15 health deficiencies
Top issue: Pharmacy Service (4 deficiencies)
12 fire-safety deficiencies
Top issue: Smoke (5 deficiencies)
Overland Park, KS
3-star overall rating with 2-star inspections with $16,153 in total fines with 15 recent health deficiencies with 12 fire-safety deficiencies in the latest cycle
5500 West 123rd St, Overland Park, KS
(913) 317-2600
Overall
3 / 5
CMS overall stars
Health inspections
2 / 5
Survey and complaint cycles
Staffing
4 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Beds
66
Certified beds
Average residents
58
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
2000-10-31
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
RN hours / resident day
0.96
Registered nurse staffing · state 0.72 · national 0.68
LPN hours / resident day
1.59
Licensed practical nurse staffing · state 0.67 · national 0.87
Aide hours / resident day
3.59
Nurse aide staffing · state 2.69 · national 2.35
Total nurse hours
6.14
All reported nurse hours · state 4.07 · national 3.89
Licensed hours
2.56
RN + LPN hours · state 1.38 · national 1.54
Weekend hours
5.77
Weekend nurse staffing · state 3.58 · national 3.43
Weekend RN hours
0.83
Weekend registered nurse coverage · state 0.50 · national 0.47
Physical therapist
0.10
Reported PT staffing · state 0.04 · national 0.07
Adjusted RN hours
1.01
CMS adjusted RN staffing hours
Adjusted total hours
6.48
CMS adjusted total nurse staffing hours
Case-mix index
1.30
Higher values indicate more complex resident acuity
RN turnover
46%
Annual RN turnover · state 46% · national 45%
Total nurse turnover
57%
Annual nurse turnover · state 50% · national 46%
SNF VBP
Program rank
1,204
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
58.82
Composite VBP score used to determine payment impact.
Payment multiplier
1.0140
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
5.46
Baseline 19.23% · Performance 18.90% · Measure score 5.46 · Achievement 5.46 · Improvement 1
Healthcare-associated infections
8.40
Baseline 4.77% · Performance 5.32% · Measure score 8.40 · Achievement 8.40 · Improvement 0
Total nurse turnover
1.16
Performance 58.93% · Measure score 1.16 · Achievement 1.16 · This facility did not have sufficient data to calculate a baseline period measure result.
Adjusted total nurse staffing
8.50
Baseline 6.09 hours · Performance 5.50 hours · Measure score 8.50 · Achievement 8.50 · Improvement 0
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.84% |
10.72%
0.9 pts better
|
No Different than the National Rate · Eligible stays 243 · Observed rate 7.41% · Lower 95% interval 7.92% |
| Discharge to community | 47.18% |
50.57%
3.4 pts worse
|
No Different than the National Rate · Eligible stays 229 · Observed rate 46.72% · Lower 95% interval 41.1% |
| Medicare spending per beneficiary | 0.69 |
1.02
0.3 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 176 · Denominator 176 |
| Falls with major injury | 0.57% |
0.77%
0.2 pts better
|
Numerator 1 · Denominator 176 |
| Discharge self-care score | 60.96% |
53.69%
7.3 pts better
|
Numerator 89 · Denominator 146 |
| Discharge mobility score | 54.79% |
50.94%
3.9 pts better
|
Numerator 80 · Denominator 146 |
| Pressure ulcers or injuries, new or worsened | 2.84% |
2.29%
0.5 pts worse
|
Numerator 5 · Denominator 176 · Adjusted rate 3.58% |
| Healthcare-associated infections requiring hospitalization | 5.32% |
7.12%
1.8 pts better
|
No Different than the National Rate · Eligible stays 136 · Observed rate 2.21% · Lower 95% interval 2.8% |
| Staff COVID-19 vaccination coverage | 2.52% |
8.2%
5.7 pts worse
|
Numerator 9 · Denominator 357 |
| Staff flu vaccination coverage | 21.92% |
42%
20.1 pts worse
|
Numerator 73 · Denominator 333 |
| Discharge function score | 69.86% |
56.45%
13.4 pts better
|
Numerator 102 · Denominator 146 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 38 · Denominator 38 |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 98 · Denominator 98 |
| Resident COVID-19 vaccinations up to date | 72.22% |
25.2%
47 pts better
|
Numerator 65 · Denominator 90 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.3 |
1.8
0.5 pts better
|
1.9
0.6 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.3 · Observed 1.2 · Expected 1.8 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.8 |
2.2
1.4 pts better
|
1.8
1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.8 · Observed 0.7 · Expected 1.5 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 95.9% |
91.8%
4.1 pts better
|
93.4%
2.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 96.6% · Q3 94.6% · Q4 92.5% · 4Q avg 95.9% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
95.5%
4.5 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 2.3% |
4.4%
2.1 pts better
|
3.3%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.8% · Q2 1.7% · Q3 1.8% · Q4 3.8% · 4Q avg 2.3% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.5% |
5.6%
5.1 pts better
|
11.4%
10.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.8% · Q3 0.0% · Q4 0.0% · 4Q avg 0.5% |
| Percentage of long-stay residents who lose too much weight | 6.8% |
5.0%
1.8 pts worse
|
5.4%
1.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 9.8% · Q2 4.8% · 4Q avg 6.8% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 11.7% |
23.2%
11.5 pts better
|
19.6%
7.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 9.8% · Q2 13.6% · 4Q avg 11.7% |
| Percentage of long-stay residents who received an antipsychotic medication | 13.4% |
19.8%
6.4 pts better
|
16.7%
3.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 13.8% · Q2 19.2% · Q3 13.5% · Q4 8.6% · 4Q avg 13.4% · Used in QM five-star |
| 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 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 19.7% |
18.4%
1.3 pts worse
|
16.3%
3.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 19.7% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 19.1% |
18.8%
0.3 pts worse
|
14.9%
4.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 25.0% · Q2 19.5% · 4Q avg 19.1% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.9% |
1.8%
0.9 pts better
|
1.0%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.9% · Q2 0.0% · Q3 0.0% · Q4 1.9% · 4Q avg 0.9% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 2.7% |
3.1%
0.4 pts better
|
1.7%
1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 7.3% · Q2 1.8% · Q3 0.0% · Q4 1.9% · 4Q avg 2.7% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 26.5% |
23.2%
3.3 pts worse
|
19.8%
6.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 17.5% · Q2 34.2% · Q3 25.6% · Q4 28.2% · 4Q avg 26.5% |
| Percentage of long-stay residents with pressure ulcers | 3.6% |
4.6%
1 pts better
|
5.1%
1.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 5.3% · Q2 3.2% · Q3 2.8% · Q4 2.9% · 4Q avg 3.6% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 92.1% |
75.6%
16.5 pts better
|
81.7%
10.4 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 96.7% · Q2 93.1% · Q3 88.5% · Q4 89.1% · 4Q avg 92.1% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 4.0% |
11.7%
7.7 pts better
|
12.0%
8 pts better
|
Short Stay · 20240701-20250630 · Adjusted 4.0% · Observed 3.9% · Expected 11.0% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.7% |
2.2%
1.5 pts better
|
1.6%
0.9 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 1.3% · Q2 1.6% · Q3 0.0% · Q4 0.0% · 4Q avg 0.7% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 91.2% |
73.5%
17.7 pts better
|
79.7%
11.5 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 91.2% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 22.9% |
23.0%
0.1 pts better
|
23.9%
1 pts better
|
Short Stay · 20240701-20250630 · Adjusted 22.9% · Observed 19.6% · Expected 20.4% · Used in QM five-star |
Survey summary
Top issue: Pharmacy Service (4 deficiencies)
12 fire-safety deficiencies
Top issue: Smoke (5 deficiencies)
Top issue: Quality of Life and Care (4 deficiencies)
14 fire-safety deficiencies
Top issue: Emergency Preparedness (4 deficiencies)
Top issue: Quality of Life and Care (3 deficiencies)
9 fire-safety deficiencies
Top issue: Smoke (4 deficiencies)
Fire safety
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 2025-08-13
Fire Safety
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
Corrected 2025-08-13
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2025-08-13
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2025-08-13
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2025-08-13
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2025-08-13
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2025-08-13
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2025-08-13
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2025-08-13
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2025-08-13
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 2025-08-13
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2025-08-13
Fire Safety
Develop Emergency Preparedness policies and procedures.
Corrected 2023-12-15
Fire Safety
Develop and maintain an Emergency Preparedness Program (EP).
Corrected 2023-12-15
Fire Safety
Implement emergency and standby power systems.
Corrected 2023-12-15
Fire Safety
Conduct risk assessment and an All-Hazards approach.
Corrected 2023-12-15
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2023-12-15
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-12-15
Fire Safety
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
Corrected 2023-12-15
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-12-15
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2023-12-15
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2023-12-15
Fire Safety
Meet requirements for outpatient facilities located next to inpatient facilities separated by fire resistive construction.
Corrected 2023-12-15
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2023-12-15
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2023-12-15
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 2023-12-15
Fire Safety
Develop and maintain an Emergency Preparedness Program (EP).
Corrected 2022-04-22
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 2022-04-22
Fire Safety
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
Corrected 2022-04-22
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2022-04-22
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2022-04-22
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2022-04-22
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2022-04-22
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2022-04-22
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2022-04-22
Inspection history
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2025-07-15
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2025-07-15
Health
Provide and implement an infection prevention and control program.
Corrected 2025-07-15
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2025-07-15
Health
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected 2025-07-15
Health
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Corrected 2025-07-15
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2025-07-15
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-07-15
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2025-07-15
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 2025-07-15
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2025-07-15
Health
Ensure that residents are free from significant medication errors.
Corrected 2025-07-15
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 2025-07-15
Health
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
Corrected 2025-07-15
Health
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Corrected 2025-07-15
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2023-11-20
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-11-20
Health
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
Corrected 2023-11-20
Health
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Corrected 2023-11-20
Health
Honor the resident's right to organize and participate in resident/family groups in the facility.
Corrected 2023-11-20
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 2023-11-20
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 2023-11-20
Health
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected 2023-11-20
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2023-11-20
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2023-11-20
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2023-11-20
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-11-20
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-08-29
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2022-03-07
Health
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
Corrected 2022-03-07
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2022-03-07
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2022-03-07
Penalties and ownership
Fine · fine $16,153
Fine
Payment Denial · denial start 2023-11-14 · 6 days
6 day denial
Operational/Managerial Control · Individual
Corporate Officer · Individual
Corporate Director · Individual
Operational/Managerial Control · Individual
Corporate Officer · Individual
Corporate Director · Individual
Corporate Director · Individual
Corporate Director · Individual
Corporate Director · Individual
Corporate Director · Individual
Corporate Director · Individual
Corporate Director · Individual
Corporate Director · Individual
Corporate Director · Individual
Corporate Director · Individual
Corporate Director · Individual
Operational/Managerial Control · Individual
Corporate Officer · Individual
Nearby options
Overland Park, KS
4-star overall rating with 4-star inspections with $7,446 in total fines with 3 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle
Overland Park, KS
1-star overall rating with 2-star inspections with $6,942 in total fines with 14 recent health deficiencies with 23 fire-safety deficiencies in the latest cycle
Overland Park, KS
5-star overall rating with 4-star inspections with $7,446 in total fines with 7 recent health deficiencies with 9 fire-safety deficiencies in the latest cycle
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