Inspection Reports for Charter Senior Living of Hasmer Lake
N168 W22026 MAIN ST, JACKSON, WI, 53037
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
5.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
15% worse than Wisconsin average
Wisconsin average: 4.6 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
10 residents
Based on a September 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Re-Inspection
Census: 10
Deficiencies: 0
Date: Sep 17, 2025
Visit Reason
The surveyor conducted two verification visits at Charter Senior Living of Hasmer Lake for Statement of Deficiencies dated 06/24/2025 and 02/04/2025, combining multiple surveys into one revisit survey.
Findings
No deficiencies were identified during this revisit survey. All previous citations were corrected. A $200 revisit fee is being assessed under statutory provisions.
Report Facts
Revisit fee: 200
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Jun 24, 2025
Visit Reason
A complaint investigation was conducted on June 24, 2025, to determine if Charter Senior Living of Hasmer Lake was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Complaint Details
The investigation was complaint-driven and concluded that the facility was not in substantial compliance with applicable statutes and administrative codes.
Findings
The Department found violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, resulting in a Notice of Violation and an imposed forfeiture of $940.00. The licensee is ordered to comply with all requirements immediately and maintain substantial compliance within 45 days.
Deficiencies (1)
Violations of Wis. Stat. ch. 50 or Wis. Admin. Code ch. DHS 83 as identified in Statement of Deficiency #81YW11
Report Facts
Forfeiture amount: 940
Reduced forfeiture amount: 611
Forfeiture payment timeframe: 10
Compliance timeframe: 45
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: 12
Deficiencies: 1
Date: Jun 24, 2025
Visit Reason
Surveyor conducted a complaint investigation at Charter Senior Living of Hasmer Lake from 06/19/2025 to 06/24/2025 following a complaint received on 02/14/2025 alleging concerns with administration of resident medications.
Complaint Details
The complaint was substantiated.
Findings
One deficiency was identified and substantiated related to Resident 1 not receiving medications as prescribed. Resident 1 received incorrect dosages of sliding scale insulin on 24 occasions and Midodrine was not held on 23 occasions when parameters indicated to hold the medication. The facility did not notify the physician when blood sugar was over 451 and the December 2024 MAR did not record sliding scale insulin units administered.
Deficiencies (1)
Resident 1 received incorrect dosage of sliding scale insulin on 24 occasions between 09/01/2024 and 11/30/2024 and Midodrine was not held on 23 occasions when parameters indicated to hold this medication.
Report Facts
Medication errors: 47
Incorrect sliding scale insulin administrations: 24
Midodrine not held: 23
Census: 12
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Regional Clinician Specialist A | Interviewed and confirmed medication administration errors; reported not assisting the community during the error period. | |
| Executive Director B | Interviewed; new to role and did not know Resident 1. | |
| Memory Care Director C | Interviewed; new to role and did not know Resident 1. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Feb 12, 2025
Visit Reason
A complaint investigation and self-report review were conducted on February 12, 2025, to determine if Charter Senior Living of Hasmer Lake was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Complaint Details
The visit was complaint-related, concluding a complaint investigation and self-report review. Specific substantiation status is not stated.
Findings
The Department found violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, resulting in a Statement of Deficiency (SOD # FVFI11) and imposed a forfeiture of $700.00 for the identified violations.
Report Facts
Forfeiture amount: 700
Reduced forfeiture amount: 455
Forfeiture tag: TAG N426, DHS Code 83.38(1)(b)
Forfeiture payment timeframe: 10
Compliance timeframe: 45
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: 14
Capacity: 24
Deficiencies: 4
Date: Feb 4, 2025
Visit Reason
An investigation into 5 complaints and a self-report was conducted at Charter Senior Living of Hasmer Lake CBRF on 02/04/2025 with information gathered through 02/12/2025.
Complaint Details
The investigation was triggered by 5 complaints and a self-report. Four of the five complaints were substantiated, including abuse allegations and communication failures regarding resident falls.
Findings
Four of 5 complaints were substantiated. Deficiencies included failure to investigate and document abuse allegations, failure to immediately notify legal representatives of resident falls and injuries, inadequate supervision resulting in a resident lying on the floor for over seven hours, and lack of staff training and policy regarding elevator use causing safety concerns.
Deficiencies (4)
Failure to ensure safety of residents and maintain documentation of investigation for abuse allegations involving caregiver CG-D.
Failure to immediately notify residents' legal representatives of falls and injuries, including Resident 4's fractured hip and multiple falls of Resident 6.
Failure to provide supervision appropriate to Resident 6's needs, resulting in Resident 6 lying on the bedroom floor for over seven hours without assistance.
Failure to ensure a safe, clean, comfortable, and homelike environment due to lack of staff training and policy on elevator use, resulting in residents being stuck and requiring fire department assistance.
Report Facts
Complaints investigated: 5
Complaints substantiated: 4
Resident falls: 12
Residents on second floor: 8
Residents needing mobility assistance on second floor: 6
Licensed capacity: 24
Hours resident lay on floor: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CG - D | Caregiver | Named in abuse investigation and termination following substantiated abuse allegations. |
| ED - A | Executive Director | Interviewed regarding abuse investigations and notification failures. |
| OS - B | Operations Specialist | Interviewed regarding abuse investigations and notification failures. |
| HWD - C | Health and Wellness Director | Resigned prior to investigation; involved in abuse investigation. |
| Former Caregiver F | Caregiver | Failed to perform required safety checks resulting in resident lying on floor; terminated. |
| ESD - J | Environmental Services Director | Interviewed regarding elevator operation and lack of staff training. |
| Team Lead/Caregiver-K | Team Lead/Caregiver | Interviewed regarding elevator incident and lack of training. |
| Regional Director of Operations L | Regional Director of Operations | Interviewed regarding elevator policy and training. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jun 11, 2024
Visit Reason
A complaint investigation and verification visit were conducted on June 11, 2024, at Charter Senior Living of Hasmer Lake to determine if the facility was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Complaint Details
The visit was complaint-related, conducted to verify compliance with Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83. The Department issued a Statement of Deficiency for violations found and required corrective action.
Findings
The Department issued a Statement of Deficiency (SOD #RT4K12) for violations found during the complaint investigation. The licensee was ordered to comply with all requirements immediately and maintain substantial compliance within 45 days. Additionally, a $200 inspection fee was assessed for a subsequent verification visit to determine if prior violations were corrected.
Report Facts
Inspection fee: 200
Timeframe for compliance: 45
Appeal timeframe: 10
Posting duration: 90
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the notice letter regarding the violation and order to comply |
| Vicky Wittman | Assisted Living Regional Director | Contact person for questions about the letter |
Inspection Report
Complaint Investigation
Census: 15
Deficiencies: 4
Date: Jun 11, 2024
Visit Reason
Surveyor conducted 2 complaint investigations and a verification visit at Charter Senior Living of Hasmer Lake, a CBRF in Jackson, including allegations of injuries with no explanation and failure to notify legal representatives of incidents.
Complaint Details
Two complaint investigations were conducted. One complaint was substantiated regarding failure to investigate injuries and notify legal representatives. One complaint was unsubstantiated.
Findings
Four deficiencies were identified, including failure to investigate injuries of unknown source, failure to notify legal representatives of incidents, failure to reassess scheduled psychotropic medications quarterly for 3 residents, and failure to maintain blood sugar records for 2 residents. One complaint was substantiated and one was unsubstantiated.
Deficiencies (4)
Provider did not ensure an injury of an unknown source was investigated for Resident 7 found with injuries on 03/07/2024.
Provider did not ensure legal representatives for 2 residents were immediately notified of incidents or injuries, including Resident 7 and Resident 4.
Provider did not ensure 3 residents were reassessed quarterly for scheduled psychotropic medications; Residents 1, 4, and 5 had no assessments in past 90 days.
Provider did not maintain blood sugar records for Residents 1 and 6; documentation of blood sugar readings was missing for multiple dates.
Report Facts
Revisit fee: 200
Deficiencies identified: 4
Residents reviewed for psychotropic reassessment: 3
Residents with missing blood sugar records: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Administrator D | Administrator | Discussed concerns regarding injuries and notification failures; stated not employed at time of some incidents. |
| Clinical Specialist E | Clinical Specialist | Interviewed regarding lack of injury investigation and psychotropic medication reassessments; stated no documentation of investigation and that management was taken over in April. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 8, 2023
Visit Reason
A complaint investigation and standard survey were conducted on November 8, 2023, to determine if Cedarhurst of Jackson was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Complaint Details
The visit was complaint-related, concluding a complaint investigation and standard survey to assess compliance with applicable statutes and administrative codes. Specific substantiation status is not stated.
Findings
The Department issued a Statement of Deficiency (SOD #RT4K11) 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, and a forfeiture of $700.00.
Report Facts
Forfeiture amount: 700
Reduced forfeiture amount: 455
Forfeiture breakdown N389: 400
Forfeiture breakdown N454: 300
Compliance timeframe: 45
Compliance notification timeframe: 7
Extension request timeframe: 10
Forfeiture payment timeframe: 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
Complaint Investigation
Census: 18
Deficiencies: 6
Date: Nov 8, 2023
Visit Reason
Surveyor conducted a complaint investigation and standard survey at Cedarhurst of Jackson, a CBRF in Jackson, to investigate a complaint and assess compliance with regulatory requirements.
Complaint Details
The complaint was unsubstantiated.
Findings
Six deficiencies were identified, including failure to update resident assessments after changes in condition, failure to update individual service plans upon changes, lack of quarterly reassessment of psychotropic medications, failure to document refusals of blood sugar monitoring and medication administration, lack of pet vaccination records, and improper handling of soiled laundry in food service areas. The complaint was unsubstantiated.
Deficiencies (6)
Provider did not ensure 2 of 3 residents reviewed were assessed when they had a change in condition; Resident 2 and Resident 3 did not have updated fall assessments.
Provider did not ensure 1 of 3 resident individual service plans was updated upon changes; Resident 2's ISP did not include behavior of refusing cares.
Provider did not ensure 1 of 1 residents reviewed were reassessed quarterly for psychotropic medications; Resident 1's use of Citalopram and Quetiapine Fumarate was not reassessed quarterly.
Provider did not ensure the facility cat was vaccinated against diseases, including rabies.
Provider did not ensure refusals of blood sugar monitoring and medication administration were documented in 1 of 3 resident records reviewed; Resident 1's refusals and missed medication administrations were not documented.
Provider did not ensure soiled laundry was not transported in areas used for serving food; soiled laundry was observed in the 2nd floor dining room near residents eating lunch.
Report Facts
Deficiencies identified: 6
Repeat deficiencies: 2
Resident refusals for bathing: 13
Resident refusals for changing clothing: 55
Resident refusals for blood sugar checks: 6
Missed medication administrations: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing B | Director of Nursing | Interviewed regarding Resident 2 and Resident 3's fall assessments, Resident 2's behaviors and ISP, Resident 1's medication and blood sugar monitoring refusals, and laundry handling observations. |
| Regional Nurse C | Regional Nurse | Interviewed regarding Resident 2 and Resident 3's fall assessments, Resident 2's behaviors and ISP, Resident 1's medication and blood sugar monitoring refusals, and laundry handling observations. |
| Interim Administrator A | Interim Administrator | Interviewed regarding the facility cat vaccination records. |
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