Inspection Reports for
Country Side Manor West
4228 KADLEC DRIVE, SHEBOYGAN, WI, 53083
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
57% better than Wisconsin average
Wisconsin average: 4.6 deficiencies/yearDeficiencies per year
8
6
4
2
0
Occupancy
Latest occupancy rate
67% occupied
Based on a November 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 6, 2025
Visit Reason
A verification visit and complaint investigation were conducted to determine if Country Side Manor West was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Complaint Details
The visit was complaint-related and included a verification visit to determine compliance. Specific substantiation status is not stated.
Findings
The Department issued a Statement of Deficiency (SOD #2EY012) citing violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83. A forfeiture of $900 was imposed for these violations, and a $200 inspection fee was assessed for a revisit to verify correction of prior deficiencies.
Report Facts
Forfeiture amount: 900
Reduced forfeiture amount: 585
Revisit inspection fee: 200
Days to pay forfeiture: 10
Days to pay reduced forfeiture: 10
Days to pay revisit fee: 10
Days to request extension: 10
Days to file appeal: 10
Posting duration for citations and statements of deficiency: 90
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the Notice and Order letter. |
| Vicky Wittman | Assisted Living Regional Director | Contact person for questions about the letter. |
Inspection Report
Complaint Investigation
Census: 42
Deficiencies: 2
Date: Nov 6, 2025
Visit Reason
Surveyors conducted one verification visit and investigated two complaints. The visit included verification of correction of one deficiency and identification of two new deficiencies.
Complaint Details
Two complaints were investigated and found unsubstantiated. One deficiency was verified as corrected and two deficiencies were identified as repeat violations.
Findings
Two of three deficiencies were repeat violations related to failure to develop and update comprehensive Individual Service Plans (ISPs) for residents. The provider did not develop a timely ISP for one resident and failed to update ISPs for three residents after changes in their conditions.
Deficiencies (2)
83.35(3)(a) Comprehensive Individualized Service Plan. The provider did not develop a comprehensive Individual Service Plan for Resident 6 within 30 days after admission. The ISP was late and unsigned by the resident or representative.
83.35(3)(d) Service plans updated annually or on changes. The provider did not update the Individual Service Plan when Residents 3, 4, and 5 had changes in plan of care or condition, including visitor restrictions, use of assistive devices, hospice services, and supplemental oxygen.
Report Facts
Revisit fee: 200
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Regional Wellness Director G | Regional Wellness Director | Interviewed regarding ISP completion and resident condition updates. |
| Associate Administrator E | Associate Administrator | Interviewed about ISP updates and resident visitor restrictions. |
| Medication Assistant H | Medication Assistant | Interviewed about Resident 4's use of assistive device. |
| Medication Assistant J | Medication Assistant | Interviewed about staff awareness of ISP changes. |
Notice
Deficiencies: 0
Date: Jun 7, 2025
Visit Reason
A standard survey and complaint investigation were conducted on June 7, 2025, to determine if Country Side Manor West was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Complaint Details
The visit included a complaint investigation; however, the substantiation status is not stated.
Findings
Violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83 were identified, resulting in the issuance of Statement of Deficiency #2EY011 and an order to comply with requirements to protect resident health, safety, and welfare.
Report Facts
Compliance timeframe: 45
Inspection fee: 200
Appeal timeframe: 10
Posting duration: 90
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the Notice and Order letter. |
| Vicky Wittman | Assisted Living Regional Director | Contact person for questions about the letter. |
Inspection Report
Complaint Investigation
Census: 44
Deficiencies: 3
Date: Jun 6, 2025
Visit Reason
Surveyor conducted a standard survey and three complaint investigations at Country Side Manor West due to concerns regarding resident care needs not being met.
Complaint Details
The visit included three complaint investigations; two complaints were substantiated. Concerns included resident care needs not being met, failure to follow care plans, and inadequate investigation of abuse allegations. Family members expressed concerns about staff not following care plans and inadequate rounds/checks on residents.
Findings
Two of three complaints were substantiated, resulting in three deficiencies related to failure to ensure resident safety and thorough investigation of abuse allegations, failure to develop a comprehensive individual service plan within 30 days of admission, and failure to update the individual service plan upon changes in resident condition.
Deficiencies (3)
Provider did not take immediate steps to ensure the safety of all residents, thoroughly investigate, and maintain documentation of investigations in response to reports alleging potential abuse, neglect, or mistreatment.
Provider did not develop a comprehensive Individual Service Plan (ISP) for one resident within 30 days after admission.
Provider did not update the Individual Service Plan when a resident had a change of condition and was admitted to hospice.
Report Facts
Complaints investigated: 3
Complaints substantiated: 2
Deficiencies cited: 3
Resident census: 44
Resident admission date: Apr 11, 2024
Resident admission date: Jun 23, 2023
ISP date: Oct 13, 2023
Hospice admission date: Nov 29, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| ED A | Executive Director | Interviewed regarding investigations, care plans, and facility practices related to complaints. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Oct 9, 2024
Visit Reason
A complaint investigation was conducted on October 9, 2024, to determine if Country Side Manor West was in substantial compliance with Wisconsin Statutes and Administrative Code requirements for community-based residential facilities.
Complaint Details
The visit was complaint-related, concluding a complaint investigation to assess compliance with statutory and administrative requirements. Specific substantiation status is not stated.
Findings
The Department issued a Statement of Deficiency (SOD #SIO811) for violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, establishing grounds for regulatory action and requiring compliance within 45 days.
Report Facts
Appeal timeframe: 10
Compliance timeframe: 45
Posting duration: 90
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the notice letter and is identified as the Bureau of Assisted Living Director. |
| Vicky Wittman | Assisted Living Regional Director | Contact person for questions about the letter. |
Inspection Report
Complaint Investigation
Census: 59
Deficiencies: 1
Date: Oct 7, 2024
Visit Reason
The inspection was conducted as a complaint investigation triggered by an allegation received on 09/30/2024 that residents were not receiving all medications as prescribed.
Complaint Details
The complaint alleged residents were not receiving all medications as prescribed. The investigation substantiated this with findings of missed medication doses and documentation discrepancies.
Findings
The provider failed to ensure that 2 out of 4 residents reviewed received all medications in the prescribed dosage and intervals. Specific instances included medications not administered despite being initialed as given, and medications missing from the medication cart on multiple occasions.
Deficiencies (1)
Residents did not receive all medications in the dosage and intervals prescribed by a practitioner for 2 out of 4 residents reviewed (Resident 1 and Resident 2).
Report Facts
Census: 59
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Administrator A | Administrator | Interviewed regarding re-education of staff on medication re-ordering and documentation |
Inspection Report
Complaint Investigation
Census: 61
Deficiencies: 0
Date: Jul 17, 2024
Visit Reason
Surveyor investigated 3 complaints at Countryside Manor West in Sheboygan on 07/17/2024 with information gathered through 07/18/2024.
Complaint Details
Three (3) of 3 complaints were unsubstantiated.
Findings
Three complaints were unsubstantiated and no deficiencies were issued as a result of the survey.
Report Facts
Complaints investigated: 3
Complaints unsubstantiated: 3
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Dec 18, 2023
Visit Reason
The Bureau of Assisted Living, Southern Regional Office conducted 2 complaint investigations at Country Side Manor West, a CBRF located in Sheboygan, WI.
Complaint Details
Two complaints were investigated and both were found to be unsubstantiated.
Findings
As a result of the investigations, 0 violations of Chapter DHS 83 were issued. Both complaints were unsubstantiated.
Report Facts
Number of complaints investigated: 2
Violations issued: 0
Inspection Report
Complaint Investigation
Census: 52
Deficiencies: 0
Date: Jun 7, 2023
Visit Reason
Surveyor conducted a standard survey and investigated two complaints at Country Side Manor West.
Complaint Details
Two complaints were investigated and found to be unsubstantiated.
Findings
Two complaints were unsubstantiated and no deficiencies were identified during the survey.
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