Colonial Village is a nursing home approved by U.S Centers for Medicare & Medicaid Services (CMS). The federal provider number is #175560. The provider type is Medicare and Medicaid. The ownership type is for profit - corporation. The address is 12500 W 137th St, Overland Park, KS 66221. The overall rating is 5.
| Federal Provider Number | 175560 |
| Provider Name | COLONIAL VILLAGE |
| Legal Business Name | CCRC OF OVERLAND PARK LLC |
| Address |
12500 W 137th St Overland Park KS 66221 |
| County | Johnson |
| Telephone | 9137303700 |
| Ownership Type | For profit - Corporation |
| Provider Type | Medicare and Medicaid |
| Date Approved | 2018-12-12 |
| Number of Certified Beds | 40 |
| Average Number of Residents per Day | 28.7 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | Y |
| Abuse Icon |
N Cited for abuse or neglect at harm level or above on survey cycle 1 (Scope/severity G or greater) or cited for abuse or neglect at potential harm level (Scope/Severity D or above) on both survey cycles 1 and 2. |
| Most Recent Health Inspection More Than 2 Years Ago | N |
| Provider Changed Ownership in Last 12 Months | N |
| With a Resident and Family Council | Resident |
| Automatic Sprinkler Systems in All Required Areas | Yes |
| Overall Rating | 5 |
| Health Inspection Rating | 5 |
| Quality Measure Rating | 3 |
| Long Stay Quality Measure Rating | 1 |
| Short Stay Quality Measure Rating | 5 |
| Staffing Rating | 4 |
| Registered Nurses Staffing Rating | 4 |
| Reported CNA Staffing Hours per Resident per Day | 2.82249 |
| Reported LPN Staffing Hours per Resident per Day | 0.88515 |
| Reported RN Staffing Hours per Resident per Day | 0.98806 |
| Reported Licensed Staffing Hours per Resident per Day | 1.87321 |
| Reported Total Nurse Staffing Hours per Resident per Day | 4.69570 |
| Reported Physical Therapist Staffing Hours per Resident Per Day | 0.08922 |
| Expected CNA Staffing Hours per Resident per Day | 2.08209 |
| Expected LPN Staffing Hours per Resident per Day | 0.68437 |
| Expected RN Staffing Hours per Resident per Day | 0.38627 |
| Expected Total Nurse Staffing Hours per Resident per Day | 3.15272 |
| Adjusted CNA Staffing Hours per Resident per Day | 2.79091 |
| Adjusted LPN Staffing Hours per Resident per Day | 0.95828 |
| Adjusted RN Staffing Hours per Resident per Day | 1.02367 |
| Adjusted Total Nurse Staffing Hours per Resident per Day | 4.76596 |
| Rating Cycle 1 Standard Survey Health Date | 2019-12-04 |
| Rating Cycle 1 Total Number of Health Deficiencies | 3 |
| Rating Cycle 1 Number of Standard Health Deficiencies | 3 |
| Rating Cycle 1 Number of Complavarchar Health Deficiencies | 0 |
| Rating Cycle 1 Health Deficiency Score | 16 |
| Rating Cycle 1 Number of Health Revisits | 1 |
| Rating Cycle 1 Health Revisit Score | 0 |
| Rating Cycle 1 Total Health Score | 16 |
| Rating Cycle 2 Standard Health Survey Date | 2018-12-12 |
| Rating Cycle 2 Total Number of Health Deficiencies | 0 |
| Rating Cycle 2 Number of Standard Health Deficiencies | 0 |
| Rating Cycle 2 Number of Complavarchar Health Deficiencies | 0 |
| Rating Cycle 2 Health Deficiency Score | 0 |
| Rating Cycle 2 Number of Health Revisits | 0 |
| Rating Cycle 2 Health Revisit Score | 0 |
| Rating Cycle 2 Total Health Score | 0 |
| Total Weighted Health Survey Score | 9.600 |
| Number of Facility Reported Incidents | 0 |
| Number of Substantiated Complavarchars | 0 |
| Number of Citations from Infection Control Inspections | 0 |
| Number of Fines | 0 |
| Total Amount of Fines in Dollars | 0.00 |
| Number of Payment Denials | 0 |
| Total Number of Penalties | 0 |
| Processing Date | 2021-05-01 |
| Notes |
CMS: Centers for Medicare & Medicaid Services CNA: Certified Nursing Assistant LPN: Licensed Practical Nurse RN: Registered Nurse |
| Role Played | Owner Name | Owner Type | Ownership Percentage | Association Date |
|---|---|---|---|---|
| 5% OR GREATER DIRECT OWNERSHIP INTEREST | POKY-5R LLC | Organization | 9% | since 11/15/2018 |
| 5% OR GREATER DIRECT OWNERSHIP INTEREST | SCENIC DEVELOPMENT LLC | Organization | 24% | since 11/15/2018 |
| 5% OR GREATER INDIRECT OWNERSHIP INTEREST | ANDERSON, WAYNE | Individual | 6% | since 11/15/2018 |
| 5% OR GREATER INDIRECT OWNERSHIP INTEREST | CADET INVESTMENT LLC | Organization | 6% | since 11/15/2018 |
| 5% OR GREATER INDIRECT OWNERSHIP INTEREST | GRW LLC | Organization | 6% | since 11/15/2018 |
| 5% OR GREATER INDIRECT OWNERSHIP INTEREST | GULLEDGE, SCOTT | Individual | 6% | since 11/15/2018 |
| 5% OR GREATER INDIRECT OWNERSHIP INTEREST | SEGC LLC | Organization | 6% | since 11/15/2018 |
| 5% OR GREATER INDIRECT OWNERSHIP INTEREST | WAYNE C ANDERSON LEGACY TRUST | Organization | 6% | since 11/15/2018 |
| 5% OR GREATER INDIRECT OWNERSHIP INTEREST | WOOD, GILBERT | Individual | 6% | since 11/15/2018 |
| 5% OR GREATER INDIRECT OWNERSHIP INTEREST | WSG LLC | Organization | 18% | since 11/15/2018 |
| MANAGING EMPLOYEE | BLIM, RICHARD | Individual | since 11/15/2018 | |
| OPERATIONAL/MANAGERIAL CONTROL | GULLEDGE, SCOTT | Individual | since 11/15/2018 | |
| OPERATIONAL/MANAGERIAL CONTROL | PIVOTAL HEALTH CARE LLC | Organization | since 11/15/2018 |
| Street Address |
12500 W 137TH ST |
| City | OVERLAND PARK |
| State | KS |
| Zip Code | 66221 |
| Nursing Home Name | Address | Telephone | Date Approved | Overall Rating |
|---|---|---|---|---|
| Shawnee Post Acute Rehabilitation Center · Maple Hills Healthcare, Inc. | 7600 Antioch Road, Overland Park, KS 66204 | 9133832001 | 2015-11-19 | 2 |
| The Forum At Overland Park · Snh Toto Tenant LLC | 3501 W 95th St, Overland Park, KS 66206 | 9136484980 | 1989-08-10 | 4 |
| Overland Park Center for Rehabilitation and Health · Leisure Operations LLC | 5211 W 103rd Street, Overland Park, KS 66207 | 9133832569 | 1989-02-12 | |
| Brookdale Overland Park · Bkd Hcr Master Lease 3 Tenant LLC | 12000 Lamar, Overland Park, KS 66209 | 9136632888 | 2010-06-28 | 4 |
| Infinity Park Post-Acute and Rehabilitation Center · Overland Park Ks Opco LLC | 6515 W 103rd Street, Overland Park, KS 66212 | 9136425545 | 1988-09-01 | 1 |
| Village Shalom Inc · Village Shalom, Inc | 5500 West 123rd St, Overland Park, KS 66209 | 9133172600 | 2000-10-31 | 2 |
| Kpc Promise Skilled Nursing Facility of Overland Park, LLC | 6505 W 103rd Street, Overland Park, KS 66212 | 9136495110 | 1993-03-01 | 4 |
| Advanced Health Care of Overland Park · Ahc of Overland Park, LLC | 4700 Indian Creek Parkway, Overland Park, KS 66207 | 9138908400 | 2014-06-11 | 5 |
| Garden Terrace At Overland Park · Overland Park Medical Investors LLC | 7541 Switzer Road, Overland Park, KS 66214 | 9136312273 | 1987-03-12 | 2 |
| Villa St Joseph · Carondelet Long Term Care Facilities Inc | 11901 Rosewood, Overland Park, KS 66209 | 9133451745 | 1989-03-20 | 3 |
| Find all nursing homes in the same city | ||||
| Nursing Home Name | Address | Telephone | Date Approved | Overall Rating |
|---|---|---|---|---|
| Infinity Park Post-Acute and Rehabilitation Center · Overland Park Ks Opco LLC | 6515 W 103rd Street, Overland Park, KS 66212 | 9136425545 | 1988-09-01 | 1 |
| Ccrc Opco - Cypress Village, LLC | 4600 Middleton Park Cir E, Jacksonville, FL 32224 | 9042236100 | 1991-10-14 | 5 |
| Nursing Center At Freedom Village, The · Ccrc Opco-Bradenton LLC | 6410 21st Ave W, Bradenton, FL 34209 | 9417988300 | 1989-06-23 | 4 |
| The Forum At Overland Park · Snh Toto Tenant LLC | 3501 W 95th St, Overland Park, KS 66206 | 9136484980 | 1989-08-10 | 4 |
| Delmar Gardens of Overland Park Operating LLC | 12100 W 109th Street, Overland Park, KS 66210 | 9134694210 | 1989-03-20 | 3 |
| Kpc Promise Skilled Nursing Facility of Overland Park, LLC | 6505 W 103rd Street, Overland Park, KS 66212 | 9136495110 | 1993-03-01 | 4 |
| Advanced Health Care of Overland Park · Ahc of Overland Park, LLC | 4700 Indian Creek Parkway, Overland Park, KS 66207 | 9138908400 | 2014-06-11 | 5 |
| Colonial Park Care Center, LLC | 800 King Russ Road, Harrisburg, PA 17109 | 7176571520 | 1977-12-01 | 1 |
| Northridge Village · Ccrc of Ames LLC | 3300 George Washington Carver Avenue, Ames, IA 50010 | 5152321000 | 2015-11-16 | 5 |
| Linden Woods Village · Ccrc of Gladstone LLC | 2901 Ne 72nd Street, Gladstone, MO 64119 | 8162684000 | 2016-06-27 | 5 |
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This dataset includes 15 thousand nursing homes approved by U.S Centers for Medicare & Medicaid Services (CMS) to provide Medicare & Medicaid services. CMS created Care Compare, a healthcare compare tool, for consumers to understand information about doctors, hospitals, and skilled nursing facilities. The information on nursing homes include number of certified beds, quality measure scores, staffing and other information used in the Five-Star Rating System.