01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-05-06 | 4 | 2025-05-06 | 12 |
| Cycle 2 | 2023-08-31 | 4 | 2023-08-31 | 6 |
| Cycle 3 | 2021-12-21 | 5 | 2021-12-21 | 7 |
CMS CCN 1754142026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Pine Village
86 Twenty-Second Avenue · Moundridge, KS 67107 · Mcpherson County
Certified beds74CMS provider file
Recent citation rows38current 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
38 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 9 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-05-06 · FIREE0007Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Address patient/client population and determine types of services needed.
Correction field: Deficient, Provider has date of correction · 2025-06-122025-05-06 · HEALTHF0757Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2025-05-232025-05-06 · 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 · 2025-05-232025-05-06 · HEALTHF0851Severity F · widespread; potential for more than minimal harm
Administration Deficiencies
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
Correction field: Deficient, Provider has date of correction · 2025-05-232025-05-06 · 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 · 2025-05-232025-05-06 · 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 · 2025-06-122025-05-06 · FIREK0324Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2025-06-122025-05-06 · 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 · 2025-06-122025-05-06 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2025-06-122025-05-06 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-06-182025-05-06 · FIREK0363Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2025-06-122025-05-06 · FIREK0511Severity F · widespread; potential for more than minimal harm
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Correction field: Deficient, Provider has date of correction · 2025-06-122025-05-06 · 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 · 2025-06-182025-05-06 · FIREK0914Severity F · widespread; 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 · 2025-06-122025-05-06 · 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 · 2025-06-192025-05-06 · FIREK0923Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have proper medical gas storage and administration areas.
Correction field: Deficient, Provider has date of correction · 2025-06-132023-08-31 · 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 · 2023-09-15 · complaint2023-08-31 · HEALTHF0689Severity D · isolated; 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 · 2023-09-15 · complaint2023-08-31 · 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 · 2023-09-15 · complaint2023-08-31 · 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 · 2023-09-15 · complaint2023-08-31 · FIREK0161Severity F · widespread; potential for more than minimal harm
Construction Deficiencies
Use approved construction type or materials.
Correction field: Deficient, Provider has date of correction · 2023-10-102023-08-31 · FIREK0321Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2023-10-102023-08-31 · FIREK0324Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2023-10-102023-08-31 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2023-10-1003 / 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
- MEMORIAL HOME, INC.Organization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 01/01/1996
- DURST, MICHELLEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/01/2021
- GOERING, LINDAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/01/2021
- GUHR, LEONIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/01/2021
- LOGANBILL, LARRYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/01/2019
- NUZUM, SARAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/01/2024
- REMPEL, THEODOREIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/01/2021
- ROSFELD, ERINIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/05/2017
- STUCKY, MARKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/01/2023
- ELMORE, HEATHERIndividual · CORPORATE OFFICERNOT APPLICABLE · since 11/21/2022
- STUCKY, JASONIndividual · CORPORATE OFFICERNOT APPLICABLE · since 11/04/2004
- STUCKY, JASONIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/21/2022
- ELMORE, HEATHERIndividual · ADP OF THE SNFNOT APPLICABLE · since 04/11/2025
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 hours5.07per resident day
RN hours0.42per resident day
Weekend nurse hours4.55per resident day
Staff turnover54.5%CMS reported field
06 / LOCAL RECORDS
Open the Moundridge ledger →