Inspection Reports for New Day Assisted Living- Elkhorn

1550 COUNTRY CLUB PARKWAY, ELKHORN, WI, 53121

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Deficiencies (last 4 years)

Deficiencies (over 4 years) 2.5 deficiencies/year

Deficiencies are regulatory violations found during state inspections.

46% better than Wisconsin average
Wisconsin average: 4.6 deficiencies/year

Deficiencies per year

4 3 2 1 0
2023
2024
2025
2026

Census

Latest occupancy rate 28 residents

Based on a January 2026 inspection.

This facility has shown a decline in demand based on occupancy rates.

Census over time

21 28 35 42 49 Mar 2023 Feb 2024 Oct 2024 Jan 2026
Inspection Report Complaint Investigation Census: 28 Deficiencies: 0 Jan 6, 2026
Visit Reason
Surveyor conducted a complaint investigation and verification visit at New Day Assisted Living-Elkhorn.
Findings
No deficiencies were identified. The deficiency from a prior Statement of Deficiency dated 08/05/2025 was substantially corrected. The complaint was unsubstantiated.
Complaint Details
The complaint was unsubstantiated.
Report Facts
Revisit fee: 200
Notice Deficiencies: 0 Aug 5, 2025
Visit Reason
A standard survey and verification visit was conducted on August 5, 2025, to determine if New Day Assisted Living-Elkhorn was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Findings
The Department found violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, resulting in a Notice of Violation, an imposed forfeiture of $510.00, and a $200 inspection fee for a verification revisit. The licensee is ordered to comply with medication administration requirements and implement corrective measures within specified timeframes.
Report Facts
Forfeiture amount: 510 Reduced forfeiture amount: 331.5 Inspection fee: 200 Compliance timeframe: 45 Notification timeframe: 7 Extension request timeframe: 10 Forfeiture payment timeframe: 10 Revisit fee payment timeframe: 10
Employees Mentioned
NameTitleContext
Kenneth BrotheridgeAssisted Living DirectorSigned the Notice and Order letter
Hillary HolmanAssisted Living Regional DirectorContact person for questions about the letter
Inspection Report Routine Census: 28 Deficiencies: 1 Aug 5, 2025
Visit Reason
A standard survey and verification visit was conducted to assess compliance with regulatory requirements at Frontida of Elkhorn.
Findings
One deficiency was identified related to medication administration for Resident 10, specifically that medications were administered despite blood pressure readings indicating they should have been held. This was a repeat violation from a prior survey.
Deficiencies (1)
Description
Provider did not ensure Resident 10 received medications as prescribed; staff administered kidney disease medication on 17 occasions despite blood pressure parameters to hold medication.
Report Facts
Revisit fee: 200 Medication administration occurrences: 17 Census: 28
Employees Mentioned
NameTitleContext
Nurse PNurseProvided reeducation to staff regarding medication administration and parameter compliance
Regional Nurse NInterviewed regarding Resident 10's medication administration
Executive Director OExecutive DirectorInterviewed regarding Resident 10's medication administration
Inspection Report Complaint Investigation Deficiencies: 1 Oct 14, 2024
Visit Reason
A complaint investigation and verification visit was conducted on October 14, 2024, to determine if Frontida of Elkhorn was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
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 $500. The licensee was ordered to comply with requirements to ensure proper care and treatment of residents, including reviewing fall risk assessments and revising Individualized Service Plans within 45 days.
Complaint Details
The visit was complaint-related, conducted to verify compliance following a complaint investigation. The Department issued a Statement of Deficiency and imposed a forfeiture.
Deficiencies (1)
Description
Violations of Wis. Stat. ch. 50 or Wis. Admin. Code ch. DHS 83 as detailed in Statement of Deficiency #NLJO13
Report Facts
Forfeiture amount: 500 Reduced forfeiture amount: 325 Inspection fee: 200 Compliance timeframe: 45 Payment timeframe: 10
Employees Mentioned
NameTitleContext
Kenneth BrotheridgeAssisted Living DirectorSigned the Notice and Order letter
Hillary HolmanAssisted Living Regional DirectorContact person for questions about the letter
Inspection Report Complaint Investigation Census: 27 Deficiencies: 1 Oct 14, 2024
Visit Reason
Surveyor conducted a complaint investigation and verification visit at Frontida of Elkhorn due to a complaint regarding failure to update individual service plans reflecting resident needs.
Findings
One deficiency was identified related to failure to update Resident 9's Individual Service Plan (ISP) to reflect fall management after multiple falls. The complaint was substantiated and the deficiency was a repeat violation from a prior survey.
Complaint Details
The complaint was substantiated. One deficiency was identified, which was a repeat violation from a prior Statement of Deficiency dated 02/27/2020. A $200 revisit fee was assessed under Wis. Stat. Ch. 50.
Deficiencies (1)
Description
Provider did not ensure Individual Service Plans were updated to reflect the needs of Resident 9, specifically failing to update the fall management plan after 8 falls between 05/01/2024 and 07/25/2024.
Report Facts
Revisit fee: 200 Number of falls: 8 Census: 27
Inspection Report Complaint Investigation Deficiencies: 1 Jun 6, 2024
Visit Reason
A complaint investigation and verification visit was conducted on June 6, 2024, to determine if Frontida of Elkhorn was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Findings
The Department found violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, resulting in a Statement of Deficiency #NLJO12. The licensee was ordered to comply with requirements immediately and implement corrective measures to ensure proper care, safety, and respect for residents' rights.
Complaint Details
The visit was complaint-related, conducted to verify compliance with applicable statutes and codes. The Department issued a Statement of Deficiency and imposed enforcement actions including a forfeiture.
Deficiencies (1)
Description
Violation of Wis. Admin. Code § DHS 83.32(3)(i) related to resident care and treatment
Report Facts
Forfeiture amount: 500 Reduced forfeiture amount: 325 Inspection fee: 200 Revisit fee: 200 Compliance timeframe: 45 Appeal timeframe: 10
Employees Mentioned
NameTitleContext
Hillary HolmanAssisted Living Regional DirectorContact person for questions about the letter
Kenneth BrotheridgeAssisted Living DirectorSigned the Notice and Order letter
Inspection Report Complaint Investigation Census: 31 Deficiencies: 2 Jun 6, 2024
Visit Reason
Surveyor conducted a complaint investigation and verification visit at Frontida of Elkhorn from 05/30/2024 to 06/06/2024 following a complaint alleging care was not provided after a change in condition.
Findings
Two deficiencies were identified, including a repeat violation related to inadequate prompt and adequate treatment for Resident 7 who sustained a stroke and did not receive timely care. Additionally, the provider failed to ensure separate storage areas or containers for clean and soiled laundry, with soiled laundry observed improperly stored and a strong urine-like odor noted.
Complaint Details
The complaint was substantiated. The investigation found that Resident 7 was observed with a change in condition on 03/31/2024, including inability to bear weight and lethargy, with delayed emergency response and 911 call. Staff and resident interviews indicated concerns about timeliness of care and communication. A $200 revisit fee was assessed under Wis. Stat. Ch. 50.
Deficiencies (2)
Description
Provider did not ensure Resident 7 received prompt and adequate treatment appropriate to the resident's needs after a stroke and change in condition.
Provider did not ensure separate storage areas or containers for clean and soiled laundry; soiled laundry was improperly stored with some baskets uncovered and a strong urine-like odor present.
Report Facts
Deficiencies identified: 2 Revisit fee: 200 Resident census: 31 Laundry baskets observed: 5 Laundry baskets inside laundry room: 3 Washer downtime: 30 Blood pressure readings: 150108 Blood pressure readings: 13693 Blood pressure max: 18884
Notice Deficiencies: 0 Feb 1, 2024
Visit Reason
A standard survey was conducted on February 1, 2024, to determine if Frontida of Elkhorn was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Findings
The Department found violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, resulting in a Statement of Deficiency (SOD #NLJO11), imposition of a forfeiture totaling $1350.00, and an order to comply with all regulatory requirements within specified timeframes.
Report Facts
Forfeiture amount: 1350 Reduced forfeiture amount: 877.5 Forfeiture for tag N219: 1000 Forfeiture for tag N352: 350 Compliance timeframe: 45 Compliance notification timeframe: 7 Appeal filing timeframe: 10
Employees Mentioned
NameTitleContext
Kenneth BrotheridgeAssisted Living DirectorSigned the Notice and Order letter.
Hillary HolmanAssisted Living Regional DirectorContact person for questions about the letter.
Inspection Report Routine Census: 32 Capacity: 44 Deficiencies: 4 Feb 1, 2024
Visit Reason
On 02/01/2024, a standard survey was conducted at Frontida of Elkhorn to assess compliance with regulatory requirements.
Findings
Four deficiencies were identified including incomplete caregiver background checks, missed medication doses for a resident, failure to follow hand hygiene procedures, and unclean kitchen equipment and utensils.
Deficiencies (4)
Description
Incomplete caregiver background check for Caregiver C who was on the misconduct registry but allowed to work.
Resident 6 missed 14 doses of prescribed Tramadol during January 2024.
Caregiver C did not wash or sanitize hands between residents during medication administration, violating CDC hand hygiene standards.
Kitchen equipment and utensils were not stored in a clean manner, including spills and food crumbs in walk-in cooler and freezer, dirty sinks, and greasy cooking surfaces.
Report Facts
Deficiencies identified: 4 Missed medication doses: 14 Census: 32 Total capacity: 44
Employees Mentioned
NameTitleContext
Caregiver CNamed in findings for incomplete background check, failure to follow hand hygiene, and medication administration issues
Director of Operations ADirector of OperationsInterviewed regarding background check and medication administration deficiencies
VP Clinical Services BVP Clinical ServicesInterviewed regarding background check and medication administration deficiencies
Inspection Report Complaint Investigation Census: 34 Deficiencies: 0 Jun 21, 2023
Visit Reason
The Bureau of Assisted Living, Southern Regional Office conducted a complaint investigation at Tender Reflections of Elkhorn located at 1550 Country Club Parkway in Elkhorn, WI.
Findings
No citations of noncompliance were issued and the complaint was not substantiated.
Complaint Details
Complaint was not substantiated.
Inspection Report Complaint Investigation Census: 32 Deficiencies: 0 Mar 16, 2023
Visit Reason
The Bureau of Assisted Living conducted a complaint investigation and verification of a Statement of Deficiency at Tender Reflections of Elkhorn.
Findings
No citations of noncompliance were issued, the Statement of Deficiency was corrected, and the complaint was unsubstantiated.
Complaint Details
The complaint was unsubstantiated.
Report Facts
Revisit fee: 200

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