Heritage Lakeside
HERITAGE LAKESIDE in RICE LAKE, WI — inspection on October 7, 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
cushion.Surveyor reviewed the care plan and there was no mention of R1's preference to sit on multiple items in the wheelchair, and no mention of the lumbar back support that was used.Example 3Surveyor reviewed R1's physicians orders.
Order was received on 09/26/25 that reads, in part, Patient may bear weight on right foot in CAM boot.Surveyor reviewed R1's chart and found no mention of the use of a CAM boot in R1's care plan nor on the CNA Kardex.
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IDENTIFICATION NUMBER:
A.
Building
COMPLETED
10/07/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Heritage Lakeside
1016 Lakeshore Dr Rice Lake, WI 54868
SUMMARY STATEMENT OF DEFICIENCIES
During the transport, driver applied brakes to avoid hitting a deer, which led to R1 falling off the seat of the wheelchair and onto the foot pedals. On 10/07/25 at 10:06 AM, Surveyor interviewed CNA C. CNA C stated R1 was sitting on a dycem, cushion, and bath blanket to the best of her knowledge.
When the driver applied the brakes, R1 slid under the safety belts and landed on the wheelchair foot pedals. R1's right foot got pinned between the wheelchair wheel and the seat belt device on the floor of the transportation van. CNA C and the van driver attempted to assist R1 but was unable.
Van driver called 911.
Paramedics arrived and lifted R1 up as another moved the wheelchair out from under R1 and lowered to the floor.
From there the paramedics used a sheet to place R1 on a stretcher and transported to the hospital via ambulance.Surveyor reviewed R1's hospital records, dated 09/16/25, which identified R1 acquired a right ankle fracture. R1 was treated and sent back to the facility with follow up orders.On 10/07/25, Surveyor interviewed Director of Nursing (DON) B and asked if having R1 sit on multiple items in the wheelchair during transport contributed to a hazard. DON B said it could have been a possibility, or the driver could have also strapped the belt over the top of the abdomen instead of under it.
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