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

PINE VALLEY COMMUNITY VILLAGE

RICHLAND CENTER, WI · 80 certified beds · Last Life Safety survey July 1, 2026

CMS Certification Number 525365 · first certified August 1984

Also on this campus

The same campus holds a state-licensed assisted living facility, with its own state record on the Assisted Living Index: Pine Valley Assisted Living Center (25951 Circle View Ln). Matched by the telephone number the two records share. The records are separate and are never added together.

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.

18
Citations on file
CMS's current file
3
Life Safety surveys
CMS's current file
2
Tags cited more than once
Across separate surveys
8
Inspection & testing records
Of the citations on file

Position within WI

18 citations — more than 51% 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

Holding steadyabout the same at the latest survey as at its earlier surveys in CMS's current file.

The latest survey found 6 citations; the earlier surveys on file averaged 6. 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 9 months from now. This facility’s last Life Safety survey was July 2026. Facilities in WI are typically surveyed 13–15 months after the last one (median 14), measured over 519 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 about three years in Virginia. 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 cited for sprinkler inspection and testing in CMS’s current file are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Emergency preparedness

2 of the 18 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)

1 physical-environment citation 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 18 Life Safety citations above. The Physical Environment Index

  • F-0880 Provide and implement an infection prevention and control program.

How that compares

Citations in CMS's current file

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

This facility18WI median17National median11
Citations in CMS's current file, compared
MeasureCitations
This facility18
Median facility in WI17
Median facility nationally11

Survey history

Citations at each Life Safety survey
42024-0482025-0562026-07
Citations at each Life Safety survey
Survey dateCitations
April 3, 20244
May 22, 20258
July 1, 20266

Most-cited tags

Most-cited tags at this facility
K-03532K-03622K-07611K-03511K-03451E-00131K-03211K-02911
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0353Inspect, test, and maintain automatic sprinkler systems.22026-07-01
K-0362Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.22026-07-01
K-0761To conduct inspection, testing and maintenance of fire doors by qualified individuals.12025-05-22
K-0351Install an approved automatic sprinkler system.12024-04-03
K-0345Have approved installation, maintenance and testing program for fire alarm systems.12025-05-22
E-0013Develop Emergency Preparedness policies and procedures.12025-05-22
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.12026-07-01
K-0291Install emergency lighting that can last at least 1 1/2 hours.12025-05-22

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 9
  • Gas, Vacuum, and Electrical Systems Deficiencies 4
  • Emergency Preparedness Deficiencies 2
  • Egress Deficiencies 2
  • Other 1
Citations by CMS category
CategoryCitations
Smoke Deficiencies9
Gas, Vacuum, and Electrical Systems Deficiencies4
Emergency Preparedness Deficiencies2
Egress Deficiencies2
Miscellaneous Deficiencies1

Every citation on file

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

July 1, 2026 — 6 citations

Citations issued on July 1, 2026
TagWhat the surveyor checksStatus
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 (July 5, 2026)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (July 15, 2026)
K-0362Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.Deficient, Provider has date of correction (July 5, 2026)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (July 2, 2026)
K-0914Ensure 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 (July 20, 2026)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (July 30, 2026)

May 22, 2025 — 8 citations

Citations issued on May 22, 2025
TagWhat the surveyor checksStatus
E-0013Develop Emergency Preparedness policies and procedures.Deficient, Provider has date of correction (June 20, 2025)
E-0033Establish methods for sharing information.Deficient, Provider has date of correction (June 20, 2025)
K-0223Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.Deficient, Provider has date of correction (June 20, 2025)
K-0291Install emergency lighting that can last at least 1 1/2 hours.Deficient, Provider has date of correction (June 20, 2025)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (June 20, 2025)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (June 20, 2025)
K-0761To conduct inspection, testing and maintenance of fire doors by qualified individuals.Deficient, Provider has date of correction (June 20, 2025)
K-0912Have power receptacles that are properly grounded.Deficient, Provider has date of correction (June 20, 2025)

April 3, 2024 — 4 citations

Citations issued on April 3, 2024
TagWhat the surveyor checksStatus
K-0351Install an approved automatic sprinkler system.Deficient, Provider has date of correction (April 23, 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 (April 23, 2024)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (April 23, 2024)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (April 23, 2024)

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