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

Golden Years of Lake Geneva

Lake Geneva, WI · 54 certified beds · Last Life Safety survey May 7, 2025

CMS Certification Number 525727 · first certified June 2018

Ownership

Independently operated (no chain recorded by CMS) · For profit - Corporation

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

14
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
1
Tags cited more than once
Across separate surveys
6
Inspection & testing records
Of the citations on file

Position within WI

14 citations — more than 35% 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 3 citations; the earlier surveys in the window averaged 5.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

Well past the typical window (June 2026 to August 2026), and past the point by which nine in ten WI facilities have been surveyed. This facility’s last Life Safety survey was May 2025. 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

1 inspection-and-testing tag has 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

2 of the 14 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

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 facility14WI median17National median11
Citations on file over three years, compared
MeasureCitations
This facility14
Median facility in WI17
Median facility nationally11

Survey history

Citations at each Life Safety survey
22022-1192024-0232025-05
Citations at each Life Safety survey
Survey dateCitations
November 10, 20222
February 8, 20249
May 7, 20253

Most-cited tags

Most-cited tags at this facility
K-07122K-09251K-09231K-03621K-03721E-00071E-00131K-09161
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0712Have simulated fire drills held at unexpected times.22024-02-08
K-0925Ensure that sources of ignition are removed from patients receiving respiratory therapy.12025-05-07
K-0923Have proper medical gas storage and administration areas.12024-02-08
K-0362Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.12024-02-08
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.12024-02-08
E-0007Address patient/client population and determine types of services needed.12025-05-07
E-0013Develop Emergency Preparedness policies and procedures.12024-02-08
K-0916Have a battery powered remote alarm panel in a location accessible by operating personnel.12022-11-10

What the citations cover

Citations by CMS category
  • Miscellaneous Deficiencies 4
  • Gas, Vacuum, and Electrical Systems Deficiencies 4
  • Smoke Deficiencies 3
  • Emergency Preparedness Deficiencies 2
  • Other 1
Citations by CMS category
CategoryCitations
Miscellaneous Deficiencies4
Gas, Vacuum, and Electrical Systems Deficiencies4
Smoke Deficiencies3
Emergency Preparedness Deficiencies2
Egress Deficiencies1

Every citation on file

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

May 7, 2025 — 3 citations

Citations issued on May 7, 2025
TagWhat the surveyor checksStatus
E-0007Address patient/client population and determine types of services needed.Deficient, Provider has date of correction (May 22, 2025)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (May 21, 2025)
K-0925Ensure that sources of ignition are removed from patients receiving respiratory therapy.Deficient, Provider has date of correction (May 22, 2025)

February 8, 2024 — 9 citations

Citations issued on February 8, 2024
TagWhat the surveyor checksStatus
E-0013Develop Emergency Preparedness policies and procedures.Deficient, Provider has date of correction (February 28, 2024)
K-0291Install emergency lighting that can last at least 1 1/2 hours.Deficient, Provider has date of correction (February 8, 2024)
K-0347Properly provide smoke detection systems in areas open to corridors.Deficient, Provider has date of correction (February 8, 2024)
K-0362Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.Deficient, Provider has date of correction (February 28, 2024)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (February 28, 2024)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (February 8, 2024)
K-0753Have restrictions on the use of highly flammable decorations.Deficient, Provider has date of correction (February 8, 2024)
K-0791Ensure that any exit in an area undergoing construction, repair, or improvements shall be inspected daily to ensure its ability to be used instantly in case of emergency.Deficient, Provider has date of correction (February 22, 2024)
K-0923Have proper medical gas storage and administration areas.Deficient, Provider has date of correction (February 8, 2024)

November 10, 2022 — 2 citations

Citations issued on November 10, 2022
TagWhat the surveyor checksStatus
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (November 9, 2022)
K-0916Have a battery powered remote alarm panel in a location accessible by operating personnel.Waiver has been granted (November 9, 2022)

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