Lewis County Nursing Home District

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain the can opener blade to be free of debris, failed to maintain the range hood to be free of grease and debris, failed to properly label, date, seal/cover/close food items, failed to discard expired food items, failed to maintain the ice machine and ensure the unit was equipped with an appropriate air gap, failed to ensure staff properly wore hair restraints, failed to ensure staff properly handled ready to eat food items, failed to utilize proper handwashing techniques, failed to cover trash cans when not in use, and failed to ensure the SCU refrigerator/freezer unit was equipped with thermometers to ensure temperatures were appropriate for storing cold/frozen food items. The facility census was 45.1. [...]

Inspectors wroteBased on observation, interview and record review, the facility did not have documentation of a detailed water flow map for the facility that identified areas in the water system that could encourage the growth and spread of Legionella (a type of bacteria found in [NAME] that causes legionnaires' disease, a severe form of pneumonia, when inhaled in water droplets or mist) or other waterborne bacteria and did not have an assigned water management team or documentation of the program to show meeting minutes or that required members attended meetings. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide restorative services to assist five residents (Resident #3, #6, #7, #28 and #30) in a review of 13 sampled residents, with mobility and/or limited range of motion to attain or maintain their highest level of functioning. The facility census was 45. Review of the facility policy, Restorative Nursing Services, dated July 2017, showed the following:-Residents will receive restorative nursing care as needed to help promote optimal safety and independence;-Restorative nursing care consists of nursing interventions that may or may not be accompanied by formalized rehabilitative services (e.g. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff transferred one resident (Resident #4), in a review of 13 sampled residents, using appropriate technique consistent with the resident's abilities and condition to ensure the resident's safety. The facility also failed to ensure chemicals were secured in a locked storage area not accessible to residents. The facility's census was 45. Review of the facility policy, Safe Lifting and Movements of Residents, revised July 2017 showed the following:-Resident safety, dignity, comfort and medical condition will be incorporated into goals and decisions regarding the safe lifting and moving of residents;-Manual lifting of resident's shall be eliminated when feasible;-Nursing staff, in conjunction with the rehabilitation staff, shall assess individual resident's needs for transfer assistance on an ongoing basis. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure inventories of schedule II controlled substance medications (substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence), schedule IV medications (medications with a lower potential for abuse) and schedule V medications (medications with lower potential for abuse than schedule IV) were monitored and reconciled every shift, per facility policy, for five sampled residents (Resident #23, #5, #13, #7 and #2) of 12 sampled residents and ten additional resident (Resident #36, #29, #153, #16, #9, #25, #45, #152, #32 and #28). The facility census was 47. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to destroy two schedule II narcotic controlled substance medications (substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence) and one schedule IV narcotic controlled substance medication (medications with a lower potential for abuse) for one resident (Resident #4) in a sample of 13 residents. The facility census was 45. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff prepared all food items and served the correct portion size of food items to residents with a physician's order for a pureed diet and mechanical soft diet. The facility census was 45. Review of the undated facility policy, Food Preparation and Service, showed the following:-Menus will be the basis for all food preparation;-Standardized recipes, adjusted to the proper yield for the facility, will be available and used in food preparation;-The food service director will oversee food preparation and service;-Portion control will be achieved through portions being indicated on regular and therapeutic diet menus, and availability of portion control tools including scoops, ladles, portion scales, pans appropriate for the recipes being prepared. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to prepare and serve food at a safe and appetizing temperature and failed to prepare food items according to the recipe for residents with a physician-ordered pureed diet, mechanical soft diet, and regular diet. The facility census was 45. Review of the undated facility policy, Food Preparation and Service, showed food will be served at acceptable temperatures. 1. During an interview on 09/24/25 at 1:30 P.M., Resident #45 said the following:-Most of the time the food was not good;-The food was either over cooked or under cooked or cold. During an interview on 09/24/25 at 1:30 P.M., Resident #25 said warm food was not served warm and cold food was not served cold, even when staff served the residents in the dining room. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed ensure residents on a pureed diet and residents on a mechanical soft diet received food in the proper form in accordance with his/her physician's orders. The facility census was 45.1. Review of the facility's undated Resident Diet Orders showed four residents had a physician-ordered pureed diet. Review of the Diet Spreadsheet for the lunch meal on 9/22/25 showed residents on a pureed diet were to receive pureed hamburger or cheeseburger on bun and pureed breaded cauliflower. Review of the recipe for Pureed Breaded Cauliflower showed to place the prepared breaded vegetables in a food processor with chicken broth. Blend until smooth. Review of the recipe for Pureed Hamburger or Cheeseburger on Bun showed to place prepared sandwiches and beef broth in a food processor. Blend until smooth. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure three Certified Nurse Aides (CNAs) in a review of three CNAs reviewed, received the required 12 hours of in-service education annually. The facility census was 45. Review of the Facility assessment dated [DATE] showed staff training/education and competencies included monthly in-services on topics of need and mandatory training as needed. 1. Review of the undated list of mandatory in-services offered to staff, dated 2025 showed the following:(9:30 A.M. and 2:00 P.M. unless otherwise posted);ALL MUST ATTEND;-01/16/25-Survey Readiness, Importance of Charting;-02/20/25-Quality of Life/Care;-03/20/25-Resident Rights/Customer Service;-04/10/25-Abuse/Neglect/Misappropriation of belongings;-05/15/25-Corporate Compliance;-06/19/25-OSHA/Slips, trips and falls; Proper Body Mechanics of Lifting;-07/18/25-Infection Control/COVID-19; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff followed professional standards of practice when staff failed to follow treatment orders for one resident, (Resident #2), in a review of 13 sampled residents. The facility census was 45. Review of the facility policy, Dressings, Dry/Clean, revised September 2013, showed the following:-Verify that there is a physician's order for this procedure;-Review the resident's care plan, current orders, and diagnoses to determine if there are special resident needs;-Check the treatment record. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary treatment and services consistent with standards of practice, when the facility failed to ensure staff cleaned one resident's (Resident #2's) pressure ulcer (an injury to skin and underlying tissue resulting from prolonged pressure on the skin, most often on bony areas of the body) according to physician's orders, failed to complete weekly skin assessments to include measurements, appearance, and any other wound characteristics, and failed to notify the physician of a change in the wound as directed by the facility policy. Facility staff also failed to turn and reposition one resident (Resident #4), who had a pressure ulcer. The facility census was 45. Review of the facility policy, Dressings, Dry/Clean, revised September 2013, showed the following:1. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure staff demonstrated the appropriate skills to effectively respond to one resident (Resident #17), who had a diagnosis of dementia, in a review of 13 sampled residents, when the resident became aggressive toward the staff. The facility failed to identify and implement approaches to address the resident's behaviors including agitation and striking out. When the resident was not redirectable, Nurse Assistant (NA) J restrained the resident by holding the resident's wrist to the resident's chest and wrapped his/her arms around the resident and sat him/her on the floor. The facility census was 45.1. Review of Resident #17's face sheet showed the resident had diagnoses of mild cognitive impairment and dementia. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the Quality Assurance (QA) committee meetings included the required members, including the Medical Director. The facility census was 45. During an interview on 09/25/25 at 5:40 P.M., the Administrator said the facility did not have a policy for Medical Director Responsibilities. Review of the facility Medical Director Agreement, dated 07/03/23, showed the following:-Medical Director Responsibilities included serving on facility committees, including QA and assist Administrator in implementing committee recommendations and plans of action;-Medical Director Services included QA committee;-Signed by the Medical Director on 07/17/23. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide to the resident or the resident's representative, a Centers for Medicare and Medicaid Services (CMS) Notice of Medicare Non-Coverage (NOMNC, form CMS-10123) for two residents (Resident #38 and Resident #101), and failed to provide to the resident or the resident's representative a complete Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN, form CMS-10055) for two residents (Resident #1 and Resident #101), in a review of three discharged from service sampled residents, when the facility initiated discharge from Medicare Part A Services when benefit days were not exhausted. The facility census was 45. [...]

Inspectors wroteRefer to event id DCUR12 Based on observation, interview and record review, the facility failed to ensure staff treated one resident (Resident #35) in a review of nine sampled residents, with dignity and respect when Certified Nurse Assistant (CNA) C performed a Covid (Coronavirus-infectious disease) test on the resident without talking with the resident prior to administering the test to request permission, to educate to the rationale or preparation for testing, or to ensure privacy of the resident when tested. The census was 52.

Inspectors wroteRefer to event id DCUR12 Based on interview and record review, the facility failed to ensure one resident (Resident #1), in a review of nine sampled residents, remained free from misappropriation of property when the resident's iPad (an electronic tablet/computer) came up missing and was presumed stolen. The facility census was 52.

Inspectors wroteRefer to event id DCUR12 Based on observation, interview and record review, the facility failed to follow professional standards of practice when Certified Nurse Assistant (CNA) C performed a Covid (Coronavirus-infectious disease) test (an invasive procedure where a cotton swab is inserted in a resident's nasal passages and a sample collected for testing) on one resident, (Resident #35), in a review of nine sampled residents. Resident #35 had not been assessed by a licensed nurse to determine the resident had symptoms that necessitated testing. Instead, CNA C performed the test without any professional basis for testing and without documented training to show he/she received appropriate training to perform the test. The facility census was 52.

Inspectors wroteRefer to event id DCUR12 Based on observation, interview and record review, the facility failed to provide incontinent care for one additional resident, (Resident #29), of nine sampled residents. The census was 52.

Inspectors wroteRefer to event id DCUR12 Based on observation, interview and record review, the facility failed to ensure one newly hired nurse assistant (NA) (NA B), of one NA employee file reviewed, obtained their certification within the required four month time frame. The census was 52.

Inspectors wroteRefer to event id DCUR12 This deficiency is uncorrected. For previous examples, refer to Statement of Deficiencies dated 11/17/23. Based on observation, interview and record review, the facility failed to ensure staff utilized appropriate personal protective equipment (PPE) during nasal swab testing (cotton swab up both nostrils) for one resident, (Resident #35), in a review of one resident tested for COVID-19 (an infectious disease caused by severe acute respiratory syndrome). The census was 52.

Inspectors wroteBased on interview and record review, the facility failed to implement their Quality Assurance and Performance Improvement (QAPI) program. This had the potential to affect 52 of 52 residents who resided at the facility.

Inspectors wroteBased on interview and record review, the facility failed to establish and maintain an infection prevention and control program (IPCP) for recording incidents of infections identified under the facility's IPCP, surveillance, tracking and trending, and the corrective actions taken by the facility. The facility failed to update their infection control policies on an annual basis. The facility also failed to provide assistance with eating in a manner to potentially prevent cross-contamination for two of 24 sampled residents (Resident (R) 19 and R24) observed during dining. The census was 52.

Inspectors wroteBased on interview and record review, the facility failed to maintain an infection prevention and control program (IPCP) that included a functional antibiotic stewardship program. The failure to have a system in place that monitored antibiotic use in accordance with established protocols has the potential to affect all 52 residents of the facility. In addition, the facility failed to ensure one Resident (R41) had appropriate clinical indications for the use of an antibiotic. The census was 52.

Inspectors wroteBased on interview and record review, the facility failed to accurately code the Minimum Data Set (MDS) assessment for three (Resident (R) 51, R6 and R16) of 24 sampled residents reviewed for quality-of-care issues. Failure to code the MDS correctly could potentially lead to inaccurate federal reimbursements and inaccurate assessment and care planning of the resident. The census was 52.

Inspectors wroteBased on interview and record review, the facility failed to revise their pneumococcal vaccine policy to reflect current pneumococcal vaccination guidelines. This failure increased the risk for residents to not be vaccinated per current guidelines and contract pneumonia. The census was 52.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff treated one resident (Resident #35) in a review of nine sampled residents, with dignity and respect when Certified Nurse Assistant (CNA) C performed a Covid (Coronavirus-infectious disease) test on the resident without talking with the resident prior to administering the test to request permission, to educate to the rationale or preparation for testing, or to ensure privacy of the resident when tested. The census was 52. The facility did not provide a policy regarding dignity when requested. Review of the booklet, Resident Rights For Long-Term Care in Missouri, showed residents should be treated with consideration and respect and with full recognition of dignity and individuality. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one resident (Resident #1), in a review of nine sampled residents, remained free from misappropriation of property when the resident's iPad (an electronic tablet/computer) came up missing and was presumed stolen. The facility census was 52. On 1/5/23, the administrator was notified of the past noncompliance which occurred on 12/25/23. On 12/26/23 the administrator identified Certified Nurse Aide (CNA) D as misappropriating Resident #1's ipad (electronic tablet/computer) after review of facility camera footage. Upon discovery, CNA D was suspended, the facility conducted an investigation and notified appropriate parties, including local law enforcement. [...]

Inspectors wroteBased on observation, interview, record review and policy review, the facility failed to ensure an alleged injury of unknown origin was reported to the State Survey Agency (SSA) in a timely manner for one of three (Residents (R) 19) residents reviewed for reporting allegations to the SSA in a timely manner. The census was 52.

Inspectors wroteBased on observation, interview, record review, the facility failed to complete a significant change assessment for one of 24 sampled residents (Resident (R) 21) after R21 suffered a cerebral vascular accident (CVA) which resulted in R21 needing a feeding tube due to being unable to take food or fluids by mouth. The census was 52.

Inspectors wroteBased on observation, interview and record review, the facility failed to follow professional standards of practice when Certified Nurse Assistant (CNA) C performed a Covid (Coronavirus-infectious disease) test (an invasive procedure where a cotton swab is inserted in a resident's nasal passages and a sample collected for testing) on one resident, (Resident #35), in a review of nine sampled residents. Resident #35 had not been assessed by a licensed nurse to determine the resident had symptoms that necessitated testing. Instead, CNA C performed the test without any professional basis for testing and without documented training to show he/she received appropriate training to perform the test. The facility census was 52. During interview on 1/11/24 at 3:21 P.M., the Director of Nursing (DON) said the facility did not have a policy for Covid testing. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide incontinent care for one additional resident, (Resident #29), of nine sampled residents. The census was 52. Review of the facility policy, Perineal Care, last revised 2/2018 showed the purpose of this procedure was to provide cleanliness and comfort to the resident, to prevent infections and skin irritation, and to observe the resident's skin condition. 1. Review of Resident #29's annual Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 11/2/23, showed the following: -Diagnoses included Alzheimer's disease (progressive disease that destroys memory and other important mental functions); -Occasionally incontinent of bladder and bowel; -Required partial to moderate assist for toileting and personal hygiene. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure pressure ulcer prevention measures were completed per facility policy and consistent with professional standards of practice, for one resident out of a sample of two residents (Resident (R) 16) reviewed for pressure ulcers. The facility failed to conduct thorough weekly skin assessments, which included measurements, descriptions, and stage of a right heel wound to be able to identify a decline or an improvement, or new skin conditions. These failures had the potential to delay identification and treatment of any new wounds the resident might develop. The census was 52.

Inspectors wroteBased on record review, observation, staff interviews, and facility policy review, the facility failed to assess nutritional status after a significant weight gain/weight loss, and failed to take corrective action after the facility determined the weight gain and loss was an error for two (Resident (R) 6 and R43) of four residents reviewed for nutrition in a total sample of 24 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one newly hired nurse assistant (NA) (NA B), of one NA employee file reviewed, obtained their certification within the required four month time frame. The census was 52. Review of the undated facility policy, Lewis County Nursing Home Job Description-Nursing, showed: -Position: Certified Nurse Assistant (CNA); -Qualifications: Must be [AGE] years old. Must be certified (non-certified personnel will be offered classes at the facility and must become certified within the specified guidelines); -General Responsibilities to the facility: Follow company policies and procedures. Adhere to professional standards, follow policy and procedures and abide by federal, state and local requirements. [...]

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure pharmacy recommendations were acted upon/responded to in a timely manner for monthly medication regimen reviews for one of five sampled residents (Resident (R) 43) reviewed for unnecessary medications. The census was 52.

Inspectors wroteBased on record review, staff interviews, and facility policy review, the facility failed to ensure two residents (Resident (R) 51 and R43) of five residents reviewed for unnecessary medication were being monitored for behaviors while taking psychotropic medications, additionally, failed to identify an indication for the use of a psychotropic medication, and failed to attempt Gradual Dose Reductions (GDRs) or document a rationale for the reason not to attempt a GDR.

Inspectors wroteBased on interview and record review, the facility failed to provide a written notice of transfer to the resident and/or resident representative when five residents (Resident #13, #47, #50, #52 and #54), in a review of 17 sampled residents, were transferred to the hospital or another facility. The facility census was 56. Review of the undated facility policy, Transfer or Discharge Notice, showed the following: -A resident and/or his/her representative (sponsor) will be given a 30-day written notice of an impending transfer or discharge from our facility; -Under the following circumstances, the notice will be given as soon as it is practicable but before the transfer or discharge: a. The transfer is necessary for the resident's welfare and the resident's needs cannot be met in the facility; b. [...]

Inspectors wroteBased on interview and record review, the facility failed to inform residents and resident representatives of their bed hold policy at the time of transfer to the hospital for five residents (Resident #13, #47, #50, #52 and #54), in a review of 17 sampled residents, who were transferred to the hospital or another facility. The facility census was 56. 1. Review of the undated facility policy Transfer or Discharge Notice showed the following: -A resident, and/or his or her representative (sponsor), will be given a 30-day written notice of an impending transfer or discharge from our facility. -Under the following circumstances, the notice will be given as soon as it is practicable but before the transfer or discharge: a. The transfer is necessary for the resident's welfare and the resident's needs cannot be met in the facility; b. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide an ongoing program of meaningful activities on a daily basis to meet the interests and the physical, mental, and psychosocial well-being for four residents (Residents #8, #32, #33, and #47), in a review of 17 sampled residents, and for six additional residents (Residents #1, #9, #10, #14, #25 and #46). Staff failed to ensure weekend and evening activities were provided for residents. The facility census was 56. Review of the undated facility policy Activities showed the following: CONDUCTING ACTIVITIES: It is the policy of this facility that the activity director/coordinator be responsible for overseeing activity programs; Procedure: 1. The activity coordinator is responsible for overseeing all activity programs; 2. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to consistently implement, evaluate, and modify interventions, in accordance with current standards of practice, as necessary to reduce the risk of falls for three residents (Resident #23, #52, and #54) in a review of 17 sampled residents. Resident #52 fell multiple times from 3/24/21-4/17/21 and ultimately sustained a dislocated shoulder ( an injury that occurs when the top of upper arm bone pops out of the socket in the shoulder blade) and fractured finger. The facility staff failed to use proper technique during gait belt (canvas belt placed around the resident's waist to assist with ambulation and transfers), transfers for two residents (Resident #4 and #31), when the resident did not bear weight, or bore only minimal weight, during transfers. The facility census was 56. [...]

Inspectors wroteBased on interview and record review, the facility failed to offer residents a daily bedtime snack for one resident (Resident #8), in a review of 17 sampled residents, and for four additional residents (Residents #9, #10, #14, and #25), who participated in group interview and reported bedtime snacks were not offered on a routine basis at the facility. The facility census was 56. Review of the undated facility policy, Serving Snacks (Between Meal and Bedtime), showed the following: Purpose: The purpose of this procedure is to provide the resident with adequate nutrition. Preparation: 1. Review the resident's care plan and provide for any special needs of the resident; 2. Assemble equipment and supplies needed; 3. Check the tray before serving the snack to be sure that it is the correct diet ordered and that the food consistency is appropriate to the resident's ability to chew and swallow; [...]