Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Luther Home during CMS and state inspections, most recent first.
A facility failed to notify a resident's POAHC of an abuse allegation involving an LPN pushing the resident back into their wheelchair. Despite the facility's policy requiring notification, the POAHC was not informed due to a decision made by the NHA, as there was no injury. The resident had severe cognitive impairment, emphasizing the importance of notifying their representative.
The facility did not implement its policies to prevent abuse, neglect, and theft by failing to conduct a timely caregiver background check for an LPN. Despite hiring the LPN, the necessary background checks were not completed, and the Nursing Home Administrator was unable to provide the required documents when requested by the surveyor.
A facility failed to ensure a thorough investigation and proper education following an abuse allegation. A CNA reported that an LPN pushed a resident with severe cognitive impairment back into their wheelchair. Although the incident was reported to the State Agency, the LPN returned to work without receiving the required abuse education, as confirmed by the absence of their name on the education sign-in sheets.
The facility failed to maintain sanitary conditions in the walk-in freezer, where extensive frost and ice buildup were observed on various surfaces. The issue, persisting for several months, was attributed to condensation from the freezer door being left open too long. Despite manual ice removal efforts and maintenance reports, the problem remained unresolved.
The facility failed to provide proper transfer notifications to three residents, their representatives, and the Ombudsman. Residents with cognitive impairments were transferred to the hospital without receiving written notices, reasons for transfer, or contact information for the Ombudsman. The Social Services staff did not follow the facility's procedures, resulting in a lack of communication and documentation.
A resident with Alzheimer's and COPD was transferred to the hospital twice without receiving the required bed hold notification. The facility's policy mandates that residents be informed of their right to hold a bed upon discharge, but this was not followed. The Social Services Director confirmed the oversight, and the Nursing Home Administrator acknowledged the failure to provide notifications.
A resident's Quarterly MDS assessment was completed but not submitted to CMS within the required 14-day timeframe, resulting in a 55-day delay. The Nursing Home Administrator acknowledged the delay, citing a communication breakdown as the cause.
Failure to Notify POAHC of Abuse Allegation
Penalty
Summary
The facility failed to notify the Power of Attorney for Healthcare (POAHC) of an allegation of abuse involving a resident with severe cognitive impairment. On August 30, 2024, a Certified Nursing Assistant (CNA) reported that a Licensed Practical Nurse (LPN) pushed the resident back into their wheelchair when the resident attempted to stand up. Despite the facility's policies requiring notification of the resident's representative about such allegations, the POAHC was not informed. The resident, who had a Brief Interview for Mental Status (BIMS) score indicating severe cognitive impairment, was not able to advocate for themselves, making the notification of their POAHC crucial. The surveyor's investigation revealed that the facility's Director of Nursing (DON) and Nursing Home Administrator (NHA) confirmed the lack of notification to the POAHC. The DON indicated that notification was determined on a case-by-case basis by the NHA, and since there was no injury, the POAHC was not informed. This oversight was confirmed during interviews with both the POAHC and the NHA, highlighting a failure to adhere to the facility's own policies regarding abuse investigations and communication with resident representatives.
Failure to Conduct Timely Background Check for LPN
Penalty
Summary
The facility failed to implement its policies and procedures to prevent abuse, neglect, and theft, specifically in conducting a thorough and timely caregiver background check for a contracted Licensed Practical Nurse (LPN). The facility's policy, reviewed in September 2024, mandates that no individual prohibited from a long-term care facility due to failure to report a crime against a resident should be employed. Despite this, the facility hired an LPN on October 27, 2023, without completing the necessary background checks. When the surveyor requested the background check information on October 30, 2024, the Nursing Home Administrator (NHA) was unable to provide it, as the Human Resources department, responsible for these checks, had left for the day. The NHA promised to send the information via email the next day, but as of October 31, 2024, the surveyor had not received the required documents, including the Background Information Disclosure (BID) form, Department of Justice (DOJ) criminal background check letter, or Integrated Background Information System (IBIS) letter for the LPN.
Failure to Ensure Abuse Education for LPN After Allegation
Penalty
Summary
The facility failed to ensure a thorough investigation of an alleged abuse incident involving a resident with severe cognitive impairment. On August 30, 2024, a Certified Nursing Assistant (CNA) reported that a Licensed Practical Nurse (LPN) pushed a resident back into their wheelchair when the resident attempted to stand. The resident, who had been diagnosed with Alzheimer's disease, anxiety, and bipolar disorder, had a Brief Interview for Mental Status (BIMS) score indicating severe cognitive impairment. The facility's investigation included interviews and written statements from the CNA and LPN, and the incident was reported to the State Agency within the appropriate timeframe. However, the facility did not ensure that the LPN received abuse education before returning to work on September 13, 2024, as required by the facility's policies. The Director of Nursing confirmed that the LPN's name and signature were absent from the education sign-in sheets, indicating that the LPN had not received the necessary training. This oversight was contrary to the facility's policy, which mandates that employees accused of abuse be suspended until the investigation is reviewed and any required training is completed.
Unsanitary Food Storage Conditions in Walk-In Freezer
Penalty
Summary
The facility failed to ensure that food was stored in a sanitary manner, as observed during a survey. The walk-in freezer was found to have extensive frost and significant ice buildup on the ceiling, motor/fan units, shelves, walls, and floor. The ice on the floor was over 1.5 inches high in some areas, creating a slippery surface. The ice appeared to result from condensation and dripping water, which was acknowledged by the Kitchen Supervisor (KS-D) and Maintenance Staff (MS-G) as an ongoing issue. The frost near the freezer door was attributed to the door being left open, and a new gasket was ordered to address this specific problem. Interviews with the Kitchen Supervisor, Certified Dietary Manager (CDM-F), and Regional Manager (RM-E) revealed that the ice buildup had been a persistent issue for several months. CDM-F had been manually removing ice every few days, and the problem had been reported to maintenance staff multiple times. Despite these efforts, the ice buildup continued, and the freezer's malfunctioning was noted since May 2024. Maintenance Staff (MS-G) confirmed that the ice buildup was due to the freezer door being left open too long, causing condensation. Signs were posted to remind staff to turn off the freezer when loading or unloading to prevent further ice accumulation.
Failure to Provide Proper Transfer Notifications
Penalty
Summary
The facility failed to provide proper notification of transfer to three residents, their representatives, and the State Long-Term Care Ombudsman as required by federal and state regulations. Residents R31, R30, and R32 were transferred to the hospital on various dates without receiving written notices of transfer, reasons for transfer, location of transfer, appeal rights, or contact information for the Ombudsman. The facility's policy, which mandates that the Social Services Director ensures written notification is provided prior to transfers, was not followed. This resulted in a lack of communication and documentation regarding the transfers. Resident R31, with severe cognitive impairment, was transferred twice due to complications related to COPD and other health issues, yet no written notifications were provided. Resident R30, with moderately impaired cognition and an activated Power of Attorney, was transferred for dehydration without proper notification. Similarly, Resident R32, also with moderately impaired cognition and an activated POA, was transferred for evaluation of tachycardia and other symptoms without receiving the required notices. The Social Services staff responsible for these notifications failed to adhere to the facility's procedures, leading to the deficiency.
Failure to Provide Bed Hold Notification
Penalty
Summary
The facility failed to provide a resident, identified as R31, with written information regarding the duration of the bed hold policy, the reserve bed payment policy, and the right to return to the facility upon transfer to a hospital. This deficiency was identified during a review of R31's medical records and staff interviews. R31, who had diagnoses including Alzheimer's dementia and chronic obstructive pulmonary disease (COPD) with associated chronic respiratory failure, was transferred to the hospital on two occasions. Despite the facility's policy requiring notification, neither R31 nor their representative received a bed hold notification for these transfers. The facility's policy, as outlined in their Bed Hold document dated April 2018, mandates that upon discharge, residents should be notified of their right to hold a bed. The charge nurse is responsible for completing the bed hold agreement and ensuring copies are distributed appropriately. However, during the survey, it was revealed that the Social Services Director did not provide the required written notifications to the resident or their representative, confirming that the facility's policy was not followed. This oversight was acknowledged by the Nursing Home Administrator, who confirmed that notifications were not provided for R31's hospital transfers.
Delayed Transmission of MDS Assessment
Penalty
Summary
The facility failed to ensure the timely transmission of a Resident Assessment Information (RAI)/Minimum Data Set (MDS) assessment for a resident, identified as R34, among 14 sampled residents. R34's Quarterly MDS assessment was completed on June 13, 2024, but was not electronically submitted to the Centers for Medicare and Medicaid Services' (CMS') Quality Improvement and Evaluation System (QIES) until August 21, 2024. This submission was 55 days late, missing the required 14-day timeframe for transmission as outlined in the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual, Version 1.18.1, dated October 2023. The surveyor reviewed R34's medical record on August 20, 2024, and found that the Quarterly MDS assessment was due for submission by June 27, 2024. However, it had not been transmitted by that date. Upon requesting a final validation report, it was confirmed that the assessment was only transmitted on August 21, 2024, at 8:17 AM. During an interview, the Nursing Home Administrator (NHA) acknowledged the delay and attributed it to a communication breakdown, despite being aware of the 14-day submission requirement.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Marinette
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Menominee Health Services | 3.2 mi | — | 0 | 0 |
| Rennes Health And Rehab Center-east | 5.8 mi | — | 3 | 0 |
| Rennes Health And Rehab Center-west | 7.2 mi | — | 3 | 0 |
| Oconto Health And Rehab Center | 18.2 mi | — | 22 | 0 |
| Sturgeon Bay Health Services | 20.3 mi | — | 8 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.