Inspection Reports for Republic Nursing and Rehab
901 State Hwy 174, Republic, MO 65738, MO, 65738
Back to Facility ProfileDeficiencies (last 4 years)
Deficiencies (over 4 years)
5.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
5% worse than Missouri average
Missouri average: 5.5 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
94 residents
Based on a July 2024 inspection.
Census over time
Inspection Report
Complaint Investigation
Census: 94
Deficiencies: 2
Date: Jul 24, 2024
Visit Reason
The inspection was conducted due to a complaint investigation regarding failure to notify the physician timely of a resident's change in condition and abnormal lab results, and failure to use appropriate infection control measures during wound care and medication administration.
Complaint Details
The complaint investigation revealed that staff failed to notify the physician timely about a resident's deteriorating condition and abnormal lab results, despite multiple documented changes and abnormal labs. The resident was eventually hospitalized with severe complications. The investigation also found lapses in infection control practices during care of two residents.
Findings
The facility failed to notify the physician in a timely manner about a resident's change in condition and abnormal lab results, resulting in delayed hospital transfer and serious health complications. Additionally, the facility failed to implement proper infection control practices during wound care and blood sugar testing, including improper handling of supplies, inadequate hand hygiene, and improper use of personal protective equipment.
Deficiencies (2)
Failed to notify the physician of a change in resident condition and abnormal laboratory results in a timely manner for one resident.
Failed to use appropriate infection control measures to prevent or reduce the risk of spreading bacteria or other infectious contaminants during wound care and blood sugar checks and insulin administration.
Report Facts
Facility census: 94
Elevated potassium: 5.8
Elevated blood urea nitrogen (BUN): 72
Elevated creatinine: 4.3
Decreased GFR: 10
Deficiency count: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN B | Licensed Practical Nurse | Documented resident condition notes and interviewed regarding failure to notify physician |
| LPN C | Licensed Practical Nurse | Documented resident condition notes |
| RN E | Registered Nurse | Documented resident progress notes and nurse practitioner notifications |
| Director of Nursing | Director of Nursing (DON) | Documented resident condition and interviewed about notification procedures |
| LPN A | Licensed Practical Nurse | Interviewed regarding resident condition assessments and notification practices |
| RN H | Registered Nurse | Interviewed regarding reporting changes in resident condition |
| LPN F | Licensed Practical Nurse | Interviewed regarding notification of physician and lab result procedures |
| LPN D | Licensed Practical Nurse | Interviewed regarding change in condition and lab result reporting |
| Assistant Director of Nursing | Assistant Director of Nursing (ADON) | Interviewed regarding lab result handling and infection control |
| LPN G | Licensed Practical Nurse | Observed providing blood glucose testing and insulin administration with infection control lapses |
| Administrator | Facility Administrator | Interviewed regarding notification policies and infection control oversight |
Inspection Report
Routine
Census: 82
Deficiencies: 8
Date: Mar 14, 2024
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care, safety, and facility operations.
Findings
The facility was found deficient in multiple areas including accurate resident assessments, comprehensive care planning, safe transfer methods, smoking safety, respiratory care, trauma-informed care, food safety, and environmental cleanliness.
Deficiencies (8)
Failed to ensure accurate nutritional and weight loss information was included in the Minimum Data Set (MDS) for one resident.
Failed to complete a comprehensive and individualized care plan addressing antianxiety medication use and hospice services for two residents.
Failed to obtain a physician's order for hospice and update the resident's care plan to reflect hospice admission for one resident.
Failed to ensure safe transfer methods and obtain therapy assessment for a non-weight bearing resident; failed to limit access to smoking materials to residents assessed as safe.
Failed to provide respiratory care consistent with standards by not having a physician's diagnosis for CPAP use and not addressing CPAP on care plan or MDS for one resident.
Failed to ensure trauma-informed care by not documenting PTSD diagnosis, triggers, or interventions in the medical record or care plan for one resident.
Failed to keep food safe from contamination by stacking wet dishware, not separating dented cans, and not properly sealing dry food containers.
Failed to maintain a sanitary kitchen environment with dirty walls, baseboards, and vents.
Report Facts
Facility census: 82
Resident weight loss: 14
Resident weight loss: 5.5
Resident weight loss: 13
CPAP pressure setting: 4
Dented cans: 2
Wet dishware stacks: 6
Open dry food bags: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN H | Licensed Practical Nurse | Interviewed regarding hospice orders, smoking policies, PTSD care plans, and CPAP care |
| MDS Coordinator | Interviewed regarding care plan responsibilities and knowledge of deficiencies in care planning | |
| Administrator | Interviewed regarding facility policies and oversight of care plans, smoking, and kitchen sanitation | |
| CNA A | Certified Nurse Aide | Observed transferring resident #1 using unsafe method |
| COTA C | Certified Occupational Therapy Assistant | Interviewed regarding transfer assessments and recommendations |
| Director of Therapy Services | Interviewed regarding transfer assessments and recommendations | |
| DA O | Dietary Aide | Interviewed regarding food storage and dented cans |
| Dishwasher M | Interviewed regarding dishwashing practices |
Inspection Report
Complaint Investigation
Census: 103
Deficiencies: 1
Date: Jul 29, 2023
Visit Reason
The inspection was conducted due to a complaint investigation regarding alleged verbal and physical abuse of a resident by a Certified Nursing Assistant (CNA A).
Complaint Details
The complaint was substantiated based on interviews with staff and review of the facility investigation. CNA A admitted to raising his/her voice and pushing the resident harder than appropriate. Other staff and administration confirmed that such behavior is considered abuse and should be reported immediately.
Findings
The facility failed to protect one resident's right to be free from verbal and physical abuse when CNA A yelled at the resident and forcefully pushed the resident by the shoulders to sit down. Multiple staff interviews and facility investigation confirmed the abuse allegation.
Deficiencies (1)
Failure to protect a resident from verbal and physical abuse by staff, including yelling and forcefully pushing the resident to sit down.
Report Facts
Facility census: 103
Resident admission date: Dec 8, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA A | Certified Nursing Assistant | Alleged perpetrator who yelled at and pushed the resident |
| LPN C | Licensed Practical Nurse | Reported the abuse allegation to the Assistant Director of Nursing |
| CNA B | Certified Nursing Assistant | Witness who observed the abuse |
| CNA D | Certified Medication Technician | Interviewed staff member who described abuse reporting procedures |
| CNA E | Certified Medication Technician | Interviewed staff member who described abuse reporting procedures |
| LPN F | Licensed Practical Nurse | Interviewed staff member who described abuse reporting procedures and removal of alleged perpetrator |
| Director of Nursing | Director of Nursing | Confirmed abuse allegation and described facility procedures for abuse allegations |
| Administrator | Administrator | Confirmed abuse allegation and described facility procedures for abuse allegations |
Inspection Report
Complaint Investigation
Census: 91
Deficiencies: 6
Date: Feb 25, 2022
Visit Reason
The inspection was conducted due to a complaint investigation regarding misappropriation of controlled medications and other care concerns at Republic Nursing & Rehab.
Complaint Details
The complaint investigation was triggered by allegations of misappropriation of controlled medications for two residents, Resident #60 and Resident #79, with findings of missing narcotics and failure to follow medication cart security protocols.
Findings
The facility failed to protect residents from misappropriation of controlled medications, failed to complete nurse aide registry checks prior to employment, failed to complete routine fall risk assessments and care planning, failed to properly maintain bed rails and document their use, failed to assess and document effectiveness of behavioral interventions for residents with dementia, and failed to maintain cleanliness under the kitchen ice machine.
Deficiencies (6)
Failed to protect residents from misappropriation of controlled medications when staff discovered missing doses for two residents.
Failed to document checking the Nurse Aide Registry prior to the start date of one staff member.
Failed to complete routine fall risk assessments, update care plans after falls, lock wheelchair wheels, and ensure proper wheelchair fit for one resident; also failed to secure courtyard door.
Failed to assess, monitor, and document bed rail use, including obtaining physician orders and care planning for residents using bed rails.
Failed to routinely assess effectiveness of behavioral interventions and complete person-centered care plans for residents with dementia/behaviors.
Failed to ensure the floor under the kitchen ice machine was clean and free from debris.
Report Facts
Missing Percocet tablets: 3
Missing oxycodone tablets: 12
Facility census: 91
Medication counts: 13
Medication counts: 20
Medication counts: 30
Medication counts: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CMT B | Certified Medication Technician | Named in medication misappropriation and narcotic count discrepancy. |
| RN C | Registered Nurse | Involved in narcotic count and investigation of missing medications. |
| LPN D | Licensed Practical Nurse | Involved in narcotic count and investigation of missing medications. |
| Housekeeper A | Named in failure to complete Nurse Aide Registry check prior to employment. | |
| Director of Nursing | DON | Involved in narcotic investigation and care plan oversight. |
| Administrator | Provided statements regarding facility policies and observations. | |
| Dietary Aide K | Provided statements regarding kitchen floor cleaning. | |
| Dietary Manager | Provided statements regarding kitchen floor cleaning. |
Inspection Report
Routine
Census: 91
Deficiencies: 6
Date: Jul 12, 2019
Visit Reason
The inspection was conducted to assess compliance with federal regulations regarding resident notice of Medicare/Medicaid coverage, employee screening, resident assessments, discharge procedures, restorative nursing services, and dialysis care.
Findings
The facility was found deficient in multiple areas including failure to provide required Medicare Part A discharge notices to a resident, failure to check employee disqualification list for a new hire, incomplete and late Minimum Data Set assessments for several residents, incomplete discharge summaries, failure to provide restorative nursing services as ordered or recommended, and inadequate communication with the dialysis center for a resident receiving dialysis.
Deficiencies (6)
Failed to provide Medicare Part A discharge notices (SNFABN and NOMNC) to one resident.
Failed to check employee disqualification list prior to contact with residents for one employee.
Failed to complete quarterly and annual Minimum Data Set assessments within required timeframes for four residents.
Failed to complete a comprehensive discharge summary for one resident discharged to the community.
Failed to provide restorative nursing services as directed by therapy for two residents.
Failed to provide ongoing communication with the dialysis center for one resident receiving dialysis.
Report Facts
Residents affected: 1
Residents affected: 1
Residents affected: 4
Residents affected: 1
Residents affected: 2
Residents affected: 1
Facility census: 91
Deficiency count: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Social Service Designee | Responsible for providing Medicare Part A discharge forms; noted failure in providing forms to Resident #38 | |
| Administrator | Responsible for oversight of employee disqualification list process | |
| Director of Nursing (DON) | Oversaw restorative program and commented on discharge summary process | |
| Assistant Director of Nursing (ADON) | Provided information on restorative program and dialysis communication | |
| Licensed Practical Nurse (LPN) B | Discussed restorative program process and discharge summary completion | |
| CNA G | Previous restorative aide; provided information on restorative program | |
| CNA H | Provided information on resident decline and restorative services | |
| Occupational Therapist | Described restorative program referral and order process | |
| Licensed Practical Nurse (LPN) A | Reported lack of dialysis communication paperwork | |
| Social Service Director | Not involved with dialysis appointments or communication |
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