01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-05-05 | 25 | 2025-05-05 | 14 |
| Cycle 2 | 2024-05-02 | 24 | 2024-05-02 | 9 |
| Cycle 3 | 2023-02-27 | 33 | 2023-02-27 | 13 |
CMS CCN 5252762026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Complete Care At Maple Grove Llc
3401 Maple Grove Dr. · Madison, WI 53719 · Dane County
Certified beds184CMS provider file
Recent citation rows118current CMS citation release
Penalty rows9current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
118 rows in the current release
7 rows carry G–L scope/severity codes; 2 carry J–L. 29 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-07-02 · HEALTHF0554Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Correction field: Deficient, Provider has no plan of correction · complaint2026-07-02 · HEALTHF0585Severity D · isolated; potential for more than minimal harm
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.
Correction field: Deficient, Provider has no plan of correction · complaint2026-07-02 · HEALTHF0645Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
PASARR screening for Mental disorders or Intellectual Disabilities
Correction field: Deficient, Provider has no plan of correction · complaint2026-07-02 · HEALTHF0677Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has no plan of correction · complaint2026-07-02 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has no plan of correction · complaint2026-07-02 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has no plan of correction · complaint2026-07-02 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has no plan of correction · complaint2026-07-02 · HEALTHF0690Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Correction field: Deficient, Provider has no plan of correction · complaint2026-07-02 · HEALTHF0699Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care or services that was trauma informed and/or culturally competent.
Correction field: Deficient, Provider has no plan of correction · complaint2026-07-02 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has no plan of correction · complaint2026-07-02 · HEALTHF0849Severity D · isolated; potential for more than minimal harm
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.
Correction field: Deficient, Provider has no plan of correction · complaint2026-06-25 · HEALTHF0760Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has plan of correction · 2026-07-23 · complaint2025-07-29 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2025-08-12 · complaint2025-05-05 · FIREE0004Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop and maintain an Emergency Preparedness Program (EP).
Correction field: Deficient, Provider has date of correction · 2025-06-242025-05-05 · FIREE0006Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct risk assessment and an All-Hazards approach.
Correction field: Deficient, Provider has date of correction · 2025-06-242025-05-05 · FIREE0039Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Correction field: Deficient, Provider has date of correction · 2025-06-242025-05-05 · HEALTHF0550Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2025-06-092025-05-05 · HEALTHF0554Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Correction field: Deficient, Provider has date of correction · 2025-06-092025-05-05 · HEALTHF0585Severity D · isolated; potential for more than minimal harm
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.
Correction field: Deficient, Provider has date of correction · 2025-06-092025-05-05 · HEALTHF0604Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Correction field: Deficient, Provider has date of correction · 2025-06-092025-05-05 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2025-06-092025-05-05 · HEALTHF0660Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Plan the resident's discharge to meet the resident's goals and needs.
Correction field: Deficient, Provider has date of correction · 2025-06-092025-05-05 · HEALTHF0675Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Honor each resident's preferences, choices, values and beliefs.
Correction field: Deficient, Provider has date of correction · 2025-06-092025-05-05 · HEALTHF0677Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2025-06-0903 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-05-05 | Fine | $58,354 | 0 |
| 2025-05-05 | Payment Denial | $0 | 21 |
| 2025-03-28 | Fine | $34,356 | 0 |
| 2024-10-21 | Fine | $12,048 | 0 |
| 2024-10-21 | Payment Denial | $0 | 8 |
| 2024-09-12 | Fine | $15,642 | 0 |
| 2023-12-04 | Fine | $15,239 | 0 |
| 2023-12-04 | Fine | $18,018 | 0 |
| 2023-12-04 | Payment Denial | $0 | 48 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- PC WCM OPCO HOLDCO LLCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 02/28/2025
- PC WCM TOPCO LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 02/28/2025
- PEACE CAPITAL HOLDINGS II LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 02/28/2025
- SMS 2021 TRUSTOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 02/28/2025
- KLUGMAN, JACOBIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 02/28/2025
- STEIN, SHALOMIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 02/28/2025
- HELLMAN, YOSEFIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 02/28/2025
- STEIN, SHALOMIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 02/28/2025
- STEIN, SHALOMIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/28/2025
- CHOLES, DIANAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/28/2025
- HELLMAN, YOSEFIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/28/2025
- MAINA, JENNIFERIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/28/2025
- MURPHY, SEANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/28/2025
- STERNBUCH, DANIELIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/28/2025
- STEIN, SHALOMIndividual · TRUSTEE OF THE SNFNOT APPLICABLE · since 02/28/2025
- DES CAPITAL LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 02/28/2025
- JRK INVESTMENTS LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 02/28/2025
- PC WCM PROPCO HOLDCO LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 02/28/2025
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours4.97per resident day
RN hours1.04per resident day
Weekend nurse hours4.46per resident day
Staff turnover64.0%CMS reported field
06 / LOCAL RECORDS
Open the Madison ledger →Other published facilities nearby
Capitol Lakes Health Center49 beds · CMS overall 4/541 citation rowsHebron Oaks70 beds · CMS overall 4/537 citation rowsMadison Health And Rehabilitation Center83 beds · CMS overall 1/584 citation rowsOak Park Nursing And Rehab Center100 beds · CMS overall 1/576 citation rowsOakwood Village East Health And Rehab Center40 beds · CMS overall 3/539 citation rowsOak Park Place Of Nakoma33 beds · CMS overall 3/557 citation rows