SFF Candidate Abuse citation flag

Overview

Address
1300 WEST SILVER SPRING DR, GLENDALE, WI 53209
Phone
4142288120
Certified beds
112
Avg daily residents
89 (80% of beds filled)
Ownership
For-profit LLC
Provider type
Medicare and Medicaid
Medicare/Medicaid since
1984-10-01
Setting
Urban
1 /5
CMS Overall Rating

CMS 5-Star Ratings

CMS rates every Medicare/Medicaid-certified nursing home on four domains. The Overall rating is driven primarily by Health Inspection results, then adjusted up or down by Staffing and Quality Measures.

Overall Rating
Composite of Health Inspection, Staffing, and Quality Measures.
1/5
Health Inspection
Based on the three most recent standard surveys, with more weight on recent results.
1/5
Staffing
Weighted combination of RN and total nurse staffing hours per resident per day, case-mix adjusted.
2/5
Quality Measures
15 resident-level quality measures split between long-stay and short-stay (post-acute) residents.
2/5
Quality Measures breakdown
Long-Stay Quality Measures 2/5
Short-Stay Quality Measures Data not available.

Staffing & Workforce

Direct-care staffing is the strongest operational driver of quality in nursing homes. Values are hours per resident per day, derived from payroll-based journal (PBJ) submissions. "Case-mix" adjusts for resident acuity; "Adjusted" is the CMS rating-input value.

Role Reported Case-mix expected Adjusted Federal floor
Total nurse
All nursing staff combined: RN + LPN + Aide
3.42 3.29 4.01 ≥ 3.48 Below floor
Registered Nurse (RN)
Licensed RN hours. Strongest driver of clinical outcomes.
0.34 0.58 0.40 ≥ 0.55 Below floor
Licensed Practical Nurse (LPN)
LPN/LVN hours. Often handles medication administration.
0.82 0.73 0.96
Nurse aide
CNA hours. Bulk of direct resident care — bathing, feeding, mobility.
2.25 1.98 2.65
Licensed (RN + LPN)
Combined licensed nurse coverage.
1.16
Physical therapist
Rehabilitation therapist hours — important for post-acute / rehab admissions.
0.00

Federal minimums (phasing in under the CMS 2024 minimum staffing rule) shown for reference. RN: 0.55 hrs/resident/day. Total nurse: 3.48 hrs/resident/day.

Weekend staffing

Total nurse (weekend)
3.08
hrs / resident / day
RN (weekend)
0.25
hrs / resident / day
Total nurse (adjusted, weekend)
3.61
hrs / resident / day

Weekend under-staffing is a common quality-of-care concern — adverse events are more frequent when licensed coverage drops.

Staff turnover

Total nursing staff turnover
59.6%
annual
RN turnover
66.7%
annual
Administrators departed
1
last 12 months

Resident acuity

Nursing Case-Mix Index
1.17
higher acuity than avg
Case-Mix Index Ratio
0.85
facility / state ratio

Health Inspections

CMS weights three inspection cycles to compute the Health Inspection rating: the most recent (50%), the second most recent (33%), and the oldest (17%). Each standard-survey deficiency is assigned a score based on scope and severity; complaint-survey findings and revisit scores are added to produce the cycle total.

Cycle Date Total defs. Standard Complaint Deficiency score Revisits Total score
Cycle 1 (most recent) 2025-09-30 68 39 33 1,124 2 1,686
Cycle 2/3 (prior) 2024-06-20 61 12 50 863 1 863
Total weighted health score
1480.3
lower is better

Deficiencies (143)

Individual survey findings. Scope/severity uses the CMS A–L matrix: letters further down the alphabet indicate greater harm and wider scope, up through J–L (immediate jeopardy).

3 A/B/C No actual harm — minor
124 D/E/F Actual harm — potential for minor
7 G/H/I Actual harm
9 J/K/L Immediate jeopardy
Tag Description Scope/Severity Survey date Corrected
0552 Ensure that residents are fully informed and understand their health status, care and treatments. D 2025-09-30 2025-11-12
0576 Ensure residents have reasonable access to and privacy in their use of communication methods. D 2025-09-30 2025-11-12
0577 Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. C 2025-09-30 2025-11-12
0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. E 2025-09-30 2025-11-12
0584 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 2025-09-30 2025-11-12
0585 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 2025-09-30 2025-11-12
0605 Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. D 2025-09-30 2025-11-12
0628 Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. D 2025-09-30 2025-11-12
0641 Ensure each resident receives an accurate assessment. E 2025-09-30 2025-11-12
0645 PASARR screening for Mental disorders or Intellectual Disabilities D 2025-09-30 2025-11-12
0677 Provide care and assistance to perform activities of daily living for any resident who is unable. D 2025-09-30 2025-11-12
0679 Provide activities to meet all resident's needs. E 2025-09-30 2025-11-12
0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. J 2025-09-30 2025-11-12
0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. J 2025-09-30 2025-11-12
0699 Provide care or services that was trauma informed and/or culturally competent. D 2025-09-30 2025-11-12
0700 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 2025-09-30 2025-11-12
0727 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. F 2025-09-30 2025-11-12
0730 Observe each nurse aide's job performance and give regular training. E 2025-09-30 2025-11-12
0756 Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. E 2025-09-30 2025-11-12
0761 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. E 2025-09-30 2025-11-12
0790 Provide routine and 24-hour emergency dental care for each resident. D 2025-09-30 2025-11-12
0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. F 2025-09-30 2025-11-12
0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. L 2025-09-30 2025-11-12
0841 Designate a physician to serve as medical director responsible for implementation of resident care policies and coordination of medical care in the facility. L 2025-09-30 2025-11-12
0842 Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. D 2025-09-30 2025-11-12
0851 Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. F 2025-09-30 2025-11-12
0867 Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. F 2025-09-30 2025-11-12
0880 Provide and implement an infection prevention and control program. F 2025-09-30 2025-11-12
0881 Implement a program that monitors antibiotic use. F 2025-09-30 2025-11-12
0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. E 2025-09-30 2025-11-12
0887 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. F 2025-09-30 2025-11-12
0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. F 2025-09-30 2025-11-12
0946 Provide training in compliance and ethics. F 2025-09-30 2025-11-12
0947 Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. D 2025-09-30 2025-11-12
0949 Provide behavior health training consistent with the requirements and as determined by a facility assessment. F 2025-09-30 2025-11-12
0609 Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. D 2025-09-30 2025-11-12
0610 Respond appropriately to all alleged violations. D 2025-09-30 2025-11-12
0656 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. E 2025-09-30 2025-11-12
0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. G 2025-09-30 2025-11-12
0558 Reasonably accommodate the needs and preferences of each resident. D 2025-07-30 2025-08-26
0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. D 2025-07-28 2025-08-26
0609 Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. D 2025-07-28 2025-08-26
0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. J 2025-07-28 2025-11-14
0732 Post nurse staffing information every day. C 2025-07-28 2025-08-26
0609 Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. D 2025-07-03 2025-08-25
0610 Respond appropriately to all alleged violations. D 2025-07-03 2025-08-25
0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. D 2025-07-03 2025-09-29
0692 Provide enough food/fluids to maintain a resident's health. J 2025-07-03 2025-11-14
0697 Provide safe, appropriate pain management for a resident who requires such services. D 2025-07-03 2025-08-25
0755 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. D 2025-07-03 2025-08-25

Showing 50 most recent of 143. See the All Data CSV for the full list.

Penalties (3)

Fines issued
1
last 3 years
Total fines
$178,395
Payment denials
2
Date Type Fine amount
2023-03-21 Fine $178,395
2024-10-30 Payment Denial
2023-03-21 Payment Denial

Source: CMS Nursing Home Penalties.

Financial Health (FY 2023)

Payer mix (share of resident days)

Medicare 9.0% Medicaid 56.0% Other 35.0%

Operating performance

Operating Margin
3.6%
Total Margin
3.9%
Occupancy Rate
91.2%
Cost per Resident Day
$31

Revenue & costs

Net Patient Revenue
$12.7M
Total Costs
$1.2M
Net Income
$504K

Balance sheet

Total Assets
$3.2M
Total Liabilities
-$47K
Fund Balance
$3.2M

Source: CMS SNF Cost Report (FY 2023). Cost report data lags by ~2 years.

Ownership & Corporate Structure

Chain: BEDROCK HEALTHCARE

Chain ID
73
Facilities in chain
9
Legal business name
BEDROCK HCS AT GLENDALE LLC
Chain-average star ratings (for peer context)
Overall
1.3
Health
1.3
Staffing
1.6
QM
2.9

Owner / manager organizations (2)

Organization Role Association
BEDROCK HC WI LLC 5% OR GREATER DIRECT OWNERSHIP INTEREST since 10/01/2019
OPAL HEALTHCARE NJ LLC OPERATIONAL/MANAGERIAL CONTROL since 10/01/2019

Owner / manager individuals (11)

Name Role Association
CHOPP, LYNN 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 10/01/2019
CHOPP, MARTIN 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 10/01/2019
CHOPP, PNINA 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 10/01/2019
CHOPP, RACHEL 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 10/01/2019
CHOPP, SARAH 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 10/01/2019
CHOPP, SOLOMON 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 10/01/2019
PRAGER, AVROHOM 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 10/01/2019
PRAGER, SHULAMIT 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 10/01/2019
NICHOLS, KENNETH OPERATIONAL/MANAGERIAL CONTROL since 10/01/2019
NICHOLS, KENNETH CORPORATE OFFICER since 10/01/2019
NICHOLS, KENNETH CONTRACTED MANAGING EMPLOYEE since 10/01/2019

Source: CMS Nursing Home Ownership. Percent ownership is rarely disclosed — CMS only requires it for specific roles.

Facility Features

CCRC
No
Hospital-based
No
Resident / family council
Both
Sprinkler systems
Yes
Special focus status
SFF Candidate
Abuse citation flag
Yes — last 2 cycles
Methodology & sources

Full methodology →

All Data

Every labeled field shipped for this facility by CMS. No national median or percentile context is available for SNFs in the current release.

Download CSV

Show 112 rows
Source Metric Value Raw key
Cost Report Cost per Resident Day ($) $31 metrics.cost_per_resident_day
Cost Report fiscal_year 2,023 fiscal_year
Cost Report Medicaid Day Share (%) 56.0% metrics.medicaid_day_share
Cost Report Medicare Day Share (%) 9.0% metrics.medicare_day_share
Cost Report Net Income ($) $503,889 metrics.net_income
Cost Report Net Patient Revenue ($) $12,737,691 metrics.net_patient_revenue
Cost Report Occupancy Rate (%) 91.2% metrics.occupancy_rate
Cost Report Operating Margin (%) 3.6% metrics.operating_margin
Cost Report Total Assets ($) $3,199,580 metrics.total_assets
Cost Report Total Costs ($) $1,173,368 metrics.total_costs
Cost Report Total Fund Balances ($) $3,246,119 metrics.fund_balance
Cost Report Total Liabilities ($) $-46,539 metrics.total_liabilities
Cost Report Total Margin (%) 3.9% metrics.total_margin
Provider Information Abuse Icon Y Abuse Icon
Provider Information Adjusted LPN Staffing Hours per Resident per Day 0.96381 Adjusted LPN Staffing Hours per Resident per Day
Provider Information Adjusted Nurse Aide Staffing Hours per Resident per Day 2.64528 Adjusted Nurse Aide Staffing Hours per Resident per Day
Provider Information Adjusted RN Staffing Hours per Resident per Day 0.39941 Adjusted RN Staffing Hours per Resident per Day
Provider Information Adjusted Total Nurse Staffing Hours per Resident per Day 4.00851 Adjusted Total Nurse Staffing Hours per Resident per Day
Provider Information Adjusted Weekend Total Nurse Staffing Hours per Resident per Day 3.60967 Adjusted Weekend Total Nurse Staffing Hours per Resident per Day
Provider Information Administrator turnover footnote Administrator turnover footnote
Provider Information Automatic Sprinkler Systems in All Required Areas Yes Automatic Sprinkler Systems in All Required Areas
Provider Information Average Number of Residents per Day 89.2 Average Number of Residents per Day
Provider Information Average Number of Residents per Day Footnote Average Number of Residents per Day Footnote
Provider Information Case-Mix LPN Staffing Hours per Resident per Day 0.73012 Case-Mix LPN Staffing Hours per Resident per Day
Provider Information Case-Mix Nurse Aide Staffing Hours per Resident per Day 1.98429 Case-Mix Nurse Aide Staffing Hours per Resident per Day
Provider Information Case-Mix RN Staffing Hours per Resident per Day 0.57549 Case-Mix RN Staffing Hours per Resident per Day
Provider Information Case-Mix Total Nurse Staffing Hours per Resident per Day 3.28990 Case-Mix Total Nurse Staffing Hours per Resident per Day
Provider Information Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day 2.89970 Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day
Provider Information Chain Average Health Inspection Rating 1.3 Chain Average Health Inspection Rating
Provider Information Chain Average Overall 5-star Rating 1.3 Chain Average Overall 5-star Rating
Provider Information Chain Average QM Rating 2.9 Chain Average QM Rating
Provider Information Chain Average Staffing Rating 1.6 Chain Average Staffing Rating
Provider Information Chain ID 73 Chain ID
Provider Information Chain Name BEDROCK HEALTHCARE Chain Name
Provider Information City/Town GLENDALE City/Town
Provider Information CMS Certification Number (CCN) 525371 CMS Certification Number (CCN)
Provider Information Continuing Care Retirement Community N Continuing Care Retirement Community
Provider Information County/Parish Milwaukee County/Parish
Provider Information Date First Approved to Provide Medicare and Medicaid Services 1984-10-01 Date First Approved to Provide Medicare and Medicaid Services
Provider Information Geocoding Footnote Geocoding Footnote
Provider Information Health Inspection Rating 1 Health Inspection Rating
Provider Information Health Inspection Rating Footnote Health Inspection Rating Footnote
Provider Information Latitude 43.1188 Latitude
Provider Information Legal Business Name BEDROCK HCS AT GLENDALE LLC Legal Business Name
Provider Information Location 1300 WEST SILVER SPRING DR,GLENDALE,WI,53209 Location
Provider Information Long-Stay QM Rating 2 Long-Stay QM Rating
Provider Information Long-Stay QM Rating Footnote Long-Stay QM Rating Footnote
Provider Information Longitude -87.926 Longitude
Provider Information Most Recent Health Inspection More Than 2 Years Ago N Most Recent Health Inspection More Than 2 Years Ago
Provider Information Number of administrators who have left the nursing home 1 Number of administrators who have left the nursing home
Provider Information Number of Certified Beds 112 Number of Certified Beds
Provider Information Number of Citations from Infection Control Inspections Number of Citations from Infection Control Inspections
Provider Information Number of Facilities in Chain 9 Number of Facilities in Chain
Provider Information Number of Fines 1 Number of Fines
Provider Information Number of Payment Denials 2 Number of Payment Denials
Provider Information Nursing Case-Mix Index 1.16546 Nursing Case-Mix Index
Provider Information Nursing Case-Mix Index Ratio 0.84598 Nursing Case-Mix Index Ratio
Provider Information Overall Rating 1 Overall Rating
Provider Information Overall Rating Footnote Overall Rating Footnote
Provider Information Ownership Type For profit - Limited Liability company Ownership Type
Provider Information Physical Therapist Staffing Footnote Physical Therapist Staffing Footnote
Provider Information Processing Date 2026-03-01 Processing Date
Provider Information Provider Address 1300 WEST SILVER SPRING DR Provider Address
Provider Information Provider Changed Ownership in Last 12 Months N Provider Changed Ownership in Last 12 Months
Provider Information Provider Name Bayshore Nursing & Rehab Provider Name
Provider Information Provider Resides in Hospital N Provider Resides in Hospital
Provider Information Provider SSA County Code 390 Provider SSA County Code
Provider Information Provider Type Medicare and Medicaid Provider Type
Provider Information QM Rating 2 QM Rating
Provider Information QM Rating Footnote QM Rating Footnote
Provider Information Rating Cycle 1 Health Deficiency Score 1124 Rating Cycle 1 Health Deficiency Score
Provider Information Rating Cycle 1 Health Revisit Score 562 Rating Cycle 1 Health Revisit Score
Provider Information Rating Cycle 1 Number of Complaint Health Deficiencies 33 Rating Cycle 1 Number of Complaint Health Deficiencies
Provider Information Rating Cycle 1 Number of Health Revisits 2 Rating Cycle 1 Number of Health Revisits
Provider Information Rating Cycle 1 Number of Standard Health Deficiencies 39 Rating Cycle 1 Number of Standard Health Deficiencies
Provider Information Rating Cycle 1 Standard Survey Health Date 2025-09-30 Rating Cycle 1 Standard Survey Health Date
Provider Information Rating Cycle 1 Total Health Score 1686 Rating Cycle 1 Total Health Score
Provider Information Rating Cycle 1 Total Number of Health Deficiencies 68 Rating Cycle 1 Total Number of Health Deficiencies
Provider Information Rating Cycle 2 Number of Standard Health Deficiencies 12 Rating Cycle 2 Number of Standard Health Deficiencies
Provider Information Rating Cycle 2 Standard Health Survey Date 2024-06-20 Rating Cycle 2 Standard Health Survey Date
Provider Information Rating Cycle 2/3 Health Deficiency Score 863 Rating Cycle 2/3 Health Deficiency Score
Provider Information Rating Cycle 2/3 Health Revisit Score 0 Rating Cycle 2/3 Health Revisit Score
Provider Information Rating Cycle 2/3 Number of Complaint Health Deficiencies 50 Rating Cycle 2/3 Number of Complaint Health Deficiencies
Provider Information Rating Cycle 2/3 Number of Health Revisits 1 Rating Cycle 2/3 Number of Health Revisits
Provider Information Rating Cycle 2/3 Total Health Score 863 Rating Cycle 2/3 Total Health Score
Provider Information Rating Cycle 2/3 Total Number of Health Deficiencies 61 Rating Cycle 2/3 Total Number of Health Deficiencies
Provider Information Registered Nurse hours per resident per day on the weekend 0.25465 Registered Nurse hours per resident per day on the weekend
Provider Information Registered Nurse turnover 66.7 Registered Nurse turnover
Provider Information Registered Nurse turnover footnote Registered Nurse turnover footnote
Provider Information Reported Licensed Staffing Hours per Resident per Day 1.16160 Reported Licensed Staffing Hours per Resident per Day
Provider Information Reported LPN Staffing Hours per Resident per Day 0.82126 Reported LPN Staffing Hours per Resident per Day
Provider Information Reported Nurse Aide Staffing Hours per Resident per Day 2.25405 Reported Nurse Aide Staffing Hours per Resident per Day
Provider Information Reported Physical Therapist Staffing Hours per Resident Per Day 0.00000 Reported Physical Therapist Staffing Hours per Resident Per Day
Provider Information Reported RN Staffing Hours per Resident per Day 0.34034 Reported RN Staffing Hours per Resident per Day
Provider Information Reported Staffing Footnote Reported Staffing Footnote
Provider Information Reported Total Nurse Staffing Hours per Resident per Day 3.41565 Reported Total Nurse Staffing Hours per Resident per Day
Provider Information Short-Stay QM Rating Short-Stay QM Rating
Provider Information Short-Stay QM Rating Footnote 2 Short-Stay QM Rating Footnote
Provider Information Special Focus Status SFF Candidate Special Focus Status
Provider Information Staffing Rating 2 Staffing Rating
Provider Information Staffing Rating Footnote Staffing Rating Footnote
Provider Information State WI State
Provider Information Telephone Number 4142288120 Telephone Number
Provider Information Total Amount of Fines in Dollars 178395.00 Total Amount of Fines in Dollars
Provider Information Total number of nurse staff hours per resident per day on the weekend 3.07580 Total number of nurse staff hours per resident per day on the weekend
Provider Information Total Number of Penalties 3 Total Number of Penalties
Provider Information Total nursing staff turnover 59.6 Total nursing staff turnover
Provider Information Total nursing staff turnover footnote Total nursing staff turnover footnote
Provider Information Total Weighted Health Survey Score 1480.25 Total Weighted Health Survey Score
Provider Information Urban Y Urban
Provider Information With a Resident and Family Council Both With a Resident and Family Council
Provider Information ZIP Code 53209 ZIP Code