Complete Care at Care Age
Brookfield · 0.8 mi · 110 beds
Citations0Substantiated0
Franciscan Woods
19525 W NORTH AVE, Brookfield, WI, 53045
Nursing home110 licensed beds0 citations on record
5 more within 6 milesOpen in Maps
Has this facility been cited?
Yes. Federal inspectors cited 17 deficiencies against Franciscan Woods in Brookfield, Wisconsin at its most recent standard inspection on 2026-04-09, 3 of them arising from complaints. 5 findings have been recorded at the actual-harm level. Medicare has fined it 1 time, totalling $120,905. Medicare rates it 1 out of 5 overall.
1 / 5Medicare overall rating
110certified beds
17deficiencies at the last inspection
0immediate-jeopardy findings on record
5actual-harm findings on record
1federal fines, $120,905
What the inspectors found
Every deficiency on record, by how serious CMS judged it
CMS grades each finding from A to L on two axes: how badly residents were affected, and how many. These are its bands, not ours. The figures cover every standard and complaint survey on record, which is a longer window than the rating cycle above.
Immediate jeopardyA resident was placed in immediate danger. The most serious band CMS uses.0
Actual harmA resident was harmed, but not placed in immediate danger.5
Potential for more than minimal harmNo resident was harmed, but the failing could have caused it.43
Potential for minimal harmThe least serious band.2
Most recentFFDDDDDDDDDDDDGDDDDD
The last 20 findings, newest first
Each is the federal requirement the home was found not to meet, in CMS’s own wording, with the tag number so it can be looked up against the inspection report.
Provide and implement an infection prevention and control program.
Infection Control Deficiencies · F0880 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Implement a program that monitors antibiotic use.
Infection Control Deficiencies · F0881 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Ensure that residents are fully informed and understand their health status, care and treatments.
Resident Rights Deficiencies · F0552 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Resident Rights Deficiencies · F0628 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Quality of Life and Care Deficiencies · F0676 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · F0684 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Quality of Life and Care Deficiencies · F0686 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies · F0689 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Ensure 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.
Quality of Life and Care Deficiencies · F0693 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service Deficiencies · F0755 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Ensure 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.
Pharmacy Service Deficiencies · F0761 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Administration Deficiencies · F0849 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Infection Control Deficiencies · F0883 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
Infection Control Deficiencies · F0887 · 2026-04-09 · standard survey · No actual harm, potential for more than minimal harm
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Quality of Life and Care Deficiencies · F0686 · 2025-12-22 · from a complaint · Actual harm to a resident
Ensure medication error rates are not 5 percent or greater.
Pharmacy Service Deficiencies · F0759 · 2025-12-22 · from a complaint · No actual harm, potential for more than minimal harm
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Freedom from Abuse, Neglect, and Exploitation Deficiencies · F0600 · 2025-12-03 · from a complaint · No actual harm, potential for more than minimal harm
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies · F0689 · 2025-05-06 · from a complaint · No actual harm, potential for more than minimal harm
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service Deficiencies · F0755 · 2025-05-06 · from a complaint · No actual harm, potential for more than minimal harm
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Pharmacy Service Deficiencies · F0757 · 2025-05-06 · from a complaint · No actual harm, potential for more than minimal harm
Medicare’s own rating
How CMS scores this home
These stars are Medicare’s, not ours — we publish no rating of our own. They are reproduced here because they are part of the public record.
OverallCombines the three below1 of 5
Health inspectionBased on the last three inspection cycles1 of 5
StaffingNurse hours per resident, adjusted for how sick residents are4 of 5
Quality measuresResident outcomes reported by the home2 of 5
Nurse hours per resident per dayReported by the home to CMS4.38995
Nursing staff turnoverShare of nursing staff who left in a year76%
Penalties
What Medicare has fined this home
FinesCivil money penalties imposed by CMS1
Total fined$120,905
Payment denials and other penaltiesMedicare refusing to pay for new admissions is the usual one3
Ownership
Who owns Franciscan Woods
Nursing homes are frequently owned through layers of companies, and the name over the door is rarely the one that holds the licence. This is the ownership CMS has on file.
| Owner | Role | Share | Since |
|---|---|---|---|
| ASCENSION HEALTH SENIOR CARE | Organization | 100% | since 07/01/2014 |
| MUSGRAVE, LISA | Individual | NOT APPLICABLE | since 01/01/2024 |
| SHADBOLT, ERIN | Individual | NOT APPLICABLE | since 01/01/2024 |
| SMOOT, KENNETH | Individual | NOT APPLICABLE | since 01/01/2024 |
| SIDHU, SARFRAZ | Individual | NOT APPLICABLE | since 11/01/2018 |
| ST LOUIS, STEVEN | Individual | NOT APPLICABLE | since 01/23/2025 |
| ASCENSION HEALTH SENIOR CARE | Organization | NOT APPLICABLE | since 07/01/2015 |
| FAST PACE MEDICAL STAFFING INC | Organization | NOT APPLICABLE | since 10/07/2022 |
| FAVORITE HEALTHCARE STAFFING LLC | Organization | NOT APPLICABLE | since 10/14/2022 |
| HEALTH DIMENSIONS CONSULTING INC | Organization | NOT APPLICABLE | since 04/29/2025 |
| HOUSE HEALTHCARE SOLUTIONS LLC | Organization | NOT APPLICABLE | since 06/10/2025 |
| MEDICAL SOLUTIONS LLC | Organization | NOT APPLICABLE | since 06/14/2017 |
Part of the ASCENSION LIVING group.
Nearby
Other licensed providers within six miles
Listed by distance. Nobody paid to appear here and the order is not for sale.
Aria of Brookfield
Brookfield · 1.9 mi · 170 beds
Citations0Substantiated0
Avina of Pewaukee
Waukesha · 3.9 mi · 120 beds
Citations0Substantiated0
Congregational Home, INC.
Brookfield · 4.1 mi · 66 beds
Citations0Substantiated0
Aria of Waukesha
Waukesha · 4.3 mi · 105 beds
Citations0Substantiated0
Contact
Ask Franciscan Woods a question
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Source: Centers for Medicare & Medicaid Services, Nursing Home Care Compare. Retrieved 2026-07-29. Facility number 525528.
Figures reproduce the state’s own totals and are not re-aggregated. Methodology · Report a correction