Lake Stockton Healthcare Facility

Based on interview and record review, the facility failed to fully implement their abuse and neglect prevention policies, when the facility failed to complete a criminal background check (CBC), an employee disqualification list (EDL - a list of individual prohibited from working in a long-term care facility in Missouri due to a finding of abuse or neglect) check, and a Nurse Aide (NA) Registry (list of individual with a Federal Indicator (a marker given to a potential employee who has committed abuse, neglect, or misappropriation of property against residents) prohibiting them from working in a certified facility) check for three sampled staff (Registered Medication Technician (RMT) G, Domestic Care Technician (DCT) M's, and Housekeeper (HK) N). The facility census was 85.Review of the facility's policy, Selection of Employee, dated September 2025, showed the following:-Applicants for employment will meet certain standard requirements before being accepted for employment with the organization;-To assure basic requirements are met for new employees and to assist in the selection 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to provide residents with an approved call light system when the facility failed to have a process in place to notify staff of call light notifications when they could not be heard on the halls, when the electronic scroll boards were not accurate on all boards, when call light boxes were not functioning for two residents (Resident #5 and #36), and when one resident (Resident #59) did not have an pull string on his/her bathroom emergency call light out of a sample of 18 residents. The facility census was 85. Review showed the facility did not provide a policy related to call lights. 1. Review of Resident #36's face sheet (brief information sheet about resident) showed the following:-admission date of [DATE];-Diagnoses included congestive heart failure (CHF - condition in which the heart can't pump enough blood to the body's other organs), peripheral vascular disease (circulatory condition in which narrowed blood vessels reduce blood flow to…

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.

Based on interview, and record review, the facility failed to provide care per standards of practice when staff failed to follow a physician order for daily weights, failed to consistently document weights, and failed to notify the physician on two occasions of a significant weight gain for one resident (Resident #43) with a diagnosis of congestive heart failure (CHF- chronic, progressive condition where the heart cannot pump blood effectively causing fluid buildup in the lungs and body) with bilateral lower extremity edema (swelling of both legs, ankles, or feet caused by abnormal fluid buildup in the tissues). The facility census was 85. Review of facility policy titled 'Patient Weights, dated April 2022, showed the following:-Facility weights will be done on admission, monthly, and as needed or as ordered;-The purpose is to monitor weight gain or loss. Review of a facility policy titled Changes in Resident Condition: Notification Guidelines, dated January 2025 , showed the following:-Physicians, residents, and families will be notified in a timely manner of changes in clinical…

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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, and record review, the facility failed to ensure all residents maintained acceptable parameters of nutritional status when staff failed to document an unplanned weight loss, failed to notify the registered dietician (RD) of the weight loss, failed to modify care plan to reflect the weight loss, and failed to implement new interventions after a continued unplanned weight loss one resident (Resident #41). The facility census was 85.Review of the facility policy titled 'Patient Weights, revised April 2022, showed in long-term care setting, weights will be done on admission, monthly, and as needed or as ordered. 1. Review of Resident #41's face sheet (admission data) showed the following information:-admission date of 10/10/20;-Diagnoses included other symptoms and signs involving cognitive functions and awareness. Review of the resident's vital signs showed the following:-On 12/06/25, at 8:39 A.M., showed the resident weighed 160 pounds 3.2 ounces;-On 12/13/25, at 12:30 P.M., showed the resident…

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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to report all allegations of possible abuse within two hours of the allegation being made to the State Survey Agency (SSA) when the facility did not report an allegation of physical abuse between to residents (Resident #1 and #2) to the Department of Health and Senior Services (DHSS). A sample of five residents were sampled. The facility census was 85.Review of the facility's policy titled Patient Abuse/Neglect, Elder Abuse, and Persons with Disability Abuse, revised 08/2021, showed the following:-Facility staff, employees, and physicians will follow regulations and standards in the identification of and procedures for handling alleged victims of abuse;-Facility purpose is to guide staff, employees, physicians, and any mandated reporter within the facility in identifying victims of abuse and provide a reporting mechanism in accordance with all local, state, and federal laws; -In the event a staff member with responsibility for the care of a person [AGE]…

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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to issue a Skilled Nursing Facility Advanced Beneficiary (SNFABN) Form CMS-10055 (2018) notice to one of two residents (Resident (#7) that remained in the facility for long-term care with Medicare A days available in the sample of 20 residents. Review of the instructions titled, Form Instructions Skilled Nursing Facility (SNFs) Advanced Beneficiary Notice of Non-Coverage SNFABN located on the Center for Medicaid and Medicare (CMS) website at cms.gov showed the following: -Medicare requires SNFs to issue the SNFABN to Original Medicare, also called fee-for-service (FFS), beneficiaries prior to providing care that Medicare usually covers, but may not pay for in this instance because the care is not medically reasonable and necessary or considered custodial. 1. Review of Resident #7's Face Sheet, in the electronic medical record (EMR) under the Demographic tab, showed the following: -Resident was admitted to the facility on [DATE]; -Resident was hospitalized…

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.

Based on interview and record review, the facility failed to have a registered nurse (RN) work for eight consecutive hours seven days per week and failed to ensure the Director of Nursing (DON) did not serve as charge nurse with a census of greater than 60. The facility census was 85. Record review showed the facility did not provide a policy regarding RN staffing. 1. Record review of the facility provided nurse schedules, dated 01/01/2022 through 01/31/2022, showed no RN coverage on any shift for the following dates: -1/4/2022; -1/8/2022; -1/9/2022; -1/10/2022; -1/13/2022; -1/14/2022; -1/18/2022; -1/19/2022; -1/22/2022; -1/26/2022. Record review of the facility provided nurse schedules, dated 02/01/2022 through 02/28/2022, showed no RN coverage on any shift for the following dates: -2/2/2022; -2/11/2022; -2/19/2022; -2/20/2022; -2/23/2022; -2/25/2022. Record review of the facility provided nurse schedules, dated 03/01/2022 through 03/31/2022, showed no RN coverage on any shift for the following dates: -3/1/2022; -3/2/2022; -3/5/2022; -3/6/2022; -3/11/2022. Record 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.

Based on observation, interview, and record review, the facility failed to keep food safe from potential contamination when staff stacked dishes while still wet and stored dented cans with other cans to be used by staff for food preparation. The facility census was 85. 1. Record review of the facility policies showed the facility did not provide a policy regarding air-drying dishes and/or utensils. Record review of the 2017 Food Code, issued by the Food and Drug Administration, showed the following information: -After cleaning and sanitizing, equipment and utensils shall be air-dried or used after adequate draining before contact with food; - Items must be allowed to drain and to air-dry before being stacked or stored. Stacking wet items such as pans prevents them from drying and may allow an environment where microorganisms can begin to grow. Observation of the kitchen on 4/25/2022, beginning 9:14 A.M., showed the following: -A large measuring cup sat upside down, on a metal shelf, with visible moisture seen inside the cup; -Five trays sat on a metal cart that held 90 juice…

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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure the staff provided showers, baths, or grooming assistance as preferred for three residents (Resident #37, #47, and #74) who were unable to perform their own activities of daily living of showering/bathing or grooming. The facility had a census of 85. Record review showed the facility did not provide a policy for showers and grooming or a copy of a facility shower schedule for residents. 1. Interviews and observations during the Resident Council Meeting on 4/26/2022, at 10:49 A.M., showed the following: -Residents #25, #30, #42, #44, #47, #61, #67, #75, and #81 attended the meeting; -All nine residents in attendance agreed residents were not getting enough showers; -Resident #30 did not speak, but shook his/her head up and down in agreement; -Resident # 61 said he/she tries to get the Jacuzzi because it makes him/her feel better and helps his/her legs feel better, but it just does not happen very often; -Resident #75 said staff has…

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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure staff cleaned and maintained a continuous positive airway pressure machine (CPAP - treatment for obstructive sleep apnea (breathing repeatedly stops and starts during sleep), with a hose and mask or nosepiece to deliver constant and steady air pressure) according to professional standards, failed to have a physician's order for a CPAP, and failed to address in the care plan the use of the CPAP for one resident (Resident #37). Staff failed to have a physician's order for the use of supplemental oxygen for three residents (Resident #15, Resident #22, and Resident #49), failed to ensure staff changed oxygen equipment per professional standards for three residents (Residents #15, #22, and #49), and failed to address in the care plan the use of oxygen for one resident (Resident #49), out of a sample of 23 residents. The facility had a census of 85. Record review of the facility's policy titled, Cleaning Personal Reusable Respiratory…

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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to establish and maintain an infection prevention and control program designed to help prevent the development and transmission of communicable diseases and infections when the facility failed to ensure employee tuberculosis (TB - a potentially serious infectious bacterial disease that mainly affects the lungs) screening tests were completed and documented per standards of practice and facility policy for four staff members. The facility census was 85. Record review of the Centers for Disease Control and Prevention website, updated 3/8/2021, showed the following information: -The TB skin test is performed by injecting a small amount of fluid (called tuberculin) into the skin on the lower part of the arm; -A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm; -Results should be documented in millimeters (mm); -A second skin test should be administered one to three…

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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure timely and complete nail care was provided two residents (Resident #49 and #75) who required assistance with nail care. The facility had a census of 85. Record review showed the facility did not provide a policy for showers and grooming. 1. Record review of Resident #49's face sheet (a document that gives resident information at a quick glance) showed the resident admitted to the facility on [DATE]. Record review of the resident's quarterly Minimum Data Set (MDS - a federally mandated assessment instrument completed by facility staff), dated 3/7/22, showed the following information: -Intact cognition; -Supervision with setup help only for bed mobility, transfers, and toilet use; -Independent from staff with personal hygiene (included combing hair and brushing teeth); -Physical help limited to transfer only for bathing and no set up help or physical help needed by staff; -Impairment in both upper and lower extremities on both sides.…

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.