Appleton City Manor

In the surveyor’s words

From the most serious findings on record at Appleton City Manor, in the surveyor’s own words.

• Immediate jeopardy, isolatedF678Feb 27, 2026

  Based on interview and record review, the facility failed to provide care that reflected the resident's wishes as expressed by the resident's advance directives (written instruction, such as a living will or durable power of attorney, relating to the provision of health care when the individual is incapacitated) when the facility failed to ensure one resident's (Resident #1) CPR order (CPR - a medical intervention used to restore circulatory and/or respiratory function) was clearly and consistently documented in the resident's chart resulting in staff failing to provide CPR when the resident was found unresponsive. The facility census was 35.The Administrator was notified on [DATE], at 5:10 P.M., of the Immediate Jeopardy (IJ) which occurred on [DATE]. […]

• Actual harm, isolatedF684Sep 9, 2024

  Based on interview and record review, the facility failed to provide care per standards of practice for all residents when staff failed to administer medications as ordered, failed to monitor the resident as ordered, and failed to notify and follow-up with the physician as ordered and in a timely manner for one resident (Resident #23) with edema (fluid retention) resulting in increased edema, weight gain, and an inability of the resident to wear his/her shoes. The facility census was 38. Review showed the facility did not provide a policy related to monitoring of changes in condition. […]

• No harm, potential for more than minimal, widespreadF880Nov 13, 2024

  Based on observation, interview, and record review, the facility failed to establish and maintain an effective infection control program when the facility failed to implement enhanced barrier precautions (EBP - an infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDRO) that employs targeted gown and glove use during high contact resident care activities) and when staff failed to follow infection control practices, per standard of practice, when staff failed to wash or sanitize hands at appropriate times during wound care to two residents (Resident #1 and Resident #2) out of a sample of three residents. […]

• No harm, potential for more than minimal, widespreadF727Oct 17, 2024

  Based on record review and interview, the facility failed to ensure the home had registered nurse (RN) coverage including a RN assigned to serve as the Director of Nursing (DON) and able to complete needed DON duties on a full time basis when the facility's DON provided routine floor coverage prior to leaving employment at the facility. This resulted in leaving the facility being without a DON or RN. The facility census was 38. Review of the facility's policy titled, Nursing Services, undated, showed the following: -It is the policy of the facility to assure that there is sufficient qualified nursing staff available at all times to provide nursing and related services to meet the residents' needs safely and in a manner that promotes each resident's rights, physical, mental, and… […]

• No harm, potential for more than minimal, widespreadF727Sep 9, 2024

  Based on interview and record review, the facility failed to provide the services of a registered nurse (RN) for at least eight consecutive hours per day seven days per week. The facility census was 37. Review of the facility's policy Nursing Services, undated, showed the following: -It is the policy of the facility to assure that there is sufficient qualified nursing staff available at all times to provide nursing and related services to meet the residents' needs safely and in a manner that promotes each resident's rights, physical, mental and psychosocial well-being; -Except when waived, the facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week; -The Director of Nursing (DON) may serve as a charge nurse only when the facility has an… […]