The nursing home failed to provide proper pressure ulcer care and failed to prevent new pressure sores from developing. Cited January 2026 — isolated incident, actual harm.
View the original federal record
F-Tag 686 — 42 CFR §483.25(b) — S/S: G
Nursing home report
TONGANOXIE TERRACE
TONGANOXIE, KS · Medicare-certified · 90 beds
Needs attention
For-profit
Data as of September 1, 2026
1 of 5 overall
Tonganoxie Terrace in Tonganoxie, KS has a 1 out of 5 star overall rating, with 1-star health inspection, staffing, and quality measures ratings. Reported nurse staffing is 3.0 hours per resident per day, below the federal benchmark of 4.1, and the facility had $22,048 in fines in the last 24 months plus a recent federal penalty.
Facility ratings
Health inspections
Staffing
2.9969 hrs/resident/day
Quality measures
Last inspection: June 23, 2026Penalties, last 24 months: $22,048recent federal penalty
Federal guidance recommends at least 4.1 nursing hours per resident each day. This facility reports 2.9969.
Staffing detail
- Registered nurses
- 0.42
- Licensed practical nurses
- 0.51
- Nurse aides
- 2.07
- Weekend nursing
- 2.71
Hours per resident per day.
Total staff turnover: 69%
Registered nurse turnover: 56%
Resident outcomes
Each measure compares a year ago with the most recent quarter. Green means the facility moved the right way; red means the wrong way.
Negative outcomes
Lower is better — fewer affected residents. A decrease is good (green); an increase is concerning (red).
Long-stay residents on antipsychotic medication
2.3%11.4%Worsening
Residents with a fall causing major injury
2.8%1.7%Improving
Residents with pressure ulcers (bedsores)
3.1%7%Worsening
Residents with a urinary tract infection
8.8%3.5%Improving
Residents who lost too much weight
11.1%5.8%Improving
Residents who were physically restrained
0%0%No change
Residents needing more help with daily activities
10.5%15.4%Worsening
Residents whose ability to walk got worse
5.5%20.4%Worsening
Long-stay residents on antianxiety or sleep medication
20.7%18.2%Improving
Short-stay residents newly given an antipsychotic
12%7.7%Improving
Residents with a long-term catheter
2.1%6.1%Worsening
Residents with new or worsening incontinence
8.7%8%Improving
Residents with depressive symptoms
23.8%7.4%Improving
Positive outcomes
Higher is better — e.g. vaccinations. An increase is good (green); a decrease is concerning (red).
Long-stay residents given the seasonal flu vaccine
—95.3%—
Long-stay residents given the pneumonia vaccine
88.9%76.3%Worsening
Short-stay residents given the seasonal flu vaccine
—82.4%—
Short-stay residents given the pneumonia vaccine
52.5%23.8%Worsening
What the inspectors found
The home failed to make notices available in a format and language the resident could understand. Cited January 2026 — widespread issue, potential for harm.
View the original federal record
F-Tag 574 — 42 CFR §483.10 — S/S: F
The nursing home failed to make survey results easy for residents to see and to help them contact advocate agencies. Cited January 2026 — widespread issue, potential for harm.
View the original federal record
F-Tag 577 — 42 CFR §483.10 — S/S: F
The home failed to conduct and document a full facility assessment to ensure it had the resources needed for daily care and emergencies. Cited January 2026 — widespread issue, potential for harm.
View the original federal record
F-Tag 838 — 42 CFR §483.70 — S/S: F
The nursing home failed to provide and carry out an infection prevention and control program to help keep residents from getting or spreading infections. Cited March 2024 — widespread issue, potential for harm.
View the original federal record
F-Tag 880 — 42 CFR §483.80(a) — S/S: F
Recent history
- STAFFING
Reported nurse staffing was below the federal recommendation of 4.1 hours per resident per day.
- INSPECTION
Health inspection found 1 health deficiency.
See what inspectors found
- INSPECTION
Health inspection found 1 health deficiency.
See what inspectors found
- PENALTY
A federal fine of $22,048 was recorded.
- PENALTY
A federal payment denial was recorded.
- PENALTY
A federal fine of $33,920 was recorded.
- STAFFING
Reported nurse staffing was below the federal recommendation of 4.1 hours per resident per day.
- INSPECTION
Health inspection found 15 health deficiencies.
See what inspectors found
- INSPECTION
Health inspection found 3 health deficiencies.
See what inspectors found
- INSPECTION
Health inspection found 16 health deficiencies.
See what inspectors found
Penalties & enforcement
On record with Medicare: 1 fine · $22,048 in total fines · 1 payment denial.
- 1 days
Medicare/Medicaid payment denial
Jan 29, 2026
- $22,048
Federal fine
Jan 29, 2026
Operator & ownership
Recent ownership change · Nov 1, 2023
Now operated by Tonganoxie Opco LLC, previously Legend Healthcare LLC.
- Ownership
- For profit - Limited Liability company
- Occupancy
- 69 residents on an average day (77% of 90 beds)
- Resident voice
- Resident council
- Medicare history
- Certified for 34 years
Things at a nursing home change — inspections, staffing, ownership, news.
Source: Centers for Medicare & Medicaid Services — public records, updated monthly. GoodStanding presents official records with plain-language summaries. Always visit a facility in person.