Inspection Reports for
Kettle Moraine Gardens Rcac
1802 EDGEWOOD ROAD, KEWASKUM, WI, 53040
Back to Facility ProfileDeficiencies (last 2 years)
Deficiencies (over 2 years)
1.5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
67% better than Wisconsin average
Wisconsin average: 4.6 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
29 residents
Based on a March 2024 inspection.
Occupancy over time
Inspection Report
Follow-Up
Census: 29
Deficiencies: 0
Date: Mar 13, 2024
Visit Reason
A verification visit was conducted to assess correction of previous deficiencies at Kettle Moraine Gardens RCAC.
Findings
Three of three previous deficiencies were corrected. A $200 revisit fee is being assessed under statutory provisions.
Report Facts
Revisit fee: 200
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Oct 25, 2023
Visit Reason
A standard survey and complaint investigation were conducted on October 25, 2023, to determine if Kettle Moraine Gardens RCAC was in substantial compliance with Wisconsin statutes and administrative codes governing residential care apartment complexes.
Complaint Details
The visit was complaint-related and included a standard survey. The Department concluded the investigation and issued a Statement of Deficiency for violations found. Specific substantiation status is not stated.
Findings
The Department issued a Statement of Deficiency (SOD #3ODV11) for violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 89, establishing grounds for regulatory action and requiring the operator to comply with applicable requirements to protect tenant health, safety, and welfare.
Report Facts
Compliance timeframe: 45
Plan of Correction submission timeframe: 10
Inspection fee: 200
Appeal filing timeframe: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the notice letter as Bureau of Assisted Living, Division of Quality Assurance |
| Vicky Wittman | Assisted Living Regional Director | Contact person for questions about the letter |
Inspection Report
Complaint Investigation
Census: 28
Deficiencies: 3
Date: Oct 25, 2023
Visit Reason
The surveyor conducted a complaint investigation and standard survey at Kettle Moraine Gardens RCAC following a complaint. The purpose was to investigate the complaint and assess compliance with regulatory requirements.
Complaint Details
The complaint was unsubstantiated.
Findings
Three deficiencies were identified: 1) One caregiver lacked timely training in fire safety, first aid, and tenant rights; 2) One tenant did not have an updated comprehensive assessment; 3) Two tenants did not have risk agreements related to their non-compliance with specialty diets.
Deficiencies (3)
One of three caregivers reviewed did not have training in safety procedures, including fire safety, first aid, and tenant rights at the time care began.
One of three tenants reviewed did not have an updated comprehensive assessment since 09/06/2022.
Two of three tenants reviewed did not have risk agreements related to their non-compliance with specialty diets.
Report Facts
Deficiencies identified: 3
Census: 28
Caregivers reviewed: 3
Tenants reviewed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Caregiver B | Named in deficiency related to lack of timely training in fire safety, first aid, and tenant rights. | |
| Human Resources C | Interviewed regarding Caregiver B's delayed training. | |
| Nurse A | Interviewed regarding tenant assessments and diet compliance. | |
| Administrator D | Involved in discussion about caregiver training delays. |
Viewing
Loading inspection reports...
