Public Record
Plaza West Healthcare and Rehab
From CMS
Facility profile
- CMS overall rating
- 1 / 5
- Certified beds
- 151
- Avg. residents per day
- 127.8
*CMS Five-Star
*CMS
*CMS
Inspection record
On record from CMS
- Citations on record
- 138
- Inspections on file
- 13
- Last inspection
- 2025-03-19
*CMS
*CMS
*CMS
Citations
138 citations on record
Each deficiency cited on a CMS health inspection of this facility, sourced from the federal record. Open a report for the raw CMS Scope and Severity grade on each finding.
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
- 0755Generalpotential for harm
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- 0698Generalpotential for harm
Provide safe, appropriate dialysis care/services for a resident who requires such services.
- 0695Generalpotential for harm
Provide safe and appropriate respiratory care for a resident when needed.
- 0636Generalpotential for harm
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
- 0655Generalpotential for harm
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
- 0657Generalpotential for harm
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
- 0677Generalpotential for harm
Provide care and assistance to perform activities of daily living for any resident who is unable.
- 0684Generalpotential for harm
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- 0686Generalpotential for harm
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
- 0757Generalpotential for harm
Ensure each resident’s drug regimen must be free from unnecessary drugs.
- 0760Generalpotential for harm
Ensure that residents are free from significant medication errors.
- 0761Generalpotential for harm
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
- 0809Generalpotential for harm
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
- 0849Generalpotential for harm
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
- 0867Generalpotential for harm
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
- 0880Generalpotential for harm
Provide and implement an infection prevention and control program.
- 0725Generalpotential for harm
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
- 0582Generalpotential for harm
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
- 0584Generalpotential for harm
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- 0600Generalpotential for harm
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- 0920Generalpotential for harm
Ensure proper usage of power strips and extension cords.
- 0918Generalpotential for harm
Have generator or other power source capable of supplying service within 10 seconds.
- 0712Generalpotential for harm
Have simulated fire drills held at unexpected times.
- 0511Generalpotential for harm
Have properly installed electrical wiring and gas equipment.
- 0374Generalpotential for harm
Install smoke barrier doors that can resist smoke for at least 20 minutes.
- 0372Generalpotential for harm
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
- 0363Generalpotential for harm
Install corridor and hallway doors that block smoke.
- 0362Generalpotential for harm
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.
- 0355Generalpotential for harm
Properly select, install, inspect, or maintain portable fire extinguishes.
- 0353Generalpotential for harm
Inspect, test, and maintain automatic sprinkler systems.
- 0345Generalpotential for harm
Have approved installation, maintenance and testing program for fire alarm systems.
- 0324Generalpotential for harm
Provide properly protected cooking facilities.
- 0321Generalpotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- 0291Generalpotential for harm
Install emergency lighting that can last at least 1 1/2 hours.
- 0223Generalpotential for harm
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
- 0211Generalpotential for harm
Keep aisles, corridors, and exits free of obstruction in case of emergency.
- 0031Generalpotential for harm
Provide emergency officials' contact information.
- 0009Generalpotential for harm
Include a process for Emergency Preparedness collaboration.
- 0004Generalpotential for harm
Develop and maintain an Emergency Preparedness Program (EP).
- 0756Generalpotential for harm
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
- 0695Generalpotential for harm
Provide safe and appropriate respiratory care for a resident when needed.
- 0550Generalpotential for harm
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- 0880Generalpotential for harm
Provide and implement an infection prevention and control program.
- 0941Generalpotential for harm
Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.
- 0942Generalpotential for harm
Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.
- 0625Generalpotential for harm
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
- 0623Generalpotential for harm
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
- 0676Generalpotential for harm
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
- 0920Generalpotential for harm
Ensure proper usage of power strips and extension cords.
- 0918Generalpotential for harm
Have generator or other power source capable of supplying service within 10 seconds.
- 0914Generalpotential for harm
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
- 0901Generalpotential for harm
Ensure that building systems meet requirements determined by risk assessment procedures performed by qualified personnel.
- 0712Generalpotential for harm
Have simulated fire drills held at unexpected times.
- 0711Generalpotential for harm
Provide a written emergency evacuation plan.
- 0511Generalpotential for harm
Have properly installed electrical wiring and gas equipment.
- 0372Generalpotential for harm
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
- 0363Generalpotential for harm
Install corridor and hallway doors that block smoke.
- 0355Generalpotential for harm
Properly select, install, inspect, or maintain portable fire extinguishes.
- 0354Generalpotential for harm
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
- 0353Generalpotential for harm
Inspect, test, and maintain automatic sprinkler systems.
- 0351Generalpotential for harm
Install an approved automatic sprinkler system.
- 0291Generalpotential for harm
Install emergency lighting that can last at least 1 1/2 hours.
- 0324Generalpotential for harm
Provide properly protected cooking facilities.
- 0345Generalpotential for harm
Have approved installation, maintenance and testing program for fire alarm systems.
- 0100Generalpotential for harm
Meet other general requirements.
- 0321Generalpotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- 0883Generalpotential for harm
Develop and implement policies and procedures for flu and pneumonia vaccinations.
- 0880Generalpotential for harm
Provide and implement an infection prevention and control program.
- 0761Generalpotential for harm
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
- 0758Generalpotential for harm
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
- 0744Generalpotential for harm
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
- 0732Generalno actual harm
Post nurse staffing information every day.
- 0726Generalpotential for harm
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
- 0699Generalpotential for harm
Provide care or services that was trauma informed and/or culturally competent.
- 0695Generalpotential for harm
Provide safe and appropriate respiratory care for a resident when needed.
- 0690Generalpotential for harm
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
- 0689Generalpotential for harm
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- 0686Seriousactual harm
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
- 0684Generalpotential for harm
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- 0679Generalpotential for harm
Provide activities to meet all resident's needs.
- 0677Generalpotential for harm
Provide care and assistance to perform activities of daily living for any resident who is unable.
- 0656Generalpotential for harm
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- 0565Generalpotential for harm
Honor the resident's right to organize and participate in resident/family groups in the facility.
- 0561Generalpotential for harm
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
- 0554Generalpotential for harm
Allow residents to self-administer drugs if determined clinically appropriate.
- 0553Generalpotential for harm
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
- 0550Generalpotential for harm
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- 0687Generalpotential for harm
Provide appropriate foot care.
- 0004Generalpotential for harm
Develop and maintain an Emergency Preparedness Program (EP).
- 0222Generalpotential for harm
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
- 0711Generalpotential for harm
Provide a written emergency evacuation plan.
- 0880Generalpotential for harm
Provide and implement an infection prevention and control program.
- 0883Generalpotential for harm
Develop and implement policies and procedures for flu and pneumonia vaccinations.
- 0887Generalpotential for harm
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
- 0684Generalpotential for harm
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- 0804Generalpotential for harm
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
- 0812Generalpotential for harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- 0757Generalpotential for harm
Ensure each resident’s drug regimen must be free from unnecessary drugs.
- 0756Generalpotential for harm
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
- 0695Generalpotential for harm
Provide safe and appropriate respiratory care for a resident when needed.
- 0690Generalpotential for harm
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
- 0689Generalpotential for harm
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- 0686Generalpotential for harm
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
- 0677Generalpotential for harm
Provide care and assistance to perform activities of daily living for any resident who is unable.
- 0657Generalpotential for harm
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
- 0552Generalpotential for harm
Ensure that residents are fully informed and understand their health status, care and treatments.
- 0550Generalpotential for harm
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- 0007Generalpotential for harm
Address patient/client population and determine types of services needed.
- 0009Generalpotential for harm
Include a process for Emergency Preparedness collaboration.
- 0013Generalpotential for harm
Develop Emergency Preparedness policies and procedures.
- 0026Generalpotential for harm
Establish roles under a Waiver declared by secretary.
- 0030Generalpotential for harm
List the names and contact information of those in the facility.
- 0035Generalpotential for harm
Provide family notifications of emergency plan.
- 0036Generalpotential for harm
Establish emergency prep training and testing.
- 0039Generalpotential for harm
Conduct testing and exercise requirements.
- 0100Generalpotential for harm
Meet other general requirements.
- 0163Generalpotential for harm
Install noncombustible or limited-combustible interior walls.
- 0222Generalpotential for harm
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
- 0300Generalpotential for harm
Meet other general requirements that are deficient.
- 0311Generalpotential for harm
Have an enclosure around a vertical opening shaft.
- 0321Generalpotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- 0324Generalpotential for harm
Provide properly protected cooking facilities.
- 0343Generalpotential for harm
Have a fire alarm with audible and visual signals that transmits the alarm automatically to notify emergency forces in event of fire.
- 0345Generalpotential for harm
Have approved installation, maintenance and testing program for fire alarm systems.
- 0346Generalpotential for harm
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
- 0353Generalpotential for harm
Inspect, test, and maintain automatic sprinkler systems.
- 0354Generalpotential for harm
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
- 0363Generalpotential for harm
Install corridor and hallway doors that block smoke.
- 0371Generalpotential for harm
Have properly sized and located compartments to protect residents from smoke.
- 0511Generalpotential for harm
Have properly installed electrical wiring and gas equipment.
- 0712Generalpotential for harm
Have simulated fire drills held at unexpected times.
- 0741Generalpotential for harm
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
- 0781Generalpotential for harm
Have restrictions on the use of portable space heaters.
- 0918Generalpotential for harm
Have generator or other power source capable of supplying service within 10 seconds.
- 0920Generalpotential for harm
Ensure proper usage of power strips and extension cords.
- 0812Generalpotential for harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- 0926Generalpotential for harm
Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.
- 0804Generalpotential for harm
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Inspection history
Every health inspection on record
Each CMS health inspection of this facility, and the deficiencies the surveyors cited. Where the verbatim Form 2567 statement of deficiencies is on file, it links to the full report.
- View inspection reportInspection40 deficiencies
- View inspection reportInspection40 deficiencies
- View inspection reportInspection1 deficiency
- View inspection reportInspection4 deficiencies
- View inspection reportInspection3 deficiencies
- View inspection reportInspection41 deficiencies
- View inspection reportInspection41 deficiencies
- View inspection reportInspection1 deficiency
- View inspection reportInspection1 deficiency
- View inspection reportInspection4 deficiencies
Showing the 10 most recent inspections. 3 earlier inspections are also on record.
FAQ
Questions and answers
- What is Plaza West Healthcare and Rehab?
- Plaza West Healthcare and Rehab is a Medicare- and Medicaid-certified nursing home in Topeka, KS, tracked by the Centers for Medicare & Medicaid Services (CMS). Its CMS Certification Number (CCN) is 175255.
- What is the CMS rating for Plaza West Healthcare and Rehab?
- Plaza West Healthcare and Rehab has a CMS overall rating of 1 out of 5 stars. CMS rates nursing homes on health inspections, staffing, and quality measures.
- How many beds does Plaza West Healthcare and Rehab have?
- Plaza West Healthcare and Rehab is certified for 151 beds. It serves an average of 127.8 residents per day.
- How many citations does Plaza West Healthcare and Rehab have?
- Plaza West Healthcare and Rehab has 138 citations on record from CMS health inspections, each tied to a federal deficiency tag.
- When was Plaza West Healthcare and Rehab last inspected?
- Plaza West Healthcare and Rehab was last inspected on March 19, 2025. CMS surveys nursing homes about once a year and after complaints.
- What can I do if I have concerns about care at this facility?
- Start by raising the concern with the facility administrator or director of nursing. Every state also runs a free long-term care ombudsman program that advocates for residents and families; the federal Eldercare Locator at eldercare.acl.gov can connect you with yours. Complaints about quality of care can also be filed with your state survey agency.
*Sourced from the Centers for Medicare & Medicaid Services (CMS). See the official record on CMS Care Compare. If you believe any information is inaccurate, report it here.
/nursing-home/175255-plaza-west-healthcare-and-rehab