10 health deficiencies
Top issue: Nutrition and Dietary (2 deficiencies)
12 fire-safety deficiencies
Top issue: Smoke (4 deficiencies)
Edwardsville, KS
4-star overall rating with 3-star inspections with $9,113 in total fines with 9 recent health deficiencies with 12 fire-safety deficiencies in the latest cycle
751 Blake Street, Edwardsville, KS
(913) 441-1900
Overall
4 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
3 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Beds
102
Certified beds
Average residents
91
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Mission Health Communities
Operator or chain grouping
Approved since
1993-04-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Staffing
RN hours / resident day
0.42
Registered nurse staffing
LPN hours / resident day
0.29
Licensed practical nurse staffing
Aide hours / resident day
1.67
Nurse aide staffing
Weekend hours
2.18
Weekend nurse staffing
RN turnover
13%
Annual RN turnover
Total nurse turnover
33%
Annual nurse turnover
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.9 |
1.8
0.1 pts worse
|
1.9
About the same
|
Long Stay · 20240701-20250630 |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.4 |
2.2
1.8 pts better
|
1.8
1.4 pts better
|
Long Stay · 20240701-20250630 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 95.0% |
91.8%
3.2 pts better
|
93.4%
1.6 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 76.8% |
95.5%
18.7 pts worse
|
95.5%
18.7 pts worse
|
Long Stay · 2024Q3-2025Q2 |
| Percentage of long-stay residents experiencing one or more falls with major injury | 2.4% |
4.4%
2 pts better
|
3.3%
0.9 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who have depressive symptoms | 2.7% |
5.6%
2.9 pts better
|
11.4%
8.7 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who lose too much weight | 1.4% |
5.0%
3.6 pts better
|
5.4%
4 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 51.1% |
23.2%
27.9 pts worse
|
19.6%
31.5 pts worse
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who received an antipsychotic medication | 100.0% |
19.8%
80.2 pts worse
|
16.7%
83.3 pts worse
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.0%
About the same
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents whose ability to walk independently worsened | 4.8% |
18.4%
13.6 pts better
|
16.3%
11.5 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents whose need for help with daily activities has increased | 6.3% |
18.8%
12.5 pts better
|
14.9%
8.6 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
1.8%
1.8 pts better
|
1.0%
1 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with a urinary tract infection | 0.8% |
3.1%
2.3 pts better
|
1.7%
0.9 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 5.6% |
23.2%
17.6 pts better
|
19.8%
14.2 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with pressure ulcers | 0.6% |
4.6%
4 pts better
|
5.1%
4.5 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of short-stay residents who had an outpatient emergency department visit | 3.9% |
11.7%
7.8 pts better
|
12.0%
8.1 pts better
|
Short Stay · 20240701-20250630 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 5.9% |
23.0%
17.1 pts better
|
23.9%
18 pts better
|
Short Stay · 20240701-20250630 |
Survey summary
Top issue: Nutrition and Dietary (2 deficiencies)
12 fire-safety deficiencies
Top issue: Smoke (4 deficiencies)
Top issue: Quality of Life and Care (6 deficiencies)
22 fire-safety deficiencies
Top issue: Smoke (8 deficiencies)
Top issue: Resident Rights (5 deficiencies)
21 fire-safety deficiencies
Top issue: Smoke (7 deficiencies)
Fire safety
Fire Safety
Include a process for Emergency Preparedness collaboration.
Corrected 2024-11-02
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2024-11-02
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-11-02
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2024-11-02
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2024-11-02
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2024-11-02
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2024-11-02
Fire Safety
Use approved construction type or materials.
Corrected 2024-11-02
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2024-11-02
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2024-11-02
Fire Safety
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Corrected 2024-11-02
Fire Safety
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Corrected 2024-11-02
Fire Safety
Develop Emergency Preparedness policies and procedures.
Corrected 2023-03-09
Fire Safety
Conduct risk assessment and an All-Hazards approach.
Corrected 2023-03-09
Fire Safety
Use approved construction type or materials.
Corrected 2023-03-09
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2023-03-09
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2023-03-09
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2023-03-09
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-03-09
Fire Safety
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
Corrected 2023-03-09
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-03-09
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2023-03-09
Fire Safety
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.
Corrected 2023-03-09
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2023-03-09
Fire Safety
Meet other general requirements that are deficient.
Corrected 2023-03-09
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2023-03-09
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2023-03-09
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2023-03-09
Fire Safety
Have restrictions on the use of portable space heaters.
Corrected 2023-03-09
Fire Safety
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Corrected 2023-03-09
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2023-03-09
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2023-03-09
Fire Safety
Provide properly protected cooking facilities.
Corrected 2023-03-09
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2023-03-09
Fire Safety
Establish emergency prep training and testing.
Corrected 2021-08-03
Fire Safety
Conduct testing and exercise requirements.
Corrected 2021-08-03
Fire Safety
Include a process for Emergency Preparedness collaboration.
Corrected 2021-08-03
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2021-08-03
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2021-08-03
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2021-08-03
Fire Safety
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
Corrected 2021-08-03
Fire Safety
Provide a written emergency evacuation plan.
Corrected 2021-08-03
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2021-08-03
Fire Safety
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Corrected 2021-08-03
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2021-08-03
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2021-08-03
Fire Safety
Use approved construction type or materials.
Corrected 2021-08-03
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2021-08-03
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2021-08-03
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2021-08-03
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2021-08-03
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2021-08-03
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2021-08-03
Fire Safety
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Corrected 2021-08-03
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2021-08-03
Inspection history
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Not marked corrected
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2025-01-25
Health
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
Corrected 2024-09-19
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-09-19
Health
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Corrected 2024-09-19
Health
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.
Corrected 2024-09-19
Health
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected 2024-09-19
Health
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected 2024-09-19
Health
Assess the resident when there is a significant change in condition
Corrected 2024-09-19
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2024-09-19
Health
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.
Corrected 2024-09-19
Health
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
Corrected 2023-06-12
Health
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected 2023-06-12
Health
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Corrected 2023-02-03
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2023-02-03
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2023-02-03
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2023-02-03
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2023-02-03
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-02-03
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-02-03
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2023-02-03
Health
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected 2023-02-03
Health
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected 2023-02-03
Health
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.
Corrected 2023-02-03
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2023-02-03
Health
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
Corrected 2021-06-10
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2021-06-10
Health
Dispose of garbage and refuse properly.
Corrected 2021-06-10
Health
Provide and implement an infection prevention and control program.
Corrected 2021-06-10
Health
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.
Corrected 2021-06-10
Health
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.
Corrected 2021-06-10
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2021-06-10
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2021-06-10
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2021-06-10
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2021-06-10
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2021-06-10
Health
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.
Corrected 2021-06-10
Penalties and ownership
Fine · fine $9,113
Fine
5% Or Greater Direct Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
Operational/Managerial Control · Organization
Operational/Managerial Control · Individual
Operational/Managerial Control · Organization
5% Or Greater Indirect Ownership Interest · Organization
Operational/Managerial Control · Individual
5% Or Greater Indirect Ownership Interest · Organization
Corporate Officer · Individual
Nearby options
Edwardsville, KS
1-star overall rating with 2-star inspections with abuse icon flag with 14 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
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3-star overall rating with 3-star inspections with 8 recent health deficiencies with 8 fire-safety deficiencies in the latest cycle
Bonner Springs, KS
1-star overall rating with 2-star inspections with $39,696 in total fines with 12 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
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