Above average — CMS composite of the measures below.
The next survey window likely opens around December 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Hillside Village Of De Soto Rehabilitation And Nur during CMS and state inspections, most recent first.
Expired vanilla Magic Cups were found stored for resident use in both the kitchenette and medication room refrigerator. Dietary staff and an RN verified the products were past expiration, and the facility’s food handling policy required safe, sanitary storage with items labeled and dated.
The facility failed to maintain a QA&A committee with the required membership in attendance. Review of committee rosters showed the Medical Director’s signature was missing from nearly all monthly meetings, with only one roster signed. Administrative staff stated the Medical Director had only signed one of the monthly meeting rosters, while the facility policy required the DON, Medical Director, Administrator, Infection Preventionist, and at least two other members to meet at least quarterly.
Failure to Notify LTCO of Hospital Discharges: The facility did not notify the LTCO of four residents’ facility-initiated hospital transfers. Records showed residents with significant medical conditions and varying levels of cognitive and functional impairment were sent out for issues such as decreased mental status, seizure activity, pneumonia-related fatigue, stroke-like symptoms, and abnormal labs. Social Services and an administrative nurse stated they were uncertain about the notification process, and the monthly discharge report used for LTCO notice did not capture all required residents.
Medication Administration Error: A resident with hypothyroidism, GERD, anemia, dysphagia, and severe cognitive impairment was given Levothyroxine, Omeprazole, and Ferrous Sulfate crushed together in yogurt at the same time, despite orders not to administer the Ferrous Sulfate with the other two meds and to give Levothyroxine on an empty stomach. A CMA later confirmed she overlooked the instructions, and an admin nurse verified the meds should not have been given together.
Improper Storage of Oxygen Equipment: Staff failed to store a resident’s unbagged oxygen tubing and nasal cannula in a sanitary manner. The tubing and cannula were observed draped over the wheelchair handle and attached to the O2 cannister, with the cannula hanging close to the floor. The facility’s policy required oxygen equipment to be kept clean and sanitary and masks or cannulas not in use to be stored in a plastic bag.
Expired nutritional supplements stored for resident use
Penalty
Summary
Food was not stored and prepared in a sanitary manner for residents receiving meals from the facility kitchenette. During lunch meal service observation, a two-door refrigerator/freezer in the kitchenette contained one box of frozen vanilla Magic Cup nutritional supplement with an expiration date of 10/16/25, and four of the cups had already been removed from the box. Dietary Staff BB later verified that the product had expired and stated the expiration date should be checked when the product was stocked in the kitchenette. A subsequent tour of the medication room found 95 vanilla Magic Cups in the refrigerator with an expiration date of 10/11/25. Administrative Nurse D verified the expired date and stated the cups would be discarded. The facility’s General Food Handling/Storage/Preparation policy stated that food and fluids would be stored, handled, and consumed safely and sanitarily, and that refrigerated items would be covered, labeled, dated, and given an expiration date.
QA&A Committee Lacked Required Medical Director Participation
Penalty
Summary
The facility failed to maintain a Quality Assessment and Assurance (QA&A) Committee with the required membership in attendance. Review of the QA&A committee attendance signed roster for monthly meetings held from 01/27/25 through 12/17/25 showed that the Medical Director’s signature was absent from the roster except for 08/29/25. On 01/06/25 at 11:31 AM, Administrative Staff A stated the Medical Director had only signed one of the monthly meeting rosters and said they would be working on scheduling QA&A meetings quarterly with the Medical Director present. The facility’s Quality Assurance and Performance Improvement policy, dated 04/2025, stated the committee would include the DON, Medical Director, Administrator, Infection Preventionist, and at least two other members, and would meet at least quarterly or more often as needed.
Failure to Notify LTCO of Hospital Discharges
Penalty
Summary
The facility failed to notify the State Long Term Care Ombudsman (LTCO) of facility-initiated discharges to the hospital for four residents. The report states that the facility’s policies required that when a resident is transferred or discharged, the discharge be documented in the medical record and a copy of the notice be sent to the State Long-Term Care Ombudsman. In interviews, Social Services and Administrative Nurse staff acknowledged uncertainty about the notification requirements and how the process was being handled. One resident had multiple hospital transfers and returns documented in the record, including episodes of not feeling well with nausea and diaphoresis, decreased mental status, and a seizure, after which the resident was sent to the hospital and later returned. The resident’s record showed significant medical complexity, including CHF, atrial fibrillation, COPD, dementia, paranoid schizophrenia, sleep disorder, and DM, and the quarterly MDS documented moderately impaired cognition and dependence for several ADLs. Social Services reported that the monthly discharge information used to notify the Ombudsman did not include this resident’s hospital discharges. A second resident with PVD, DM with foot ulcer, CHF, major depressive disorder, and atherosclerotic heart disease was sent to the hospital after extreme fatigue and not improving while being treated for pneumonia, then returned to the facility. A third resident with atherosclerotic heart disease, chronic respiratory failure, asthma, and hypoxia was sent to the emergency room after abnormal vital signs, grayish skin, inability to arouse, facial drooping, and slurred speech, then returned to the facility; the clinical record lacked documentation that the LTCO was notified. A fourth resident with DM, atrial fibrillation, PVD, CKD, quadriplegia, and weakness was sent to the hospital for abnormal labs, hyponatremia, cellulitis, and malaise, then returned to the facility; the record also lacked documentation of LTCO notification. Social Services stated the monthly discharge report used for Ombudsman notification did not identify Medicare residents correctly and that the omitted discharges were not sent.
Medication Administration Error
Penalty
Summary
The facility failed to administer R6’s medications as prescribed and instructed. R6 had diagnoses including hypothyroidism, GERD, severe protein-calorie malnutrition, dysphagia, muscle weakness, need for assistance with personal care, and vascular dementia. The quarterly MDS documented severe cognitive impairment, wheelchair use, and partial to moderate assistance needs for toileting, dressing, bed mobility, and transfers. The care plan addressed anticoagulant, diuretic, antidepressant, antianxiety, and nutritional problems, but did not include instructions related to hypothyroidism or GERD medications or conditions. Physician orders directed staff to give Levothyroxine 100 mcg by mouth daily on an empty stomach for hypothyroidism, Omeprazole 40 mg by mouth twice daily for GERD, and Ferrous Sulfate 325 mg by mouth in the morning for anemia, with instructions not to administer the Ferrous Sulfate with Omeprazole or Levothyroxine. A CMA prepared R6’s morning medications and gave the Ferrous Sulfate, Levothyroxine, and Omeprazole crushed together and mixed in yogurt at the same time. Later that day, the CMA reviewed the EMAR and confirmed she had overlooked the instructions not to give the Ferrous Sulfate with Omeprazole or Levothyroxine. An administrative nurse verified the medications should not have been administered together.
Improper Storage of Oxygen Equipment
Penalty
Summary
The facility failed to implement acceptable infection control practices when staff did not properly store Resident 14’s oxygen tubing and nasal cannula in a sanitary manner. On 01/05/26 at 10:45 AM, observation showed the resident’s unbagged oxygen tubing and nasal cannula draped over the handle of her wheelchair and attached to the oxygen cannister behind the wheelchair. On 01/06/26 at 07:45 AM, the same unbagged tubing and nasal cannula were again observed draped over the wheelchair handle, attached to the oxygen cannister behind the wheelchair, with the nasal cannula approximately 10 inches from the floor. Administrative Nurse D stated on 01/06/26 at 04:10 PM that oxygen tubing and cannulas should be stored in a bag when not in use. The facility’s Oxygen Storage policy, dated 01/2022, stated that oxygen equipment would be maintained in a clean and sanitary manner and that masks or cannulas not temporarily in use would be stored in a plastic bag.
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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.
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Nursing homes near De Soto
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Medicalodges Eudora | 7.2 mi | ★★★★★ | 1 | 1 |
| Bonner Springs Nursing & Rehab Center | 8.1 mi | ★★★★★ | 0 | 0 |
| Evergreen Community Of Johnson County | 8.4 mi | ★★★★★ | 2 | 0 |
| Kaw River Care And Rehab | 10.2 mi | ★★★★★ | 0 | 0 |
| Parkway Operator Llc | 10.2 mi | ★★★★★ | 0 | 0 |
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