Franciscan Woods
Nursing home · 19525 W NORTH AVE, Brookfield, WI 53045 · Waukesha County
Prices
No published price is available. Ask the facility directly.
Facility
- Type
- Nursing home · TITLE 18 SNF TITLE 19 NF
- Capacity
- 110
- State license
- 3129
- Medicare CCN
- 525528
- Licensed entity
- WHEATON FRANCISCAN HEALTHCARE TERRACE AT ST. FRANCIS, INC.
- Chain
- ASCENSION LIVING
- Ownership
- Non profit - Corporation
- Phone
- (262) 785-1114
- Nurse staffing
- 4.39 hours per resident per day; 76.0% nursing staff turnover
- Medicare ratings
- Inspections 1★ · Staffing 4★ · Quality 2★
- Official record
- Wisconsin DQA Provider Search
- Official record
- Medicare Care Compare
Penalties
- Feb 11, 2025 — Payment Denial · payment denial 97 days
- Feb 11, 2025 — Fine ($120,905)
- Nov 14, 2024 — Payment Denial · payment denial 31 days
Inspection findings
-
Apr 9, 2026 Health · 19 findings
-
Not serious
Scope/severity D
F0552 Resident Rights Deficiencies
Ensure that residents are fully informed and understand their health status, care and treatments.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity D
F0628 Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity D
F0676 Quality of Life and Care Deficiencies
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity D
F0684 Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity D
F0686 Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity D
F0689 Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity D
F0693 Quality of Life and Care Deficiencies
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.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity D
F0755 Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity D
F0761 Pharmacy Service Deficiencies
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.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity D
F0849 Administration Deficiencies
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.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity F
F0880 Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity F
F0881 Infection Control Deficiencies
Implement a program that monitors antibiotic use.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity D
F0883 Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity D
F0887 Infection Control Deficiencies
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.
Corrected May 8, 2026 · CMS health inspection
-
Not serious
Scope/severity F
K0321 Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected May 30, 2026 · CMS fire safety
-
Not serious
Scope/severity F
K0353 Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Corrected May 8, 2026 · CMS fire safety
-
Not serious
Scope/severity F
K0364 Smoke Deficiencies
Install properly constructed windows in hallway walls or doors.
Corrected May 30, 2026 · CMS fire safety
-
Not serious
Scope/severity F
K0372 Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected May 30, 2026 · CMS fire safety
-
Not serious
Scope/severity F
K0916 Gas, Vacuum, and Electrical Systems Deficiencies
Have a battery powered remote alarm panel in a location accessible by operating personnel.
Corrected May 8, 2026 · CMS fire safety
-
Not serious
Scope/severity D
-
Dec 22, 2025 Health · 2 findings
-
Serious
Scope/severity G
Complaint
F0686 Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected Feb 3, 2026 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
F0759 Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Corrected Feb 3, 2026 · CMS health inspection
-
Serious
Scope/severity G
Complaint
-
Dec 3, 2025 Health · 1 finding
-
Not serious
Scope/severity D
Complaint
F0600 Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected Dec 19, 2025 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
-
May 6, 2025 Health · 3 findings
-
Not serious
Scope/severity D
Complaint
F0689 Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected Jun 2, 2025 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
F0755 Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected Jun 2, 2025 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
F0757 Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected Jun 2, 2025 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
-
Mar 20, 2025 Health · 8 findings
-
Not serious
Scope/severity D
Complaint
F0585 Resident Rights Deficiencies
Honor 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.
Corrected Apr 23, 2025 · CMS health inspection
-
Not serious
Scope/severity E
Complaint
F0607 Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected Apr 23, 2025 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
F0609 Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected Apr 23, 2025 · CMS health inspection
-
Not serious
Scope/severity E
Complaint
F0610 Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Corrected Apr 23, 2025 · CMS health inspection
-
Serious
Scope/severity G
Complaint
F0686 Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected Jun 18, 2025 · CMS health inspection
-
Serious
Scope/severity G
Complaint
F0692 Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
Corrected Apr 23, 2025 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
F0700 Quality of Life and Care Deficiencies
Try 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.
Corrected Apr 23, 2025 · CMS health inspection
-
Not serious
Scope/severity F
Complaint
F0880 Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Corrected Jun 2, 2025 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
-
Feb 11, 2025 Health · 2 findings
-
Not serious
Scope/severity D
Complaint
F0684 Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected Mar 12, 2025 · CMS health inspection
-
Serious
Scope/severity G
Complaint
F0686 Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected Jun 18, 2025 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
-
Jan 14, 2025 Health · 1 finding
-
Not serious
Scope/severity D
Complaint
F0757 Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected Feb 14, 2025 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
-
Dec 23, 2024 Health · 1 finding
-
Not serious
Scope/severity D
Complaint
F0755 Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected Jan 23, 2025 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
-
Nov 14, 2024 Fire Safety · 19 findings
-
Not serious
Scope/severity D
E0013 Emergency Preparedness Deficiencies
Develop Emergency Preparedness policies and procedures.
Corrected Jan 8, 2025 · CMS fire safety
-
Not serious
Scope/severity D
E0015 Emergency Preparedness Deficiencies
Address subsistence needs for staff and patients.
Corrected Jan 8, 2025 · CMS fire safety
-
Not serious
Scope/severity D
Complaint
F0580 Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected Dec 10, 2024 · CMS health inspection
-
Not serious
Scope/severity D
F0585 Resident Rights Deficiencies
Honor 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.
Corrected Dec 10, 2024 · CMS health inspection
-
Not serious
Scope/severity D
F0623 Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected Dec 10, 2024 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
F0677 Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected Dec 10, 2024 · CMS health inspection
-
Serious
Scope/severity G
Complaint
F0693 Quality of Life and Care Deficiencies
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.
Corrected Dec 10, 2024 · CMS health inspection
-
Not serious
Scope/severity F
Complaint
F0725 Nursing and Physician Services Deficiencies
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Corrected Dec 10, 2024 · CMS health inspection
-
Not serious
Scope/severity C
F0732 Nursing and Physician Services Deficiencies
Post nurse staffing information every day.
Corrected Dec 10, 2024 · CMS health inspection
-
Not serious
Scope/severity D
F0758 Pharmacy Service Deficiencies
Implement 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.
Corrected Dec 10, 2024 · CMS health inspection
-
Not serious
Scope/severity E
F0812 Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected Dec 10, 2024 · CMS health inspection
-
Not serious
Scope/severity E
F0880 Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Corrected Dec 10, 2024 · CMS health inspection
-
Not serious
Scope/severity D
K0211 Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected Jan 14, 2025 · CMS fire safety
-
Not serious
Scope/severity D
K0222 Egress Deficiencies
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.
Corrected Jan 13, 2025 · CMS fire safety
-
Not serious
Scope/severity F
K0353 Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Corrected Jan 8, 2025 · CMS fire safety
-
Not serious
Scope/severity F
K0511 Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Corrected Jan 8, 2025 · CMS fire safety
-
Not serious
Scope/severity F
K0751 Miscellaneous Deficiencies
Have restrictions on the use of flammable curtains.
Corrected Jan 8, 2025 · CMS fire safety
-
Not serious
Scope/severity F
K0918 Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
CMS fire safety
-
Not serious
Scope/severity D
K0925 Gas, Vacuum, and Electrical Systems Deficiencies
Ensure that sources of ignition are removed from patients receiving respiratory therapy.
Corrected Jan 8, 2025 · CMS fire safety
-
Not serious
Scope/severity D
-
Apr 5, 2024 Health · 1 finding
-
Not serious
Scope/severity E
Complaint
F0842 Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected May 5, 2024 · CMS health inspection
-
Not serious
Scope/severity E
Complaint
-
Oct 5, 2023 Health · 10 findings
-
Not serious
Scope/severity C
Complaint
F0607 Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected Nov 4, 2023 · CMS health inspection
-
Not serious
Scope/severity E
Complaint
F0609 Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected Nov 4, 2023 · CMS health inspection
-
Not serious
Scope/severity E
Complaint
F0610 Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Corrected Nov 4, 2023 · CMS health inspection
-
Not serious
Scope/severity D
Complaint
F0684 Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected Nov 4, 2023 · CMS health inspection
-
Not serious
Scope/severity D
F0686 Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected Nov 4, 2023 · CMS health inspection
-
Not serious
Scope/severity D
F0755 Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected Nov 4, 2023 · CMS health inspection
-
Not serious
Scope/severity D
F0758 Pharmacy Service Deficiencies
Implement 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.
Corrected Nov 4, 2023 · CMS health inspection
-
Not serious
Scope/severity F
K0353 Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Corrected Nov 4, 2023 · CMS fire safety
-
Not serious
Scope/severity E
K0363 Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Corrected Nov 4, 2023 · CMS fire safety
-
Not serious
Scope/severity D
K0920 Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Corrected Nov 4, 2023 · CMS fire safety
-
Not serious
Scope/severity C
Complaint
Owners and managers (as published by CMS)
- MUSGRAVE, LISA — adp of the snf, NOT APPLICABLE, since 01/01/2024
- MUSGRAVE, LISA — corporate director, NOT APPLICABLE, since 01/01/2024
- SHADBOLT, ERIN — adp of the snf, NOT APPLICABLE, since 01/01/2024
- SHADBOLT, ERIN — corporate director, NOT APPLICABLE, since 01/01/2024
- SIDHU, SARFRAZ — adp of the snf, NOT APPLICABLE, since 11/01/2018
- SIDHU, SARFRAZ — operational/managerial control, NOT APPLICABLE, since 11/01/2018
- SMOOT, KENNETH — adp of the snf, NOT APPLICABLE, since 01/01/2024
- SMOOT, KENNETH — corporate director, NOT APPLICABLE, since 01/01/2024
- ST LOUIS, STEVEN — adp of the snf, NOT APPLICABLE, since 01/23/2025
- ST LOUIS, STEVEN — operational/managerial control, NOT APPLICABLE, since 01/23/2025
- ASCENSION HEALTH SENIOR CARE — adp of the snf, NOT APPLICABLE, since 07/01/2015
- ASCENSION HEALTH SENIOR CARE — 5% or greater direct ownership interest, 100%, since 07/01/2014
- FAST PACE MEDICAL STAFFING INC — adp of the snf, NOT APPLICABLE, since 10/07/2022
- FAVORITE HEALTHCARE STAFFING LLC — adp of the snf, NOT APPLICABLE, since 10/14/2022
- HEALTH DIMENSIONS CONSULTING INC — adp of the snf, NOT APPLICABLE, since 04/29/2025
- HOUSE HEALTHCARE SOLUTIONS LLC — adp of the snf, NOT APPLICABLE, since 06/10/2025
- MEDICAL SOLUTIONS LLC — adp of the snf, NOT APPLICABLE, since 06/14/2017
- MEDICAL STAFFING SOLUTIONS LLC — adp of the snf, NOT APPLICABLE, since 10/06/2020
- MICHAEL PORTER — adp of the snf, NOT APPLICABLE, since 05/09/2021
- NURSING CENTERS, INC. — adp of the snf, NOT APPLICABLE, since 06/08/2020
- PERSONNEL SPECIALISTS LLC — adp of the snf, NOT APPLICABLE, since 04/10/2025
- PRN HEALTH SERVICES, INC. — adp of the snf, NOT APPLICABLE, since 08/19/2022
- PROLINK HEALTHCARE LLC — adp of the snf, NOT APPLICABLE, since 04/26/2023
- STAFF ONE, LTD. — adp of the snf, NOT APPLICABLE, since 04/27/2020
Sources: Wisconsin Department of Health Services (directory, assisted-living survey documents) and CMS Care Compare (nursing homes). “Harm or jeopardy level” is CMS scope/severity G–L. About this data.