NHC Healthcare, Joplin

Inspectors wroteBased on observation, interview and record review, the facility failed to provide adequate assistance with toileting needs in a manner that promoted quality of life, dignity, respect, and individuality for three residents (Residents #77, #72, and #51) of 23 sampled residents. The facility census was 79. Review of the facility policy Quality of Life-Dignity, revised August 2009, showed the following: -Residents shall be treated with dignity and respect at all times; -Treated with dignity means the resident will be assisted in maintaining and enhancing his or her self-esteem and self-worth; -Demeaning practices and standards of care that compromise dignity are prohibited. Staff shall promote dignity and assist residents as needed by promptly responding to the resident's request for toileting assistance; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide appropriate catheter care for two residents (Residents # 77 and #82) of four sampled residents with catheters when facility staff placed the catheter bag on the low bed and the urinary catheter bag lay on the fall mat on the floor increasing the residents' risk for infection. The facility census was 79. Review of the facility policy from the Infection Control Manual Volume 1, updated March 2026, showed for patients with urinary catheters, staff were to keep drainage bags off the floor, but below the level of the patient's bladder.1. [...]

Inspectors wroteBased on interview and record review, the facility staff failed to notify one resident's (Resident #19) durable power of attorney (DPOA) of any medication changes, refusals of repositioning, transfers, and medications. The facility census was 79. The facility did not provide a notification policy.1. Review of Resident #19's face sheet (brief resident profile sheet) showed the following:-readmitted to the facility on [DATE];-Diagnoses included paraplegia (paralysis of the lower portion of the body and of both legs), mild dementia with anxiety, chronic kidney disease (impaired kidney function); heart failure (impaired heart function); [...]

Inspectors wroteBased on observation and interview, the facility failed to provide a sanitary and comfortable environment when staff failed to replace a soiled privacy curtain for one resident (Resident #55). A sample of 23 residents were reviewed; the facility census was 79. The facility did not present a policy specific to the cleaning of privacy curtains. 1. Review of Resident #55's face sheet (gives basic profile information) showed the following:-admitted to the facility on [DATE];-Received hospice services;-Diagnoses included breathing disorders with dependence on supplemental oxygen, chronic kidney disease, heart disease, congestive heart failure, irregular heart function, severe obesity, diabetes, pain, dementia, and anxiety. Review of the resident's quarterly Minimum Data Set (MDS; [...]

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

Inspectors wroteBased on record review and interview, the facility failed to ensure each resident's choice of code status (whether to receive cardiopulmonary resuscitation (CPR - an emergency lifesaving procedure performed when the heart stops beating) or do not resuscitate (DNR)) was clearly and consistently documented throughout residents' medical records and facility documentation when the facility staff documented contradictory information regarding the code status of three residents (Resident #76, #23, and #36). A sample of 11 residents was selected for review out of a facility census of 85. [...]

Inspectors wroteBased on record review and interview, the facility failed to have processes in place to ensure each resident was offered a pneumococcal immunization, unless the immunization is medically contraindicated or the resident has already been immunized, when staff failed to follow-up regarding pneumococcal vaccines at admission for three residents (Residents #9, #49, and #91). A sample of five residents was selected for review out of a facility census of 85. [...]

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

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an observed medication error rate below 5% when staff made two medication errors in 25 opportunities resulting in a medication error rate of 8% involving two residents (Resident #19 and Resident #3). The facility census was 85. Review of the facility policy, Specific Medication Administration Procedures: Insulin Administration, revised 2/25/25, showed the following:-Perform hand hygiene and don gloves;-Attach pen needle to pen. Prime pen by dialing up 2 units and hold the pen with the needle pointing upwards. [...]

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

Inspectors wroteBased on observation, record review, and interviews, the facility failed to implement an effective infection control program when staff did not complete appropriate hand hygiene when providing incontinent care to one resident (Resident #23). Staff also failed to follow Enhanced Barrier Precautions (EBP - an infection control intervention designed to reduce transmission of multi-drug-resistant organisms (MDRO) that employs targeted gown and glove use during high-contact activities) during catheter care and personal hygiene for one resident (Resident #49) of eight residents with indwelling catheters. The facility had a census of 85. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide pressure ulcer care and monitoring per standards of practice when staff failed to follow physician orders for treatment of an unstageable pressure ulcer (occurs when the base of a full-thickness tissue loss wound is covered by a layer of dead tissue that prevents staging of the ulcer) to one resident's (Resident #1's) coccyx (tailbone area), failed to update the treatment after a visit to the wound clinic, and failed to complete a weekly wound assessment of the resident's pressure ulcer. The resident developed a subsequent infection of his/her pressure ulcer that required hospitalization. The facility census was 68. Review of the facility assessment guideline titled, Assessments, dated January 2024, showed the following:: [...]

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

Inspectors wroteBased on interview and record review, the facility failed to ensure COVID-19 resident vaccinations were offered, administered, or refused by the resident and/or resident representative for four (Resident #36, #39, #42, and #49) of five sampled residents reviewed for immunizations. In addition, the facility failed to develop and implement a COVID-19 policy for resident vaccination against the COVID-19 virus. The facility census was 70. 1. Review of Resident #36's Face Sheet located in the Face Sheet tab of the electronic medical record (EMR) showed the following: -admission date of 08/21/21; -Diagnoses included multiple sclerosis (a long-lasting (chronic) disease of the central nervous system), diabetes (a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces), and chronic kidney disease. [...]

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

Inspectors wroteBased on interview and record review, the facility failed to ensure medications were available for administration for one resident (Resident #39) of five sampled residents reviewed for unnecessary medications. The resident had the potential to experience adverse effects as the result of missing prescribed medications. The facility census was 70. 1. Review of Resident #39's electronic medical record (EMR) Face Sheet tab showed the following: -admission date of 02/18/22; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one resident (Resident #49) of five sampled residents reviewed for unnecessary medications, was not administered an antiseptic medication used to treat recurrent urinary tract infections while being administered an antibiotic for a urinary tract infection. This failure placed the resident at risk for complications related to the use of a medication that is not recommended to be used when being administered an antibiotic. The facility census was 70. Review of a facility policy titled, Adverse Consequences and Medication Errors, revised April 2014, showed the following: -Residents receiving any medication that has a potential for an adverse consequence will be monitored to ensure that any such consequences are promptly identified and reported. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish and monitor resident-specific behaviors for the use of an antipsychotic medication for two residents (Residents #49 and #39) out of ten sampled residents. These failures placed residents at risk for a diminished quality of life and potential unmet care needs. The facility census was 70. Review of a facility policy titled, Medication Monitoring and Management, revised 01/09/19, showed the following: -In order to optimize the therapeutic benefit of medication therapy and minimize or prevent potential adverse consequences, facility staff, the attending physician/prescriber, and the consultant pharmacist perform ongoing monitoring for appropriate, effective, and safe medication use; [...]

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure all residents were free from significant medication errors when staff failed to ensure one resident's (Resident # 1) insulin was administered per manufacturer's recommendation. The facility census was 70. , Review of the facility policy titled, Adverse Consequences and Medication Error, revised April 2014, showed the following: -A medication error is defined as the preparation or administration of drugs or biological which is not in accordance with physician's orders, manufacturer specifications, or accepted professional standards and principles of the professional(s) providing services; -Examples of medication error include wrong time. Review of the Manufacturer's Drug Insert for Novolog aspart insulin (fast acting insulin) provided by the Director of Nursing (DON) showed the following: [...]

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

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

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to store dishes in a clean condition when they stacked dishes with food particles still inside. The facility failed to provide the required air gap between the ice machine drain pipe and the floor drain that would prevent the backflow of wastewater. The facility had a census of 85 residents. 1. Record review of the Missouri Food Code, published 2013, showed dishes are required to be air dried before being stacked and stored and the FDA guidelines mandate all wares should be air dried, while using a towel is never permitted. Record review of the facility's policy, titled Warewashing Machines Operation, dated 11/2017, from the Safety and Sanitation Best Practice Guidelines, and showed the following information: -Air dry all items; -Towels may contaminate items; [...]

Inspectors wroteBased on record review and interview, the facility failed to administer one resident's (Resident #39) fentanyl (narcotic pain relief) patch per physician orders. Staff failed to provide wound care for three residents (Resident #58, #60, and #402) as ordered by the physician. A sample of 23 residents was selected for review; the facility census was 85. Record review of a facility policy and procedure entitled, administering pain medications, revised October 2010, showed the following information: -The pain management program is based on a facility-wide commitment to resident comfort; -Conduct a pain assessment as indicated; -Administer pain medications as ordered. 1. Record review of Resident #39's face sheet (resident profile sheet) showed the following information: -re-admitted to the facility from the hospital on [DATE]; -Diagnoses included: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide respiratory care in accordance with professional standards of practice when facility staff administered oxygen to one resident (Resident #52) for 45 days without a physician's order. The facility also failed to ensure staff changed oxygen equipment per professional standards for three residents (Resident #24, #49, and #52) out of a sample of 23 residents selected for review. The facility had a census of 85. Record review of the facility's policy titled, oxygen administration, dated October 2010, showed the following information: -Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration; -Change tubing and cannula, mask or attachments every 7 days; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide adequate assistance for activities of daily living (ADLs) of grooming and personal hygiene for two residents (Resident #52 and Resident #73) out of a sample of 23 residents selected for review. The facility census was 85. Record review showed the facility did not provide a shower policy when requested by the surveyor. 1. Record review of Resident #52's face sheet (brief resident profile sheet) showed the following information: -admission date of 9/18/18; [...]

Inspectors wroteBased on observation, interview and record review, staff failed to obtain physician orders for wound care for one resident (Resident #186) and failed to provide physician prescribed wound care for two residents (Residents #42 and #186). A sample of 23 residents was selected for review in facility with a census of 85. Record review of the facility policy titled Skin and Wound Management, dated April 2018, showed the following: -The nursing staff and practitioner will assess and document an individual's significant risk factors for developing pressure ulcers; for example, immobility, recent weight loss, and a history of pressure ulcers; -The physician will order pertinent wound treatments, including pressure reduction surfaces, wound cleansing and debridement approaches, dressings, and application of topical agents; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide incontinent care per nursing standards for two residents (Resident #2 and Resident #22). A sample of 23 residents was selected for review in facility with a census of 85. Record review of the facility policy, titled perineal (genital) care, dated February 2018, showed the following information: -The purposes of this procedure are to provide cleanliness and comfort to the resident, and prevent infections and skin irritation, and to observe the resident's skin condition. -Place the equipment on the bedside stand. Arrange the supplies so they can be easily reached. -Wash and dry hands thoroughly; -Wash perineal area, wiping from front to back; -The policy did not address hand hygiene when going from a soiled area to a clean area; -Rinse and dry thoroughly; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to notify the physician and obtain psychiatric services for one resident (Resident #24) out of a sample of 23, who displayed sadness, and had little interest and pleasure in doing things. The facility census was 85. On [DATE] and [DATE], surveyors requested the facility policy regarding obtaining mental health services and did not receive a policy. 1. Record review of Resident #24's face sheet (brief resident profile sheet) showed the following information: -admission date of [DATE]; -Latest return [DATE]; -Diagnoses included schizophrenia, bipolar disorder, restlessness and agitation, anxiety disorder, major depressive disorder, unspecified psychosis not due to a substance or known physiological condition, and unspecified dementia without behavioral disturbance. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to use appropriate infection control procedures to prevent the spread of bacteria or other infectious carrying contaminants when staff failed to use appropriate hand hygiene after performing incontinent care for two residents (Resident #2 and Resident #22), in a sample of 23 residents. The facility census was 85. Record review of the facility policy, titled handwashing/hand hygiene, dated August 2015, showed the following information: -The facility considered hand hygiene the primary means to prevent the spread of infections; -All personnel shall be trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of healthcare associated infections; -Use an alcohol based hand rub containing at least 62% alcohol or alternatively soap and water for the following situations; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe and clean environment in the kitchen. The facility census was 85. 1. Record review of the 2013 Missouri Food Code showed physical facilities shall be cleaned as often as necessary to keep them clean. Record review of the kitchen's dishwasher checklist, for staff training and to follow daily, showed the following information: -Make sure the dish room is wiped down, all sinks, etc. -Sweep and mop the floor, get under everything as best you can; -Take out the trash. Record review of the kitchen's cook checklist, for staff training and to follow daily, showed the following information: -Sweep and mop the walk-in, stock room and kitchen; -When cleaning the grill, make sure to clean around the fryer, too; -Clean and set up the steam table for breakfast; -Cleaning for each night included: [...]