Federal inspection record · CMS data as of October 1, 2026
Bayshore Nursing & Rehab
1300 West Silver Spring Dr, Glendale, WI · (414) 228-8120
- Cited for abuse (CMS abuse icon)
- Special Focus Facility
- Certified beds
- 112
- Residents per day
- 0
- Ownership
- For-Profit
- Chain
- Bedrock Healthcare
- Medicare / Medicaid
- Medicare + Medicaid
- Certified since
- October 1, 1984
1
How this home got 1 star
The overall rating isn't an average. CMS starts from the inspection rating and nudges it at most two steps. Here is the arithmetic for this home, using CMS's own rules.
-
Health inspections
★★★★★starting point
Everything starts from what state inspectors found on site. This is a ranking against other homes in Wisconsin.
-
Staffing
Not ratednot rated
CMS did not rate staffing here, so it does not move the star.
-
Quality measures
★★★★★no change
Same rule: 5 stars adds one, 1 star takes one away. These measures are mostly reported by the home itself.
-
Overall
★★★★★1 of 5
Matches the rating CMS publishes on Care Compare.
This home carries CMS's abuse icon, which caps its inspection rating at 2 stars and so its overall rating at 4.
2
Where it sits among Wisconsin homes
Bayshore Nursing & Rehab carries 1032.25 inspection points. That is fewer than 0% of Wisconsin's 321 rated homes.
Inspectors' citations earn points by how serious and how widespread they were (the grid below). CMS then ranks every home in Wisconsin: the 10% with the fewest points get 5 stars, the 20% with the most get 1 star, and the middle 70% split evenly into 2, 3 and 4.
- 5★ 0–11 pts
- 4★ 11–37 pts
- 3★ 37–76 pts
- 2★ 76–130.75 pts
- 1★ over 130.75 pts
Bars show every rated home in Wisconsin by its weighted inspection score. CMS recalibrates the cut points monthly but holds a home's rating until its own score changes, so a home can sit just outside today's band.
3
What inspectors found
128 health citations on record since 2023. Each one gets a letter: the row says how badly residents were affected, the column how many.
Immediate jeopardyResidents at risk of serious injury or death
Actual harmA resident was hurt
Potential for harmNo one was hurt, but could have been
Minimal harmPaperwork-level problems
Read the rows, not the total. Most citations nationwide are a D: one problem, nobody hurt. Rows G–I mean a resident was harmed; J–L mean inspectors found residents in immediate danger of serious injury or death.
Small numbers in each cell are the inspection points CMS assigns per citation. Those points are what the state curve above ranks.
Harm and immediate-jeopardy citations (10)
-
L
Administer the facility in a manner that enables it to use its resources effectively and efficiently.
-
L
Designate a physician to serve as medical director responsible for implementation of resident care policies and coordination of medical care in the facility.
-
J
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
-
J
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
-
G
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
-
J
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
-
J
Provide enough food/fluids to maintain a resident's health.
-
L
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
-
G
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
-
G
Ensure that residents are free from significant medication errors.
Everything else, by area of care
Resident Rights25F
- E
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
- E
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.
- D
Ensure that residents are fully informed and understand their health status, care and treatments.
- D
Ensure residents have reasonable access to and privacy in their use of communication methods.
- D
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- D
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
- C
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.
- D
Reasonably accommodate the needs and preferences of each resident.
- F
Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.
- D
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
- D
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- F
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- D
Allow residents to self-administer drugs if determined clinically appropriate.
- D
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
- D
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.
- F
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- E
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- D
Reasonably accommodate the needs and preferences of each resident.
- D
Honor 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.
- E
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- D
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- D
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.
- E
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- E
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
- E
Notify 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.
Quality of Life and Care19E
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- E
Provide activities to meet all resident's needs.
- D
Provide care and assistance to perform activities of daily living for any resident who is unable.
- D
Provide care or services that was trauma informed and/or culturally competent.
- D
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.
- D
Provide routine and 24-hour emergency dental care for each resident.
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Provide safe, appropriate pain management for a resident who requires such services.
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
- D
Provide safe and appropriate respiratory care for a resident when needed.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- D
Provide enough food/fluids to maintain a resident's health.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- D
Provide care and assistance to perform activities of daily living for any resident who is unable.
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Provide enough food/fluids to maintain a resident's health.
- D
Provide safe and appropriate respiratory care for a resident when needed.
- D
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Freedom from Abuse, Neglect, and Exploitation12F
- D
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- D
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
- D
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- D
Respond appropriately to all alleged violations.
- D
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- D
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- F
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
- D
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- D
Respond appropriately to all alleged violations.
- D
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- D
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
- D
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Resident Assessment and Care Planning12E
- D
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
- D
Ensure services provided by the nursing facility meet professional standards of quality.
- E
Ensure each resident receives an accurate assessment.
- E
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- D
PASARR screening for Mental disorders or Intellectual Disabilities
- D
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
- D
Ensure each resident receives an accurate assessment.
- D
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
- D
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
- D
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- E
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
- D
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Pharmacy Service12E
- E
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
- E
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.
- D
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- D
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- D
Ensure medication error rates are not 5 percent or greater.
- D
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.
- D
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- D
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
- D
Ensure each resident’s drug regimen must be free from unnecessary drugs.
- D
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.
- D
Ensure medication error rates are not 5 percent or greater.
- D
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.
Nutrition and Dietary11F
- F
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- F
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
- F
Dispose of garbage and refuse properly.
- F
Dispose of garbage and refuse properly.
- F
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
- D
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
- D
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
- E
Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs.
- E
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- D
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
- C
Dispose of garbage and refuse properly.
Administration9F
- F
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
- F
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
- F
Provide training in compliance and ethics.
- F
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
- F
Develop, implement, and/or maintain an effective training program for all new and existing staff members.
- F
Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.
- F
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
- F
Provide training in compliance and ethics.
- F
Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility.
Infection Control8F
- F
Provide and implement an infection prevention and control program.
- F
Implement a program that monitors antibiotic use.
- F
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.
- E
Develop and implement policies and procedures for flu and pneumonia vaccinations.
- F
Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.
- E
Provide and implement an infection prevention and control program.
- F
Provide and implement an infection prevention and control program.
- E
Provide and implement an infection prevention and control program.
Nursing and Physician Services5F
- F
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
- E
Observe each nurse aide's job performance and give regular training.
- D
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
- C
Post nurse staffing information every day.
- F
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Environmental5F
- F
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
- F
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
- F
Keep all essential equipment working safely.
- D
Make sure that a working call system is available in each resident's bathroom and bathing area.
- F
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Inspection history
2025-09-30
43 health deficiencies · 20 fire-safety deficiencies
Top issue: Quality of Life and Care (9 deficiencies)
2024-06-20
51 health deficiencies · 16 fire-safety deficiencies
Top issue: Resident Rights (12 deficiencies)
2023-03-21
34 health deficiencies · 15 fire-safety deficiencies
Top issue: Nutrition and Dietary (7 deficiencies)
5
Fines and payment denials
$424,350 in federal fines on record over the past three years.
| Date | Penalty | Amount |
|---|---|---|
| 2025-05-29 | Fine | $424,350 |
| 2025-05-29 | Payment Denial · 100 day denial | $0 |
| 2024-10-30 | Payment Denial · 36 day denial | $0 |
6
Resident outcomes
Quality measures compared with state and national averages. Most come from assessments the home itself reports.
| Measure | This home | State | U.S. |
|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine19.1 pts worse | 76.9% | 96.0% | 93.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine13.1 pts worse | 82.5% | 95.6% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury0.3 pts worse | 3.6% | 3.3% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms5.2 pts better | 0.8% | 6.0% | 13.5% |
| Percentage of long-stay residents who lose too much weight3 pts worse | 7.9% | 4.9% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication2.8 pts worse | 19.6% | 16.8% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication7.4 pts worse | 23.3% | 15.9% | 15.4% |
| Percentage of long-stay residents who were physically restrained0.2 pts worse | 0.3% | 0.1% | 0.1% |
| Percentage of long-stay residents whose ability to walk independently worsened2.5 pts better | 14.5% | 17.0% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased2.3 pts worse | 18.1% | 15.8% | 13.5% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder1.5 pts better | 0.4% | 1.9% | 0.7% |
| Percentage of long-stay residents with a urinary tract infection1.1 pts better | 1.6% | 2.7% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence0.1 pts better | 23.5% | 23.6% | 18.3% |
| Percentage of long-stay residents with pressure ulcers0.5 pts worse | 5.4% | 4.9% | 4.5% |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine34.3 pts worse | 52.6% | 86.9% | 82.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit9.9 pts worse | 25.5% | 15.6% | 11.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication1.2 pts better | 0.0% | 1.2% | 1.5% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine16.2 pts worse | 66.0% | 82.2% | 80.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission20 pts worse | 42.5% | 22.5% | 23.4% |
·
Who owns and runs it
12 owners and managers reported to CMS. The last column counts how many nursing homes each one is tied to.
Show ownership list
| Name | Role | Share | Homes |
|---|---|---|---|
| Chopp, Martin | 5% Or Greater Indirect Ownership Interest · Individual | 18% | 8 facilities |
| Chopp, Pnina | 5% Or Greater Indirect Ownership Interest · Individual | 18% | 8 facilities |
| Chopp, Lynn | 5% Or Greater Indirect Ownership Interest · Individual | 17% | 3 facilities |
| Prager, Avrohom | 5% Or Greater Indirect Ownership Interest · Individual | 13% | 3 facilities |
| Prager, Shulamit | 5% Or Greater Indirect Ownership Interest · Individual | 13% | 3 facilities |
| Chopp, Solomon | 5% Or Greater Indirect Ownership Interest · Individual | 10% | 8 facilities |
| Chopp, Rachel | 5% Or Greater Indirect Ownership Interest · Individual | 7% | 3 facilities |
| Chopp, Sarah | 5% Or Greater Indirect Ownership Interest · Individual | 5% | 3 facilities |
| Nichols, Kenneth | Contracted Managing Employee · Individual | 0% | 4 facilities |
| Nichols, Kenneth | Corporate Officer · Individual | 0% | 4 facilities |
| Nichols, Kenneth | Operational/Managerial Control · Individual | 0% | 4 facilities |
| Opal Healthcare Nj LLC | Operational/Managerial Control · Organization | 0% | 4 facilities |
·
Fire safety
51 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Smoke18F
- F
Have approved installation, maintenance and testing program for fire alarm systems.
- F
Inspect, test, and maintain automatic sprinkler systems.
- F
Properly select, install, inspect, or maintain portable fire extinguishes.
- E
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- E
Install corridor and hallway doors that block smoke.
- E
Install smoke barrier doors that can resist smoke for at least 20 minutes.
- D
Provide properly protected cooking facilities.
- F
Provide properly protected cooking facilities.
- F
Have approved installation, maintenance and testing program for fire alarm systems.
- E
Inspect, test, and maintain automatic sprinkler systems.
- E
Install corridor and hallway doors that block smoke.
- E
Install smoke barrier doors that can resist smoke for at least 20 minutes.
- D
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- D
Properly select, install, inspect, or maintain portable fire extinguishes.
- F
Have approved installation, maintenance and testing program for fire alarm systems.
- F
Inspect, test, and maintain automatic sprinkler systems.
- E
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- D
Provide properly protected cooking facilities.
Egress11F
- F
Install emergency lighting that can last at least 1 1/2 hours.
- E
Have exits that are accessible at all times.
- D
Have stairways and smokeproof enclosures used as exits that meet safety requirements.
- E
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.
- E
Have corridors or aisles that are unobstructed and are at least 8 feet in width.
- E
Install resident room doors of proper design and width.
- E
Have exits that are accessible at all times.
- D
Have stairways and smokeproof enclosures used as exits that meet safety requirements.
- F
Install emergency lighting that can last at least 1 1/2 hours.
- E
Have exits that are accessible at all times.
- D
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.
Gas, Vacuum, and Electrical Systems8F
- F
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
- F
Have generator or other power source capable of supplying service within 10 seconds.
- D
Ensure proper usage of power strips and extension cords.
- F
Have generator or other power source capable of supplying service within 10 seconds.
- F
Have a battery powered remote alarm panel in a location accessible by operating personnel.
- F
Have generator or other power source capable of supplying service within 10 seconds.
- E
Meet requirements for the use of electrical equipment.
- E
Ensure proper usage of power strips and extension cords.
Miscellaneous7F
- F
Have simulated fire drills held at unexpected times.
- D
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
- F
Have simulated fire drills held at unexpected times.
- F
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
- F
Have simulated fire drills held at unexpected times.
- E
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
- D
Have restrictions on the use of portable space heaters.
Services4F
- D
Have properly installed electrical wiring and gas equipment.
- D
Install properly constructed and protected linen or trash chutes.
- F
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
- E
Install properly constructed and protected linen or trash chutes.
Emergency Preparedness3F
- F
Conduct testing and exercise requirements.
- F
Develop and maintain an Emergency Preparedness Program (EP).
- F
Address patient/client population and determine types of services needed.
·
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- E
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