Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

GOLDEN AGE MANOR

AMERY, WI · 85 certified beds · Last Life Safety survey June 24, 2026

CMS Certification Number 525507 · first certified May 1993

Ownership

Independently operated (no chain recorded by CMS) · Government - County

No change of ownership on CMS record since January 1, 2016, when the records begin.

16
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
0
Tags cited more than once
Across separate surveys
3
Inspection & testing records
Of the citations on file

Position within WI

16 citations — more than 43% of the 323 certified nursing homes in WI. Compared within WI rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Improvingfewer citations at the latest survey than at its earlier surveys in the window.

The latest survey found 2 citations; the earlier surveys in the window averaged 7. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window opens August 2027 — about 10 months from now. This facility’s last Life Safety survey was June 2026. Facilities in WI are typically surveyed 13–15 months after the last one (median 14), measured over 516 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

Emergency preparedness

2 of the 16 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

6 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 16 Life Safety citations above. The Physical Environment Index

  • F-0880 Provide and implement an infection prevention and control program.
  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

How that compares

Citations on file over three years

Compared with the median facility in WI, and nationally. Surveyors differ markedly between states, so the WI figure is the meaningful one.

This facility16WI median17National median11
Citations on file over three years, compared
MeasureCitations
This facility16
Median facility in WI17
Median facility nationally11

Survey history

Citations at each Life Safety survey
22024-03122025-0422026-06
Citations at each Life Safety survey
Survey dateCitations
March 7, 20242
April 10, 202512
June 24, 20262

Most-cited tags

Most-cited tags at this facility
K-02111K-07411K-03431K-02221K-09121K-03531K-03451K-02931
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.12025-04-10
K-0741Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.12024-03-07
K-0343Have a fire alarm with audible and visual signals that transmits the alarm automatically to notify emergency forces in event of fire.12025-04-10
K-0222Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.12026-06-24
K-0912Have power receptacles that are properly grounded.12025-04-10
K-0353Inspect, test, and maintain automatic sprinkler systems.12025-04-10
K-0345Have approved installation, maintenance and testing program for fire alarm systems.12025-04-10
K-0293Have properly located and lighted "Exit" signs.12025-04-10

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 6
  • Miscellaneous Deficiencies 3
  • Egress Deficiencies 3
  • Gas, Vacuum, and Electrical Systems Deficiencies 2
  • Other 2
Citations by CMS category
CategoryCitations
Smoke Deficiencies6
Miscellaneous Deficiencies3
Egress Deficiencies3
Gas, Vacuum, and Electrical Systems Deficiencies2
Emergency Preparedness Deficiencies2

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

June 24, 2026 — 2 citations

Citations issued on June 24, 2026
TagWhat the surveyor checksStatus
K-0222Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.Deficient, Provider has no plan of correction
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has no plan of correction

April 10, 2025 — 12 citations

Citations issued on April 10, 2025
TagWhat the surveyor checksStatus
E-0013Develop Emergency Preparedness policies and procedures.Deficient, Provider has date of correction (May 22, 2025)
E-0033Establish methods for sharing information.Deficient, Provider has date of correction (May 22, 2025)
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (May 22, 2025)
K-0293Have properly located and lighted "Exit" signs.Deficient, Provider has date of correction (May 22, 2025)
K-0342Have a complete alarm system manually initiated and initiated by fire sprinkler system connection.Deficient, Provider has date of correction (May 22, 2025)
K-0343Have a fire alarm with audible and visual signals that transmits the alarm automatically to notify emergency forces in event of fire.Deficient, Provider has date of correction (May 22, 2025)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (May 22, 2025)
K-0351Install an approved automatic sprinkler system.Deficient, Provider has date of correction (May 22, 2025)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (May 22, 2025)
K-0753Have restrictions on the use of highly flammable decorations.Deficient, Provider has date of correction (May 22, 2025)
K-0781Have restrictions on the use of portable space heaters.Deficient, Provider has date of correction (May 22, 2025)
K-0912Have power receptacles that are properly grounded.Deficient, Provider has date of correction (May 22, 2025)

March 7, 2024 — 2 citations

Citations issued on March 7, 2024
TagWhat the surveyor checksStatus
K-0741Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.Deficient, Provider has date of correction (March 29, 2024)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (March 29, 2024)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.