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Data from CMS, Census Bureau & CareScout. Not affiliated with the U.S. government.

© 2026 NursingHomes.us. All data from CMS.gov.
HomeWisconsinCapitol Lakes Health Center

Capitol Lakes Health Center

333 W Main St, Madison, WI 537036082832000
3/5Average
Accepts Medicare Accepts Medicaid Sprinkler System
Health
2/5
Staffing
5/5
Quality
4/5
Beds
72
certified

Key Findings

• CMS rates this facility 3/5 stars (average)

• Has 72 certified beds with an average of 27.7 residents per day (38% occupancy)

• Last health inspection found 8 deficiencies (inspected Nov 6, 2024)

• No fines on record

• Total nursing staff: 7.79 hours per resident per day

• Staff turnover rate: 47.6%

• Part of the Pacific Retirement Services chain (10 facilities)

Capitol Lakes Health Center is a 3-star Medicare and Medicaid certified nursing home in Madison, Wisconsin with 72 certified beds. It has been operating since 1979. The facility scored at average compared to Wisconsin facilities.

Beds
72
Avg Residents/Day
27.7
Ownership
Non profit - Corporation
Provider Type
Medicare and Medicaid
In Hospital
No
First Approved
Sep 4, 1979
Sprinklers
Yes
Council
Resident
County
Dane
Last Inspection
Nov 6, 2024
Deficiencies (Cycle 1)
8
Weighted Score
67.0
Infection Citations
0

Deficiency Citations (22)

F0684Potential for Harm

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Survey: Nov 6, 2024Corrected: NoCycle: 1
F0687Potential for Harm

Provide appropriate foot care.

Survey: Nov 6, 2024Corrected: NoCycle: 1
F0688Potential for Harm

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.

Survey: Nov 6, 2024Corrected: NoCycle: 1
F0698Potential for Harm

Provide safe, appropriate dialysis care/services for a resident who requires such services.

Survey: Nov 6, 2024Corrected: NoCycle: 1
F0804Potential for Harm

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Survey: Nov 6, 2024Corrected: NoCycle: 1
F0812Potential for Harm

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Survey: Nov 6, 2024Corrected: NoCycle: 1
F0880Potential for Harm

Provide and implement an infection prevention and control program.

Survey: Nov 6, 2024Corrected: NoCycle: 1
F0686Potential for Harm

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Survey: Nov 6, 2024Corrected: NoCycle: 1
F0578Potential for Harm

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.

Survey: Oct 5, 2023Corrected: NoCycle: 2
F0758Potential for Harm

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.

Survey: Oct 5, 2023Corrected: NoCycle: 2
F0759Potential for Harm

Ensure medication error rates are not 5 percent or greater.

Survey: Oct 5, 2023Corrected: NoCycle: 2
F0809Potential for Harm

Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.

Survey: Oct 5, 2023Corrected: NoCycle: 2
F0580Actual Harm

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Survey: Jun 21, 2023Corrected: NoCycle: 3
F0697Potential for Harm

Provide safe, appropriate pain management for a resident who requires such services.

Survey: Jun 21, 2023Corrected: NoCycle: 3
F0554Potential for Harm

Allow residents to self-administer drugs if determined clinically appropriate.

Survey: Aug 11, 2022Corrected: NoCycle: 3
F0561Potential for Harm

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

Survey: Aug 11, 2022Corrected: NoCycle: 3
F0583Potential for Harm

Keep residents' personal and medical records private and confidential.

Survey: Aug 11, 2022Corrected: NoCycle: 3
F0678Potential for Harm

Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.

Survey: Aug 11, 2022Corrected: NoCycle: 3
F0689Potential for Harm

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Survey: Aug 11, 2022Corrected: NoCycle: 3
F0755Potential for Harm

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Survey: Aug 11, 2022Corrected: NoCycle: 3
F0842Minimal Harm

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Survey: Aug 11, 2022Corrected: NoCycle: 3
F0880Potential for Harm

Provide and implement an infection prevention and control program.

Survey: Aug 11, 2022Corrected: NoCycle: 3
Total Fines
$0
Number of Fines
0
Payment Denials
0
Total Penalties
0

No penalties on record.

Staffing hours per resident per day. The black line shows the national average.

Nurse Aide4.98 hrs
National avg: 2.35 hrs
LPN0.78 hrs
National avg: 0.86 hrs
RN2.02 hrs
National avg: 0.68 hrs
Total Nursing7.79 hrs
National avg: 3.89 hrs
Weekend Total6.18 hrs
National avg: 0.00 hrs
Physical Therapist0.06 hrs
National avg: 0.07 hrs
Total Turnover
47.6%
RN Turnover
20.0%
Administrators Left
0

Quality measures as percentages of residents. Lower is better for all measures.

Ownership Type
Non profit - Corporation
Recent Change
No

Owners & Managers (11)

NameRoleTypeOwnership %Since
PACIFIC RETIREMENT SERVICES INCOPERATIONAL/MANAGERIAL CONTROLOrganizationN/AApr 1, 2008
DREW, SALLYCORPORATE DIRECTORIndividualN/AOct 10, 2016
BISHOP, RICHARDCORPORATE OFFICERIndividualN/AOct 1, 2021
CENTER, SUECORPORATE OFFICERIndividualN/AJun 21, 2017
JOHANNSEN, STEPHENCORPORATE OFFICERIndividualN/AJan 16, 2019
NORRBOM, CLAYCORPORATE OFFICERIndividualN/ANov 17, 2017
PETERSON, HARRYCORPORATE OFFICERIndividualN/AJun 21, 2017
SHOLTY, ERICCORPORATE OFFICERIndividualN/AMay 27, 2018
CONROY, TIMOTHYW-2 MANAGING EMPLOYEEIndividualN/AMar 23, 2009
KBC BANK NV5% OR GREATER SECURITY INTERESTOrganizationN/AJan 1, 2022
LAPIS MUNICIPAL OPPORTUNITIES FUND III LP5% OR GREATER SECURITY INTERESTOrganizationN/AJan 1, 2022

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Frequently Asked Questions

What is the CMS rating for Capitol Lakes Health Center?▾
Capitol Lakes Health Center has an overall CMS rating of 3 out of 5 stars, with a health inspection rating of 2/5, staffing rating of 5/5, and quality measures rating of 4/5. This facility is rated average.
Has Capitol Lakes Health Center had any health inspection violations?▾
Capitol Lakes Health Center had 8 deficiency citations in its most recent health inspection (Nov 6, 2024). The facility has no fines on record.
What are the staffing levels at Capitol Lakes Health Center?▾
Capitol Lakes Health Center provides 7.79 total nursing staff hours per resident per day, including 2.02 RN hours, 0.78 LPN hours, and 4.98 nurse aide hours. The total staff turnover rate is 47.6%.
How many beds does Capitol Lakes Health Center have?▾
Capitol Lakes Health Center has 72 certified beds with an average of 27.7 residents per day, resulting in approximately 38% occupancy. The facility is Non profit - Corporation owned and is part of the Pacific Retirement Services chain.
Are there other nursing homes near Capitol Lakes Health Center?▾
Yes, there are 6 other nursing homes in Madison, Wisconsin with an average rating of 1.8/5. You can compare all facilities on the Madison nursing homes page.

Part of Pacific Retirement Services

This chain operates 10 facilities. View all →