| Trinity Manor | |
| 510 W Frontview Street, Dodge City, Kansas 67801 | |
| (620) 227-8551 | |
| Name | Trinity Manor |
|---|---|
| Location | 510 W Frontview Street, Dodge City, Kansas |
| Certified By | Medicare and Medicaid |
| No. of Certified Beds | 46 |
| Occupancy Rate | 78.91% |
| Medicare ID (CCN) | 175377 |
| Legal Business Name | Trinity Manor Opco LLC |
| Ownership Type | For Profit - Limited Liability Company |
| Chain | Frontline Management (9 nursing homes) |
| Chain Average Overall Rating | 3.2 out of 5 |
| NPI Number | 1497019749 |
| Match | Confirmed listed in Medicare enrollment records |
| Organization Name | Trinity Manor Opco LLC |
| Doing Business As | Trinity Manor |
| Address | 510 W Frontview St, Dodge City, KS 67801 |
| Phone Number | 620-227-8551 |
| Ratings from Surveys (Inspections): | |
| Ratings from Quality Measures: | |
| Ratings from Staffing Data: | |
| Overall Rating: |
|---|
| Staffing Measure | Provider | National Avg. |
|---|---|---|
| Total nurse staff hours per resident per day | 3.69 | 3.86 |
| Registered nurse (RN) hours per resident per day | 1.04 | 0.69 |
| Licensed practical nurse (LPN) hours per resident per day | 0.21 | 0.86 |
| Nurse aide hours per resident per day | 2.43 | 2.32 |
| Total nurse staff hours per resident per day on the weekend | 3.25 | 3.42 |
| RN hours per resident per day on the weekend | 0.94 | 0.48 |
| Physical therapist hours per resident per day | 0.02 | 0.07 |
| Total nursing staff turnover | 40.5% | 45.8% |
| Registered nurse turnover | 63.6% | 42.9% |
| Number of administrators who have left the nursing home | 0 | 0.5 |
| Cited for abuse, neglect or exploitation of residents (Care Compare abuse icon) | No |
| Number of Fines | 2 |
| Total Amount of Fines in Dollars | $29,773 |
| Number of Payment Denials | 0 |
| Total Number of Penalties | 2 |
| Date | Deficiency | Harm Level | Status |
|---|---|---|---|
| Jan 23, 2025 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. F0812, Nutrition and Dietary, Standard inspection, Complaint inspection | Potential for harm, widespread | Corrected by Feb 28, 2025 |
| Jan 23, 2025 | Provide and implement an infection prevention and control program. F0880, Infection Control, Standard inspection, Complaint inspection | Potential for harm, widespread | Corrected by Feb 28, 2025 |
| Jan 23, 2025 | Ensure that residents are free from significant medication errors. F0760, Pharmacy Service, Standard inspection, Complaint inspection | Potential for harm, isolated | Corrected by Feb 28, 2025 |
| Jul 15, 2024 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. F0689, Quality of Life and Care, Complaint inspection | Immediate jeopardy, isolated | Past non-compliance (already corrected) |
| Feb 8, 2024 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. F0689, Quality of Life and Care, Complaint inspection | Immediate jeopardy, isolated | Past non-compliance (already corrected) |
| Feb 9, 2023 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. F0812, Nutrition and Dietary, Standard inspection | Potential for harm, widespread | Corrected by Feb 28, 2023 |
| Feb 9, 2023 | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. F0623, Resident Rights, Standard inspection | Potential for harm, isolated | Corrected by Feb 28, 2023 |
| Feb 9, 2023 | Ensure each resident’s drug regimen must be free from unnecessary drugs. F0757, Pharmacy Service, Standard inspection | Potential for harm, isolated | Corrected by Feb 28, 2023 |
| Jul 15, 2021 | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. F0801, Nutrition and Dietary, Standard inspection | Potential for harm, widespread | Corrected by Aug 24, 2021 |
| Jul 15, 2021 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. F0812, Nutrition and Dietary, Standard inspection | Potential for harm, widespread | Corrected by Aug 24, 2021 |
| Jul 15, 2021 | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. F0582, Resident Rights, Standard inspection | Potential for harm, isolated | Corrected by Aug 24, 2021 |
| Jul 15, 2021 | Protect each resident from the wrongful use of the resident's belongings or money. F0602, Freedom from Abuse, Neglect, and Exploitation, Standard inspection | Potential for harm, isolated | Corrected by Aug 24, 2021 |
| Jul 15, 2021 | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. F0756, Pharmacy Service, Standard inspection | Potential for harm, isolated | Corrected by Aug 24, 2021 |
| Jul 15, 2021 | Ensure each resident’s drug regimen must be free from unnecessary drugs. F0757, Pharmacy Service, Standard inspection | Potential for harm, isolated | Corrected by Aug 24, 2021 |
| Jul 15, 2021 | 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. F0758, Pharmacy Service, Standard inspection | Potential for harm, isolated | Corrected by Aug 24, 2021 |
| Quality Measure | Provider | National Avg. |
|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased | 25.81 | 13.87 |
| Percentage of long-stay residents who lose too much weight | 4.72 | 5.19 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0 | 0.82 |
| Percentage of long-stay residents with a urinary tract infection | 0 | 1.59 |
| Percentage of long-stay residents who have depressive symptoms | 0 | 12.8 |
| Percentage of long-stay residents who were physically restrained | 0 | 0.13 |
| Percentage of long-stay residents experiencing one or more falls with major injury | 5.71 | 3.23 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 93.57 | 93.55 |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 88.68 | 82.04 |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0 | 1.56 |
| Percentage of long-stay residents whose ability to walk independently worsened | 33.07 | 14.07 |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 21.32 | 19.52 |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100 | 95.46 |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 84.85 | 79.75 |
| Percentage of long-stay residents with pressure ulcers | 3.46 | 4.62 |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 25.32 | 19.01 |
| Percentage of long-stay residents who received an antipsychotic medication | 23.47 | 15.38 |