All citations for Edenbrook of Fond Du Lac

State inspectors check nursing homes that take Medicare or Medicaid against federal rules, usually about once a year, and also look into complaints. Each rule a home did not meet is a citation.

Back to Edenbrook of Fond Du Lac

Last standard health inspection on record

June 11, 2025

Showing 1 to 22 of 22 citations

  1. No harm, with potential for more than minimal harm

    Provide a written emergency evacuation plan.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0711, Miscellaneous Deficiencies. Inspection of June 11, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (October 20, 2025).

  2. No harm, with potential for more than minimal harm

    Have generator or other power source capable of supplying service within 10 seconds.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0918, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of May 15, 2024. Found during a standard inspection.

    A waiver was granted (September 25, 2024).

  3. No harm, with potential for more than minimal harm

    Have approved installation, maintenance and testing program for fire alarm systems.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0345, Smoke Deficiencies. Inspection of April 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 18, 2023).

  4. No harm, with potential for more than minimal harm

    Have simulated fire drills held at unexpected times.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0712, Miscellaneous Deficiencies. Inspection of April 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 9, 2023).

  5. No harm, with potential for more than minimal harm

    Have generator or other power source capable of supplying service within 10 seconds.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0918, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 9, 2023).

  6. No harm, with potential for more than minimal harm

    Provide properly protected cooking facilities.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0324, Smoke Deficiencies. Inspection of June 11, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (June 20, 2025).

  7. No harm, with potential for more than minimal harm

    Inspect, test, and maintain automatic sprinkler systems.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0353, Smoke Deficiencies. Inspection of June 11, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (August 15, 2025).

  8. No harm, with potential for more than minimal harm

    Properly select, install, inspect, or maintain portable fire extinguishes.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0355, Smoke Deficiencies. Inspection of June 11, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 3, 2025).

  9. No harm, with potential for more than minimal harm

    Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0372, Smoke Deficiencies. Inspection of June 11, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 3, 2025).

  10. No harm, with potential for more than minimal harm

    To conduct inspection, testing and maintenance of fire doors by qualified individuals.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0761, Miscellaneous Deficiencies. Inspection of June 11, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 7, 2025).

  11. No harm, with potential for more than minimal harm

    Keep aisles, corridors, and exits free of obstruction in case of emergency.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0211, Egress Deficiencies. Inspection of May 15, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (June 27, 2024).

  12. No harm, with potential for more than minimal harm

    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.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0222, Egress Deficiencies. Inspection of May 15, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (June 27, 2024).

  13. No harm, with potential for more than minimal harm

    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.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0222, Egress Deficiencies. Inspection of April 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 18, 2023).

  14. No harm, with potential for more than minimal harm

    Install corridor and hallway doors that block smoke.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0363, Smoke Deficiencies. Inspection of April 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 9, 2023).

  15. No harm, with potential for more than minimal harm

    Ensure proper usage of power strips and extension cords.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0920, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 8, 2023).

  16. No harm, with potential for more than minimal harm

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

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0521, Services Deficiencies. Inspection of June 11, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 7, 2025).

  17. No harm, with potential for more than minimal harm

    Have an enclosure around a vertical opening shaft.

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0311, Smoke Deficiencies. Inspection of May 15, 2024. Found during a standard inspection.

    A waiver was granted (August 30, 2024).

  18. No harm, with potential for more than minimal harm

    Inspect, test, and maintain automatic sprinkler systems.

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0353, Smoke Deficiencies. Inspection of May 15, 2024. Found during a standard inspection.

    A waiver was granted (September 30, 2024).

  19. No harm, with potential for more than minimal harm

    Provide properly protected cooking facilities.

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0324, Smoke Deficiencies. Inspection of April 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 8, 2023).

  20. No harm, with potential for more than minimal harm

    Inspect, test, and maintain automatic sprinkler systems.

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0353, Smoke Deficiencies. Inspection of April 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 15, 2023).

  21. No harm, with potential for more than minimal harm

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

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0521, Services Deficiencies. Inspection of April 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 18, 2023).

  22. No harm, with potential for more than minimal harm

    Meet requirements for the use of electrical equipment.

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0919, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 10, 2023).

Source: CMS Provider Information, Fire Safety Deficiencies, Health Deficiencies, Citation Code Look-up, data as of October 1, 2026. Inspection results describe the home at the time of each inspection.