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Nursing Home Violations
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Ingleside Manor, Mount Horeb, Wisconsin

74
Citations from health inspectionsWisconsin average: 28 a home
6
Residents harmed or put in dangerWisconsin average: 2.0 a home
$283,060
Fines from the federal governmentWisconsin average: $48,150 a home
No rating given
Overall rating in starsWisconsin average: 3.0

The figures come from Medicare Care Compare files released October 8, 2026 by CMS, the federal Medicare agency. The citations span each home's three most recent inspection cycles plus their complaint visits, going back to March 2017 at the earliest; the fines span about three years, beginning September 2023. Browse the CMS files

Nine inspection visits produced 74 citations. Residents were in immediate danger in three findings. Residents were found hurt in three cases. Federal fines came to $283,060 (five fines). Two times, Medicare stopped paying for new admissions.

This home is a Special Focus Facility. Homes that have done poorly on past inspections are put on this list by CMS, and they get extra attention.

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Quick Look at the Record

The home's overall star rating
No rating is given while the home stays on the Special Focus list
Rating for health inspections
No rating is given while the home stays on the Special Focus list
Rating for staffing
No rating is given while the home stays on the Special Focus list
Rating for quality of care
No rating is given while the home stays on the Special Focus list
Nurse time for each resident
4.15 hours each dayThe Wisconsin average is 4.21 hours
Time from registered nurses
1.06 hours each dayThe Wisconsin average is 0.99 hours
Nursing staff who left during one year
80.6%against the Wisconsin average of 46.9%
Beds that are certified
80
Ownership
Corporation (non profit)
Chain
Wisconsin Illinois Senior Housing, Inc., with seven homes
Street address
407 N. Eighth St., Mount Horeb, Wisconsin 53572
County
Dane

Each inspection's citations

Every citation marks a federal rule inspectors found broken, along with its seriousness and the number of residents affected.

15 citations dated Oct. 13, 2025

  • F883 Flu and Pneumonia Vaccines: risk of harm, no one found hurt, one or a few residents.
  • F880 Infection Prevention and Control: risk of harm, no one found hurt, widespread.
  • F867 Ongoing Quality Review Group and Correction Plans: risk of harm, no one found hurt, one or a few residents.
  • F849 Arrange Hospice Care When Needed: risk of harm, no one found hurt, one or a few residents.
  • F806 Food That Meets Allergies and Preferences: risk of harm, no one found hurt, one or a few residents.
  • F761 Labeling and Locking Up Medicines: risk of harm, no one found hurt, one or a few residents.
  • F759 Medication Error Rate of 5 Percent or More: risk of harm, no one found hurt, one or a few residents.
  • F692 Enough Food and Fluids: risk of harm, no one found hurt, one or a few residents.
  • F690 Bladder, Bowel and Catheter Care: risk of harm, no one found hurt, one or a few residents.
  • F686 Pressure Ulcer (Bedsore) Care: immediate danger to residents, one or a few residents.
  • F684 Quality of Care: risk of harm, no one found hurt, a pattern, several residents.
  • F609 Reporting Suspected Abuse: risk of harm, no one found hurt, one or a few residents.
  • F584 A Safe, Clean, Homelike Room: risk of harm, no one found hurt, a pattern, several residents.
  • F578 The Right to Refuse Treatment: risk of harm, no one found hurt, a pattern, several residents.
  • F565 Right to Resident and Family Groups: risk of harm, no one found hurt, a pattern, several residents.

Eight citations dated Sept. 15, 2025

  • F760 Significant Medication Errors: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F755 Pharmacy Services: risk of harm, no one found hurt, a pattern, several residents, found on a complaint visit.
  • F740 Behavioral Health Care and Services: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F690 Bladder, Bowel and Catheter Care: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F686 Pressure Ulcer (Bedsore) Care: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F684 Quality of Care: residents were harmed, one or a few residents, found on a complaint visit.
  • F584 A Safe, Clean, Homelike Room: risk of harm, no one found hurt, a pattern, several residents, found on a complaint visit.
  • F550 Dignity and Resident Rights: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.

11 citations dated Aug. 13, 2025

  • F925 Pest Control Program: risk of harm, no one found hurt, a pattern, several residents, found on a complaint visit.
  • F880 Infection Prevention and Control: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F760 Significant Medication Errors: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F755 Pharmacy Services: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F712 Face to Face Doctor Visits: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F692 Enough Food and Fluids: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F689 Accident Hazards and Supervision: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F684 Quality of Care: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F677 Help With Daily Living: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F609 Reporting Suspected Abuse: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F580 Telling the Family About a Change: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.

Nine citations dated July 9, 2025

  • F868 Quality Group Membership and Quarterly Meetings: risk of harm, no one found hurt, widespread, found on a complaint visit.
  • F842 Medical Records and Privacy: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F730 Review Nurse Aide Performance and Training: risk of harm, no one found hurt, widespread, found on a complaint visit.
  • F693 Feeding Tube Care: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F692 Enough Food and Fluids: immediate danger to residents, one or a few residents, found on a complaint visit.
  • F689 Accident Hazards and Supervision: immediate danger to residents, one or a few residents, found on a complaint visit.
  • F658 Care That Meets Professional Standards: risk of harm, no one found hurt, widespread, found on a complaint visit.
  • F610 Investigating Abuse Allegations: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F609 Reporting Suspected Abuse: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.

One citation dated June 10, 2025

  • F689 Accident Hazards and Supervision: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.

Five citations dated March 14, 2025

  • F759 Medication Error Rate of 5 Percent or More: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F755 Pharmacy Services: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F610 Investigating Abuse Allegations: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F609 Reporting Suspected Abuse: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.
  • F580 Telling the Family About a Change: risk of harm, no one found hurt, one or a few residents, found on a complaint visit.

15 citations dated July 11, 2024

  • F883 Flu and Pneumonia Vaccines: risk of harm, no one found hurt, one or a few residents.
  • F880 Infection Prevention and Control: risk of harm, no one found hurt, widespread.
  • F814 Dispose of Garbage Properly: risk of harm, no one found hurt, widespread.
  • F812 Food Storage and Kitchen Safety: risk of harm, no one found hurt, widespread.
  • F760 Significant Medication Errors: risk of harm, no one found hurt, one or a few residents.
  • F759 Medication Error Rate of 5 Percent or More: risk of harm, no one found hurt, one or a few residents.
  • F758 Psychotropic Drugs and PRN Orders: risk of harm, no one found hurt, one or a few residents.
  • F755 Pharmacy Services: risk of harm, no one found hurt, one or a few residents.
  • F692 Enough Food and Fluids: risk of harm, no one found hurt, one or a few residents.
  • F686 Pressure Ulcer (Bedsore) Care: risk of harm, no one found hurt, one or a few residents.
  • F684 Quality of Care: residents were harmed, one or a few residents.
  • F656 A Complete Care Plan: risk of harm, no one found hurt, one or a few residents.
  • F584 A Safe, Clean, Homelike Room: risk of harm, no one found hurt, a pattern, several residents.
  • F580 Telling the Family About a Change: risk of harm, no one found hurt, one or a few residents.
  • F558 Meeting Residents' Needs and Preferences: risk of harm, no one found hurt, a pattern, several residents.

One citation dated Nov. 1, 2023

  • F689 Accident Hazards and Supervision: residents were harmed, one or a few residents, found on a complaint visit.

Nine citations dated March 30, 2023

  • F880 Infection Prevention and Control: risk of harm, no one found hurt, a pattern, several residents.
  • F812 Food Storage and Kitchen Safety: risk of harm, no one found hurt, widespread.
  • F809 Meals and Snacks at Preferred Times: risk of harm, no one found hurt, widespread.
  • F689 Accident Hazards and Supervision: risk of harm, no one found hurt, one or a few residents.
  • F677 Help With Daily Living: risk of harm, no one found hurt, one or a few residents.
  • F585 Right to File Complaints Without Retaliation: risk of harm, no one found hurt, a pattern, several residents.
  • F580 Telling the Family About a Change: risk of harm, no one found hurt, one or a few residents.
  • F565 Right to Resident and Family Groups: risk of harm, no one found hurt, a pattern, several residents.
  • F554 Let Residents Take Own Medicines When Appropriate: risk of harm, no one found hurt, one or a few residents.

Payment Denials and Fines

DatePenaltyAmount
Oct. 13, 2025Fine$83,597
Oct. 13, 2025Payment denial for new admissions35 days
June 10, 2025Fine$20,420
June 10, 2025Fine$128,700
June 10, 2025Payment denial for new admissions68 days
July 11, 2024Fine$36,946
Nov. 1, 2023Fine$13,397

Ownership and Management of the Home

  • The home is run by Carriage Healthcare Companies Inc. (operational or managerial control).

The CMS Care Compare files, updated every month, provide provider information, health deficiencies, penalties, and ownership. The CMS certification number is 525331. Other homes in Wisconsin.