Deficiencies (last 4 years)
Deficiencies (over 4 years)
15.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
163% worse than Kansas average
Kansas average: 6 deficiencies/yearDeficiencies per year
40
30
20
10
0
Occupancy
Latest occupancy rate
94% occupied
Based on a July 2024 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Routine
Census: 66
Deficiencies: 19
Date: Jul 10, 2024
Visit Reason
Routine inspection of The Healthcare Resort of Kansas City to assess compliance with healthcare regulations and resident care standards.
Findings
The facility was found deficient in multiple areas including failure to provide wheelchair pedals, resident-to-resident abuse, delayed lab testing, improper application of leg braces, unsafe environment hazards, inadequate infection control, medication administration errors, insufficient behavioral health care, dementia care deficiencies, and incomplete staff training documentation.
Deficiencies (19)
F 0558: The facility failed to provide wheelchair pedals for Resident 39 when staff pushed her wheelchair, leaving her vulnerable to injury.
F 0600: The facility failed to prevent resident-to-resident abuse when Resident 31 threw hot coffee on Resident 40, placing residents at risk of harm.
F 0610: The facility failed to fully investigate and implement interventions after the resident-to-resident coffee throwing incident involving Residents 31 and 40.
F 0684: The facility failed to obtain physician-ordered STAT labs timely for Resident 45, delaying care for a urinary tract infection.
F 0688: The facility failed to apply Resident 39's leg/ankle brace when out of bed, risking worsening contractures and decreased mobility.
F 0689: The facility failed to maintain a safe environment free from hazards including unsecured oxygen tanks, chemical storage, and wet floor hazards, risking resident accidents.
F 0689: The facility failed to follow fall prevention interventions for Residents 29 and 58, and failed to ensure Resident 6's room was free from hazards.
F 0690: The facility failed to provide appropriate peri care for Resident 39, risking urinary tract infections due to poor hand hygiene and care practices.
F 0692: The facility failed to monitor weights consistently and adjust enteral nutrition for Resident 27, resulting in significant unplanned weight loss of 11.74% within two months.
F 0698: The facility failed to consistently communicate Resident 6's medical condition before and after hemodialysis, risking adverse outcomes.
F 0732: The facility failed to post daily nurse staffing data with required information and failed to retain posted staffing data as required.
F 0740: The facility failed to adequately meet Resident 46's behavioral health needs, resulting in repeated behavioral episodes and unmet care needs.
F 0744: The facility failed to identify and address dementia-related behaviors for Resident 29, risking preventable injuries and loss of function.
F 0757: The facility failed to monitor blood pressure and pulse as ordered prior to administration of antihypertensive medication for Resident 41, risking unnecessary medication and side effects.
F 0761: The facility failed to secure medication and treatment carts, placing residents at risk for medication errors.
F 0880: The facility failed to follow infection control standards related to soiled laundry handling, medication administration, and PPE disposal, risking infectious disease transmission.
F 0941: The facility failed to ensure agency direct care staff received required communication training, risking impaired care and decreased quality of life.
F 0942: The facility failed to ensure agency direct care staff received required resident rights training, risking impaired care and decreased quality of life.
F 0947: The facility failed to ensure agency direct care staff received required dementia training, risking impaired care and decreased quality of life.
Report Facts
Resident census: 66
Sample size: 19
Weight loss percent: 11.74
Weight loss percent: 7.35
Weight loss percent: 8.13
Weight loss percent: 11.74
BIMS score: 8
BIMS score: 15
BIMS score: 13
BIMS score: 14
BIMS score: 9
BIMS score: 11
BIMS score: 14
BIMS score: 9
BIMS score: 14
Medication monitoring period: 12
Medication monitoring period: 21
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Administrative Nurse D | Administrative Nurse | Provided multiple statements regarding facility policies and deficiencies |
| Licensed Nurse G | Licensed Nurse | Provided statements on medication administration and resident care |
| Certified Nurse's Aide O | CNA | Involved in peri care deficiency for Resident 39 |
| Certified Nurse's Aide M | CNA | Provided statements on fall prevention and resident care |
| Licensed Nurse H | Licensed Nurse | Provided statements on medication monitoring and resident care |
| Administrative Staff A | Administrative Staff | Provided statements on staffing and agency training |
| Consultant GG | Consultant | Provided statements on nutrition and weight loss concerns |
Inspection Report
Routine
Census: 66
Deficiencies: 18
Date: Jul 10, 2024
Visit Reason
Routine inspection of The Healthcare Resort of Kansas City to assess compliance with regulatory requirements related to resident care, safety, and facility operations.
Findings
The facility was found deficient in multiple areas including failure to provide wheelchair pedals and leg braces, resident-to-resident abuse, delayed lab testing and follow-up, unsafe environment hazards, inadequate infection control practices, failure to monitor significant weight loss, inconsistent dialysis communication, incomplete nurse staffing data posting, and insufficient training for agency staff on communication, resident rights, and dementia care.
Deficiencies (18)
F 0558: The facility failed to provide wheelchair pedals for Resident 39 when staff pushed her wheelchair, placing her at risk of injury.
F 0600: The facility failed to prevent resident-to-resident abuse when Resident 31 threw hot coffee on Resident 40, placing residents at risk of harm.
F 0610: The facility failed to fully investigate a resident-to-resident altercation involving Residents 31 and 40 and implement interventions to prevent further abuse.
F 0684: The facility failed to ensure timely collection of STAT labs and physician notification for Resident 45, delaying care for a urinary tract infection.
F 0688: The facility failed to apply Resident 39's leg/ankle brace when she was out of bed, risking worsening contractures and decreased mobility.
F 0689: The facility failed to maintain a safe environment free from hazards and failed to follow fall prevention interventions for Residents 6, 29, and 58.
F 0690: The facility failed to provide appropriate peri care for Resident 39, risking urinary tract infections due to poor hand hygiene and care practices.
F 0692: The facility failed to monitor weights and adjust enteral nutrition for Resident 27, resulting in significant unplanned weight loss of 11.74% within two months.
F 0698: The facility failed to consistently communicate Resident 6's medical condition pre- and post-hemodialysis, risking adverse outcomes.
F 0732: The facility failed to post daily nurse staffing data with required information and failed to retain posted staffing data as required.
F 0740: The facility failed to adequately meet Resident 46's behavioral health needs, resulting in repeated behavioral episodes and unmet care needs.
F 0744: The facility failed to identify and address dementia-related behaviors for Resident 29, placing her at risk for preventable injuries and loss of function.
F 0757: The facility failed to monitor blood pressure and pulse as ordered prior to administration of antihypertensive medication for Resident 41, risking unnecessary medication and side effects.
F 0761: The facility failed to secure medication and treatment carts, placing residents at risk for medication errors.
F 0880: The facility failed to follow infection control standards related to soiled laundry handling, medication administration, and PPE disposal, risking infectious disease transmission.
F 0941: The facility failed to ensure agency direct care staff received required communication training, risking impaired care and decreased quality of life.
F 0942: The facility failed to ensure agency direct care staff received required resident rights training, risking impaired care and decreased quality of life.
F 0947: The facility failed to ensure agency direct care staff received required dementia training, risking impaired care and decreased quality of life.
Report Facts
Resident census: 66
Sample size: 19
Weight loss percentage: 11.74
Weight loss percentage: 7.35
Weight loss percentage: 8.13
Weight loss in pounds: 11.74
Weight: 66
Weight: 155
Weight: 136.8
Weight: 251
Weight: 143.6
Weight: 142.4
Weight: 145.2
Weight: 155.1
Weight: 251
Weight: 136.8
Weight: 55
Weight: 60
Weight: 150
Weight: 25
Weight: 1
Weight: 66
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Administrative Nurse D | Administrative Nurse | Interviewed about multiple deficiencies including abuse, lab delays, brace application, infection control, dialysis communication, and staffing |
| Licensed Nurse G | Licensed Nurse | Interviewed about wheelchair pedals, abuse incident, brace application, infection control, dialysis communication, medication monitoring |
| Certified Nurse's Aide M | Certified Nurse's Aide | Interviewed about abuse incident, fall prevention, infection control, resident care |
| Certified Nurse's Aide O | Certified Nurse's Aide | Observed providing peri care with deficient hand hygiene |
| Licensed Nurse H | Licensed Nurse | Interviewed about medication monitoring and behavioral interventions |
| Administrative Staff A | Administrative Staff | Interviewed about staffing and agency training |
| Consultant GG | Consultant | Interviewed about weight loss communication |
| Licensed Nurse F | Licensed Nurse | Interviewed about oxygen tank storage |
| Certified Medication Aide T | Certified Medication Aide | Observed failing hand hygiene during medication preparation |
| Licensed Nurse J | Licensed Nurse | Observed unsecured medication carts |
| Certified Nurse's Aide M | Certified Nurse's Aide | Interviewed about fall prevention and care plans |
| Licensed Nurse LN | Licensed Nurse | Interviewed about fall prevention and care plans |
| Certified Nurse's Aide P | Certified Nurse's Aide | Training record reviewed, lacked communication and resident rights training |
| Certified Nurse's Aide Q | Certified Nurse's Aide | Training record reviewed, lacked communication and resident rights training |
| Certified Nurse's Aide LL | Certified Nurse's Aide | Training record reviewed, lacked communication and resident rights training |
Inspection Report
Complaint Investigation
Census: 55
Deficiencies: 1
Date: Mar 28, 2024
Visit Reason
The inspection was conducted due to a complaint investigation regarding the facility's failure to provide appropriate wound care and monitoring for Resident 1, who had diabetes and amputations, resulting in worsening infection and surgical removal of a toe.
Complaint Details
The investigation was complaint-driven, focusing on Resident 1's wound care and monitoring. The complaint was substantiated as the facility failed to adequately monitor and treat the resident's foot wound, leading to infection and amputation.
Findings
The facility failed to ensure Resident 1 received appropriate wound care and monitoring after a concern was noted on 02/15/24. The resident's left foot wound became infected and progressively worsened, ultimately requiring surgical amputation of the third toe. Documentation and treatment orders were delayed or incomplete.
Deficiencies (1)
F 0684: The facility failed to provide appropriate treatment and care according to orders and resident preferences, resulting in actual harm to Resident 1. The resident's foot wound was not properly monitored or treated, leading to infection and surgical amputation.
Report Facts
Resident census: 55
Wound measurement: 1.4
Wound measurement: 2
Wound measurement: 0.2
Antibiotic dosage: 800
Antibiotic dosage: 160
Antibiotic treatment duration: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Consultant GG | Nurse Practitioner/Physician Assistant | Documented foot ulcer and treatment plan; provided progress notes on Resident 1's wound |
| Licensed Nurse G | Licensed Nurse | Provided wound care and reported on monitoring and documentation of Resident 1's toe wound |
| Administrative Nurse D | Administrative Nurse | Provided statements regarding notification and treatment processes for Resident 1's wound |
| Administrative Nurse E | Administrative Nurse | Provided statements regarding wound care and monitoring of Resident 1's toe |
Inspection Report
Complaint Investigation
Census: 64
Deficiencies: 2
Date: Mar 20, 2023
Visit Reason
The inspection was conducted due to a complaint investigation regarding the facility's failure to notify a resident's physician of a change in condition and failure to prevent medication errors.
Complaint Details
The investigation was complaint-related, focusing on failure to notify the physician of a resident's elevated blood pressure and medication administration errors. The complaint was substantiated as the facility failed in both areas.
Findings
The facility failed to notify Resident 1's physician of elevated blood pressures during a seven-day admission, placing the resident at risk for health complications. Additionally, the facility failed to administer medications as ordered, resulting in a significant medication error and increased risk for cardiac complications.
Deficiencies (2)
F 0580: The facility failed to notify Resident 1's physician of elevated diastolic and systolic blood pressures during the resident's seven-day admission. This placed the resident at risk for health complications due to delayed physician involvement or uncommunicated care needs.
F 0760: The facility failed to administer Carvedilol as ordered for Resident 1, resulting in a medication error. This placed the resident at increased risk for cardiac complications and high blood pressure.
Report Facts
Resident census: 64
Medication tablets received: 28
Inspection Report
Annual Inspection
Census: 63
Deficiencies: 10
Date: Nov 2, 2022
Visit Reason
Annual inspection of The Healthcare Resort of Kansas City to assess compliance with healthcare regulations and standards.
Findings
The facility had multiple deficiencies including failure to notify physicians timely about medication administration issues, incomplete care plans, inadequate assistance with activities of daily living, unsafe environment leading to falls, inaccurate fluid intake monitoring, delayed pain medication administration, improper medication administration via feeding tube, failure to reconcile controlled substances, medication availability issues, improper medication labeling and storage, and infection control lapses.
Deficiencies (10)
F580: The facility failed to notify Resident 29's physician immediately of medications not administered in a timely manner, placing the resident at risk for physical decline.
F656: The facility failed to develop a comprehensive care plan for Resident 29's hypertension medication, placing the resident at risk for physical decline and complications.
F677: The facility failed to provide scheduled bathing for Resident 16, placing the resident at risk for skin problems and poor hygiene.
F689: The facility failed to provide a safe environment and resident-centered fall interventions for Resident 46, placing the resident at risk for further falls and injury.
F692: The facility failed to accurately monitor fluid intake for Resident 16 on a 2000 ml per day fluid restriction, placing the resident at risk for dehydration.
F697: The facility failed to provide pain medication timely for Resident 172, placing the resident at risk for further pain and discomfort.
F726: The facility failed to ensure licensed nursing staff administered Resident 41's medications via feeding tube as ordered, placing the resident at risk for aspiration.
F755: The facility failed to reconcile controlled medications at shift changes and failed to ensure Resident 29's medications were available for administration, placing residents at risk for medication misappropriation and ineffective regimens.
F761: The facility failed to label insulin pens with opened dates and failed to secure medication carts, placing residents at risk for ineffective medication and unsafe access.
F880: The facility failed to transport clean clothing in a sanitary manner and failed to adequately disinfect a glucometer, placing residents at risk for infectious disease.
Report Facts
Residents present: 63
Sample size: 19
Medication unavailability days: 9
Medication unavailability days: 4
Medication unavailability days: 5
Medication unavailability days: 3
Medication unavailability days: 3
Medication unavailability days: 6
Medication unavailability days: 3
Fluid intake average: 658
Fluid intake average: 731
Pain medication delay: 20
Medication cart reconciliation missing counts: 14
Medication cart reconciliation missing counts: 25
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Nurse J | Licensed Nurse | Contacted pharmacy about Resident 29's medication coverage and insurance issues |
| Administrative Nurse D | Administrative Nurse | Provided statements regarding medication notification failures and medication reconciliation |
| Licensed Nurse I | Licensed Nurse | Administered Resident 41's medication by mouth despite orders for feeding tube administration |
| Certified Medication Aide S | Certified Medication Aide | Reported Resident 172 did not receive pain medication on admission day due to lack of emergency kit code |
Inspection Report
Routine
Census: 43
Deficiencies: 13
Date: Jun 16, 2021
Visit Reason
Routine inspection of The Healthcare Resort of Kansas City to assess compliance with healthcare regulations including resident care, medication management, infection control, and safety.
Findings
The facility was found deficient in multiple areas including failure to document discharge recapitulation, inadequate assistance with activities of daily living, failure to implement physician orders, delayed wound care, failure to investigate falls and implement interventions, inadequate catheter care, failure to act on pharmacist recommendations, improper medication storage, and failure to follow infection control precautions.
Deficiencies (13)
F0661: Facility failed to document a recapitulation of stay for Resident 33 upon discharge, risking miscommunication of care needs.
F0677: Facility failed to provide needed assistance with personal hygiene for dependent Resident 15, risking infection and decreased wellbeing.
F0684: Facility failed to implement a physician order for urinalysis with culture and sensitivity for Resident 15, risking delayed treatment of urinary tract infections.
F0686: Facility failed to provide ordered pressure ulcer treatments and delayed preventative measures for Resident 92, resulting in worsening wounds and actual harm.
F0688: Facility failed to provide appropriate treatment and services to increase range of motion and prevent further decrease for Resident 28.
F0689: Facility failed to investigate falls and implement interventions for Resident 8, placing resident at risk for further falls and injuries.
F0690: Facility failed to ensure catheter care orders for Resident 39 and failed to notify physician of abnormal urinalysis and low urine output for Resident 17, risking infections and complications.
F0695: Facility failed to obtain oxygen and Bi-Pap orders and failed to implement tubing changes and equipment cleaning for Residents 16 and 30, risking respiratory infections and complications.
F0698: Facility failed to utilize an effective communication system with dialysis center for Resident 25, risking impaired dialysis care.
F0756: Facility failed to act on consultant pharmacist recommendations for Residents 39, 16, 8, 28, and 17, including failure to monitor behavior and implement gradual dose reductions, risking unnecessary medication use and side effects.
F0757: Facility failed to reinstate medication orders with necessary administration instructions for Resident 39 after hospital stay, risking unnecessary medication use and side effects.
F0761: Facility failed to properly store and date insulin pens and tuberculin vials, failed to properly store medications, and failed to discard expired medications, risking ineffective treatment and physical complications.
F0880: Facility failed to ensure proper infection control practices for Residents 193 and 197 on droplet precautions, risking spread of illness and infection.
Report Facts
Resident census: 43
Sample size: 14
Medication administration record missing entries: 15
Medication administration record missing entries: 11
Medication expiration: 4
Medication expiration: 1
Medication expiration: 3
Medication expiration: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Nurse H | Interviewed regarding discharge instructions and medication storage | |
| Administrative Nurse D | Interviewed regarding discharge summary, catheter care, infection control, and medication regimen review | |
| Licensed Nurse G | Interviewed regarding catheter care, oxygen use, medication regimen review, and fall interventions | |
| Certified Nurse Aide M | Interviewed regarding fall prevention and infection control | |
| Administrative Nurse E | Interviewed regarding urinalysis, medication regimen review, and oxygen tubing changes | |
| Therapy Consultant HH | Interviewed regarding brace application for Resident 28 | |
| Medical Consultant II | Interviewed regarding wound care | |
| Consultant Physician Assistant II | Interviewed regarding urinalysis results and treatment | |
| Pharmacy Consultant GG | Pharmacy Consultant | Unavailable for interview regarding medication regimen review |
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