Cycle 1
Health 2025-04-16 · Fire 2025-04-16
0 health deficiencies
No concentrated health issue counts in this cycle.
4 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Reedsburg, WI
Ridgeview Terrace Long Term Care
5-star overall rating with 5-star inspections with 4 fire-safety deficiencies in the latest cycle
2350 N Dewey Ave, Reedsburg, WI
(608) 524-6577
Overall
5 / 5
CMS overall stars
Health inspections
5 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
25
Certified beds
Average residents
22
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
2003-03-31
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
1.64
Registered nurse staffing · state 0.97 · national 0.68
LPN hours / resident day
0.00
Licensed practical nurse staffing
Aide hours / resident day
3.37
Nurse aide staffing · state 2.59 · national 2.35
Total nurse hours
5.01
All reported nurse hours · state 4.20 · national 3.89
Licensed hours
1.64
RN + LPN hours · state 1.60 · national 1.54
Weekend hours
4.58
Weekend nurse staffing · state 3.72 · national 3.43
Weekend RN hours
1.32
Weekend registered nurse coverage · state 0.66 · national 0.47
Physical therapist
0.08
Reported PT staffing · state 0.06 · national 0.07
Adjusted RN hours
1.84
CMS adjusted RN staffing hours
Adjusted total hours
5.61
CMS adjusted total nurse staffing hours
Case-mix index
1.22
Higher values indicate more complex resident acuity
RN turnover
11%
Annual RN turnover · state 42% · national 45%
Total nurse turnover
39%
Annual nurse turnover · state 48% · national 46%
SNF VBP
Value-based purchasing
Program rank
2,183
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
51.18
Composite VBP score used to determine payment impact.
Payment multiplier
1.0055
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
2.58
Performance 20.23% · Measure score 2.58 · Achievement 2.58 · This facility did not have sufficient data to calculate a baseline period measure result.
Healthcare-associated infections
5.13
Performance 6.30% · Measure score 5.13 · Achievement 5.13 · This facility did not have sufficient data to calculate a baseline period measure result.
Total nurse turnover
7.65
Performance 32.43% · Measure score 7.65 · Achievement 7.65 · This facility did not have sufficient data to calculate a baseline period measure result.
Adjusted total nurse staffing
Not reported
This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10% |
10.72%
0.7 pts better
|
No Different than the National Rate · Eligible stays 41 · Observed rate 4.88% · Lower 95% interval 6.88% |
| Discharge to community | 48.01% |
50.57%
2.6 pts worse
|
No Different than the National Rate · Eligible stays 44 · Observed rate 45.45% · Lower 95% interval 35.65% |
| Medicare spending per beneficiary | 0.87 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 34 · Denominator 34 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 34 |
| Discharge self-care score | 55.17% |
53.69%
1.5 pts better
|
Numerator 16 · Denominator 29 |
| Discharge mobility score | 37.93% |
50.94%
13 pts worse
|
Numerator 11 · Denominator 29 |
| Pressure ulcers or injuries, new or worsened | 0% |
2.29%
2.3 pts better
|
Numerator 0 · Denominator 34 · Adjusted rate 0% |
| Healthcare-associated infections requiring hospitalization | 6.3% |
7.12%
0.8 pts better
|
No Different than the National Rate · Eligible stays 27 · Observed rate 0% · Lower 95% interval 2.82% |
| Staff COVID-19 vaccination coverage | 10.96% |
8.2%
2.8 pts better
|
Numerator 8 · Denominator 73 |
| Staff flu vaccination coverage | 54.37% |
42%
12.4 pts better
|
Numerator 56 · Denominator 103 |
| Discharge function score | 62.07% |
56.45%
5.6 pts better
|
Numerator 18 · Denominator 29 |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 10 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 17 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | Not Available |
25.2%
|
Numerator Not Available · Denominator 15 · Too few residents or stays to report publicly. |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 89.9% |
95.7%
5.8 pts worse
|
93.4%
3.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q3 90.5% · Q4 95.0% · 4Q avg 89.9% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
95.0%
5 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 5.1% |
3.2%
1.9 pts worse
|
3.3%
1.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q3 4.8% · Q4 5.0% · 4Q avg 5.1% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
5.0%
5 pts better
|
11.4%
11.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents who lose too much weight | 0.0% |
4.9%
4.9 pts better
|
5.4%
5.4 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 0.0% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 13.7% |
16.6%
2.9 pts better
|
19.6%
5.9 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 13.7% |
| Percentage of long-stay residents who received an antipsychotic medication | 0.0% |
16.7%
16.7 pts better
|
16.7%
16.7 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.1%
0.1 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 19.7% |
21.1%
1.4 pts better
|
16.3%
3.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 19.7% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 12.2% |
17.3%
5.1 pts better
|
14.9%
2.7 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 12.2% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
2.3%
2.3 pts better
|
1.0%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q3 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.0% |
3.0%
3 pts better
|
1.7%
1.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q3 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 28.9% |
25.5%
3.4 pts worse
|
19.8%
9.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q3 28.6% · 4Q avg 28.9% |
| Percentage of long-stay residents with pressure ulcers | 3.6% |
5.5%
1.9 pts better
|
5.1%
1.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q3 4.0% · 4Q avg 3.6% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 84.0% |
86.8%
2.8 pts worse
|
81.7%
2.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 95.2% · 4Q avg 84.0% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 17.5% |
15.0%
2.5 pts worse
|
12.0%
5.5 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 17.5% · Observed 15.0% · Expected 9.6% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.3%
1.3 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 32.0% |
22.7%
9.3 pts worse
|
23.9%
8.1 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 32.0% · Observed 25.0% · Expected 18.6% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-05-15 · Fire 2024-05-15
0 health deficiencies
No concentrated health issue counts in this cycle.
6 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Cycle 3
Health 2023-03-02 · Fire 2023-03-02
0 health deficiencies
No concentrated health issue counts in this cycle.
4 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2025-04-16
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2025-05-02
E · Potential for more than minimal harm
2025-04-16
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2025-05-02
E · Potential for more than minimal harm
2025-04-16
K541 · Services Deficiencies
Fire Safety
Install properly constructed and protected linen or trash chutes.
Corrected 2025-05-02
D · Potential for more than minimal harm
2025-04-16
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2025-05-02
F · Potential for more than minimal harm
2024-05-15
K132 · Construction Deficiencies
Fire Safety
Meet requirements for outpatient facilities located next to inpatient facilities separated by fire resistive construction.
Corrected 2024-11-08
E · Potential for more than minimal harm
2024-05-15
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2024-06-30
E · Potential for more than minimal harm
2024-05-15
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2024-06-30
D · Potential for more than minimal harm
2024-05-15
K223 · Egress Deficiencies
Fire Safety
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Corrected 2024-06-30
D · Potential for more than minimal harm
2024-05-15
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-06-30
D · Potential for more than minimal harm
2024-05-15
K362 · Smoke Deficiencies
Fire Safety
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.
Corrected 2024-06-30
D · Potential for more than minimal harm
2023-03-02
K131 · Construction Deficiencies
Fire Safety
Meet requirements for sections of health care facilities separated by fire resistive construction.
Corrected 2023-03-17
D · Potential for more than minimal harm
2023-03-02
K362 · Smoke Deficiencies
Fire Safety
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.
Corrected 2023-03-17
D · Potential for more than minimal harm
2023-03-02
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2023-03-17
D · Potential for more than minimal harm
2023-03-02
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2023-03-17
Inspection history
Recent health citations
Penalties and ownership
What sits behind the stars
Ownership
Bass, Judy
Corporate Director · Individual
Borchert, Barry
Operational/Managerial Control · Individual
Borchert, Barry
Corporate Officer · Individual
Fast, Spencer
Operational/Managerial Control · Individual
Koenecke, Tammy
Corporate Director · Individual
Peterson, Phil
Corporate Director · Individual
Schwartz, Kathryn
Corporate Director · Individual
Shear, Ryan
Operational/Managerial Control · Individual
Shear, Ryan
Corporate Officer · Individual
Vanmeeteren, Robert
Operational/Managerial Control · Individual
Vanmeeteren, Robert
Corporate Officer · Individual
Nearby options
Other facilities in reach
#1
Sauk Co Health Care Center
Reedsburg, WI
2-star overall rating with 2-star inspections with $160,977 in total fines with 7 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
#2
Wisconsin Dells Health Services
Wisconsin Dells, WI
3-star overall rating with 2-star inspections with 9 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
#3
Complete Care at Jefferson Meadows LLC
Baraboo, WI
3-star overall rating with 2-star inspections with $73,275 in total fines with 14 recent health deficiencies with 11 fire-safety deficiencies in the latest cycle
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