01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2024-09-25 | 3 | 2024-09-25 | 7 |
| Cycle 2 | 2023-03-15 | 4 | 2023-03-15 | 9 |
| Cycle 3 | 2021-08-26 | 0 | 2021-08-26 | 7 |
CMS CCN 1755532026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Moundridge Manor
710 N Christian Avenue · Moundridge, KS 67107 · Mcpherson County
Certified beds78CMS provider file
Recent citation rows30current CMS citation release
Penalty rows1current 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
30 rows in the current release
2 rows carry G–L scope/severity codes; 0 carry J–L. 6 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2024-09-25 · HEALTHF0689Severity G · isolated actual 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 · 2024-10-192024-09-25 · HEALTHF0804Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Correction field: Deficient, Provider has date of correction · 2024-10-192024-09-25 · 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 · 2024-10-192024-09-25 · 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 · 2024-11-132024-09-25 · FIREK0355Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Correction field: Deficient, Provider has date of correction · 2024-11-132024-09-25 · FIREK0372Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Correction field: Deficient, Provider has date of correction · 2024-11-132024-09-25 · FIREK0511Severity D · isolated; potential for more than minimal harm
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Correction field: Deficient, Provider has date of correction · 2024-11-132024-09-25 · FIREK0711Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Provide a written emergency evacuation plan.
Correction field: Deficient, Provider has date of correction · 2024-11-132024-09-25 · 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 · 2024-11-132024-09-25 · FIREK0926Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.
Correction field: Deficient, Provider has date of correction · 2024-10-252023-03-15 · HEALTHF0661Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
Correction field: Deficient, Provider has date of correction · 2023-04-262023-03-15 · HEALTHF0689Severity G · isolated actual 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 · 2023-04-262023-03-15 · HEALTHF0756Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Correction field: Deficient, Provider has date of correction · 2023-04-262023-03-15 · 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 · 2023-04-262023-03-15 · FIREK0324Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2023-05-262023-03-15 · FIREK0325Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Have properly installed hallway dispensers for alcohol-based hand rub.
Correction field: Deficient, Provider has date of correction · 2023-05-262023-03-15 · FIREK0353Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2023-05-262023-03-15 · FIREK0363Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2023-05-262023-03-15 · FIREK0511Severity D · isolated; potential for more than minimal harm
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Correction field: Deficient, Provider has date of correction · 2023-05-262023-03-15 · FIREK0521Severity F · widespread; potential for more than minimal harm
Services Deficiencies
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Correction field: Deficient, Provider has date of correction · 2023-05-262023-03-15 · FIREK0914Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Correction field: Deficient, Provider has date of correction · 2023-05-262023-03-15 · 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 · 2023-05-262023-03-15 · FIREK0920Severity E · pattern; 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 · 2023-05-262021-08-26 · FIREK0222Severity E · pattern; 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 · 2021-10-1303 / 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 |
|---|---|---|---|
| 2024-09-25 | Fine | $20,295 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- CHURCH OF GOD IN CHRIST MENNONITEOrganization · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 01/30/2015
- DYCK, ANDREWIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2023
- ENSZ, GLENIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2015
- KOEHN, BRENTONIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2017
- KOEHN, CHADIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2025
- KOEHN, KEITHIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2021
- KOEHN, KELLYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2021
- KOEHN, STEVEIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2021
- MARTENS, KENDALLIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2020
- SMITH, DAVIDIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2021
- UNRUH, GREGIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2022
- UNRUH, SHELBYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2019
- WIEBE, ANTHONYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2024
- WIEBE, KENTIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2024
- UNRUH, KEVINIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 08/01/2014
- BECKER, TRAVISIndividual · CORPORATE OFFICERNOT APPLICABLE · since 06/06/2016
- BECKER, TRAVISIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/06/2016
- DECKER, PAMIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/20/2000
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 hours4.86per resident day
RN hours0.74per resident day
Weekend nurse hours4.05per resident day
Staff turnover19.8%CMS reported field
06 / LOCAL RECORDS
Open the Moundridge ledger →