Deficiency timeline
Ascension Living - Lakeshore at Siena
Dated inspection findings, penalties, and correction notes for this nursing home in Racine, WI. Newest events first.
- Class IIActual harm (H)cms
F0686: Quality of Life and Care
Quality of life & care
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected Apr 27, 2026
- Class IIActual harm (G)Complaint-relatedcms
F0689: Quality of Life and Care
Quality of life & care
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected Apr 27, 2026
- Class IIActual harm (G)cms
F0744: Quality of Life and Care
Quality of life & care
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (F)cms
F0606: Freedom from Abuse, Neglect, and Exploitation
Abuse, neglect & exploitation
Not hire anyone with a finding of abuse, neglect, exploitation, or theft.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (F)cms
F0842: Resident Assessment and Care Planning
Assessment & care planning
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (F)cms
F0865: Administration
Administration
Have a plan that describes the process for conducting QAPI and QAA activities.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (F)cms
F0868: Administration
Administration
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (F)cms
F0880: Infection Control
Infection control
Provide and implement an infection prevention and control program.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (F)cms
F0881: Infection Control
Infection control
Implement a program that monitors antibiotic use.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (F)cms
F0882: Infection Control
Infection control
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (F)cms
F0944: Administration
Administration
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (E)cms
F0657: Resident Assessment and Care Planning
Assessment & care planning
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (E)Complaint-relatedcms
F0684: Quality of Life and Care
Quality of life & care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (E)Complaint-relatedcms
F0755: Pharmacy Service
Pharmacy services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (E)cms
F0761: Pharmacy Service
Pharmacy services
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.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)cms
F0561: Resident Rights
Resident rights
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)cms
F0585: Resident Rights
Resident rights
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.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0609: Freedom from Abuse, Neglect, and Exploitation
Abuse, neglect & exploitation
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0610: Freedom from Abuse, Neglect, and Exploitation
Abuse, neglect & exploitation
Respond appropriately to all alleged violations.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)cms
F0628: Resident Rights
Resident rights
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)cms
F0688: Quality of Life and Care
Quality of life & care
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)cms
F0690: Quality of Life and Care
Quality of life & care
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)cms
F0695: Quality of Life and Care
Quality of life & care
Provide safe and appropriate respiratory care for a resident when needed.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)cms
F0756: Pharmacy Service
Pharmacy services
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)cms
F0757: Pharmacy Service
Pharmacy services
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0759: Pharmacy Service
Pharmacy services
Ensure medication error rates are not 5 percent or greater.
Corrected Mar 31, 2026
- Class IVMinimal harm / potential for minimal harm (C)Complaint-relatedcms
F0732: Nursing and Physician Services
Nursing & physician services
Post nurse staffing information every day.
Corrected Mar 31, 2026
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0610: Freedom from Abuse, Neglect, and Exploitation
Abuse, neglect & exploitation
Respond appropriately to all alleged violations.
Corrected Aug 8, 2025
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0692: Quality of Life and Care
Quality of life & care
Provide enough food/fluids to maintain a resident's health.
Corrected Aug 8, 2025
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0609: Freedom from Abuse, Neglect, and Exploitation
Abuse, neglect & exploitation
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected Jun 19, 2025
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0842: Resident Assessment and Care Planning
Assessment & care planning
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected Mar 7, 2025
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0689: Quality of Life and Care
Quality of life & care
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected Jan 21, 2025
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0755: Pharmacy Service
Pharmacy services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected Jan 21, 2025
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0563: Resident Rights
Resident rights
Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing.
Corrected Nov 1, 2024
- Class IIIPotential for more than minimal harm (D)cms
F0578: Resident Rights
Resident rights
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Corrected Nov 1, 2024
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0600: Freedom from Abuse, Neglect, and Exploitation
Abuse, neglect & exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected Oct 23, 2024
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0609: Freedom from Abuse, Neglect, and Exploitation
Abuse, neglect & exploitation
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected Nov 1, 2024
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0610: Freedom from Abuse, Neglect, and Exploitation
Abuse, neglect & exploitation
Respond appropriately to all alleged violations.
Corrected Nov 1, 2024
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0745: Quality of Life and Care
Quality of life & care
Provide medically-related social services to help each resident achieve the highest possible quality of life.
Corrected Nov 1, 2024
- cms
Payment denial
Medicare/Medicaid payment denial issued following a survey deficiency.
- Class IIActual harm (G)Complaint-relatedcms
F0686: Quality of Life and Care
Quality of life & care
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected Oct 23, 2024
- Class IIIPotential for more than minimal harm (E)Complaint-relatedcms
F0908: Environmental
Environment
Keep all essential equipment working safely.
Corrected Oct 23, 2024
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0677: Quality of Life and Care
Quality of life & care
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected May 14, 2024
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0684: Quality of Life and Care
Quality of life & care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected May 14, 2024
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0585: Resident Rights
Resident rights
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.
Corrected May 14, 2024
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0689: Quality of Life and Care
Quality of life & care
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected Mar 7, 2024
- Class IIIPotential for more than minimal harm (D)Complaint-relatedcms
F0686: Quality of Life and Care
Quality of life & care
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected Mar 7, 2024
- Class IIIPotential for more than minimal harm (E)Complaint-relatedcms
F0755: Pharmacy Service
Pharmacy services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected Nov 9, 2023
- Class IIIPotential for more than minimal harm (E)cms
F0755: Pharmacy Service
Pharmacy services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected Jul 26, 2023
- Class IIIPotential for more than minimal harm (E)cms
F0867: Administration
Administration
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Corrected Jul 20, 2023
- Class IIIPotential for more than minimal harm (D)cms
F0661: Resident Assessment and Care Planning
Assessment & care planning
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
Corrected Jul 26, 2023
- Class IIIPotential for more than minimal harm (D)cms
F0686: Quality of Life and Care
Quality of life & care
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected Jul 20, 2023
- Class IIIPotential for more than minimal harm (E)cms
F0641: Resident Assessment and Care Planning
Assessment & care planning
Ensure each resident receives an accurate assessment.
Corrected Aug 7, 2023
- Class IIIPotential for more than minimal harm (D)cms
F0692: Quality of Life and Care
Quality of life & care
Provide enough food/fluids to maintain a resident's health.
Corrected Jul 26, 2023
- Class IIIPotential for more than minimal harm (D)cms
F0756: Pharmacy Service
Pharmacy services
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected Jul 20, 2023
- Class IIIPotential for more than minimal harm (D)cms
F0758: Pharmacy Service
Pharmacy services
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected Jul 26, 2023
- Class IVMinimal harm / potential for minimal harm (C)cms
F0732: Nursing and Physician Services
Nursing & physician services
Post nurse staffing information every day.
Corrected Jul 15, 2023
- Class IIIPotential for more than minimal harm (D)cms
F0689: Quality of Life and Care
Quality of life & care
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected Jul 26, 2023
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AHCA class rollups without individual citation dates appear as a single summary row. CMS nursing home deficiencies include survey date, tag, category, scope/severity, and fine amounts when published. Back to community profile