Deficiencies per Year
4
3
2
1
0
Unclassified
Inspection Report
Routine
Census: 4
Deficiencies: 3
Nov 12, 2025
Visit Reason
A standard licensure survey was conducted at Bella Vista to assess compliance with health and safety regulations.
Findings
Three violations were identified including failure to ensure staff health screenings for communicable diseases were completed within 90 days prior to employment, the home was not clean and well-maintained with evidence of animal odors and feces, and incomplete background information and criminal history records for new employees prior to working unsupervised with residents.
Deficiencies (3)
| Description |
|---|
| The licensee did not ensure 2 of 2 service providers had been screened for illnesses detrimental to residents, including tuberculosis, within 90 days before the start of providing service. |
| The provider did not ensure the home was clean and well-maintained, with odors of dogs and cats, animal feces in a basement room accessible to residents, and scattered cat litter. |
| The licensee did not ensure criminal history records, background information forms, and integrated background information system letters were complete and timely for new employees prior to working unsupervised with residents. |
Report Facts
Violations identified: 3
Residents present: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Caregiver B | Named in findings related to incomplete health screening and background checks | |
| Caregiver C | Named in findings related to incomplete health screening and background checks | |
| Licensee A | Interviewed regarding staff hiring dates, health screenings, and home conditions |
Inspection Report
Complaint Investigation
Deficiencies: 1
Oct 20, 2025
Visit Reason
A standard survey and complaint investigation was conducted to determine if Pine Meadows 3 was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Findings
The Department issued a Statement of Deficiency (SOD #OBDO11) for violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, resulting in a Notice of Violation, Order to Comply, Special Orders regarding staffing and training, and a forfeiture of $650.
Complaint Details
The visit was triggered by a complaint investigation combined with a standard survey. The substantiation status is not explicitly stated.
Deficiencies (1)
| Description |
|---|
| Violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83 as identified in SOD #OBDO11 |
Report Facts
Forfeiture amount: 650
Reduced forfeiture amount: 422.5
Forfeiture amount: 400
Forfeiture amount: 250
Compliance timeframe: 45
Payment timeframe: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Haugen | Assisted Living Regional Director | Contact person for questions about the letter |
| Kenneth Brotheridge | Assisted Living Director | Signed the Notice and Order letter |
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