Orchard Gardens

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

damaged or discolored areas to maintenance staff. Consultant GG stated the expectation was for the facility to be free of black/brown substances on the walls, with repairs to be performed as needed.The facility's undated Quality of Life - Homelike Environment policy documented residents would be provided with a safe, clean, comfortable, and homelike environment. Staff and management would provide characteristics of a homelike setting that included a clean and sanitary environment. The facility's undated Smoking Policy - Residents policy documented metal containers with self-closing cover devices would be available in smoking areas. The policy did not contain additional information related to the proper disposal of cigarette buts or other used smoking materials.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/03/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Orchard Gardens

1600 S Woodlawn Blvd Wichita, KS 67218

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Aide (CNA) N revealed she had received an in-service recently that covered abuse, neglect, and exploitation.During an interview on 09/03/25 at 01:30 PM, Administrative Staff A reported the facility terminated Maintenance U for verbal abuse to Resident R1. The investigation was unable to determine if Maintenance U or Resident R1 started yelling first, and Maintenance U was observed by other residents and staff yelling at Resident R1. Administrative Staff A said Maintenance U was informed the behavior was unacceptable and was immediately suspended pending the investigation and terminated effective 09/03/25.During an

interview on 09/03/25 at 02:40 PM, Licensed Nurse (LN) H revealed she had received an in-service related to abuse, neglect, and exploitation within the last few days.During an interview on 09/03/25 at 03:05 PM, Resident R1 confirmed that he was involved in a verbal exchange with Maintenance U and that voices were raised and profanities were exchanged. Resident R1 reported no lasting ill effects as a result, and the exchange was from a personality conflict. Resident R1 reported that in the future, if he experiences that again, he will leave the situation and notify a staff member.The facility's Recognizing Signs and Symptoms of Abuse/Neglect/Exploitation policy, dated 10/2021, documented the facility would not condone any form of resident abuse. The policy defined abuse as willful infliction of injury or intimidation that resulted in physical harm, pain, or mental anguish.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/03/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Orchard Gardens

1600 S Woodlawn Blvd Wichita, KS 67218

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

The facility reported a census of 70 residents, and one main kitchen. Based on observation, record review and interview the facility failed to prepare and serve food under sanitary conditions to prevent the potential for food borne bacteria. This placed the residents at risk for food borne illnesses. Findings included:- During

an observation on 09/03/25 at 09:53 AM, several dead roaches and live roaches were observed in different stages of life throughout the kitchen on the floor. The roaches were observed behind and on the side of the refrigerators, freezers, under the clean dish storage rack, under the meal prep counter, behind doors, and

in the dry storage room. Dietary Staff CC said she had seen several roaches and had reported the concern to Dietary Staff BB, Certified Dietary Manager (CDM). Additionally, Dietary Staff CC said a person would come into the kitchen weekly to try to control all the roaches. Further observation revealed two garbage cans with no lids on them in the kitchen. Dietary Staff CC reported the lids were off, as it was easier to throw items away.During an interview on 09/03/25 at 10:00 AM, Dietary Staff BB confirmed the roaches in all stages of life throughout the kitchen in dry storage, behind fridges, freezers, under counters, and behind doors. Dietary Staff BB reported the facility had a pest control service came monthly, which was due sometime in September, and stated Administrative Staff A is responsible for calling the pest control company. Dietary Staff BB reported the kitchen staff had been dealing with roaches for about six months now.During an interview on 09/03/25 at 04:50 PM, Administrative Staff A stated he expected the kitchen to be pest-free, and the facility has tried to accomplish this. Administrative Staff A confirmed there were roaches in the kitchen.The facility's Pest Control policy dated June 2025, documented our facility shall maintain an effective pest control program. This facility maintains an ongoing pest control program to ensure the building is kept free of insects and rodents.

Event ID:

Facility ID:

If continuation sheet