Inspection Reports for Brillion West Haven
220 Achievement Dr, Brillion, WI 54110, WI, 54110
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
1.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
72% better than Wisconsin average
Wisconsin average: 4.6 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
51 residents
Based on a August 2025 inspection.
Census over time
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Aug 25, 2025
Visit Reason
A complaint investigation was conducted on August 25, 2025, to determine if Brillion West Haven was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Complaint Details
The complaint investigation concluded that the facility was not in substantial compliance with applicable statutes and codes, resulting in issuance of a Statement of Deficiency and enforcement actions.
Findings
The Department issued a Statement of Deficiency (SOD #M5NH11) identifying violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83. The licensee was ordered to comply with requirements, develop corrective measures, and was assessed a forfeiture of $1,000 for the violations.
Deficiencies (1)
Health monitoring deficiency identified in Statement of Deficiency M5NH11
Report Facts
Forfeiture amount: 1000
Reduced forfeiture amount: 650
Compliance timeframe: 45
Payment timeframe: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the notice letter |
| Vicky Wittman | Assisted Living Regional Director | Contact person for questions about the letter |
Inspection Report
Complaint Investigation
Census: 51
Deficiencies: 2
Date: Aug 20, 2025
Visit Reason
The surveyor conducted a complaint investigation triggered by a complaint received on 07/28/2025 regarding medication administration at Brillion West Haven.
Complaint Details
One complaint was substantiated. The complaint involved medication administration errors leading to Resident 1 not receiving prescribed antibiotics, resulting in aspiration pneumonia and hospitalization. Resident 1 subsequently passed away on 04/01/2025.
Findings
The investigation found that Resident 1 did not receive a prescribed dose of Levofloxacin on 03/24/2025 due to the medication not being in the medication cart, resulting in aspiration pneumonia and subsequent hospitalization. Additionally, the facility failed to properly monitor Resident 1's health and make appropriate arrangements for physical health services, including lack of communication with the physician regarding the need to crush medications due to swallowing difficulties.
Deficiencies (2)
Resident 1 did not receive all prescribed medications in the dosage and intervals prescribed, specifically missing the 8PM dose of Levofloxacin on 03/24/2025.
The provider did not monitor the health of Resident 1 adequately and failed to make arrangements for physical health services, including lack of physician communication regarding crushing medications for swallowing difficulties.
Report Facts
Deficiencies issued: 2
Medication dosage: 750
Census: 51
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN A | Registered Nurse | Interviewed regarding medication administration and health monitoring failures for Resident 1 |
| Pharmacist C | Pharmacist | Verified medication order and delivery to facility |
| Family Member B | Health Care Power of Attorney | Provided information about Resident 1's condition and medication administration issues |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 60
Deficiencies: 1
Date: Dec 18, 2024
Visit Reason
The survey was conducted as a complaint investigation and standard survey at Brillion West Haven from 12/13/2024 to 12/18/2024.
Complaint Details
The complaint investigation was unsubstantiated.
Findings
One deficiency was identified related to the provider not ensuring that resident assessments included all applicable areas, specifically the use of adaptive equipment such as bed rails. The complaint was unsubstantiated.
Deficiencies (1)
The provider did not ensure the resident assessment included all areas applicable to the resident including the use of adaptive equipment, specifically bed rails for Resident 1.
Report Facts
Census: 52
Total capacity: 60
Deficiencies identified: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| A | Director of Nursing | Interviewed regarding Resident 1's use of bed rails and acknowledged the deficiency. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Dec 18, 2024
Visit Reason
A standard survey and complaint investigation were conducted to determine if Brillion West Haven was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Complaint Details
The visit included a complaint investigation concluded on December 18, 2024, but the substantiation status is not stated.
Findings
The Department issued a Statement of Deficiency (SOD #TM4J11) for violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, establishing grounds for regulatory action against the facility.
Report Facts
Appeal time frame: 10
Compliance time frame: 45
Posting duration: 90
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the notice letter |
| Vicky Wittman | Assisted Living Regional Director | Contact person for questions about the letter |
Inspection Report
Complaint Investigation
Census: 50
Deficiencies: 0
Date: Nov 8, 2023
Visit Reason
Surveyor conducted a complaint investigation at Brillion West Haven on 11/08/2023.
Complaint Details
Complaint was unsubstantiated.
Findings
The complaint was unsubstantiated and no deficiencies were identified during the investigation.
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