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Leisure Terrace

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About Leisure Terrace

General Information

Legal Business NameLeisure Terrace LLC
Ownership TypeFor Profit - Corporation
Changed Ownership In The Last 12 MonthsNo
First Accepted MedicareFebruary 12, 1989 (29 years)
Capacity248
Residents91
Percent Occupied37%
Program ParticipationMedicare And Medicaid
Resident And Family CouncilsBoth
In HospitalNo
Continuing Care Retirement CommunityNo
Special Focus FacilityNo
Auto Sprinkler System In Required AreasYes

Ratings for Leisure Terrace

Leisure Terrace
was reviewed by Medicare to have a rating of 1 out of 5. About Medicare Ratings
Overall Rating
Health Inspections Rating
Quality Measures Rating
Staff Rating
RN Staff Rating

Overall Ratings of Kansas Nursing Homes

Fines, Complaints, and Inspection Problems in the Past 3 Years

Compare The Number of Problems

Types of Problems at Nursing Homes

Some issues within a nursing home are much more severe than others. Medicare evaluates each problem based on 2 scales: the number of residents affected by a problem and the severity of the potential or actual harm to residents based on the problem. We have color coded the matrix below to make it easier to pick out the more severe problems. In general, orange and red issues related to the treatment of a resident are considered substandard quality of care.

  Residents Affected
Severity of the Deficiency Few Some Many
Immediate jeopardy to resident health or safety J K L
Actual harm that is not immediate jeopardy G H I
No actual harm with potential for more than minimal harm that is not immediate jeopardy D E F
No actual harm with potential for minimal harm A B C

October 24, 2016 - 10 months ago

 Residents AffectedSeveritySource/TypeDescription
FManyPotential for HarmComplaintStore, cook, and serve food in a safe and clean way.
FManyPotential for HarmComplaintHave a program that investigates, controls and keeps infection from spreading.
FManyPotential for HarmComplaintSet up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action.
FManyPotential for HarmComplaintHire sufficient dietary support personnel.
FManyPotential for HarmComplaintHave enough nurses to care for every resident in a way that maximizes the resident's well being.
ESomePotential for HarmComplaintMaintain drug records and properly mark/label drugs and other similar products according to accepted professional standards.
DFewPotential for HarmComplaintEnsure that each resident who enters the nursing home without a catheter is not given a catheter, unless medically necessary, and that incontinent patients receive proper services to prevent urinary tract infections and restore normal bladder functions.
DFewPotential for HarmComplaintProvide care by qualified persons according to each resident's written plan of care.
DFewPotential for HarmComplaintAt least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor.
DFewPotential for HarmComplaintEnsure that residents with limited range of motion receive appropriate treatment and services to increase range of motion or prevent further decrease in range of motion.
DFewPotential for HarmComplaintAllow residents the right to participate in the planning or revision of care and treatment.
DFewPotential for HarmComplaintProperly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses.
DFewPotential for HarmComplaintEnsure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being.

September 22, 2016 - 11 months ago

 Residents AffectedSeveritySource/TypeDescription
DFewPotential for HarmComplaintEnsure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents.

August 30, 2016 - 12 months ago

 Residents AffectedSeveritySource/TypeDescription
FManyPotential for HarmComplaint+InspectionHire sufficient dietary support personnel.
FManyPotential for HarmComplaint+InspectionUse a registered nurse at least 8 hours a day, 7 days a week.
FManyPotential for HarmComplaint+InspectionStore, cook, and serve food in a safe and clean way.
FManyPotential for HarmComplaint+InspectionHave a program that investigates, controls and keeps infection from spreading.
FManyPotential for HarmComplaint+InspectionSet up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action.
FManyPotential for HarmComplaint+InspectionHave enough nurses to care for every resident in a way that maximizes the resident's well being.
GFewActual HarmComplaint+InspectionEnsure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents.
ESomePotential for HarmComplaint+InspectionProvide housekeeping and maintenance services.
ESomePotential for HarmComplaint+InspectionPrepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.
ESomePotential for HarmComplaint+InspectionAt least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor.
ESomePotential for HarmComplaint+InspectionMaintain drug records and properly mark/label drugs and other similar products according to accepted professional standards.
ESomePotential for HarmComplaint+InspectionEnsure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being.
ESomePotential for HarmComplaint+InspectionDevelop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
DFewPotential for HarmComplaint+InspectionProvide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse.
DFewPotential for HarmComplaint+InspectionProvide activities to meet the interests and needs of each resident.
DFewPotential for HarmComplaint+InspectionGive residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.
DFewPotential for HarmComplaint+InspectionProvide necessary care and services to maintain or improve the highest well being of each resident .
DFewPotential for HarmComplaint+InspectionReasonably accommodate the needs and preferences of each resident.
DFewPotential for HarmComplaint+InspectionGive notice to the resident before a room or roommate change.
DFewPotential for HarmComplaint+InspectionMake sure that special or therapeutic diets are ordered by the attending doctor.
DFewPotential for HarmComplaint+InspectionEnsure that each resident who enters the nursing home without a catheter is not given a catheter, unless medically necessary, and that incontinent patients receive proper services to prevent urinary tract infections and restore normal bladder functions.
DFewPotential for HarmComplaint+InspectionProperly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses.
DFewPotential for HarmComplaint+InspectionGive each resident enough fluids to keep them healthy and prevent dehydration.
DFewPotential for HarmComplaint+InspectionGive proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible.
DFewPotential for HarmComplaint+InspectionAllow residents the right to participate in the planning or revision of care and treatment.
DFewPotential for HarmComplaint+InspectionEnsure that residents with limited range of motion receive appropriate treatment and services to increase range of motion or prevent further decrease in range of motion.
DFewPotential for HarmComplaint+InspectionEnsure each resident receives an accurate assessment by a qualified health professional.
DFewPotential for HarmHealth InspectionProvide care by qualified persons according to each resident's written plan of care.

July 10, 2015 - 2 years ago

 Residents AffectedSeveritySource/TypeDescription
DFewPotential for HarmComplaintKeep accurate, complete and organized clinical records on each resident that meet professional standards.
DFewPotential for HarmComplaintProperly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses.
DFewPotential for HarmComplaintDevelop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

March 3, 2015 - 2 years ago

 Residents AffectedSeveritySource/TypeDescription
FManyPotential for HarmComplaint+InspectionStore, cook, and serve food in a safe and clean way.
FManyPotential for HarmComplaint+InspectionKeep accurate, complete and organized clinical records on each resident that meet professional standards.
ESomePotential for HarmComplaint+InspectionMaintain drug records and properly mark/label drugs and other similar products according to accepted professional standards.
ESomePotential for HarmComplaint+InspectionMake sure that a working call system is available in each resident's room or bathroom and bathing area.
ESomePotential for HarmComplaint+InspectionEnsure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents.
CManyPotential for Minimal HarmComplaint+InspectionAllow residents to easily view the results of the nursing home's most recent inspection.
CManyPotential for Minimal HarmComplaint+InspectionGive residents a notice of rights, rules, services and charges.
DFewPotential for HarmComplaint+InspectionMake sure that residents receive treatments/services to maintain or improve their ability to care for themselves.
DFewPotential for HarmComplaint+InspectionUpon the death of a resident, convey the residentís personal funds and an accounting of those funds to the appropriate party.
DFewPotential for HarmComplaint+InspectionDevelop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
DFewPotential for HarmComplaint+InspectionAllow residents the right to participate in the planning or revision of care and treatment.
DFewPotential for HarmComplaint+InspectionEnsure that residents with limited range of motion receive appropriate treatment and services to increase range of motion or prevent further decrease in range of motion.

September 25, 2014 - 3 years ago

 Residents AffectedSeveritySource/TypeDescription
DFewPotential for HarmComplaintProvide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse.
DFewPotential for HarmComplaintKeep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.

August 26, 2014 - 3 years ago

 Residents AffectedSeveritySource/TypeDescription
DFewPotential for HarmComplaintAssist those residents who need help with eating/drinking, grooming and personal and oral hygiene.
DFewPotential for HarmComplaintProvide necessary care and services to maintain or improve the highest well being of each resident .

July 3, 2014 - 3 years ago

 Residents AffectedSeveritySource/TypeDescription
---Payment DenialPayment denial for 46 days
---Fine$16,200 fine

Staffing Levels Per Resident per Day

Medicare determines the expected staffing time per resident per day depending on level of care the residents of Leisure Terrace require. It is important to compare the reported time to expected time for a single facility instead of comparing the amount of time per resident of two facilities. Learn why.

1hr 60min
2hr 20min
ReportedExpected
CNA
60min
40min
ReportedExpected
LPN
25min
50min
ReportedExpected
RN
3hr 20min
3hr 50min
ReportedExpected
Total Nursing

This facility also provides approximately 10min per resident per WEEK of physical therapist time.

Quality Measures for Long Stay Residents

93.9%
97.7%
97.7%
97.7%
95.4%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine
98.8%
89.0%
91.0%
95.1%
92.8%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine
54.8%
40.0%
38.7%
33.3%
39.7%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of low risk long-stay residents who lose control of their bowels or bladder
30.7%
25.3%
25.0%
19.7%
24.3%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents who received an antianxiety or hypnotic medication
16.7%
50.9%
33.3%
32.9%
19.3%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents whose ability to move independently worsened
30.1%
29.2%
30.4%
22.2%
20.2%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents who received an antipsychotic medication
15.1%
28.4%
25.0%
22.9%
16.7%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents whose need for help with daily activities has increased
6.5%
6.3%
6.6%
11.1%
10.4%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents who self-report moderate to severe pain
2.4%
6.1%
9.3%
6.3%
7.5%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents who lose too much weight
6.5%
6.6%
9.4%
2.0%
5.2%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of high risk long-stay residents with pressure ulcers
1.4%
0.0%
1.4%
1.3%
6.4%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents who have depressive symptoms
1.2%
1.2%
0.0%
3.8%
6.0%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents with a urinary tract infection
1.2%
4.9%
3.8%
4.9%
4.8%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents experiencing one or more falls with major injury
1.1%
2.3%
1.9%
2.8%
2.6%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents with a catheter inserted and left in their bladder
0.0%
0.0%
0.0%
0.0%
0.2%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of long-stay residents who were physically restrained

Quality Measures for Short Stay Residents

86.1%
55.2%
67.7%
51.7%
76.2%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine
72.4%
64.3%
64.3%
64.3%
74.2%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine
-
-
-
-
69.5%
Q4 2015Q1 2016Q2 2016Q3 2016KS
* The data for this facility for some quarters is unavailable.
Percentage of short-stay residents who made improvements in function
14.3%
-
38.1%
-
20.9%
Q4 2015Q1 2016Q2 2016Q3 2016KS
* The data for this facility for some quarters is unavailable.
Percentage of short-stay residents who self-report moderate to severe pain
-
-
-
-
2.7%
Q4 2015Q1 2016Q2 2016Q3 2016KS
* The data for this facility for some quarters is unavailable.
Percentage of short-stay residents who newly received an antipsychotic medication
0.0%
2.5%
2.9%
0.0%
1.9%
Q4 2015Q1 2016Q2 2016Q3 2016KS
Percentage of short-stay residents with pressure ulcers that are new or worsened