01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2024-10-31 | 10 | 2024-10-31 | 7 |
| Cycle 2 | 2023-06-08 | 14 | 2023-06-08 | 9 |
| Cycle 3 | 2021-11-02 | 4 | 2021-11-02 | 8 |
CMS CCN 1755602026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Colonial Village
12500 W 137Th St · Overland Park, KS 66221 · Johnson County
Certified beds40CMS provider file
Recent citation rows52current CMS citation release
Penalty rows0current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
52 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 10 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2024-10-31 · HEALTHF0623Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Correction field: Deficient, Provider has date of correction · 2024-11-212024-10-31 · HEALTHF0625Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2024-11-212024-10-31 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2024-11-212024-10-31 · HEALTHF0690Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Correction field: Deficient, Provider has date of correction · 2024-11-212024-10-31 · HEALTHF0692Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
Correction field: Deficient, Provider has date of correction · 2024-11-212024-10-31 · HEALTHF0730Severity F · widespread; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Observe each nurse aide's job performance and give regular training.
Correction field: Deficient, Provider has date of correction · 2024-11-212024-10-31 · HEALTHF0758Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2024-11-212024-10-31 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2024-11-212024-10-31 · HEALTHF0849Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2024-11-212024-10-31 · HEALTHF0880Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2024-11-212024-10-31 · FIREK0222Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2025-01-062024-10-31 · FIREK0291Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Install emergency lighting that can last at least 1 1/2 hours.
Correction field: Deficient, Provider has date of correction · 2025-01-062024-10-31 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-01-062024-10-31 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2025-01-062024-10-31 · FIREK0761Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2025-01-062024-10-31 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2025-01-062024-10-31 · FIREK0920Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Correction field: Deficient, Provider has date of correction · 2025-01-062023-06-08 · HEALTHF0554Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Correction field: Deficient, Provider has date of correction · 2023-06-302023-06-08 · HEALTHF0604Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Correction field: Deficient, Provider has date of correction · 2023-06-302023-06-08 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2023-06-302023-06-08 · HEALTHF0657Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Correction field: Deficient, Provider has date of correction · 2023-06-302023-06-08 · HEALTHF0677Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2023-06-302023-06-08 · HEALTHF0688Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Correction field: Deficient, Provider has date of correction · 2023-06-302023-06-08 · HEALTHF0689Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2023-06-3003 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- SCENIC DEVELOPMENT LLCOrganization · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/01/2018
- SCENIC HOLDINGS LLCOrganization · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/31/2022
- 3RK, LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 01/01/2021
- 5 R CATTLE, LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/01/2018
- CADET INVESTMENT LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/01/2018
- LMRAY, LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/01/2018
- POKY - 5R LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 07/31/2022
- POKY FEEDERS INCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/01/2018
- WSG LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/01/2018
- ANDERSON, JORDANIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 10/01/2021
- ANDERSON, MARLENEIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/01/2018
- ANDERSON, WAYNEIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/01/2018
- GULLEDGE, SCOTTIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/01/2018
- GULLEDGE, TRAVISIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 10/01/2021
- HOWARD, STEVENIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/01/2018
- WOOD, GILBERTIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/01/2018
- PIVOTAL HEALTH CARE LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2018
- SCENIC DEVELOPMENT LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2018
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours4.43per resident day
RN hours1.00per resident day
Weekend nurse hours4.02per resident day
Staff turnover63.0%CMS reported field
06 / LOCAL RECORDS
Open the Overland Park ledger →Other published facilities nearby
Advanced Health Care Of Overland Park38 beds · CMS overall 5/565 citation rowsAspen Health And Wellness102 beds · CMS overall 1/5101 citation rowsBrookdale Overland Park94 beds · CMS overall 4/537 citation rowsDelmar Gardens Of Overland Park120 beds · CMS overall 3/577 citation rowsGarden Terrace At Overland Park163 beds · CMS overall 1/588 citation rowsIgnite Medical Resort Overland Park Llc102 beds · CMS overall 2/572 citation rowsOverland Park Post Acute140 beds · CMS overall 1/598 citation rowsShawnee Post Acute Rehabilitation Center101 beds · CMS overall 2/559 citation rows