Federal inspection record · CMS data as of October 1, 2026
Medical Suites at Oak Creek (The)
2700 Honadel Boulevard, Oak Creek, WI · (414) 435-2005
- Special Focus Facility
- Certified beds
- 144
- Residents per day
- 112
- Ownership
- For-Profit
- Chain
- Champion Care
- Medicare / Medicaid
- Medicare + Medicaid
- Certified since
- April 8, 2020
3
What inspectors found
121 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)
-
K
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.
-
J
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
-
G
Provide safe, appropriate pain management for a resident who requires such services.
-
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.
-
J
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
-
K
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.
-
J
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
-
J
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Everything else, by area of care
Quality of Life and Care26D
- D
Provide care and assistance to perform activities of daily living for any resident who is unable.
- D
Provide enough food/fluids to maintain a resident's health.
- D
Provide care and assistance to perform activities of daily living for any resident who is unable.
- 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 enough food/fluids to maintain a resident's health.
- D
Provide medically-related social services to help each resident achieve the highest possible quality of life.
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
- D
Provide care and assistance to perform activities of daily living for any resident who is unable.
- 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.
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Provide care and assistance to perform activities of daily living for any resident who is unable.
- D
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
- D
Provide care and assistance to perform activities of daily living for any resident who is unable.
- D
Provide activities to meet all resident's needs.
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
- D
Provide 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.
- D
Provide enough food/fluids to maintain a resident's health.
- D
Provide safe and appropriate respiratory care for a resident when needed.
Pharmacy Service19E
- E
Ensure that residents are free from significant medication errors.
- 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
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- E
Ensure medication error rates are not 5 percent or greater.
- D
Ensure each resident’s drug regimen must be free from unnecessary drugs.
- 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
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
- 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.
- 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
Ensure each resident’s drug regimen must be free from unnecessary drugs.
- D
Ensure medication error rates are not 5 percent or greater.
- 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
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.
Resident Rights16F
- F
Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.
- 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.
- E
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- D
Allow residents to self-administer drugs if determined clinically appropriate.
- 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.
- D
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
- D
Allow residents to self-administer drugs if determined clinically appropriate.
- D
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
- D
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.
- D
Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made.
- 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.
- 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.
- D
Allow residents to self-administer drugs if determined clinically appropriate.
- D
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Administration13F
- 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
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
- F
Have a plan that describes the process for conducting QAPI and QAA activities.
- D
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.
- D
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.
- D
Provide timely, quality laboratory services/tests to meet the needs of residents.
- F
Develop, implement, and/or maintain an effective training program for all new and existing staff members.
- E
Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.
- E
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
- E
Provide training in compliance and ethics.
- E
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
Freedom from Abuse, Neglect, and Exploitation11F
- F
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
- E
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
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.
- D
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- E
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.
- D
Respond appropriately to all alleged violations.
Infection Control8F
- F
Provide and implement an infection prevention and control program.
- F
Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.
- D
Develop and implement policies and procedures for flu and pneumonia vaccinations.
- D
Provide and implement an infection prevention and control program.
- D
Implement a program that monitors antibiotic use.
- F
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
- E
Provide and implement an infection prevention and control program.
- E
Provide and implement an infection prevention and control program.
Resident Assessment and Care Planning7D
- D
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- D
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
- 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.
- D
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
- 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.
Nutrition and Dietary6F
- D
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
- F
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- F
Dispose of garbage and refuse properly.
- E
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
- F
Dispose of garbage and refuse properly.
- D
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Nursing and Physician Services4F
- F
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
- F
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
- F
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
- E
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Environmental1E
- E
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Inspection history
2025-10-03
53 health deficiencies · 14 fire-safety deficiencies
Top issue: Quality of Life and Care (16 deficiencies)
2024-07-15
33 health deficiencies · 9 fire-safety deficiencies
Top issue: Quality of Life and Care (8 deficiencies)
2023-07-27
35 health deficiencies · 10 fire-safety deficiencies
Top issue: Quality of Life and Care (11 deficiencies)
4
Nursing time per resident, per day
Each resident here gets about 4 h of nursing staff time a day, 42 min of it from a registered nurse.
This home
4 h
Wisconsin average
4 h 15 min
U.S. average
3 h 54 min
- Registered nurse
- Licensed practical nurse
- Nurse aide
Turnover: 64% of nursing staff and 48% of registered nurses left in the past year, along with 2 administrators.
Reported hours from payroll data the home submits to CMS, divided by its daily resident count. Not adjusted for how sick residents are.
5
Fines and payment denials
$199,227 in federal fines on record over the past three years.
| Date | Penalty | Amount |
|---|---|---|
| 2025-10-03 | Fine | $106,600 |
| 2024-07-15 | Fine | $64,527 |
| 2024-07-15 | Payment Denial · 49 day denial | $0 |
| 2024-04-17 | Fine | $28,100 |
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. |
|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days0.1 pts better | 1.5 | 1.6 | 1.8 |
| Number of outpatient emergency department visits per 1000 long-stay resident days0.2 pts better | 2.0 | 2.2 | 1.7 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine4.5 pts worse | 91.5% | 96.0% | 93.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine13.7 pts worse | 81.9% | 95.6% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury0.6 pts worse | 3.9% | 3.3% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms1.3 pts better | 4.7% | 6.0% | 13.5% |
| Percentage of long-stay residents who lose too much weight7.6 pts worse | 12.5% | 4.9% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication5.9 pts better | 10.9% | 16.8% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication8.5 pts better | 7.4% | 15.9% | 15.4% |
| Percentage of long-stay residents who were physically restrained0.1 pts better | 0.0% | 0.1% | 0.1% |
| Percentage of long-stay residents whose ability to walk independently worsened9.8 pts worse | 26.8% | 17.0% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased9.9 pts worse | 25.7% | 15.8% | 13.5% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder1.2 pts better | 0.7% | 1.9% | 0.7% |
| Percentage of long-stay residents with a urinary tract infection2.1 pts better | 0.6% | 2.7% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence8.1 pts worse | 31.7% | 23.6% | 18.3% |
| Percentage of long-stay residents with pressure ulcers0.8 pts worse | 5.7% | 4.9% | 4.5% |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine8.3 pts worse | 78.6% | 86.9% | 82.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit0.3 pts better | 15.3% | 15.6% | 11.8% |
| Percentage of short-stay residents who newly received an antipsychotic medicationAbout the same | 1.2% | 1.2% | 1.5% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine9.6 pts worse | 72.6% | 82.2% | 80.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission6.4 pts worse | 28.9% | 22.5% | 23.4% |
·
Who owns and runs it
15 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 |
|---|---|---|---|
| Oak Creek Operations Holdings LLC | 5% Or Greater Direct Ownership Interest · Organization | 100% | 1 facilities |
| Amdrastek, Natalie | Operational/Managerial Control · Individual | 0% | 1 facilities |
| Amdrastek, Natalie | Adp Of The SNF · Individual | 0% | 1 facilities |
| Champion Care LLC | Adp Of The SNF · Organization | 0% | 14 facilities |
| Markwardt, Anne | Operational/Managerial Control · Individual | 0% | 4 facilities |
| Markwardt, Anne | Adp Of The SNF · Individual | 0% | 4 facilities |
| National Health Investors, Inc. | Adp Of The SNF · Organization | 0% | 31 facilities |
| Nhi-Reit Of Wisconsin LLC | Adp Of The SNF · Organization | 0% | 1 facilities |
| Ramanujam, Sandeep | Operational/Managerial Control · Individual | 0% | 5 facilities |
| Ramanujam, Sandeep | Adp Of The SNF · Individual | 0% | 5 facilities |
| Ruvel, Menachem | Indirect Ownership Interest · Individual | 0% | 23 facilities |
| Ruvel, Menachem | Corporate Officer · Individual | 0% | 23 facilities |
| Ruvel, Menachem | Adp Of The SNF · Individual | 0% | 23 facilities |
| Weinberg, Yisroel | Indirect Ownership Interest · Individual | 0% | 22 facilities |
| Weinberg, Yisroel | Adp Of The SNF · Individual | 0% | 22 facilities |
·
Fire safety
33 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Smoke13F
- F
Have approved installation, maintenance and testing program for fire alarm systems.
- F
Inspect, test, and maintain automatic sprinkler systems.
- E
Install a fire alarm system that can be heard throughout the facility.
- E
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
- E
Install smoke barrier doors that can resist smoke for at least 20 minutes.
- F
Inspect, test, and maintain automatic sprinkler systems.
- F
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
- E
Install corridor and hallway doors that block smoke.
- C
Have approved installation, maintenance and testing program for fire alarm systems.
- F
Provide properly protected cooking facilities.
- 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.
- E
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Gas, Vacuum, and Electrical Systems8F
- F
Have generator or other power source capable of supplying service within 10 seconds.
- E
Ensure proper usage of power strips and extension cords.
- 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.
- E
Meet requirements for the installation and maintenance of electrical systems.
- E
Have proper fire barriers, ventilation and signs for the transfilling of oxygen.
Miscellaneous6F
- F
Provide a written emergency evacuation plan.
- F
Have simulated fire drills held at unexpected times.
- E
Have restrictions on the use of portable space heaters.
- D
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
- C
Have simulated fire drills held at unexpected times.
- F
Have simulated fire drills held at unexpected times.
Emergency Preparedness3F
- F
Conduct risk assessment and an All-Hazards approach.
- F
Develop and maintain an Emergency Preparedness Program (EP).
- F
Establish emergency prep training and testing.
Egress3F
- E
Keep aisles, corridors, and exits free of obstruction in case of emergency.
- E
Have properly located and lighted "Exit" signs.
- F
Install emergency lighting that can last at least 1 1/2 hours.
·
Other homes nearby
-
Maple Ridge Health Services
Milwaukee, WI · North Shore Healthcare
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 3 h 32 min
- Fines
- $14,433
-
Autumn Lake Healthcare at Greenfield
Milwaukee, WI · Autumn Lake Healthcare · Abuse icon
★★★★★- Worst citation, 3 yrs
- K
- Nursing / resident / day
- 4 h 28 min
- Fines
- $152,619
-
Greendale Park Nursing and Rehab
Greendale, WI · Bedrock Healthcare
★★★★★- Worst citation, 3 yrs
- K
- Nursing / resident / day
- 4 h 22 min
- Fines
- $280,827