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Complaint Investigation

Edenbrook Of Appleton North

September 2, 2025 · Appleton, WI · 2915 N Meade St
Citations 2
CMS Rating 2/5
Beds 95
Provider ID 525484
Healthcare Facility
Edenbrook Of Appleton North
Appleton, WI  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

Edenbrook of Appleton North in Appleton, WI — inspection on September 2, 2025.

Found 2 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

Inspection Findings

FF0686
Quality of Life and Care Deficiencies

was provided for 1 resident (R) (R1) of 2 sampled residents.R1 had a deep tissue injury on the right

followed.Findings include:The facility's Procedure Clean Dressing Change policy, dated 2/24/23, indicates: .1.

Verify physician's order for the procedure/treatment. 2.

Review the resident's care plan, current orders, and diagnoses as applicable to determine if there are special resident needs .16.

Date and initial wound dressing when applied .Medical record documentation and follow-up as applicable: 1.

The date and time the dressing was changed. On 9/2/25, Surveyor reviewed R1's medical record. R1 was admitted to the facility on [DATE] and had diagnoses including sepsis, cellulitis of right lower limb, non-pressure chronic ulcer of other part of right lower leg with fat layer exposed, and abrasion of left elbow. R1's Minimum Data Set (MDS) assessment, dated 11/20/24, had a Brief Interview for Mental Status (BIMS) score of 9 out of 15 which indicated R1 had moderately impaired cognition. R1 had an activated Power of Attorney for Healthcare (POAHC). R1's medical record contained the following orders:~ Treatment - Right Heel - Betadine daily and as needed (PRN) every day shift for wound care (start date 11/26/24).~ Treatment - Right Heel - Clean with wound cleanser, pat dry, apply Santyl to wound bed, apply Telfa, wrap in Kerlix daily and PRN every day shift for wound care (start date 12/3/24).R1's December 2024 Treatment Administration Record (TAR) indicated R1's dressing change was not completed on 12/4/24.A Nurse Practitioner (NP) note, dated 12/10/24, indicated R1 had what appeared to be a deep tissue injury (DTI) on the right heel that measured 1.5 centimeters (cm) x 3.5 cm x 0.1 cm.

The surface area measured 5.25 square centimeters (cm2) with 80% eschar and 20% slough.

There was light serous exudate, no induration, and the edges appeared cliff-like.

The peri-wound was normal in temperature and color.

The note indicated the wound deteriorated overall due to nutritional compromise. R1 was started on Prostat, vitamin C, and a multivitamin. On 9/2/25 at 3:01 PM, Surveyor interviewed Director of Nursing (DON)-B who verified R1's dressing change was not completed on 12/4/24 and confirmed R1's DTI dressing should be changed daily. DON-B stated DON-B expects staff to follow orders for daily wound care and indicated R1's wound care should be completed daily and documented.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

525484 09/02/2025

Edenbrook of Appleton North 2915 N Meade St Appleton, WI 54911

medication. R4 was noted to remove gripper socks and attempted to self-transfer due to impaired

8/12/25. On 9/2/25 at 2:15 PM, Surveyor observed R4 in bed without a urinal at R4's bedside. On

have a urinal at the bedside. LPN-C checked R4's bathroom and did not see a urinal there either.On 9/2/25 at 4:30 PM, Surveyor interviewed Director of Nursing (DON)-B who confirmed fall interventions should be in place for residents, however, DON-B needed to review R4's care plan and was unsure if R4 was capable of using a urinal.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Appleton, WI, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Edenbrook of Appleton North or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


More Reports

About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

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

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.