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Holy Family Memorial Inc.

No longer in CMS list This agency is not in CMS's current list of Medicare-certified home health agencies (file dated 2026-09-21), but it has federal inspection records. It may have closed, changed ownership, or changed its certification number. Address shown is from its inspection records.
1520 S. 41ST St., Manitowoc, WI 54220
CMS Certification Number 527154
14deficiencies since 2018
0serious
3inspections
n/aCMS quality stars
Data from CMS inspection reports (Form 2567), 2018-01-02 to 2026-10-15, downloaded 2026-10-21; CMS agency list file dated 2026-09-21. What the labels mean

Inspection 2025-02-18

· Recertification · 8 deficiencies · CMS source report (PDF)
Moderate Encoding And Transmitting Oasis

The agency failed to transmit OASIS (Outcome and Assessment Information Set) assessments within 30 days.

Source: CMS Form 2567, inspection 2025-02-18, tag G0372 · view on CMS
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Minor Property And Person Treated With Respect

The agency failed to inform patient and/or patient's legal representatives, in writing, of the right to have his or her property and person treated with respect in 1 of 1 home health admission booklets reviewed.

Source: CMS Form 2567, inspection 2025-02-18, tag G0428 · view on CMS
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Minor Participate In Care

The agency failed to inform patient and/or patient's legal representatives of the right to participate in, be informed of and consent or refuse care regarding completion of assessments, care to be furnished based on assessments, and establishing and revising of the plan of care in 1 of 1 home…

Source: CMS Form 2567, inspection 2025-02-18, tag G0434 · view on CMS
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Minor Receive All Services In Plan Of Care

The agency failed to inform patient and/or patient's legal representatives of the right to receive all services as outlined in the plan of care in 1 of 1 home health admission booklets reviewed.

Source: CMS Form 2567, inspection 2025-02-18, tag G0436 · view on CMS
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Minor Investigate Complaints Made By Patient

The agency failed to inform patient and/or patient's legal representatives of the complaint procedures for the agency’s responsibility to investigate complaints made including treatment or care that is or fails to be furnished, and regarding mistreatment, neglect, or verbal, mental, sexual and…

Source: CMS Form 2567, inspection 2025-02-18, tag G0478 · view on CMS
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Minor Protect Patient During Investigation

The agency failed to inform patient and/or patient's legal representatives of the complaint procedures that the agency must take action to prevent further potential violations, including retaliation while a complaint is being investigated in 1 of 1 home health admission booklets reviewed.

Source: CMS Form 2567, inspection 2025-02-18, tag G0486 · view on CMS
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Minor Immediate Reporting Of Abuse By All Staff

The agency failed to inform patient and/or patient's legal representatives of the agency’s staff responsibility to report incidences of mistreatment, neglect, or verbal, mental, sexual and physical abuse, and misappropriation of property by anyone furnishing services immediateley to the home health…

Source: CMS Form 2567, inspection 2025-02-18, tag G0488 · view on CMS
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Minor Required Items In Clinical Record

Agency staff failed to document wound measurements in 3 out of 4 medical records with wounds out of a total of 10 patient records reviewed (Patients # 6,7,8).

Source: CMS Form 2567, inspection 2025-02-18, tag G1012 · view on CMS
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Inspection 2022-03-09

· Recertification · 3 deficiencies · CMS source report (PDF)
Moderate Ep Testing Requirements

The home health agency failed to analyze the agency's response to the emergency preparedness tabletop exercise/drill as part of a health system and need for emergency preparedness plan revision based on the analysis in 1 of 1 Emergency Preparedness Programs reviewed.

Source: CMS Form 2567, inspection 2022-03-09, tag E0039 · view on CMS
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Moderate Integrated Ep Program

The agency and healthcare integrated system failed to demonstrate and document the home health agency’s active involvement in the tabletop exercise/drill in 1 of 1 Emergency Preparedness Programs reviewed.

Source: CMS Form 2567, inspection 2022-03-09, tag E0042 · view on CMS
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Minor Provide Services In The Plan Of Care

This agency failed to provide services ordered on the plan of care in 1 of 5 patient observations (Patient # 2.) Findings Include: Review of policy titled "Coordination of Services and Documentation #15184-8219 version 7.2" dated 6/8/2021, revealed in part, "Policy 1.2. The individualized Plan of…

Source: CMS Form 2567, inspection 2022-03-09, tag G0710 · view on CMS
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Inspection 2019-04-04

· Recertification · 3 deficiencies · CMS source report (PDF)
Moderate Names And Contact Information

The agency failed to document an updated emergency contact list in 1 of 1 emergency preparedness program reviewed.

Source: CMS Form 2567, inspection 2019-04-04, tag E0030 · view on CMS
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Moderate Retrieval Of Records

The agency failed to notify patients of their right to have clinical records made available, free of charge, upon request at the next home visit or within four business days, whichever comes first, in 1 of 1 "Rights and Responsibilities" forms reviewed.

Source: CMS Form 2567, inspection 2019-04-04, tag G1030 · view on CMS
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Minor Payment From Federally Funded Programs

The agency failed to inform the patient and/or representative of their rights, orally or in writing, of any changes in care regarding the payment sources and charges as soon as possible in advance of the next home health visit in 13 of 13 patients (Patient's #1, #2, #3, #4, #5, #6, #7, #8, #9, #10…

Source: CMS Form 2567, inspection 2019-04-04, tag G0440 · view on CMS
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