Deficiencies per Year
4
3
2
1
0
Unclassified
Census Over Time
Inspection Report
Enforcement
Deficiencies: 0
Dec 10, 2024
Visit Reason
A Verification Visit was conducted on December 10, 2024, to determine if Lake Pointe Villa Assisted Living was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities (CBRF).
Findings
The Department found violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, resulting in a Statement of Deficiency (SOD # XEPV12) and an imposed forfeiture of $4,000. The licensee is ordered to comply with all requirements immediately and maintain substantial compliance within 45 days.
Report Facts
Forfeiture amount: 4000
Reduced forfeiture amount: 2600
Inspection fee: 200
Days to achieve compliance: 45
Days to request extension: 10
Days to pay forfeiture: 10
Days to pay inspection fee: 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
Follow-Up
Census: 18
Deficiencies: 1
Dec 10, 2024
Visit Reason
Surveyors conducted a verification visit to Lake Pointe Villa Assisted Living to assess correction of previously cited deficiencies and to identify any new citations.
Findings
The facility had one uncorrected deficiency and one new citation related to failure to update Resident 2's individual service plan (ISP) after multiple falls. Resident 2 experienced 8 falls between 10/01/2024 and 11/28/2024, but the ISP was not updated to reflect new interventions or post-fall assessments.
Deficiencies (1)
| Description |
|---|
| Failure to update Resident 2's individual service plan based on assessment to meet needs for fall prevention after multiple falls. |
Report Facts
Revisit fee: 200
Number of falls: 8
Census: 18
Inspection Report
Abbreviated Survey
Census: 19
Deficiencies: 2
Jul 9, 2024
Visit Reason
Surveyors conducted an abbreviated survey at Lakepointe Villa Assisted Living to assess compliance with training requirements and individual service plan updates following an elopement incident.
Findings
Two deficiencies were identified: failure to ensure task-specific training for employees providing personal care, and failure to update a resident's individual service plan (ISP) after an elopement incident, including lack of involvement of the resident and guardian and incomplete risk assessment documentation.
Deficiencies (2)
| Description |
|---|
| The provider did not ensure 2 of 3 employees reviewed obtained all task specific training, specifically in provision of personal care prior to assuming duties. |
| The provider did not update Resident 1's individual service plan based on assessment and involvement of Resident 1 and legal guardian after an elopement incident on 01/08/2024; the ISP lacked clear identification of elopement risk, did not specify frequency of safety checks, and was not initially signed by Resident 1 or guardian. |
Report Facts
Number of deficiencies identified: 2
Census: 19
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Caregiver A | Named in deficiency for lack of personal care training | |
| Wellness Coordinator C | Named in deficiency for lack of personal care training and involved in Resident 1's care | |
| Assistant Executive Director D | Assistant Executive Director | Provided training records and interviews related to deficiencies |
| Caregiver H | Observed administering medications and documented Resident 1's wander guard status | |
| Wellness Director G | Wellness Director | Revised Resident 1's ISP and acknowledged lack of involvement in ISP development |
| Executive Director F | Executive Director | Interviewed regarding Resident 1's elopement risk and ISP updates |
Report
File
XEPV11ENFS.PDF_16733.pdf
Report
File
XEPV13SODS.PDF_16733.pdf
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