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Nhc Healthcare, Joplin

2700 East 34th Street, Joplin, MO 64803 · For profit - Limited Liability company · 124 certified beds · (417) 781-1737 Medicare & Medicaid certified

Call the home — (417) 781-1737 Need help choosing, fast? Free, unbiased: Eldercare Locator 1-800-677-1116
Abuse/neglect citation on record (F0602) — cited Aug 2023Behavioral-health or dementia-care citation — no harm found (F0758)1 actual-harm citation
Insights

This home has serious findings on its record. Read them closely before you consider it.

In its favor
  • a middle-of-the-pack inspection score (3/5)
  • no federal fines or payment denials on record
  • fewer deficiencies at its most recent standard inspection than at the one before — a sign of improvement
Worth asking about
  • it has an abuse, neglect, or exploitation citation (F0602), cited Aug 2023
  • it has a citation for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0609) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
  • it has 1 actual-harm citation
  • a high number of inspection citations overall (28) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
  • its payroll-based staffing rating is low (1/5)

One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.

A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.

2/5
CMS overall
2 of 5
Health inspectionSurveyor-assigned, ranked within your stateInspector-verified 3 of 5
StaffingFrom payroll records (PBJ) 1 of 5
Quality measuresSelf-reported by the facility 3 of 5

Location & what’s nearby

Hospital
★★ 2/5 CMS · Emergency dept. usually open 24/7 · ER 24/7
Urgent care / clinic
2302 E 32nd St · (417) 626-7337 · Call to confirm hours
Pharmacy
2131 E 32nd St · (417) 781-2332 · Call to confirm hours
Grocery
2800 E 32nd St · (417) 624-2727 · Call to confirm hours
Park
E 34th St · Typically dawn to dusk
Place of worship

Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Overall quality measures 3 of 5
Long-stay residentspeople who live here 2 of 5
Short-stay residentsrehab / post-hospital 3 of 5

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Trend — is this home getting better or worse?

Over 2025-02 to 2026-06, this home’s CMS overall rating held steady at 2 stars. From monthly CMS archive snapshots.

Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.

Overall rating2★
Inspection scorelower = better
See all quality measures vs. state & national benchmarks
MeasureThis homeState avgTypical statevs typical state
Long-stay residents whose need for help with daily activities increased28.9%18.1%15.4%worse
Long-stay residents who lose too much weight6.1%5.3%5.4%worse
Long-stay residents with a catheter left in their bladder1.9%1.1%0.9%worse
Long-stay residents with a urinary tract infection1.8%2.3%2.0%typical
Long-stay residents with depressive symptoms2.0%18.5%6.5%better than state — see note marked double-dagger below the table
Long-stay residents who were physically restrained0.0%0.0%0.1%better than state — see note marked double-dagger below the table
Long-stay residents with falls causing major injury7.4%4.1%3.3%worse
Long-stay residents whose ability to walk worsened32.9%17.4%16.1%worse
Long-stay residents on antianxiety or hypnotic medication21.8%25.6%18.9%worse
Long-stay residents given the seasonal flu vaccine100.0%90.9%95.3%typical
Long-stay residents with pressure ulcers2.3%4.5%4.7%better
Long-stay residents with worsening bladder/bowel control26.7%17.8%21.2%worse
Long-stay residents who got an antipsychotic medication — see the note below the table4.2%23.5%17.1%better
Short-stay residents who newly got an antipsychotic medication7.1%2.2%1.4%worse
Short-stay residents given the seasonal flu vaccine88.1%63.5%79.4%better
Short-stay residents rehospitalized after admission16.1%26.0%22.6%better
Short-stay residents with an outpatient ER visit19.0%13.7%12.0%worse
Long-stay hospitalizations per 1,000 resident days1.962.111.67worse
Long-stay outpatient ER visits per 1,000 resident days0.842.331.80better

On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.

§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.

CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

49.2% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 32 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

49.2%U.S. median 51.5%
Got home and stayed home
11.2%U.S. median 10.7%
Went back to hospital
56.0%U.S. median 56.6%
Met the expected recovery
0.17U.S. median 0.31
Therapy hours / resident / day
0.08hours / resident / day
Physical therapy
0.07hours / resident / day
Occupational therapy
0.01hours / resident / day
Speech therapy

Met the expected recovery: 56.0% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 25 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.

Therapy staffing: this home’s payroll records show 0.17 therapist hours per resident per day in 2026Q1 — more than 16% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 15% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

See every short-stay measure CMS publishes for this home
MeasureThis homeU.S. medianPeriod coveredCMS’s call
Got home and stayed homeRate of successful return to home or community from a SNF49.2%CMS range 35.4–65.651.5%Oct 2022–Sep 2024no different from U.S.
Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF11.2%CMS range 7.2–16.510.7%Oct 2022–Sep 2024no different from U.S.
Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge56.0%56.6%Oct 2024–Sep 2025CMS makes no comparison for this measure
Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge56.0%52.8%Oct 2024–Sep 2025CMS makes no comparison for this measure
Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge56.0%50.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified78.8%98.7%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care settingnot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final dischargenot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay6.1%0.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened0.0%1.9%Oct 2024–Sep 2025CMS makes no comparison for this measure
Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization8.9%CMS range 4.5–13.77.1%Oct 2023–Sep 2024no different from U.S.
Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs0.931.02Oct 2022–Sep 2024CMS makes no comparison for this measure

From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.

Staffing

RN hours/ resident / day
LPN hours/ resident / day
Aide hours/ resident / day
Total nurse hours/ resident / day
RN hoursweekends
50.0%
Total nursing turnover
75.0%
RN turnover

How full it usually is: this home is certified for 124 beds and averages 83.3 residents a day — about 67% occupied, or roughly 41 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Weekend coverage: total nurse staffing is 2.83 hrs/resident/day on weekends vs 3.46 on weekdays — 18% thinner on weekends. RN hours go from 0.36 to 0.22 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 50% is about the same as the national median of 45%.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

7
deficiencies at the latest standard inspection (2025-08-04)
9
at the previous standard inspection (2023-10-27)

Deficiencies are fewer than at the previous inspection — improving. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

ABCDEFGHIJKL

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

28 citations, most serious first. The 11 most serious are shown; the remaining 17 are one tap away and print in full.

  • Actual harm · Gcited before2024-06-24 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolated
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to provide pressure ulcer care and monitoring per standards of practice when staff failed to follow physician orders for treatment of an unstageable pressure ulcer (occurs when the base of a full-thickness tissue loss wound is covered by a layer of dead tissue that prevents staging of the ulcer) to one resident's (Resident #1's) coccyx (tailbone area), failed to update the treatment after a visit to the wound clinic, and failed to complete a weekly wound assessment of the resident's pressure ulcer. The resident developed a subsequent infection of his/her pressure ulcer that required hospitalization. The facility census was 68. Review of the facility assessment guideline titled, Assessments, dated January 2024, showed the following:: -Braden Scale (skin risk assessment completed by facility staff) completed within 24 hours of admission and then weekly for four weeks; -Weekly wound assessment; -Daily pressure ulcer monitoring will include an evaluation of…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Fcited before2025-08-04 · tag F0812 — failed to store, cook, and serve food safely — widespread
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure food was stored in a manner to protect the food from possible contamination when staff failed to store food in sealed containers and failed to dispose of expired food items. The facility had a census of 85 residents. 1. Review of the facility's policy titled, Safety and Sanitation Best Practice Guidelines-Dry Storage, revised June 2025, showed the following:-All Time/Temperature Control for Safety (TCS) foods shall be stored in a clean and dry location; not exposed to splash, dust or other contamination;-Items will be stored at least six inches off the floor;-Foods will be stored in their original packages, if possible. If opened, packages should be closed securely to protect product. Review of the facility's policy titled, Safety and Sanitation Best Practice Guidelines-Refrigerator and Freezer Storage, revised June 2025, showed the following:-Each center will have a system for date marking. Foods will be stored in their original…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2025-08-04 · tag F0678 — failed to provide CPR when needed — pattern
    Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure each resident's choice of code status (whether to receive cardiopulmonary resuscitation (CPR - an emergency lifesaving procedure performed when the heart stops beating) or do not resuscitate (DNR)) was clearly and consistently documented throughout residents' medical records and facility documentation when the facility staff documented contradictory information regarding the code status of three residents (Resident #76, #23, and #36). A sample of 11 residents was selected for review out of a facility census of 85. Review of the facility policy titled, Advanced Directives, revised [DATE], showed the following information:-Information about whether or not the resident has executed an advance directive shall be displayed prominently in the medical record;-The plan of care for each resident will be consistent with his or her documented treatment preferences and/or advance directive;-The Interdisciplinary Team (IDT) will conduct ongoing review of the…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2025-08-04 · tag F0883 — failed to offer flu and pneumonia vaccines — pattern
    Develop and implement policies and procedures for flu and pneumonia vaccinations.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview, the facility failed to have processes in place to ensure each resident was offered a pneumococcal immunization, unless the immunization is medically contraindicated or the resident has already been immunized, when staff failed to follow-up regarding pneumococcal vaccines at admission for three residents (Residents #9, #49, and #91). A sample of five residents was selected for review out of a facility census of 85. Review of the facility's policy entitled Pneumococcal Vaccine, revised August 2016, showed the following:-All residents will be offered pneumococcal vaccines to aid in preventing pneumonia/pneumococcal infections;-Prior to or upon admission, residents will be assessed for eligibility to receive the pneumococcal vaccine series, and when indicated, will be offered the vaccine series within 30 days of admission to the facility unless medically contraindicated or the resident has already been vaccinated;-Assessments of pneumococcal vaccination status will be conducted within five working days of the resident's admission if not conducted…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2025-08-04 · tag F0679 — failed to provide activities — isolated
    Provide activities to meet all resident's needs.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and record review, the facility failed to provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities when staff failed to provide preferred activities to one resident (Resident #70) who voice importance of routinely getting fresh air. The facility census was 85. Review of the facility's policy titled Recreation Policy and Procedure Manual-Philosophy, Goals and Objectives, Standards/Performance Standards, revised 09/01/14, showed the following:-Recreation/Activity/Wellness partners will gather data about each resident's leisure preferences and plan to meet individual needs based on resident's abilities and preferences;-Family members, friends and other partners can be extremely important to recreation. The recreation partners will utilize these resources, when appropriate, to enhance the resident's leisure time;-Residents will be encouraged to participate in the center's recreation program and/or in their own independent leisure interests, but…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2025-08-04 · tag F0759 — failed to keep medication error rate low — isolated
    Ensure medication error rates are not 5 percent or greater.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to maintain an observed medication error rate below 5% when staff made two medication errors in 25 opportunities resulting in a medication error rate of 8% involving two residents (Resident #19 and Resident #3). The facility census was 85. Review of the facility policy, Specific Medication Administration Procedures: Insulin Administration, revised 2/25/25, showed the following:-Perform hand hygiene and don gloves;-Attach pen needle to pen. Prime pen by dialing up 2 units and hold the pen with the needle pointing upwards. Tap the pen gently to remove air bubbles and then push the injection button until a drop of insulin appears at the tip of the needle;-Turn the dose selector to the number of units needed;-Expose the area to be injected and clean the skin with an alcohol wipe;-Administer the injection by holding the pen at a 90 degree angle into the skin. Insert the needle fully into the skin. Press the injection button and hold it for a…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2025-08-04 · tag F0760 — failed to prevent significant medication errors — isolated
    Ensure that residents are free from significant medication errors.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interview, the facility failed to ensure residents were free of significant medication errors when staff failed to prime the insulin pens prio to insulin administration for two resident (Residents #19 and #3). The facility census was 85.Review of the facility policy, Specific Medication Administration Procedures: Insulin Administration, revised 2/25/25, showed the following:-Perform hand hygiene and don gloves;-Attach pen needle to pen. Prime pen by dialing up 2 units and hold the pen with the needle pointing upwards. Tap the pen gently to remove air bubbles and then push the injection button until a drop of insulin appears at the tip of the needle;-Turn the dose selector to the number of units needed;-Expose the area to be injected and clean the skin with an alcohol wipe;-Administer the injection by holding the pen at a 90 degree angle into the skin. Insert the needle fully into the skin. Press the injection button and hold it for a count of 10 to ensure the full dose is delivered.…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2025-08-04 · tag F0880 — failed to prevent and control infections — isolated
    Provide and implement an infection prevention and control program.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, record review, and interviews, the facility failed to implement an effective infection control program when staff did not complete appropriate hand hygiene when providing incontinent care to one resident (Resident #23). Staff also failed to follow Enhanced Barrier Precautions (EBP - an infection control intervention designed to reduce transmission of multi-drug-resistant organisms (MDRO) that employs targeted gown and glove use during high-contact activities) during catheter care and personal hygiene for one resident (Resident #49) of eight residents with indwelling catheters. The facility had a census of 85.Review of a facility policy entitled Handwashing/Hand Hygiene, revised August 2015, showed the following:-The facility considered hand hygiene the primary means to prevent the spread of infections;-All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors;-Hand hygiene products and supplies shall be readily accessible and convenient for staff use to encourage…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2023-10-27 · tag F0725 — failed to have enough nursing staff — pattern
    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observations, interviews, and record review, the facility failed to have sufficient staff on duty to perform resident showers. This failure affected seven residents (Resident #6, #15, #17, #21, #25, #28, and #40) on one of four halls (B hall). The facility census was 70. Review of the facility's policy titled, Certified Nurse Assistant Job Descriptions, dated 11/03/21, showed the following: -Performs all tasks/procedures included on assignment or reports to charge nurse any tasks not completed. 1. During an interview on 10/24/23, at 10:48 A.M., Resident #28 said he/she had not had shower since a week ago Tuesday. The facility got rid of the shower aide and now residents are not getting showers. During the resident group interview on 10/25/23, at 1:00 P.M., Resident #25 said he/she only gets a shower every three weeks. If residents don't give their own, resident don't get one. The residents in the group interview said the shower aide hasn't been at the facility for weeks. During an interview on 10/26/23, at 1:30 P.M., Shower Aide (SA) 2 said she had not been at the facility…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2023-10-27 · tag F0887 — pattern
    Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interview and record review, the facility failed to ensure COVID-19 resident vaccinations were offered, administered, or refused by the resident and/or resident representative for four (Resident #36, #39, #42, and #49) of five sampled residents reviewed for immunizations. In addition, the facility failed to develop and implement a COVID-19 policy for resident vaccination against the COVID-19 virus. The facility census was 70. 1. Review of Resident #36's Face Sheet located in the Face Sheet tab of the electronic medical record (EMR) showed the following: -admission date of 08/21/21; -Diagnoses included multiple sclerosis (a long-lasting (chronic) disease of the central nervous system), diabetes (a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces), and chronic kidney disease. Review of the resident's Immunizations located in the Preventative Health tab of the EMR showed no documentation staff offered the COVID-19 vaccination upon or after admission or that the resident refused.…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-10-27 · tag F0698 — failed to provide proper dialysis care — isolated
    Provide safe, appropriate dialysis care/services for a resident who requires such services.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and record review, the facility failed to ensure communication occurred with the dialysis (a type of treatment that helps the body remove extra fluid and waste products from the blood when the kidneys are not able to) center for one resident (Resident #1) of one sampled resident reviewed for dialysis. This failure placed the resident at risk of complications that might otherwise have gone unnoticed. The facility census was 70. Review of the facility's Dialysis Contract, dated 10/01/18, showed the following: -Collaboration of Care - Both parties shall ensure that there is documented evidence of collaboration of care and communication between the Long-Term Care Facility and the ESRD (End-Stage Renal Disease - permanent kidney failure that requires a regular course of dialysis or a kidney transplant) Dialysis Unit; -To provide to the Long-Term Care Facility information on all aspects of the management of the ESRD resident's care related to the provision of Renal Dialysis Services. the Long-Term Care Facility shall ensure that ESRD residents are prepared…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
Show the remaining 17 citations
  • Potential for harm · D2023-10-27 · tag F0755 — failed to provide safe pharmacy services — isolated
    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interview and record review, the facility failed to ensure medications were available for administration for one resident (Resident #39) of five sampled residents reviewed for unnecessary medications. The resident had the potential to experience adverse effects as the result of missing prescribed medications. The facility census was 70. 1. Review of Resident #39's electronic medical record (EMR) Face Sheet tab showed the following: -admission date of 02/18/22; -Diagnoses included hypertensive (high blood pressure) heart disease with heart failure (the heart can't pump enough oxygen-rich blood to meet the body's needs.), atherosclerotic heart disease (build-up of fats/cholesterol in the artery walls) of native coronary artery without angina pectoris (chest pain or discomfort that keeps coming back), hyperlipidemia (elevated blood lipids (cholesterol, triglycerides)), depression, and gastroesophageal reflux disease. Review of the resident's EMR Orders tab showed the following orders: -An order, dated 12/16/22, for atorvastatin (antilipidemic) 40 milligrams (mg), one tab to be…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-10-27 · tag F0757 — failed to avoid unnecessary drugs — isolated
    Ensure each resident’s drug regimen must be free from unnecessary drugs.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interview and record review, the facility failed to ensure one resident (Resident #49) of five sampled residents reviewed for unnecessary medications, was not administered an antiseptic medication used to treat recurrent urinary tract infections while being administered an antibiotic for a urinary tract infection. This failure placed the resident at risk for complications related to the use of a medication that is not recommended to be used when being administered an antibiotic. The facility census was 70. Review of a facility policy titled, Adverse Consequences and Medication Errors, revised April 2014, showed the following: -Residents receiving any medication that has a potential for an adverse consequence will be monitored to ensure that any such consequences are promptly identified and reported. 1. Review of Resident #49's Face Sheet located in the Face Sheet tab of the electronic medical record (EMR) showed the following: -admission date of 02/16/22; -Diagnoses included Parkinson's disease (a progress disease of the nervous system) and dementia. Review of the…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-10-27 · tag F0758 — failed to limit and justify psychotropic drugs — isolated
    Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and record review, the facility failed to establish and monitor resident-specific behaviors for the use of an antipsychotic medication for two residents (Residents #49 and #39) out of ten sampled residents. These failures placed residents at risk for a diminished quality of life and potential unmet care needs. The facility census was 70. Review of a facility policy titled, Medication Monitoring and Management, revised 01/09/19, showed the following: -In order to optimize the therapeutic benefit of medication therapy and minimize or prevent potential adverse consequences, facility staff, the attending physician/prescriber, and the consultant pharmacist perform ongoing monitoring for appropriate, effective, and safe medication use; -When selecting medications and nonpharmacological interventions, members of the interdisciplinary team participate in the care process to identify, assess, address, advocate for, monitor, and communicate the resident's needs and changes in condition. 1. Review of Resident #49's Face Sheet located in the Face Sheet tab of…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2023-10-27 · tag F0760 — failed to prevent significant medication errors — isolated
    Ensure that residents are free from significant medication errors.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interviews, and record review, the facility failed to ensure all residents were free from significant medication errors when staff failed to ensure one resident's (Resident # 1) insulin was administered per manufacturer's recommendation. The facility census was 70. , Review of the facility policy titled, Adverse Consequences and Medication Error, revised April 2014, showed the following: -A medication error is defined as the preparation or administration of drugs or biological which is not in accordance with physician's orders, manufacturer specifications, or accepted professional standards and principles of the professional(s) providing services; -Examples of medication error include wrong time. Review of the Manufacturer's Drug Insert for Novolog aspart insulin (fast acting insulin) provided by the Director of Nursing (DON) showed the following: -Inject subcutaneously (below the skin) within 5 to 10 minutes before a meal into the abdominal area, thigh, buttocks, or upper arm; -Warnings and precautions hypoglycemia (low blood sugar) may be life-threatening;…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2023-10-27 · tag F0883 — failed to offer flu and pneumonia vaccines — isolated
    Develop and implement policies and procedures for flu and pneumonia vaccinations.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to offer or provide documentation of consent refusal of pneumonia vaccinations for two residents (Resident #1 and #42) of five sampled residents The facility census was 70. Review of Centers for Disease Control and Prevention (CDC) website titled Pneumococcal Vaccination: Summary of Who and When to Vaccinate, showed the following: -CDC recommends pneumococcal vaccination for all adults 65 years or older; -For adults 65 years or older who have not previously received any pneumococcal vaccine, CDC recommends one dose of PCV15 or PCV20. If PCV15 is used, this should be followed by a dose of PPSV23 at least one year later; -If PCV20 is used, a dose of PPSV23 is not indicated; -For adults 65 years or older who have only received a PPSV23, CDC recommends to give one dose of PCV15 or PCV20; -The PCV15 or PCV20 dose should be administered at least one year after the most recent PPSV23 vaccination;. -For adults 65 years or older who have only received PCV13, CDC…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-10-27 · tag F0947 — failed to train nurse aides adequately — isolated
    Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview, the facility failed to ensure two of six staff members (Shower Aide (SA) 2 and Certified Medication Technician (CMT) 4) received appropriate training to meet the needs of the residents. The facility census was 70. Review of the facility's policy titled, Certified Nurse Assistant Job Description, revised date of 11/03/21, showed the following: -Certified nursing assistant or currently enrolled in a nurse aide training program, must attend in-service programs, as assigned, to learn procedures and develop skills and meet state requirements. 1. Review of SA 2's personnel file showed the following: -Hired on 08/25/23 as a certified nurse assistant (CNA); -SA 2 was identified to be scheduled to work as one of two shower aides in the facility; -SA 2's education record revealed no documented dementia care training. 2. Review of CMT 4's personnel file showed the following: -Hired on 10/04/23 as a CMT/CNA; -CMT 4's education record showed no documentation of abuse/neglect/exploitation prevention training. 3. During an interview on 10/27/23, at 9:27 A.M.,…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-08-08 · tag F0602 — failed to protect residents from theft of their belongings — isolated
    Protect each resident from the wrongful use of the resident's belongings or money.
    What the surveyor found here — the official record, unedited, may be distressing

    Deficiency Text Not Available

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-08-08 · tag F0609 — failed to report abuse allegations — isolated
    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
    What the surveyor found here — the official record, unedited, may be distressing

    Deficiency Text Not Available

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Fcited before2021-05-03 · tag F0812 — failed to store, cook, and serve food safely — widespread
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and record review, the facility staff failed to store dishes in a clean condition when they stacked dishes with food particles still inside. The facility failed to provide the required air gap between the ice machine drain pipe and the floor drain that would prevent the backflow of wastewater. The facility had a census of 85 residents. 1. Record review of the Missouri Food Code, published 2013, showed dishes are required to be air dried before being stacked and stored and the FDA guidelines mandate all wares should be air dried, while using a towel is never permitted. Record review of the facility's policy, titled Warewashing Machines Operation, dated 11/2017, from the Safety and Sanitation Best Practice Guidelines, and showed the following information: -Air dry all items; -Towels may contaminate items; -Ensure items are completely dry before stacking to prevent wet-nesting (when items are put away wet and prevented from drying, creating conditions that encourage microorganisms to grow.). Observation on 4/26/2021, beginning at 11:17 A.M., showed the…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2021-05-03 · tag F0684 — failed to provide proper treatment and quality of care — pattern
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to administer one resident's (Resident #39) fentanyl (narcotic pain relief) patch per physician orders. Staff failed to provide wound care for three residents (Resident #58, #60, and #402) as ordered by the physician. A sample of 23 residents was selected for review; the facility census was 85. Record review of a facility policy and procedure entitled, administering pain medications, revised October 2010, showed the following information: -The pain management program is based on a facility-wide commitment to resident comfort; -Conduct a pain assessment as indicated; -Administer pain medications as ordered. 1. Record review of Resident #39's face sheet (resident profile sheet) showed the following information: -re-admitted to the facility from the hospital on [DATE]; -Diagnoses included: Parkinson's disease, dorsalgia (back pain), neck pain, left and right shoulder pain, history of falling, muscle weakness, restless legs syndrome, muscle spasm, rheumatoid…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2021-05-03 · tag F0695 — failed to provide proper breathing / tracheostomy care — pattern
    Provide safe and appropriate respiratory care for a resident when needed.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to provide respiratory care in accordance with professional standards of practice when facility staff administered oxygen to one resident (Resident #52) for 45 days without a physician's order. The facility also failed to ensure staff changed oxygen equipment per professional standards for three residents (Resident #24, #49, and #52) out of a sample of 23 residents selected for review. The facility had a census of 85. Record review of the facility's policy titled, oxygen administration, dated October 2010, showed the following information: -Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration; -Change tubing and cannula, mask or attachments every 7 days; -Document on the patient's treatment administration record (TAR) or medication administration record (MAR) or label tubing with date and your initials. 1. Record review of Resident #52's face sheet (brief…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2021-05-03 · tag F0677 — failed to help fully-dependent residents with daily care — isolated
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to provide adequate assistance for activities of daily living (ADLs) of grooming and personal hygiene for two residents (Resident #52 and Resident #73) out of a sample of 23 residents selected for review. The facility census was 85. Record review showed the facility did not provide a shower policy when requested by the surveyor. 1. Record review of Resident #52's face sheet (brief resident profile sheet) showed the following information: -admission date of 9/18/18; -Diagnoses included atrial fibrillation (irregular heartbeat), shortness of breath, chronic obstructive pulmonary disease (chronic inflammatory lung disease that causes obstructed airflow from the lungs), chronic respiratory failure with cardiomyopathy (difficulty for the heart to pump blood to the body), dependence on supplemental oxygen, congestive heart failure, anxiety disorder, panic disorder, and major depressive disorder. Record review of the resident's electronic…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2021-05-03 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolated
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, staff failed to obtain physician orders for wound care for one resident (Resident #186) and failed to provide physician prescribed wound care for two residents (Residents #42 and #186). A sample of 23 residents was selected for review in facility with a census of 85. Record review of the facility policy titled Skin and Wound Management, dated April 2018, showed the following: -The nursing staff and practitioner will assess and document an individual's significant risk factors for developing pressure ulcers; for example, immobility, recent weight loss, and a history of pressure ulcers; -The physician will order pertinent wound treatments, including pressure reduction surfaces, wound cleansing and debridement approaches, dressings, and application of topical agents; -Nursing staff will review the resident's care plan, and current physician orders; -In preparation for a dressing change, the nurse will verify a physician's order for the procedure; -In addition, the…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2021-05-03 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolated
    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to provide incontinent care per nursing standards for two residents (Resident #2 and Resident #22). A sample of 23 residents was selected for review in facility with a census of 85. Record review of the facility policy, titled perineal (genital) care, dated February 2018, showed the following information: -The purposes of this procedure are to provide cleanliness and comfort to the resident, and prevent infections and skin irritation, and to observe the resident's skin condition. -Place the equipment on the bedside stand. Arrange the supplies so they can be easily reached. -Wash and dry hands thoroughly; -Wash perineal area, wiping from front to back; -The policy did not address hand hygiene when going from a soiled area to a clean area; -Rinse and dry thoroughly; -Wash and rinse the rectal area thoroughly, including the buttocks; -Dry the area thoroughly; -Remove gloves and discard into designated container; -Wash and dry hands thoroughly.…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2021-05-03 · tag F0742 — isolated
    Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to notify the physician and obtain psychiatric services for one resident (Resident #24) out of a sample of 23, who displayed sadness, and had little interest and pleasure in doing things. The facility census was 85. On [DATE] and [DATE], surveyors requested the facility policy regarding obtaining mental health services and did not receive a policy. 1. Record review of Resident #24's face sheet (brief resident profile sheet) showed the following information: -admission date of [DATE]; -Latest return [DATE]; -Diagnoses included schizophrenia, bipolar disorder, restlessness and agitation, anxiety disorder, major depressive disorder, unspecified psychosis not due to a substance or known physiological condition, and unspecified dementia without behavioral disturbance. Record review of the Level One Nursing Facility Pre-admission Screening for Mental Illness/Mental Retardation or Related Condition (PASARR) completed by the hospital prior to the…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2021-05-03 · tag F0880 — failed to prevent and control infections — isolated
    Provide and implement an infection prevention and control program.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to use appropriate infection control procedures to prevent the spread of bacteria or other infectious carrying contaminants when staff failed to use appropriate hand hygiene after performing incontinent care for two residents (Resident #2 and Resident #22), in a sample of 23 residents. The facility census was 85. Record review of the facility policy, titled handwashing/hand hygiene, dated August 2015, showed the following information: -The facility considered hand hygiene the primary means to prevent the spread of infections; -All personnel shall be trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of healthcare associated infections; -Use an alcohol based hand rub containing at least 62% alcohol or alternatively soap and water for the following situations; -Before and after coming on duty; -Before and after direct contact with residents; -Before moving from a contaminated body site to a clean…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2021-05-03 · tag F0921 — failed to keep a safe, functional, sanitary building — isolated
    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and record review, the facility failed to provide a safe and clean environment in the kitchen. The facility census was 85. 1. Record review of the 2013 Missouri Food Code showed physical facilities shall be cleaned as often as necessary to keep them clean. Record review of the kitchen's dishwasher checklist, for staff training and to follow daily, showed the following information: -Make sure the dish room is wiped down, all sinks, etc. -Sweep and mop the floor, get under everything as best you can; -Take out the trash. Record review of the kitchen's cook checklist, for staff training and to follow daily, showed the following information: -Sweep and mop the walk-in, stock room and kitchen; -When cleaning the grill, make sure to clean around the fryer, too; -Clean and set up the steam table for breakfast; -Cleaning for each night included: Monday, steam table; Tuesday, top oven; Wednesday, bottom oven; Thursday, cook station and white bins; Friday, dessert station, Saturday, stove and fryer and Sunday's the milk cooler; and -Empty boxes need to be…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Environmental Deficiencies · Deficient, Provider has date of correction

“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.

Worried about a resident here? There are three different people you can turn to, and they do different jobs:
  • Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
  • Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
  • State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Not sure where to start, or need other help? Dial 2-1-1 for local resources — and if a call is hard or impossible for you, many local 211s also take a text (send your ZIP code to 898-211) or a web chat at 211.org; both vary by area, and 211.org will show what yours offers. Deaf or hard of hearing: dial 711 for the telecommunications relay service, then any number above. In an emergency, call 911.
It is illegal for a facility to retaliate against a resident or family for reporting a concern: federal law gives a resident the right to voice grievances — to the home or to any outside agency — without discrimination or reprisal (42 CFR §483.10(j)(1)). You may report anonymously.

Fines & penalties

No federal fines in the current CMS record.

Part of a chain

This home belongs to NATIONAL HEALTHCARE CORPORATION — 69 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

RatingThis homeChain avg
Overall 2 of 54.0-2.0 vs chain
Health inspection 3 of 53.5-0.5 vs chain
Staffing 1 of 53.5-2.5 vs chain
Quality measures 3 of 54.4-1.4 vs chain
The other 68 homes this chain runs (chain average 4.0★, per CMS)
1 of 5NHC Healthcare - MauldinGreenville, SC 2 of 5NHC Healthcare - CharlestonCharleston, SC 2 of 5NHC Healthcare, GlasgowGlasgow, KY 2 of 5Nhc Healthcare RossvilleRossville, GA 2 of 5Nhc Healthcare, AnnistonAnniston, AL 2 of 5Nhc Healthcare, FranklinFranklin, TN 2 of 5Nhc Healthcare, SpringfieldSpringfield, TN 2 of 5Osage Beach Rehabilitation And Health Care CenterOsage Beach, MO 2 of 5White Oak Manor-ShelbyShelby, NC 3 of 5Adamsplace, LLCMurfreesboro, TN 3 of 5NHC Healthcare - GreenwoodGreenwood, SC 3 of 5Nhc Healthcare, Ft SandersKnoxville, TN 3 of 5Nhc Healthcare, HendersonvilleHendersonville, TN 3 of 5Nhc Healthcare, KnoxvilleKnoxville, TN 3 of 5Nhc Healthcare, LewisburgLewisburg, TN 3 of 5Nhc Healthcare, PulaskiPulaski, TN 3 of 5Nhc Healthcare, SmithvilleSmithville, TN 3 of 5Nhc Healthcare, SpartaSparta, TN 3 of 5Nhc Healthcare, TullahomaTullahoma, TN 3 of 5The Health Center At Richland PlaceNashville, TN 3 of 5The MeadowsNashville, TN 3 of 5White Oak Manor - YorkYork, SC 4 of 5NHC HealthCare - North AugustaNorth Augusta, SC 4 of 5NHC Healthcare - BlufftonOkatie, SC 4 of 5NHC Healthcare - Garden CityGarden City, SC 4 of 5NHC Healthcare - LexingtonWest Columbia, SC 4 of 5Nhc Healthcare, ChattanoogaChattanooga, TN 4 of 5Nhc Healthcare, ColumbiaColumbia, TN 4 of 5Nhc Healthcare, DeslogeDesloge, MO 4 of 5Nhc Healthcare, Maryland HeightsMaryland Heights, MO 4 of 5Nhc Healthcare, MilanMilan, TN 4 of 5Nhc Healthcare, Oak RidgeOak Ridge, TN 4 of 5Nhc Healthcare, OakwoodLewisburg, TN 4 of 5Nhc Healthcare, St CharlesSaint Charles, MO 4 of 5Nhc Place At Cool SpringsFranklin, TN 4 of 5White Oak Manor - CharlestonCharleston, SC 4 of 5White Oak Manor - SpartanburgSpartanburg, SC 5 of 5HeartlandNashville, TN 5 of 5Holston Health & Rehabilitation CenterKnoxville, TN 5 of 5Macon Health Care CenterMacon, MO

Showing 40 of 68; lowest-rated first.

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

Investor-owned

CMS ownership filings flag an owner of this facility as an investment firm. That’s a fact worth knowing about who ultimately profits from the home. Read the inspection and staffing record above on its own merits.

  • MORGAN STANLEY — investment firm · 5.30% share · 5% Or Greater Indirect Ownership Interest
  • VANGUARD GROUP INC — investment firm · 9.00% share · 5% Or Greater Indirect Ownership Interest

Source: CMS SNF ownership filings (PECOS). These flags are self-reported and undercount — federal auditors (GAO) and researchers find CMS captures only a fraction of true private-equity and REIT ties, so the absence of a flag on other homes is not proof they lack investor owners. How investor ownership affects care →

Owner / managerTypeRoleSince
NHC/DELAWARE INCOrganizationDIRECT OWNERSHIP INTERESTsince 02/01/2000
RECTOR, MELVINIndividualMANAGING CONTROL - GOVERNING BODY; CORPORATE OFFICER; OPERATIONAL/MANAGERIAL CONTROLsince 02/01/2000
NATIONAL HEALTHCARE CORPORATIONOrganizationOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 02/01/2000
NHC-OP LPOrganizationOPERATIONAL/MANAGERIAL CONTROLsince 02/01/2000
CHANCE, JOLIEIndividualOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 02/01/2000
DODSON, VICKIIndividualOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 06/01/2019
JONES, STEPHANIEIndividualOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 04/24/2025
KIDD, BRIANIndividualOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 01/01/2017
SHOCKLEY, CASSANDRAIndividualOPERATIONAL/MANAGERIAL CONTROLsince 02/16/2021
USSERY, ROBERTIndividualOPERATIONAL/MANAGERIAL CONTROLsince 02/01/2000
BLACKROCK INCOrganizationADP OF THE SNFsince 01/20/2010
NATIONAL HEALTH CORPORATIONOrganizationADP OF THE SNFsince 04/21/2025
VANGUARD GROUP INCOrganizationADP OF THE SNFsince 11/30/2006

CMS files one row per role, so the 20 rows in the source record cover these 13 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.

6 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

Follow the money — this home’s finances

Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.

$7.3M
Net patient revenuemost recent cost report
-5.7%
Operating marginrevenue minus expenses
$604K
Related-party expense8% of expenses
Who pays — share of resident-days
Medicaid 58%Medicare 2%Other / private 40%

This home reported $604K paid to related parties (affiliated landlords or management companies) in its most recent cost report. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.

Cost & finances

$279per resident / day
operating cost
$8,494per month
≈ monthly operating cost
$264per day
avg. revenue, all payers

Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.

What families pay in MO

Paying with Medicaid

This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Missouri Medicaid page.

Typical monthly cost in Missouri
$6,741/mo
Nursing home (semi-private)
$7,604/mo
Nursing home (private)
$5,400/mo
Assisted living

Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.

Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 265175. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2025-08-04, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →

Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →

Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.

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