Inspection Reports for
Miller County Care and Rehabilitation Center
1157 HIGHWAY 17, TUSCUMBIA, MO, 65082-2100
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
12.7 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
131% worse than Missouri average
Missouri average: 5.5 deficiencies/yearDeficiencies per year
16
12
8
4
0
Occupancy
Latest occupancy rate
70% occupied
Based on a April 2025 inspection.
Occupancy rate over time
Inspection Report
Annual Inspection
Census: 60
Deficiencies: 5
Date: Apr 24, 2025
Visit Reason
The inspection was conducted as an annual survey of Miller County Care and Rehabilitation Center to assess compliance with federal and state regulations, including coordination of PASARR assessments, resident mobility, dietary staffing, and food safety.
Findings
The facility was found deficient in coordinating PASARR assessments for residents with mental health diagnoses, ensuring appropriate restorative nursing care to prevent decline in range of motion, employing a qualified dietary staff member, and following food safety protocols for thawing frozen foods. Several residents' records and care plans lacked timely and accurate screenings and interventions.
Deficiencies (5)
F644 Coordination of PASARR and Assessments CFR(s): 483.20(e)(1)(2). Facility staff failed to complete accurate Level I Pre-Admission Screening for residents with new mental health diagnoses. The facility census was 60.
F645 PASARR Screening for MD & ID CFR(s): 483.20(k)(1)-(3). Facility staff failed to accurately complete the Pre-Admission Screening and Resident Review process prior to admission for two residents. The facility census was 60.
F688 Increase/Prevent Decrease in ROM/Mobility CFR(s): 483.25(c)(1)-(3). Facility staff failed to provide appropriate treatment and services to prevent further decrease in range of motion for one resident with a contracture. The facility census was 60.
F801 Qualified Dietary Staff CFR(s): 483.60(a)(1)(2). Facility failed to employ a full-time qualified dietitian or designate a qualified person to serve as Director of Food and Nutrition Services. The facility census was 60.
F812 Food Procurement, Store/Prepare/Serve-Sanitary CFR(s): 483.60(i)(1)(2). Facility staff failed to properly thaw frozen meat to prevent growth of food-borne pathogens, risking all residents' safety. The facility census was 60.
Report Facts
Facility census: 60
Inspection Report
Life Safety
Census: 60
Capacity: 86
Deficiencies: 4
Date: Apr 24, 2025
Visit Reason
The inspection was conducted to assess compliance with the Life Safety Code, specifically focusing on the fire alarm and sprinkler systems being out of service for extended periods.
Findings
The facility failed to meet the requirements for fire alarm and sprinkler systems being out of service for more than four hours. Policies for fire watch were incomplete and did not contain all required information, potentially affecting all facility occupants.
Deficiencies (4)
K346 Fire Alarm System - Out of Service. The facility failed to ensure a complete policy for fire watch when the fire alarm system is out of service for more than four hours in a 24-hour period. The census was 60 with a capacity of 86.
K354 Sprinkler System - Out of Service. The facility failed to ensure a complete policy for fire watch when the sprinkler system is out of service for more than four hours in a 24-hour period. The census was 60 with a capacity of 86.
A2025 Fire Alarm System-Out of Service > than 4hrs. The facility did not immediately notify the department and local fire authority or implement an approved fire watch during the outage. This regulation is not met as evidenced by Class II deficiency.
A2036 Sprinkler System Out of Service More Than 4hr. The facility did not immediately notify the department and local fire authority or implement an approved fire watch during the outage. This regulation is not met as evidenced by Class II deficiency.
Report Facts
Census: 60
Total Capacity: 86
Deficiencies cited: 2
Inspection Report
Routine
Census: 60
Deficiencies: 5
Date: Apr 24, 2025
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to pre-admission screening, resident care including range of motion, staffing qualifications in food and nutrition services, and food safety practices.
Findings
The facility failed to complete accurate and timely Level I Pre-admission Screenings for residents with new mental health diagnoses, did not provide appropriate treatment to prevent further decrease in range of motion for a resident with contracture, failed to employ a qualified Director of Food and Nutrition Services, and improperly thawed frozen foods in the kitchen, risking foodborne illness.
Deficiencies (5)
Failed to complete accurate Level I Pre-admission Screening for residents with new mental health diagnoses.
Failed to accurately complete the Pre-admission Screening and Resident Review (PASRR) process prior to admission for sampled residents.
Failed to provide appropriate treatment and services to prevent further decrease in range of motion for a resident with contracture.
Failed to designate a qualified Director of Food and Nutrition Services when no full-time qualified dietitian was employed.
Failed to thaw frozen meat in a manner to prevent growth of food-borne pathogens, including thawing frozen foods in standing water without running water.
Report Facts
Residents sampled: 18
Facility census: 60
Hire date: Mar 17, 2025
Frozen food weight: 10
Water temperature: 82
Employees mentioned
| Name | Title | Context |
|---|---|---|
| M | Certified Medication Technician (CMT) | Mentioned in relation to observations and interviews about resident's contracture care |
| O | Restorative Aide (RA) | Mentioned in relation to resident's contracture care and interventions |
| Rehabilitation Director | Interviewed regarding resident's contracture care and expectations for staff | |
| Director of Nursing (DON) | Director of Nursing | Interviewed regarding PASARR screening and resident contracture care |
| Social Service Designee (SSD) | Responsible for completing PASARR screenings; interviewed about failures in screening completion | |
| Administrator | Interviewed regarding PASARR screening responsibilities and dietary manager qualifications | |
| DM | Dietary Manager | Interviewed about qualifications and food thawing practices |
| Cook | Interviewed about food thawing practices |
Inspection Report
Complaint Investigation
Census: 62
Deficiencies: 3
Date: Feb 23, 2024
Visit Reason
The inspection was conducted due to complaints regarding failure to notify a resident's physician about high blood sugar levels, failure to provide continuous oxygen as ordered, and inadequate infection prevention and control practices including hand hygiene and water system management.
Complaint Details
The investigation was complaint-driven, focusing on allegations that staff failed to notify a resident's physician about high blood sugar readings, failed to provide continuous oxygen therapy as ordered, and failed to maintain proper infection control practices including hand hygiene and water system management. The complaints were substantiated with observations, interviews, and record reviews confirming these deficiencies.
Findings
The facility failed to notify a resident's physician when blood sugar levels exceeded 450 mg/dL, failed to ensure continuous oxygen therapy for a resident as ordered, and failed to perform proper hand hygiene and implement a complete water management program to prevent infection risks including Legionnaire's Disease.
Deficiencies (3)
Failure to notify resident's physician when blood sugar exceeded 450 mg/dL.
Failure to provide continuous oxygen as ordered for a resident requiring oxygen therapy.
Failure to perform hand hygiene as required and failure to develop and implement complete water management policies to prevent infection.
Report Facts
Blood sugar readings: 456
Blood sugar readings: 522
Blood sugar readings: 493
Blood sugar readings: 462
Blood sugar readings: 485
Oxygen order: 3
Facility census: 62
Employees mentioned
| Name | Title | Context |
|---|---|---|
| J | Certified Medication Technician (CMT) | Named in failure to notify physician of high blood sugars |
| K | Licensed Practical Nurse (LPN) | Named in failure to notify physician of high blood sugars and oxygen therapy issues |
| J | Certified Nurse Aide (CNA) | Observed not providing oxygen as ordered |
| O | Certified Nurse Aide (CNA) | Observed failing to perform hand hygiene properly during resident care |
| P | Certified Nurse Aide (CNA) | Observed failing to perform hand hygiene properly during resident care |
| H | Registered Nurse (RN) | Interviewed regarding hand hygiene practices |
| F | Dietary Aide (DA) | Observed and interviewed regarding hand hygiene in food preparation |
| G | Dietary Aide (DA) | Observed and interviewed regarding hand hygiene in food preparation |
| DM | Dietary Manager | Interviewed regarding hand hygiene training |
| Maintenance Director | Interviewed regarding water management program | |
| Administrator | Interviewed regarding water management program and overall facility compliance | |
| Medical Director (MD) | Interviewed regarding expectations for notification and oxygen therapy | |
| Director of Nursing (DON) | Interviewed regarding expectations for notification, oxygen therapy, and hand hygiene |
Inspection Report
Annual Inspection
Census: 62
Deficiencies: 3
Date: Feb 23, 2024
Visit Reason
The inspection was an annual survey conducted to assess compliance with federal regulations and ensure the facility meets health and safety standards.
Findings
The facility was found deficient in notifying physicians of significant changes in residents' conditions, respiratory care and oxygen administration, and infection prevention and control practices. Staff failed to notify physicians timely about residents' blood sugar levels and oxygen needs, and hand hygiene protocols were not consistently followed.
Deficiencies (3)
F580 Notification of Changes: Facility staff failed to notify a resident's physician when blood sugar exceeded 450 mg/dL, and documentation of such notifications was lacking.
F695 Respiratory/Tracheostomy Care: Staff failed to ensure continuous oxygen was provided per physician orders and did not report broken portable oxygen concentrators.
F880 Infection Prevention & Control: Facility failed to maintain an effective infection control program, including inadequate hand hygiene and incomplete water management documentation.
Report Facts
Facility census: 62
Blood sugar readings: 5
Completion dates: Apr 5, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| J | Certified Medication Technician (CMT) | Interviewed regarding notification of physician about blood sugar levels and oxygen use |
| K | Licensed Practical Nurse (LPN) | Interviewed about expectations for notifying physicians of blood sugar levels and oxygen use |
| Director of Nursing (DON) | Interviewed about staff notification and documentation practices | |
| Administrator | Interviewed about resident care orders and staff responsibilities | |
| H | Registered Nurse (RN) | Interviewed about hand hygiene and glove use |
Inspection Report
Plan of Correction
Census: 62
Capacity: 86
Deficiencies: 4
Date: Feb 23, 2024
Visit Reason
The inspection was conducted to assess the facility's emergency preparedness policies and procedures, including compliance with regulations related to subsistence needs, tracking of staff and patients during emergencies, and roles under a waiver declared by the Secretary.
Findings
The facility failed to ensure its emergency preparedness plan included policies and procedures for sewage and waste disposal during emergencies, a system to track on-duty staff during emergencies, and policies regarding the facility's role in providing care at alternate care sites under a waiver. These deficiencies have the potential to affect all facility occupants.
Deficiencies (4)
E015: The facility failed to ensure the emergency preparedness plan contained policies and procedures for the disposal of sewage and waste during an emergency. This failure affects all facility occupants.
E018: The facility failed to maintain an emergency preparedness plan that included a system to track the location of on-duty staff during an emergency. This failure has the potential to delay response procedures and affect all occupants.
E026: The facility failed to develop policies and procedures regarding its role in providing care and treatment at alternate care sites under an 1135 waiver. This failure may delay response procedures and affect all occupants.
A2058: The facility did not have an up-to-date fire drill and emergency preparedness plan as required by state regulations. The deficiency was classified as Class II due to the extent of the violation.
Report Facts
Facility census: 62
Total capacity: 86
Inspection Report
Routine
Census: 61
Deficiencies: 7
Date: Nov 17, 2022
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident rights, physician orders, employee qualifications, bed hold policies, accident prevention, food safety, and infection control.
Findings
The facility was found deficient in multiple areas including failure to support resident self-determination regarding smoking policy, inconsistent documentation of residents' Physician's Orders for Life-Sustaining Treatment, failure to perform quarterly Employee Disqualification List checks, failure to notify residents of bed hold policies, unsafe wheelchair propulsion practices, inadequate food safety and hygiene practices, and improper wound care procedures increasing risk of infection.
Deficiencies (7)
Facility staff failed to create an environment supporting resident choice regarding smoking policy, restricting residents from smoking outside due to temperature restrictions.
Facility staff failed to provide consistent documentation of residents' Physician's Orders for Life-Sustaining Treatment for four residents.
Facility staff failed to perform quarterly Employee Disqualification List checks for nine out of ten sampled employees.
Facility staff failed to notify residents or their representatives in writing of the bed hold policy for three sampled residents.
Facility staff failed to ensure safe wheelchair propulsion, resulting in residents' feet dragging on the floor or touching the floor while being propelled.
Facility staff failed to perform hand hygiene as necessary, sanitize food preparation sinks between uses, store dishes properly, use hair restraints, store sanitation rags submerged, ensure ice bin drained through an air gap, and properly store open food.
Facility staff failed to provide wound care in a manner to reduce infection risk, including failure to perform hand hygiene between glove changes and improper handling of wound care supplies.
Report Facts
Residents affected: 4
Residents affected: 4
Employees affected: 9
Residents affected: 3
Residents affected: 2
Facility census: 61
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN D | Licensed Practical Nurse | Named in wound care infection control deficiency |
| CNA C | Certified Nurse Aide | Named in wheelchair propulsion deficiency |
| Certified Nurse Assistant E | Certified Nurse Assistant | Named in smoking policy deficiency |
| Director of Nursing | Director of Nursing | Provided statements on smoking policy and wheelchair safety |
| Administrator | Administrator | Provided statements on smoking policy, Employee Disqualification List, bed hold policy, food safety, and infection control |
| Dietary Supervisor | Dietary Supervisor | Provided statements on food safety and hygiene deficiencies |
| Medical Director | Medical Director | Provided statements on smoking policy and infection control |
| Social Service Designee | Social Service Designee | Named in smoking policy and bed hold notification deficiencies |
| Human Resource Manager | Human Resource Manager | Provided statements on Employee Disqualification List checks |
| Cleaning Service Supervisor | Cleaning Service Supervisor | Named in wheelchair propulsion deficiency |
| Dishwasher G | Dishwasher | Named in food safety deficiency |
Inspection Report
Complaint Investigation
Census: 61
Deficiencies: 7
Date: Nov 17, 2022
Visit Reason
The inspection was conducted due to a complaint investigation regarding the facility's smoking policy and other regulatory compliance issues.
Complaint Details
The complaint investigation focused on the facility's smoking policy and residents' rights to smoke outside. The complaint was substantiated as staff failed to allow residents to smoke outside during cold weather conditions, causing distress. Additional deficiencies were identified during the investigation.
Findings
The facility failed to allow residents to smoke outside according to their smoking policy during certain weather conditions, resulting in resident distress. Additional deficiencies were found related to documentation of life-sustaining treatment orders, abuse/neglect policies, bed hold policies, accident hazards, food safety, infection control, and other regulatory requirements.
Deficiencies (7)
F 561 Self-determination: Facility staff failed to create an environment allowing residents to make choices regarding smoking, restricting four residents from smoking outside due to a new smoking policy.
F 578 Request/Refuse/Discontinue Treatment; Advance Directives: Facility staff failed to provide consistent documentation of residents' Physician's Orders for life-sustaining treatment for four residents.
F 607 Develop/Implement Abuse/Neglect Policies: Facility staff failed to check the Employee Disqualification List quarterly for nine of ten sampled employees.
F 625 Notice of Bed Hold Policy Before/Upon Transfer: Facility staff failed to provide written bed hold policy information to three residents or their representatives.
F 689 Free of Accident Hazards/Supervision/Devices: Facility staff failed to ensure residents' environment was free of accident hazards, including improper wheelchair use and foot pedal use, affecting two residents.
F 812 Food Procurement, Store, Prepare, Serve-Sanitary: Facility staff failed to maintain food safety, including improper hand hygiene, food storage, and sanitation practices, with the facility census at 61.
F 880 Infection Prevention & Control: Facility staff failed to establish and maintain an infection prevention and control program, including wound care and hand hygiene, affecting two residents.
Report Facts
Facility census: 61
Number of sampled employees not checked on EDL quarterly: 9
Number of residents affected by deficient life-sustaining treatment documentation: 4
Number of residents affected by deficient smoking policy enforcement: 4
Number of residents affected by deficient bed hold policy notification: 3
Number of residents affected by accident hazards: 2
Number of residents affected by deficient infection control wound care: 2
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