Autumn Lake Healthcare at Beloit
2121 Pioneer Dr., Beloit, WI 53511 · Rock County · 120 certified beds · avg 77 residents/day · certified since Jul 12, 2001
Part of chain: AUTUMN LAKE HEALTHCARE (59 facilities, chain avg rating 2.8★)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★★☆☆3/5 · CMS overall rating: 3/5
The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.
Most serious findings (actual harm or immediate jeopardy)
▲ Actual harm, one-off · Nov 25, 2025 · F-0686 · triggered by a complaint
The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving.
Why it matters: Bedsores are painful, can become deeply infected, and in serious cases can be life-threatening.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Dec 17, 2025 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Nov 25, 2025 · F-0689 · triggered by a complaint
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Dec 17, 2025 (Deficient, Provider has date of correction)
All citations in the current public record (14)
CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.
| Date | Severity | What the facility was cited for |
|---|---|---|
| Feb 12, 2026 | F · Potential for harm, facility-wide | The facility did not serve food and drinks that were appetizing, attractive, and at a safe and pleasant temperature. |
| Feb 12, 2026 | F · Potential for harm, facility-wide | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| Feb 12, 2026 | D · Potential for harm, one-off | The facility did not provide safe and appropriate pain management for a resident who needed it. |
| Jan 6, 2026 | D · Potential for harm, one-off | The facility did not have enough nursing staff each day to meet every resident's needs, or did not have a licensed nurse in charge on each shift. Adequate staffing is one of the strongest predictors of good care. · from a complaint |
| Jan 6, 2026 | D · Potential for harm, one-off | The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. · from a complaint |
| Jan 6, 2026 | C · Minimal risk, facility-wide | The facility did not post its nurse staffing information every day. Nursing homes must publicly display how many nurses and aides are on duty each day. · from a complaint |
| Nov 25, 2025 | ▲ G · Actual harm, one-off | The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving. · from a complaint |
| Nov 25, 2025 | ▲ G · Actual harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Dec 21, 2023 | D · Potential for harm, one-off | The facility did not honor residents' right to make their own choices about their daily lives, such as when to wake up, what to eat, or how to spend their time. · from a complaint |
| Dec 21, 2023 | D · Potential for harm, one-off | The facility did not provide proper care for residents with a colostomy, urostomy, or ileostomy — surgical openings in the abdomen that let waste leave the body into a pouch. These require regular, skilled attention to stay clean and healthy. · from a complaint |
| Jun 29, 2023 | F · Potential for harm, facility-wide | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| Jun 29, 2023 | F · Potential for harm, facility-wide | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. |
| Jun 29, 2023 | D · Potential for harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. |
| Jun 29, 2023 | D · Potential for harm, one-off | The facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it. |
Inspection trend by year
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 6 | 0 | F |
| 2025 | 2 | 2 | G ▲ |
| 2026 | 6 | 0 | F |
Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.
Fines and enforcement (last 3 years)
No fines or payment denials in the published 3-year window.
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Wisconsin avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 2.47 | 4.29 | 3.95 | bottom 1% in Wisconsin; bottom 3% in the U.S. |
| Registered Nurse hours | 0.63 | 1.01 | 0.69 | bottom 14% in Wisconsin; top 45% in the U.S. |
| Weekend total nurse staffing | 2.09 | 3.84 | 3.50 | bottom 1% in Wisconsin; bottom 2% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.48 | 0.68 | 0.48 | bottom 29% in Wisconsin; top 36% in the U.S. |
| Total nursing staff turnover (%) | 37.3 | 46.9 | 45.8 | top 23% in Wisconsin; top 30% in the U.S. |
| RN turnover (%) | 23.1 | 39.7 | 42.9 | top 22% in Wisconsin; top 18% in the U.S. |
Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 2.78, RN 0.70, weekend 2.35. Staffing rating: 2/5.
Self-reported quality measures
Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.
Quality measures rating: 4/5 · long-stay residents: 4/5 · short-stay residents: 4/5
Who owns this facility
For profit - Limited Liability company
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| A&r Stern Family Holdings, LLC | Organization | 5% or Greater Direct Ownership Interest | 62% | 02/01/2019 |
| Davis, Yehoshua | Individual | 5% or Greater Direct Ownership Interest | 13% | 02/01/2019 |
| Gluck, Rivka | Individual | 5% or Greater Direct Ownership Interest | 20% | 02/01/2019 |
| Stern, Aryeh | Individual | Direct Ownership Interest | NOT APPLICABLE | 02/01/2019 |
| A&r Stern Family Holdings, LLC | Organization | ADP of the SNF | NOT APPLICABLE | 02/01/2019 |
| Accurate Staffing LLC | Organization | ADP of the SNF | NOT APPLICABLE | 02/01/2019 |
| Beloit Rehab Realty LLC | Organization | 5% or Greater Mortgage Interest | NOT APPLICABLE | 02/01/2019 |
| Beloit Rehab Realty LLC | Organization | ADP of the SNF | NOT APPLICABLE | 02/01/2019 |
| Brand Sonnenschine LLP | Organization | ADP of the SNF | NOT APPLICABLE | 02/01/2019 |
| Davis, Yehoshua | Individual | ADP of the SNF | NOT APPLICABLE | 02/01/2019 |
| Gluck, Rivka | Individual | ADP of the SNF | NOT APPLICABLE | 02/01/2019 |
| Schwartz, Mark | Individual | Corporate Officer | NOT APPLICABLE | 02/01/2019 |
| Schwartz, Mark | Individual | Operational/Managerial Control | NOT APPLICABLE | 02/01/2019 |
| Stern, Aryeh | Individual | ADP of the SNF | NOT APPLICABLE | 02/01/2019 |
| Tolentino, Annabelle | Individual | Operational/Managerial Control | NOT APPLICABLE | 02/01/2019 |
| Tolentino, Annabelle | Individual | ADP of the SNF | NOT APPLICABLE | 02/01/2019 |
| Viken, Susan | Individual | Operational/Managerial Control | NOT APPLICABLE | 02/01/2019 |
| Viken, Susan | Individual | ADP of the SNF | NOT APPLICABLE | 02/01/2019 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "How do you prevent bedsores for residents who can't move themselves, and how often are at-risk residents repositioned?"
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "Could I join residents for a meal to see the food quality and temperature for myself?"
- "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
- "How do you assess and manage residents' pain, especially for those who have trouble communicating?"
- "What is your nurse and aide staffing ratio on each shift, including nights and weekends?"
- "How does your pharmacist review residents' medications, and how quickly can you fill new or urgent prescriptions?"
- "Where do you post your daily staffing numbers, and can I see today's?"
- "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
- "Can I see the results and plan of correction from your most recent state inspection?"
Nearby facilities (within 20 miles)
| Facility | Distance | City | Overall | Inspection | Flags |
|---|---|---|---|---|---|
| Beloit Health and Rehabilitation Center | 1.1 mi | Beloit, WI | ★★☆☆☆ | 2/5 | |
| Fair Oaks Rehab & Healthcare | 3.8 mi | South Beloit, IL | ★☆☆☆☆ | 2/5 | abuse |
| Alden Meadow Park HCC | 8.0 mi | Clinton, WI | ★★★☆☆ | 3/5 | |
| Cedar Crest Health Center | 8.8 mi | Janesville, WI | ★★★★★ | 5/5 | |
| Oak Park Place of Janesville | 9.7 mi | Janesville, WI | ★★☆☆☆ | 2/5 | |
| St Elizabeth Nursing Home | 10.5 mi | Janesville, WI | ★★☆☆☆ | 2/5 | |
| Mercy Manor Transition Center | 10.8 mi | Janesville, WI | ★★★★★ | 4/5 | |
| Rock Haven | 12.1 mi | Janesville, WI | ★★★★☆ | 3/5 | |
| River Bluff Nursing Home | 14.6 mi | Rockford, IL | ★★☆☆☆ | 2/5 | |
| Avira Health Pavilion | 14.9 mi | Loves Park, IL | ★★★★☆ | 4/5 | |
| Alpine Fireside Health Center | 15.0 mi | Rockford, IL | ★★★☆☆ | 3/5 | |
| Rock River Health Care | 15.1 mi | Rockford, IL | ★★★☆☆ | 3/5 |
Compare this facility with the 3 closest →
Facility data as of CMS processing date 2026-08-01. CCN 525663.