NHA) A who stated that following the incident, CNA G continued to work the rest of her shift, until 6:30 AM on the 100 hall. NHA A later provided information which stated that CNA G worked on 09/11/25 from 6 AM - 2:30 PM and on 09/12/25 from 6 AM - 2:30 PM.
While working CNA G primarily worked on one of the facility's 4 halls, but she had the potential to assist with any of the residents on any of the halls.
Review of the facility's roster matrix provided on 09/15/25 revealed that 16 residents resided on the 100 hall on 09/09/25.
525209 09/16/2025
Mulder Health Care Facility 713 Leonard St N West Salem, WI 54669
During AM medication pass, resident was complaining of 10/10 pain in right arm.
Resident stated last night (8/22) . was being transferred by EZ stand to bathroom, arm was hit on the door frame on accident. R1 indicated the Certified Nursing Assistant (CNA) stated sorry after.After this incident was reported by the resident on 08/23/25, the facility gathered other statements including the ones below.Surveyor reviewed a witness statement written by CNA D on 08/23/25, which states in part: I assisted with putting resident on toilet, her right arm was brushed against the door due to easy stand barely fits and resident arm was hanging, Resident stated it hurt but it was fine. It occurred on 08/22/25, at approximately 9:15 PM.Surveyor reviewed a witness statement written by CNA E which states in part was using EZ stand with resident to use the bathroom and while pushing her in to the bathroom her right arm hit the frame of the door. I apologized and repeatedly asked if she wanted an ice pack, and she said no. It occurred on 08/22/25, at approximately 9:30 PM.Surveyor reviewed R1's medical record and could not locate any information related to the above incident in the medical record on 08/22/25, when the incident occurred.Interview with DON B on 09/15/25 at 3:40 PM confirmed that CNAs did not report the incident to the nurse working with R1 at the time of the incident, or the charge nurse, or to the oncoming shift, as the policy directs.
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.