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

Lake Mills Health Services

LAKE MILLS, WI · 50 certified beds · Last Life Safety survey March 26, 2025

CMS Certification Number 525314 · first certified July 1981

Ownership

Operated by NORTH SHORE HEALTHCARE · For profit - Corporation

  • Ownership changed October 1, 2017 (change of ownership)from FMG MULBERRY STREET WISCONSIN LLC
29
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
5
Tags cited more than once
Across separate surveys
13
Inspection & testing records
Of the citations on file

Position within WI

29 citations — more than 84% 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

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

The latest survey found 11 citations; the earlier surveys in the window averaged 9. 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 (May 2026 to June 2026), and past the point by which nine in ten WI facilities have been surveyed. This facility’s last Life Safety survey was March 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

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

4 of the 29 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)

4 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 29 Life Safety citations above. The Physical Environment Index

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

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 facility29WI median17National median11
Citations on file over three years, compared
MeasureCitations
This facility29
Median facility in WI17
Median facility nationally11

Survey history

Citations at each Life Safety survey
92022-1092024-02112025-03
Citations at each Life Safety survey
Survey dateCitations
October 17, 20229
February 8, 20249
March 26, 202511

Most-cited tags

Most-cited tags at this facility
K-03633K-03533E-00133K-03452K-07532K-03721K-01311K-03621
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0363Install corridor and hallway doors that block smoke.32025-03-26
K-0353Inspect, test, and maintain automatic sprinkler systems.32025-03-26
E-0013Develop Emergency Preparedness policies and procedures.32025-03-26
K-0345Have approved installation, maintenance and testing program for fire alarm systems.22024-02-08
K-0753Have restrictions on the use of highly flammable decorations.22025-03-26
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.12022-10-17
K-0131Meet requirements for sections of health care facilities separated by fire resistive construction.12024-02-08
K-0362Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.12024-02-08

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 14
  • Miscellaneous Deficiencies 5
  • Emergency Preparedness Deficiencies 4
  • Gas, Vacuum, and Electrical Systems Deficiencies 3
  • Other 3
Citations by CMS category
CategoryCitations
Smoke Deficiencies14
Miscellaneous Deficiencies5
Emergency Preparedness Deficiencies4
Gas, Vacuum, and Electrical Systems Deficiencies3
Egress Deficiencies2
Construction Deficiencies1

Every citation on file

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

March 26, 2025 — 11 citations

Citations issued on March 26, 2025
TagWhat the surveyor checksStatus
E-0013Develop Emergency Preparedness policies and procedures.Deficient, Provider has date of correction (April 10, 2025)
E-0031Provide emergency officials' contact information.Deficient, Provider has date of correction (April 10, 2025)
K-0281Install proper backup exit lighting.Deficient, Provider has date of correction (April 15, 2025)
K-0347Properly provide smoke detection systems in areas open to corridors.Deficient, Provider has plan of correction (August 1, 2025)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (April 9, 2025)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (April 14, 2025)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (March 31, 2025)
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 (April 16, 2025)
K-0753Have restrictions on the use of highly flammable decorations.Deficient, Provider has date of correction (April 9, 2025)
K-0761To conduct inspection, testing and maintenance of fire doors by qualified individuals.Deficient, Provider has date of correction (April 15, 2025)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (April 16, 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 (March 21, 2024)
K-0131Meet requirements for sections of health care facilities separated by fire resistive construction.Deficient, Provider has date of correction (March 21, 2024)
K-0324Provide properly protected cooking facilities.Deficient, Provider has date of correction (March 21, 2024)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (March 21, 2024)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (March 26, 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 (March 21, 2024)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (March 21, 2024)
K-0753Have restrictions on the use of highly flammable decorations.Deficient, Provider has date of correction (March 21, 2024)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (March 21, 2024)

October 17, 2022 — 9 citations

Citations issued on October 17, 2022
TagWhat the surveyor checksStatus
E-0013Develop Emergency Preparedness policies and procedures.Deficient, Provider has date of correction (October 21, 2022)
K-0293Have properly located and lighted "Exit" signs.Deficient, Provider has date of correction (November 11, 2022)
K-0321Ensure 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 (November 10, 2022)
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 (November 15, 2022)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (November 16, 2022)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (November 11, 2022)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (November 11, 2022)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (November 11, 2022)
K-0911Meet requirements for the installation and maintenance of electrical systems.Deficient, Provider has date of correction (November 11, 2022)

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