Hillside Manor
803 S University Ave · Beaver Dam, WI · 53916 · 9208875901
115 certified beds Non profit - Corporation Chain: Sanford Health Hospital-based
Why this verdict
- Inspectors found immediate jeopardy — danger of serious harm or death — in the most recent cycle (1 citation).
- Inspection record is far worse than the national median (deficiency count and severity).
- Federal penalties on record: $227,895 in fines in the last 24 months.
- Inspection results are getting worse cycle over cycle, not better.
- Staffing hours comfortably above national benchmarks.
Red flags
1 immediate-jeopardy citation in the most recent inspection cycle
Immediate jeopardy is the most serious finding an inspector can make: a situation likely to cause serious injury, harm, or death.
$227,895 in federal fines in the last 24 months
1 fine — CMS fines are reserved for verified, serious non-compliance.
If someone you love was harmed at a facility with findings like these, you have options — read this.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 1 of 5 Inspections: 1 of 5 Staffing: 4 of 5 Quality measures: 3 of 5
| Total nurse hours / resident-day | 4.18 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 1.07 | 0.55–0.75 |
| Weekend hours / resident-day | 3.70 | ≈ weekday level |
| Nursing turnover / year | 53% | median 45% |
| Fines (3-yr window) | 1 · $227,895 |
Inspection citations (29 in the current record)
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Actual harm · G March 12, 2026
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected April 4, 2026 · Quality of Life and Care
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Potential for harm · D March 12, 2026
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected April 4, 2026 · Resident Rights
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Potential for harm · D March 12, 2026
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected April 4, 2026 · Quality of Life and Care
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Potential for harm · D March 12, 2026
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected April 4, 2026 · Quality of Life and Care
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Potential for harm · D March 12, 2026
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Corrected April 4, 2026 · Quality of Life and Care
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Potential for harm · E March 12, 2026
Ensure medication error rates are not 5 percent or greater.
Corrected April 4, 2026 · Pharmacy Service
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Potential for harm · D March 12, 2026
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected April 4, 2026 · Nutrition and Dietary
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Potential for harm · F March 12, 2026
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected April 4, 2026 · Nutrition and Dietary
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Potential for harm · D March 12, 2026
Provide and implement an infection prevention and control program.
Corrected April 4, 2026 · Infection Control
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Immediate jeopardy · J July 21, 2025 · found via complaint
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected July 22, 2025 · Quality of Life and Care
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Potential for harm · D July 21, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected July 22, 2025 · Quality of Life and Care
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Potential for harm · D July 21, 2025 · found via complaint
Ensure that the resident and his/her doctor meet face-to-face at all required visits.
Corrected July 24, 2025 · Nursing and Physician Services
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Potential for harm · D June 24, 2025 · found via complaint
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 July 24, 2025 · Resident Rights
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Potential for harm · D June 24, 2025 · found via complaint
Respond appropriately to all alleged violations.
Corrected July 24, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Actual harm · G November 14, 2024 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected December 31, 2024 · Quality of Life and Care
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Potential for harm · D November 14, 2024
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Corrected December 31, 2024 · Resident Rights
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Potential for harm · D November 14, 2024
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected December 31, 2024 · Resident Assessment and Care Planning
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Potential for harm · D November 14, 2024
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected December 31, 2024 · Pharmacy Service
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Potential for harm · D November 14, 2024
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 December 31, 2024 · Pharmacy Service
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Potential for harm · D November 14, 2024
Ensure medication error rates are not 5 percent or greater.
Corrected December 31, 2024 · Pharmacy Service
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Potential for harm · D November 14, 2024
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 December 31, 2024 · Pharmacy Service
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Potential for harm · F November 14, 2024
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected December 31, 2024 · Nutrition and Dietary
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Potential for harm · D November 14, 2024
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Corrected December 31, 2024 · Nutrition and Dietary
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Potential for harm · F November 14, 2024
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected December 31, 2024 · Nutrition and Dietary
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Potential for harm · F November 14, 2024
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
Corrected December 31, 2024 · Administration
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| June 24, 2025 | Fine | $227,895 |
| November 14, 2024 | Payment Denial | 20 days |
Family & resident reviews — a separate signal, never mixed into the score
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 525447 · certified since November 15, 1989. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.