PINE VILLAGE
86 TWENTY-SECOND AVENUE
MOUNDRIDGE, KS, 67107
6203452901
CCN: 175414
4
Overall4
Health4
Staffing2
QualitySpecial FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
Ownership
| Name | Role | % |
|---|---|---|
| MEMORIAL HOME, INC. | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% |
| DURST, MICHELLE | CORPORATE DIRECTOR | NOT APPLICABLE |
| GOERING, LINDA | CORPORATE DIRECTOR | NOT APPLICABLE |
| GUHR, LEON | CORPORATE DIRECTOR | NOT APPLICABLE |
| LOGANBILL, LARRY | CORPORATE DIRECTOR | NOT APPLICABLE |
| NUZUM, SARA | CORPORATE DIRECTOR | NOT APPLICABLE |
| REMPEL, THEODORE | CORPORATE DIRECTOR | NOT APPLICABLE |
| ROSFELD, ERIN | CORPORATE DIRECTOR | NOT APPLICABLE |
| STUCKY, MARK | CORPORATE DIRECTOR | NOT APPLICABLE |
| STUCKY, JASON | CORPORATE OFFICER | NOT APPLICABLE |
| ELMORE, HEATHER | CORPORATE OFFICER | NOT APPLICABLE |
| STUCKY, JASON | OPERATIONAL/MANAGERIAL CONTROL | NOT 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/Day3.68
5.43
RN Hrs/Resident/Day0.54
0.52
LPN Hrs/Resident/Day0.81
1.21
CNA Hrs/Resident/Day2.33
3.70
PT Hrs/Resident/Day0.12
0.01
Data as of 2026-03-01