Inspection Reports for
Shores of Sheboygan Assisted Living I
3315 SUPERIOR AVE, SHEBOYGAN, WI, 53081
Back to Facility Profile4 Reports
Inspection Report — Jun 17, 2025
Routine State
Date: Jun 17, 2025
Visit Reason
Surveyor conducted a standard survey and one complaint investigation at The Shores of Sheboygan Assisted Living I.
Complaint Details
One complaint was investigated and found to be unsubstantiated.
Findings
One complaint was unsubstantiated and no deficiencies were issued as a result of the survey.
Inspection Report — Mar 19, 2024
Follow-Up State
Date: Mar 19, 2024
Visit Reason
Verification visit to Shores of Sheboygan Assisted Living I to assess correction of previous deficiencies.
Findings
Three out of three previous deficiencies were corrected. A $200 revisit fee is being assessed under statutory provisions.
Report Facts
Revisit fee: 200
Inspection Report — Sep 7, 2023
Complaint Investigation State
Date: Sep 7, 2023
Visit Reason
The inspection was conducted as a Standard Survey and Complaint Investigation to determine if Shores of Sheboygan Assisted Living I 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 standard survey. The Department found violations substantiating the complaint, resulting in a Statement of Deficiency and a forfeiture.
Findings
The Department issued a Statement of Deficiency (SOD #LSZ211) for violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83. A forfeiture of $500 was imposed for violations related to tag N408 (83.37(1)(i)).
Report Facts
Forfeiture amount: 500
Reduced forfeiture amount: 325
Forfeiture per violation: 500
Forfeiture payment deadline: 10
Compliance timeframe: 45
Appeal request deadline: 10
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 — Aug 30, 2023
Complaint Investigation State
Date: Aug 30, 2023
Visit Reason
Surveyor conducted 3 complaint investigations and a standard survey at Shores of Sheboygan Assisted Living I, a Community-Based Residential Facility (CBRF). The visit was triggered by complaints and a routine compliance check.
Complaint Details
Three complaints were investigated and all were unsubstantiated.
Findings
Three deficiencies were identified, including one repeat deficiency. Three complaints were unsubstantiated. Deficiencies included failure to ensure an employee completed required standard precautions training prior to job duties, failure to reassess a resident receiving scheduled psychotropic medication quarterly, and failure to include rationale and detailed behavior descriptions for PRN psychotropic medications in residents' individual service plans.
Deficiencies (3)
Caregiver C did not complete required standard precautions training prior to assuming job duties that exposed them to blood or bodily fluids.
Resident 1 was not reassessed at least quarterly by a pharmacist, practitioner, or registered nurse for the desired responses and possible side effects of scheduled psychotropic medication Escitalopram.
Residents 1 and 2's individual service plans did not include the rationale for use and detailed description of behaviors indicating the need for administration of PRN psychotropic medications.
Report Facts
PRN psychotropic medication administrations: 51
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Caregiver C | Caregiver | Named in deficiency for not completing standard precautions training prior to job duties. |
| Administrator A | Interviewed regarding Caregiver C's training and onboarding process. | |
| Wellness Director B | Wellness Director | Interviewed regarding psychotropic medication reassessments and individual service plans. |
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