Pine View Manor INC
307 N Pineview Street, Stanberry, MO 64489 · Non profit - Corporation · 70 certified beds · (660) 783-2118 Medicare & Medicaid certified
This home has serious findings on its record. Read them closely before you consider it.
- no federal fines or payment denials on record
- lower-than-typical staff turnover (29% vs 45% nationally) — better care continuity
- fewer deficiencies at its most recent standard inspection than at the one before — a sign of improvement
- CMS has flagged it for abuse
- it has an abuse, neglect, or exploitation citation (F0600), cited Apr 2026
- 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 (18) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- its independent health-inspection rating is low (2/5)
- its payroll-based staffing rating is low (1/5)
- its facility-reported quality-measure rating is low (2/5)
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.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 2 of 5 |
| StaffingFrom payroll records (PBJ) | 1 of 5 |
| Quality measuresSelf-reported by the facility | 2 of 5 |
Location & what’s nearby
Open in Google Maps ↗ · Directions ↗ · Larger map ↗
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 | 2 of 5 |
| Long-stay residentspeople who live here | 1 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 3 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.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 19.4% | 18.1% | 15.4% | worse |
| Long-stay residents who lose too much weight | 8.4% | 5.3% | 5.4% | worse |
| Long-stay residents with a catheter left in their bladder | 5.9% | 1.1% | 0.9% | worse |
| Long-stay residents with a urinary tract infection | 1.0% | 2.3% | 2.0% | better |
| Long-stay residents with depressive symptoms | 0.0% | 18.5% | 6.5% | check this* — see note marked star below the table |
| Long-stay residents who were physically restrained | 0.0% | 0.0% | 0.1% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents with falls causing major injury | 3.0% | 4.1% | 3.3% | typical |
| Long-stay residents whose ability to walk worsened | 16.4% | 17.4% | 16.1% | typical |
| Long-stay residents on antianxiety or hypnotic medication | 27.6% | 25.6% | 18.9% | worse |
| Long-stay residents given the seasonal flu vaccine | 96.5% | 90.9% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 9.6% | 4.5% | 4.7% | worse |
| Long-stay residents with worsening bladder/bowel control | 14.0% | 17.8% | 21.2% | better |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 30.9% | 23.5% | 17.1% | worse |
| Short-stay residents who newly got an antipsychotic medication | 0.0% | 2.2% | 1.4% | better |
| Short-stay residents given the seasonal flu vaccine | 60.0% | 63.5% | 79.4% | worse |
| Short-stay residents rehospitalized after admission | 29.9% | 26.0% | 22.6% | worse |
| Short-stay residents with an outpatient ER visit | 4.3% | 13.7% | 12.0% | better |
| Long-stay hospitalizations per 1,000 resident days | 3.59 | 2.11 | 1.67 | worse |
| Long-stay outpatient ER visits per 1,000 resident days | 4.26 | 2.33 | 1.80 | worse |
* This home reported 0% on a measure where lower is better. That can mean genuinely excellent care — but because the number is self-reported, a zero can also mean the problem was not recorded. Weigh it against the inspection record above.
‡ 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.
38.4% 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 42 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Met the expected recovery: 43.2% 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 37 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 0.10 therapist hours per resident per day in 2026Q1 — more than 6% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 12% 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
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | 38.4%CMS range 26.8–51.4 | 51.5% | Oct 2022–Sep 2024 | no different from U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 11.2%CMS range 7.5–16.6 | 10.7% | Oct 2022–Sep 2024 | no 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 discharge | 43.2% | 56.6% | Oct 2024–Sep 2025 | CMS 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 discharge | 35.1% | 52.8% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | 27.0% | 50.0% | Oct 2024–Sep 2025 | CMS 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 identified | 98.0% | 98.7% | Oct 2024–Sep 2025 | CMS 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 setting | not 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 discharge | not 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 stay | 0.0% | 0.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | 0.0% | 1.9% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | 7.4%CMS range 4.5–13.2 | 7.1% | Oct 2023–Sep 2024 | no different from U.S. |
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 0.80 | 1.02 | Oct 2022–Sep 2024 | CMS 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
How full it usually is: this home is certified for 70 beds and averages 57.8 residents a day — about 83% occupied, or roughly 12 beds typically open. It usually has some room. 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 2.30 hrs/resident/day on weekends vs 2.85 on weekdays — 19% thinner on weekends. RN hours go from 0.32 to 0.16 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 29% is below 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
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.
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.
18 citations, most serious first. The 11 most serious are shown; the remaining 7 are one tap away and print in full.
- Actual harm · G2026-04-13 · tag F0600 — failed to protect residents from abuse and neglect — isolatedProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
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 protect one of three sampled residents right to be free from abuse when staff observed Resident #1 and Resident #2 get into a verbal argument, and a short while later, Resident #2 went into Resident #1s room and a physical altercation occurred where both residents were found on the floor. The nurse assessed Resident #1 and found he/she was upset and with physical injuries including a scraped left knee and left elbow and a red mark on the left side of his/her ribs. This affected one of three sampled residents. The facility census was 55. Review of the facilities Abuse and Neglect Protocol policy, dated 2/15/22, showed: -It was the purpose of the facility to prohibit and prevent abuse and to assist the facility staff members in recognizing incidents of abuse; -Abuse was defined as the willful infliction of injury, intimidation or punishment with resulting physical harm or pain. Review of the facilities Resident-to-Resident Altercations…
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.
- Potential for harm · E2025-05-22 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — patternProvide 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 2. Review of the Resident #40's Significant Change in Status MDS, dated [DATE] showed: - Cognitive skills severely impaired; - Upper extremity and lower extremity impaired on both sides; - Dependent on the assistance of staff for toilet use; - Had a Foley catheter (sterile tube inserted into the bladder to drain urine); - Always incontinent of bowel; - The resident had seven antibiotics in the last seven days; - Diagnoses included traumatic brain injury, seizure, dementia and depression. Review of resident's Urinalysis (UA, a test to analyze urine contents) and urine culture and sensitivity ( C & S, at test that identifies the amount and type of bacteria and medications to treat the infection), dated 10/11/24 showed: - The presence of bacteria indicative of a possible urinary tract infection (UTI); - The C & S showed the presence of organisms indicative of a UTI; - The resident was started on Cipro 250 mg (Antibiotic medication) twice daily for seven days, for a UTI. Review of the resident's urine culture…
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.
- Potential for harm · Ecited before2025-05-22 · tag F0700 — patternTry different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
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, record review, and interviews, the facility failed check bed rails regularly to make sure they were still installed correctly as rails may shift or loosen over time. The facility failed to inspect and regularly check the mattress and bed rails for areas of possible entrapment, and failed to include an evaluation of attempted alternatives prior to the installation or use of a bed rail on resident beds. This included three of 12 residents sampled (Resident #1, #33, and #34). The facility census was 48. Review of facility policy, side rail policy/ grab bars, revised 5/21/25, showed: -Facility would strive to provide a safe sleeping environment for all residents. -If resident wanted or needed side rails the MDS Coordinator or Nursing would contact the physical therapy department. The original side rail assessment was completed by physical therapy department for proper use and safety. -If deemed appropriate the entrapment assessment would be done by maintenance staff to ensure the safety by…
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.
- Potential for harm · Ecited before2025-05-22 · tag F0812 — failed to store, cook, and serve food safely — patternProcure 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, and the facility failed to prepare and serve food in accordance with professional standards for food service safety when staff failed to keep all hair contained in hair restraints, failed to label and date food when it was opened, and failed to complete temperature checks on the refrigerator and freezers. This had the potential to impact all residents in the facility. The facility census was 48. 1. Review of facility policy, Hair Restraints, dated 5/29/24, showed: -Hair restraints shall be worn by all dietary staff when in food production areas, dishwashing areas, or serving food. -Staff shall wear hair restraints in all food production, dishwashing, and serving areas. -Hair restraints, such as hairnets, hats, hair bonnets, and/or beard guards shall be used to prevent hair from contacting exposed food. Facial hair was discouraged. Any facial hair that is longer than the eyebrow shall require coverage with a beard guard in the production, serving, and dishwashing areas. -Hair bonnets are to be one shift use and washed. Observation…
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.
- Potential for harm · Ecited before2025-05-22 · tag F0880 — failed to prevent and control infections — patternProvide 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 3. Review of Resident #40's Significant Change in Status MDS, dated [DATE] showed: - Cognitive skills severely impaired; - Upper extremity and lower extremity impaired on both sides; - Dependent on the assistance of staff for toilet use; - Had a Foley catheter (sterile tube inserted into the bladder to drain urine); - Always incontinent of bowel; - The resident had seven antibiotics in the last seven days; - Diagnoses included traumatic brain injury, seizure, dementia and depression. Review of the resident's Physician Order Sheet (POS), dated May 2025, showed: - Foley catheter for urinary retention. Review of the resident's undated care plan, showed: - The resident had an indwelling Foley catheter for bladder retention; - The resident had a Foley catheter. Position catheter bag and tubing below the level of the bladder and away from entrance room door. Check tubing for kinks on every shift. Monitor, record, report to physician for signs and symptoms of UTI: pain, burning, blood tinged urine, cloudiness, no…
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.
- Potential for harm · Fcited before2024-05-31 · tag F0812 — failed to store, cook, and serve food safely — widespreadProcure 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 facility policy review, the facility failed to maintain professional standards in the kitchen. Specifically, the facility failed to ensure dented canned foods were not in circulation in 1 of 1 dry storage area observed. This had the potential to affect all 55 residents who resided in the facility and received meals from the kitchen. Findings included: A facility policy titled, Food Receiving and Storage, revised 05/29/2024, indicated, Foods shall be received and stored in a manner that complies with safe food handling practices. The policy also indicated, When food is delivered to the facility it will be inspected for safe transport and quality before being accepted. During an interview on 05/29/2024 at 2:56 PM, the Administrator stated the facility had no specific policy regarding dented canned food. Observations of the facility's dry storage area on 05/28/2024 at 10:08 AM revealed compromised canned foods in the facility storage rack, specifically: - One unlabeled 6-pound can of food had dents along the rim, - One dented 46 ounce (oz.) can 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.
- Potential for harm · Ecited before2024-05-31 · tag F0880 — failed to prevent and control infections — patternProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
2. A facility policy titled, Oxygen Administration, revised in 10/2010, indicated, The purpose of this procedure is to provide guidelines for safe oxygen administration; however, the policy did not address infection control measures for labeling or storage of oxygen equipment/supplies. During an interview on 05/31/2024 at 12:20 PM, the Director of Nursing Services (DNS) stated that night shift staff should change oxygen tubing once per week. The DNS stated the tubing should be labeled and stored in a blue bag. An admission Record revealed the facility admitted Resident #3 on 06/19/2023. According to the admission Record, the resident had a medical history that included diagnoses of pneumonia and heart failure. A quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 03/06/2024, revealed Resident #3 had a Brief Interview for Mental Status (BIMS) score of 15, which indicated the resident had intact cognition. Resident #3's Order Summary Report, listing active orders as of 05/31/2024, contained an order, started on 06/19/2023, for two liters of supplemental oxygen…
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.
- Potential for harm · D2024-05-31 · tag F0554 — isolatedAllow residents to self-administer drugs if determined clinically appropriate.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, record review, and facility policy review, the facility failed to ensure 1 (Resident #5) of 1 sampled resident reviewed for self-administration of medications was assessed to determine if they were clinically appropriate to do so after the resident expressed a desire to self-administer one of their medications. Findings included: A facility policy titled, Self-Administration of Medications, revised in 12/2016, indicated Residents have the right to self-administer medications if the interdisciplinary team has determined that it is clinically appropriate and safe for the resident to do so. Policy Interpretation and Implementation 1. As part of their overall evaluation, the staff and practitioner will assess each resident's mental and physical abilities to determine whether self-administering medications is clinically appropriate for the resident. 2. In addition to general evaluation of decision-making capacity, the staff and practitioner will perform a more specific skill assessment, including (but not limited to) the resident's: a. Ability to read and…
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.
- Potential for harm · Dcited before2024-05-31 · tag F0656 — failed to write and follow a full care plan — isolatedDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, record review, and facility policy review, the facility failed to develop a care plan addressing the use of as needed, supplemental oxygen for 1 (Resident #3) of 3 sampled residents reviewed for respiratory care. Findings included: A facility policy titled, Oxygen Administration, revised in 10/2010, indicated, The purpose of this procedure is to provide guidelines for safe oxygen administration. The policy further indicated, 2. Review the resident's care plan to assess for any special needs of the resident. An admission Record revealed the facility admitted Resident #3 on 06/19/2023. According to the admission Record, the resident had a medical history that included diagnoses of pneumonia and heart failure. A quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 03/06/2024, revealed Resident #3 had a Brief Interview for Mental Status (BIMS) score of 15, which indicated the resident had intact cognition. Resident #3's Order Summary Report, listing active orders as of 05/31/2024, contained an order, started on 06/19/2023, for two…
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.
- Potential for harm · D2024-05-31 · tag F0658 — failed to meet professional standards of care — isolatedEnsure services provided by the nursing facility meet professional standards of quality.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review, interview, and facility policy review, the facility failed to ensure only licensed personnel adjusted the flow rate on an oxygen concentrator for 1 (Resident #45) of 3 residents reviewed for supplemental oxygen use. Findings included: A facility policy titled, Administering Medications, reviewed 05/12/2017, revealed, Only persons licensed or permitted by this state to prepare, administer and document the administration of medications may do so. An admission Record revealed the facility admitted Resident #45 on 03/19/2024. According to the admission record, Resident #45 had a medical history that included a diagnosis of chronic obstructive pulmonary disease (COPD). An admission Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 03/26/2024, revealed Resident #45 had a Brief Interview for Mental Status (BIMS) score of 15, which indicated the resident had intact cognition. The MDS indicated Resident #45 had an active diagnosis of asthma, COPD, or chronic lung disease. The MDS indicated Resident #45 received oxygen therapy while 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.
- Potential for harm · D2024-05-31 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolatedProvide safe and appropriate respiratory care for a resident when needed.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, record review, and facility policy review, the facility failed to specify dose parameters for 1 (Resident #7) of 3 residents reviewed for supplemental oxygen use. Specifically, the facility failed to ensure Resident #7's supplemental oxygen orders specified liters per minute (L/min) parameters. Findings included: A facility policy titled, Oxygen Administration, revised October 2010, indicated under the section titled Preparation to Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. The policy also indicated, Adjust the oxygen delivery device so that it is comfortable for the resident and the proper flow of oxygen is being administered. Resident #7's admission Record revealed the facility admitted the resident on 09/15/2022. According to the admission Record, the resident had a medical history that included diagnoses of hypoxemia (low blood oxygen levels) dystonia (involuntary muscle movements causing twisting and contorting), torticollis (involuntary muscle…
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.
Show the remaining 7 citations
- Potential for harm · D2024-05-31 · tag F0760 — failed to prevent significant medication errors — isolatedEnsure that residents are free from significant medication errors.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interview, record review, and facility policy review, the facility failed to ensure 1 (Resident #50) of 5 residents reviewed for unnecessary medications was free of significant medication errors. Specifically, staff administered metoprolol tartrate (a medication used for high blood pressure) to Resident #50 despite the resident's blood pressure being below the ordered parameters for administration and without monitoring the resident's pulse. Findings included: A facility policy titled, Administering Medications revised 12/2012, indicated, 3. Medications must be administered in accordance with orders, including any required time frame. The policy revealed, 8. The following information must be checked/verified for each resident prior to administering medications: a. Allergies to medications; and b. Vital signs, if necessary. An admission Record revealed the facility admitted Resident #50 on 04/24/2024. According to the admission Record, the resident had a medical history that included a diagnosis of essential (primary) hypertension. An admission Minimum Data Set (MDS), with…
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.
- Potential for harm · D2024-05-31 · tag F0761 — failed to label and store drugs safely — isolatedEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, record review, and facility policy review, the facility failed to ensure medication was safely stored for 1 (Resident #5) of 1 sampled resident reviewed for self-administration of medication. Specifically, Resident #5 had an order to keep their Flonase nasal spray at the bedside; however, the facility failed to ensure the medication was stored in a safe and secure place, not accessible to other residents, as directed by the facility's policy. Findings included: A facility policy titled, Self-Administration of Medications, revised in 12/2016, indicated 8. Self-administered medications must be stored in a safe and secure place, which is not accessible by other residents. If safe storage is not possible in the resident's room, the medications of residents permitted to self-administer will be stored on a central medication cart or in the medication room. An admission Record revealed the facility admitted Resident #5 on 07/11/2022. According to the admission Record, Resident #5 had a medical history that included a diagnosis of chronic obstructive…
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.
- Potential for harm · D2024-05-31 · tag F0947 — failed to train nurse aides adequately — isolatedEnsure 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 interview, record review, and review of the Facility Assessment Tool, the facility failed to ensure nurse aides received 12 hours of required in-service training per year for 2 (Certified Medication Technician [CMT] #3 and CMT #10) of 5 nurse aide employee files reviewed. Findings included: The Facility Assessment Tool, reviewed by the Quality Assurance and Performance Improvement (QAPI) Committee on 08/23/2023, revealed, Required in-service training for nurse aides. In-service training must: - Be sufficient to ensure the continuing competence of nurse aides, but must be no less than 12 hours per year. - Include dementia management training and resident abuse prevention training. CMT #3's Orientation Checklist revealed she was hired as a CMT on 06/28/2018. CMT #3's Employee Inservice Attendance Record revealed that for the timeframe from 06/18/2022 to 06/18/2023 (most recent full year based on her hire date of 06/28/2018), CMT #3 attended only four in-services, none of which pertained to dementia management. The Employee Inservice Attendance Record did not reflect 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.
- Potential for harm · D2024-01-29 · tag F0609 — failed to report abuse allegations — isolatedTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interview and record review, the facility staff failed to report to Department of Health and Senior Services (DHSS) an injury of unknown origin when the facility staff became aware on 12/14/23 that one resident (Resident #1) had a broken femur and did not know the source of the fracture. The facility census was 54. Review of facility policy, Abuse and Neglect Protocol, dated 2/15/22, showed: -Response and Reporting: It is the purpose of this facility to report to the state agency and appropriate law enforcement entity, any reasonable suspicion of a crime against any individual who is a resident of or is receiving care from the facility. The facility shall report not later than 2 hours after forming the suspicion, if the events that cause the suspicion result in serious bodily injury, or not later than 24 hours. Serious bodily injury would be classified as a fracture. The facility will report the results of all investigations to the Administrator or designee, DHSS and to other officials in accordance with State law, and within five working days of the incident, and if 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.
- Potential for harm · Ecited before2022-06-14 · tag F0656 — failed to write and follow a full care plan — patternDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
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, record review and interview, the facility failed to develop and implement a comprehensive person-centered plan of care which included measurable objectives and timeframe's to meet each resident's medical, nursing, and mental psychosocial needs identified in the comprehensive assessment for of three of 13 sampled residents (Residents #2, #22 and #30). The facility census was 51. Review of the facility policy titled Care Plans, Comprehensive Person-Centered, revised December 2016, showed the following: - A comprehensive, person-centered care plan that includes measurable objectives to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident; - The Interdisciplinary Team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident; - The care plan interventions are derived from a thorough analysis of the information gathered as part…
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.
- Potential for harm · E2022-06-14 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — patternEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interviews and record review, the facility failed to develop and implement a fall plan for one of 13 sampled residents who was at risk for falls, had multiple falls and a recent fall with an injury (Residents #30). The facility census was 51. Review of the facility policy Fall Protocol and Management dated 4/15/22 showed: -The purposes of this procedure are to provide guidelines for assessing a resident after a fall and to assist staff in identifying causes of the fall and implementing interventions to prevent falls. 1. Review of Resident #30's Minimum Data Set (MDS a federally mandated assessment tool completed by facility staff) dated 4/27/22, showed: - A Brief Interview of Mental Status (BIMS) of 15 which indicated no cognitive impairment; - Diagnoses of : unsteadiness on feet, overactive bladder (a sudden uncontrolled need or urge to urinate), hypertension (high blood pressure), diabetes mellitus (a long-lasting health condition that affects how your body turns food into energy), personality with behavior disorder and nocturia (a condition that causes you to wake at…
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.
- Potential for harm · Ecited before2022-06-14 · tag F0700 — patternTry different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
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, record review, and interview, the facility failed to ensure they assessed residents for risk of entrapment from bed rails prior to installation, and failed to review the risks and benefits with the resident or resident representative and failed to obtain informed consent from resident or resident representative. This affected three of 13 sampled residents (Residents #22, #47, and #50). The facility census was 51. Review of the pamphlet titled A Guide to Bed Safety, dated October 2000, included: - Which ways of reducing risk are best: o A process that requires ongoing patient evaluation and monitoring will result in optimizing bed safety. Many patients go through a period of adjustment to become comfortable with new options. Patients and their families should talk to their health care planning team to find out which options are best for them; - Patient or family concerns about bed rail use: o Encourage patients or family to talk to their health care planning team to determine whether or not…
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.
“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.
- 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.
Fines & penalties
No federal fines in the current CMS record.
Who owns this facility
| Owner / manager | Type | Role | Since |
|---|---|---|---|
| HAILEY, PAMELA | Individual | CORPORATE DIRECTOR; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 09/09/2012 |
| ALLEN, KIMBERLY | Individual | CORPORATE OFFICER | since 06/01/2022 |
| CULVER, BEVERLY | Individual | CORPORATE OFFICER | since 02/28/2022 |
| DIAS, GREGORY | Individual | CORPORATE OFFICER | since 06/01/2023 |
| GROOMER, JOHN | Individual | CORPORATE OFFICER | since 07/01/2015 |
| HENGGELER, CHRIS | Individual | CORPORATE OFFICER | since 06/30/2021 |
| JENNINGS, TONY | Individual | CORPORATE OFFICER | since 06/01/2021 |
| KARNS, STACEY | Individual | CORPORATE OFFICER | since 06/01/2022 |
| MESSNER, MARCI | Individual | CORPORATE OFFICER | since 08/22/2024 |
| PARSONS, LILLI | Individual | CORPORATE OFFICER | since 10/31/2021 |
| STUART, TERESA | Individual | CORPORATE OFFICER | since 06/01/2015 |
| MARTIN, ANGELIA | Individual | ADP OF THE SNF | since 02/14/2025 |
CMS files one row per role, so the 14 rows in the source record cover these 12 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.
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.
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
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
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.
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 265506. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2025-05-22, 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.