Federal inspection record · CMS data as of October 1, 2026
Holton Manor
645 N Church St, Elkhorn, WI · (262) 723-4963
- Certified beds
- 60
- Residents per day
- 53
- Ownership
- Non-Profit
- Chain
- Wisconsin Illinois Senior Housing, Inc.
- Medicare / Medicaid
- Medicare + Medicaid
- Certified since
- March 16, 1994
1
How this home got 2 stars
The overall rating isn't an average. CMS starts from the inspection rating and nudges it at most two steps. Here is the arithmetic for this home, using CMS's own rules.
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Health inspections
★★★★★starting point
Everything starts from what state inspectors found on site. This is a ranking against other homes in Wisconsin.
-
Staffing
★★★★★no change
Only a 5-star staffing rating adds a star, and only a 1-star rating removes one. Ratings of 2 to 4 change nothing.
-
Quality measures
★★★★★no change
Same rule: 5 stars adds one, 1 star takes one away. These measures are mostly reported by the home itself.
-
Overall
★★★★★2 of 5
Matches the rating CMS publishes on Care Compare.
2
Where it sits among Wisconsin homes
Holton Manor carries 116.5 inspection points. That is fewer than 24% of Wisconsin's 321 rated homes.
Inspectors' citations earn points by how serious and how widespread they were (the grid below). CMS then ranks every home in Wisconsin: the 10% with the fewest points get 5 stars, the 20% with the most get 1 star, and the middle 70% split evenly into 2, 3 and 4.
- 5★ 0–11 pts
- 4★ 11–37 pts
- 3★ 37–76 pts
- 2★ 76–130.75 pts
- 1★ over 130.75 pts
Bars show every rated home in Wisconsin by its weighted inspection score. CMS recalibrates the cut points monthly but holds a home's rating until its own score changes, so a home can sit just outside today's band.
3
What inspectors found
17 health citations on record since 2023. Each one gets a letter: the row says how badly residents were affected, the column how many.
Immediate jeopardyResidents at risk of serious injury or death
Actual harmA resident was hurt
Potential for harmNo one was hurt, but could have been
Minimal harmPaperwork-level problems
Read the rows, not the total. Most citations nationwide are a D: one problem, nobody hurt. Rows G–I mean a resident was harmed; J–L mean inspectors found residents in immediate danger of serious injury or death.
Small numbers in each cell are the inspection points CMS assigns per citation. Those points are what the state curve above ranks.
Harm and immediate-jeopardy citations (3)
-
G
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
-
G
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
-
G
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Everything else, by area of care
Quality of Life and Care5E
- D
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
- D
Provide care and assistance to perform activities of daily living for any resident who is unable.
- D
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.
- D
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
- E
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Nursing and Physician Services3E
- C
Post nurse staffing information every day.
- E
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
- D
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.
Infection Control2F
- F
Provide and implement an infection prevention and control program.
- F
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Freedom from Abuse, Neglect, and Exploitation2D
- D
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- D
Respond appropriately to all alleged violations.
Resident Assessment and Care Planning1D
- D
PASARR screening for Mental disorders or Intellectual Disabilities
Resident Rights1D
- D
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.
Inspection history
2026-05-06
10 health deficiencies · 9 fire-safety deficiencies
Top issue: Quality of Life and Care (6 deficiencies)
2024-11-27
2 health deficiencies · 4 fire-safety deficiencies
Top issue: Nursing and Physician Services (2 deficiencies)
2023-08-24
5 health deficiencies · 4 fire-safety deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (2 deficiencies)
4
Nursing time per resident, per day
Each resident here gets about 4 h 25 min of nursing staff time a day, 42 min of it from a registered nurse.
This home
4 h 25 min
Wisconsin average
4 h 15 min
U.S. average
3 h 54 min
- Registered nurse
- Licensed practical nurse
- Nurse aide
Turnover: 48% of nursing staff and 33% of registered nurses left in the past year.
Reported hours from payroll data the home submits to CMS, divided by its daily resident count. Not adjusted for how sick residents are.
5
Resident outcomes
Quality measures compared with state and national averages. Most come from assessments the home itself reports.
| Measure | This home | State | U.S. |
|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days0.6 pts better | 1.0 | 1.6 | 1.8 |
| Number of outpatient emergency department visits per 1000 long-stay resident days0.1 pts worse | 2.3 | 2.2 | 1.7 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine4 pts better | 100.0% | 96.0% | 93.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine4.4 pts better | 100.0% | 95.6% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury2.6 pts better | 0.7% | 3.3% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms5.3 pts better | 0.7% | 6.0% | 13.5% |
| Percentage of long-stay residents who lose too much weight4.9 pts better | 0.0% | 4.9% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication5.2 pts worse | 22.0% | 16.8% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication4.1 pts worse | 20.0% | 15.9% | 15.4% |
| Percentage of long-stay residents who were physically restrained0.1 pts better | 0.0% | 0.1% | 0.1% |
| Percentage of long-stay residents whose ability to walk independently worsened8.5 pts worse | 25.5% | 17.0% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased2.2 pts worse | 18.0% | 15.8% | 13.5% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder1.9 pts better | 0.0% | 1.9% | 0.7% |
| Percentage of long-stay residents with a urinary tract infection1.3 pts better | 1.4% | 2.7% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence4.3 pts better | 19.3% | 23.6% | 18.3% |
| Percentage of long-stay residents with pressure ulcers2.1 pts worse | 7.0% | 4.9% | 4.5% |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine12.4 pts better | 99.3% | 86.9% | 82.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit11.8 pts worse | 27.4% | 15.6% | 11.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication0.7 pts better | 0.5% | 1.2% | 1.5% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine15.9 pts better | 98.1% | 82.2% | 80.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission5.6 pts worse | 28.1% | 22.5% | 23.4% |
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Who owns and runs it
26 owners and managers reported to CMS. The last column counts how many nursing homes each one is tied to.
Show ownership list
| Name | Role | Share | Homes |
|---|---|---|---|
| Carriage Healthcare Companies Inc | Operational/Managerial Control · Organization | 0% | 8 facilities |
| Dupont, Lori | Corporate Officer · Individual | 0% | 6 facilities |
| Dupont, Lori | Operational/Managerial Control · Individual | 0% | 6 facilities |
| Gehler, Miriam | Corporate Director · Individual | 0% | 7 facilities |
| Gehler, Miriam | Operational/Managerial Control · Individual | 0% | 7 facilities |
| Gerlach, Keri | Corporate Director · Individual | 0% | 4 facilities |
| Gerlach, Keri | Operational/Managerial Control · Individual | 0% | 4 facilities |
| Hbt It LLC | Adp Of The SNF · Organization | 0% | 6 facilities |
| Jt And Associates LLC | Adp Of The SNF · Organization | 0% | 6 facilities |
| Kerwin, Andrew | Corporate Officer · Individual | 0% | 7 facilities |
| Kerwin, Andrew | Operational/Managerial Control · Individual | 0% | 7 facilities |
| Kerwin, Andrew | Individual Is An Owner, Partner Or Trustee Of Any Adp Of The SNF · Individual | 0% | 7 facilities |
| Kumar, Rajeev Shiva | Corporate Director · Individual | 0% | 7 facilities |
| Kumar, Rajeev Shiva | Operational/Managerial Control · Individual | 0% | 7 facilities |
| Lynn, Nicholas | Corporate Director · Individual | 0% | 7 facilities |
| Lynn, Nicholas | Operational/Managerial Control · Individual | 0% | 7 facilities |
| Oak Medical Sc | Adp Of The SNF · Organization | 0% | 7 facilities |
| Partners In Wealth Management, Inc | Adp Of The SNF · Organization | 0% | 6 facilities |
| Pinion, LLC | Adp Of The SNF · Organization | 0% | 6 facilities |
| Rehab Solutions Group, LLC | Adp Of The SNF · Organization | 0% | 7 facilities |
| Sarasin, Alyssa | Adp Of The SNF · Individual | 0% | 1 facilities |
| Sherman, Stephanie | Operational/Managerial Control · Individual | 0% | 7 facilities |
| Sherman, Stephanie | Adp Of The SNF · Individual | 0% | 7 facilities |
| Siebel, Robert | Operational/Managerial Control · Individual | 0% | 4 facilities |
| Siebel, Robert | Adp Of The SNF · Individual | 0% | 4 facilities |
| Twomagnets LLC | Adp Of The SNF · Organization | 0% | 57 facilities |
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Fire safety
17 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Miscellaneous4F
- F
Have simulated fire drills held at unexpected times.
- E
Have restrictions on the use of highly flammable decorations.
- D
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
- D
Have restrictions on the use of portable space heaters.
Gas, Vacuum, and Electrical Systems4F
- F
Have generator or other power source capable of supplying service within 10 seconds.
- D
Ensure that sources of ignition are removed from patients receiving respiratory therapy.
- F
Meet requirements for the installation and maintenance of electrical systems.
- E
Have proper medical gas storage and administration areas.
Egress4E
- E
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
- E
Have exits that are accessible at all times.
- E
Keep aisles, corridors, and exits free of obstruction in case of emergency.
- E
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Services3F
- D
Have properly installed electrical wiring and gas equipment.
- F
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
- E
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Smoke2F
- E
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- F
Inspect, test, and maintain automatic sprinkler systems.
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Other homes nearby
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Lakeland Health Care Ctr
Elkhorn, WI
★★★★★- Worst citation, 3 yrs
- K
- Nursing / resident / day
- 4 h
- Fines
- $84,168
-
Delavan Health Services
Delavan, WI · North Shore Healthcare
★★★★★- Worst citation, 3 yrs
- F
- Nursing / resident / day
- 3 h 29 min
- Fines
- $0
-
Williams Bay Health Services
Williams Bay, WI · North Shore Healthcare
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 3 h 31 min
- Fines
- $0