Ascension Living - Lakeshore at SienaCMS ratings, inspections and fines
- Address
- 5643 Erie Street, Racine, WI 53402
- CCN
- 525495
- Ownership type
- Non-profit, church related
- Certified beds
- 60
- Chain
- Ascension Living
- Residents per day
- 53
- CMS flags
- None in the CMS record
Open the watch listCare Compare record (Medicare.gov)
The watch list stays in this browser. After each CMS update, it shows the values that changed at the homes on the list.
CMS gives Ascension Living - Lakeshore at Siena an overall rating of 1 of 5 stars. The last standard survey was on 9 Feb 2026. The latest survey cycle has 27 health citations. The median for nursing homes in Wisconsin is 7. CMS lists no fines for this home in its penalties file. CMS also lists 1 payment denial.
Facilities may see a change in their overall rating for a number of reasons. Since the overall rating is based on three individual domains, a change in any one of the domains can affect the overall rating. Any new data for a nursing home could potentially change a star rating domain.
Centers for Medicare & Medicaid Services, Five-Star Quality Rating System: Technical Users' Guide, July 2026. CMS processed this record on .
Since the last CMS update
The site has no recorded change for this home. In each CMS update, the site compares the ratings, the penalties and the citations of each home.
Ratings
CMS gives each home 1 to 5 stars for health inspections, for staffing and for quality measures, and one overall rating.
| Rating (1 to 5 stars) | This home | Racine County median | Wisconsin median | US average (CMS) |
|---|---|---|---|---|
| Overall rating | 1 | 1.0 | 3.0 | 3.0 |
| Health inspection rating | 1 | 1.0 | 3.0 | 2.8 |
| Staffing rating | 3 | 3.0 | 4.0 | 2.9 |
| Quality measure rating | 2 | 3.0 | 3.0 | 3.6 |
A median is the middle value of the homes in the group: 6 homes in the county, 323 homes in the state. What the CMS star ratings measure
Citations by survey cycle
CMS keeps the last three cycles, and cycle 1 is the latest. A cycle has one standard survey. Citations from complaint and infection control inspections go into cycles of 12 months.
| Survey cycle | Standard survey | Citations | Wisconsin median |
|---|---|---|---|
| Cycle 1 (latest) | 9 Feb 2026 | 27 | 7 |
| Cycle 2 | 23 Sep 2024 | 14 | 7 |
| Cycle 3 | No date | 16 | 6 |
Health citations
The record of one deficiency in an inspection. One inspection can give many citations.
Scope and severity. A letter from A to L on each citation. Scope is the number of residents that the deficiency affected. Severity is the level of harm.
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy to resident health or safety | J0 | K0 | L0 |
| Actual harm that is not immediate jeopardy | I0 | ||
| No actual harm, potential for more than minimal harm | |||
| No actual harm, potential for minimal harm | A0 | B0 |
Survey cycle 1 (latest): 27 citations
Standard survey of this cycle: .
| Survey date | F-tag | Requirement (CMS text) | Scope and severity | Survey type | Corrected |
|---|---|---|---|---|---|
| 9 Feb 2026 | F0561 | Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | D | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0585 | 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. | D | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0606 | Not hire anyone with a finding of abuse, neglect, exploitation, or theft. | F | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Complaint investigation | 31 Mar 2026 |
| 9 Feb 2026 | F0610 | Respond appropriately to all alleged violations. | D | Complaint investigation | 31 Mar 2026 |
| 9 Feb 2026 | F0628 | Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. | D | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0657 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | E | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | E | Complaint investigation | 31 Mar 2026 |
| 9 Feb 2026 | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | H | Standard survey | 27 Apr 2026 |
| 9 Feb 2026 | F0688 | 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 | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | Complaint investigation | 27 Apr 2026 |
| 9 Feb 2026 | F0690 | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | D | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0695 | Provide safe and appropriate respiratory care for a resident when needed. | D | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0732 | Post nurse staffing information every day. | C | Complaint investigation | 31 Mar 2026 |
| 9 Feb 2026 | F0744 | Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. | G | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | E | Complaint investigation | 31 Mar 2026 |
| 9 Feb 2026 | F0756 | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | D | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0757 | Ensure each resident’s drug regimen must be free from unnecessary drugs. | D | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0759 | Ensure medication error rates are not 5 percent or greater. | D | Complaint investigation | 31 Mar 2026 |
| 9 Feb 2026 | F0761 | 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. | E | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | F | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0865 | Have a plan that describes the process for conducting QAPI and QAA activities. | F | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0868 | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | F | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0880 | Provide and implement an infection prevention and control program. | F | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0881 | Implement a program that monitors antibiotic use. | F | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0882 | Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | F | Standard survey | 31 Mar 2026 |
| 9 Feb 2026 | F0944 | Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. | F | Standard survey | 31 Mar 2026 |
Survey cycle 2: 14 citations
Standard survey of this cycle: .
| Survey date | F-tag | Requirement (CMS text) | Scope and severity | Survey type | Corrected |
|---|---|---|---|---|---|
| 21 Jul 2025 | F0610 | Respond appropriately to all alleged violations. | D | Complaint investigation | 8 Aug 2025 |
| 21 Jul 2025 | F0692 | Provide enough food/fluids to maintain a resident's health. | D | Complaint investigation | 8 Aug 2025 |
| 30 May 2025 | F0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Complaint investigation | 19 Jun 2025 |
| 11 Feb 2025 | F0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | Complaint investigation | 7 Mar 2025 |
| 26 Dec 2024 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Complaint investigation | 21 Jan 2025 |
| 26 Dec 2024 | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Complaint investigation | 21 Jan 2025 |
| 23 Sep 2024 | F0563 | Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing. | D | Complaint investigation | 1 Nov 2024 |
| 23 Sep 2024 | F0578 | 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. | D | Standard survey | 1 Nov 2024 |
| 23 Sep 2024 | F0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | Complaint investigation | 23 Oct 2024 |
| 23 Sep 2024 | F0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Complaint investigation | 1 Nov 2024 |
| 23 Sep 2024 | F0610 | Respond appropriately to all alleged violations. | D | Complaint investigation | 1 Nov 2024 |
| 23 Sep 2024 | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | G | Complaint investigation | 23 Oct 2024 |
| 23 Sep 2024 | F0745 | Provide medically-related social services to help each resident achieve the highest possible quality of life. | D | Complaint investigation | 1 Nov 2024 |
| 23 Sep 2024 | F0908 | Keep all essential equipment working safely. | E | Complaint investigation | 23 Oct 2024 |
Survey cycle 3: 16 citations
The CMS provider file has no standard survey date for this cycle.
| Survey date | F-tag | Requirement (CMS text) | Scope and severity | Survey type | Corrected |
|---|---|---|---|---|---|
| 17 Apr 2024 | F0585 | 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. | D | Complaint investigation | 14 May 2024 |
| 17 Apr 2024 | F0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Complaint investigation | 14 May 2024 |
| 17 Apr 2024 | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Complaint investigation | 14 May 2024 |
| 23 Jan 2024 | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | Complaint investigation | 7 Mar 2024 |
| 23 Jan 2024 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Complaint investigation | 7 Mar 2024 |
| 5 Oct 2023 | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | E | Complaint investigation | 9 Nov 2023 |
| 22 Jun 2023 | F0641 | Ensure each resident receives an accurate assessment. | E | Standard survey | 7 Aug 2023 |
| 22 Jun 2023 | F0661 | Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | D | Standard survey | 26 Jul 2023 |
| 22 Jun 2023 | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | Standard survey | 20 Jul 2023 |
| 22 Jun 2023 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard survey | 26 Jul 2023 |
| 22 Jun 2023 | F0692 | Provide enough food/fluids to maintain a resident's health. | D | Standard survey | 26 Jul 2023 |
| 22 Jun 2023 | F0732 | Post nurse staffing information every day. | C | Standard survey | 15 Jul 2023 |
| 22 Jun 2023 | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | E | Standard survey | 26 Jul 2023 |
| 22 Jun 2023 | F0756 | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | D | Standard survey | 20 Jul 2023 |
| 22 Jun 2023 | F0758 | 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. | D | Standard survey | 26 Jul 2023 |
| 22 Jun 2023 | F0867 | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | E | Standard survey | 20 Jul 2023 |
The requirement text is the CMS summary of the F-tag. It is not the report of the surveyor. How to read an inspection report
Penalties
A fine, or a payment denial: a period in which Medicare or Medicaid does not pay for new admissions. The CMS penalties file holds three years.
| Date | Type | Fine | Days without payment |
|---|---|---|---|
| 23 Sep 2024 | Payment denial | 19 |
Staffing
Hours per resident per day. The nurse hours for one resident on an average day. CMS calculates the figure from the hours that the home reports for a quarter.
| Staff | This home | Wisconsin median | Wisconsin average (CMS) |
|---|---|---|---|
| All nurse staff | 4.70 | 4.00 | 4.21 |
| Registered nurses (RN) | 0.96 | 0.90 | 0.99 |
| Licensed practical nurses (LPN) | 1.25 | 0.64 | |
| Nurse aides | 2.49 | 2.58 | |
| All nurse staff, weekends | 4.05 | 3.60 | 3.77 |
- Nurse staff turnover in a year
- 73.3%
- Nurse staff turnover, Wisconsin median
- 46.2%
- RN turnover in a year
- 72.2%
- Administrators who left in a year
- No data
Homes report the hours to CMS in the Payroll-Based Journal.
Quality measures
A figure that CMS calculates from the assessments of residents. One example is the percentage of long-stay residents with a fall and a major injury.
| Measure (CMS text) | Residents | This home | Wisconsin median | US median |
|---|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased | Long Stay | 18.8% | 15.4% | 12.6% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | Long Stay | 0.7% | 1.5% | 0.3% |
| Percentage of long-stay residents with a urinary tract infection | Long Stay | 0.0% | 2.3% | 0.9% |
| Percentage of long-stay residents experiencing one or more falls with major injury | Long Stay | 5.9% | 3.0% | 2.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication | Short Stay | 0.3% | 0.9% | 1.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | Long Stay | 24.6% | 16.8% | 12.5% |
| Percentage of long-stay residents with pressure ulcers | Long Stay | 8.6% | 4.4% | 4.2% |
| Percentage of long-stay residents who received an antipsychotic medication | Long Stay | 14.3% | 14.4% | 13.4% |
For each measure in this table, CMS gives more points in the quality measure rating for a lower percentage. The site calculates the medians from the CMS file. What the CMS star ratings measure
Ownership
An organisation in the CMS ownership file. CMS records its role, for example an ownership interest, operational or managerial control, or a mortgage interest.
- Ownership type
- Non-profit, church related
- Legal business name
- Ascension Living - Lakeshore at Siena Inc
- Chain
- Ascension Living (12 homes in the CMS chain file)
| Organisation | Role in the CMS record | Interest | Since |
|---|---|---|---|
| Ascension Health Senior Care | 5% or greater direct ownership interest | 100% | 1 Jul 2014 |
| Ascension Health Senior Care | Adp of the snf | 14 Jul 2015 | |
| Health Dimensions Consulting Inc | Adp of the snf | 2 Aug 2019 | |
| House Healthcare Solutions LLC | Adp of the snf | 10 Jun 2025 | |
| Intelycare Inc | Adp of the snf | 8 Feb 2022 | |
| Medical Solutions LLC | Adp of the snf | 14 Jun 2017 | |
| Metis LTC LLC | Adp of the snf | 2 Sep 2024 | |
| Personnel Specialists LLC | Adp of the snf | 10 Apr 2025 | |
| Prolink Healthcare LLC | Adp of the snf | 26 Apr 2023 |
The site shows organisations only. It does not show the names of persons.
Other homes in Racine County
| Nursing home | City | Overall rating | Citations, latest cycle | Fines | Last standard survey | |
|---|---|---|---|---|---|---|
| Lincoln Park Nursing and Rehab LLC | Racine | 1 of 5 | 8 | $182,618 | 22 Apr 2026 | |
| Complete Care at Ridgewood LLC | Racine | 3 of 5 | 8 | $0 | 12 Aug 2025 | |
| Oak Ridge Care Center | Union Grove | 3 of 5 | 6 | $118,771 | 7 May 2025 | |
| WI Veterans Home-Boland HallSpecial Focus candidate | Union Grove | 1 of 5 | 19 | $281,174 | 22 Apr 2026 | |
| Burlington Health and Rehabilitation Center | Burlington | 1 of 5 | 28 | $371,858 | 13 Aug 2025 |
Official channels
- Care Compare record of this nursing homeMedicare.gov. The official CMS record of this home.
- Contact information for State Survey AgenciesCMS. The web address and the telephone number of the State Survey Agency of each state. These agencies investigate complaints about nursing homes.
- Filing a complaintMedicare.gov. The page names the State Survey Agency as the place for a complaint about nursing home care or facility conditions.
- Eldercare LocatorAdministration for Community Living. A public service that connects older adults and their families to local services. Telephone: 1-800-677-1116.
Cite this page
Centers for Medicare & Medicaid Services, Care Compare. Record of Ascension Living - Lakeshore at Siena (CCN 525495). Data processed 1 Aug 2026. Elder Care Record, https://eldercarerecord.com/facility/ascension-living-lakeshore-at-siena-racine-wi-525495/
Provenance
- Licence
- US government work, public domain
- CMS processed the data on
A program makes this page from the CMS files, and the same files always give the same text. How the site makes the figures. Report an error.
Questions
- When was Ascension Living - Lakeshore at Siena last inspected?
- The latest inspection with a citation in the CMS record was on 9 Feb 2026. It was a standard survey and a complaint investigation. It gave 27 citations. The standard survey before the last one was on 23 Sep 2024.
- Who operates Ascension Living - Lakeshore at Siena?
- The CMS record gives the ownership type as non-profit, church related. CMS lists the home in the chain Ascension Living. The CMS ownership file names no organisation for operational or managerial control. This site does not show the names of persons.
- Is Ascension Living - Lakeshore at Siena a Special Focus Facility?
- No. The CMS provider file lists no Special Focus status for this home. CMS lists 2 homes in Wisconsin as Special Focus Facilities and 10 as candidates.
- Where does the data on this page come from?
- The data comes from the CMS Care Compare files for nursing homes. CMS processed the files on 1 Aug 2026. The Care Compare record on Medicare.gov is the official record of the home.