Deficiencies per Year
4
3
2
1
0
Unclassified
Notice
Deficiencies: 1
Mar 7, 2023
Visit Reason
A compliance visit was conducted on 03/07/2023 to verify The Waterford at Fitchburg's compliance with Wisconsin statutes and administrative codes governing registered residential care apartment complexes (RCAC). The visit was triggered by a complaint regarding adequate care for Tenant 1 from 12/21/2022 to 12/23/2022.
Findings
The facility failed to provide sufficient nursing services of health monitoring to Tenant 1, who was found sitting on the toilet for extended periods, weak, confused, and ingesting soiled incontinence products. Tenant 1 developed dehydration, pressure wounds, and was hospitalized. The facility nurse was not informed of Tenant 1's deteriorating condition in a timely manner.
Complaint Details
The complaint concerned inadequate care of Tenant 1 from 12/21/2022 to 12/23/2022, including prolonged time on the toilet, weakness, confusion, and ingestion of soiled incontinence products. The complaint was substantiated by the investigation.
Deficiencies (1)
| Description |
|---|
| Failure to ensure minimum required nursing services of health monitoring were provided to Tenant 1 who developed a need for those services. |
Report Facts
Dates of tenant observed on toilet: 3
Date of compliance visit: Mar 7, 2023
Hospital stay duration: 5
Date of discharge from SNF: Jan 22, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Caregiver B | Caregiver | Administered PRN medication to Tenant 1, documented observations of Tenant 1 sitting on the toilet, and communicated with Family Member E. |
| Administrator A | Administrator | Acknowledged Tenant 1's condition and facility's failure to notify nurse and respond appropriately. |
| Caregiver C | Caregiver | Administered Tenant 1's evening medications and assisted with dressing on 12/22/2022. |
| Caregiver D | Caregiver | Administered Tenant 1's morning medications on 12/22/2022 and 12/23/2022. |
| Wellness Director F | Wellness Director (not a licensed nurse) | Assessed Tenant 1 but is not a licensed nurse. |
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