Above average — CMS composite of the measures below.
The next survey window likely opens around January 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Hillview Health Care Ctr during CMS and state inspections, most recent first.
The facility failed to develop complete care plans for several residents with identified needs. Records showed missing care plan coverage for anticoagulant therapy, type 1 diabetes with insulin and glucose monitoring, CPAP and respiratory needs, hospice services, and antipsychotic medication use with related side effects. The DON and RN staff acknowledged that these items should have been care planned, but the plans did not include the required focuses, goals, or approaches.
Catheter Bag Left Exposed: A resident with an indwelling Foley catheter and intact cognition was observed with an uncovered drainage bag attached to the calf, with urine visible in the bag and the bag visible from the hallway. The resident stated the exposed bag and urine bothered her and wished it could be covered; CNA and RN confirmed there was no privacy cover, and the DON stated the bag should have been covered to respect dignity.
A resident with moderate cognitive impairment was transferred to the hospital after nausea, emesis, and abdominal pain, with the hospital admission related to ileus. The facility did not provide the resident and/or representative a written transfer notice or appeal rights, and the DON/Administrator and SSM confirmed the transfer form was not given at the time of transfer.
Missing Signed Influenza Vaccine Declinations: The facility failed to obtain signed declinations with documented education on the risks and benefits of the influenza vaccine for two cognitively intact residents who declined the vaccine. Records showed both residents were offered and declined the flu shot, but the EMR and hard chart contained no signed declination or documentation of vaccine education, and the DON stated she was not aware this documentation was required.
Staff routinely cleaned resident room floors using only water, without detergent or disinfectant, despite CDC guidelines requiring a two-step cleaning and disinfection process for bodily fluid spills. CNAs reported being told not to use cleaning products due to concerns about the flooring warranty and product costs. The DON confirmed that water alone was insufficient for proper cleaning and disinfection, resulting in a deficiency in infection control practices.
The facility failed to maintain sanitary food handling practices, with staff observed not following proper hand hygiene protocols. Culinary Services Assistants were seen handling ready-to-eat foods with contaminated hands and not changing gloves between tasks. A Food Service Supervisor acknowledged these improper practices, indicating a lack of adherence to established procedures.
The facility failed to maintain an effective infection control program, as staff were observed improperly handling and disposing of PPE and soiled linens. A CNA and RN were seen exiting rooms with contaminated items without bagging them, and an LPN did not wear a gown during catheter care for a resident under Enhanced Barrier Precautions. These actions violated the facility's infection control policies.
Incomplete Care Plans for Ordered Treatments and Resident Needs
Penalty
Summary
The facility failed to develop complete care plans that addressed residents’ identified needs for 5 of 22 sampled residents. Review of records and interviews showed that care plans were missing for several ordered treatments and conditions, including anticoagulant therapy, diabetes management, CPAP use, hospice services, and antipsychotic medication use with related side effects. The Director of Nursing stated that care plans were started by nurse supervisors and that nurses used the CAA to create the care plan, and also stated that antipsychotic medications and breathing treatments should have a care plan. For R9, the record showed diagnoses including urine retention and multiple psychiatric disorders, a BIMS score of 15, and physician orders for CPAP for sleep and naps and albuterol inhalation as needed for wheezing. The care plan did not address the resident’s respiratory needs or the CPAP and albuterol orders. For R27, the record showed admission to hospice, a BIMS score of 15, and hospice services on the MDS, but the care plan did not address hospice needs or use of hospice services. For R30, the record showed admission to hospice, a BIMS score of 15, and an order for risperidone for dementia with behavioral disturbances, but the care plan did not address psychological needs or antipsychotic medication side effects. For R1, the record showed a diagnosis of long-term anticoagulant use and a prosthetic heart valve, a BIMS score of 15, and a physician order for Coumadin with INR recheck. The comprehensive care plan did not include a focus, goal, or approaches for anticoagulant use, and the DON stated it was not care planned because it was on the MAR. For R2, the record showed type 1 diabetes, long-term insulin use, a BIMS score of 14, and multiple insulin and blood glucose monitoring orders, but the comprehensive care plan did not include a focus, goals, or approaches related to diabetes. RN1 stated that the resident should have a care plan for diabetes. The facility policy stated care plans include instructions needed to provide effective, person-centered services and should be updated as changes occur and as often as needed.
Catheter Bag Left Exposed
Penalty
Summary
The facility failed to ensure the urinary catheter drainage bag was covered for privacy and dignity for one resident with an indwelling catheter. R9 was admitted with a diagnosis of urine retention, had a BIMS score of 15 out of 15 indicating cognitive intactness, and had a care plan goal for the resident's dignity to remain intact. Physician orders documented a Foley catheter for urinary retention. An observation showed R9 wearing a urinary catheter bag with no privacy cover, attached to the left calf, with urine visible in the bag and the bag visible from the hallway while the resident was in her room. R9 stated that the bag and exposed urine bothered her and that she wished there was something to cover it with. Later observations again showed the catheter bag exposed while the resident was in the hallway in her wheelchair. CNA 6 confirmed the bag did not have a privacy cover, RN 2 stated all catheter bags should have a privacy cover and confirmed R9 did not have one, and the DON stated R9 should have a privacy cover to ensure her dignity was respected.
Failure to Provide Hospital Transfer Notice and Appeal Rights
Penalty
Summary
The facility failed to provide a notice of hospital transfer and appeal rights for one resident, R28, out of a sample of 22. Facility policy titled Discharge/Transfer Documents stated that any resident being transferred to the hospital shall have a Resident Transfer Form completed by Nursing Service, the Hospital Transfer Checklist completed, and a copy of the transfer form sent with the resident and filed in the medical record. Review of the record showed R28 was admitted to the facility after sustaining a fracture of the arm/wrist from a fall at home and had a quarterly MDS BIMS score of 12 out of 15, indicating moderate cognitive impairment. Nursing notes documented that R28 developed nausea with yellowish-brown emesis and later requested to go back to the hospital due to continued emesis and abdominal pain. The resident was admitted for ileus and later returned to the facility. During interviews, the DON/Administrator stated, "I don't think we have done this," when asked whether the resident and/or representative was notified in writing of the hospital transfer and appeal rights, and the SSM confirmed that the transfer form was not provided to R28 and/or the representative at the time of transfer.
Missing Signed Influenza Vaccine Declinations
Penalty
Summary
The facility failed to obtain a signed declination that included education on the risks and benefits of the influenza vaccine for 2 of 5 residents reviewed for vaccines. The facility policy titled, Acute Respiratory Illness Protocol, dated 11/30/25, stated that consent would be obtained from the resident or responsible person prior to vaccine administration and that a declination form would be completed if the vaccine was declined. R18 was admitted with a diagnosis of cancer with metastasis to the bone and had a BIMS score of 15 out of 15 on the annual MDS, indicating cognitive intactness. The record showed R18 was offered and declined the influenza vaccine, but the EMR and hard chart contained no signed declination and no documentation that education on the risks and benefits was provided. R30 was admitted with diagnoses including a personal history of mental and behavioral illnesses and had a BIMS score of 15 out of 15 on the quarterly MDS, indicating cognitive intactness. The record showed R30 was offered and declined the influenza vaccine, but the EMR and hard chart contained no signed declination and no documentation that education on the risks and benefits was provided. During interview, the DON stated she was not aware that a vaccine declination needed to be in the medical record with documentation showing the risks and benefits were explained to the resident.
Failure to Follow Infection Control Guidelines for Floor Cleaning
Penalty
Summary
The facility failed to follow infection control and prevention guidelines for environmental cleaning of floors in resident areas for 34 sampled residents. According to interviews and record reviews, staff were routinely mopping resident room floors using only water, without any cleaning solution or disinfectant, contrary to CDC guidelines which require a two-step process of cleaning with detergent and then disinfecting, especially in the case of spills involving bodily fluids. Certified Nurse Aides (CNAs) reported that they were instructed not to use cleaning products due to concerns about the flooring warranty and the cost of approved products. In cases of visible contamination, such as bowel movements, some staff used hydrogen peroxide wipes, but this was not standard practice and was discouraged by management. Staff expressed concerns that using only water did not adequately clean or disinfect the floors and could spread contaminants. The Supportive Systems Manager confirmed that only water had been used for mopping and stated that a new cleaning and disinfecting product was expected to arrive soon. The Director of Nursing acknowledged that using only water was not appropriate, as it did not kill germs, and stated an expectation that staff should use detergent followed by a sanitizer. The facility's practice of cleaning floors with only water, without proper cleaning agents or disinfectants, was inconsistent with both CDC recommendations and internal expectations, leading to a deficiency in infection control practices.
Improper Hand Hygiene and Food Handling Practices
Penalty
Summary
The facility failed to maintain a safe and sanitary environment for food preparation, storage, and distribution, potentially affecting all 51 residents. Observations revealed that staff did not adhere to proper hand hygiene protocols. For instance, a Culinary Services Assistant (CSA) was seen washing hands but turning off the faucet with clean hands, which is against the facility's policy. Another CSA was observed handling ready-to-eat foods with contaminated hands after touching a garbage can lid and not changing gloves between tasks, such as moving items and touching food directly. Further observations included a CSA wearing the same gloves throughout meal service, touching various surfaces and food items without changing gloves. Additionally, a Food Service Supervisor instructed a CSA to wash hands after touching their hair net and face, but the CSA washed hands inadequately and turned off the faucet with clean hands. The Food Service Supervisor acknowledged the improper hand hygiene practices and mentioned that staff should not wear gloves during tray line service but use utensils instead. Despite having training on hand hygiene, the facility lacked written audits, relying only on daily visual checks.
Inadequate Infection Control Practices Observed
Penalty
Summary
The facility failed to establish and maintain an effective infection prevention and control program, as evidenced by multiple observations of improper handling and disposal of personal protective equipment (PPE) and soiled linens. Staff members, including a Certified Nursing Assistant (CNA), a Registered Nurse (RN), and a Nurse Manager, were observed exiting resident rooms with contaminated PPE and linens without placing them in a plastic bag, contrary to the facility's policy. This practice was observed during the care of a resident with wound care needs, where staff members discarded PPE in hallway hampers without proper containment. Further observations revealed that a CNA repeatedly exited resident rooms with soiled linens and PPE gowns not contained in bags, despite Enhanced Barrier Precautions (EBP) signs on the doors. The CNA was seen carrying linens and PPE gowns against her body and disposing of them in hallway bins without proper containment. This practice was inconsistent with the facility's policy, which requires soiled items to be bagged before leaving the resident's room. Additionally, a Licensed Practical Nurse (LPN) failed to don a gown while providing catheter care to a resident under Enhanced Barrier Precautions due to a chronic suprapubic catheter. The LPN acknowledged the need for gown and gloves during such care but did not adhere to the protocol. These actions demonstrate a lack of adherence to the facility's infection control policies, potentially affecting all residents in the facility.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near La Crosse
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Bethany St Joseph Care Ctr | 1 mi | ★★★★★ | 0 | 0 |
| Benedictine Manor Of Lacrosse | 1.3 mi | ★★★★★ | 1 | 0 |
| Riverside | 2.1 mi | ★★★★★ | 12 | 0 |
| La Crescent Health Services | 6.3 mi | ★★★★★ | 25 | 1 |
| Onalaska Care Center | 7.2 mi | ★★★★★ | 1 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.