Avina on Division

517 E Division St · Fond Du Lac, WI · 54935 · 9209216800

50 certified beds For profit - Limited Liability company Chain: Avina Healthcare

Why this verdict

  • Inspectors found immediate jeopardy — danger of serious harm or death — in the most recent cycle (1 citation).
  • Inspection record is far worse than the national median (deficiency count and severity).
  • Inspection results are getting worse cycle over cycle, not better.
  • No federal fines or payment denials in CMS’s 3-year window.

The complete Safety Report — $19

Everything on this page plus the full citation-by-citation history with inspector findings, the complete penalty record, staffing vs benchmarks, side-by-side nearby comparisons, and the printable tour checklist. One PDF, emailed in minutes, yours to keep and share with family.

Get the Safety Report

Red flags

1 immediate-jeopardy citation in the most recent inspection cycle

Immediate jeopardy is the most serious finding an inspector can make: a situation likely to cause serious injury, harm, or death.

2 actual-harm citations in the most recent cycle

Inspectors found deficiencies that caused real harm to residents, beyond potential-harm paperwork findings.

Score breakdown

Inspection record 30% of score 20
Serious harm & abuse 20% 58
Staffing 20% 60
Federal penalties 15% 100
Trend 10% 18
Context 5% 75

Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.

CMS ratings & staffing

Overall: 1 of 5 Inspections: 1 of 5 Staffing: 1 of 5 Quality measures: 4 of 5

Total nurse hours / resident-day3.403.48 min · 4.1 strong
RN hours / resident-day0.360.55–0.75
Weekend hours / resident-day2.96≈ weekday level
Nursing turnover / year35%median 45%
Fines (3-yr window)none

Inspection citations (42 in the current record)

  • Potential for harm · D April 30, 2026 · found via complaint

    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.

    Deficient, Provider has no plan of correction · Resident Rights

  • Potential for harm · D April 30, 2026 · found via complaint

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

    Deficient, Provider has no plan of correction · Quality of Life and Care

  • Potential for harm · D April 30, 2026 · found via complaint

    Provide for the safe, appropriate administration of IV fluids for a resident when needed.

    Deficient, Provider has no plan of correction · Quality of Life and Care

  • Potential for harm · F April 30, 2026 · found via complaint

    Provide and implement an infection prevention and control program.

    Deficient, Provider has no plan of correction · Infection Control

  • Immediate jeopardy · L March 28, 2026 · found via complaint

    Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

    Corrected April 23, 2026 · Nursing and Physician Services

  • Actual harm · G March 28, 2026 · found via complaint

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

    Corrected April 23, 2026 · Quality of Life and Care

  • Actual harm · G March 28, 2026 · found via complaint

    Ensure that residents are free from significant medication errors.

    Corrected April 23, 2026 · Pharmacy Service

  • Potential for harm · D March 28, 2026 · found via complaint

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

    Corrected April 23, 2026 · Resident Rights

  • Potential for harm · F March 28, 2026 · found via complaint

    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

    Corrected April 23, 2026 · Nursing and Physician Services

  • Potential for harm · F March 28, 2026 · found via complaint

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

    Corrected April 23, 2026 · Nutrition and Dietary

  • Potential for harm · F March 28, 2026 · found via complaint

    Administer the facility in a manner that enables it to use its resources effectively and efficiently.

    Corrected April 23, 2026 · Administration

  • Potential for harm · D May 21, 2025

    Reasonably accommodate the needs and preferences of each resident.

    Corrected June 12, 2025 · Resident Rights

  • Potential for harm · D May 21, 2025

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

    Corrected June 12, 2025 · Pharmacy Service

  • Potential for harm · F May 21, 2025

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

    Corrected May 29, 2025 · Nutrition and Dietary

  • Potential for harm · F May 21, 2025

    Dispose of garbage and refuse properly.

    Corrected June 12, 2025 · Nutrition and Dietary

  • Potential for harm · E May 21, 2025

    Provide and implement an infection prevention and control program.

    Corrected June 13, 2025 · Infection Control

  • No harm found · C November 18, 2024 · found via complaint

    Dispose of garbage and refuse properly.

    Corrected November 21, 2024 · Nutrition and Dietary

  • Potential for harm · D March 27, 2024

    Give the resident's representative the ability to exercise the resident's rights.

    Corrected April 16, 2024 · Resident Rights

  • Potential for harm · D March 27, 2024

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

    Corrected March 27, 2024 · Resident Rights

  • Potential for harm · D March 27, 2024

    Ensure each resident receives an accurate assessment.

    Corrected March 27, 2024 · Resident Assessment and Care Planning

  • Potential for harm · E March 27, 2024

    PASARR screening for Mental disorders or Intellectual Disabilities

    Corrected April 16, 2024 · Resident Assessment and Care Planning

  • Potential for harm · D March 27, 2024

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

    Corrected April 16, 2024 · Quality of Life and Care

  • Potential for harm · D March 27, 2024

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

    Corrected March 27, 2024 · Quality of Life and Care

  • Potential for harm · F March 27, 2024

    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.

    Corrected April 19, 2024 · Nutrition and Dietary

  • Potential for harm · D March 27, 2024

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

    Corrected April 17, 2024 · Nutrition and Dietary

Showing the 25 most recent. The Safety Report includes every citation with full findings.

Family & resident reviews — a separate signal, never mixed into the score

No approved reviews yet. If your family has experience with this facility, yours could be the review that helps the next family decide.

Sign in to share your family's experience — reviews are moderated and never affect the Safety Score.

Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 525522 · certified since August 24, 1993. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.