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

MEADOWBROOK AT BLACK RIVER FALLS

BLACK RIVER FALLS, WI · 45 certified beds · Last Life Safety survey January 14, 2026

CMS Certification Number 525488 · first certified May 1992

Ownership

Operated by SYNERGY SENIOR CARE · For profit - Corporation

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

Citations on file

Rolling three-year window

Life Safety surveys

In the same window

Tags cited more than once

Across separate surveys

Inspection & testing records

Of the citations on file

Position within WI

36 citations — more than 94% 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 7 citations; the earlier surveys in the window averaged 14.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window opens February 2027 — about 5 months from now. This facility’s last Life Safety survey was January 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

Get an email about MEADOWBROOK AT BLACK RIVER FALLS

One email when it happens. No account; stop it any time with one click.

3 inspection-and-testing tags have been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Emergency preparedness

3 of the 36 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)

5 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 36 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.

Citations on file over three years, compared
Measure	Citations
This facility	36
Median facility in WI	17
Median facility nationally	11

Survey history

Citations at each Life Safety survey

Citations at each Life Safety survey
Survey date	Citations
October 18, 2023	12
October 16, 2024	17
January 14, 2026	7

Most-cited tags

Most-cited tags at this facility

Most-cited tags at this facility
Tag	What the surveyor checks	Times cited	Last cited
K-0321	Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.	3	2026-01-14
K-0291	Install emergency lighting that can last at least 1 1/2 hours.	2	2024-10-16
K-0918	Have generator or other power source capable of supplying service within 10 seconds.	2	2026-01-14
K-0225	Have stairways and smokeproof enclosures used as exits that meet safety requirements.	2	2024-10-16
K-0232	Have corridors or aisles that are unobstructed and are at least 8 feet in width.	2	2024-10-16
K-0712	Have simulated fire drills held at unexpected times.	2	2026-01-14
K-0920	Ensure proper usage of power strips and extension cords.	2	2024-10-16
K-0741	Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.	2	2026-01-14

What the citations cover

Citations by CMS category

Smoke Deficiencies 9
Gas, Vacuum, and Electrical Systems Deficiencies 9
Egress Deficiencies 7
Miscellaneous Deficiencies 6
Other 5

Citations by CMS category
Category	Citations
Smoke Deficiencies	9
Gas, Vacuum, and Electrical Systems Deficiencies	9
Egress Deficiencies	7
Miscellaneous Deficiencies	6
Emergency Preparedness Deficiencies	3
Construction Deficiencies	1
Services Deficiencies	1

Every citation on file

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

January 14, 2026 — 7 citations

Citations issued on January 14, 2026
Tag	What the surveyor checks	Status
K-0321	Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.	Deficient, Provider has date of correction (February 11, 2026)
K-0346	Follow proper procedures when the fire alarm was out of service for more than 4 hours.	Deficient, Provider has date of correction (February 11, 2026)
K-0355	Properly select, install, inspect, or maintain portable fire extinguishes.	Deficient, Provider has date of correction (February 11, 2026)
K-0712	Have simulated fire drills held at unexpected times.	Deficient, Provider has date of correction (February 11, 2026)
K-0741	Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.	Deficient, Provider has date of correction (February 11, 2026)
K-0761	To conduct inspection, testing and maintenance of fire doors by qualified individuals.	Deficient, Provider has date of correction (February 11, 2026)
K-0918	Have generator or other power source capable of supplying service within 10 seconds.	Deficient, Provider has date of correction (February 11, 2026)

October 16, 2024 — 17 citations

Citations issued on October 16, 2024
Tag	What the surveyor checks	Status
E-0006	Conduct risk assessment and an All-Hazards approach.	Deficient, Provider has date of correction (January 5, 2025)
E-0013	Develop Emergency Preparedness policies and procedures.	Deficient, Provider has date of correction (December 30, 2024)
K-0222	Add 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 date of correction (December 20, 2024)
K-0225	Have stairways and smokeproof enclosures used as exits that meet safety requirements.	Deficient, Provider has plan of correction (December 20, 2024)
K-0232	Have corridors or aisles that are unobstructed and are at least 8 feet in width.	Deficient, Provider has date of correction (December 20, 2024)
K-0291	Install emergency lighting that can last at least 1 1/2 hours.	Deficient, Provider has date of correction (December 27, 2024)
K-0321	Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.	Deficient, Provider has date of correction (December 20, 2024)
K-0331	Construct fire resistant interior walls.	Deficient, Provider has date of correction (December 20, 2024)
K-0353	Inspect, test, and maintain automatic sprinkler systems.	Deficient, Provider has date of correction (December 30, 2024)
K-0372	Ensure smoke barriers are constructed to a 1 hour fire resistance rating.	Deficient, Provider has date of correction (December 20, 2024)
K-0521	Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.	Deficient, Provider has plan of correction (December 20, 2024)
K-0712	Have simulated fire drills held at unexpected times.	Deficient, Provider has date of correction (December 27, 2024)
K-0912	Have power receptacles that are properly grounded.	Deficient, Provider has date of correction (December 27, 2024)
K-0918	Have generator or other power source capable of supplying service within 10 seconds.	Deficient, Provider has date of correction (December 27, 2024)
K-0919	Meet requirements for the use of electrical equipment.	Deficient, Provider has date of correction (December 20, 2024)
K-0920	Ensure proper usage of power strips and extension cords.	Deficient, Provider has date of correction (December 20, 2024)
K-0923	Have proper medical gas storage and administration areas.	Deficient, Provider has date of correction (December 20, 2024)

October 18, 2023 — 12 citations

Citations issued on October 18, 2023
Tag	What the surveyor checks	Status
E-0039	Conduct testing and exercise requirements.	Deficient, Provider has date of correction (December 22, 2023)
K-0132	Meet requirements for outpatient facilities located next to inpatient facilities separated by fire resistive construction.	Waiver has been granted (January 3, 2024)
K-0225	Have stairways and smokeproof enclosures used as exits that meet safety requirements.	Waiver has been granted (December 22, 2023)
K-0232	Have corridors or aisles that are unobstructed and are at least 8 feet in width.	Deficient, Provider has date of correction (December 22, 2023)
K-0291	Install emergency lighting that can last at least 1 1/2 hours.	Deficient, Provider has date of correction (December 22, 2023)
K-0321	Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.	Deficient, Provider has date of correction (December 22, 2023)
K-0363	Install corridor and hallway doors that block smoke.	Deficient, Provider has date of correction (December 22, 2023)
K-0741	Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.	Deficient, Provider has date of correction (December 22, 2023)
K-0751	Have restrictions on the use of flammable curtains.	Deficient, Provider has date of correction (December 22, 2023)
K-0914	Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.	Deficient, Provider has date of correction (December 22, 2023)
K-0920	Ensure proper usage of power strips and extension cords.	Deficient, Provider has date of correction (December 22, 2023)
K-0927	Have proper fire barriers, ventilation and signs for the transfilling of oxygen.	Deficient, Provider has date of correction (December 22, 2023)

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