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

DOVE HEALTHCARE - ST CROIX FALLS

ST CROIX FALLS, WI · 50 certified beds · Last Life Safety survey September 18, 2025

CMS Certification Number 525532 · first certified June 1994

Ownership

Operated by DOVE HEALTHCARE · For profit - Limited Liability company

  • Ownership changed February 15, 2019 (change of ownership)to DIVINE REHABILITATION AND NURSING AT ST CROIX LLC from THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
13
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
2
Tags cited more than once
Across separate surveys
5
Inspection & testing records
Of the citations on file

Position within WI

13 citations — more than 28% 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 6 citations; the earlier surveys in the window averaged 3.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window opens October 2026 — about 1 month from now. This facility’s last Life Safety survey was September 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.

Physical environment (health survey)

8 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 13 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 facility13WI median17National median11
Citations on file over three years, compared
MeasureCitations
This facility13
Median facility in WI17
Median facility nationally11

Survey history

Citations at each Life Safety survey
22023-0752024-0762025-09
Citations at each Life Safety survey
Survey dateCitations
July 12, 20232
July 17, 20245
September 18, 20256

Most-cited tags

Most-cited tags at this facility
K-09182K-03212K-01311K-03411K-01321K-03631K-03721K-07531
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0918Have generator or other power source capable of supplying service within 10 seconds.22025-09-18
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.22025-09-18
K-0131Meet requirements for sections of health care facilities separated by fire resistive construction.12024-07-17
K-0341Install a fire alarm system that can be heard throughout the facility.12025-09-18
K-0132Meet requirements for outpatient facilities located next to inpatient facilities separated by fire resistive construction.12025-09-18
K-0363Install corridor and hallway doors that block smoke.12023-07-12
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.12023-07-12
K-0753Have restrictions on the use of highly flammable decorations.12024-07-17

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 7
  • Construction Deficiencies 2
  • Gas, Vacuum, and Electrical Systems Deficiencies 2
  • Miscellaneous Deficiencies 1
  • Other 1
Citations by CMS category
CategoryCitations
Smoke Deficiencies7
Construction Deficiencies2
Gas, Vacuum, and Electrical Systems Deficiencies2
Miscellaneous Deficiencies1
Egress Deficiencies1

Every citation on file

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

September 18, 2025 — 6 citations

Citations issued on September 18, 2025
TagWhat the surveyor checksStatus
K-0132Meet requirements for outpatient facilities located next to inpatient facilities separated by fire resistive construction.Deficient, Provider has date of correction (November 19, 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 (October 18, 2025)
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 (October 18, 2025)
K-0341Install a fire alarm system that can be heard throughout the facility.Deficient, Provider has date of correction (October 18, 2025)
K-0351Install an approved automatic sprinkler system.Deficient, Provider has date of correction (October 18, 2025)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (October 18, 2025)

July 17, 2024 — 5 citations

Citations issued on July 17, 2024
TagWhat the surveyor checksStatus
K-0131Meet requirements for sections of health care facilities separated by fire resistive construction.Deficient, Provider has date of correction (August 27, 2024)
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 (August 27, 2024)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (August 27, 2024)
K-0753Have restrictions on the use of highly flammable decorations.Deficient, Provider has date of correction (August 27, 2024)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (August 27, 2024)

July 12, 2023 — 2 citations

Citations issued on July 12, 2023
TagWhat the surveyor checksStatus
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (August 21, 2023)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (August 21, 2023)

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