Facility profile · CCN 525655
Fond Du Lac Lutheran Home
45 federal citations on record , including 1 at the Immediate Jeopardy level, and 1 federal enforcement actions totaling $9,113.
Record summary
Federal record · Q1 202645
Total citations
41
Last 3 years
2
Actual harm+
1
Federal penalties
$9,113
Total fines
1
Overall ★ rating
Most common violation categories here
Most common F-tags at this facility
Citation history
45 on record| Survey | F-Tag | Violation | Severity | Source |
|---|---|---|---|---|
| Mar 27, 2025 | F947 | Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. | D | Complaint |
| Mar 27, 2025 | F846 | Have policies and procedures ensuring the administrator's responsibilities for facility closure are completed successfully. | C | Complaint |
| Mar 27, 2025 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | J | Complaint |
| Mar 27, 2025 | F584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | D | Complaint |
| Dec 19, 2024 | F607 | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | D | Complaint |
| Sep 24, 2024 | F684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | G | Complaint |
| Sep 24, 2024 | F610 | Respond appropriately to all alleged violations. | D | Complaint |
| Jul 10, 2024 | F880 | Provide and implement an infection prevention and control program. | D | Standard |
| Jul 10, 2024 | F761 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | D | Standard |
| Jul 10, 2024 | F755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Standard |
| Jul 10, 2024 | F725 | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | E | Standard |
| Jul 10, 2024 | F700 | Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. | D | Standard |
| Jul 10, 2024 | F691 | Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services. | D | Standard |
| Jul 10, 2024 | F690 | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | D | Standard |
| Jul 10, 2024 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard |
| Jul 10, 2024 | F677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Standard |
| Jul 10, 2024 | F656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Standard |
| Jul 10, 2024 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Standard |
| Jul 10, 2024 | F600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | Standard |
| Jul 10, 2024 | F554 | Allow residents to self-administer drugs if determined clinically appropriate. | D | Standard |
| Jul 10, 2024 | F551 | Give the resident's representative the ability to exercise the resident's rights. | D | Standard |
| Jul 10, 2024 | F550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | Standard |
| Apr 10, 2024 | F726 | Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | D | Complaint |
| Apr 10, 2024 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Complaint |
| Apr 10, 2024 | F684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Complaint |
| Nov 27, 2023 | F880 | Provide and implement an infection prevention and control program. | E | Complaint |
| Nov 27, 2023 | F684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Complaint |
| Nov 27, 2023 | F585 | Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | D | Complaint |
| Aug 3, 2023 | F755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Complaint |
| Jul 17, 2023 | F887 | Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. | D | — |
| Jul 17, 2023 | F883 | Develop and implement policies and procedures for flu and pneumonia vaccinations. | D | — |
| May 24, 2023 | F883 | Develop and implement policies and procedures for flu and pneumonia vaccinations. | D | Standard |
| May 24, 2023 | F725 | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | F | Standard |
| May 24, 2023 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard |
| May 24, 2023 | F686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | Standard |
| May 24, 2023 | F684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Standard |
| May 24, 2023 | F677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Standard |
| May 24, 2023 | F610 | Respond appropriately to all alleged violations. | D | Standard |
| May 24, 2023 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Standard |
| May 24, 2023 | F585 | Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | D | Standard |
| May 24, 2023 | F554 | Allow residents to self-administer drugs if determined clinically appropriate. | D | Standard |
| Mar 17, 2023 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Complaint |
| May 25, 2022 | F698 | Provide safe, appropriate dialysis care/services for a resident who requires such services. | D | Standard |
| May 25, 2022 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard |
| May 25, 2022 | F677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Standard |
Federal enforcement history
Federal regulators have imposed 1 enforcement actions against this facility, including 1 civil money penalties totaling $9,113 .
| Date | Type | Fine | Payment denial |
|---|---|---|---|
| Mar 27, 2025 | Fine | $9,113 | — |
About this record
A citation is a finding by a state survey team working under federal contract. It is not a court
judgment. The description above is drawn verbatim from federal public datasets. Facilities have
the right to appeal findings through an Informal Dispute Resolution (IDR/IIDR) process.
Concerned about care at Fond Du Lac Lutheran Home?
An attorney who focuses on nursing-home abuse and neglect can review the facility's record with you — citation patterns, scope/severity levels, complaint-driven findings — and tell you whether the law recognizes what happened.
- Consultation is free and confidential
- You pay nothing unless there is a recovery
- Your note is shared only with vetted plaintiff attorneys