Inspection Reports for Ivy Manor of West Bend
370 S Forest Ave, West Bend, WI 53095, United States, WI, 53095
Back to Facility ProfileDeficiencies (last 2 years)
Deficiencies (over 2 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
4
3
2
1
0
Census
Latest occupancy rate
20 residents
Based on a January 2024 inspection.
Census over time
Inspection Report
Re-Inspection
Census: 20
Deficiencies: 0
Date: Jan 29, 2024
Visit Reason
Surveyors conducted a verification visit for statement of deficiency (SOD) MJE711, one complaint, and reviewed one self-report at Ivy Manor of West Bend.
Complaint Details
Complaint was unsubstantiated.
Findings
All previous deficiencies were corrected, the complaint was unsubstantiated, and no new deficiencies were identified.
Report Facts
Revisit fee: 200
Inspection Report
Abbreviated Survey
Deficiencies: 0
Date: Sep 18, 2023
Visit Reason
An abbreviated survey and complaint investigation were conducted to determine if Ivy Manor of West Bend 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 explicitly stated in the document.
Findings
The Department issued a Statement of Deficiency (SOD #MJE711) for violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, establishing grounds for enforcement action and requiring the licensee to comply with all applicable requirements.
Report Facts
Inspection fee: 200
Compliance timeframe: 45
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
Abbreviated Survey
Census: 20
Deficiencies: 4
Date: Sep 14, 2023
Visit Reason
Surveyor conducted an abbreviated licensure survey and a complaint investigation at Ivy Manor of West Bend. The complaint was unsubstantiated.
Complaint Details
Complaint was unsubstantiated.
Findings
Four deficiencies were identified including failure to update individual service plans annually or upon changes, lack of documented medication regimen review for 2021 and 2022, improper clothes dryer vent tubing, and missing documentation of gas furnace servicing within required intervals.
Deficiencies (4)
Individual service plan was not updated annually or when there was a change in condition, missing documentation of dietary concerns, medication refusal, and behaviors related to PRN pain medication.
No documentation of onsite medication administration and storage system review by a physician, pharmacist, or registered nurse for 2021 and 2022.
Clothes dryer vent tubing was flexible foil type instead of rigid material with required fire rating.
No documentation indicating the gas furnace had been serviced at least every 3 calendar years as required.
Report Facts
Deficiencies identified: 4
Census: 20
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