Not rated by CMS — ratings are suppressed for new or low-volume facilities.
A standard survey is most likely before around October 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Northland Rehabilitation & Health Care Center during CMS and state inspections, most recent first.
A resident with multiple sclerosis, bilateral lower extremity impairment, wheelchair dependence, prior falls, and a history of right femur fracture was care planned as dependent for transfers, requiring two staff and a sit‑to‑stand lift. A CNA who had not worked with the resident recently attempted to transfer the resident alone from bed to a shower chair using only a gait belt, relying on the resident’s statement that only one staff member and no lift were needed and without checking the care plan or Kardex or consulting the charge nurse. During the transfer, the shower chair moved, the resident’s legs gave out, and the CNA lowered the resident to the floor, after which the resident developed right knee pain. X‑rays obtained following the incident showed an acute nondisplaced distal right femur fracture, and the resident was evaluated in the emergency room and returned with a knee immobilizer.
Two residents with complex medical needs did not receive breakfast within the facility's scheduled timeframe on consecutive days. One resident, recently admitted with multiple health conditions, missed breakfast entirely until staff were alerted, while another with GERD and anxiety received breakfast late, causing distress. Staff interviews revealed confusion about the cause of the delays, despite policies requiring timely meal service.
The facility failed to maintain proper food storage and hygiene practices in the kitchen, risking foodborne illness for 96 residents. Observations revealed an unclean ice machine, improperly stored food in the freezer, and unsanitary glove use during meal service. The Dietary Manager and Maintenance Director acknowledged these issues, with the DM noting a focus on other areas and unsuccessful attempts to correct staff during service.
The facility failed to implement Enhanced Barrier Precautions (EBP) for residents with chronic wounds or indwelling devices, increasing the risk of MDRO spread. A resident with an enteral feeding tube and another with a suprapubic catheter did not receive care with the required gown and glove use. Staff were not informed about EBP requirements, and the facility had not yet implemented these precautions.
A resident with intact cognition reported verbal abuse by a CNA, including foul language and physical abuse. The incident was documented and given to the former ADON, but there was no evidence of reporting to the SSA or investigation. The DON acknowledged the need for reporting and staff removal, but the facility failed to follow its abuse prevention policy.
A resident with intact cognition reported verbal abuse by a CNA, providing a detailed account to the former ADON. Despite the facility's policy requiring thorough investigation, there was no documentation or evidence of such an investigation. The resident expressed discomfort seeing the CNA, who continued working in the same hall. Interviews revealed a lack of proper documentation and investigation, with the DON acknowledging the need for an investigation to ensure resident safety.
The facility failed to update care plans for two residents, resulting in inaccuracies and lack of coordination with hospice services. One resident's care plan included an outdated diagnosis of dehydration without supporting orders, while another resident's care plan did not reflect hospice services despite being admitted to hospice care. Interviews revealed that the care plans were not updated from previous admissions, and there was no policy for coordinating care with hospice providers.
A facility failed to implement pressure ulcer treatment and prevention measures for a resident with dementia and peripheral vascular disease. A wound treatment order was not correctly entered into the EMR, leading to a lack of scheduled treatment. Additionally, the resident was observed without heel protectors or floated heels, despite having an order for them. Staff were not instructed to apply these measures, contributing to the deficiency.
A resident with severe cognitive impairment was given two doses of psychotropic medications without documented clinical need. Despite Lorazepam being noted as effective, Haloperidol was also administered without justification. Interviews with nursing staff confirmed the lack of documentation and inappropriate administration of a second dose, leading to a deficiency.
Improper One‑Person Transfer Without Lift Leads to Femur Fracture
Penalty
Summary
The deficiency involves the facility’s failure to ensure a safe transfer for a resident by not following the resident’s care plan, which required two staff members and use of a sit‑to‑stand lift for transfers. On the date of the incident, a CNA attempted to transfer the resident alone from bed to a shower chair using only a gait belt. The CNA positioned and locked the shower chair next to the bed and began the transfer without verifying the resident’s transfer status in the care plan or Kardex, despite knowing that this information was available and that staff could consult the charge nurse if unsure. During the transfer, the shower chair moved, and the CNA was unable to safely complete the transfer back to the bed. The resident involved had multiple medical conditions and functional limitations documented in the record. Diagnoses included multiple sclerosis, anxiety disorder, a history of falls, and a prior fracture of the right femur. The most recent MDS showed the resident had impairment in both lower extremities, used a wheelchair for mobility, required moderate assistance with ADLs, was dependent on staff for transfers, and had experienced a prior fall with major injury. The comprehensive care plan in effect before the fall specified that the resident required assistance of two staff members and use of a sit‑to‑stand lift for transfers, and also noted that the resident had a history of manipulating staff by telling them he or she could do more than physically able. On the day of the event, the CNA, who had not worked with the resident in some time, believed the resident was a one‑person assist with a gait belt and relied in part on the resident’s statement that he or she could transfer with only one staff member and no lift. The CNA did not review the care plan or Kardex and did not consult the charge nurse before proceeding. During the transfer from bed to shower chair, the resident stood and began to turn toward the shower chair when the resident’s legs gave out, and the CNA lowered the resident to the floor. The resident came to rest on the floor with the right leg underneath the body and requested that the CNA move the leg out in front. The LPN who responded found the resident sitting on the floor with legs extended and initially noted no acute injury, but later the resident reported right knee pain. Subsequent x‑rays revealed an acute nondisplaced distal right femur fracture, and the resident was sent to the emergency room, where the fracture was confirmed and an immobilizing knee brace was applied before the resident returned to the facility. Interviews with facility leadership and the resident’s physician confirmed that the expectation was for staff to follow the comprehensive care plan, Kardex, and therapy recommendations for transfers, and to verify instructions with the charge nurse if a resident’s statements conflicted with the care plan. The CNA acknowledged awareness of these expectations and admitted not checking the care plan or Kardex before attempting the transfer alone. The facility’s fall prevention policy described a fall as an unintentional coming to rest on a lower level and defined serious injury to include fractures, and the resident’s event met these criteria when the transfer attempt resulted in the resident being lowered to the floor and sustaining a nondisplaced distal femur fracture.
Failure to Serve Meals According to Scheduled Mealtimes
Penalty
Summary
The facility failed to serve meals in accordance with its own policy and scheduled mealtimes, resulting in two residents not receiving breakfast within the expected timeframe. According to the facility's posted schedule, breakfast is to be served at 8:30 A.M., and residents should receive their meals within one hour of the start time. However, observations and interviews revealed that one resident, who had multiple medical conditions including acute osteomyelitis, stroke, malnutrition, diabetes, and dementia, did not receive breakfast for two consecutive days after admission. On the second day, the resident expressed feeling hungry and neglected, and staff only became aware of the missed meal after being prompted, eventually delivering breakfast two hours late. Another resident, with diagnoses including a fractured femur, cognitive communication deficit, osteoporosis, GERD, and anxiety disorder, also received breakfast over 1.5 hours late on two consecutive days. This resident's care plan required small, frequent meals due to GERD and anxiety-related nutrition risk. The resident reported increased anxiety and a preference for breakfast at the scheduled time, as late meals caused discomfort and uncertainty. Staff interviews indicated a lack of clarity regarding why these delays occurred, despite established procedures for meal delivery and new admissions.
Food Storage and Hygiene Deficiencies in Kitchen
Penalty
Summary
The facility failed to maintain proper food storage and hygiene practices in the kitchen, which could potentially lead to the spread of foodborne illness among all 96 residents. During an inspection, it was observed that the ice machine had a brownish-yellowish-greenish substance on the inside of the lid, indicating inadequate cleaning. The Dietary Manager (DM) acknowledged that the maintenance department was responsible for cleaning the ice machine and claimed it had been cleaned recently. Additionally, in the stand-alone freezer, bags containing chicken nuggets, hash brown patties, and hamburger patties were found open and unsealed, which the DM confirmed should not have been the case. The DM, who was new to the position, admitted to focusing on other areas and had not noticed these issues. During lunch service, further unsanitary practices were observed. A breadstick that fell onto the steam table was placed back into the pan for serving. Dietary cook (DC) 2 was seen using the same gloves to handle various kitchen equipment and food items, including ready-to-eat foods, without changing them, which could lead to contamination. A meal tray card that fell into a pan of breadsticks was removed by DC1 using gloved hands, and the breadsticks were still served. The DM attempted to correct these unsanitary practices during the service but was unsuccessful. The Maintenance Director (MD) stated that the ice machine was cleaned monthly, but he did not notice the substance on the lid, focusing instead on the ice compartment.
Failure to Implement Enhanced Barrier Precautions
Penalty
Summary
The facility failed to implement Enhanced Barrier Precautions (EBP) for residents with chronic wounds or indwelling devices, which are at increased risk for multidrug-resistant organism (MDRO) acquisition. This deficiency was observed in three residents, including one who was admitted with an enteral feeding tube and another with a suprapubic catheter. The facility's policy required gown and glove use during high-contact care activities for such residents, but this was not followed. In one instance, a Hospice Registered Nurse provided care to a resident with an enteral feeding tube without wearing a gown, despite the facility's policy. The nurse was not informed about the EBP requirements and stated that the facility had not communicated the need for such precautions. Similarly, the Assistant Director of Nursing and a Licensed Practical Nurse also failed to wear gowns while administering medications and tube feeding to the same resident. Another resident with a suprapubic catheter did not have EBP signage or PPE supplies available at the room entrance. Staff members confirmed that they only wore gloves during catheter care and were not aware of the EBP requirements. The Director of Nursing acknowledged that the facility had not yet implemented EBP, although preparations were underway. This lack of implementation created the potential for the spread of MDROs throughout the facility.
Failure to Report Alleged Verbal Abuse
Penalty
Summary
The facility failed to report an allegation of verbal abuse involving a resident to the State Survey Agency (SSA). The incident involved a resident with intact cognition who reported being verbally abused by a Certified Nursing Assistant (CNA). The resident had previously undergone a procedure affecting her memory but recalled the CNA using foul language and being physically abusive. The resident had documented the incident and submitted it to the former Assistant Director of Nursing (ADON), who then passed it to the former Administrator. However, there was no evidence that the allegation was reported to the SSA or that an investigation was conducted. Interviews with staff revealed that the former ADON was aware of the resident's complaint but did not ensure it was reported to the state. The CNA involved was informed by a charge nurse not to provide care to the resident but was not interviewed or asked to provide a statement regarding the allegations. The Director of Nursing (DON) acknowledged that the allegations should have been reported to ensure resident safety and that the staff involved should have been removed from the care area pending investigation. The lack of documentation and follow-up on the allegations highlights the facility's failure to adhere to its abuse prevention and reporting policy.
Failure to Investigate Allegation of Verbal Abuse
Penalty
Summary
The facility failed to thoroughly investigate an allegation of verbal abuse involving a resident, identified as R37, who had intact cognition and was admitted with diagnoses including depression and anxiety. R37 reported being verbally abused by a Certified Nursing Assistant (CNA7) and provided a detailed written account of the incident to the former Assistant Director of Nursing (FADON), who then passed it to the former Administrator. Despite this, there was no documentation or evidence of a thorough investigation into the allegations, as required by the facility's abuse prevention policy. R37 expressed discomfort seeing CNA7, who was still working in the same hall, as it brought back unpleasant memories. Interviews with the FADON and CNA7 revealed that the allegations were not properly documented or investigated. The FADON acknowledged receiving a report from R37 about CNA7's rudeness but did not recall specific details or document the incident. CNA7 confirmed being informed by a charge nurse not to provide care to R37 but was never interviewed or asked to provide a statement regarding the allegations. The Director of Nursing (DON) confirmed that the allegations should have been investigated to ensure resident safety, highlighting a failure in the facility's response to the reported abuse.
Care Plan Inaccuracies and Lack of Hospice Coordination
Penalty
Summary
The facility failed to revise the care plan for two residents, leading to inaccuracies in their medical records and care coordination. For one resident, the care plan inaccurately included a diagnosis of dehydration, which was not current. The resident's care plan included interventions such as monitoring fluid intake and output and conducting lab work, but there were no orders or documentation to support these interventions. Interviews with the Director of Nursing (DON) and other staff revealed that the care plan was not updated from a previous admission, and the process for verifying and updating care plans was not adequately followed. Another resident's care plan failed to address hospice services despite the resident being admitted to hospice care. The care plan mentioned a terminal prognosis related to Alzheimer's disease but did not include goals or interventions for hospice care. The collaborative care plan in the hospice binder outlined the hospice services to be provided, but this information was not incorporated into the resident's care plan. Interviews with staff, including the MDS Coordinator, indicated that the care plan should have been updated to reflect hospice services and coordination of care, but this was not done in a timely manner. The lack of coordination and communication between facility staff and hospice providers was evident, as the care plan did not reflect the necessary hospice services. The facility did not have a policy in place to ensure coordination of care between the facility and hospice providers, leading to gaps in the care plan. The DON acknowledged that the care plan should have included hospice services to ensure proper communication and care delivery by the direct care staff.
Failure to Implement Pressure Ulcer Prevention and Treatment
Penalty
Summary
The facility failed to implement pressure ulcer treatment orders and prevention measures for a resident, leading to potential wound deterioration or the development of avoidable pressure ulcers. The resident, who was admitted with diagnoses including dementia, venous insufficiency, muscle weakness, and peripheral vascular disease, was at risk for pressure ulcers. Despite having a care plan that included floating heels and following treatment orders, the facility did not ensure these measures were consistently implemented. A wound was identified on the resident's left outer foot, but the treatment order was not correctly entered into the electronic medical record (EMR) system, resulting in the treatment not being scheduled or documented as performed. The wound was later noted to be healed, but there was no documentation of the treatment being administered. Additionally, the Infection Preventionist/Wound Care Nurse admitted to not completing any assessments of the wound, which was a deviation from the typical protocol. Furthermore, the resident was observed multiple times without heel protectors or floated heels, despite having an order for heel protectors to be used as tolerated. Staff members confirmed that they had not been instructed to apply heel protectors or float the resident's heels, and no heel protectors were found in the resident's room. This lack of adherence to the care plan and treatment orders contributed to the deficiency identified in the facility's care practices.
Failure to Document and Justify PRN Psychotropic Medication Use
Penalty
Summary
The facility failed to ensure a resident was free from unnecessary medications when a resident was administered two separate doses of psychotropic medications without any documented clinical need. The resident, who had severe cognitive impairment and was prescribed antipsychotic medication, was given Lorazepam and Haloperidol on the same day. The Treatment Administration Record indicated that Lorazepam was administered and noted as effective, yet Haloperidol was also given shortly after without any documented behaviors of agitation or restlessness. Interviews with the Registered Nurse and the Director of Nursing revealed that staff should have documented the resident's behaviors and justification for the use of PRN medications in the progress notes. They also stated that if the initial dose was effective, a second dose should not have been administered. The lack of documentation and the unnecessary administration of a second dose of medication were identified as inappropriate actions, leading to the deficiency.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 537 citations issued within 25 miles in the last 12 months — including the 15 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Kansas City
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Ignite Medical Resort Kansas City, Llc | 2.1 mi | — | 11 | 0 |
| Parkview Healthcare | 3.4 mi | — | 6 | 1 |
| Mccrite Plaza At Briarcliff Skilled Facility | 3.6 mi | — | 3 | 0 |
| Linden Woods Village | 4.4 mi | — | 0 | 0 |
| Pleasant Valley Manor Care Center | 4.6 mi | — | 0 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Northland Rehabilitation & Health Care Center.
100% money-back within 48 hours.
Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.