6 Reports
Inspection Report — Apr 30, 2025
Routine
Date: Apr 30, 2025
Visit Reason
Missouri Department of Health and Senior Services State Form (state licensure survey); the survey type is not stated.
Findings
Six state licensure deficiencies were cited addressing administrator/operator responsibilities and room occupancy, tuberculosis screening of residents/staff, food sourcing and labeling, food storage and container coverage, ventilation hood cleanliness, and annual review of resident rights.
Deficiencies (6)
19 CSR 30-86.047(6) Operator/Administrator Responsibilities: The operator placed two residents together in room 228 which was licensed by DHSS for one resident and the facility did not provide a policy regarding placement of residents in rooms; residents reported insufficient bedroom space and storage.
19 CSR 30-86.047(19) TB Screen Residents & Staff: The facility failed to ensure required TB screening/two-step testing or an annual evaluation was completed for two of six sampled residents (Residents #2 and #3) and did not provide a policy regarding TB screening.
19 CSR 30-87.030(11) Food-Safe, Obtain From Appropriate Sources: Food in the walk-in cooler (a gallon-sized Ziploc bag of raw chicken, ground beef wrapped in plastic, a tub of sour cream) was unlabeled/undated and the facility did not provide a policy regarding labeling and dating food items.
19 CSR 30-87.030(14) Food-Clean Containers, Storage, Covers: Prepared food and food items were found uncovered (tray of condiments, trays with bowls of pudding) and the facility did not provide a policy regarding food storage.
19 CSR 30-87.030(55) Ventilation Hoods, Clean, Filters Removable: Vent hood filters above the grill, griddle and fryer were caked with grease hanging over the edge and the facility did not provide a policy regarding cleaning of vent hood filters.
19 CSR 30-88.010(4) Resident Rights-Admission/Annual Review: The facility failed to ensure resident rights were reviewed annually for five of six sampled residents and did not provide a policy regarding annual review of resident rights.
Report Facts
residents sampled: 6
residents affected: 2
residents affected: 5
Inspection Report — Mar 10, 2025
Follow-Up
Date: Mar 10, 2025
Visit Reason
Missouri Department of Health and Senior Services state licensure surveys (State Form) including the initial survey completed 2025-03-10 and subsequent revisit/follow-up state forms dated 07/08/2025 and 11/04/2025.
Findings
Twelve state deficiencies were recorded across the forms. They address fire drills and evacuation, fire alarm testing/maintenance, incomplete sprinkler protection (including repeated/unresolved sprinkler deficiencies on revisits), use of approved wastebaskets, oxygen storage, building repairs/maintenance, approved heating sources, electrical wiring and extension cord use, and maintaining resident rooms neat and orderly.
Deficiencies (12)
19 CSR 30-86.022(5)(D) Fire Drill Requirements, Evacuation: Based on record review and interview on March 10, 2025, the facility failed to conduct required fire drills on each shift and a full resident evacuation annually; facility records showed incomplete drills for the reporting period.
19 CSR 30-86.022(9)(C) Fire Alarm System-Test/Maintain: Based on record review and interview on March 10, 2025, the facility failed to test and maintain the complete fire alarm system per NFPA 72; only an annual fire alarm report from May 17, 2024 was available and no semi-annual documentation was found.
19 CSR 30-86.022(11)(A) Complete Sprinkler System-NFPA 13: Based on observation and interview on March 10, 2025, the facility failed to install and maintain a complete sprinkler system in accordance with NFPA 13; porch and deck combinations extended more than four feet from the building and were not protected by sprinkler heads.
19 CSR 30-86.022(15)(A) Wastebaskets, Metal/UL/FM-Requirements: Based on observation and interview on March 10, 2025, the facility failed to ensure only metal or UL-/FM-fire-resistant wastebaskets were used; multiple unapproved trash cans were observed in numerous rooms.
19 CSR 30-86.022(17) Oxygen Storage Requirements: Based on observation and interview on March 10, 2025, the facility failed to store portable oxygen cylinders in an approved manner; cylinders were observed standing upright and unsecured in a resident room.
19 CSR 30-86.032(2) Substantially Constructed & Maintained: Based on observation and interview on March 10, 2025, the facility failed to maintain the building in good repair; inspectors observed a large hole above the sprinkler riser, cracked ceiling/wall joins, and areas of drywall tape needing repair in multiple locations.
19 CSR 30-86.032(10) Heaters-Approved Label, Venting, No Portable: Based on observation and interview on March 10, 2025, the facility failed to ensure only approved heating sources were used; a portable space heater was observed in the living area of resident room 102 and another in a bathroom.
19 CSR 30-86.032(13) Electrical Wiring, Maintained, Inspected: Based on observation and interview on March 10, 2025, the facility failed to maintain electrical wiring in good repair; a ceiling light was observed hanging from its wires in the activity center closet.
19 CSR 30-86.032(18) Extension Cords/Duplex Receptacles: Based on observation on March 10, 2025, the facility failed to ensure only UL-approved extension cords and adapters were used; numerous unapproved extension cords and adapters were found in multiple resident rooms.
19 CSR 30-86.032(23) Rooms Neat, Orderly, Cleaned Daily: Based on observation and interview on March 10, 2025, the facility failed to keep resident rooms neat and orderly; resident room 222 contained excessive clutter that could impede timely exit during an emergency.
19 CSR 30-86.022(11)(A) Complete Sprinkler System-NFPA 13: This deficiency is uncorrected. Based on observation and interview on July 8, 2025, porch and deck combinations were observed with deck widths greater than four feet from the building and exposed floor joists not protected by sprinkler heads.
19 CSR 30-86.022(11)(A) Complete Sprinkler System-NFPA 13: This deficiency is uncorrected. Based on observation on November 4, 2025, multiple porch and deck combos were observed with widths over four feet from the building and exposed floor joists that were not protected by sprinkler heads.
Report Facts
residents affected: 66
Inspection Report — Mar 7, 2024
Complaint Investigation
Date: Mar 7, 2024
Visit Reason
Missouri state licensure survey (State Form); complaint investigation citing complaint number MO00232716.
Complaint Details
MO00232716; substantiation not stated.
Findings
One state licensure deficiency (Class II) for protective oversight related to failure to use gait belts during resident transfers.
Deficiencies (1)
19 CSR 30-86.047(35) Protective Oversight: Observation, interview and record review found Level One Medication Aides (LIMA) B, LIMA C, LIMA D and LIMA E transferred Resident #1 and other residents without using a gait belt, including placing their arms under the resident and pulling by the pants during transfers.
Report Facts
residents_sampled: 3
residents_affected: 1
Inspection Report — Oct 3, 2023
Routine
Date: Oct 3, 2023
Visit Reason
Missouri Department of Health and Senior Services State Form (state licensure survey); the survey type is not stated.
Findings
Twelve state deficiencies were cited, all related to fire and life-safety systems and procedures including fire extinguishers, range hood suppression, fire drill/evacuation planning and documentation, areas of refuge signage and procedures, monthly fire alarm testing, dryer venting, atrium smoke separation, sprinkler system monthly checks, flame-retardant curtains, approved wastebaskets, and oxygen storage ventilation.
Deficiencies (12)
19 CSR 30-86.022(3)(D) Fire Extinguishers UL/FM, Maintain/Check: The facility failed to document and date monthly checks of all fire extinguishers.
19 CSR 30-86.022(4)(A)(1)(2) Range Hood-On or before 7/11/80 Range Hood Extinguishing Systems: The facility failed to have the range hood extinguishing system maintained/certified as required by NFPA 96.
19 CSR 30-86.022(5)(B)(1 - 10) Fire Drill/Evacuation Plan Requirements: The facility failed to produce a written plan for fire evacuation and drills that included responding to and using areas of refuge.
19 CSR 30-86.022(5)(D) Fire Drill Requirements, Evacuation: The facility failed to produce documentation of at least twelve fire drills within the last year and failed to document required drills on each shift and at least one resident evacuation during the last 12 months.
19 CSR 30-86.022(7)(D)(1 - 8) Area of Refuge Requirements: The facility failed to post required "AREA OF REFUGE IN CASE OF FIRE" signage and provide instructions for use of the areas of refuge and associated intercom/communication procedures.
19 CSR 30-86.022(9)(E) Fire Alarm System Monthly Test: The facility failed to show proof that the complete fire alarm system had been activated at least once each month.
19 CSR 30-86.022(10)(C) Clothes Dryers Vented, Lint Traps: The facility failed to keep dryer vent hoses attached and in good repair and had observable lint buildup behind a dryer.
19 CSR 30-86.022(10)(F) Atriums: The facility failed to ensure the door providing separation between resident rooms and the atrium provided the required one-hour rated smoke separation and was closing and latching properly.
19 CSR 30-86.022(11)(B) Sprinkler System Maintenance/Testing: The facility failed to record monthly pressure gauge readings and valve position checks of the sprinkler system and had no monthly valve position/pressure gauge records.
19 CSR 30-86.022(13)(D) Curtains/Drapes, Flame Resistant: The facility failed to ensure curtains and drapes were certified flame-retardant or chemically treated as required.
19 CSR 30-86.022(15)(A) Wastebaskets, Metal/UL/FM-Requirements: The facility failed to insure all wastebaskets were the approved metal or UL/FM fire-resistant types and observed unapproved types in resident rooms.
19 CSR 30-86.022(17) Oxygen Storage Requirements: The facility failed to provide a proper oxygen storage room ventilation system with a constantly on ventilation fan.
Report Facts
residents potentially affected: 70
Inspection Report — Jan 7, 2020
Routine
Date: Jan 7, 2020
Visit Reason
Missouri Department of Health and Senior Services State Form (licensure/fire safety portion); the survey type is not stated.
Findings
Seven Missouri state deficiencies were cited addressing range hood extinguishing system certification, fire alarm testing/maintenance, dryer lint traps/venting, smoke partition doors not latching, sprinkler system maintenance, use of non-fire-resistant wastebaskets, and building repair/maintenance deficiencies. Four deficiencies were Class II and three were Class III.
Deficiencies (7)
19 CSR 30-86.022(4)(C) Range Hood Certification: The range hood extinguishing system lacked documentation of the required semi-annual inspection/certification; records showed only the initial certification in 01/2019 and no semi-annual inspection documentation.
19 CSR 30-86.022(9)(C) Fire Alarm System-Test/Maintain: The facility failed to provide documentation of testing and maintaining the complete fire alarm system as required; record review showed no documentation of the required semi-annual fire alarm inspection.
19 CSR 30-86.022(10)(C) Clothes Dryers Vented, Lint Traps: The facility failed to properly maintain clothes dryers and lint traps; observations showed a gap allowing lint discharge into the laundry room and lint traps with multiple layers of lint indicating they were not being cleaned after each use.
19 CSR 30-86.022(10)(I) Smoke Section Partitions > than 20 beds: The facility failed to maintain required smoke partitions; multiple smoke partition doors in various hallways did not close and latch properly and were dragging or prevented from fully closing.
19 CSR 30-86.022(11)(B) Sprinkler System Maintenance/Testing: The facility failed to properly maintain the sprinkler system; record review showed no documentation of monthly sprinkler gauge readings being recorded.
19 CSR 30-86.022(15)(A) Wastebaskets, Metal/UL/FM-Requirements: The facility failed to ensure the use of metal or fire-resistant wastebaskets; unapproved wastebaskets were observed in numerous resident rooms and common areas.
19 CSR 30-86.032(2) Substantially Constructed & Maintained: The facility failed to maintain the building in good repair; an approximate 12" by 12" opening in the ceiling with a disconnected access panel was observed in the 2nd floor storage room.
Report Facts
residents affected: 54
Inspection Report — Aug 9, 2019
Complaint Investigation
Date: Aug 9, 2019
Visit Reason
Missouri state licensure survey (State Form); a complaint investigation number is referenced (MO00159356).
Complaint Details
MO00159356; substantiation status not stated in the document.
Findings
One Missouri state licensure deficiency concerning minimum square footage per resident and incorrect bed listing/double occupancy assignments that affected residents.
Deficiencies (1)
19 CSR 30-86.012(6) Minimum Square Feet Per Resident: The facility failed to ensure rooms housing multiple residents met the required minimum square footage. The facility's bed listing incorrectly identified certain rooms as single occupancy while residents were housed as double occupancy, negatively affecting six residents.
Report Facts
residents affected: 6
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