About Cedarburg Health Services
Cedarburg Health Services, located in Cedarburg, WI, is a for-profit organization that accepts Medicare and Medicaid.
Why Families Choose Cedarburg Health Services
- Top Ranked: Ranked #8 out of 48 facilities within 25 miles.
- More Nursing Time: Staff spends 4.10 hours per resident daily (National Avg: 3.87).
Key Performance Indicators
- CMS Overall Rating 3 Stars
- Nursing Hours 4.10 hrs
- Safety Record Clean
Chain Affiliations & Network
This facility is part of the NORTH SHORE HEALTHCARE network. This chain operates 59 facilities.
Chain Performance Overview
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Nursing Staff Analysis
Staffing levels are a critical indicator of quality care. We analyze the daily hours of care provided by Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Certified Nursing Assistants (CNAs).
Mixed Staffing Levels
Cedarburg Health Services provides less care hours than the state average and more than the national average.
Registered Nurses (RN)
Licensed Practical Nurses
Certified Assistants
CMS Quality Ratings
| Category | Rating | Stars |
|---|---|---|
| Overall Rating | 3 |
|
| Health Inspection | 4 |
|
| Quality Measures | 1 |
|
| Staffing | 3 |
|
Health Inspection History
| Inspection Cycle | Score | Date |
|---|---|---|
| Cycle 1 (Most Recent) | 24 | Jan 23, 2025 |
| Weighted Average | 32 | Combined Score |
Detailed Quality Measures
Rates are from CMS quality measures (claims-based and MDS-based) for the reporting period ending May 01, 2026. Some measures may be omitted when CMS does not report a numeric rate for this facility.
Medicare claims-based measures
Typically includes short-stay outcomes, hospitalizations, and ED use from Medicare claims.
| Measure | Rate |
|---|---|
| Percentage of short-stay residents who were rehospitalized after a nursi... (QM521) | 37.7% |
| Percentage of short-stay residents who had an outpatient emergency depar... (QM522) | 18.7% |
| Number of hospitalizations per 1000 long-stay resident days (QM551) | 4.5% |
| Number of outpatient emergency department visits per 1000 long-stay resi... (QM552) | 2.9% |
MDS-based measures
Resident assessment data; often used for long-stay care quality.
| Measure | Rate |
|---|---|
| Percentage of long-stay residents whose need for help with daily activit... (QM401) | 20.5% |
| Percentage of long-stay residents who lose too much weight (QM404) | 5.3% |
| Percentage of long-stay residents with a catheter inserted and left in t... (QM406) | 3.0% |
| Percentage of long-stay residents with a urinary tract infection (QM407) | 6.9% |
| Percentage of long-stay residents who have depressive symptoms (QM408) | 0.0% |
| Percentage of long-stay residents who were physically restrained (QM409) | 10.4% |
| Percentage of long-stay residents experiencing one or more falls with ma... (QM410) | 4.3% |
| Percentage of long-stay residents assessed and appropriately given the p... (QM415) | 97.5% |
| Percentage of short-stay residents assessed and appropriately given the... (QM430) | 83.6% |
| Percentage of short-stay residents who newly received an antipsychotic m... (QM434) | 1.9% |
| Percentage of long-stay residents whose ability to walk independently wo... (QM451) | 37.5% |
| Percentage of long-stay residents who received an antianxiety or hypnoti... (QM452) | 15.4% |
| Percentage of long-stay residents assessed and appropriately given the s... (QM454) | 95.6% |
| Percentage of short-stay residents who were assessed and appropriately g... (QM472) | 62.7% |
| Percentage of long-stay residents with pressure ulcers (QM479) | 9.1% |
| Percentage of long-stay residents with new or worsened bowel or bladder... (QM480) | 32.6% |
| Percentage of long-stay residents who received an antipsychotic medicati... (QM481) | 26.1% |
Complaints & Deficiencies
Complaint History by Year
This chart shows the number of complaints filed each year.
Summary:
- 2023: 3 complaints
- 2024: 5 complaints
- Total: 8 complaints on record
Recent Complaints (Since Jan 2023)
| Date | Description |
|---|---|
| Oct 25, 2024 | Reasonably accommodate the needs and preferences of each resident. |
| Oct 25, 2024 | 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. |
| Apr 30, 2024 | Provide enough food/fluids to maintain a resident's health. |
| Apr 30, 2024 | Respond appropriately to all alleged violations. |
| Apr 30, 2024 | Develop and implement policies and procedures to prevent abuse, neglect, and theft. |
| Dec 29, 2023 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. |
| Dec 05, 2023 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. |
| Dec 05, 2023 | Respond appropriately to all alleged violations. |
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Owner & Operator Information
Business Entity
NSH CEDARBURG LLC
Ownership Structure
- DAVID MILLS Indirect
- NSHF OPERATIONS LLC Direct: 100%
Management & Direction
- JEFFREY HOEHN W-2 MANAGING EMPLOYEE
- NORTH SHORE HEALTHCARE LLC OPERATIONAL/MANAGERIAL CONTROL
Associated Doctors
Local Comparison
| Facility | Distance | Rating |
|---|---|---|
| Clement Manor Health Care Center | N/A | 5 |
| Lasata Care Center | N/A | 5 |
| Masonic Center For Health and Rehab Inc | N/A | 5 |
| Milwaukee Catholic Home | N/A | 5 |
| Milwaukee Health and Rehab | N/A | 4 |
| Complete Care at Germantown | N/A | 4 |
| Shorehaven Hlth and Rehab Ctr | N/A | 5 |
| Cedarburg Health Services | N/A | 3 |
| St Ann Health and Rehabilitation Center | N/A | 4 |
| Cedar Lake Health and Rehab Center | N/A | 4 |
Related Analysis
Best Nursing Homes in Cedarburg, WI
Compare Cedarburg Health Services to the top-rated facilities in the area.
Ownership Details
Complete list of registered owners, including direct and indirect ownership.
Noted Deficiencies
Detailed history of deficiencies with descriptions and correction dates.
Nursing Hours Analysis
Detailed breakdown of staffing hours per resident by role.
Frequently Asked Questions
- Skilled Nursing Care: 24/7 medical supervision and complex medical treatments
- Long-term Residential Care: Assistance with daily living activities for extended stays
- Short-term Rehabilitation: Recovery services after hospital stays or surgeries
- Memory Care: Specialized programs for residents with dementia and Alzheimer's disease
- Level of care needed (skilled nursing vs. long-term care)
- Room type (private vs. semi-private)
- Insurance coverage (Medicare, Medicaid, private insurance)
- Length of stay and specific services required
For current rates and to discuss payment options, contact Cedarburg Health Services directly at 2623767676. Their admissions team can help determine coverage and out-of-pocket expenses.
Environment & Cleanliness
- Overall cleanliness and odors
- Resident room conditions
- Common area maintenance
- Safety features and accessibility
Staff & Care Quality
- Staff-to-resident ratios
- How staff interact with residents
- Response time to resident needs
- Staff knowledge and professionalism
Ask to speak with current residents and their families, tour at different times of day, and review the facility's most recent inspection reports.