Inspection Reports for
Pleasant Valley Manor Care Center
6814 SOBBIE RD, LIBERTY, MO, 64068-9555
Back to Facility ProfileDeficiencies (last 8 years)
Deficiencies (over 8 years)
12.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
133% worse than Missouri average
Missouri average: 5.5 deficiencies/year
Deficiencies per year
80
60
40
20
0
Occupancy
Latest occupancy rate
61% occupied
Based on a September 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Annual Inspection
Census: 62
Deficiencies: 7
Date: Sep 5, 2025
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care, medication management, food service, and financial practices at Pleasant Valley Manor Care Center.
Findings
The facility was found deficient in multiple areas including failure to inform residents or their representatives about risks and benefits of psychotropic medications, failure to provide timely refunds and notifications related to resident funds, medication errors exceeding acceptable rates, improper medication storage and expired medications, failure to provide suitable meal substitutes and properly prepared therapeutic diets, and inadequate food storage and labeling practices.
Deficiencies (7)
Failed to ensure residents or their representatives were informed of risks and benefits of psychotropic medications for three sampled residents.
Failed to provide personal funds and final accounting within 30 days upon discharge for three residents and failed to notify one resident when within $200 of SSI resource limit.
Medication error rate was 16%, exceeding the 5% threshold, due to missed medication administrations and improper medication preparation.
Failed to discard expired medications and biologicals, had loose pills and wedged medication packages in medication carts.
Failed to provide an alternative appealing meal option of similar nutritive value to a resident who refused the served meal.
Failed to ensure therapeutic diet foods were prepared properly; main entree was not mechanically altered with gravy or broth as ordered.
Failed to store, prepare, and serve food in accordance with professional standards including failure to discard expired food, label and date leftovers, and properly date incoming food products.
Report Facts
Residents affected: 3
Residents affected: 4
Medication error rate: 16
Medication errors: 4
Facility census: 62
Credit balance: 4422.14
Credit balance: 4981.98
Credit balance: 2923.04
Resident account balance: 8276.82
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse C | Licensed Practical Nurse | Interviewed regarding psychotropic medication consent forms |
| Director of Nursing | Director of Nursing | Interviewed regarding psychotropic medication consents and medication preparation |
| Administrator | Administrator | Interviewed regarding psychotropic medication consents, resident funds reconciliation, and meal substitutions |
| Business Office Manager | Business Office Manager | Interviewed regarding resident funds and refunds |
| Certified Medication Technician A | Certified Medication Technician | Observed and interviewed regarding medication preparation and resident meal refusal |
| Licensed Practical Nurse A | Licensed Practical Nurse | Interviewed regarding medication preparation and expired medications |
| Dietary Manager | Dietary Manager | Interviewed regarding food storage, labeling, and meal substitutions |
| Dietary A | Dietary Staff | Interviewed regarding food storage and meal preparation |
| Registered Dietitian | Registered Dietitian | Interviewed regarding therapeutic diet preparation and food storage |
Inspection Report
Complaint Investigation
Census: 60
Deficiencies: 4
Date: Sep 5, 2024
Visit Reason
A Recertification and Complaint survey was conducted by Healthcare Management Solutions, LLC on behalf of the State of Missouri to assess compliance with 42 CFR 483 subpart B.
Complaint Details
The survey included a complaint investigation as indicated by the initial comments and findings related to mechanical lift failures and other resident safety concerns.
Findings
The facility was found not to be in substantial compliance with several requirements including safe environment, dialysis care coordination, nurse aide performance reviews, and food safety. Deficiencies were identified related to mechanical lift functionality, air conditioning unit maintenance, dialysis communication, nurse aide training, and food procurement and storage.
Deficiencies (4)
F584 Safe/Clean/Comfortable/Homelike Environment. The facility failed to ensure the sit to stand mechanical lift functioned properly, air conditioning units had gaps allowing pests, and the laundry room floor was unsealed and unsafe.
F698 Dialysis. The facility failed to coordinate resident care with outside dialysis providers, lacking communication and documentation for residents receiving dialysis.
F730 Nurse Aide Performance Review-12 hr/yr In-Service. The facility failed to ensure two of three CNAs received annual performance reviews and required in-service training hours were not tracked.
F812 Food Procurement, Store, Prepare, Serve-Sanitary. The facility failed to ensure food items were properly dated, stored, and monitored for temperature and sanitation, risking foodborne illness.
Report Facts
Survey Census: 60
Sample Size: 28
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing (DON) | Provided list of residents using lifts and denied knowledge of sit to stand lift battery charging issues |
| Maintenance Director | Maintenance Director (MD) | Denied knowledge of sit to stand lift battery charging issues and confirmed batteries needed charging |
| Certified Nursing Assistant 5 | Certified Nursing Assistant (CNA) | Delivered lunch tray and reported sit to stand batteries do not last |
| Certified Nursing Assistant 1 | Certified Nursing Assistant (CNA) | Reported putting resident to bed and batteries ran out during use of sit to stand lift |
| Certified Medication Technician | Certified Medication Technician (CMT) | Confirmed facility did not prepare or send dialysis information |
Inspection Report
Life Safety
Census: 62
Capacity: 95
Deficiencies: 3
Date: Sep 5, 2024
Visit Reason
A Life Safety Code Survey was conducted to assess compliance with Medicare/Medicaid participation requirements and the 2012 Edition of the National Fire Protection Association (NFPA) 101 Life Safety Code.
Findings
The facility was found to be noncompliant with emergency lighting, fire alarm system testing and maintenance, smoke detection sensitivity testing, and smoke barrier door closure requirements. These deficiencies had the potential to affect all 62 residents present during the survey.
Deficiencies (3)
K291 Emergency Lighting: The facility failed to ensure emergency lighting was working when tested and on the lighting circuit as required by NFPA 101 and NFPA 70. Emergency lights were improperly plugged into electrical outlets and did not operate when the lighting circuit was disconnected.
K345 Fire Alarm System - Testing and Maintenance: The facility failed to ensure smoke detection sensitivity testing was completed every alternate year as required by NFPA 72. The inspection report lacked reference to smoke detection sensitivity testing.
K374 Subdivision of Building Spaces - Smoke Barrier Doors: The facility failed to ensure smoke barrier doors closed completely when released by the fire alarm system as required by NFPA 101. Observed smoke barrier doors near nurses' stations did not close completely.
Report Facts
Current occupied beds: 62
Total licensed beds: 95
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Director | Verified emergency lighting and smoke barrier door deficiencies during interviews |
Inspection Report
Annual Inspection
Census: 60
Deficiencies: 7
Date: Sep 5, 2024
Visit Reason
The inspection was conducted to assess compliance with regulatory standards related to resident safety, care coordination, staff training, environmental conditions, and food safety at Pleasant Valley Manor Care Center.
Findings
The facility was found deficient in multiple areas including malfunctioning mechanical lifts, unsealed air conditioning units allowing pest entry, unclean and unsafe shower and laundry areas, failure to coordinate dialysis care with outside providers, lack of annual performance reviews and in-service training for some CNAs, and improper food storage and thermometer sanitation practices. These deficiencies posed minimal harm or potential for actual harm to residents.
Deficiencies (7)
Failure to ensure the sit to stand mechanical lift was functioning properly before use for one resident.
Air conditioning units for two residents had unsealed gaps allowing pests to enter the rooms.
Laundry room floor was exposed, unsealed concrete with minimal floor tiles.
Northeast shower room was unclean and unsafe, including a soiled privacy curtain and a loose electrical outlet.
Failure to coordinate resident care with outside dialysis provider, lacking documentation and communication.
Two CNAs lacked annual performance reviews and tracking of required in-service training hours.
Food stored in the kitchen was not properly labeled or dated, and thermometer was not sanitized between uses.
Report Facts
Residents affected: 60
Residents affected: 28
Residents affected: 3
Residents affected: 3
CNA performance review delay: 13
In-service training hours: 12
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant 1 | CNA | Named in deficiency related to lack of annual performance review and in-service training |
| Certified Nursing Assistant 2 | CNA | Named in deficiency related to lack of annual performance review and in-service training |
| Director of Nursing | DON | Interviewed regarding knowledge of lift battery issues, dialysis care coordination, and staff training |
| Maintenance Director | MD | Interviewed regarding knowledge of mechanical lift and air conditioning unit conditions |
| Dietary Aide 1 | DA | Observed and interviewed regarding food storage and thermometer sanitation |
| Dietary Manager | DM | Interviewed regarding food safety practices and expiration date awareness |
Inspection Report
Plan of Correction
Census: 69
Deficiencies: 5
Date: Sep 25, 2023
Visit Reason
The inspection was conducted in response to allegations of abuse involving a Certified Nurse Aide (CNA) and Resident #1, focusing on reporting and investigation of alleged violations.
Complaint Details
The complaint involved allegations of abuse by a Certified Nurse Aide (CNA) towards Resident #1. The investigation found the facility failed to report the abuse to law enforcement and the Department of Health and Senior Services within required timeframes and failed to thoroughly investigate the allegations.
Findings
The facility failed to report alleged abuse to law enforcement and the Department of Health and Senior Services within required timeframes. The facility also failed to thoroughly investigate allegations of abuse and prevent further potential abuse during the investigation.
Deficiencies (5)
F609: The facility did not report alleged abuse involving a CNA and Resident #1 to law enforcement or the Department of Health and Senior Services within required timeframes. The facility's Abuse Prevention Policy requires immediate reporting and investigation of all allegations.
F610: The facility failed to thoroughly investigate allegations of abuse from Resident #1 when the Director of Nursing was made aware on 9/9/23. The investigation did not prevent further potential abuse during the investigation period.
A8023: The facility did not develop and implement written policies prohibiting mistreatment, neglect, and abuse of residents, including reporting requirements to the department and Department of Mental Health for vulnerable persons.
A8024: The facility failed to ensure all staff were trained on laws and rules regarding reporting suspected abuse and neglect of residents.
A8025: The facility did not ensure administrators or employees with reasonable cause to suspect abuse or neglect immediately reported or caused a report to be made to the department and Department of Mental Health.
Report Facts
Facility census: 69
Date of survey completed: Sep 25, 2023
Inspection Report
Complaint Investigation
Census: 69
Deficiencies: 2
Date: Sep 25, 2023
Visit Reason
The inspection was conducted due to a complaint alleging abuse by a Certified Nurse Aide (CNA A) towards Resident #1, specifically that CNA A pushed the resident's lips shut during care on September 9, 2023.
Complaint Details
The complaint involved an allegation that CNA A pushed Resident #1's lips shut and was rough during care on 9/9/23. The allegation was substantiated by resident and staff interviews. The facility delayed reporting to authorities and did not notify law enforcement, citing no serious injury. The investigation started two days after the allegation was reported internally.
Findings
The facility failed to timely report the suspected abuse to law enforcement and the Department of Health and Senior Services. The investigation was delayed until September 11, 2023, and the Administrator did not consider the allegation serious enough to report within two hours or to law enforcement. Resident #1 and staff interviews confirmed the abuse allegation, and the agency staff CNA A was removed from the facility.
Deficiencies (2)
Failed to timely report suspected abuse to law enforcement and state authorities as required by policy and regulation.
Failed to appropriately investigate allegations of abuse in a timely manner.
Report Facts
Facility census: 69
Date of abuse allegation: Sep 9, 2023
Date investigation started: Sep 11, 2023
Date DHSS report received: Sep 11, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN A | Registered Nurse | Reported abuse allegation to DON and spoke with resident and family |
| CNA A | Certified Nurse Aide | Alleged perpetrator of abuse towards Resident #1 |
| Administrator | Facility Administrator | Responsible for investigation and reporting; delayed reporting to authorities |
| DON | Director of Nursing | Received abuse allegation on 9/10/23; delayed reporting and investigation |
| Assistant DON | Assistant Director of Nursing | Conducted staff interviews as part of investigation |
| Social Services Director | Social Services Director | Interviewed residents during abuse investigation |
| CNA B | Certified Nurse Aide | Reported abuse allegation against CNA A to RN A |
Inspection Report
Life Safety
Census: 76
Capacity: 102
Deficiencies: 11
Date: Jun 22, 2023
Visit Reason
The inspection was a Life Safety Code survey conducted to assess compliance with fire safety and related regulations at Pleasant Valley Manor Care Center.
Findings
The facility was found deficient in multiple areas including improper storage of combustible materials, emergency lighting issues, fire alarm system maintenance, sprinkler system maintenance, electrical hazards, HVAC ventilation, fire drills, smoking regulations, and electrical system testing. These deficiencies had the potential to affect residents, staff, and visitors.
Deficiencies (11)
K100: The facility failed to ensure proper storage of a dumpster and wooden pallets near the building, posing a fire hazard.
K291: Emergency lighting was not maintained to prevent being turned off by a light switch, risking inadequate illumination during emergencies.
K324: The facility failed to maintain the kitchen hood suppression system, creating a fire risk in seven smoke compartments.
K345: The fire alarm system was not properly maintained; trouble signals were not displayed on the panel during power tests.
K353: Sprinkler heads were loaded with debris and storage was within 18 inches of sprinkler heads in three smoke compartments.
K511: Electrical hazards were present including exposed wiring and taped plugs in resident rooms.
K521: The facility failed to ensure one portable air conditioning unit was vented properly to the outside.
K712: Fire drills were not conducted at all required times under varying conditions, risking staff readiness.
K741: Smoking regulations were not followed; cigarettes were not properly disposed of and smoking was not limited to designated areas.
K914: Annual testing of non-hospital grade electrical receptacles was incomplete and not fully documented.
K920: The facility failed to ensure safe use of power strips and extension cords in resident areas, risking electrical hazards.
Report Facts
Facility capacity: 102
Resident census: 76
Number of smoke compartments affected: 7
Number of sprinkler heads affected: 4
Number of rooms inspected for power strips: 5
Number of rooms inspected for power strips: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Madonna Vaughan | Administrator | Named in signature and plan of correction approval |
| Maintenance Director | Interviewed regarding multiple deficiencies including dumpster storage, lighting, fire alarm, sprinkler system, electrical hazards, and power strip use | |
| Administrator | Interviewed regarding corrective actions and trash company change |
Inspection Report
Routine
Census: 76
Deficiencies: 11
Date: Jun 22, 2023
Visit Reason
The inspection was conducted to evaluate compliance with resident dignity, safety, care planning, medication management, environment, and other regulatory requirements.
Findings
The facility was found deficient in multiple areas including failure to provide dignified care, maintain a safe and homelike environment, ensure proper care planning and medication review, maintain safe bed rails and entrapment assessments, and provide appropriate catheter care. Several residents were observed with unmet needs related to privacy, positioning, hygiene, and safety.
Deficiencies (11)
Failure to honor residents' dignity including privacy during care, clothing assistance, and responding to residents' needs.
Failure to maintain a homelike environment including temperature control and excessive noise from door alarms.
Failure to check CNA Registry for non-certified staff to prevent employment of individuals with abuse history.
Failure to develop and implement complete care plans addressing fall risk, oxygen use, hospice services, side rails, and smoking.
Failure to provide appropriate positioning during meals for residents dependent on staff assistance.
Failure to provide adequate care and assistance for activities of daily living including hygiene and nail care.
Failure to ensure safe environment including accessible call lights, secured medications, and safe catheter care.
Failure to ensure proper catheter care and secure catheter drainage bags off the floor.
Failure to complete entrapment assessments for residents with side rails and failure to obtain informed consent.
Failure to ensure monthly pharmacist medication regimen reviews are completed, reviewed, and acted upon timely.
Failure to regularly inspect bed frames, mattresses, and bed rails for safety and proper attachment.
Report Facts
Residents affected: 4
Facility census: 76
Medication regimen reviews: 2
Medication regimen reviews: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA A | Certified Nurse Aide | Named in catheter care and call light accessibility findings |
| CNA B | Certified Nurse Aide | Named in catheter care findings |
| CNA H | Certified Nurse Aide | Named in catheter bag and resident care findings |
| CNA J | Certified Nurse Aide | Named in catheter bag and resident care findings |
| Director of Nursing | Director of Nursing | Provided statements on care expectations and deficiencies |
| Administrator | Administrator | Provided statements on facility policies and deficiencies |
| Staffing Coordinator | Staffing Coordinator | Provided statements on registry checks |
| Maintenance Director | Maintenance Director | Provided statements on bed rails and entrapment assessments |
| Physical Therapist | Physical Therapist | Provided statements on side rails and hospice beds |
| Licensed Practical Nurse A | Licensed Practical Nurse | Provided statements on alarm noise and catheter care |
| Medication Technician A | Medication Technician | Provided statements on alarm noise |
| RN B | Registered Nurse | Provided statements on alarm noise |
Inspection Report
Annual Inspection
Census: 76
Deficiencies: 10
Date: Jun 22, 2023
Visit Reason
The inspection was the annual survey of Pleasant Valley Manor Care Center to assess compliance with federal regulations and identify deficiencies.
Findings
The facility was found to have multiple deficiencies related to resident rights, safe environment, abuse prevention, comprehensive care plans, medication management, bed rails, and infection control. The facility census was 76 at the time of inspection.
Deficiencies (10)
F550 Resident Rights: The facility failed to ensure residents were cared for with dignity, privacy, and respect, including failure to respond to residents yelling, provide privacy during catheter care, and maintain proper clothing and call light access.
F584 Safe Environment: The facility failed to maintain a homelike environment with appropriate noise levels, temperature control, and maintenance of blinds and lighting.
F607 Abuse/Neglect Policies: The facility failed to check the Certified Nurses Assistant Registry for all staff to ensure no individuals with abuse or neglect history were employed.
F656 Comprehensive Care Plan: The facility failed to develop and implement comprehensive, person-centered care plans with measurable objectives and timeframes for five sampled residents.
F675 Quality of Life: The facility failed to provide appropriate positioning for residents during meals and failed to maintain dignity and respect in care.
F689 Free of Accident Hazards: The facility failed to provide a safe environment free of accident hazards, including failure to maintain call light accessibility and proper supervision.
F690 Bowel/Bladder Incontinence, Catheter, UTI: The facility failed to ensure proper catheter care, including securing catheter bags off the floor and educating staff on catheter care procedures.
F700 Bedrails: The facility failed to assess and monitor the use of bed rails for risk of entrapment and obtain informed consent prior to installation.
F756 Drug Regimen Review: The facility failed to ensure monthly pharmacist review of drug regimens for four sampled residents and failed to act on identified irregularities.
F909 Resident Bed: The facility failed to complete regular assessments of bed rails and mattresses to prevent entrapment hazards for four sampled residents.
Report Facts
Facility census: 76
Sampled residents: 16
Deficiencies cited: 10
Inspection Report
Routine
Census: 72
Deficiencies: 1
Date: Apr 13, 2023
Visit Reason
The inspection was conducted to assess compliance with facility policies and regulatory requirements regarding the provision of care and assistance for activities of daily living, specifically focusing on showering dependent residents.
Findings
The facility failed to ensure that staff provided at least two showers per week to five dependent residents out of eight sampled. Observations, interviews, and record reviews showed many residents received fewer showers than the facility policy required, with some residents reporting feeling unclean and embarrassed due to infrequent showers.
Deficiencies (1)
Facility failed to provide at least two showers per week to dependent residents as required by policy.
Report Facts
Residents affected: 5
Residents sampled: 8
Showers received by Resident #10 in April: 1
Showers received by Resident #10 in March: 4
Showers received by Resident #10 in February: 2
Showers received by Resident #11 in January: 3
Showers received by Resident #11 in February: 1
Showers received by Resident #11 in March: 1
Showers received by Resident #12 in March: 2
Showers received by Resident #13 in January: 3
Showers received by Resident #13 in March: 1
Showers received by Resident #14 in January: 2
Showers received by Resident #14 in February: 2
Showers received by Resident #14 in March: 3
Showers received by Resident #14 in April: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nurses Aide A | Certified Nurses Aide | Reported being agency staff and described shower assignments |
| Certified Nurses Aide B | Certified Nurses Aide | Reported issues with showers when short staffed and resident preferences |
| Certified Nurses Aide C | Certified Nurses Aide | Reported skipping showers if short staffed and re-offering showers |
| Director of Nursing | Director of Nursing | Returned from retirement recently, unaware showers were not being completed, described shower sheet checks |
| Administrator | Administrator | Expected showers to be provided weekly, preferably twice a week |
Inspection Report
Plan of Correction
Census: 72
Deficiencies: 2
Date: Apr 13, 2023
Visit Reason
The inspection was conducted to assess compliance with care requirements for dependent residents, specifically focusing on the provision of showers and personal hygiene services.
Findings
The facility failed to ensure dependent residents received the required frequency of showers, with multiple residents receiving fewer showers than the facility policy mandates. Observations and interviews revealed issues with shower scheduling, staff shortages, and resident dissatisfaction with hygiene care.
Deficiencies (2)
F677: The facility failed to provide at least two showers per week to five of eight dependent residents observed, resulting in inadequate personal hygiene care.
A4076: Each resident shall be clean, dry, and free of body and mouth odor offensive to others; this regulation was not met as evidenced by odors and poor hygiene.
Report Facts
Facility census: 72
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dalonna Vaughan | Administrator | Signed the statement of deficiencies and plan of correction |
| Certified Nurses Aide (CNA) A | Reported agency status and shower assignment procedures | |
| Certified Nurses Aide (CNA) B | Reported issues with shower completion and resident preferences | |
| Certified Nurses Aide (CNA) C | Reported skipping showers when short staffed and resident refusals | |
| Director of Nursing (DON) | Returned from retirement, provided shower policy and oversight details | |
| Administrator | Provided expectations for shower frequency |
Inspection Report
Plan of Correction
Census: 76
Deficiencies: 2
Date: Nov 2, 2022
Visit Reason
The inspection was conducted to assess compliance with catheter care guidelines and related nursing care standards at Pleasant Valley Manor Care Center.
Findings
The facility failed to provide catheter care that adhered to established guidelines, including failure to wash hands and secure catheter tubing properly for three sampled residents. Deficiencies were noted in catheter care practices and nursing care per resident condition.
Deficiencies (2)
F690: The facility staff failed to provide catheter care adhering to guidelines, including hand washing and securing catheter tubing for three residents. The catheter tubing was not secured properly, and hand hygiene was not followed during care.
A4075: Each resident shall receive personal attention and nursing care consistent with current acceptable nursing practice. This regulation was not met as evidenced by the catheter care deficiencies noted in F690.
Report Facts
Facility census: 76
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA A | Named in catheter care deficiency observations and interviews | |
| Director of Nursing | Director of Nursing | Provided expectations regarding catheter care during interview |
Inspection Report
Complaint Investigation
Census: 70
Deficiencies: 4
Date: Jan 6, 2022
Visit Reason
The inspection was conducted due to a complaint investigation regarding failure to notify the resident's guardian of the resident's death and failure to ensure the resident environment remained free of accident hazards.
Complaint Details
The complaint investigation substantiated that the facility failed to notify the resident's guardian of the resident's death in a timely manner and failed to maintain accident-free environment, resulting in injury to a resident.
Findings
The facility failed to notify the resident's guardian of the resident's death in a timely manner and failed to maintain the mechanical lift properly, resulting in an injury to a resident. Policies and procedures for notification and equipment maintenance were not adequately followed.
Deficiencies (4)
F580 Notification of Changes: The facility failed to notify the resident's guardian of the resident's death in a timely manner, delaying notification to the resident's next of kin. The facility census was 72 at the time.
F689 Free of Accident Hazards/Supervision/Devices: The facility failed to ensure the residents' environment remained free of accident hazards when staff did not properly maintain a Liko Viking mechanical lift, causing injury to a resident. The facility census was 70 at the time.
A4075 Nursing Care per Resident Condition: Each resident shall receive personal attention and nursing care consistent with current acceptable nursing practice. Refer to F689.
A4088 Notify Responsible Party-Change in Condition: Facility staff shall immediately notify the person designated in the resident's record as the designee or responsible party in the event of accident, injury, or significant change. Refer to F580.
Report Facts
Facility census: 72
Facility census: 70
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse A | Licensed Practical Nurse | Documented hospice presence and notification duties during resident death |
| Licensed Practical Nurse B | Licensed Practical Nurse | Interviewed regarding notification responsibilities |
| Licensed Practical Nurse C | Licensed Practical Nurse | Interviewed regarding guardian notification procedures |
| Director of Nursing | Director of Nursing | Interviewed regarding hospice notification expectations and incident report |
| Certified Nurse Aide A | Certified Nurse Aide | Involved in resident transfer during mechanical lift incident |
| Administrator | Administrator | Interviewed regarding notification expectations and maintenance procedures |
Inspection Report
Abbreviated Survey
Deficiencies: 0
Date: Aug 19, 2021
Visit Reason
A COVID-19 Focused Emergency Preparedness survey was conducted on 8/18/21 and 8/19/21 to assess compliance with CMS and CDC COVID-19 guidelines.
Findings
The facility was found to be in compliance with 42 CFR 483.73 related to emergency preparedness for COVID-19.
Inspection Report
Life Safety
Census: 78
Capacity: 102
Deficiencies: 10
Date: Jul 1, 2021
Visit Reason
The inspection was conducted to assess compliance with the 2012 Life Safety Code of the National Fire Protection Association and related regulations, focusing on building construction, means of egress, fire protection systems, and safety features.
Findings
The facility was found deficient in multiple areas including building construction type and height, means of egress requirements, fire protection systems maintenance, sprinkler system testing, cooking facilities safety, and electrical systems maintenance. Several doors and smoke barriers did not meet code requirements, and sprinkler heads were found with dust and debris.
Deficiencies (10)
K161 Building Construction Type and Height: The facility failed to maintain the Type V (111) protected wood frame construction standard due to holes and penetrations in ceilings.
K200 Means of Egress Requirements - Other: The facility failed to ensure doors did not require keys, tools, or special knowledge for operation, evidenced by a locked slide bolt on a corridor door.
K222 Egress Doors: The facility failed to ensure controlled egress locking arrangements were accepted and functional on nine exit doors.
K300 Protection - Other: The facility failed to maintain the firebox area of two clothes dryers free from lint buildup, posing a fire hazard.
K324 Cooking Facilities: The facility failed to ensure hood vent filters were cleaned regularly and blow-off caps remained on nozzles to prevent grease buildup.
K353 Sprinkler System - Maintenance and Testing: The facility failed to ensure sprinkler heads were free from dust and debris in multiple rooms and areas.
K363 Corridor - Doors: The facility failed to ensure corridor doors were solid, resisted smoke passage, and had positive latching hardware.
K372 Subdivision of Building Spaces - Smoke Barrier: The facility failed to maintain smoke barrier walls to ensure required fire resistance rating and no openings.
K741 Smoking Regulations: The facility failed to provide proper metal containers with self-closing covers for ashtrays in smoking areas.
K914 Electrical Systems - Maintenance and Testing: The facility failed to properly document annual testing of non-hospital grade electrical receptacles in resident sleeping areas.
Report Facts
Facility capacity: 102
Resident census: 78
Deficiencies cited: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Director | Interviewed regarding penetrations in ceilings, slide bolt use, sprinkler head maintenance, and door locking issues | |
| Administrator | Interviewed regarding elopement risk and door locking issues | |
| Laundry Aide A | Interviewed regarding cleaning of lint traps and firebox area | |
| Dietary Manager | Interviewed regarding cleaning of hood filters | |
| Housekeeping supervisor or designee | Responsible for monitoring sprinkler head cleaning |
Inspection Report
Abbreviated Survey
Census: 78
Deficiencies: 2
Date: Feb 18, 2021
Visit Reason
A COVID-19 focused emergency preparedness survey was conducted to assess infection prevention and control practices related to COVID-19 at Pleasant Valley Manor Care Center.
Findings
The facility failed to maintain proper infection control practices including cleaning of equipment, changing PPE between residents, and hand hygiene. Several lapses in PPE use and equipment sanitation were observed, posing risks for COVID-19 transmission.
Deficiencies (2)
F880 Infection Prevention & Control: The facility failed to clean a mechanical lift and pulse oximeter between residents, did not change PPE between residents, and did not perform proper hand hygiene.
A4085 Infection Control/Communicable Disease: The facility failed to report positive PCR test results for residents and staff within 24 hours as required by state regulations.
Report Facts
Facility census: 78
Residents positive for COVID-19: 16
Inspection Report
Abbreviated Survey
Deficiencies: 0
Date: Oct 15, 2020
Visit Reason
A COVID-19 focused infection control and emergency preparedness survey was conducted to assess compliance with CMS and CDC recommended practices and relevant federal regulations.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices for COVID-19 infection control and with 42 CFR 483.73 related to emergency preparedness.
Inspection Report
Routine
Deficiencies: 0
Date: Jul 16, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey and a COVID-19 Focused Emergency Preparedness Survey were conducted to assess compliance with CMS and CDC recommended practices and emergency preparedness regulations.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices for COVID-19 infection control and with 42 CFR 483.73 related to emergency preparedness.
Inspection Report
Routine
Deficiencies: 0
Date: Jun 17, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey and a COVID-19 Focused Emergency Preparedness survey were conducted from June 15 to June 17, 2020 to assess compliance with CMS and CDC recommended practices and federal regulations.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices for COVID-19 infection control and with 42 CFR 483.73 related to emergency preparedness.
Inspection Report
Routine
Deficiencies: 0
Date: May 21, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey and a COVID-19 Focused Emergency Preparedness survey were conducted from May 19 through May 21, 2020 to assess compliance with CMS and CDC recommended practices and 42 CFR 483.73 related to emergency preparedness.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices for COVID-19 infection control and with 42 CFR 483.73 related to emergency preparedness.
Inspection Report
Annual Inspection
Census: 81
Deficiencies: 8
Date: Feb 21, 2019
Visit Reason
Annual state survey of Pleasant Valley Manor Care Center to assess compliance with federal and state regulations related to resident care, safety, and facility operations.
Findings
The facility was found deficient in multiple areas including management of personal funds, surety bond security, PASARR screening, comprehensive care planning, infection control, and accident prevention. Deficiencies affected multiple residents and involved failures in policy implementation, documentation, and staff practices.
Deficiencies (8)
F567 Protection/Management of Personal Funds: The facility failed to ensure residents with more than $100 had funds in an interest-bearing account as required.
F570 Surety Bond-Security of Personal Funds: The facility did not purchase a surety bond in an amount sufficient to cover all residents' personal funds.
F645 PASARR Screening for Mental Disorder and Intellectual Disability: The facility failed to ensure staff completed Level 1 PASARR screening prior to admission for one resident.
F656 Develop/Implement Comprehensive Care Plan: The facility failed to develop and implement comprehensive, person-centered care plans with measurable objectives for two residents.
F657 Care Plan Timing and Revision: The facility failed to develop and revise care plans timely and did not include interdisciplinary team input for two residents.
F689 Free of Accident Hazards/Supervision/Devices: The facility failed to ensure safe mechanical lift transfers and adequate supervision to prevent accidents for one resident.
F812 Food Procurement, Store, Prepare, Serve-Sanitary: The facility failed to properly clean and sanitize food preparation areas, exposing residents to potential foodborne illness.
F880 Infection Prevention & Control: The facility failed to establish and maintain an effective infection control program, including isolation precautions and hand hygiene.
Report Facts
Facility census: 81
Surety bond limit: 13000
Surety bond amount: 10000
Required bond amount: 13500
Petty cash average: 316.9
Non-interest bearing checking account average: 3522.71
Interest bearing checking account average: 4718.8
Inspection Report
Life Safety
Census: 81
Capacity: 102
Deficiencies: 7
Date: Feb 21, 2019
Visit Reason
The inspection was a Life Safety Code survey conducted to assess compliance with fire safety and building construction requirements.
Findings
The facility failed to maintain the one-hour fire rating of ceilings, did not install emergency lighting in the medication dispensing room, failed to initiate fire alarms monthly, did not maintain sprinkler system inspections timely, and failed to provide corridor doors that resist smoke passage. Fire drills were not conducted on every shift as required.
Deficiencies (7)
K161: The facility failed to maintain the one-hour fire rating of ceilings with holes and gaps around cables, wires, and sprinkler heads, risking fire spread. The facility had a capacity of 102 and a census of 81 at the time of the survey.
K291: The facility failed to install emergency lighting in a computerized medication dispensing room, affecting staff's ability to see during power loss. The facility had a capacity of 102 and a census of 81.
K342: The facility failed to assure monthly initiation of their fire alarm system and lacked documentation of fire alarm activations during drills. The facility had a capacity of 102 and a census of 81.
K353: The facility failed to maintain timely quarterly inspections of the sprinkler system, affecting its ability to function properly in emergencies. The facility had a capacity of 102 and a census of 81.
K363: The facility failed to provide corridor doors that resist smoke passage and had doors with holes, gaps, and louvers, affecting seven smoke compartments and residents. The facility had a capacity of 102 and a census of 81.
K372: The facility failed to maintain smoke barrier walls free of penetrations and gaps, affecting all seven smoke compartments and residents. The facility had a capacity of 102 and a census of 81.
K712: The facility failed to conduct fire drills on every shift quarterly, with missed drills over the past 12 months, affecting staff readiness. The facility had a capacity of 102 and a census of 81.
Report Facts
Facility capacity: 102
Resident census: 81
Fire drill missed months: 8
Fire drill counts: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary Sue Johnson | Named in corridor doors deficiency (K363) for interview and observation | |
| Maintenance Supervisor | Interviewed regarding fire alarm testing, emergency lighting, sprinkler inspections, and fire drills | |
| Maintenance Staff A | Interviewed regarding ceiling holes and corridor door gaps |
Inspection Report
Life Safety
Deficiencies: 0
Date: Feb 13, 2018
Visit Reason
The inspection was conducted to assess compliance with the Life Safety Code and licensure requirements for Pleasant Valley Manor Care Center.
Findings
The facility met the applicable provisions of the 2012 edition of the Life Safety Code with no deficiencies cited. No state licensure deficiencies were identified during this inspection.
Inspection Report
Plan of Correction
Census: 81
Deficiencies: 6
Date: Feb 13, 2018
Visit Reason
The inspection was conducted to identify deficiencies related to resident care, medication administration, infection control, and other regulatory compliance issues at Pleasant Valley Manor Care Center.
Findings
The facility was found deficient in multiple areas including failure to notify physicians of significant changes in residents' conditions, failure to follow physician orders for insulin administration, inadequate assistance with activities of daily living, improper use of mechanical lifts, medication storage and labeling issues, and infection control practices. The facility census was reported as 81 during the survey.
Deficiencies (6)
F580: The facility failed to notify the resident's physician when blood glucose levels reached or exceeded the high parameter set by the physician for sampled residents. Staff did not document physician notification for high blood glucose levels.
F658: The facility failed to ensure staff followed professional standards of care for residents with diabetes, including proper insulin administration and physician notification for high blood glucose levels.
F677: The facility failed to provide adequate assistance with activities of daily living, including perineal care and grooming, for residents requiring staff assistance.
F689: The facility failed to maintain a resident environment free of accident hazards by not following manufacturer guidelines and facility policy for mechanical lift use during resident transfers.
F761: The facility failed to properly label, store, and discard medications and controlled substances, including expired and discontinued medications.
F880: The facility failed to establish and maintain an infection prevention and control program that included proper cleaning, disinfection, and staff education, resulting in unsafe practices.
Report Facts
Facility census: 81
Sampled residents: 21
Deficiency counts: 6
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