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Nursing HomeMedicaid Investigative

Legacy Square

Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.

1621 Front Street, Henderson, NE 6837140 bedsLicensed & Active
2/5
Medicare
Inspection
Quality
Staffing
Google rating
3.3/5

based on 3 Google reviews

Legacy Square Nursing Home in Henderson, NE — Street View
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3/ 10
moderate Risk

Quality Concerns Identified

Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.

  • Low overall rating (2/5 stars)
  • Above-median deficiencies (7 vs median 5)

Below average in NE · Meets national RN staffing standard · $21,645 in fines

Source: Medicare data

What this means for your family

Due to a lack of descriptive reviews, it is impossible to provide an informed recommendation for Legacy Square. We strongly advise families to schedule an in-person tour to observe the facility's environment and staffing levels firsthand before making a decision.

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.87hrs
OK
Registered nurses for medical care
Total Nursing
4.20hrs
OK
All nurses + aides combined
Staff Turnover
28%
Lower is better (< 30% = good)
RN Turnover
0%
Lower is better (< 30% = good)

This facility meets the national staffing benchmarks. Higher staffing is linked to fewer falls and better day-to-day care.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 15 measures

Medicare Rating
5/ 5
Better Than Avg

12

measures

Worse Than Avg

2

measures

Mixed Results

1

measures

Long-Stay Residents
💊

Residents on anti-anxiety or sleep medication

↓ Lower is better
This Facility5.2%
Better than Avg
Here
5.2%
US
19.5%
NE
19.3%
York
19.6%
🛏️

Residents needing more daily help over time

↓ Lower is better
This Facility27.1%
Worse than Avg
Here
27.1%
US
14.4%
NE
19.5%
York
21.3%
😔

Residents with depression symptoms

↓ Lower is better
This Facility0.8%
Better than Avg
Here
0.8%
US
12.1%
NE
4.3%
York
7.8%

Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.

💊

Residents on antipsychotic medication

↓ Lower is better
This Facility11.4%
Better than Avg
Here
11.4%
US
15.5%
NE
20.8%
York
18.7%
🚿

Residents whose bladder or bowel control got worse

↓ Lower is better
This Facility20.0%
Mixed vs Avgs
Here
20.0%
US
19.4%
NE
26.3%
York
25.5%
🚶

Residents whose walking got worse

↓ Lower is better
This Facility13.9%
Better than Avg
Here
13.9%
US
15.3%
NE
19.1%
York
20.1%
Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility95.0%
Better than Avg
Here
95.0%
US
81.8%
NE
80.5%
York
76.1%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

8deficiencies
2penalties
Above state avg (6.7)
5 complaint-triggered
$21,645 in fines

Legacy Square shows a concerning pattern of families filing complaint reports, triggering 5 deficiencies including serious issues with abuse reporting and resident safety supervision. The facility has repeated problems with safety hazards, medication management, and building safety systems across multiple surveys. While all deficiencies show correction dates, the recent 2025 complaints about failure to properly report suspected abuse and ongoing safety supervision issues warrant careful consideration during any visit.

Jan 15, 2026Routine
6
0812Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

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

0880Potential for harm · WidespreadCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0882Potential for harm · WidespreadCorrected

Infection Control Deficiencies

Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.

0353Potential for harm · WidespreadCorrected

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

0712Potential for harm · WidespreadCorrected

Miscellaneous Deficiencies

Have simulated fire drills held at unexpected times.

0580Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Oct 23, 2025Complaint
4
0689Immediate jeopardy · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

0868Potential for harm · WidespreadCorrected

Administration Deficiencies

Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

0609Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

0610Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Respond appropriately to all alleged violations.

Sep 4, 2024Routine
2
0759Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure medication error rates are not 5 percent or greater.

0760Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure that residents are free from significant medication errors.

Sep 4, 2024Complaint
1
0550Potential for harm · PatternCorrected

Resident Rights Deficiencies

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Sep 6, 2023Routine
5
0222Potential for harm · WidespreadCorrected

Egress Deficiencies

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.

0712Potential for harm · WidespreadCorrected

Miscellaneous Deficiencies

Have simulated fire drills held at unexpected times.

0916Potential for harm · WidespreadCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have a battery powered remote alarm panel in a location accessible by operating personnel.

0920Potential for harm · PatternCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Ensure proper usage of power strips and extension cords.

0923Potential for harm · IsolatedCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have proper medical gas storage and administration areas.

Federal Penalties

Fine

Oct 23, 2025

$14,069

Payment Denial

Oct 23, 2025

16-day denial

Ownership & Operations

Who Operates This Facility

Owner / Operator

Legacy Square

Organization Type

for profit

Ownership & Management

Owners

Undisclosed

Ownership Data Not Available · Organization

Source: Medicare provider data

Contact

Get in Touch

Contact this facility directly and verify the details that matter most to your family.

References & Resources

EveryPlace is a research directory. Facility information is compiled from public sources — Medicare.gov, state licensing portals, Google Places, and publicly available street-level imagery. Listings do not constitute endorsement, recommendation, or advertisement, and we do not accept payment for placement. Families should verify all details directly with the facility and the original sources linked above before making any care decisions. See our Research Policy for our editorial standards, correction process, and image-removal policy.

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