Meadowbrook At Bloomer

Inspection findings

1. Apr 29, 2026 Health · 8 findings
   • Not serious Scope/severity E

     F0628 Resident Rights Deficiencies

     Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

     Corrected May 29, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0645 Resident Assessment and Care Planning Deficiencies

     PASARR screening for Mental disorders or Intellectual Disabilities

     Corrected May 29, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0699 Quality of Life and Care Deficiencies

     Provide care or services that was trauma informed and/or culturally competent.

     Corrected May 29, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0761 Pharmacy Service Deficiencies

     Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

     Corrected May 29, 2026 · CMS health inspection

   • Not serious Scope/severity F

     F0812 Nutrition and Dietary Deficiencies

     Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

     Corrected May 29, 2026 · CMS health inspection

   • Not serious Scope/severity F

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected May 29, 2026 · CMS health inspection

   • Not serious Scope/severity F

     K0353 Smoke Deficiencies

     Inspect, test, and maintain automatic sprinkler systems.

     Corrected May 22, 2026 · CMS fire safety

   • Not serious Scope/severity E

     K0741 Miscellaneous Deficiencies

     Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.

     Corrected May 22, 2026 · CMS fire safety

2. Mar 13, 2025 Health · 13 findings
   • Not serious Scope/severity D Complaint

     F0609 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

     Corrected Mar 27, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0641 Resident Assessment and Care Planning Deficiencies

     Ensure each resident receives an accurate assessment.

     Corrected Mar 27, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0656 Resident Assessment and Care Planning Deficiencies

     Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

     Corrected Mar 27, 2025 · CMS health inspection

   • Not serious Scope/severity F

     F0812 Nutrition and Dietary Deficiencies

     Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

     Corrected Mar 27, 2025 · CMS health inspection

   • Not serious Scope/severity F

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Mar 27, 2025 · CMS health inspection

   • Not serious Scope/severity D

     K0222 Egress Deficiencies

     Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.

     Corrected Apr 7, 2025 · CMS fire safety

   • Not serious Scope/severity D

     K0223 Egress Deficiencies

     Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.

     Corrected Apr 7, 2025 · CMS fire safety

   • Not serious Scope/severity D

     K0351 Smoke Deficiencies

     Install an approved automatic sprinkler system.

     Corrected Apr 7, 2025 · CMS fire safety

   • Not serious Scope/severity E

     K0353 Smoke Deficiencies

     Inspect, test, and maintain automatic sprinkler systems.

     Corrected Apr 7, 2025 · CMS fire safety

   • Not serious Scope/severity F

     K0521 Services Deficiencies

     Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

     Corrected Apr 7, 2025 · CMS fire safety

   • Not serious Scope/severity E

     K0911 Gas, Vacuum, and Electrical Systems Deficiencies

     Meet requirements for the installation and maintenance of electrical systems.

     Corrected Apr 7, 2025 · CMS fire safety

   • Not serious Scope/severity F

     K0920 Gas, Vacuum, and Electrical Systems Deficiencies

     Ensure proper usage of power strips and extension cords.

     Corrected Apr 7, 2025 · CMS fire safety

   • Not serious Scope/severity D

     K0923 Gas, Vacuum, and Electrical Systems Deficiencies

     Have proper medical gas storage and administration areas.

     Corrected Apr 7, 2025 · CMS fire safety

3. Aug 26, 2024 Health · 1 finding
   • Not serious Scope/severity E Complaint

     F0689 Quality of Life and Care Deficiencies

     Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

     Corrected Sep 16, 2024 · CMS health inspection

4. Mar 6, 2024 Health · 7 findings
   • Not serious Scope/severity F

     F0812 Nutrition and Dietary Deficiencies

     Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

     Corrected Mar 7, 2024 · CMS health inspection

   • Not serious Scope/severity F

     F0851 Administration Deficiencies

     Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.

     Corrected Dec 31, 2023 · CMS health inspection

   • Not serious Scope/severity F

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Mar 7, 2024 · CMS health inspection

   • Not serious Scope/severity C

     K0341 Smoke Deficiencies

     Install a fire alarm system that can be heard throughout the facility.

     Corrected Apr 10, 2024 · CMS fire safety

   • Not serious Scope/severity C

     K0351 Smoke Deficiencies

     Install an approved automatic sprinkler system.

     Corrected Apr 10, 2024 · CMS fire safety

   • Not serious Scope/severity D

     K0919 Gas, Vacuum, and Electrical Systems Deficiencies

     Meet requirements for the use of electrical equipment.

     Corrected Apr 10, 2024 · CMS fire safety

   • Not serious Scope/severity D

     K0923 Gas, Vacuum, and Electrical Systems Deficiencies

     Have proper medical gas storage and administration areas.

     Corrected Apr 10, 2024 · CMS fire safety

Owners and managers (as published by CMS)

• DICKSON, ERIK — operational/managerial control, NOT APPLICABLE, since 08/17/2021
• DICKSON, ERIK — adp of the snf, NOT APPLICABLE, since 08/17/2021
• LINDEMANN, MITUL — operational/managerial control, NOT APPLICABLE, since 12/01/2019
• LINDEMANN, MITUL — corporate officer, NOT APPLICABLE, since 12/01/2019
• LINDEMANN, MITUL — adp of the snf, NOT APPLICABLE, since 12/01/2019
• MASLOVSKY, BORIS — adp of the snf, NOT APPLICABLE, since 12/01/2019
• PUKSHANSKY, ROSTISLAV — adp of the snf, NOT APPLICABLE, since 12/01/2019
• SHRADER, KAIYA — operational/managerial control, NOT APPLICABLE, since 06/10/2022
• SHRADER, KAIYA — adp of the snf, NOT APPLICABLE, since 06/10/2022
• VANDER VELDEN, BARBARA — adp of the snf, NOT APPLICABLE, since 12/01/2019
• VANDER VELDEN, BARBARA — corporate director, NOT APPLICABLE, since 12/01/2019
• BLOOMER NURSING REALTY LLC — adp of the snf, NOT APPLICABLE, since 04/05/2022
• REINHART BOERNER VAN DEUREN S.C. — adp of the snf, NOT APPLICABLE, since 12/01/2019
• ROTH & CO, LLP — adp of the snf, NOT APPLICABLE, since 12/01/2019
• SYNERGY SENIOR CARE LLC — operational/managerial control, NOT APPLICABLE, since 12/01/2019
• SYNERGY SENIOR CARE LLC — adp of the snf, NOT APPLICABLE, since 02/28/2025
• WIPFLI LLP — adp of the snf, NOT APPLICABLE, since 12/01/2019