Starfile / Wisconsin

CHI FRANCISCAN VILLA

3601 S CHICAGO AVE, SOUTH MILWAUKEE, WI 53172 · CCN 525526

Abuse icon

Inspection history vs Wisconsin & national averages

Cycle 1 is the most recent standard health inspection. Lower total deficiency counts are better.

Cycle 1 deficiencies by category

Staffing (hours per resident per day)

Fines & penalties

Total fines

$271,775

Number of fines

4

Number of penalties

5

Payment denials

1

Chain

Chain

COMMONSPIRIT HEALTH

Facilities in chain

19

Chain avg overall

2.90 / 5

Inspection citations (69)7 immediate jeopardy4 actual harm

1. DF0573Let each resident or the resident's legal representative access or purchase copies of all the resident's records.2025-12-23 · Health · corrected 2026-01-26

   Potential for more than minimal harm

2. GF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2025-11-13 · Health · corrected 2025-12-05

   Actual harm

3. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2025-10-17 · Health · corrected 2025-12-05

   Potential for more than minimal harm

4. DF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2025-10-17 · Health · corrected 2025-12-05

   Potential for more than minimal harm

5. DF0880Provide and implement an infection prevention and control program.2025-10-17 · Health · corrected 2025-12-05

   Potential for more than minimal harm

6. EF0602Protect each resident from the wrongful use of the resident's belongings or money.2025-07-16 · Health · corrected 2025-08-06

   Potential for more than minimal harm

7. DF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2025-07-16 · Health · corrected 2025-07-17

   Potential for more than minimal harm

8. EF0610Respond appropriately to all alleged violations.2025-07-16 · Health · corrected 2025-07-17

   Potential for more than minimal harm

9. JF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2025-07-16 · Health · corrected 2025-06-12

   Immediate jeopardy

10. DF0641Ensure each resident receives an accurate assessment.2025-05-30 · Health · corrected 2025-06-30

    Potential for more than minimal harm

11. DF0677Provide care and assistance to perform activities of daily living for any resident who is unable.2025-05-30 · Health · corrected 2025-06-30

    Potential for more than minimal harm

12. DF0692Provide enough food/fluids to maintain a resident's health.2025-05-30 · Health · corrected 2025-06-30

    Potential for more than minimal harm

13. FF0801Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.2025-05-30 · Health · corrected 2025-06-30

    Potential for more than minimal harm

14. DF0880Provide and implement an infection prevention and control program.2025-05-30 · Health · corrected 2025-06-30

    Potential for more than minimal harm

15. DF0677Provide care and assistance to perform activities of daily living for any resident who is unable.2025-02-20 · Health · corrected 2025-02-28

    Potential for more than minimal harm

16. DF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2025-02-20 · Health · corrected 2025-02-28

    Potential for more than minimal harm

17. DF0686Provide appropriate pressure ulcer care and prevent new ulcers from developing.2025-02-20 · Health · corrected 2025-02-28

    Potential for more than minimal harm

18. GF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2025-02-20 · Health · corrected 2025-02-28

    Actual harm

19. DF0695Provide safe and appropriate respiratory care for a resident when needed.2025-02-20 · Health · corrected 2025-02-28

    Potential for more than minimal harm

20. FF0880Provide and implement an infection prevention and control program.2025-02-20 · Health · corrected 2025-03-20

    Potential for more than minimal harm

21. JF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2024-11-08 · Health · corrected 2024-11-20

    Immediate jeopardy

22. EF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2024-11-08 · Health · corrected 2024-11-20

    Potential for more than minimal harm

23. DF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2024-06-20 · Health · corrected 2024-07-05

    Potential for more than minimal harm

24. EF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2024-06-20 · Health · corrected 2024-07-05

    Potential for more than minimal harm

25. DF0554Allow residents to self-administer drugs if determined clinically appropriate.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

26. DF0558Reasonably accommodate the needs and preferences of each resident.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

27. DF0578Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

28. DF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

29. DF0610Respond appropriately to all alleged violations.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

30. DF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

31. EF0686Provide appropriate pressure ulcer care and prevent new ulcers from developing.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

32. JF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-12-05 · Health · corrected 2024-01-02

    Immediate jeopardy

33. DF0690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

34. CF0732Post nurse staffing information every day.2023-12-05 · Health · corrected 2024-01-02

    Potential for minimal harm

35. DF0759Ensure medication error rates are not 5 percent or greater.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

36. EF0761Ensure 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.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

37. FF0851Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

38. DF0880Provide and implement an infection prevention and control program.2023-12-05 · Health · corrected 2024-01-02

    Potential for more than minimal harm

39. EF0607Develop and implement policies and procedures to prevent abuse, neglect, and theft.2023-09-05 · Health · corrected 2023-09-15

    Potential for more than minimal harm

40. JF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2023-07-12 · Health · corrected 2023-07-15

    Immediate jeopardy

41. JF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-07-12 · Health · corrected 2023-08-03

    Immediate jeopardy

42. EF0730Observe each nurse aide's job performance and give regular training.2023-07-12 · Health · corrected 2023-08-04

    Potential for more than minimal harm

43. EF0944Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.2023-07-12 · Health · corrected 2023-08-04

    Potential for more than minimal harm

44. EF0947Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.2023-07-12 · Health · corrected 2023-08-04

    Potential for more than minimal harm

45. EF0949Provide behavior health training consistent with the requirements and as determined by a facility assessment.2023-07-12 · Health · corrected 2023-08-04

    Potential for more than minimal harm

46. DF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2023-05-04 · Health · corrected 2023-06-01

    Potential for more than minimal harm

47. DF0610Respond appropriately to all alleged violations.2023-05-04 · Health · corrected 2023-06-01

    Potential for more than minimal harm

48. DF0554Allow residents to self-administer drugs if determined clinically appropriate.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

49. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

50. JF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2022-08-25 · Health · corrected 2022-09-23

    Immediate jeopardy

51. DF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

52. DF0610Respond appropriately to all alleged violations.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

53. CF0623Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.2022-08-25 · Health · corrected 2022-09-23

    Potential for minimal harm

54. DF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

55. EF0657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

56. EF0677Provide care and assistance to perform activities of daily living for any resident who is unable.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

57. GF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2022-08-25 · Health · corrected 2022-09-23

    Actual harm

58. GF0686Provide appropriate pressure ulcer care and prevent new ulcers from developing.2022-08-25 · Health · corrected 2022-09-23

    Actual harm

59. DF0688Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

60. KF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2022-08-25 · Health · corrected 2022-09-23

    Immediate jeopardy

61. DF0690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

62. DF0695Provide safe and appropriate respiratory care for a resident when needed.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

63. DF0698Provide safe, appropriate dialysis care/services for a resident who requires such services.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

64. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

65. EF0756Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

66. DF0757Ensure each resident’s drug regimen must be free from unnecessary drugs.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

67. DF0758Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

68. FF0880Provide and implement an infection prevention and control program.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

69. FF0886Perform COVID19 testing on residents and staff.2022-08-25 · Health · corrected 2022-09-23

    Potential for more than minimal harm

Ownership

Other facilities in SOUTH MILWAUKEE

Source: CMS Provider Data Catalog, Nursing Home Care Compare files (processed 2026-03-01). Citations show the 3 most recent inspection cycles.