5 Reports
Inspection Report — Jun 20, 2023
Routine
Date: Jun 20, 2023
Visit Reason
Missouri state licensure survey (State Form); the survey type is not stated.
Findings
Two state deficiencies were cited addressing sprinkler system maintenance and building maintenance/repair. Deficiencies involved missing or loose sprinkler head escutcheon rings and unsealed pipes/damaged drywall that could permit fire extension.
Deficiencies (2)
19 CSR 30-86.022(11)(B) Sprinkler System Maintenance/Testing: During the fire safety inspection on June 15, 2023 the facility failed to maintain the sprinkler system in accordance with the applicable edition of NFPA 13R; observations found missing or loose sprinkler head escutcheon rings in multiple locations, affecting all nineteen residents.
19 CSR 30-86.032(2) Substantially Constructed & Maintained: Observations found unsealed dryer pipes in the laundry ceiling, separated/falling drywall seams, a hole next to a sprinkler escutcheon plate, and exposed drywall screws in multiple closets/rooms, indicating the building was not maintained in good repair and could permit fire to enter the attic prior to sprinkler activation.
Report Facts
residents affected: 19
Inspection Report — Jan 26, 2022
Routine
Date: Jan 26, 2022
Visit Reason
Missouri Department of Health and Senior Services State Form (state licensure survey); the survey type is not stated.
Findings
2 state deficiencies were cited addressing personnel records (missing physician statements for employees) and resident admission records (incomplete admission information for sampled residents). Both deficiencies were classified as Class III.
Deficiencies (2)
19 CSR 30-86.047(20)(I) Personnel Record-physician statement, employ: Based on interview and record review, facility staff failed to ensure four of seven staff (Certified Medication Aide (CMA) A, CMA B, CMA C, and Patient Care Assistant (PCA) D) had a written statement signed by a licensed physician or physician designee indicating they could work in a long-term care facility.
19 CSR 30-86.047(58)(A) Resident Record Admission Info: Based on interview and record review, the facility staff failed to ensure resident records were complete for two of three sampled residents (Residents #1 and #2), missing items such as personal inventory, address for the legally authorized responsible party/designee, and documentation of history and physical.
Report Facts
residents sampled: 3
residents affected: 2
employees affected: 4
Inspection Report — Nov 1, 2019
Routine
Date: Nov 1, 2019
Visit Reason
Missouri state licensure survey (State Form); the survey type is not stated.
Findings
One state licensure deficiency was cited related to medication administration. The deficiency concerns missing documentation on the MAR, failure to implement a safe and effective medication system, and staff not identifying or notifying when a resident was out of medication.
Deficiencies (1)
19 CSR 30-86.047(46) Safe & Effective Medication System: Based on interview and record review, facility staff failed to implement a safe and effective system of medication administration. Review showed missing documentation on the MAR and staff did not identify or notify when a resident was out of medications.
Report Facts
medication count and dose: 30
Inspection Report — Aug 21, 2019
Routine
Date: Aug 21, 2019
Visit Reason
Missouri state licensure survey (State Form); the survey type is not stated.
Findings
One Missouri state licensure deficiency was cited for unsafe food storage and labeling. The finding involved multiple unsealed, undated, and unlabeled food items observed in kitchen and staff lounge refrigeration.
Deficiencies (1)
19 CSR 30-87.030(13) Food-Protected, Temp, Need to Contact DHSS: Based on observation and interview, facility staff failed to store and maintain food in a safe and sanitary manner to prevent contamination; staff failed to seal, date and label opened prepackaged food and multiple unsealed, undated and unlabeled containers and bags were observed in the kitchen freezer, kitchen refrigerator and the staff lounge refrigerator.
Inspection Report — Aug 12, 2019
Routine
Date: Aug 12, 2019
Visit Reason
Missouri Department of Health and Senior Services State Form (licensure survey); the survey type is not stated.
Findings
1 state licensure deficiency related to fire drills and emergency preparedness: the facility failed to conduct required quarterly fire drills on each shift and had missing drill records.
Deficiencies (1)
19 CSR 30-86.022(5)(D) Fire Drill Requirements, Evacuation Fire Drills and Emergency Preparedness: Record review and interview found the facility did not conduct the required fire drills every three months on each shift and records showed numerous months with no drills, affecting all residents.
Report Facts
residents affected: 25
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