Above average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
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 Ranch House Senior Living Llc during CMS and state inspections, most recent first.
Two dependent residents with cognitive and physical impairments did not receive the required number of bathing and grooming opportunities, including shaving, according to their preferences and needs. Documentation was incomplete, and staff did not consistently offer or record bathing and grooming services as required by facility policy. Observations confirmed both residents had visible beard stubble, and staff interviews highlighted inconsistent follow-up on refusals and lack of adherence to care plans.
Two residents at risk for pressure ulcers did not receive consistent and documented interventions as required by their care plans and physician orders. One resident with a pressure ulcer did not have proper heel offloading or a documented repositioning schedule, and an ordered offloading bootie was not provided. Another resident, fully dependent and cognitively impaired, was observed without a low air loss mattress as specified in the care plan, and developed open wounds with inconsistent documentation and communication among staff. Facility policy for skin assessment, documentation, and individualized interventions was not followed.
A resident with severe cognitive impairment and a history of falls suffered a significant injury after a fall, but the facility did not conduct or document an investigation to determine the cause or implement interventions. Staff interviews and record reviews confirmed the absence of required incident investigation, despite facility policy mandating thorough review and documentation of all falls.
The facility did not follow physician orders for blood pressure monitoring and medication administration parameters for three residents receiving antihypertensive medications. Medications were given without required blood pressure checks or outside of prescribed parameters, and staff did not consistently hold medications or notify physicians as directed. These actions were confirmed by both medication aides and nursing staff, and facility policy required proper monitoring to prevent unnecessary drug use.
A resident with cognitive intactness was exploited by a housekeeping staff member for approximately $100. The staff member, despite having received training on abuse and exploitation, obtained money under false pretenses and requested a loan for rent. The incident was discovered when the resident's family reviewed bank records and alerted the facility.
Failure to Provide Adequate Bathing and Grooming for Dependent Residents
Penalty
Summary
The facility failed to provide adequate bathing opportunities and grooming, specifically shaving, in accordance with the preferences and needs of two dependent residents. One resident with Alzheimer's disease and major depressive disorder was dependent on staff for all activities of daily living, including bathing and grooming. Documentation showed that this resident received only one shower over a four-week period, with only four bathing opportunities offered, despite the minimum requirement of eight unless otherwise indicated by resident preference. The care plan did not include the resident's bathing preferences or schedule, and there was a lack of documentation regarding bathing opportunities offered or refusals. Observations confirmed the resident had prominent beard stubble, and staff interviews revealed that shaving was typically provided during baths or as needed, but documentation and follow-up on refusals were inconsistent. Another resident with diabetes mellitus and end-stage renal disease also required moderate to maximal assistance with personal hygiene, including shaving, due to involuntary movements and cognitive impairment. The care plan indicated the resident preferred to maintain a mustache and would request shaving or trimming as needed. However, records showed only six bathing opportunities were offered over a similar period, with several refusals and instances where bathing was marked as non-applicable. Observations found the resident with prominent beard stubble and a mustache, and the resident expressed a desire for assistance with shaving. Staff interviews confirmed the resident's increasing need for help with personal hygiene due to worsening tremors, but documentation of offered and refused services was incomplete. Facility policy required that residents dependent on staff for activities of daily living receive necessary services to maintain grooming and personal hygiene, based on comprehensive assessment and resident choice. Despite this, both residents did not receive the minimum required bathing and grooming opportunities, and staff failed to consistently document offers and refusals or follow up as required. These deficiencies were confirmed through record review, staff interviews, and direct observation.
Failure to Provide and Document Pressure Ulcer Prevention and Care
Penalty
Summary
The facility failed to implement and document appropriate pressure ulcer prevention and care measures for two residents at risk for pressure injuries. For one resident with a history of decreased mobility, diabetes, and recent hospitalization, staff did not ensure consistent offloading of the heels or develop a documented repositioning plan, despite the presence of a left heel pressure ulcer. The resident's care plan directed side-to-side turning and repositioning in bed and chair, but the electronic health record (EHR) lacked a turn and repositioning program, and staff interviews revealed confusion about documentation requirements. Additionally, an ordered offloading bootie was not provided due to a missed order, and the resident's left heel was observed to be in direct contact with the mattress during inspection. Another resident with severe cognitive impairment and total dependence for activities of daily living was also at risk for pressure ulcers. The care plan specified the use of a low air loss mattress and pressure-relieving cushions, but the resident was observed with a regular mattress and no air mattress order was found in the physician's orders. The EHR and care plan lacked a documented turn and repositioning program, and staff interviews indicated that the resident had never had an air mattress as required. The resident developed open areas on the buttocks and lower shin, with inconsistent documentation and communication regarding wound assessments and interventions. Facility policy required skin assessments, Braden Scale evaluations, timely wound nurse assessments, and individualized care plans with specific wound healing interventions and repositioning schedules. However, these standards were not consistently followed for the residents reviewed, resulting in missed interventions, lack of documentation, and failure to provide required equipment and care as outlined in the residents' care plans and physician orders.
Failure to Investigate and Address Resident Fall Resulting in Injury
Penalty
Summary
The facility failed to provide an environment free from accident hazards and did not ensure adequate supervision to prevent accidents for two residents, specifically focusing on one resident with Alzheimer's disease and severe cognitive impairment. This resident required maximal assistance with activities of daily living and was at high risk for falls, as documented in multiple assessments and care plans. Despite these known risks, the resident experienced a fall that resulted in a major injury, specifically a fractured toe and foot, which required the use of a boot and orthopedic follow-up. Following the incident, the facility did not complete an investigation to determine the causative factors of the fall or the resulting injuries. There was no documentation in the electronic health record or other facility records indicating that an investigation was conducted or that the root cause of the incident was identified. Interviews with administrative and nursing staff confirmed that they could not locate any investigation or related documentation regarding the resident's fractures or the circumstances leading to the injury. The facility's policy required that all fall occurrences be documented and thoroughly investigated using risk management procedures. However, the lack of investigation and documentation after the resident's fall and injury demonstrated a failure to follow this policy. This inaction left the resident at risk for further falls and related injuries, as no interventions or changes to care were implemented based on an analysis of the incident.
Failure to Follow Physician Orders for Blood Pressure Monitoring and Medication Administration
Penalty
Summary
The facility failed to ensure that residents' drug regimens were free from unnecessary medications by not following physician orders related to blood pressure monitoring and medication administration parameters for three residents. For one resident with Alzheimer's disease and hypertension, the medication Cozaar was administered outside of the prescribed blood pressure parameters on 45 out of 54 occasions. The care plan required staff to hold the medication if the blood pressure was below a certain threshold and notify the physician, but this was not consistently done. Staff confirmed that the medication should have been held and the physician notified when the resident's blood pressure was outside the specified range. Another resident with diagnoses including agoraphobia, anxiety, and hypertension was prescribed Norvasc with instructions to hold the medication if the systolic blood pressure was below a certain value. However, blood pressure was not obtained prior to administration of the medication on 74 occasions. Staff administering the medication did not monitor blood pressure as required by the physician's order, and this omission was confirmed by administrative nursing staff upon review of the medication administration records. A third resident with diabetes, end-stage renal disease, and hypertension was prescribed Procardia with instructions to contact the physician if blood pressure exceeded a certain value. There was no evidence that blood pressure was checked prior to administration of the medication, and staff reported that they did not routinely check blood pressure unless prompted by the electronic medication administration record. Nursing staff acknowledged that the required monitoring was not in place and that the physician's parameters should have been included in the documentation to alert staff. Facility policy required that each resident's drug regimen be free of unnecessary drugs, including those used in excessive doses or without proper monitoring.
Misappropriation of Resident Funds by Housekeeping Staff
Penalty
Summary
The facility failed to protect a resident from the misappropriation of funds by a housekeeping staff member. The resident, who had a history of hemiparesis, hemiplegia, dementia, depression, anxiety, and traumatic brain injury, was cognitively intact as indicated by a BIMS score of 14. The incident involved the housekeeping staff member exploiting the resident for approximately $100, which was discovered when the resident's family member alerted the facility's administrative staff. The investigation revealed that the housekeeping staff member had obtained money from the resident under false pretenses, claiming it was for haircuts, although the resident cut his own hair. The staff member had also requested a loan of $200 for rent from the resident, who directed the staff member to contact his spouse. The resident's family reviewed bank records and found a check written to the staff member, further substantiating the claim of exploitation. Interviews with facility staff confirmed that the housekeeping staff member had received training on abuse, neglect, and exploitation, as well as on the facility's policy against accepting gifts or money from residents. Despite this, the staff member did not follow the established procedures for handling outside purchases, leading to the misappropriation of funds from the resident.
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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 Garden City
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Garden Valley Retirement Village | 2 mi | ★★★★★ | 0 | 0 |
| Kearny County Hospital Ltcu | 22 mi | ★★★★★ | 0 | 0 |
| The Shepherd's Center | 29.9 mi | ★★★★★ | 24 | 0 |
| Park Lane Nursing Home | 33.1 mi | ★★★★★ | 0 | 0 |
| Bethel Home | 35.7 mi | ★★★★★ | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.