PINE VILLAGE

86 TWENTY-SECOND AVENUE
MOUNDRIDGE, KS, 67107
6203452901
CCN: 175414
4
Overall
4
Health
4
Staffing
2
Quality
Special FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
Ownership
NameRole%
MEMORIAL HOME, INC.5% OR GREATER DIRECT OWNERSHIP INTEREST100%
DURST, MICHELLECORPORATE DIRECTORNOT APPLICABLE
GOERING, LINDACORPORATE DIRECTORNOT APPLICABLE
GUHR, LEONCORPORATE DIRECTORNOT APPLICABLE
LOGANBILL, LARRYCORPORATE DIRECTORNOT APPLICABLE
NUZUM, SARACORPORATE DIRECTORNOT APPLICABLE
REMPEL, THEODORECORPORATE DIRECTORNOT APPLICABLE
ROSFELD, ERINCORPORATE DIRECTORNOT APPLICABLE
STUCKY, MARKCORPORATE DIRECTORNOT APPLICABLE
STUCKY, JASONCORPORATE OFFICERNOT APPLICABLE
ELMORE, HEATHERCORPORATE OFFICERNOT APPLICABLE
STUCKY, JASONOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
Health Deficiencies (13)
2025-05-06 · Health
E
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
F
F851 · Administration Deficiencies
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
F
F812 · Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
D
F757 · Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
2023-08-31 · Health
D
F758 · 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.
F
F730 · Nursing and Physician Services Deficiencies
Observe each nurse aide's job performance and give regular training.
D
F689 · Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
D
F661 · 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.
2021-12-21 · Health
D
F758 · 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.
D
F700 · Quality of Life and Care Deficiencies
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
D
F689 · Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
D
F645 · Resident Assessment and Care Planning Deficiencies
PASARR screening for Mental disorders or Intellectual Disabilities
D
F582 · Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day
5.43
3.68
RN Hrs/Resident/Day
0.52
0.54
LPN Hrs/Resident/Day
1.21
0.81
CNA Hrs/Resident/Day
3.70
2.33
PT Hrs/Resident/Day
0.01
0.12
Data as of 2026-03-01