Starfile / Wisconsin

FRANCISCAN WOODS

19525 W NORTH AVE, BROOKFIELD, WI 53045 · CCN 525528

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

$118,144

Number of fines

1

Number of penalties

3

Payment denials

2

Chain

Chain

ASCENSION LIVING

Facilities in chain

19

Chain avg overall

2.60 / 5

Inspection citations (52)6 actual harm

1. GF0686Provide appropriate pressure ulcer care and prevent new ulcers from developing.2025-12-22 · Health · corrected 2026-02-03

   Actual harm

2. DF0759Ensure medication error rates are not 5 percent or greater.2025-12-22 · Health · corrected 2026-02-03

   Potential for more than minimal harm

3. DF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2025-12-03 · Health · corrected 2025-12-19

   Potential for more than minimal harm

4. DF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2025-05-06 · Health · corrected 2025-06-02

   Potential for more than minimal harm

5. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2025-05-06 · Health · corrected 2025-06-02

   Potential for more than minimal harm

6. DF0757Ensure each resident’s drug regimen must be free from unnecessary drugs.2025-05-06 · Health · corrected 2025-06-02

   Potential for more than minimal harm

7. DF0585Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.2025-03-20 · Health · corrected 2025-04-23

   Potential for more than minimal harm

8. EF0607Develop and implement policies and procedures to prevent abuse, neglect, and theft.2025-03-20 · Health · corrected 2025-04-23

   Potential for more than minimal harm

9. DF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2025-03-20 · Health · corrected 2025-04-23

   Potential for more than minimal harm

10. EF0610Respond appropriately to all alleged violations.2025-03-20 · Health · corrected 2025-04-23

    Potential for more than minimal harm

11. GF0686Provide appropriate pressure ulcer care and prevent new ulcers from developing.2025-03-20 · Health · corrected 2025-06-18

    Actual harm

12. GF0692Provide enough food/fluids to maintain a resident's health.2025-03-20 · Health · corrected 2025-04-23

    Actual harm

13. DF0700Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.2025-03-20 · Health · corrected 2025-04-23

    Potential for more than minimal harm

14. FF0880Provide and implement an infection prevention and control program.2025-03-20 · Health · corrected 2025-06-02

    Potential for more than minimal harm

15. DF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2025-02-11 · Health · corrected 2025-03-12

    Potential for more than minimal harm

16. GF0686Provide appropriate pressure ulcer care and prevent new ulcers from developing.2025-02-11 · Health · corrected 2025-06-18

    Actual harm

17. DF0757Ensure each resident’s drug regimen must be free from unnecessary drugs.2025-01-14 · Health · corrected 2025-02-14

    Potential for more than minimal harm

18. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2024-12-23 · Health · corrected 2025-01-23

    Potential for more than minimal harm

19. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2024-11-14 · Health · corrected 2024-12-10

    Potential for more than minimal harm

20. DF0585Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.2024-11-14 · Health · corrected 2024-12-10

    Potential for more than minimal harm

21. DF0623Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.2024-11-14 · Health · corrected 2024-12-10

    Potential for more than minimal harm

22. DF0677Provide care and assistance to perform activities of daily living for any resident who is unable.2024-11-14 · Health · corrected 2024-12-10

    Potential for more than minimal harm

23. GF0693Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.2024-11-14 · Health · corrected 2024-12-10

    Actual harm

24. FF0725Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.2024-11-14 · Health · corrected 2024-12-10

    Potential for more than minimal harm

25. CF0732Post nurse staffing information every day.2024-11-14 · Health · corrected 2024-12-10

    Potential for minimal harm

26. 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.2024-11-14 · Health · corrected 2024-12-10

    Potential for more than minimal harm

27. EF0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.2024-11-14 · Health · corrected 2024-12-10

    Potential for more than minimal harm

28. EF0880Provide and implement an infection prevention and control program.2024-11-14 · Health · corrected 2024-12-10

    Potential for more than minimal harm

29. EF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2024-04-05 · Health · corrected 2024-05-05

    Potential for more than minimal harm

30. CF0607Develop and implement policies and procedures to prevent abuse, neglect, and theft.2023-10-05 · Health · corrected 2023-11-04

    Potential for minimal harm

31. EF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2023-10-05 · Health · corrected 2023-11-04

    Potential for more than minimal harm

32. EF0610Respond appropriately to all alleged violations.2023-10-05 · Health · corrected 2023-11-04

    Potential for more than minimal harm

33. DF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2023-10-05 · Health · corrected 2023-11-04

    Potential for more than minimal harm

34. DF0686Provide appropriate pressure ulcer care and prevent new ulcers from developing.2023-10-05 · Health · corrected 2023-11-04

    Potential for more than minimal harm

35. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2023-10-05 · Health · corrected 2023-11-04

    Potential for more than minimal harm

36. 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.2023-10-05 · Health · corrected 2023-11-04

    Potential for more than minimal harm

37. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2023-03-07 · Health · corrected 2023-04-06

    Potential for more than minimal harm

38. DF0582Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

39. EF0607Develop and implement policies and procedures to prevent abuse, neglect, and theft.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

40. DF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

41. DF0610Respond appropriately to all alleged violations.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

42. DF0623Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

43. DF0625Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

44. DF0660Plan the resident's discharge to meet the resident's goals and needs.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

45. DF0661Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

46. GF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2022-07-18 · Health · corrected 2022-08-16

    Actual harm

47. DF0695Provide safe and appropriate respiratory care for a resident when needed.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

48. DF0740Ensure each resident must receive and the facility must provide necessary behavioral health care and services.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

49. DF0756Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

50. 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.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

51. DF0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

52. DF0880Provide and implement an infection prevention and control program.2022-07-18 · Health · corrected 2022-08-16

    Potential for more than minimal harm

Ownership

Other facilities in BROOKFIELD

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