01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-06-04 | 15 | 2025-06-04 | 12 |
| Cycle 2 | 2023-10-19 | 12 | 2023-10-19 | 14 |
| Cycle 3 | 2022-02-07 | 5 | 2022-02-07 | 9 |
CMS CCN 1754412026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Village Shalom Inc
5500 West 123Rd St · Overland Park, KS 66209 · Johnson County
Certified beds66CMS provider file
Recent citation rows67current CMS citation release
Penalty rows2current 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
67 rows in the current release
2 rows carry G–L scope/severity codes; 0 carry J–L. 17 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-06-04 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2025-07-152025-06-04 · HEALTHF0582Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Correction field: Deficient, Provider has date of correction · 2025-07-152025-06-04 · HEALTHF0605Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Correction field: Deficient, Provider has date of correction · 2025-07-152025-06-04 · 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 · 2025-07-152025-06-04 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-07-152025-06-04 · 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 · 2025-07-152025-06-04 · 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 · 2025-07-152025-06-04 · 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 · 2025-07-152025-06-04 · 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 · 2025-07-152025-06-04 · HEALTHF0760Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2025-07-152025-06-04 · HEALTHF0761Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2025-07-152025-06-04 · HEALTHF0808Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2025-07-152025-06-04 · 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 · 2025-07-152025-06-04 · 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 · 2025-07-152025-06-04 · HEALTHF0947Severity D · isolated; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Correction field: Deficient, Provider has date of correction · 2025-07-152025-06-04 · FIREK0211Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Correction field: Deficient, Provider has date of correction · 2025-08-132025-06-04 · 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 · 2025-08-132025-06-04 · FIREK0291Severity E · pattern; 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 · 2025-08-132025-06-04 · FIREK0321Severity D · isolated; 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 · 2025-08-132025-06-04 · FIREK0346Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
Correction field: Deficient, Provider has date of correction · 2025-08-132025-06-04 · 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 · 2025-08-132025-06-04 · 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 · 2025-08-132025-06-04 · FIREK0372Severity E · pattern; 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 · 2025-08-132025-06-04 · 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 · 2025-08-1303 / 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 |
|---|---|---|---|
| 2023-10-19 | Fine | $16,153 | 0 |
| 2023-10-19 | Payment Denial | $0 | 6 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- BETTINGER, IRENEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/18/2018
- GEDULDIG, STEVENIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/25/2023
- GERSHON, ROBERTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/26/2022
- HELZBERG, SHIRLEYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/08/2006
- KLEIN, JAMESIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/14/2008
- KOFFMAN, BRADLEYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 09/24/2024
- KRANTZ, RACHELIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/26/2022
- KRASHIN, JEREMYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 08/02/2021
- LIPSMAN, FRANKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/22/2015
- RUBEN, STEVEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/26/2023
- SCHWARTZ, NEALIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/26/2022
- STEIN, STEWARTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/25/2019
- ABRAHMS, SIMONIndividual · CORPORATE OFFICERNOT APPLICABLE · since 06/26/2023
- CAMPBELL, MARKIndividual · CORPORATE OFFICERNOT APPLICABLE · since 09/11/2023
- VARNER PAREDES, JAMIEIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/20/2021
- ABRAHMS, SIMONIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/26/2023
- CAMPBELL, MARKIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/26/2023
- VARNER PAREDES, JAMIEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/20/2021
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 hours5.86per resident day
RN hours0.90per resident day
Weekend nurse hours5.78per resident day
Staff turnover59.2%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 rowsColonial Village40 beds · CMS overall 2/552 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 rows