10 Reports
Inspection Report — Nov 8, 2023
Routine
Date: Nov 8, 2023
Visit Reason
CMS-2567 federal health survey and Missouri Department of Health and Senior Services State Form; the survey type is not stated.
Findings
Two deficiencies were cited: one federal health deficiency for resident self-administration of medications (SS=E) involving failure to obtain physician orders and assessments for bedside medications, and one Missouri state citation for self-administration of medication (Class II) referring to the federal finding.
Deficiencies (1)
19 CSR 30-85.042(50) Self-Administration of Medication: Please refer to federal citation F554.
Report Facts
residents affected: 2
residents sampled: 4
Inspection Report — Oct 6, 2021
Complaint Investigation
Date: Oct 6, 2021
Visit Reason
CMS-2567 federal health survey (statement of deficiencies) and Missouri Department of Health and Senior Services State Form are included; the file documents a complaint investigation (MO191719, MO191718, MO191716, MO191821, MO190796).
Complaint Details
Complaint investigation numbers MO191719, MO191718, MO191716, MO191821, MO190796; substantiation not stated in the form.
Findings
Five deficiencies were cited: three federal deficiencies addressing quality of care, accident hazards/supervision/devices, and pain management, and two Missouri state licensure deficiencies referencing nursing care per resident condition and physician notification/change in condition.
Deficiencies (2)
19 CSR 30-85.042(67) Nursing Care per Res Condition: Refer to F684, F689 and F697.
19 CSR 30-85.042(79) Dr Notification-Change in Condition: Refer to F684.
Report Facts
residents sampled: 2
Inspection Report — May 4, 2021
Complaint Investigation
Date: May 4, 2021
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure survey (State Form); the file includes a complaint investigation (complaint number MO184846).
Complaint Details
Complaint number MO184846; substantiation not stated in the record.
Findings
Four deficiencies were cited: two federal deficiencies addressing a resident representative/DPOA decision-making issue and transfer/discharge notice requirements, and two Missouri state deficiencies addressing 30-day notice and discharge appeal rights. The federal findings involved allowing a DPOA to make medical decisions before a resident was declared incompetent and failure to provide a required 30-day discharge notice.
Deficiencies (2)
19 CSR 30-88.010(15) 30 Day Notice-Transfer/Discharge: Refer to F623.
19 CSR 30-88.010(17) Discharge Appeal Rights: Refer to F623.
Report Facts
residents sampled: 2
residents affected: 1
Inspection Report — Nov 5, 2020
Routine
Date: Nov 5, 2020
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure survey (State Form); the survey type is not stated.
Findings
Three deficiencies were cited: two federal health deficiencies involving failure to notify/resident transfer/room assignment errors and quality of care related to two residents (one resident was mistakenly sent to the hospital and another was not sent as ordered and later expired), and one Missouri state licensure deficiency regarding notification of responsible party for change in condition. Past noncompliance was noted for the quality of care finding.
Deficiencies (1)
19 CSR 30-85.042(80) Notify Responsible Party-Change in Condition: Please refer to F580.
Report Facts
residents affected: 2
audits per week: 5
audit duration (weeks): 4
Inspection Report — Jan 14, 2020
Complaint Investigation
Date: Jan 14, 2020
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure form are included; a complaint investigation is cited (MO00165264) and the file also contains a later revisit (R-C) set of federal pages.
Complaint Details
MO00165264; substantiation not stated in the documents.
Findings
Two deficiencies were cited: one federal finding for failures to follow physician orders and to administer and document IV therapy and one Missouri state finding for failure to provide nursing care consistent with residents' conditions (the state citation references the federal finding).
Deficiencies (1)
19 CSR 30-85.042(67) Nursing Care per Res Condition: Please refer to F 658.
Report Facts
residents sampled: 3
Inspection Report — Oct 17, 2019
Routine
Date: Oct 17, 2019
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure survey (State Form); the survey type is not stated.
Findings
There are 10 federal health deficiencies covering resident rights/required postings and ombudsman contact information, advance directives documentation, transfer/discharge notice requirements, comprehensive care planning and professional care standards (pressure ulcers, LAL mattress settings, insulin administration), catheter and peri-care, enteral feeding management and documentation, nurse staffing postings, nutrition/mealtime service, and infection prevention and control. There are 6 Missouri State Form deficiencies addressing nursing care per resident condition, infection control/communicable disease, clinical records/assessment and interventions, nutritional needs, resident rights postings/Alzheimer's unit information, and emergency discharges.
Deficiencies (6)
19 CSR 30-85.042(67) Nursing Care per Res Condition: See F578, F658, F690, F693, F880.
19 CSR 30-85.042(78) Infection Control/Communicable Disease: Refer to F880.
19 CSR 30-85.042(99)(B) Clinical Records - assessment/interventions: Refer to F656.
19 CSR 30-85.052(1) Nutritional Needs Met, Assess Res, Inform Dr.: See F800.
19 CSR 30-88.010(7) Res Rights/Rules Posted, Alz Unit Info: The facility failed to ensure resident rights were posted in a conspicuous location.
19 CSR 30-88.010(18) Emergency Discharges: Refer to F623.
Report Facts
residents sampled: 19
Inspection Report — Oct 17, 2019
Life Safety
Date: Oct 17, 2019
Visit Reason
CMS-2567 Life Safety survey (K-tag findings) and Missouri Department of Health and Senior Services State Form; the survey type is not stated.
Findings
Three deficiencies were cited: two federal life-safety deficiencies addressing smoke barrier construction/penetrations and electrical systems maintenance/testing of resident room receptacles, and one Missouri state deficiency for smoke section walls/doors that references the life-safety finding.
Deficiencies (1)
19 CSR 30-85.022(29) Smoke Section Walls/Doors: Refer to K372.
Report Facts
smoke barrier walls affected: 3
rooms inspected: 6
Inspection Report — Oct 3, 2019
Complaint Investigation
Date: Oct 3, 2019
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure survey (State Form); complaint investigation referenced by MO161145 and MO161491.
Complaint Details
MO161145 and MO161491; outcome not stated.
Findings
2 deficiencies: one federal health deficiency concerning transfer and discharge requirements (failure to provide 30-day discharge notices to sampled residents) and one Missouri licensure deficiency concerning the 30-day notice for transfer/discharge.
Deficiencies (1)
19 CSR 30-88.010(15) 30 Day Notice-Transfer/Discharge: See the deficiency cited at F622.
Report Facts
residents sampled: 2
Inspection Report — Apr 17, 2019
Routine
Date: Apr 17, 2019
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure survey (State Form); the survey type is not stated.
Findings
Two deficiencies were cited related to infection prevention and control. One federal deficiency (failure of staff to follow proper infection control during a dressing change affecting one resident) and one Missouri state licensure deficiency referencing the federal finding were issued.
Deficiencies (1)
19 CSR 30-85.042(78) Infection-Control/Communicable Disease: See the deficiency cited at F 880.
Report Facts
residents affected: 1
Inspection Report — Dec 14, 2018
Routine
Date: Dec 14, 2018
Visit Reason
Federal health survey (CMS-2567) and Missouri Department of Health and Senior Services State Form; the survey type is not stated.
Findings
Four deficiencies were cited: two federal deficiencies for resident rights/exercise of rights and residents being free of significant medication errors, and two Missouri state deficiencies addressing medication errors/adverse reaction reporting and dignity/privacy (each referring to the related federal deficiency).
Deficiencies (2)
19 CSR 30-85.042(52) Medication Errors/Adverse Reactions Reported: Refer to F760.
19 CSR 30-88.010(29) Dignity/Privacy: Refer to F550.
Report Facts
sampled residents affected (dignity/call light issues): 3
sampled residents affected (medication errors): 3
26 CMS Surveys
Inspection Report — Dec 30, 2025
Annual Inspection
Date: Dec 30, 2025
Visit Reason
The inspection was conducted as part of the facility's annual survey to assess compliance with regulations, specifically focusing on meal service times and nutritional care.
Findings
The facility failed to serve meals in accordance with its policy and scheduled mealtimes, resulting in delayed breakfast service for two sampled residents. Observations and interviews confirmed that meals were served late, causing resident dissatisfaction and potential nutritional risk.
Deficiencies (1)
Failed to serve meals and snacks at times in accordance with resident’s needs, preferences, and requests, including providing suitable and nourishing alternative meals for residents who want to eat at non-traditional times or outside of scheduled meal times.
Report Facts
Meal service times: 8.5
Meal service times: 12.5
Meal service times: 17.5
Number of sampled residents affected: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant A | Certified Nursing Assistant | Interviewed regarding meal delivery process and late breakfast meals for residents |
| Dietary Manager | Dietary Manager | Interviewed about meal ordering process and new resident meal preferences |
| Administrator | Administrator | Interviewed about meal service expectations and timing |
Inspection Report — Jun 28, 2024
Complaint Investigation
Date: Jun 28, 2024
Visit Reason
CMS-2567 federal health survey (Recertification and Complaint Survey as stated in Initial Comments). No separate Life Safety (K) or Missouri State Form (A/L) pages in this file.
Findings
Seven federal deficiencies were cited covering failure to report and investigate alleged abuse, timely care plan revision and hospice coordination, pressure ulcer prevention and treatment, unnecessary psychotropic/PRN medication use, food storage/food service sanitation, and infection prevention including Enhanced Barrier Precautions.
Deficiencies (7)
F609 Reporting of Alleged Violations: Based on record review, interview, and facility policy review, the facility failed to report an allegation of verbal abuse to the State Survey Agency for one of four residents (Resident R37) reviewed for abuse out of 25 sample residents; this failure had the potential to affect resident safety at the facility.
F610 Investigate/Prevent/Correct Alleged Violation: Based on record review, interview, and facility policy review, the facility failed to thoroughly investigate an allegation of verbal abuse for one of four residents (Resident R37), with inadequate documentation and no evidence of appropriate investigation or follow-up.
F657 Care Plan Timing and Revision: Based on record review and interview, the facility failed to ensure care plans were revised for two of three residents reviewed for care plan accuracy, including failing to identify inaccurate medical diagnoses and not revising the care plan to address hospice services and related interventions.
F686 Treatment/Svcs to Prevent/Heal Pressure Ulcer: Based on observations, interviews, record review, and policy review, the facility failed to ensure pressure ulcer treatment orders and prevention measures were implemented for one of two residents reviewed for pressure ulcers, including missing/unclearly scheduled treatment entries and lack of monitoring documentation.
F758 Free from Unnec Psychotropic Meds/PRN Use: Based on record review and interview, the facility failed to ensure a resident was free from unnecessary psychotropic medications when one resident (R10) received separate doses of psychotropic medications without documented clinical need or appropriate documentation of justification and effectiveness.
F812 Food Procurement,Store,Prepare,Serve-Sanitary: Based on observations, interviews, and policy review, the facility failed to store foods in sealed containers, ensure cleanliness of the ice machine, and maintain adequate hand hygiene and safe food handling during meal service in one kitchen, with these failures having the potential to cause the spread of foodborne illness to all residents.
F880 Infection Prevention & Control: Based on observations, interviews, record review, and policy review, the facility failed to implement required infection prevention measures including Enhanced Barrier Precautions for residents with chronic wounds or indwelling devices, lacked EBP signage and PPE availability, and had not fully implemented related policies and staff training.
Report Facts
residents sampled: 25
residents potentially affected by foodborne illness: 96
residents reviewed for Enhanced Barrier Precautions: 25
Inspection Report — Jun 25, 2024
Life Safety
Date: Jun 25, 2024
Visit Reason
CMS-2567 Life Safety Code survey (K-tags present); Life Safety Code Survey conducted by Healthcare Management Solutions on behalf of the Missouri Department of Health and Senior Services.
Findings
2 life safety deficiencies were cited involving exit signage visibility in the courtyard and unprotected/unsecured low-voltage wiring and conduit in the fire alarm/control areas.
Deficiencies (2)
K 293 Exit Signage: Based on observation and interview, the facility failed to ensure the exit sign in the courtyard was not obscured; the exit sign above the exit door could not be seen because of the bulkhead.
K 511 Utilities - Gas and Electric: Observations revealed low-voltage wiring under seven feet was not protected and a 4 1/2 inch electrical conduit was not secured within three feet of a box or panel; wiring in the Fire Control Alarm Room was not protected or secured.
Report Facts
residents potentially affected: 71
Inspection Report — Nov 8, 2023
Routine
Date: Nov 8, 2023
Visit Reason
CMS-2567 federal health survey and Missouri Department of Health and Senior Services State Form; the survey type is not stated.
Findings
Two deficiencies were cited: one federal health deficiency for resident self-administration of medications (SS=E) involving failure to obtain physician orders and assessments for bedside medications, and one Missouri state citation for self-administration of medication (Class II) referring to the federal finding.
Deficiencies (1)
F 554 Resident Self-Admin Meds-Clinically Approp: Based on observations, interviews, and record review, the facility failed to ensure staff obtained physician orders and assessed residents for safe self-administration of medications kept at the bedside for two of four sampled residents.
Report Facts
residents affected: 2
residents sampled: 4
Inspection Report — Sep 22, 2023
Routine
Date: Sep 22, 2023
Visit Reason
Federal health survey (CMS-2567): COVID-19 Focused Emergency Preparedness and COVID-19 Focused Infection Control Survey as stated on the form.
Findings
No deficiencies were cited; the facility was found to be in compliance for the COVID-19 focused emergency preparedness and infection control survey.
Inspection Report — Feb 22, 2023
Routine
Date: Feb 22, 2023
Visit Reason
CMS-2567 health survey (F) and CMS-2567 Emergency Preparedness (E) form; the surveys were COVID-19 focused infection control and emergency preparedness surveys as stated on the forms.
Findings
No health or emergency preparedness deficiencies were cited. The facility was found in compliance with CMS/CDC recommended practices for COVID-19 infection control and with 42 CFR 483.73 emergency preparedness.
Inspection Report — Dec 22, 2022
Complaint Investigation
Date: Dec 22, 2022
Visit Reason
Federal CMS-2567 health survey form and Missouri Department of Health and Senior Services state licensure form; the state form identifies the activity as a licensure inspection/complaint investigation.
Findings
No federal health survey deficiencies were cited and no state licensure deficiencies were cited; zero deficiencies were identified across both the CMS-2567 and the Missouri state form.
Inspection Report — Mar 2, 2022
Routine
Date: Mar 2, 2022
Visit Reason
CMS-2567 federal health (F) and Emergency Preparedness (E) forms; the document states it was a COVID-19 Focused Emergency Preparedness survey.
Findings
No federal health (F) or Emergency Preparedness (E) deficiencies were cited; the survey documents only initial comments indicating compliance with the referenced emergency preparedness requirement.
Inspection Report — Jan 26, 2022
Routine
Date: Jan 26, 2022
Visit Reason
Federal CMS-2567 health survey; a COVID-19 Focused Emergency Preparedness and Infection Control survey was conducted.
Findings
No deficiencies were cited. The facility was found in compliance with CMS and CDC recommended practices for COVID-19 emergency preparedness and infection control.
Inspection Report — Oct 6, 2021
Complaint Investigation
Date: Oct 6, 2021
Visit Reason
CMS-2567 federal health survey (statement of deficiencies) and Missouri Department of Health and Senior Services State Form are included; the file documents a complaint investigation (MO191719, MO191718, MO191716, MO191821, MO190796).
Complaint Details
Complaint investigation numbers MO191719, MO191718, MO191716, MO191821, MO190796; substantiation not stated in the form.
Findings
Five deficiencies were cited: three federal deficiencies addressing quality of care, accident hazards/supervision/devices, and pain management, and two Missouri state licensure deficiencies referencing nursing care per resident condition and physician notification/change in condition.
Deficiencies (3)
F684 Quality of Care: Based on interview and record review, the facility failed to thoroughly assess two sampled residents after falls and failed to notify residents' physicians; staff did not ensure understanding of falls definitions and did not complete post-fall assessments or required 72-hour monitoring.
F689 Free of Accident Hazards/Supervision/Devices: Based on interview and record review, the facility failed to ensure staff were trained and informed of individual resident care needs and transfer requirements; a resident who required a Hoyer lift was transferred using a sit-to-stand device (STS), was unable to hold on, was lowered to the floor and sustained a femur fracture.
F697 Pain Management: Based on interview and record review, the facility failed to assess, treat, and reassess sampled residents for pain following incidents; staff did not timely or adequately document pain assessments or follow-up interventions, and residents with documented fractures did not receive consistent pain management documentation.
Report Facts
residents sampled: 2
Inspection Report — Aug 5, 2021
Routine
Date: Aug 5, 2021
Visit Reason
Federal CMS-2567 health and emergency preparedness forms; the Initial Comments state a COVID-19 Focused Emergency Preparedness survey was conducted.
Findings
No federal health or emergency preparedness deficiencies were cited on the CMS-2567 forms; initial comments state the facility was found in compliance with COVID-19 emergency preparedness requirements.
Inspection Report — Jun 15, 2021
Routine
Date: Jun 15, 2021
Visit Reason
Federal CMS-2567 health and emergency preparedness forms; a COVID-19 Focused Infection Control Survey and a COVID-19 Focused Emergency Preparedness survey were conducted on 06/15/2021.
Findings
No health survey (infection control) or emergency preparedness deficiencies were cited.
Inspection Report — May 4, 2021
Complaint Investigation
Date: May 4, 2021
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure survey (State Form); the file includes a complaint investigation (complaint number MO184846).
Complaint Details
Complaint number MO184846; substantiation not stated in the record.
Findings
Four deficiencies were cited: two federal deficiencies addressing a resident representative/DPOA decision-making issue and transfer/discharge notice requirements, and two Missouri state deficiencies addressing 30-day notice and discharge appeal rights. The federal findings involved allowing a DPOA to make medical decisions before a resident was declared incompetent and failure to provide a required 30-day discharge notice.
Deficiencies (2)
F551 Rights Exercised by Representative: Based on interview and record review, the facility failed to protect the rights of one sampled resident by allowing the resident's Durable Power of Attorney to make medical decisions for the resident before the resident was declared incompetent.
F623 Notice Requirements Before Transfer/Discharge: Based on interview and record review, the facility failed to provide a required 30-day discharge notice to one sampled resident prior to transfer/discharge.
Report Facts
residents sampled: 2
residents affected: 1
Inspection Report — Feb 2, 2021
Routine
Date: Feb 2, 2021
Visit Reason
CMS-2567 federal health (F tag) and Emergency Preparedness (E tag) surveys; a COVID-19 Focused Infection Control and Emergency Preparedness survey was conducted.
Findings
No health survey deficiencies were cited and no emergency preparedness deficiencies were cited. The survey found the facility in compliance with CDC recommended practices for COVID-19 and with 42 CFR 483.73 related to E-0024(b)(6).
Inspection Report — Dec 3, 2020
Routine
Date: Dec 3, 2020
Visit Reason
Federal health survey (CMS-2567) — COVID-19 Focused Infection Control Survey, and Emergency Preparedness survey (CMS-2567 E-section) — COVID-19 Focused Emergency Preparedness Survey.
Findings
No federal health (F) deficiencies were cited and no Emergency Preparedness (E) deficiencies were cited; both surveys were documented as in compliance.
Inspection Report — Nov 5, 2020
Routine
Date: Nov 5, 2020
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure survey (State Form); the survey type is not stated.
Findings
Three deficiencies were cited: two federal health deficiencies involving failure to notify/resident transfer/room assignment errors and quality of care related to two residents (one resident was mistakenly sent to the hospital and another was not sent as ordered and later expired), and one Missouri state licensure deficiency regarding notification of responsible party for change in condition. Past noncompliance was noted for the quality of care finding.
Deficiencies (2)
F 580 Notify of Changes (Injury/Decline/Room, etc.): Based on interview and record review, the facility failed to immediately notify the resident representative for one resident when the resident was mistakenly sent to the hospital emergency department after room numbers were switched, and the facility did not provide any policy regarding notifications.
F 684 Quality of Care: Based on interview and record review, the facility failed to ensure that two residents received treatment and care in accordance with professional standards when Resident #1 was not sent to the hospital as ordered and was later found expired and Resident #2 was wrongfully sent to the hospital due to switched room numbers; the facility's administrator noted past noncompliance.
Report Facts
residents affected: 2
audits per week: 5
audit duration (weeks): 4
Inspection Report — Oct 27, 2020
Routine
Date: Oct 27, 2020
Visit Reason
CMS-2567 federal health (F tags) infection control and CMS-2567 emergency preparedness (E tags) surveys; a COVID-19 Focused Infection Control and Emergency Preparedness survey as stated in the Initial Comments.
Findings
Zero deficiencies were cited. The facility was found in compliance with COVID-19 infection control practices and with emergency preparedness requirements.
Inspection Report — May 28, 2020
Routine
Date: May 28, 2020
Visit Reason
CMS-2567 federal health (infection control) and emergency preparedness survey; the forms state this was a COVID-19 focused infection control and emergency preparedness survey conducted May 20 through May 28, 2020.
Findings
No deficiencies were cited. The surveyor found the facility in compliance with CMS and CDC recommended practices to prepare for COVID-19 and in compliance with 42 CFR 483.73 related to emergency preparedness.
Inspection Report — Jan 14, 2020
Complaint Investigation
Date: Jan 14, 2020
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure form are included; a complaint investigation is cited (MO00165264) and the file also contains a later revisit (R-C) set of federal pages.
Complaint Details
MO00165264; substantiation not stated in the documents.
Findings
Two deficiencies were cited: one federal finding for failures to follow physician orders and to administer and document IV therapy and one Missouri state finding for failure to provide nursing care consistent with residents' conditions (the state citation references the federal finding).
Deficiencies (1)
F658 Services Provided Meet Professional Standards: Based on observation, record review and interviews, the facility failed to ensure staff followed physicians' orders and administer IV therapy and failed to obtain and document vital signs or notify the physician when the resident's condition declined for Resident #1 and others.
Report Facts
residents sampled: 3
Inspection Report — Oct 17, 2019
Routine
Date: Oct 17, 2019
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure survey (State Form); the survey type is not stated.
Findings
There are 10 federal health deficiencies covering resident rights/required postings and ombudsman contact information, advance directives documentation, transfer/discharge notice requirements, comprehensive care planning and professional care standards (pressure ulcers, LAL mattress settings, insulin administration), catheter and peri-care, enteral feeding management and documentation, nurse staffing postings, nutrition/mealtime service, and infection prevention and control. There are 6 Missouri State Form deficiencies addressing nursing care per resident condition, infection control/communicable disease, clinical records/assessment and interventions, nutritional needs, resident rights postings/Alzheimer's unit information, and emergency discharges.
Deficiencies (10)
F575 Required Postings: The facility failed to post resident rights/ombudsman and state agency contact information in a conspicuous location.
F578 Request/Refuse/Discntnue Trmnt;Formlte Adv Dir: Staff failed to obtain appropriate advance directive documentation and verifications for a sampled resident.
F623 Notice Requirements Before Transfer/Discharge: The facility failed to ensure written notice of transfer or discharge was provided to residents or their responsible parties.
F656 Develop/Implement Comprehensive Care Plan: The facility failed to develop and implement comprehensive, measurable person-centered care plans for sampled residents.
F658 Services Provided Meet Professional Standards: Staff failed to follow professional standards for Low Air Loss mattress settings and for priming/administration and timing of fast-acting insulin.
F690 Bowel/Bladder Incontinence, Catheter, UTI: The facility failed to ensure complete peri and catheter care to prevent infection, affecting sampled residents with indwelling catheters.
F693 Tube Feeding Mgmt/Restore Eating Skills: The facility failed to ensure staff followed enteral feeding procedures and documented the amount of tube feeding and water actually administered each shift.
F732 Posted Nurse Staffing Information: The facility failed to post complete nurse staffing data in a prominent, readily accessible location.
F800 Provided Diet Meets Needs of Each Resident: The facility failed to provide timely, consistent meal service and otherwise ensure residents received nourishing, palatable meals consistent with preferences and needs.
F880 Infection Prevention & Control: The facility failed to ensure staff followed hand hygiene and dressing/change protocols and other infection control practices, affecting multiple sampled residents.
Report Facts
residents sampled: 19
Inspection Report — Oct 17, 2019
Life Safety
Date: Oct 17, 2019
Visit Reason
CMS-2567 Life Safety survey (K-tag findings) and Missouri Department of Health and Senior Services State Form; the survey type is not stated.
Findings
Three deficiencies were cited: two federal life-safety deficiencies addressing smoke barrier construction/penetrations and electrical systems maintenance/testing of resident room receptacles, and one Missouri state deficiency for smoke section walls/doors that references the life-safety finding.
Deficiencies (2)
K372 Subdivision of Building Spaces - Smoke Barrier: Based on observation and interview, the facility failed to maintain the required one-hour fire resistance rating of several smoke barrier walls; openings at the roof deck and penetrations (an unsealed electrical metal-flex cable at smoke barrier doors) were observed.
K914 Electrical Systems - Maintenance and Testing: Based on observation, interview and record review, the facility failed to complete the annual inspection and testing of resident room electrical receptacles not listed as hospital grade, and only a limited number of rooms had been inspected.
Report Facts
smoke barrier walls affected: 3
rooms inspected: 6
Inspection Report — Oct 3, 2019
Complaint Investigation
Date: Oct 3, 2019
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure survey (State Form); complaint investigation referenced by MO161145 and MO161491.
Complaint Details
MO161145 and MO161491; outcome not stated.
Findings
2 deficiencies: one federal health deficiency concerning transfer and discharge requirements (failure to provide 30-day discharge notices to sampled residents) and one Missouri licensure deficiency concerning the 30-day notice for transfer/discharge.
Deficiencies (1)
F622 Transfer and Discharge Requirements: Based on interviews and record reviews, the facility failed to give two sampled residents 30 day discharge notices.
Report Facts
residents sampled: 2
Inspection Report — Apr 17, 2019
Routine
Date: Apr 17, 2019
Visit Reason
Federal health survey (CMS-2567) and Missouri state licensure survey (State Form); the survey type is not stated.
Findings
Two deficiencies were cited related to infection prevention and control. One federal deficiency (failure of staff to follow proper infection control during a dressing change affecting one resident) and one Missouri state licensure deficiency referencing the federal finding were issued.
Deficiencies (1)
F 880 Infection Prevention & Control: Based on observation, interviews, and record reviews, the facility failed to ensure staff followed acceptable infection control procedures when performing a dressing change, affecting one resident.
Report Facts
residents affected: 1
Inspection Report — Dec 14, 2018
Routine
Date: Dec 14, 2018
Visit Reason
Federal health survey (CMS-2567) and Missouri Department of Health and Senior Services State Form; the survey type is not stated.
Findings
Four deficiencies were cited: two federal deficiencies for resident rights/exercise of rights and residents being free of significant medication errors, and two Missouri state deficiencies addressing medication errors/adverse reaction reporting and dignity/privacy (each referring to the related federal deficiency).
Deficiencies (2)
F550 Resident Rights/Exercise of Rights: Based on observations, interviews and record reviews, staff failed to respond in a timely manner to resident call lights for sampled residents and failed to follow Resident #3's preference regarding facial hair removal.
F760 Residents are Free of Significant Med Errors: Based on observations, interviews, and record reviews, the facility failed to provide a safe and effective medication administration system free from significant medication errors for three sampled residents when staff failed to administer medications per physician orders and administered medications hours late.
Report Facts
sampled residents affected (dignity/call light issues): 3
sampled residents affected (medication errors): 3
Inspection Report — Aug 7, 2018
Routine
Date: Aug 7, 2018
Visit Reason
CMS-2567 federal health survey (statement of deficiencies) and Missouri Department of Health and Senior Services State Form licensure inspection; the survey type is not stated on the forms.
Findings
No federal health survey deficiencies were cited and no Missouri state licensure deficiencies were cited.
Inspection Report — Aug 7, 2018
Life Safety
Date: Aug 7, 2018
Visit Reason
File contains CMS-2567 pages for Emergency Preparedness (E 000) and Life Safety (K 000) and a Missouri Department of Health and Senior Services licensure State Form. The CMS Life Safety initial comments reference the Life Safety Code, so the inspection is a life safety survey.
Findings
Zero deficiencies were cited. The CMS Emergency Preparedness and Life Safety pages contain only initial comments and no cited deficiencies, and the Missouri licensure form states no state licensure deficiencies were cited.
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