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Complaint Investigation

Lake Country Health Services

March 12, 2025 · Oconomowoc, WI · 2195 North Summit Village Way
Citations 3
CMS Rating 2/5
Beds 100
Provider ID 525702
Healthcare Facility
Lake Country Health Services
Oconomowoc, WI  ·  View full profile →
Inspection Summary

LAKE COUNTRY HEALTH SERVICES in OCONOMOWOC, WI — inspection on March 12, 2025.

Found 3 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.

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Inspection Findings

FF578
Minimal harm or be ,d+[DATE]. On [DATE] Evening shift, Surveyor noted R1's Pain level score to be ,d+[DATE]. On [DATE] Few d+[DATE]. On [DATE] Night shift, Surveyor noted R1's Pain level score to be ,d+[DATE]. On [DATE] day affected

F-F578).

525702

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 525702 B.

Wing 03/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Lake Country Health Services 2195 North Summit Village Way Oconomowoc, WI 53066

According to Five Possible Side Effects of CPR, You Should Know, The methods used in Cardiopulmonary Resuscitation can have adverse effects such as the following:

1.

Aspiration & Vomiting: The most frequent occurrence during CPR, vomiting can present a danger to the cardiac arrest victim.

Since the cardiac arrest victim is unconscious, he cannot clear the vomit from his mouth. If not cleared, the victim is likely to aspirate (inhale) it into his lungs, blocking the airway and leading to possible infection.

2.

Broken Ribs Bone: A rib fracture is the most common complication of CPR because the force of chest compressions is likely to break ribs.

Other chest injury related to chest compressions are sternal fracture and other uncommon complication like lung contusion, pneumothorax, and haemothorax. In the elderly, this is significantly more common due to the brittleness and weakness of their bones.

Broken ribs present danger because a broken rib could puncture or lacerate (cut) a lung, the spleen, or the liver.

They are also very painful.

The frequency of rib fractures associated with out of hospital cardiopulmonary resuscitation is underestimated by conventional chest x-ray.

3.

Internal Brain Injuries: Since CPR leaves the brain receiving 5% less oxygen than normal, brain damage is possible.

Brain damage occurs within 4 to 6 minutes from the time the brain is deprived of oxygen, and after 10 minutes, it definitely occurs.

This can lead to long-term health complications.

4.

Abdominal Distension: As a result of air being forced into the lungs, the abdomen of the cardiac arrest patient usually becomes distended (bloated) and full of air during CPR, leading to compression of the lungs (making ventilation more difficult) and an increased chance of vomiting.

5.

Aspiration Pneumonia: The result of vomit and foreign objects (like a person's own teeth) being inhaled into the lungs can lead to aspiration pneumonia.

This can be very dangerous to a victim's health and could complicate recovery, or even be fatal, even if the cardiac arrest victim does survive CPR.

Overall, all of these side effects mean that if a person survives CPR, their long-term health could suffer and be alive.

But their overall health and quality of life may be significantly affected.

Additionally, the psychological ramifications of a near-death experience can substantially affect a survivor, leading to anxiety, stress, and depression, among other psychological conditions. https://www.mycprcertificationonline. com/blog/five-possible-cpr-side-effects-you-should-know/

The facility's failure to honor R1's DNR wishes which led to facility staff completing chest compressions that caused R1 extreme pain, created a reasonable likelihood for serious harm, thus leading to a finding of immediate jeopardy that began on [DATE].

The immediate jeopardy was removed on [DATE] when the facility implemented the following action plan:

525702

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 525702 B.

Wing 03/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Lake Country Health Services 2195 North Summit Village Way Oconomowoc, WI 53066

F-F760).

On [DATE] at 12:00 PM, Surveyor requested to speak with LPN-M to conduct an interview.

Director of Nursing (DON)-B informed Surveyor that LPN-M was no longer employed at facility.

R1's progress note dated [DATE] at 6:40 documents in part: [R1] passed away at approximately 6:30 AM .

525702

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 525702 B.

Wing 03/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Lake Country Health Services 2195 North Summit Village Way Oconomowoc, WI 53066

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 OCONOMOWOC, 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 LAKE COUNTRY HEALTH SERVICES or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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