Legacy Square
1621 Front Street · Henderson, NE · 68371 · 4027235301
40 certified beds For profit - Corporation Hospital-based
Why this verdict
- Inspectors found immediate jeopardy — danger of serious harm or death — in the most recent cycle (1 citation).
- Inspection record is far worse than the national median (deficiency count and severity).
- Inspection results are getting worse cycle over cycle, not better.
- Staffing hours comfortably above national benchmarks.
The complete Safety Report — $19
Everything on this page plus the full citation-by-citation history with inspector findings, the complete penalty record, staffing vs benchmarks, side-by-side nearby comparisons, and the printable tour checklist. One PDF, emailed in minutes, yours to keep and share with family.
Red flags
1 immediate-jeopardy citation in the most recent inspection cycle
Immediate jeopardy is the most serious finding an inspector can make: a situation likely to cause serious injury, harm, or death.
Medicare/Medicaid payments were denied
CMS refused payment for new admissions for a period — one of its strongest enforcement tools.
If someone you love was harmed at a facility with findings like these, you have options — read this.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 2 of 5 Inspections: 1 of 5 Staffing: 5 of 5 Quality measures: 5 of 5
| Total nurse hours / resident-day | 4.20 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.87 | 0.55–0.75 |
| Weekend hours / resident-day | 3.55 | ≈ weekday level |
| Nursing turnover / year | 28% | median 45% |
| Fines (3-yr window) | 1 · $14,069 |
Inspection citations (11 in the current record)
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Potential for harm · D January 15, 2026
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected March 1, 2026 · Resident Rights
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Potential for harm · F January 15, 2026
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected March 1, 2026 · Nutrition and Dietary
-
Potential for harm · F January 15, 2026
Provide and implement an infection prevention and control program.
Corrected March 1, 2026 · Infection Control
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Potential for harm · F January 15, 2026
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Corrected March 1, 2026 · Infection Control
-
Immediate jeopardy · J October 23, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected December 7, 2025 · Quality of Life and Care
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Potential for harm · D October 23, 2025 · found via complaint
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected December 7, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D October 23, 2025 · found via complaint
Respond appropriately to all alleged violations.
Corrected December 7, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · F October 23, 2025 · found via complaint
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Corrected December 7, 2025 · Administration
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Potential for harm · D September 4, 2024
Ensure medication error rates are not 5 percent or greater.
Corrected October 19, 2024 · Pharmacy Service
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Potential for harm · D September 4, 2024
Ensure that residents are free from significant medication errors.
Corrected October 19, 2024 · Pharmacy Service
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Potential for harm · E September 4, 2024 · found via complaint
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected October 19, 2024 · Resident Rights
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| October 23, 2025 | Fine | $14,069 |
| October 23, 2025 | Payment Denial | 16 days |
Family & resident reviews — a separate signal, never mixed into the score
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 28E173 · certified since June 1, 1981. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.