Inspection Reports for The Auberge at Brookfield
1105 Davidson Road, Brookfield, WI 53045, WI, 53045
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
74% worse than Wisconsin average
Wisconsin average: 4.6 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
53 residents
Based on a January 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Follow-Up
Census: 53
Deficiencies: 1
Jan 22, 2025
Visit Reason
The Bureau of Assisted Living conducted a verification visit of a statement of deficiency (SOD) at Auberge At Brookfield Memory Care Community to assess compliance with medication administration requirements.
Findings
The facility failed to ensure that Residents 3, 4, and 5 received their prescribed lidocaine transdermal patches in the correct dosage and intervals. The facility had not requested medication refills as required, and documentation showed incomplete administration due to resident refusals and lack of follow-up. This was a repeat citation of noncompliance.
Deficiencies (1)
| Description |
|---|
| Failure to ensure Residents 3, 4, and 5 received all prescribed lidocaine transdermal patches in the dosage and intervals prescribed by a practitioner. |
Report Facts
Census: 53
Revisit fee: 200
Medication doses administered: 96
Potential doses: 107
Medication doses administered: 20
Potential doses: 20
Medication doses administered: 20
Potential doses: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Facility Nurse B | Facility Nurse | Provided records for Residents 3, 4, and 5 and acknowledged medication administration issues |
| Pharmacist H | Pharmacist | Interviewed regarding medication deliveries and refill requests for Residents 3, 4, and 5 |
| Caregiver F | Observed administering Resident 3's medication and reported refusals | |
| Caregiver G | Observed administering Residents 4 and 5's medications and reported refusals and documentation practices |
Inspection Report
Enforcement
Deficiencies: 1
Jan 22, 2025
Visit Reason
A verification visit was conducted to determine if Auberge at Brookfield A Memory Care Community was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Findings
The Department issued a Statement of Deficiency (SOD #RRPX12) citing violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, resulting in a Notice of Violation and an imposed forfeiture of $1160.00. The licensee is ordered to comply with medication management and administration procedures and conduct staff training immediately.
Deficiencies (1)
| Description |
|---|
| Violations related to medication management and administration including documentation, administration, error prevention, monitoring, storage, discontinuation, and record maintenance. |
Report Facts
Forfeiture amount: 1160
Reduced forfeiture amount: 754
Inspection fee: 200
Compliance timeframe: 45
Posting duration: 90
Appeal timeframe: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the Notice and Order letter |
| Hillary Holman | Assisted Living Regional Director | Contact person for questions about the letter |
Inspection Report
Complaint Investigation
Deficiencies: 2
Aug 27, 2024
Visit Reason
A standard survey and complaint investigation was conducted to determine if Auberge at Brookfield A Memory Care Community was in substantial compliance with Wisconsin Statutes chapter 50 and Administrative Code chapter DHS 83, which govern community-based residential facilities.
Findings
The Department issued a Statement of Deficiency (SOD #RRPX11) for violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83. A total forfeiture of $1270.00 was imposed for these violations, with specific fines of $870.00 and $400.00 for two cited violations.
Complaint Details
The visit was a combined standard survey and complaint investigation concluded on August 27, 2024. Specific substantiation status is not stated.
Deficiencies (2)
| Description |
|---|
| Violation of DHS Code 83.32(3)(h) |
| Violation of DHS Code 83.47(2)(d) |
Report Facts
Forfeiture amount: 1270
Forfeiture amount: 870
Forfeiture amount: 400
Reduced forfeiture amount: 825.5
Compliance timeframe: 45
Payment timeframe: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the Notice and Order letter |
| Hillary Holman | Assisted Living Regional Director | Contact person for questions about the letter |
Inspection Report
Complaint Investigation
Census: 57
Deficiencies: 3
Aug 27, 2024
Visit Reason
The Bureau of Assisted Living conducted a standard licensing survey and a complaint investigation at Auberge At Brookfield Memory Care Community.
Findings
Three citations of noncompliance were issued, including medication administration failures for two residents and deficiencies in fire and emergency evacuation drill documentation and execution. The complaint was unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated. The visit included a complaint investigation triggered by medication administration concerns for Residents 1 and 2.
Deficiencies (3)
| Description |
|---|
| Resident 1 did not receive 2 prescribed lidocaine patches daily as ordered between 07/22/2024 and 08/27/2024. |
| Resident 2 did not receive prescribed lithium orotate 5 mg capsules on 3 of 3 occasions from 08/26/2024 through 08/27/2024. |
| Fire drills documentation was unclear regarding evacuation times and frequency; provider did not ensure required emergency or disaster evacuation drills were conducted semi-annually. |
Report Facts
Citations of noncompliance: 3
Lidocaine patches required: 72
Medication administrations missed: 3
Census: 57
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Caregiver C | Observed dispensing and administering Resident 1's lidocaine patches. | |
| Facility Nurse B | Interviewed regarding Resident 1 and Resident 2 medication issues and charting. | |
| Caregiver E | Observed administering medications to Resident 2 and interviewed about missing lithium capsules. | |
| Administrator A | Provided Resident 1's records and interviewed regarding medication issues and fire drills. | |
| Environmental Services Director D | Interviewed regarding fire drills and evacuation drill documentation and practices. |
Inspection Report
Complaint Investigation
Census: 47
Deficiencies: 0
Jun 4, 2024
Visit Reason
The Bureau of Assisted Living, Southern Regional Office conducted a complaint investigation and verification visit of statement of deficiency (SOD) Y77R15 at Auberge At Brookfield Memory Care Community.
Findings
No citations of noncompliance were issued and the complaint was unsubstantiated.
Complaint Details
Complaint was unsubstantiated.
Report Facts
Revisit fee: 200
Inspection Report
Complaint Investigation
Deficiencies: 1
Feb 22, 2024
Visit Reason
A complaint investigation was conducted on February 22, 2024, to determine if Auberge at Brookfield Memory Care Community was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Findings
The Department issued a Notice of Violation and Statement of Deficiency (SOD #Y77R15) for violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, resulting in an imposed forfeiture of $1700. The licensee was ordered to comply with requirements immediately and provide documentation to legal representatives and case managers for specified residents.
Complaint Details
The investigation was complaint-driven and concluded on February 22, 2024. The Department found violations substantiated as detailed in the Statement of Deficiency #Y77R15.
Deficiencies (1)
| Description |
|---|
| Violation of Wis. Stat. ch. 50 or Wis. Admin. Code ch. DHS 83 as detailed in SOD #Y77R15 |
Report Facts
Forfeiture amount: 1700
Reduced forfeiture amount: 1105
Forfeiture amount for tag N196: 500
Forfeiture amount for tag N353: 1200
Inspection fee: 200
Compliance timeframe: 45
Notification timeframe: 7
Extension request timeframe: 10
Revisit fee payment timeframe: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the Notice and Order letter |
| Hillary Holman | Assisted Living Regional Director | Contact person for questions about the letter |
Inspection Report
Complaint Investigation
Census: 39
Deficiencies: 2
Feb 13, 2024
Visit Reason
The Bureau of Assisted Living conducted three complaint investigations and a verification visit related to a prior statement of deficiency at Auberge At Brookfield Memory Care Community. One of three complaints was substantiated.
Findings
Two citations of noncompliance were issued, including a repeat violation. One substantiated complaint involved failure to provide prompt and adequate treatment to Resident 10, specifically related to insulin administration and blood glucose monitoring, resulting in hospitalization for diabetic ketoacidosis and cerebrovascular accident. Another finding involved failure to send required notices to legal representatives within 7 days as ordered.
Complaint Details
One of three complaints was substantiated. The substantiated complaint involved Resident 10 not receiving prescribed insulin and blood glucose monitoring, leading to hospitalization for diabetic ketoacidosis and cerebrovascular accident.
Deficiencies (2)
| Description |
|---|
| Failure to send statement of deficiency and Notice and Order letter to legal representatives and case managers for Residents 2, 7, 8, and 9 within 7 days as required by department special order. |
| Failure to provide Resident 10 with prompt and adequate treatment, including lack of insulin administration and blood glucose monitoring from 10/26/2023 to 10/29/2023, resulting in hospitalization for diabetic ketoacidosis and cerebrovascular accident. |
Report Facts
Revisit fee: 200
Resident census: 39
Blood glucose level: 1055
Novolin 70-30 insulin doses not administered: 5
Glargine insulin doses not administered: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Administrator E | Administrator | Named in failure to send notices and oversight of insulin administration issues |
| Facility Nurse Y | Facility Nurse | Interviewed regarding insulin administration, communication with pharmacy and legal representative |
| Facility Nurse JJ | Facility Nurse | Interviewed regarding Resident 10's care and medication administration |
| Pharmacy Staff HH | Pharmacy Staff | Interviewed regarding medication orders and communication with facility and legal representative |
| Legal Representative II | Legal Representative | Resident 10's legal representative involved in medication authorization and communication |
Inspection Report
Complaint Investigation
Deficiencies: 4
Sep 18, 2023
Visit Reason
A complaint investigation and verification visit was conducted to determine if Auberge at Brookfield A Memory Care Community was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Findings
The Department issued a Statement of Deficiency (SOD) #Y77R14 identifying multiple violations related to medication management, health monitoring, and other operational requirements. A total forfeiture of $1980.00 was imposed for these violations, with specific fines assigned to four code violations.
Complaint Details
The visit was complaint-related, conducted to verify compliance following a complaint investigation. The report does not explicitly state substantiation status.
Deficiencies (4)
| Description |
|---|
| Violation of DHS Code 83.12(3)(a) |
| Violation of DHS Code 83.32(3)(h) |
| Violation of DHS Code 83.37(1)(i) |
| Violation of DHS Code 83.38(1)(g) |
Report Facts
Forfeiture amount: 1980
Forfeiture amount: 300
Forfeiture amount: 180
Forfeiture amount: 900
Forfeiture amount: 600
Reduced forfeiture amount: 1287
Inspection fee: 200
Compliance timeframe: 45
Notification timeframe: 7
Payment timeframe: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the Notice and Order letter |
| Hillary Holman | Assisted Living Regional Director | Contact person for questions about the letter |
Inspection Report
Complaint Investigation
Census: 34
Deficiencies: 5
Sep 13, 2023
Visit Reason
The Bureau of Assisted Living conducted a complaint investigation and verification visit triggered by allegations related to Resident 2's injuries and caregiver misconduct at Auberge At Brookfield Memory Care Community.
Findings
Five citations of noncompliance were issued, including failure to investigate injuries of unknown source, failure to report law enforcement involvement timely, failure to administer prescribed medications, incomplete individual service plans for PRN psychotropic medications, and inadequate health monitoring after a resident fall.
Complaint Details
The complaint was substantiated. It involved allegations of caregiver misconduct and failure to investigate injuries of unknown source for Resident 2. Law enforcement was called on 08/14/2023 due to these allegations.
Deficiencies (5)
| Description |
|---|
| Failure to investigate Resident 2's injuries of unknown source. |
| Failure to submit a written report within 3 working days after law enforcement was called regarding caregiver misconduct. |
| Resident 9 did not receive prescribed Fentanyl patches on 6 occasions from 08/27/2023 to 09/13/2023. |
| Individual service plans for Residents 7, 8, and 9 did not include rationale and detailed behaviors indicating the need for administration of PRN psychotropic medications. |
| Resident 7's health was not adequately monitored after a fall on 08/16/2023; no incident or fall report was found documenting assessment or follow-up. |
Report Facts
Citations of noncompliance: 5
Revisit fee: 200
Missed medication administrations: 6
PRN psychotropic medication administrations: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Administrator E | Administrator | Provided information about Resident 2's injuries, law enforcement involvement, medication issues, and fall incident. |
| Caregiver T | Caregiver | Reported on Resident 2's injuries and behaviors during the night of 08/12/2023 to 08/13/2023. |
| Former Caregiver R | Former Caregiver | Alleged caregiver misconduct and was terminated after investigation. |
| Caregiver W | Caregiver | Documented Resident 9's Fentanyl patches as unavailable. |
| Nurse Y | Facility Nurse | Provided information on Resident 2's injury documentation and medication administration. |
| Pharmacy Technician Z | Pharmacy Technician | Reported refill requests and dispensing dates for Resident 9's Fentanyl patches. |
Inspection Report
Complaint Investigation
Census: 34
Deficiencies: 5
Apr 20, 2023
Visit Reason
The Bureau of Assisted Living conducted a complaint investigation and verification visit following a complaint at Auberge At Brookfield Memory Care Community. The visit aimed to investigate allegations of noncompliance.
Findings
Five citations of noncompliance were issued, including repeat violations. Deficiencies included failure to ensure employee communicable disease screening, incomplete individual service plans reflecting resident condition changes, inadequate documentation of PRN psychotropic medication rationale, incomplete resident records, and incomplete background checks for employees.
Complaint Details
The complaint was substantiated. Five citations of noncompliance were issued, including repeat violations. A $200.00 revisit fee was assessed under Wisconsin Statutes.
Deficiencies (5)
| Description |
|---|
| Failure to ensure 2 of 2 caregivers were screened for communicable diseases including tuberculosis within 90 days before employment. |
| Resident 4's individual service plan was not revised to reflect significant changes in condition and required services. |
| Resident 5's individual service plan did not include rationale for use and detailed description of behaviors indicating need for PRN psychotropic medication. |
| Resident 4's record did not include documentation to accurately describe significant changes in condition and treatment. |
| Caregiver N did not undergo a complete background check upon hire; original background check documentation was missing and replaced with a new check dated on the day of survey. |
Report Facts
Citations of noncompliance: 5
Revisit fee: 200
Dates of employee hires: Caregiver N hired 02/16/2023; Caregiver P hired 02/03/2023.
Dates of PRN medication administration: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Assistant Executive Director J | Assistant Executive Director | Interviewed regarding employee screenings, resident care plans, and background checks. |
| Caregiver N | Caregiver | Not screened for communicable diseases properly; background check incomplete. |
| Caregiver P | Caregiver | No evidence of communicable disease screening. |
| Resident 4 | Resident | Subject of deficient individual service plan and record documentation. |
| Resident 5 | Resident | Subject of deficient PRN psychotropic medication documentation. |
| Hospice Nurse M | Hospice Nurse | Provided hospice care and documentation for Resident 4. |
| Business Office Manager O | Business Office Manager | Assisted in running new DOJ background check for Caregiver N. |
| Former Health Services Director A | Former Health Services Director | Responsible for employee screenings and resident service plans; failed to complete required documentation. |
| Caregiver L | Caregiver | Interviewed about Resident 4's condition and care. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Apr 20, 2023
Visit Reason
A complaint investigation and verification visit was conducted to determine if Auberge at Brookfield Memory Care Community was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Findings
The Department issued a Statement of Deficiency (SOD #Y77R13) identifying violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83. A total forfeiture of $900 was imposed for these violations, with a reduced forfeiture option of $585 if not appealed. A revisit fee of $200 was also assessed following a verification visit to confirm correction of prior violations.
Complaint Details
The visit was complaint-related, concluding on April 20, 2023, with issuance of a Statement of Deficiency for violations found. The report does not explicitly state substantiation status.
Report Facts
Forfeiture amount: 900
Reduced forfeiture amount: 585
Revisit inspection fee: 200
Forfeiture breakdown: 400
Forfeiture breakdown: 300
Forfeiture breakdown: 200
Compliance timeframe: 45
Payment timeframe: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kenneth Brotheridge | Assisted Living Director | Signed the Notice and Order letter |
| Hillary Holman | Assisted Living Regional Director | Contact person for questions about the letter |
Inspection Report
Complaint Investigation
Census: 37
Deficiencies: 0
Mar 14, 2023
Visit Reason
Surveyors conducted 2 complaint investigations at Auberge At Brookfield A Memory Care Community on 03/13/2023.
Findings
No deficiencies were identified. Two of the two complaints were unsubstantiated.
Complaint Details
Two complaints were investigated; both were unsubstantiated.
Report Facts
Complaints investigated: 2
Complaints unsubstantiated: 2
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