Map showing the location of LEGACY ON 10TH AVENUE in TOPEKA, Kansas
2015 SE 10TH AVENUE, TOPEKA, KS, 66607

Overall Score

CMS Five-Star Quality Rating
1/5Much below averageCMS Five-Star overall rating
  1. Much below average
  2. Below average
  3. Average
  4. Above average
  5. Much above average

Where it ranks

  • KansasLowest tier among peers294 rated homes · average 3.0★
  • Shawnee CountyLowest tier among peers15 rated homes · average 2.8★
  • United StatesLowest tier among peers14,574 rated homes · average 3.0★

How the rating is built

  • Health inspectionsStarting point1★−1.8 vs KS avg
  • StaffingCan add or remove a star2★−1.4 vs KS avg
  • Quality measuresCan add or remove a star2★−1.1 vs KS avg

CMS starts from the health inspection stars, then adds or subtracts a star for staffing and for quality measures. Stars are assigned relative to other facilities in the same state.

Ratings & measures

Tap a row to see what it means
Health inspection ratingCMS stars from the last three on-site inspection cycles1★Lowest tier among peersKS avg2.8★U.S. avg2.8★
What is health inspection rating?

Stars assigned from the last three standard surveys and every complaint investigation in that window, weighted toward the most recent and the most serious findings. CMS assigns these stars relative to other facilities in the same state.

Why it matters

It carries the most weight in the overall rating and is the only domain based on what trained inspectors saw on site rather than what the facility reported.

Staffing ratingCMS stars from payroll-reported hours and turnover2★Above only 12% of peersKS avg3.4★U.S. avg2.9★
What is staffing rating?

Nurse and aide hours per resident day from payroll records CMS collects every quarter, adjusted for how much care residents need, plus staff turnover and weekend coverage.

Why it matters

More hours and lower turnover are the strongest predictors of fewer falls, pressure sores, and avoidable hospital stays.

Quality measures ratingCMS stars from clinical outcomes and resident assessments2★Above only 11% of peersKS avg3.1★U.S. avg3.6★
What is quality measures rating?

Clinical outcomes from resident assessments and Medicare claims: falls with injury, pressure ulcers, hospitalizations, antipsychotic use, and more, for both short-stay and long-stay residents.

Why it matters

It shows whether care is working, but part of it comes from the facility’s own assessments, so read it alongside the inspection results.

Total nurse hoursPer resident per day, all nursing staff3.03hrsAbove only 7% of peersKS avg4.07Benchmark4.10
What is total nurse hours?

All licensed nurse and aide hours worked, divided by the number of residents, on an average day. Reported from payroll, not self-reported.

Why it matters

Federal research links 4.1 hours a day to fewer avoidable harms. Below about 3 hours, residents wait longer for help with basics like toileting and repositioning.

RN hoursPer resident per day, registered nurses only0.45hrsAbove only 19% of peersKS avg0.71Benchmark0.75
What is rn hours?

Registered nurse hours only. RNs assess residents, manage medications, and catch changes in condition; LPNs and aides deliver most hands-on care.

Why it matters

RN coverage is the staffing measure most tied to fewer hospital transfers and infections, and it is where thinly staffed facilities cut first.

Nursing staff turnoverShare of nursing staff who left within a year · lower is better59%Above only 26% of peersKS avg50%RN turnover50%
What is nursing staff turnover?

The share of nursing staff who left within the past year, from the same payroll data.

Why it matters

High turnover means residents are cared for by people who do not know them, and it is one of the strongest predictors of inspection problems.

Fines in the last three yearsCivil money penalties imposed by CMS · lower is better$103,737Above only 3% of peersKS avg$21,017Fines · denials1 · 1
What is fines in the last three years?

Civil money penalties CMS imposed after serious or uncorrected deficiencies, and denials of Medicare payment for new admissions.

Why it matters

Penalties follow the worst inspection findings. A recent fine is the clearest sign that inspectors found real harm.

Inspection history

Last three inspection cycles
45citations
9inspection dates
0actual harm (G–I)
3immediate jeopardy (J–L)
Jul 7, 2025most recent

Citations by monthOct 2021 – Jul 2025

  • No actual harm (D–F)
  • Actual harm (G–I)
  • Immediate jeopardy (J–L)
  • $Fine or payment denial

Click a month or a year to filter the findings below. Arrow keys move between months; Esc clears.

Jul 7, 20251 citationCycle 1worst D · no actual harm
  1. F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Quality of Life and CareD · isolatedCorrected Jul 2, 2025
Oct 9, 202417 citationsCycle 1worst F · no actual harm
  1. F584Honor 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.Resident RightsE · patternCorrected Nov 20, 2024
  2. F585Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.Resident RightsE · patternCorrected Nov 20, 2024
  3. F679Provide activities to meet all resident's needs.Quality of Life and CareE · patternCorrected Nov 20, 2024
  4. F680Ensure the activities program is directed by a qualified professional.Quality of Life and CareE · patternCorrected Nov 20, 2024
  5. F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Quality of Life and CareE · patternCorrected Nov 20, 2024
  6. F732Post nurse staffing information every day.Nursing and Physician ServicesC · widespreadCorrected Nov 20, 2024
  7. F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.Resident RightsD · isolatedCorrected Nov 20, 2024
  8. F758Implement 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.Pharmacy ServiceD · isolatedCorrected Nov 20, 2024
  9. F838Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.AdministrationF · widespreadCorrected Nov 20, 2024
  10. F849Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.AdministrationD · isolatedCorrected Nov 20, 2024
  11. F880Provide and implement an infection prevention and control program.Infection ControlE · patternCorrected Nov 20, 2024
  12. F925Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.EnvironmentalE · patternCorrected Nov 20, 2024
  13. F553Allow resident to participate in the development and implementation of his or her person-centered plan of care.Resident RightsD · isolatedCorrected Nov 20, 2024
  14. F558Reasonably accommodate the needs and preferences of each resident.Resident RightsD · isolatedCorrected Nov 20, 2024
  15. F567Honor the resident's right to manage his or her financial affairs.Resident RightsE · patternCorrected Nov 20, 2024
  16. F576Ensure residents have reasonable access to and privacy in their use of communication methods.Resident RightsC · widespreadCorrected Nov 20, 2024
  17. F756Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.Pharmacy ServiceD · isolatedCorrected Nov 20, 2024
Jun 18, 20242 citationsCycle 2worst D · no actual harm
  1. F623Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.Resident RightsD · isolatedCorrected Jul 19, 2024
  2. 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.Resident RightsD · isolatedCorrected Jul 19, 2024
Apr 23, 20241 citationCycle 2worst E · no actual harm
  1. F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.Pharmacy ServiceE · patternCorrected May 31, 2024
Oct 25, 20232 citationsCycle 3worst D · no actual harm
  1. F690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.Quality of Life and CareD · isolatedCorrected Dec 6, 2023
  2. F691Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.Quality of Life and CareD · isolatedCorrected Dec 6, 2023
Oct 2, 20231 citationCycle 3worst D · no actual harm
  1. F623Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.Resident RightsD · isolatedCorrected Oct 27, 2023
Jul 11, 20233 citationsCycle 3worst K · immediate jeopardy
  1. F699Provide care or services that was trauma informed and/or culturally competent.Quality of Life and CareD · isolatedCorrected Aug 4, 2023
  2. F610Respond appropriately to all alleged violations.Freedom from Abuse, Neglect, and ExploitationK · patternCorrected Aug 4, 2023
  3. F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Freedom from Abuse, Neglect, and ExploitationJ · isolatedCorrected Aug 4, 2023
Apr 18, 202314 citationsCycle 2worst J · immediate jeopardy$103,737, payment denial
  1. F925Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.EnvironmentalE · patternCorrected May 22, 2023
  2. Ensure each resident’s drug regimen must be free from unnecessary drugs.Pharmacy ServiceD · isolatedCorrected Jun 30, 2023
  3. F582Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.Resident RightsD · isolatedCorrected May 22, 2023
  4. F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.Resident Assessment and Care PlanningD · isolatedCorrected May 22, 2023
  5. F692Provide enough food/fluids to maintain a resident's health.Quality of Life and CareD · isolatedCorrected May 22, 2023
  6. F700Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.Quality of Life and CareE · patternCorrected May 22, 2023
  7. F726Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.Nursing and Physician ServicesD · isolatedCorrected May 22, 2023
  8. F761Ensure 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.Pharmacy ServiceE · patternCorrected May 22, 2023
  9. F880Provide and implement an infection prevention and control program.Infection ControlF · widespreadCorrected May 22, 2023
  10. F550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.Resident RightsD · isolatedCorrected May 22, 2023
  11. F584Honor 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.Resident RightsE · patternCorrected Jun 30, 2023
  12. F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Quality of Life and CareJ · isolatedCorrected Jun 30, 2023
  13. F801Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.Nutrition and DietaryF · widespreadCorrected May 22, 2023
  14. F804Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.Nutrition and DietaryD · isolatedCorrected May 22, 2023
Oct 25, 20214 citationsCycle 3worst F · no actual harm
  1. F584Honor 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.Resident RightsE · patternCorrected Nov 25, 2021
  2. F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Nutrition and DietaryF · widespreadCorrected Nov 25, 2021
  3. F881Implement a program that monitors antibiotic use.Infection ControlF · widespreadCorrected Nov 25, 2021
  4. F924Put firmly secured handrails on each side of hallways.EnvironmentalE · patternCorrected Nov 25, 2021

Staffing

From quarterly payroll reports

Hours per resident per day

  • All nursing staffRNs, LPNs and aides combined3.03hrsAbove only 7% of peers−1.04 vs KS avg
  • Registered nursesRN hours only0.45hrsAbove only 19% of peers−0.26 vs KS avg
  • Licensed practical nursesLPN hours0.68hrs
  • Nurse aidesCNA hours1.90hrs
  • Weekend nursingAll staff on Saturdays and Sundays2.69hrs
  • Kansas average
  • Research benchmark (4.10 total, 0.75 RN)

Turnover & capacity

  • Nursing staff turnoverShare who left within a year · lower is better59%Above only 26% of peersKS avg 50%
  • RN turnoverRegistered nurses only50%Not ranked by CMS
  • Administrators who leftIn the past year2Leadership changed
  • Occupancy60 certified beds · ~52 residents a day87%Above 56% of peersKS avg 82%

Fines & penalties

Roughly the past three years

Enforcement summary

  • $103,737In fines
  • 1Fine
  • 1Payment denial
  • $21,017KS avg in fines
Above only 3% of peersFewer fines than 3% of rated homes in Kansas

Actions on record

  1. Apr 18, 2023Civil money penalty$103,737
  2. Apr 18, 2023Denial of payment for new admissionsfrom May 17, 2023

Ownership

As filed with CMS

Structure

Ownership type
For profit - Limited Liability company
Chain
Advena Living Communities6 facilities in the chain1.5★ chain average
Certification
Medicare and Medicaid
Location type
Urban
Ownership change
None in the last 12 months

People and entities on file

Operational or managerial control
  • New Paradigm Solutions INC
  • Michelle Novotny
  • William Novotny

Person Organization

Sources & notes

Public data, updated quarterly

Data sources

  • CMS Care Compare · Provider InformationStar ratings, staffing hours, turnover, penalties and flags · processed February 2026.
  • CMS Health CitationsEvery deficiency from the last three inspection cycles, with scope, severity and inspection cycle.
  • CMS Penalties and Ownership filesCivil money penalties, payment denials, and the owners and managers on file.

Notes

  • CMS Certification Number 175113 · 2015 SE 10TH AVENUE, TOPEKA, KS, 66607.
  • Percentiles compare this facility with every rated nursing home in Kansas and Shawnee County. Turnover and fines are inverted so a high percentile is always good.
  • This is an informational summary of public data, not medical, legal, or placement advice. Facilities cannot pay to change it; a facility that believes a record is wrong can dispute it with CMS.

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