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Complete Care at Christian Home: Fall Care Failures - WI

Healthcare Facility
Complete Care At Christian Home Llc
Waupun, WI  ·  2/5 stars

Inspectors visited the facility on October 14, 2025, following a complaint. What they found, when they sat down with staff and reviewed records, was a gap between what the nursing home said it did after falls and what it actually did.

A registered nurse told inspectors that every fall is supposed to trigger an incident report, a post-fall assessment, and documented follow-up every shift for 72 hours. The incident report, the RN explained, is how the facility identifies the root cause and decides what interventions to put in place.

None of that made it into the care plan for the resident identified in the report as R1.

When inspectors reviewed his care plan alongside LPN J, the nurse responsible for updating it, LPN J confirmed it had not been changed after any of his seven falls. Not one.

Her explanation pointed to a breakdown in communication. LPN J said she updates care plans after interdisciplinary team meetings held each morning, and that she relies on those meetings to learn what new interventions have been decided. If she doesn't attend, or no one tells her, she said she wouldn't know the care plan needed changing.

Seven falls. Seven opportunities. Nobody told her, or nobody followed through, or both.

The care plan is not a formality. It is the document that tells every nurse and aide who walks into a resident's room what that person needs and what precautions are in place. A care plan that doesn't reflect seven falls is a care plan that leaves the next staff member walking in blind.

R1's care plan, as of the inspection, still did not reflect a single one of them.

Full Inspection Report

The details above represent a summary of key findings. View the complete inspection report for Complete Care At Christian Home LLC from 2025-10-14 including all violations, facility responses, and corrective action plans.

Download the official CMS inspection PDF from Medicare.gov

Additional Resources

Editorial Standards & Data Disclosure

Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.

Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.

Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.

Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.

Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.

Last verified: September 9, 2026  ·  Our methodology

Quick Answer

Complete Care at Christian Home LLC in Waupun, WI was cited for violations during a health inspection on October 14, 2025.

Inspectors visited the facility on October 14, 2025, following a complaint.

Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.

Frequently Asked Questions

What happened at Complete Care at Christian Home LLC?
Inspectors visited the facility on October 14, 2025, following a complaint.
How serious are these violations?
Violation severity varies from minor documentation issues to serious safety concerns. Review the inspection report for specific deficiency codes and scope. All violations must be corrected within required timeframes and are subject to follow-up verification inspections.
What should families do?
Families should: (1) Ask facility administration about specific corrective actions taken, (2) Request to see the follow-up inspection report verifying corrections, (3) Check if this represents a pattern by reviewing prior inspection reports, (4) Compare this facility's ratings with other nursing homes in Waupun, WI, (5) Report any new concerns directly to state authorities.
Where can I see the full inspection report?
The complete inspection report is available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request a copy directly from Complete Care at Christian Home LLC or from the state Department of Health. The report includes specific deficiency codes, facility responses, and correction timelines. This facility's federal provider number is 525531.
Has this facility had violations before?
To check Complete Care at Christian Home LLC's history, visit Medicare.gov's Care Compare and review their inspection history, quality ratings, and staffing levels. Look for patterns of repeated violations, especially in critical areas like abuse prevention, medication management, infection control, and resident safety.