Inspection Reports for
Serenity Spring Senior Living at Scandia Village
2311 Meadow Wood Dr, Sister Bay, WI, 54234
Back to Facility ProfileDeficiencies (last 1 years)
Deficiencies (over 1 years)
2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
57% better than Wisconsin average
Wisconsin average: 4.6 deficiencies/year
Deficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
23 residents
Based on a September 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy over time
Inspection Report
Re-Inspection
Census: 23
Deficiencies: 0
Date: Sep 10, 2025
Visit Reason
Surveyor conducted a verification visit and probationary survey at Serenity Spring Senior Living at Scandia Village in Sister Bay to verify correction of previous deficiencies.
Findings
Two of two deficiencies were corrected and no new deficiencies were identified during the visit.
Report Facts
Revisit fee: 200
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jun 20, 2025
Visit Reason
A complaint investigation was conducted on June 20, 2025, to determine if Serenity Spring Senior Living at Scandia Village was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Complaint Details
The complaint investigation concluded that the facility was not in substantial compliance with applicable statutes and administrative codes, resulting in issuance of a Statement of Deficiency and a Notice of Violation.
Findings
The Department issued a Statement of Deficiency (SOD # XK0V11) 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 within 45 days.
Report Facts
Compliance timeframe: 45
Inspection fee: 200
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
Complaint Investigation
Census: 21
Deficiencies: 2
Date: Jun 20, 2025
Visit Reason
The surveyor conducted a complaint investigation triggered by a complaint received on 2025-04-28 regarding medication administration at Serenity Spring Senior Living at Scandia Village.
Complaint Details
One complaint was substantiated regarding medication administration. The complaint was received on 2025-04-28 and involved Resident 1 not receiving prescribed medication as requested.
Findings
The investigation found that Resident 1 did not receive prescribed medication (Loperamide) as ordered on 2025-04-15 when requested. Staff refused to administer the medication due to concerns about bowel obstruction, despite the resident's request and family involvement. Additionally, Resident 1 was not properly assessed for medication management needs, and over-the-counter medication was found in the resident's room without proper documentation or physician orders.
Deficiencies (2)
Provider did not ensure Resident 1 received all prescribed medications in the dosage and intervals prescribed by a practitioner.
Provider did not ensure Resident 1 was assessed to ensure his/her medication administration and management needs were met.
Report Facts
Deficiencies issued: 2
Medication tablets observed: 24
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Manager A | Wrote progress note on 2025-04-15 and refused to administer Loperamide to Resident 1 | |
| Nurse Manager B | Interviewed by surveyor regarding medication administration | |
| Family Member C | Health care power of attorney for Resident 1 and reported Resident 1 was upset about not receiving medication |
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