PINE VILLAGE
86 TWENTY-SECOND AVENUE, MOUNDRIDGE, KS 67107 · CCN 175414
Ratings
- Overall
- ★★★★☆ 4
- Health inspection
- ★★★★☆ 4
- Quality measures
- ★★☆☆☆ 2
- Staffing
- ★★★★☆ 4
Facility
- Ownership type
- Non profit - Corporation
- Certified beds
- 74
- Avg residents/day
- 65.9
- Phone
- 6203452901
Inspection history vs Kansas & national averages
Cycle 1 is the most recent standard health inspection. Lower total deficiency counts are better.
| Cycle | Inspection date | This facility | Kansas avg | National avg | vs state |
|---|---|---|---|---|---|
| 1 | 2025-05-06 | 4 | 10.1 | 9.5 | -6.1 better |
| 2 | 2023-08-31 | 4 | 9.9 | 9.8 | -5.9 better |
| 3 | 2021-12-21 | 5 | 7.2 | 9.3 | -2.2 better |
Cycle 1 deficiencies by category
| Category | Deficiencies |
|---|---|
| Nutrition and dietary | 1 |
| Pharmacy service | 1 |
| Administration | 1 |
| Infection control | 1 |
Staffing (hours per resident per day)
| Metric | This facility | Turnover |
|---|---|---|
| Total nurse staffing (reported) | 5.43 | 44.0% |
| RN staffing (reported) | 0.52 | 50.0% |
| Total nurse staffing (adjusted) | 6.53 | — |
Fines & penalties
- Total fines
- $0
- Number of fines
- 0
- Number of penalties
- 0
- Payment denials
- 0
Inspection citations (13)
- DF0757Ensure each resident’s drug regimen must be free from unnecessary drugs.2025-05-06 · Health · corrected 2025-05-23
Potential for more than minimal harm
- FF0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.2025-05-06 · Health · corrected 2025-05-23
Potential for more than minimal harm
- FF0851Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.2025-05-06 · Health · corrected 2025-05-23
Potential for more than minimal harm
- EF0880Provide and implement an infection prevention and control program.2025-05-06 · Health · corrected 2025-05-23
Potential for more than minimal harm
- DF0661Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.2023-08-31 · Health · corrected 2023-09-15
Potential for more than minimal harm
- DF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-08-31 · Health · corrected 2023-09-15
Potential for more than minimal harm
- FF0730Observe each nurse aide's job performance and give regular training.2023-08-31 · Health · corrected 2023-09-15
Potential for more than minimal harm
- DF0758Implement 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.2023-08-31 · Health · corrected 2023-09-15
Potential for more than minimal harm
- DF0582Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.2021-12-21 · Health · corrected 2022-01-26
Potential for more than minimal harm
- DF0645PASARR screening for Mental disorders or Intellectual Disabilities2021-12-21 · Health · corrected 2022-01-26
Potential for more than minimal harm
- DF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2021-12-21 · Health · corrected 2022-01-26
Potential for more than minimal harm
- DF0700Try 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.2021-12-21 · Health · corrected 2022-01-26
Potential for more than minimal harm
- DF0758Implement 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.2021-12-21 · Health · corrected 2022-01-26
Potential for more than minimal harm
Ownership
| Owner | Type | Role | Percent | Since |
|---|---|---|---|---|
| MEMORIAL HOME, INC. | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% | 1996-01-01 |
| STUCKY, JASON | Individual | OPERATIONAL/MANAGERIAL CONTROL | — | 2022-11-21 |
| DURST, MICHELLE | Individual | CORPORATE DIRECTOR | — | 2021-03-01 |
| GOERING, LINDA | Individual | CORPORATE DIRECTOR | — | 2021-03-01 |
| GUHR, LEON | Individual | CORPORATE DIRECTOR | — | 2021-03-01 |
| LOGANBILL, LARRY | Individual | CORPORATE DIRECTOR | — | 2019-03-01 |
| NUZUM, SARA | Individual | CORPORATE DIRECTOR | — | 2024-03-01 |
| REMPEL, THEODORE | Individual | CORPORATE DIRECTOR | — | 2021-03-01 |
| ROSFELD, ERIN | Individual | CORPORATE DIRECTOR | — | 2017-03-05 |
| STUCKY, MARK | Individual | CORPORATE DIRECTOR | — | 2023-03-01 |
| ELMORE, HEATHER | Individual | CORPORATE OFFICER | — | 2022-11-21 |
| STUCKY, JASON | Individual | CORPORATE OFFICER | — | 2004-11-04 |
Other facilities in MOUNDRIDGE
| Name | Overall | Beds |
|---|---|---|
| MOUNDRIDGE MANOR | ★★★★★ | 78 |
Source: CMS Provider Data Catalog, Nursing Home Care Compare files (processed 2026-03-01). Citations show the 3 most recent inspection cycles.