CCRC

Overview

Address
425 N UNIVERSITY DR, WAUKESHA, WI 53188
Phone
2625246400
Certified beds
61
Avg daily residents
56 (92% of beds filled)
Ownership
Non-profit corporation
Provider type
Medicare
Medicare/Medicaid since
1989-02-24
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.
4/5
Quality Measures
15 resident-level quality measures split between long-stay and short-stay (post-acute) residents.
1/5
Quality Measures breakdown
Long-Stay Quality Measures 1/5
Short-Stay Quality Measures 1/5

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
4.14 3.46 4.62 ≥ 3.48
Registered Nurse (RN)
Licensed RN hours. Strongest driver of clinical outcomes.
0.89 0.61 1.00 ≥ 0.55
Licensed Practical Nurse (LPN)
LPN/LVN hours. Often handles medication administration.
0.47 0.77 0.53
Nurse aide
CNA hours. Bulk of direct resident care — bathing, feeding, mobility.
2.77 2.09 3.09
Licensed (RN + LPN)
Combined licensed nurse coverage.
1.37
Physical therapist
Rehabilitation therapist hours — important for post-acute / rehab admissions.
0.08

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)
3.91
hrs / resident / day
RN (weekend)
0.71
hrs / resident / day
Total nurse (adjusted, weekend)
4.36
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
76.1%
annual
RN turnover
83.3%
annual
Administrators departed
0
last 12 months

Resident acuity

Nursing Case-Mix Index
1.23
higher acuity than avg
Case-Mix Index Ratio
0.89
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) 2025-09-25 17 13 5 155 1 155
Cycle 2/3 (prior) 2024-06-11 25 20 7 183 1 183
Total weighted health score
162.0
lower is better

Deficiencies (47)

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).

1 A/B/C No actual harm — minor
44 D/E/F Actual harm — potential for minor
2 J/K/L Immediate jeopardy
Tag Description Scope/Severity Survey date Corrected
0628 Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. D 2026-01-21 2026-02-10
0552 Ensure that residents are fully informed and understand their health status, care and treatments. D 2025-09-25 2025-10-23
0628 Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. E 2025-09-25 2025-10-23
0656 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. D 2025-09-25 2025-10-23
0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. D 2025-09-25 2025-10-23
0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. D 2025-09-25 2025-10-23
0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. J 2025-09-25 2025-10-23
0756 Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. D 2025-09-25 2025-10-23
0759 Ensure medication error rates are not 5 percent or greater. D 2025-09-25 2025-10-23
0849 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 2025-09-25 2025-10-23
0941 Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members. E 2025-09-25 2025-10-23
0944 Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. E 2025-09-25 2025-10-23
0946 Provide training in compliance and ethics. E 2025-09-25 2025-10-23
0609 Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. D 2025-09-25 2025-10-23
0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. D 2025-05-29 2025-06-18
0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. D 2025-05-29 2025-06-18
0755 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. D 2025-05-29 2025-06-18
0552 Ensure that residents are fully informed and understand their health status, care and treatments. D 2024-06-11 2024-07-10
0576 Ensure residents have reasonable access to and privacy in their use of communication methods. E 2024-06-11 2024-07-10
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 2024-06-11 2024-07-10
0655 Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted D 2024-06-11 2024-07-10
0656 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. D 2024-06-11 2024-07-10
0677 Provide care and assistance to perform activities of daily living for any resident who is unable. D 2024-06-11 2024-07-10
0679 Provide activities to meet all resident's needs. D 2024-06-11 2024-07-10
0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. J 2024-06-11 2024-07-10
0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. D 2024-06-11 2024-07-10
0690 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 2024-06-11 2024-07-10
0695 Provide safe and appropriate respiratory care for a resident when needed. D 2024-06-11 2024-07-10
0732 Post nurse staffing information every day. C 2024-06-11 2024-07-10
0755 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. D 2024-06-11 2024-07-10
0758 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 2024-06-11 2024-07-10
0759 Ensure medication error rates are not 5 percent or greater. D 2024-06-11 2024-07-10
0760 Ensure that residents are free from significant medication errors. D 2024-06-11 2024-07-10
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. D 2024-06-11 2024-07-10
0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. F 2024-06-11 2024-07-10
0554 Allow residents to self-administer drugs if determined clinically appropriate. D 2024-06-11 2024-07-10
0580 Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. D 2024-06-11 2024-07-10
0578 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 2024-03-27 2024-04-27
0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. D 2024-03-27 2024-04-27
0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. D 2024-03-27 2024-04-27
0690 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 2024-03-27 2024-04-27
0880 Provide and implement an infection prevention and control program. D 2024-03-27 2024-04-27
0580 Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. D 2023-02-13 2023-03-13
0656 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. D 2023-02-13 2023-03-20
0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. D 2023-02-13 2023-03-17
0758 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 2023-02-13 2023-03-09
0880 Provide and implement an infection prevention and control program. E 2023-02-13 2023-03-14

Penalties (1)

Fines issued
1
last 3 years
Total fines
$39,621
Date Type Fine amount
2024-06-11 Fine $39,621

Source: CMS Nursing Home Penalties.

Financial Health (FY 2024)

Payer mix (share of resident days)

Medicare 14.8% Medicaid 17.8% Other 67.5%

Operating performance

Operating Margin
-19.2%
Total Margin
-12.7%
Occupancy Rate
75.5%
Cost per Resident Day
$67

Revenue & costs

Net Patient Revenue
$6.8M
Total Costs
$949K
Net Income
-$918K

Balance sheet

Total Assets
-$6.1M
Total Liabilities
$551K
Fund Balance
-$6.7M

Source: CMS SNF Cost Report (FY 2024). Cost report data lags by ~2 years.

Ownership & Corporate Structure

Owner / manager organizations (3)

Organization Role Association
THE HILLS AT CORTLAND RIDGE, INC. 5% OR GREATER DIRECT OWNERSHIP INTEREST since 02/14/2023
MARQUARDT VILLAGE INC 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 03/07/2023
ILLUMINUS INC OPERATIONAL/MANAGERIAL CONTROL since 03/20/2023

Owner / manager individuals (14)

Name Role Association
LEMBKE, ADAM OPERATIONAL/MANAGERIAL CONTROL since 03/20/2023
MARKS, JULIE OPERATIONAL/MANAGERIAL CONTROL since 06/05/2025
MAUTHE, MATTHEW OPERATIONAL/MANAGERIAL CONTROL since 03/20/2023
SIDHU, SARFRAZ OPERATIONAL/MANAGERIAL CONTROL since 11/16/2020
DETTMAN, SCOTT CORPORATE DIRECTOR since 09/01/2020
FISCHER, TODD CORPORATE DIRECTOR since 03/07/2023
HEROUX, STEVEN CORPORATE DIRECTOR since 08/01/2024
KOHLHOFF, KEVIN CORPORATE DIRECTOR since 09/01/2023
KONKOL, DENNIS CORPORATE DIRECTOR since 10/01/2024
MEIDENBAUER, ROBERT CORPORATE DIRECTOR since 03/07/2023
VAN DER LINDEN, KATIE CORPORATE DIRECTOR since 03/07/2023
WAGNER, LYNNE CORPORATE DIRECTOR since 10/01/2024
MARKS, JULIE CORPORATE OFFICER since 06/05/2025
MAUTHE, MATTHEW CORPORATE OFFICER since 03/20/2023

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

Facility Features

CCRC
Yes
Hospital-based
No
Resident / family council
Resident
Sprinkler systems
Yes
Abuse citation flag
No
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.

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Show 112 rows
Source Metric Value Raw key
Cost Report Cost per Resident Day ($) $67 metrics.cost_per_resident_day
Cost Report fiscal_year 2,024 fiscal_year
Cost Report Medicaid Day Share (%) 17.8% metrics.medicaid_day_share
Cost Report Medicare Day Share (%) 14.8% metrics.medicare_day_share
Cost Report Net Income ($) $-918,490 metrics.net_income
Cost Report Net Patient Revenue ($) $6,832,691 metrics.net_patient_revenue
Cost Report Occupancy Rate (%) 75.5% metrics.occupancy_rate
Cost Report Operating Margin (%) -19.2% metrics.operating_margin
Cost Report Total Assets ($) $-6,123,327 metrics.total_assets
Cost Report Total Costs ($) $949,468 metrics.total_costs
Cost Report Total Fund Balances ($) $-6,674,517 metrics.fund_balance
Cost Report Total Liabilities ($) $551,190 metrics.total_liabilities
Cost Report Total Margin (%) -12.7% metrics.total_margin
Provider Information Abuse Icon N Abuse Icon
Provider Information Adjusted LPN Staffing Hours per Resident per Day 0.52872 Adjusted LPN Staffing Hours per Resident per Day
Provider Information Adjusted Nurse Aide Staffing Hours per Resident per Day 3.09381 Adjusted Nurse Aide Staffing Hours per Resident per Day
Provider Information Adjusted RN Staffing Hours per Resident per Day 0.99746 Adjusted RN Staffing Hours per Resident per Day
Provider Information Adjusted Total Nurse Staffing Hours per Resident per Day 4.61999 Adjusted Total Nurse Staffing Hours per Resident per Day
Provider Information Adjusted Weekend Total Nurse Staffing Hours per Resident per Day 4.36415 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 56.4 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 0.76774 Case-Mix LPN Staffing Hours per Resident per Day
Provider Information Case-Mix Nurse Aide Staffing Hours per Resident per Day 2.08653 Case-Mix Nurse Aide Staffing Hours per Resident per Day
Provider Information Case-Mix RN Staffing Hours per Resident per Day 0.60514 Case-Mix RN Staffing Hours per Resident per Day
Provider Information Case-Mix Total Nurse Staffing Hours per Resident per Day 3.45941 Case-Mix Total Nurse Staffing Hours per Resident per Day
Provider Information Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day 3.04911 Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day
Provider Information Chain Average Health Inspection Rating Chain Average Health Inspection Rating
Provider Information Chain Average Overall 5-star Rating Chain Average Overall 5-star Rating
Provider Information Chain Average QM Rating Chain Average QM Rating
Provider Information Chain Average Staffing Rating Chain Average Staffing Rating
Provider Information Chain ID Chain ID
Provider Information Chain Name Chain Name
Provider Information City/Town WAUKESHA City/Town
Provider Information CMS Certification Number (CCN) 525422 CMS Certification Number (CCN)
Provider Information Continuing Care Retirement Community Y Continuing Care Retirement Community
Provider Information County/Parish Waukesha County/Parish
Provider Information Date First Approved to Provide Medicare and Medicaid Services 1989-02-24 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 43.0181 Latitude
Provider Information Legal Business Name LINDENGROVE COMMUNITIES LLC Legal Business Name
Provider Information Location 425 N UNIVERSITY DR,WAUKESHA,WI,53188 Location
Provider Information Long-Stay QM Rating 1 Long-Stay QM Rating
Provider Information Long-Stay QM Rating Footnote Long-Stay QM Rating Footnote
Provider Information Longitude -88.269 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 0 Number of administrators who have left the nursing home
Provider Information Number of Certified Beds 61 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 Number of Facilities in Chain
Provider Information Number of Fines 1 Number of Fines
Provider Information Number of Payment Denials 0 Number of Payment Denials
Provider Information Nursing Case-Mix Index 1.22551 Nursing Case-Mix Index
Provider Information Nursing Case-Mix Index Ratio 0.88957 Nursing Case-Mix Index Ratio
Provider Information Overall Rating 1 Overall Rating
Provider Information Overall Rating Footnote Overall Rating Footnote
Provider Information Ownership Type Non profit - Corporation 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 425 N UNIVERSITY DR Provider Address
Provider Information Provider Changed Ownership in Last 12 Months N Provider Changed Ownership in Last 12 Months
Provider Information Provider Name LINDENGROVE WAUKESHA Provider Name
Provider Information Provider Resides in Hospital N Provider Resides in Hospital
Provider Information Provider SSA County Code 660 Provider SSA County Code
Provider Information Provider Type Medicare Provider Type
Provider Information QM Rating 1 QM Rating
Provider Information QM Rating Footnote QM Rating Footnote
Provider Information Rating Cycle 1 Health Deficiency Score 155 Rating Cycle 1 Health Deficiency Score
Provider Information Rating Cycle 1 Health Revisit Score 0 Rating Cycle 1 Health Revisit Score
Provider Information Rating Cycle 1 Number of Complaint Health Deficiencies 5 Rating Cycle 1 Number of Complaint Health Deficiencies
Provider Information Rating Cycle 1 Number of Health Revisits 1 Rating Cycle 1 Number of Health Revisits
Provider Information Rating Cycle 1 Number of Standard Health Deficiencies 13 Rating Cycle 1 Number of Standard Health Deficiencies
Provider Information Rating Cycle 1 Standard Survey Health Date 2025-09-25 Rating Cycle 1 Standard Survey Health Date
Provider Information Rating Cycle 1 Total Health Score 155 Rating Cycle 1 Total Health Score
Provider Information Rating Cycle 1 Total Number of Health Deficiencies 17 Rating Cycle 1 Total Number of Health Deficiencies
Provider Information Rating Cycle 2 Number of Standard Health Deficiencies 20 Rating Cycle 2 Number of Standard Health Deficiencies
Provider Information Rating Cycle 2 Standard Health Survey Date 2024-06-11 Rating Cycle 2 Standard Health Survey Date
Provider Information Rating Cycle 2/3 Health Deficiency Score 183 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 7 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 183 Rating Cycle 2/3 Total Health Score
Provider Information Rating Cycle 2/3 Total Number of Health Deficiencies 25 Rating Cycle 2/3 Total Number of Health Deficiencies
Provider Information Registered Nurse hours per resident per day on the weekend 0.70570 Registered Nurse hours per resident per day on the weekend
Provider Information Registered Nurse turnover 83.3 Registered Nurse turnover
Provider Information Registered Nurse turnover footnote Registered Nurse turnover footnote
Provider Information Reported Licensed Staffing Hours per Resident per Day 1.36747 Reported Licensed Staffing Hours per Resident per Day
Provider Information Reported LPN Staffing Hours per Resident per Day 0.47374 Reported LPN Staffing Hours per Resident per Day
Provider Information Reported Nurse Aide Staffing Hours per Resident per Day 2.77207 Reported Nurse Aide Staffing Hours per Resident per Day
Provider Information Reported Physical Therapist Staffing Hours per Resident Per Day 0.07944 Reported Physical Therapist Staffing Hours per Resident Per Day
Provider Information Reported RN Staffing Hours per Resident per Day 0.89373 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 4.13954 Reported Total Nurse Staffing Hours per Resident per Day
Provider Information Short-Stay QM Rating 1 Short-Stay QM Rating
Provider Information Short-Stay QM Rating Footnote Short-Stay QM Rating Footnote
Provider Information Special Focus Status Special Focus Status
Provider Information Staffing Rating 4 Staffing Rating
Provider Information Staffing Rating Footnote Staffing Rating Footnote
Provider Information State WI State
Provider Information Telephone Number 2625246400 Telephone Number
Provider Information Total Amount of Fines in Dollars 39621.00 Total Amount of Fines in Dollars
Provider Information Total number of nurse staff hours per resident per day on the weekend 3.91030 Total number of nurse staff hours per resident per day on the weekend
Provider Information Total Number of Penalties 1 Total Number of Penalties
Provider Information Total nursing staff turnover 76.1 Total nursing staff turnover
Provider Information Total nursing staff turnover footnote Total nursing staff turnover footnote
Provider Information Total Weighted Health Survey Score 162.000 Total Weighted Health Survey Score
Provider Information Urban Y Urban
Provider Information With a Resident and Family Council Resident With a Resident and Family Council
Provider Information ZIP Code 53188 ZIP Code