Inspection Reports for
The Manor at the Meadows LLC
590 W. ROLLING MEADOWS DR, FOND DU LAC, WI, 54937
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
20 residents
Based on a March 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy over time
Inspection Report
Follow-Up
Census: 20
Deficiencies: 0
Date: Mar 17, 2025
Visit Reason
Surveyor conducted a verification visit to Manor at the Meadows LLC to assess correction of previous deficiencies.
Findings
Three of three previous deficiencies were corrected and no new deficiencies were identified during the visit.
Report Facts
Revisit fee: 200
Notice
Deficiencies: 0
Date: Oct 11, 2024
Visit Reason
A Standard Survey and Complaint Investigation were conducted on October 11, 2024, to determine if Manor at Meadows LLC was in substantial compliance with Wisconsin statutes and administrative codes governing community-based residential facilities.
Complaint Details
The visit included a complaint investigation as part of the Standard Survey conducted on October 11, 2024.
Findings
The Department found violations of Wis. Stat. ch. 50 and Wis. Admin. Code ch. DHS 83, resulting in a Statement of Deficiency (SOD # TEH011) and imposed a total forfeiture of $2,200.00 for specific violations.
Report Facts
Forfeiture amount: 2200
Forfeiture amount: 600
Forfeiture amount: 400
Forfeiture amount: 1200
Reduced forfeiture amount: 1430
Compliance timeframe: 45
Payment timeframe: 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
Complaint Investigation
Census: 12
Capacity: 44
Deficiencies: 3
Date: Oct 11, 2024
Visit Reason
Surveyor conducted a complaint investigation and probationary survey at Manor at the Meadows LLC due to concerns with resident elopements.
Complaint Details
The complaint was substantiated. The Department received a complaint on 07/23/2024 alleging concerns with resident elopements. Resident 1 eloped 6 times and Resident 2 eloped once without proper reporting or adequate supervision.
Findings
Three deficiencies were identified including failure to report resident elopements to the Department, failure to update individual service plans to reflect residents' elopement and suicidal risks, and inadequate supervision of residents leading to multiple elopements.
Deficiencies (3)
Provider did not ensure that a written report was sent to the Department within 3 working days after 2 residents eloped from the facility multiple times.
Provider did not ensure Individual Service Plans were updated to reflect the needs of Resident 1, including new interventions to mitigate elopement and suicidal risks.
Provider did not provide supervision adequate to meet the needs of 2 residents who were significant elopement risks, resulting in multiple elopement incidents without staff knowledge.
Report Facts
Deficiencies cited: 3
Resident 1 elopements: 6
Resident 2 elopements: 1
Facility licensed capacity: 44
Average daily traffic count: 10200
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Community Manager B | Community Manager | Interviewed regarding elopement incidents, reporting requirements, and supervision concerns. |
| Caregiver C | Caregiver | Interviewed and identified Resident 1 as a high elopement risk. |
| Caregiver D | Caregiver | Reported Resident 2 as a high elopement risk and described elopement incident. |
| Administrator A | Administrator | Interviewed regarding alarm system concerns and supervision. |
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