Burlington Health & Rehabilitation Center

• Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Jan 22, 2026

• Provide and implement an infection prevention and control program.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadFound during a complaint inspectionCorrected Sep 12, 2025

• Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadFound during a complaint inspectionCorrected Sep 12, 2025

• Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadFound during a complaint inspectionCorrected Sep 12, 2025

• Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadFound during a complaint inspectionCorrected Sep 12, 2025

• Ensure residents have reasonable access to and privacy in their use of communication methods.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadCorrected Sep 12, 2025

• Have exits that are accessible at all times.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Sep 12, 2025

• 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.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Sep 12, 2025

• Ensure each resident receives an accurate assessment.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Sep 12, 2025

• Provide care and assistance to perform activities of daily living for any resident who is unable.

  Severity E of L: no actual harm, potential for more than minimal harm, patternFound during a complaint inspectionCorrected Sep 12, 2025

• Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

  Severity E of L: no actual harm, potential for more than minimal harm, patternFound during a complaint inspectionCorrected Sep 12, 2025

• Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  Severity E of L: no actual harm, potential for more than minimal harm, patternFound during a complaint inspectionCorrected Sep 12, 2025

• Have properly installed electrical wiring and gas equipment.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Sep 12, 2025

• Install corridor and hallway doors that block smoke.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Sep 12, 2025

• Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Sep 12, 2025

• Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Sep 12, 2025

• Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Sep 12, 2025

• Inspect, test, and maintain automatic sprinkler systems.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Sep 12, 2025

• Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Sep 12, 2025

• Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Sep 12, 2025

• Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Sep 12, 2025

• Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Sep 12, 2025

• Respond appropriately to all alleged violations.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Sep 12, 2025

• PASARR screening for Mental disorders or Intellectual Disabilities

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Sep 12, 2025

• Provide appropriate pressure ulcer care and prevent new ulcers from developing.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Sep 12, 2025

• 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.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Sep 12, 2025

• Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Sep 12, 2025

• Provide safe and appropriate respiratory care for a resident when needed.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Sep 12, 2025

• Provide safe, appropriate pain management for a resident who requires such services.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Sep 12, 2025

• Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Sep 12, 2025

• Provide and implement an infection prevention and control program.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Jul 22, 2025

• Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadFound during a complaint inspectionCorrected Jun 5, 2025

• Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadFound during a complaint inspectionCorrected Jun 5, 2025

• Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadFound during a complaint inspectionCorrected Jun 5, 2025

• Allow residents to self-administer drugs if determined clinically appropriate.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Jun 5, 2025

• Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Jun 5, 2025

• Ensure that residents are free from significant medication errors.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Jun 5, 2025

• Provide safe, appropriate dialysis care/services for a resident who requires such services.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Jun 5, 2025

• Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

  Severity E of L: no actual harm, potential for more than minimal harm, patternFound during a complaint inspectionCorrected Feb 27, 2025

• Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

  Severity E of L: no actual harm, potential for more than minimal harm, patternFound during a complaint inspectionCorrected Oct 31, 2024

• Respond appropriately to all alleged violations.

  Severity E of L: no actual harm, potential for more than minimal harm, patternFound during a complaint inspectionCorrected Oct 31, 2024

• 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.

  Severity E of L: no actual harm, potential for more than minimal harm, patternFound during a complaint inspectionCorrected Oct 31, 2024

• Ensure medication error rates are not 5 percent or greater.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 31, 2024

• Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 31, 2024

• Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 31, 2024

• Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 31, 2024

• Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 31, 2024

• Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 31, 2024

• Provide enough food/fluids to maintain a resident's health.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 31, 2024

• Provide safe and appropriate respiratory care for a resident when needed.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 31, 2024

• Ensure each resident’s drug regimen must be free from unnecessary drugs.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 31, 2024

• Ensure that residents are free from significant medication errors.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 31, 2024

• Provide and implement an infection prevention and control program.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 31, 2024

• Provide medically-related social services to help each resident achieve the highest possible quality of life.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Jun 12, 2024

• Provide appropriate pressure ulcer care and prevent new ulcers from developing.

  Severity G of L: actual harm, isolatedFound during a complaint inspectionCorrected Jul 5, 2024

• Conduct risk assessment and an All-Hazards approach.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadCorrected Jun 14, 2024

• Inspect, test, and maintain automatic sprinkler systems.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadCorrected Jun 6, 2024

• Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadCorrected Jun 13, 2024

• Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Jun 13, 2024

• Install smoke barrier doors that can resist smoke for at least 20 minutes.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Jun 4, 2024

• 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.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected May 29, 2024

• Install corridor and hallway doors that block smoke.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Jun 7, 2024

• Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Jun 13, 2024

• 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.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 13, 2024

• Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Jun 13, 2024

• Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 13, 2024

• Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 13, 2024

• Assist a resident in gaining access to vision and hearing services.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 13, 2024

• Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 13, 2024

• Provide safe, appropriate dialysis care/services for a resident who requires such services.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 13, 2024

• Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 13, 2024

• Ensure that residents are free from significant medication errors.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 13, 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.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 13, 2024

• Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 13, 2024

• Provide and implement an infection prevention and control program.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 13, 2024

• Install a fire alarm system that can be heard throughout the facility.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 11, 2024

• Ensure proper usage of power strips and extension cords.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Jun 4, 2024

• Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadFound during a complaint inspectionCorrected Apr 17, 2024

• Ensure each resident must receive and the facility must provide necessary behavioral health care and services.

  Severity J of L: immediate jeopardy, isolatedFound during a complaint inspectionCorrected Dec 6, 2023

• Designate a physician to serve as medical director responsible for implementation of resident care policies and coordination of medical care in the facility.

  Severity J of L: immediate jeopardy, isolatedFound during a complaint inspectionCorrected Dec 6, 2023

• Respond appropriately to all alleged violations.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Dec 6, 2023

• Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Dec 6, 2023

• Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Dec 6, 2023

• Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.

  Severity K of L: immediate jeopardy, patternFound during a complaint inspectionCorrected Oct 17, 2023

• Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

  Severity J of L: immediate jeopardy, isolatedFound during a complaint inspectionCorrected Oct 17, 2023

• Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

  Severity J of L: immediate jeopardy, isolatedFound during a complaint inspectionCorrected Oct 17, 2023

• Ensure each resident must receive and the facility must provide necessary behavioral health care and services.

  Severity G of L: actual harm, isolatedFound during a complaint inspectionCorrected Dec 6, 2023

• 1) Protect residents from being forced to work at the nursing home, or 2) let residents work if they want to.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadFound during a complaint inspectionCorrected Oct 17, 2023

• Observe each nurse aide's job performance and give regular training.

  Severity E of L: no actual harm, potential for more than minimal harm, patternFound during a complaint inspectionCorrected Oct 17, 2023

• Respond appropriately to all alleged violations.

  Severity E of L: no actual harm, potential for more than minimal harm, patternFound during a complaint inspectionCorrected Dec 6, 2023

• Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.

  Severity E of L: no actual harm, potential for more than minimal harm, patternFound during a complaint inspectionCorrected Oct 17, 2023

• Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Oct 17, 2023

• Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedFound during a complaint inspectionCorrected Dec 6, 2023

• Provide appropriate pressure ulcer care and prevent new ulcers from developing.

  Severity J of L: immediate jeopardy, isolatedCorrected Apr 18, 2023

• Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadCorrected Apr 18, 2023

• Provide and implement an infection prevention and control program.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadCorrected Apr 18, 2023

• Have simulated fire drills held at unexpected times.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadCorrected Apr 11, 2023

• Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.

  Severity F of L: no actual harm, potential for more than minimal harm, widespreadCorrected Apr 18, 2023

• Keep aisles, corridors, and exits free of obstruction in case of emergency.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Mar 4, 2023

• 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.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Mar 2, 2023

• Install proper backup exit lighting.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Mar 4, 2023

• Provide properly protected cooking facilities.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Apr 19, 2023

• Install corridor and hallway doors that block smoke.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Mar 2, 2023

• Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Mar 2, 2023

• Install properly constructed and protected linen or trash chutes.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Mar 2, 2023

• Ensure each resident’s drug regimen must be free from unnecessary drugs.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Apr 18, 2023

• Ensure proper usage of power strips and extension cords.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Apr 10, 2023

• Develop and implement policies and procedures to prevent abuse, neglect, and theft.

  Severity E of L: no actual harm, potential for more than minimal harm, patternCorrected Apr 18, 2023

• Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Apr 18, 2023

• Respond appropriately to all alleged violations.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Apr 18, 2023

• Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Apr 18, 2023

• Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Apr 18, 2023

• Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Mar 2, 2023

• Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Mar 2, 2023

• Develop and implement policies and procedures for flu and pneumonia vaccinations.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Apr 18, 2023

• 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.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Apr 18, 2023

• Provide enough food/fluids to maintain a resident's health.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Apr 18, 2023

• Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  Severity D of L: no actual harm, potential for more than minimal harm, isolatedCorrected Apr 18, 2023

Burlington Health & Rehabilitation Center offers Skilled Nursing / Long Term Care.

Burlington Health & Rehabilitation Center is located at 677 E State St in Burlington, Wisconsin.

Reviews for Burlington Health & Rehabilitation Center are sharply divided. Several families praise the kindness of staff and the quality of physical therapy, while other reviewers describe serious concerns about cleanliness, slow response to call lights, and delayed medication administration.

Burlington Health & Rehabilitation Center had 12 government inspection visits in the last three years, with 118 citations on file according to CMS Care Compare data. The full history, including what each citation was for and whether it was corrected, is in the inspection section on this page.

Submit the Request Information form on this page to connect with Burlington Health & Rehabilitation Center and arrange a tour. Sharing your timeline and care needs up front helps the community prepare for your visit.