Inspection Reports for
Life Care Center of Carrollton
300 LIFE CARE LN, CARROLLTON, MO, 64633-1861
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
13 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
136% worse than Missouri average
Missouri average: 5.5 deficiencies/yearDeficiencies per year
24
18
12
6
0
Occupancy
Latest occupancy rate
48% occupied
Based on a November 2025 inspection.
Occupancy rate over time
Inspection Report
Complaint Investigation
Census: 57
Deficiencies: 1
Date: Nov 24, 2025
Visit Reason
The inspection was conducted due to resident-to-resident altercations involving physical abuse where Resident #1 held Resident #2 down and squeezed their jaw, and pushed Resident #3 against a wall. The facility was investigating these incidents and the facility's response to ensure resident safety.
Complaint Details
The complaint involved substantiated resident-to-resident abuse incidents where Resident #1 physically restrained and squeezed Resident #2's jaw and pushed Resident #3 against a wall. The facility investigated, notified families and providers, and implemented corrective actions including psychiatric evaluation and staff training.
Findings
The facility failed to protect residents from physical abuse by another resident. Resident #1 exhibited aggressive behaviors resulting in physical altercations with Residents #2 and #3. The facility initiated immediate interventions including one-on-one monitoring, emergency room evaluations, psychiatric hospitalization referral, and staff education on abuse prevention and reporting.
Deficiencies (1)
Failure to protect residents from physical abuse by another resident.
Report Facts
Residents affected: 3
Medication dosage: 50
Medication dosage: 150
Medication dosage: 0.5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse A | LPN | Interviewed regarding Resident #1's behavior and facility response |
| Certified Medication Technician A | CMT | Interviewed about Resident #1 pushing Resident #2 and staff training |
| Certified Nursing Assistant A | CNA | Interviewed about resident altercation and staff response |
| Director of Nursing | DON | Provided information on incidents, interventions, and staff training |
| Social Services Director | Interviewed about resident rights and abuse incidents | |
| Senior Executive Director | Acting Administrator | Interviewed about resident incidents and facility placement plans |
Inspection Report
Complaint Investigation
Census: 57
Deficiencies: 1
Date: Nov 18, 2025
Visit Reason
The inspection was conducted due to a complaint investigation regarding alleged financial exploitation of Resident #1 by a certified nursing assistant (CNA B).
Complaint Details
The complaint investigation substantiated that CNA B financially exploited Resident #1 by coercing and accepting money totaling approximately $220. The resident was cognitively intact but vulnerable to exploitation. CNA B was suspended on 8/17/25 and terminated on 9/18/25. Police were involved but did not pursue criminal charges. The facility reimbursed the resident $220.
Findings
The facility failed to protect Resident #1 from financial exploitation by CNA B, who requested and accepted money from the resident, violating facility policy. The investigation confirmed CNA B borrowed approximately $220 from the resident and was suspended and later terminated. The resident was reimbursed $220 by the facility.
Deficiencies (1)
Failure to protect a resident from misappropriation of resident property when a staff member accepted money from the resident.
Report Facts
Amount of money taken: 220
Facility census: 57
Additional money given to CNA B by other employees: 217
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA B | Certified Nursing Assistant | Named in financial exploitation finding involving Resident #1 |
| LPN A | Licensed Practical Nurse | Notified Administrator of financial exploitation situation |
| Administrator | Conducted investigation, notified police, suspended and terminated CNA B | |
| Regional Director of Clinical Services | Provided information on investigation and reimbursement receipt | |
| Director of Nursing | Director of Nursing | Interviewed regarding resident's decision-making and vulnerability |
| Account Specialist | Notified about incident and reassured resident |
Inspection Report
Routine
Census: 58
Deficiencies: 3
Date: Apr 25, 2025
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care, accommodations, and the facility environment at Life Care Center of Carrollton.
Findings
The facility failed to provide reasonable accommodations for two residents, including lack of hot water accessibility for one resident and inadequate transfer assistance for another. Additionally, the facility did not maintain a clean and comfortable homelike environment, with dirt and debris observed in resident rooms and common areas. These deficiencies were found to have minimal harm or potential for actual harm and affected some residents.
Deficiencies (3)
Failed to provide acceptable sink accommodation for hot water for Resident #14.
Failed to provide transfer assistance for Resident #156 to eat meals in their room.
Failed to maintain a clean and comfortable homelike environment; dirt and food debris observed in dining room and resident rooms.
Report Facts
Facility census: 58
Sampled residents: 15
Residents affected: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| COTA A | Certified Occupational Therapy Assistant | Provided information about occupational therapy assessment and accommodations for Resident #14 |
| Housekeeper A | Interviewed regarding housekeeping practices and cleaning of dining room | |
| Housekeeping Supervisor | Interviewed regarding housekeeping staff duties and cleaning procedures | |
| Administrator | Interviewed regarding facility policies and response to deficiencies | |
| DON | Director of Nursing | Interviewed regarding facility policies and response to deficiencies |
| Maintenance Supervisor | Interviewed regarding sink accommodation devices for Resident #14 | |
| CMT B | Interviewed regarding notification and assistance provided to Resident #156 | |
| CNA F | Observed assisting Resident #156 out of bed |
Inspection Report
Routine
Census: 58
Deficiencies: 6
Date: Apr 25, 2025
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care, safety, rights, food service, and facility environment at Life Care Center of Carrollton.
Findings
The facility was found deficient in multiple areas including failure to provide reasonable accommodations for residents, improper handling of resident funds, incorrect documentation of Do Not Resuscitate orders, inadequate housekeeping resulting in unclean environments, failure to provide trauma-informed care for a resident with PTSD, and unsafe food storage and handling practices.
Deficiencies (6)
Failed to provide acceptable sink accommodation for hot water and transfer assistance for eating for two residents.
Failed to provide personal funds and final accounting within 30 days upon discharge for two residents.
Do Not Resuscitate orders had guardian's name printed instead of resident's name for two residents.
Failed to maintain a clean and comfortable homelike environment; dirt, food debris, and dead bugs observed in resident rooms and common areas.
Failed to provide trauma informed care for a resident with PTSD; care plan lacked PTSD diagnosis and interventions.
Failed to store, prepare, and serve food in accordance with professional standards; food items were unlabeled, expired items not discarded, and temperature checks not consistently performed.
Report Facts
Residents affected: 15
Facility census: 58
Resident refund balance: 803
Resident refund balance: 5618.32
Temperature: 108
Temperature: 155
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Occupational Therapy Assistant A | COTA | Discussed sink accommodation for Resident #14 |
| Business Office Manager | BOM | Discussed resident fund refunds |
| Certified Nurses Aide A | CNA | Provided information on DNR orders and resident care |
| Licensed Practical Nurse A | LPN | Provided information on DNR orders and resident care |
| Social Services Designee | SSD | Reviewed and discussed DNR orders |
| Director of Nursing | DON | Discussed expectations for DNR orders and PTSD care planning |
| Administrator | Discussed facility policies and expectations for resident care and food safety | |
| Housekeeper A | Housekeeper | Discussed housekeeping practices |
| Dietary Manager | DM | Discussed food safety and temperature checks |
| Dietician | Discussed food safety and temperature checks | |
| Certified Nurses Aide B | CNA | Discussed resident PTSD care |
Inspection Report
Routine
Census: 62
Deficiencies: 3
Date: Sep 24, 2024
Visit Reason
The inspection was conducted to evaluate the nursing facility's compliance with professional standards of quality of care, specifically regarding medication administration and blood sugar monitoring for a new admission.
Findings
The facility failed to ensure staff obtained a physician's order to check blood sugars and failed to ensure medications for a new admission were obtained and administered timely. This affected one of five sampled residents, Resident #3, with minimal harm or potential for actual harm.
Deficiencies (3)
Failure to obtain a physician's order to check blood sugars for a diabetic resident.
Failure to ensure medications for a new admission were obtained and administered as ordered.
Failure to complete the admission Minimum Data Set (MDS) and baseline care plan for Resident #3.
Report Facts
Facility census: 62
Medication doses: 20
Dates: Aug 30, 2024
Dates: Sep 1, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) A | Licensed Practical Nurse | Admitted the resident and provided information about medication receipt and orders |
| Director of Nursing (DON) | Director of Nursing | Provided statements regarding the need for physician orders and medication administration |
| Infection Preventionist (IP) | Infection Preventionist | Interviewed regarding medication delays and physician orders for blood sugar monitoring |
Inspection Report
Census: 59
Deficiencies: 1
Date: Feb 27, 2024
Visit Reason
The inspection was conducted to assess the facility's compliance with providing care and assistance for activities of daily living to residents unable to perform these tasks independently.
Findings
The facility failed to ensure that staff provided necessary care and services to three of 15 sampled residents who were unable to complete their own activities of daily living, specifically failing to reposition or provide incontinent care in a timely manner.
Deficiencies (1)
Failure to provide care and assistance to perform activities of daily living for residents unable to do so independently, including timely repositioning and incontinent care.
Report Facts
Residents sampled: 15
Residents affected: 3
Facility census: 59
Inspection Report
Routine
Census: 59
Deficiencies: 14
Date: Jan 5, 2024
Visit Reason
The inspection was a routine survey to assess compliance with regulatory requirements including resident rights, safety, care, medication administration, infection control, and facility maintenance.
Findings
The facility was found deficient in multiple areas including failure to promote resident choice in meals, inadequate maintenance of floors and handrails, failure to provide timely transfer/discharge notices, medication administration errors, inadequate infection control practices, insufficient dietary management qualifications, unsanitary kitchen conditions, failure to provide adequate activities, inadequate supervision during meals, improper catheter care, failure to assist residents with eating, and improper medication storage and labeling.
Deficiencies (14)
Failure to promote residents' right to make choices regarding foods served to sampled residents.
Failure to keep floors, doors, and handrails in good repair causing unsafe surfaces.
Failure to provide written notice of transfer or discharge to residents or responsible parties including appeal rights.
Failure to follow professional standards in medication administration including not cleaning insulin pen ports and vial ports and improper use of nasal spray.
Failure to properly use and maintain the Arivo 2 Nasal High Flow oxygen delivery system including lack of staff education and improper cleaning.
Failure to provide necessary care and assistance with activities of daily living including personal hygiene and positioning for dependent residents.
Failure to provide adequate activities to meet residents' needs including lack of individualized activities and failure to assist residents to activities.
Failure to provide adequate supervision during meals and failure to monitor safety and choking risks of a resident on a mechanically altered diet.
Failure to provide appropriate catheter care including cleaning drainage spout and use of dignity covers, and failure to clean perineal areas properly.
Failure to provide enough food/fluids and assistance to a resident with significant weight loss and failure to encourage meal consumption.
Medication administration errors including failure to clean insulin pen ports, failure to prime insulin pens, and crushing medications that should not be crushed.
Failure to ensure medications and biologicals are properly labeled, stored, and discarded including expired medications and undated insulin pens, and failure to have physician orders for medications kept at bedside.
Failure to maintain sanitary kitchen conditions including dirty vents, peeling paint, missing baseboards, expired food items, improper storage of food, lack of paper towels, and expired sanitizer test strips.
Failure to maintain effective infection prevention and control program including failure of staff to perform hand hygiene when passing food trays, assisting residents to eat, and administering eye drops.
Report Facts
Medication errors: 7
Resident census: 59
Weight loss: 16.6
Weight loss percentage: 10.3
Sanitizer test strip expiration: 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN A | Licensed Practical Nurse | Named in insulin administration errors and medication handling. |
| CNA C | Certified Nurse Aide | Named in catheter care deficiencies. |
| CNA H | Certified Nurse Aide | Named in infection control and feeding assistance deficiencies. |
| Dietary Manager | Dietary Manager | Named in dietary management and kitchen sanitation deficiencies. |
| Registered Dietitian | Registered Dietitian | Named in dietary management and kitchen sanitation deficiencies. |
| Administrator | Facility Administrator | Named in dietary management and kitchen sanitation deficiencies. |
| LPN B | Licensed Practical Nurse | Named in medication crushing and medication knowledge deficiencies. |
| LPN E | Licensed Practical Nurse | Named in infection control deficiency during eye drop administration. |
| CNA G | Certified Nurse Aide | Named in infection control deficiencies. |
| Dietary Aide A | Dietary Aide | Named in dishwasher sanitizer testing deficiencies. |
| Maintenance Director | Maintenance Director | Named in kitchen maintenance deficiencies. |
Inspection Report
Complaint Investigation
Census: 59
Deficiencies: 3
Date: Jan 5, 2024
Visit Reason
The inspection was conducted based on complaints regarding failure to provide necessary care and assistance to residents unable to perform activities of daily living, failure to assist a resident with eating despite significant weight loss, and failure to maintain kitchen sanitation.
Complaint Details
The visit was complaint-related due to allegations of inadequate care for residents unable to perform activities of daily living, failure to assist a resident with eating despite weight loss, and unsanitary kitchen conditions. The report documents observations, interviews, and record reviews supporting these complaints.
Findings
The facility failed to provide adequate personal hygiene care and assistance with activities of daily living to two residents, failed to assist one resident with eating despite significant weight loss, and failed to maintain the kitchen in a sanitary manner including improper food storage, unclean vents, expired sanitizer test strips, and inadequate dishwasher sanitization.
Deficiencies (3)
Failure to provide necessary care and assistance with activities of daily living to residents unable to complete their own care, including hygiene and repositioning.
Failure to assist a resident with eating despite significant weight loss and cognitive impairment.
Failure to maintain kitchen sanitation including dirty vents, peeling paint, missing baseboards, uncovered food containers, expired sanitizer test strips, and improper dishwasher sanitizer levels.
Report Facts
Weight loss: 16.6
Census: 59
Sanitizer level: 50
Sanitizer level: 100
Sanitizer test strip expiration date: 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA D | Certified Nurse Aide | Named in findings related to failure to provide timely incontinent care and improper application of splints. |
| CNA E | Certified Nurse Aide | Named in findings related to improper transfer and positioning of resident. |
| CNA B | Certified Nurse Aide | Named in findings related to failure to provide oral care to resident. |
| CNA C | Certified Nurse Aide | Named in findings related to failure to provide oral care to resident. |
| LPN A | Licensed Practical Nurse | Charge nurse who acknowledged staffing limitations affecting care. |
| Director of Nursing | Director of Nursing | Provided expectations for resident care and staff responsibilities. |
| Dietary Aide A | Dietary Aide | Observed using expired sanitizer test strips and unaware of sanitizer levels in dishwasher. |
| Dietary Aide B | Dietary Aide | Observed failing to wash hands after picking up bowl from floor before serving food. |
| Dishwasher Service Technician | Provided information on dishwasher sanitizer requirements. | |
| Maintenance Director | Maintenance Director | Responsible for HVAC vent cleaning and kitchen ceiling maintenance. |
| Registered Dietitian | Registered Dietitian | Provided expectations for kitchen sanitation and staff training. |
| Administrator | Administrator | Provided expectations for kitchen cleanliness and staff hygiene. |
Inspection Report
Routine
Census: 60
Deficiencies: 7
Date: Dec 9, 2021
Visit Reason
The inspection was conducted to assess compliance with Medicare/Medicaid regulations including proper use of beneficiary notices, restraint use, care planning, medication administration, catheter care, nutritional intake documentation, food safety, and medication error rates.
Findings
The facility failed to use updated beneficiary notice forms, maintain proper restraint documentation and consent, implement comprehensive care plans including nutritional intake documentation, ensure proper medication administration timing, provide adequate catheter care and documentation, prepare pureed meals according to recipes, and maintain safe food storage and labeling practices. Medication error rate exceeded 5% due to improper inhaler administration timing.
Deficiencies (7)
Failed to use the most updated SNFABN form for beneficiary notifications for five residents.
Failed to maintain proper documentation and monitoring for physical restraint use and assessments for one resident.
Failed to implement comprehensive care plans including documentation of meal intakes and restraint use for sampled residents.
Failed to ensure medication administration followed professional standards, specifically timing between inhaled medications.
Failed to provide and document catheter care and timely emptying of catheter bags as ordered.
Failed to follow provided recipes when preparing pureed meals, risking alteration of nutritional value.
Failed to store and prepare food in a safe and sanitary manner, including unlabeled and expired food items and unsanitary kitchen conditions.
Report Facts
Residents affected: 5
Residents affected: 1
Residents affected: 2
Residents affected: 1
Residents affected: 2
Residents affected: 1
Residents affected: 1
Medication error rate: 7.69
Facility census: 60
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Pharmacist A | Provided expert opinion on medication administration timing for inhalers | |
| Certified Medication Technician C | Observed administering inhaled medications improperly | |
| Director of Nursing | Director of Nursing | Provided expectations on restraint assessments, medication administration, and catheter care documentation |
| Certified Nurse Aide B | Certified Nurse Aide | Provided information on restraint use and care plan knowledge |
| MDS Coordinator | Provided information on restraint care plan and corporate instructions | |
| Dietary Manager | Discussed pureed food preparation and food safety practices | |
| Registered Dietician | Provided expectations on pureed meal recipe use | |
| Licensed Practical Nurse B | Licensed Practical Nurse | Provided information on catheter care and output documentation |
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