Villa Maria
116 S Central Ave, Mulvane, KS 67110 · Non profit - Corporation · 64 certified beds · (316) 777-1129 Medicare & Medicaid certified
This home’s record is mixed — some reassuring signs, some worth asking about.
- a strong health-inspection score (5/5) — the hardest rating to game (though it’s ranked within its own state, not nationally)
- fewer deficiencies at its most recent standard inspection than at the one before — a sign of improvement
- a high number of inspection citations overall (18) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- the CMS record shows $22,081 in federal fines (most recent 2025-01-16)
- nursing-staff turnover (66%) runs well above the national median (45%)
One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.
A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 5 of 5 |
| StaffingFrom payroll records (PBJ) | 3 of 5 |
| Quality measuresSelf-reported by the facility | 4 of 5 |
Location & what’s nearby
Open in Google Maps ↗ · Directions ↗ · Larger map ↗
Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.
Quality measures — how residents actually fare
| Overall quality measures | 4 of 5 |
| Long-stay residentspeople who live here | 3 of 5 |
| Short-stay residentsrehab / post-hospital | 5 of 5 |
Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.
Trend — is this home getting better or worse?
Over 2025-02 to 2026-06, this home’s CMS overall rating improved from 3 to 5 stars. From monthly CMS archive snapshots.
Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 28.8% | 17.9% | 15.4% | worse |
| Long-stay residents who lose too much weight | 3.7% | 4.9% | 5.4% | better |
| Long-stay residents with a catheter left in their bladder | 0.0% | 1.6% | 0.9% | better |
| Long-stay residents with a urinary tract infection | 3.9% | 2.9% | 2.0% | worse |
| Long-stay residents with depressive symptoms | 0.0% | 6.5% | 6.5% | check this* — see note marked star below the table |
| Long-stay residents who were physically restrained | 0.0% | 0.0% | 0.1% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents with falls causing major injury | 3.7% | 4.3% | 3.3% | worse |
| Long-stay residents whose ability to walk worsened | 22.2% | 16.2% | 16.1% | worse |
| Long-stay residents on antianxiety or hypnotic medication | 15.2% | 23.2% | 18.9% | better |
| Long-stay residents given the seasonal flu vaccine | 100.0% | 95.5% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 7.5% | 4.4% | 4.7% | worse |
| Long-stay residents with worsening bladder/bowel control | 24.0% | 22.6% | 21.2% | worse |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 9.5% | 18.1% | 17.1% | better |
| Short-stay residents who newly got an antipsychotic medication | 1.5% | 1.9% | 1.4% | typical |
| Short-stay residents given the seasonal flu vaccine | 100.0% | 73.8% | 79.4% | better |
| Short-stay residents rehospitalized after admission | 20.1% | 22.4% | 22.6% | better |
| Short-stay residents with an outpatient ER visit | 8.9% | 11.5% | 12.0% | better |
| Long-stay hospitalizations per 1,000 resident days | 0.87 | 1.80 | 1.67 | better |
| Long-stay outpatient ER visits per 1,000 resident days | 1.60 | 2.13 | 1.80 | better |
* This home reported 0% on a measure where lower is better. That can mean genuinely excellent care — but because the number is self-reported, a zero can also mean the problem was not recorded. Weigh it against the inspection record above.
‡ On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.
§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.
CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.
Short-stay rehab — if you are coming here from a hospital
Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.
64.6% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that better than the national rate. This is CMS’s risk-adjusted rate over 50 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Met the expected recovery: 66.7% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 39 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.
Therapy staffing: this home’s payroll records show 0.35 therapist hours per resident per day in 2026Q1 — more than 59% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 2% of this home’s weekday level — it runs therapy on weekdays, with essentially none at the weekend. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.
This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.
See every short-stay measure CMS publishes for this home
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | 64.6%CMS range 53.2–74.2 | 51.5% | Oct 2022–Sep 2024 | better than U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 8.4%CMS range 5.2–13.0 | 10.7% | Oct 2022–Sep 2024 | no different from U.S. |
| Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge | 66.7% | 56.6% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | 51.3% | 52.8% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | 61.5% | 50.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | 100.0% | 98.7% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting | 100.0% | 100.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay | 0.0% | 0.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | 4.2% | 1.9% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | 6.3%CMS range 3.7–10.5 | 7.1% | Oct 2023–Sep 2024 | no different from U.S. |
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 0.59 | 1.02 | Oct 2022–Sep 2024 | CMS makes no comparison for this measure |
From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.
Staffing
How full it usually is: this home is certified for 64 beds and averages 56.9 residents a day — about 89% occupied, or roughly 7 beds typically open. It runs fairly full. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.
Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.92 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.62 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.80 is at or above the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.
Weekend coverage: total nurse staffing is 3.59 hrs/resident/day on weekends vs 4.05 on weekdays — 11% thinner on weekends. RN hours go from 0.71 to 0.39 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 66% is well above the national median of 45%. 1 administrator has left in the past year.
Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.
Inspection trend
Deficiencies are fewer than at the previous inspection — improving. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.
Inspection deficiencies
State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.
Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.
18 citations, most serious first. The 10 most serious are shown; the remaining 8 are one tap away and print in full.
- Potential for harm · Dcited before2025-07-30 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolatedEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility reported a census of 57 residents; the sample included three residents. Based on observation, interviews, and record review, the facility failed to ensure an environment free from accidents when staff failed to assess Resident (R) 1's ability to safely manage hot liquids resulting in a hot liquid spill. This deficient practice placed R1 at risk for burns and pain.Findings included:- R1's Electronic Health Record (EHR) included diagnoses of dementia (a progressive mental disorder characterized by failing memory and confusion), and Parkinsonism (a clinical syndrome characterized by a group of symptoms including resting tremors, rolling of the fingers, masklike faces, shuffling gait, muscle rigidity, and weakness).R1's 01/06/25 Annual Minimum Data Set (MDS) documented a Brief Interview of Mental Status (BIMS) score of 11, which indicated moderately impaired cognition. The MDS documented R1 required set-up assistance for eating and oral care. The MDS documented R1 was dependent for toileting, bathing,…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-02-08 · tag F0550 — failed to protect resident dignity and rights — isolatedHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility had a census of 57 residents. The sample included 15 residents, with one reviewed for dignity. Based on observation, record review, and interview, the facility failed to provide dignity and quality of life for Resident (R)5, placing the resident at risk for embarrassment and an undignified living environment. Findings included: - R5's Electronic Medical Record (EMR) recorded diagnoses of post-polio syndrome (polio, or poliomyelitis, is an infectious viral disease that can harm the nervous system. post-polio syndrome (PPS-usually occurs 15-40 years after the infection and recovery. PPS is believed to be the result of a deterioration of nerve cells called motor neurons over many years that leads to loss of muscle strength and dysfunction), and paraplegia (paralysis characterized by motor or sensory loss in the lower limbs and trunk). R5's Significant Change Minimum Data Set (MDS), dated [DATE], recorded the resident had a Brief Interview for Mental Status (BIMS) score of 15 (cognitively intact), and…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-02-08 · tag F0582 — isolatedGive residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
What the surveyor found here — an excerpt from the official record, may be distressing
The facility had a census of 57 residents. The sample included 15 residents. Based on record review and interview, the facility failed to provide three sampled residents, Resident (R)13, R16 and R146 (or their representative) the completed Skilled Nursing Facility Advanced Beneficiary Notices (ABN) form 10055, (CMS) Centers for Medicare and Medicare Services which placed them at risk to make uninformed decisions about their skilled care. Findings included: - The Medicare ABN form 10055 informed the beneficiary that Medicare may not pay for future skilled therapy services. The form included an option for the beneficiary to receive specific services listed, and bill Medicare for an official decision on payment. The form stated 1) I understand if Medicare does not pay, I will be responsible for payment, but can make an appeal to Medicare, (2) receive therapy listed, but do not bill Medicare, I am responsible for payment for services, (3) I do not want the listed services. The facility failed to provide R29 the completed form 10055, which estimated the cost for the services to be able…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-02-08 · tag F0657 — failed to keep the care plan current — isolatedDevelop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
What the surveyor found here — an excerpt from the official record, may be distressing
The facility had a census of 57 residents. The sample included 16 residents with one resident reviewed for side rails. Based on observation, interview, and record review the facility failed to care plan the use of beds rails for Resident (R) 30. This deficient practice placed R30 at risk for impaired safety due to lack of staff direction for the use of the bed rails. Findings included: - R30's Electronic Medical Record (EMR) documented diagnoses of dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities), atrial fibrillation (an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart), and obesity (abnormal or excessive fat accumulation that presents a risk to health). The Significant Change Minimum Data Set (MDS), dated 12/12/22, documented R30 was cognitively impaired with a Brief Interview for Mental Status (BIMS) score of zero. The MDS documented R30 required extensive assistance of one staff for eating, hygiene, two staff for bed mobility, and total assistance for transfers,…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-02-08 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolatedProvide appropriate pressure ulcer care and prevent new ulcers from developing.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility had a census of 57 residents. The sample included 16 residents of which four residents were reviewed for pressure ulcers (PU-injury to skin and underlying tissue resulting from prolonged pressure on the skin). Based on observation, record review, and interview, the facility failed to implement interventions to prevent Resident (R) 33's left buttock pressure ulcer from worsening and failed to implement treatment for R34's facility acquired pressure ulcer when identified. These deficient practices placed R33 and R34 at risk for delayed healing or worsening pressure ulcers. Findings included: - The Medical Diagnosis section within R33's Electronic Medical Record (EMR) included diagnoses metabolic encephalopathy (inflammatory condition of the brain ), anemia (condition without enough healthy red blood cells to carry adequate oxygen to body tissues), major depressive disorder (abnormal emotional state characterized by exaggerated feelings of sadness, worthlessness, emptiness and hopelessness), overactive…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-02-08 · tag F0692 — failed to prevent malnutrition and dehydration — isolatedProvide enough food/fluids to maintain a resident's health.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility had a census of 57 residents and the sample included 16 residents, in which one resident was reviewed for weight loss, Resident (R) 33. Based on observation, record review, and interview, the facility failed to implement dietician's recommendations which placed the resident at risk for further weight loss, malnutrition, and delayed in wound healing. Findings included: -The Medical Diagnosis section within R33's Electronic Medical Record (EMR) included diagnoses metabolic encephalopathy (inflammatory condition of the brain ), anemia (condition without enough healthy red blood cells to carry adequate oxygen to body tissues), major depressive disorder (abnormal emotional state characterized by exaggerated feelings of sadness, worthlessness, emptiness and hopelessness), overactive bladder, vascular dementia (a progressive mental disorder characterized by failing memory and confusion caused by a decreased blood flow to the brain )with agitation, intertrochanteric(hip area of large thigh bone) fracture of…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-02-08 · tag F0700 — isolatedTry 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.
What the surveyor found here — an excerpt from the official record, may be distressing
The facility had a census of 57 residents. The sample included 16 residents with one resident reviewed for side rails. Based on observation, interview, and record review the facility failed to assess Resident (R) 30 for risk of entrapment from bed rails, obtain informed consent, and ensure the bed rail dimensions were within recommended safe dimensions. This deficient practice placed R30 at risk for entrapment in the bed rail and potentially serious injury. Findings included: - R30's Electronic Medical Record (EMR) documented diagnoses of dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities), atrial fibrillation (an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart), and obesity (abnormal or excessive fat accumulation that presents a risk to health). The Significant Change Minimum Data Set (MDS), dated 12/12/22, documented R30 was cognitively impaired with a Brief Interview for Mental Status (BIMS) score of zero. The MDS documented R30 required extensive assistance of one…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-02-08 · tag F0755 — failed to provide safe pharmacy services — isolatedProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility had a census of 57 residents. The sample included 16 residents. Based on observation, interview and record review the facility's staff failed to safely discard a fentanyl (controlled, narcotic pain medication at high risk for abuse, addiction, or overdose) patch properly for Resident (R)10, per facility policy. This deficient practice created a risk for diversion, illicit use and accidental overdose. Findings included: - R10's Electronic Medical Records (EMR) documented diagnoses of chronic pain, Parkinson's (slowly progressive neurologic disorder characterized by resting tremor, rolling of the fingers, masklike faces, shuffling gait, muscle rigidity and weakness), and anxiety (mental or emotional reaction characterized by apprehension, uncertainty and irrational fear). The Significant Change Minimum Data Set (MDS), dated [DATE], documented a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. The MDS documented R10 required extensive assistance with bed mobility,…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · F2021-04-20 · tag F0812 — failed to store, cook, and serve food safely — widespreadProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
The facility reported a census of 44 residents. Based on observation and interview, the facility failed to prepare and serve food under sanitary conditions, for the residents of the facility. Findings included: - On 04/13/2021 at 11:07 AM, an initial tour of the kitchen with Dietary Staff (DS) BB, revealed seven frying pans with a brown substance and irregular cooking surfaces, which made them unsanitizable. On 04/13/2021 at 11:07 AM, DS BB verified the above and stated the seven frying pans were not the ones provided by the facility. He explained that the facility cooks brought in these seven personal frying pans from home to cook for the residents. He agreed the pans all had irregular cooking surfaces, and brown debris inside which came into direct contact with the food cooked in them. These seven pans were unsanitizable and should not be used. The facility failed to provide a policy to address the procurement and use of appropriate cookware to ensure sanitation and safe cooking practices. The facility failed to prepare and serve food under sanitary conditions for the residents of…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · F2021-04-20 · tag F0814 — failed to dispose of garbage properly — widespreadDispose of garbage and refuse properly.
What the surveyor found here — an excerpt from the official record, may be distressing
The facility reported a census of 44 residents. Based on observation, interview, and record review, the facility failed to maintain and/or dispose of kitchen garbage and refuse properly. Findings included: - On 04/19/21 at 11:40 AM, during a Kitchen tour with Dietary Staff (DS) BB, revealed the lack of a trash can adjacent to the hand washing sink in the food preparation area. An open barrel located approximately 10 feet away from the handwashing sink sat next to the bread rack. The open barrel had paper towels overflowing from the top of the barrel. On 04/19/21 at 11:40 AM, DS BB verified the above findings. He reported the kitchen staff used the barrel to dispose of the paper towels used to dry their hands after washing them. He stated they previously had a foot operated trash can adjacent to the handwashing sink, in the food preparation area, but the staff used the barrel instead. DS BB agreed the trash receptacle did not adequately contain the trash and that it should not be located next to the bread rack. Additionally, he stated the handwashing sink should have a foot operated…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
Show the remaining 8 citations
- Potential for harm · F2021-04-20 · tag F0880 — failed to prevent and control infections — widespreadProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
The facility reported a census of 44 residents. Based on observation, interview, and record review, the facility failed to follow the Center for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) recommended practices to prevent transmission of the pandemic COVID-19 virus. The facility failed to ensure staff were answering screening questions appropriately at the beginning of the shift, failed to quarantine residents when a staff member tested positive for COVID-19 that previously worked two shifts with respiratory symptoms, allowed the facility staff to continue to wear cloth or surgical masks while the facility was in outbreak status (the occurrence of one or more resident and/or staff that test positive for COVID-19), and failed to have a policy in place to provide instruction on the steps the facility should take when an outbreak occurred. The above practices increased the risk of transmission of COVID-19 to the residents of the facility. Findings included: - On 04/13/21 at 09:30 AM, the Administrative Staff B reported they were in outbreak…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-04-20 · tag F0661 — isolatedEnsure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility reported census of 44 residents, with 12 residents selected for review, which included one reviewed for discharge summary. Based on record review and interview the facility failed to complete a discharge summary which included a recapitulation of stay, reconciliation, and disposition of medications for the one sampled resident (R)44, as required. Findings included: - Review of Resident's (R)44's undated Physician Orders, documentation revealed diagnoses which included discitis (infection of the discs between the vertebra of the spine), poliomyelitis of the vertebra (inflammation of bone or bone marrow usually due to infection, spinal (back) cord compression, and intervertebral (inside vertebra disc) displacement (misaligned) at the thoracic (mid-back) region. The Admission, Minimum Data Set (MDS) dated [DATE], documented the resident entered the facility on 12/22/2020. The documentation included the Brief Interview for Mental Status (BIMS) score of 15, which indicated cognitively intact. The…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2021-04-20 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolatedEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility reported a census of 44 residents with 12 selected for review including three residents reviewed for accidents. Based on observation, interview, and record review, the facility failed to ensure equipment was in proper working condition, failed to implement a new intervention following falls, failed to implement appropriate interventions following two falls for one of the three residents, Resident (R)16. Findings included: - The Order Summary Report, dated 04/06/21, for R16, included diagnoses of osteoarthritis to her right knee, pain in her right hip, cognitive communication deficit, need for assistance with personal care, other abnormalities of gait and mobility, unsteadiness on feet, difficulty in walking, muscle weakness, low back pain, dementia (progressive mental disorder characterized by failing memory, confusion), history of falling, and repeated falls. The Significant Change in Status Minimum Data Set (MDS), dated [DATE], assessed R16 with a Brief Interview of Mental Status Score (BIMS) of…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-04-20 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolatedProvide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility reported a census of 44 residents with 12 residents selected for review including two residents reviewed for urinary catheter (insertion of a catheter into the bladder to drain the urine into a collection bag). Based on observation, interview, and record review, the facility failed to keep the catheter tubing from touching directly on the floor for one of the two residents reviewed, Resident (R)38, creating a risk for developing urinary tract infections. Findings included: - The Order Summary Report, dated 04/02/21, for Resident (R)38, included diagnoses of retention of urine, obstructive and reflux uropathy (urine flows backwards into the kidneys due to an obstruction), other specified disorders of bladder, and neuromuscular dysfunction of the bladder. The Annual Minimum Data Set (MDS), dated [DATE], assessed R38 with a Brief Interview of Mental Status (BIMS) score of 8, indicating moderate cognitive impairment. R38 required extensive assist of one staff for toilet use and had an indwelling urinary…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-04-20 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolatedProvide safe and appropriate respiratory care for a resident when needed.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility reported a census of 44 residents with 12 selected for review including three residents reviewed for respiratory services. Based on observation, record review, and interview, the facility failed to provide appropriate cleaning and storage of two of the three sampled residents respiratory equipment including, Resident (R)34's nebulizer (device which changes liquid medication into a mist easily inhaled into the lungs) administration kit. R13 with the facility failure to clean the oxygen concentrator filter, failed to label the oxygen tubing when changed, and failed to label the distilled water container when opened and store appropriately. These practices increased the risk for R34 and R13 of developing a respiratory infection. Findings included: - The Order Summary Report, dated 03/03/21, for Resident (R)34, included diagnoses of cough and other specified symptoms and signs involving the circulatory and respiratory systems. The Annual Minimum Data Set (MDS), dated [DATE], assessed R34 with a Brief…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-04-20 · tag F0756 — failed to review each resident's drug regimen — isolatedEnsure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility reported a census of 44 residents with 12 selected for review including five reviewed for unnecessary medications. Based on record review and interview, the facility failed to act upon recommendations timely from the consultant pharmacist for three of the five sampled residents, Resident (R)11, R16, and R27. Findings included: - The Order Summary Report, dated 04/10/21, for Resident (R)11 included the diagnoses of chronic obstructive pulmonary disease (progressive and irreversible condition characterized by diminished lung capacity and difficulty or discomfort in breathing), chronic atrial fibrillation (rapid, irregular heart beat), and congestive heart failure (a condition with low heart output and the becomes congested with fluid). The medication Order Summary Report, dated 04/10/21, also revealed R11 had a physician order dated 11/08/20, for diltiazem (a medication that lowers the heart rate) 90 milligrams (mg), give two tablets by mouth at bedtime for atrial fibrillation. Review of the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-04-20 · tag F0757 — failed to avoid unnecessary drugs — isolatedEnsure each resident’s drug regimen must be free from unnecessary drugs.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY - Resident (R) 11's Medication Review Report, dated 04/10/21, included a diagnosis of diabetes mellitus (when the body cannot use glucose, not enough insulin is made or the body cannot respond to the insulin). The Quarterly Minimum Data Set (MDS), dated [DATE], assessed R11 with a Brief Interview of Mental Status (BIMS) score of 14, indicating intact cognition. He received insulin injections six of the seven days of the assessment period. A standing physician order, dated 05/17/19, instructed the facility staff to contact the physician if the blood sugar was greater than 300. The Medication Review Report, dated 04/10/21, included an order with a start date of 03/23/21 for Novolog (insulin) flexpen solution, 100 unit/milliliter (ml) per sliding scale, inject 30 units subcutaneous with meals for diabetes mellitus. A physician order, dated 09/03/20, instructed staff of a standing order to obtain the resident's blood glucose levels fasting and two hours postprandial (after a meal). Review of the Treatment…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-04-20 · tag F0758 — failed to limit and justify psychotropic drugs — isolatedImplement 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.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility reported a census of 44 residents with 12 selected for review including five reviewed for unnecessary medications. Based on record review and interview, the facility failed to ensure two of the residents, Resident (R)27 and R16 were free of unnecessary psychotropic medications when the facility failed to address their orders for psychotropic (class of medications capable of affecting the mind, emotions, and behavior) medications. Findings included: - The Order Summary Report dated 04/06/21, for Resident (R)27, included diagnoses of psychotic disorder (any major mental disorder characterized by a gross impairment in reality testing ) with delusions (untrue persistent belief or perception held by a person although evidence shows it was untrue), metabolic encephalopathy (a chemical imbalance in the blood that affects the brain that can lead to personality changes), and major depressive disorder (major mood disorder). The Annual Minimum Data Set (MDS), dated [DATE], assessed R27 as being rarely/never…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.
- Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
- Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
- State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Fines & penalties
$22,081 in federal fines across 1 penalty.
- $22,081 — penalty dated 2025-01-16
Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.
Who owns this facility
| Owner / manager | Type | Role | Since |
|---|---|---|---|
| BURRUS, MICHAEL | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| CAMPBELL, BRIAN | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| ETHEREDGE, WESLEY | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| HAMPEL, MELICIA | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| HOFFMAN, MARK | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| LAFLEUR, CYNTHIA | Individual | CORPORATE DIRECTOR; CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| LAZAR, JERALD | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| MACIAS, JEAN | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| MEIER, CONNOR | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| POOL, SUSAN | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| SCHUMER, MARY | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| STRECKER, KEVIN | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| TRAN, DAN | Individual | CORPORATE DIRECTOR | since 05/15/2025 |
| CARTER, ANDREA | Individual | CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| DAVIS, BRENDA | Individual | CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| DEHASS, BRENDA | Individual | CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| FUNK, JONATHAN | Individual | CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| GIRRENS, JONI | Individual | CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| GUTHRIE, GEORGE | Individual | CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| HIEBERT, DEVON | Individual | CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| HINSHAW, MICAH | Individual | CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| MEIER-MCFERREN, SHAWN | Individual | CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| OBLINGER, WARREN | Individual | CORPORATE OFFICER | since 05/15/2025 |
| SANDERS, JENNIFER | Individual | CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| VEGA, DANIELLE | Individual | CORPORATE OFFICER; ADP OF THE SNF | since 05/15/2025 |
| YORK, PATRICK | Individual | CORPORATE OFFICER | since 05/15/2025 |
| CATHOLIC CARE CENTER INC | Organization | OPERATIONAL/MANAGERIAL CONTROL | since 07/01/2025 |
| IPC HEALTHCARE INC | Organization | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 01/28/2026 |
| BRETTON, ANGELICA | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 05/15/2025 |
| MCCUE, TAMARA | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 05/01/2020 |
| ARIA DENTAL CARE PC | Organization | ADP OF THE SNF | since 01/01/2010 |
| ARTHUR J GALLAGHER RISK MANAGEMENT SERVICES INC | Organization | ADP OF THE SNF | since 07/01/2025 |
| AUBURN PHARMACY INC | Organization | ADP OF THE SNF | since 07/01/2025 |
| BANK OF NY MELLON | Organization | ADP OF THE SNF | since 07/01/2025 |
| DETTWILLER RCM CONSULTING, LLC | Organization | ADP OF THE SNF | since 07/01/2025 |
| FORVIS MAZARS LLP | Organization | ADP OF THE SNF | since 01/01/2010 |
| HEALTH TECHNOLOGIES, INC | Organization | ADP OF THE SNF | since 07/01/2025 |
| JADYN RYA SAUNDERS | Organization | ADP OF THE SNF | since 10/01/2024 |
| KANSAS STATE BANK | Organization | ADP OF THE SNF | since 07/12/2017 |
| NATIONWIDE MUTUAL INSURANCE COMPANY | Organization | ADP OF THE SNF | since 07/01/2025 |
| QUALITY REHAB MANAGEMENT | Organization | ADP OF THE SNF | since 07/01/2025 |
| TERESA A. UNRUH | Organization | ADP OF THE SNF | since 01/01/1990 |
| CAUDLE, KENDALL | Individual | ADP OF THE SNF | since 05/15/2025 |
| WOODROW, FELICIA | Individual | ADP OF THE SNF | since 05/15/2025 |
CMS files one row per role, so the 60 rows in the source record cover these 44 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.
14 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.
Follow the money — this home’s finances
Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.
Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2024. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.
Cost & finances
Straight from this home’s Medicare cost report (CMS, FY2024). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.
What families pay in KS
This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Kansas Medicaid page.
Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.
Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 175456. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2024-12-17, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →
Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →
Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.