3 Reports
Inspection Report — Jul 3, 2025
Routine
Date: Jul 3, 2025
Visit Reason
Missouri Department of Health and Senior Services State Form (statement of deficiencies); the survey type is not stated.
Findings
One state deficiency (Class II) was cited related to the facility's medication administration system and a Personal Care Aide who administered medications with an inactive LIMA certification.
Deficiencies (1)
19 CSR 30-86.047(46) Safe & Effective Medication System: Based on interview and record review, the facility failed to ensure a safe and effective medication system was in place when Personal Care Aide (PCA) A passed medications to residents with an expired level one medication aide (LIMA) certification. The facility census was 22.
Inspection Report — Nov 14, 2019
Routine
Date: Nov 14, 2019
Visit Reason
Missouri state licensure survey (State Form); the survey type is not stated.
Findings
1 state licensure deficiency regarding range hood extinguishing system certification and maintenance, including an overdue hydrostatic test; the deficiency potentially affected 30 residents.
Deficiencies (1)
19 CSR 30-86.022(4)(C) Range Hood Certification: Based on record review and interview during the fire safety inspection on November 14, 2019, the facility failed to maintain the range hood and its extinguishing system in accordance with NFPA 96; the most recent inspection showed the cylinder on the extinguishing system was past due for a hydrostatic test and the deficiency potentially affected thirty (30) residents.
Report Facts
residents potentially affected: 30
Inspection Report — May 28, 2019
Complaint Investigation
Date: May 28, 2019
Visit Reason
Missouri state licensure survey (State Form); complaint investigation MO00155755.
Findings
1 state deficiency for failure to provide proper care per the individualized service plan, involving an unwitnessed fall and inadequate follow-up, notification, and documentation.
Deficiencies (1)
19 CSR 30-86.047(36) Proper Care Per Individual Service Plan: Based on interview and record review the facility failed to provide proper care and update one resident's change in condition on the resident's Individualized Service Plan, and failed to notify the resident's physician and the Director of Nursing or to follow the facility's fall follow-up documentation procedures.
Report Facts
residents affected: 1
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