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Fire Safety Inspection & Emergency Preparedness Summary
Crossroads Care Center of Weyauwega
717 E Alfred St
Weyauwega, WI 54983
(920) 867-3121
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Deficiency Category
Inspection Date:
2/13/24
Complaint Reporting Period:
4/1/24 - 3/31/25
Inspection Date:
1/12/23
Complaint Reporting Period:
4/1/23 - 3/31/24
Inspection Date:
1/31/22
Complaint Reporting Period:
4/1/22 - 3/31/23
Emergency Preparedness Deficiencies000
Automatic Sprinkler Systems Deficiencies000
Building Construction Deficiencies000
Services Deficiencies000
Corridor Walls and Doors Deficiencies000
Egress Deficiencies000
Electrical Deficiencies000
Emergency Plans and Fire Drills Deficiencies000
Fire Alarm Systems Deficiencies000
Smoke Deficiencies000
Interior Finish Deficiencies000
Gas, Vacuum, and Electrical Systems Deficiencies000
Hazardous Area Deficiencies000
Illumination and Emergency Power Deficiencies000
Laboratories Deficiencies000
Medical Gases and Anesthetizing Areas Deficiencies000
Smoking Regulations Deficiencies000
Miscellaneous Deficiencies000
Detailed result for inspection on 2/13/24
Total number of Fire Safety & Emergency Preparedness Deficiencies for this nursing home:7
Average number of Fire Safety & Emergency Preparedness Deficiencies in Wisconsin:6.8
Average number of Fire Safety & Emergency Preparedness Deficiencies in the United States:4.8
Emergency Preparedness Deficiencies
No Emergency Preparedness Deficiencies were found during this inspection period.
Automatic Sprinkler Systems Deficiencies
No Automatic Sprinkler Systems Deficiencies were found during this inspection period.
Building Construction Deficiencies
No Building Construction Deficiencies were found during this inspection period.
Services Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

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

2/13/244/12/24
2 - Minimal harm or potential for actual harm
Some
Corridor Walls and Doors Deficiencies
No Corridor Walls and Doors Deficiencies were found during this inspection period.
Egress Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

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.

2/13/246/8/24
2 - Minimal harm or potential for actual harm
Some
Electrical Deficiencies
No Electrical Deficiencies were found during this inspection period.
Emergency Plans and Fire Drills Deficiencies
No Emergency Plans and Fire Drills Deficiencies were found during this inspection period.
Fire Alarm Systems Deficiencies
No Fire Alarm Systems Deficiencies were found during this inspection period.
Smoke Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

2/13/243/13/24
2 - Minimal harm or potential for actual harm
Few

Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.

2/13/243/13/24
2 - Minimal harm or potential for actual harm
Many
Interior Finish Deficiencies
No Interior Finish Deficiencies were found during this inspection period.
Gas, Vacuum, and Electrical Systems Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Meet requirements for the installation and maintenance of electrical systems.

2/13/243/13/24
2 - Minimal harm or potential for actual harm
Few

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

2/13/243/13/24
2 - Minimal harm or potential for actual harm
Many
Hazardous Area Deficiencies
No Hazardous Area Deficiencies were found during this inspection period.
Illumination and Emergency Power Deficiencies
No Illumination and Emergency Power Deficiencies were found during this inspection period.
Laboratories Deficiencies
No Laboratories Deficiencies were found during this inspection period.
Medical Gases and Anesthetizing Areas Deficiencies
No Medical Gases and Anesthetizing Areas Deficiencies were found during this inspection period.
Smoking Regulations Deficiencies
No Smoking Regulations Deficiencies were found during this inspection period.
Miscellaneous Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Have simulated fire drills held at unexpected times.

2/13/243/13/24
2 - Minimal harm or potential for actual harm
Many
Detailed result for inspection on 1/12/23
Total number of Fire Safety & Emergency Preparedness Deficiencies for this nursing home:11
Average number of Fire Safety & Emergency Preparedness Deficiencies in Wisconsin:6
Average number of Fire Safety & Emergency Preparedness Deficiencies in the United States:4.6
Emergency Preparedness Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Establish emergency prep training and testing.

1/12/232/28/23
2 - Minimal harm or potential for actual harm
Many

Address subsistence needs for staff and patients.

1/12/232/28/23
2 - Minimal harm or potential for actual harm
Many

Create arrangements with other facilities to receive patients.

1/12/232/28/23
2 - Minimal harm or potential for actual harm
Many
Automatic Sprinkler Systems Deficiencies
No Automatic Sprinkler Systems Deficiencies were found during this inspection period.
Building Construction Deficiencies
No Building Construction Deficiencies were found during this inspection period.
Services Deficiencies
No Services Deficiencies were found during this inspection period.
Corridor Walls and Doors Deficiencies
No Corridor Walls and Doors Deficiencies were found during this inspection period.
Egress Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

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.

1/12/232/28/23
2 - Minimal harm or potential for actual harm
Some
Electrical Deficiencies
No Electrical Deficiencies were found during this inspection period.
Emergency Plans and Fire Drills Deficiencies
No Emergency Plans and Fire Drills Deficiencies were found during this inspection period.
Fire Alarm Systems Deficiencies
No Fire Alarm Systems Deficiencies were found during this inspection period.
Smoke Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Follow proper procedures when the fire alarm was out of service for more than 4 hours.

1/12/232/28/23
2 - Minimal harm or potential for actual harm
Many

Provide properly protected cooking facilities.

1/12/232/28/23
2 - Minimal harm or potential for actual harm
Some

Install an approved automatic sprinkler system.

1/12/232/28/23
2 - Minimal harm or potential for actual harm
Some

Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.

1/12/232/28/23
2 - Minimal harm or potential for actual harm
Many

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

1/12/232/28/23
2 - Minimal harm or potential for actual harm
Some
Interior Finish Deficiencies
No Interior Finish Deficiencies were found during this inspection period.
Gas, Vacuum, and Electrical Systems Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

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

1/12/232/28/23
2 - Minimal harm or potential for actual harm
Many

Have power receptacles that are properly grounded.

1/12/232/28/23
2 - Minimal harm or potential for actual harm
Few
Hazardous Area Deficiencies
No Hazardous Area Deficiencies were found during this inspection period.
Illumination and Emergency Power Deficiencies
No Illumination and Emergency Power Deficiencies were found during this inspection period.
Laboratories Deficiencies
No Laboratories Deficiencies were found during this inspection period.
Medical Gases and Anesthetizing Areas Deficiencies
No Medical Gases and Anesthetizing Areas Deficiencies were found during this inspection period.
Smoking Regulations Deficiencies
No Smoking Regulations Deficiencies were found during this inspection period.
Miscellaneous Deficiencies
No Miscellaneous Deficiencies were found during this inspection period.
Detailed result for inspection on 1/31/22
Total number of Fire Safety & Emergency Preparedness Deficiencies for this nursing home:6
Average number of Fire Safety & Emergency Preparedness Deficiencies in Wisconsin:6.3
Average number of Fire Safety & Emergency Preparedness Deficiencies in the United States:4.3
Emergency Preparedness Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Develop and maintain an Emergency Preparedness Program (EP).

1/31/222/15/22
2 - Minimal harm or potential for actual harm
Many

Establish emergency prep training and testing.

1/31/222/15/22
2 - Minimal harm or potential for actual harm
Many
Automatic Sprinkler Systems Deficiencies
No Automatic Sprinkler Systems Deficiencies were found during this inspection period.
Building Construction Deficiencies
No Building Construction Deficiencies were found during this inspection period.
Services Deficiencies
No Services Deficiencies were found during this inspection period.
Corridor Walls and Doors Deficiencies
No Corridor Walls and Doors Deficiencies were found during this inspection period.
Egress Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Have corridors or aisles that are unobstructed and are at least 8 feet in width.

1/31/222/15/22
2 - Minimal harm or potential for actual harm
Some
Electrical Deficiencies
No Electrical Deficiencies were found during this inspection period.
Emergency Plans and Fire Drills Deficiencies
No Emergency Plans and Fire Drills Deficiencies were found during this inspection period.
Fire Alarm Systems Deficiencies
No Fire Alarm Systems Deficiencies were found during this inspection period.
Smoke Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

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

1/31/222/15/22
2 - Minimal harm or potential for actual harm
Some

Install smoke barrier doors that can resist smoke for at least 20 minutes.

1/31/222/15/22
2 - Minimal harm or potential for actual harm
Some
Interior Finish Deficiencies
No Interior Finish Deficiencies were found during this inspection period.
Gas, Vacuum, and Electrical Systems Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

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

1/31/222/15/22
2 - Minimal harm or potential for actual harm
Many
Hazardous Area Deficiencies
No Hazardous Area Deficiencies were found during this inspection period.
Illumination and Emergency Power Deficiencies
No Illumination and Emergency Power Deficiencies were found during this inspection period.
Laboratories Deficiencies
No Laboratories Deficiencies were found during this inspection period.
Medical Gases and Anesthetizing Areas Deficiencies
No Medical Gases and Anesthetizing Areas Deficiencies were found during this inspection period.
Smoking Regulations Deficiencies
No Smoking Regulations Deficiencies were found during this inspection period.
Miscellaneous Deficiencies
No Miscellaneous Deficiencies were found during this inspection period.
Complaints and facility-reported incidents in the past 3 years
This nursing home has not been cited for any deficiencies from incidents reported by the nursing home or complaints in the last 3 years.
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