814 West South Avenue, Maryville, MO 64468 · Nodaway County · (660) 582-8161
86 certified beds, about 30 residents a day · For profit - Limited Liability company · Medicare and Medicaid since 1994
CMS Care Compare ratings, data as of September 1, 2026 · CCN 265591 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on March 14, 2025, inspectors cited 10 health deficiencies (the Missouri average is 11.4, the national average 9.2).
None of its 52 health citations since September 2021 was rated as actual harm or immediate jeopardy.
CMS lists no fines against this home in the last three years.
Nurses and nurse aides worked 2.99 hours per resident per day, against 3.43 across Missouri and 3.86 nationally. Registered nurses accounted for 0.92 of those hours.
77.1% of nursing staff left within the year CMS measured (Missouri average 56.0%).
CMS links it to Mo Op Holdco, LLC, an affiliated group of 9 nursing homes.
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 52 health citations on file.
Inspectors wroteBased on observation, interview and record review the facility failed to protect two residents (Resident #31 and #12) right to be free from physical and verbal abuse, when Resident #11, pushed resident #31 against a wall and when Resident #11 ran at Resident #12 with raised fists and threatened to kill him/her. This affected two of three sampled residents (Resident #31 and #12). The facility census was 33. Review of the facility's policy titled Abuse Prevent Program, dated December 2016, showed:-Residents had the right to be free from verbal and physical abuse;-The facility will protect residents from abuse;-The facility will implement policies and procedures to prevent abuse or mistreatment of residents. I think it would be best to move Resident #11's information to the top since this person was involved in both incidents. 1. [...]
Inspectors wroteBased on interview and record review the facility failed to ensure sufficient number of nursing staff (including aides) to respond to residents call lights timely. This affected three (Resident #1, #2, and #3) of four sampled residents. The facility census was 30. Review of the facility Staffing policy, dated October 2017, included staffing numbers and the skill requirements of direct care staff are determined by the needs of the residents based on each resident's plan of care. The facility will provide enough staff with the skills and competency necessary to provide care and services for all residents in accordance with resident care plans and the facility assessment. Review of the facility policy titled Answering the Call Light, dated March 2021, included: - The purpose of the procedure is to ensure timely response to the resident's requests and needs; [...]
Inspectors wroteBased on interview and policy review, the facility failed to ensure a Quality Assurance and Performance Improvement (QAPI) program to identify, maintain, and evaluate concerns for effective resident care. This deficient practice had the potential to not identify issues and/or capture the efforts made in measuring the care and services for 28 residents. The facility census is 28. Review of the facility policy titled Quality Assurance and Performance Improvement (QAPI) Program revised April 2014 revealed, Policy Statement The facility shall develop, implement, and maintain an ongoing, facility- wide Quality Assurance and performance Improvement (QAPI) program to actively pursue quality of care and quality of life goals. [...]
Inspectors wroteBased on interview and policy review, the facility failed to ensure a Quality Assurance and Performance Improvement (QAPI) program committee met on a quarterly basis to work on performance improvement projects (PIP) and track the performance of the PIP. This deficient practice had the potential to not identify or improve the care and services for 28 residents. The facility census is 28. Review of the facility policy titled, Quality Assurance and Performance Improvement (QAPI) Plan revised April 2014 revealed, Policy Statement This facility shall develop, implement, and maintain an ongoing, facility-wide QAPI Plan designed to monitor and evaluate the quality and safety of resident care, pursue methods to improve care quality, and resolve identified problems. Policy Interpretation and Implementation The objectives of the QAPI Plan are to: 1. [...]
Inspectors wroteBased on interview, record review, and policy review, the facility failed to ensure residents were provided the Skilled Nursing Facility Advance Beneficiary Notice, form CMS-10055, or the Notice of Medicare Non-coverage (NOMNC) form CMS-10123 for Medicare Part A Services when they were no longer covered or coverage was ending for two of three residents reviewed (Resident (R) 24, and R32) out of a total sample of 18 residents. This deficient practice had the potential for residents not to be provided the information about what services may not be covered by Medicare for residents to make an informed decision about receiving therapies. The facility census is 28. Review of the facility policy titled, Medicare Advance Beneficiary Notices dated April 2021 revealed, Policy Statement: Residents are informed in advance when changes will occur to their bills. [...]
Inspectors wroteBased on record review, interview, and policy review, the facility failed to inform the Ombudsman of hospital transfers for two of four residents (Resident (R)8 and R27) reviewed for hospitalization out of a total sample of 18. The failure had the potential to cause the Ombudsman to not be aware of any trends or patterns of hospitalization of residents at the facility. The facility census was 28. 1. Review of the Census tab in the electronic medical record (EMR) revealed R8 was admitted on [DATE]. Review of the Discharge Return Anticipated Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 02/25/25 located under the MDS tab in the EMR revealed R8 was discharged from the facility with an anticipated return from the hospital. [...]
Inspectors wroteBased on policy review, record review, observations, and interviews, the facility failed to label and date enteral feedings for two of two residents (Residents (R) 27 and R29) who required enteral feedings out of a total sample of 18 residents. This failure increased the risk of nurses not knowing if the correct formula and rate was being provided and what date the formula was hung. The facility census is 28. Review of the policy titled Enteral Feeding via Continuous Pump revised November 2018 revealed . On the formula label document initials, date and time the formula was hung/administered, and initial that the label was checked against the order . 1. [...]
Inspectors wroteBased on record review and interview, the facility failed to initiate a new PASARR (Pre-admission Screening and Resident Review) Level One for one of four residents (Resident (R) 21) reviewed for PASARR to reflect new psychiatric diagnoses out of a total sample of 18 residents. The failure to maintain a PASARR Level One that reflected the new diagnoses of R21 had the potential to delay or limit necessary assistance should R21 experience a psychiatric episode that disrupted her daily life. The facility census is 28. Review of the Census tab in the electronic medical record (EMR) revealed R21 was originally admitted on [DATE]. [...]
Inspectors wroteBased on record review, interview, and policy review, the facility failed to provide a PASARR (Pre-admission Screening and Resident Review) Level One for one of four residents (Resident (R)21) reviewed for PASARR to reflect a positive or negative screen result out of 18 sample residents. The failure to maintain a PASARR Level One that reflected either a positive or negative screen result had the potential to limit or delay the assistance needed for R21 should R21 experience a psychiatric episode. The facility census is 28. Review of the Census tab in the electronic medical record (EMR) revealed R21 was originally admitted on [DATE]. Review of the Med Diag (Medical Diagnoses) tab of the EMR revealed that R21 was diagnosed with morbid obesity and dysphagia. There was no reference to a psychiatric diagnosis. [...]
Inspectors wroteBased on interview, record review, and policy review, the facility failed to ensure showers were provided per resident preference for one of 18 sampled residents (Resident (R)18). This deficient practice had the potential for residents dependent on staff to not maintain personal hygiene and not maintain participation in activities of daily living. The facility census is 28. Review of the facility policy titled, Activities of Daily Living (ADLs), Supporting revised March 2018, revealed, Policy Statement: Residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Policy Interpretation and Implementation l. [...]
Inspectors wroteBased on the policy review, record review, and interview, the facility failed to follow the recommendations to obtain weekly weights for one of two residents (Resident (R) 27) reviewed for nutrition out of a total sample of 18 resident which caused inadequate tracking of weight loss or gain. The facility census is 28. Review of the facility's policy titled Weighing and Measuring revised March 2011 revealed .The purpose of this procedure are to determine the resident's weight and height, to provide a baseline and an ongoing record of the resident's body weight as an indicator of the nutritional status and medical condition of the resident, and provide a baseline height in order to determine the ideal weight of the resident . [...]
Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure the oxygen (O2) concentrators had dust free filters on the inlet where the air came into the machine for one of two residents (Resident (R) 25) reviewed for oxygen usage out of a total sample of 18 residents. This deficient practice had the potential for increased chance of infection and unnecessary respiratory treatment. The facility census is 28. Review of the facility's policy titled, Departmental (Respiratory Therapy)- Prevention of Infection revised November 2011, revealed, Purpose: The purpose of this procedure is to guide prevention of infection associated with respiratory therapy tasks and equipment, including ventilators, among residents and staff. Steps in the Procedure Infection control considerations Related to oxygen Administration. 9. [...]
Inspectors wroteBased on observation, interviews and record reviews, the facility failed to assure staff followed acceptable standards of practice for one (1) of the five (5) sampled residents, (Resident #1), when staff failed to follow provider orders, remove a resident's surgical staples in a timely manner, and charted that the surgical staples had been removed per provider orders and were not actually removed. The facility census was 24. The facility did not provide policies and procedures relating to physician orders and weekly skin assessments. Review of the facility's policy for Wound Care, revised October, 2010, showed: - The purpose of this procedure is to provide guidelines for the care of wounds to promote healing; - Verify that there is a physician's order for this procedure; - Review the resident's care plan to assess for any special needs of the resident; [...]
Inspectors wroteBased on observations, interviews and record review, the facility failed to promote an environment respectful of the rights of each resident to make choices about significant aspects of their lives when staff did not offer evening (HS) snacks to all residents. This affected eight of 12 sampled residents, (#1,#2, #4, #9, #12 and #16) and other residents who attended the resident group interview. The facility census was 22. Review of the facility's policy for serving snacks between meal and bedtime, revised September 2010, showed, in part: - The purpose of this procedure is to provide the resident with adequate nutrition; - Review the resident's care plan and provide for any special needs of the resident; - The person performing this procedure should record the following information in the resident's medical record: the date and time the snack was served; [...]
Inspectors wroteDuring an interview and record review, the facility failed to maintain a Department of Health and Senior Services (DHSS) approved surety bond that was equal or greater than one and one-half times the average monthly balance for the residents' personal funds for the last 12 consecutive months from July 2022 through June 2023. This has the potential to affect all residents who had money in the trust account. The facility census was 22. Review of the facility policy, Surety Bond, dated March 2021, showed: -Our facility has a current surety bond to assure the security of all residents' personal funds deposited with the facility; [...]
Inspectors wroteBased on record review and interview, the facility failed to ensure they utilized the correct Skilled Nursing Facility Advance Beneficiary Notice of non- coverage (SNFABN) form (a form that provides information to residents/beneficiaries so that they can decide if they wish to continue receiving the skilled services that may not be paid for by Medicare and assume financial responsibility), for two of three residents sampled for beneficiary notifications (Residents #5 and #12). The facility census was 22. Review of the facility policy, Medicare Advance Beneficiary Notice, dated April 2021, did not address the utilization of the correct 2020 dated ABN form. Review of Resident #5's Beneficiary Notice CMS-10055 form showed his/her last covered day of Part A services was 2/28/23. The resident signed the form on 2/16/23. The facility did not use the most updated form from 2020. [...]
Inspectors wroteBased on observation and interviews, the facility failed to maintain a clean and comfortable homelike environment when staff failed to: properly clean resident room floors, properly strip and re-wax to maintain tiles around the base of resident toilets. Additionally, the facility failed to repair damaged base boards in resident room [ROOM NUMBER], fix a dragging door to restroom in room [ROOM NUMBER], and repair a damaged circular metal floor plate in the 500 hall; As well as failure to maintain the entrance to the facility by not removing spider webs, and a bird's nest from above main entry doors. This effected the quality of life for all residents in the facility. The facility census was 22. Review of the facility policy on floor cleaning and maintenance dated December of 2009, showed: - Floors shall be maintained in a clean, safe, and sanitary manner; [...]
Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement a comprehensive plan of care which included measurable objectives and timeframe's for two sampled resident, (Resident #24 and Resident #9). Staff failed to implement a comprehensive person-centered plan of care that addressed hearing issues for Resident #9 and develop a plan of care to address Resident #24's diagnosis of a Post Traumatic Stress Disorder (PTSD, a disorder that develops in some people who have experienced a shocking, scary or dangerous event). The facility census was 22. Review of the facility's Comprehensive, Person-Centered Care Plan Policy, revised December 2016, showed: [...]
Inspectors wroteBased on record review and interview, the facility failed to complete a discharge summary for two residents out of the two sampled closed resident records (Resident #15 and Resident #28). The facility census was 22. The facility did not provide a policy addressing discharge summaries. 1. Review of Resident #15's admission Minimum Data Set (MDS), a federally mandated assessment completed by facility staff, dated 4/28/23 showed: - No cognitive impairment; - Assistance of one staff for Activities of Daily Living (ADL's); - Diagnosis included, high blood pressure and depression; - Resident planned to return to the community. Review of the resident's care plan, dated 4/21/23 showed: -The resident is a full code; -The resident would like to return home following his/her rehabilitation stay. Review of the nurses' notes dated 5/5/23 at 9:16 A.M. [...]
Inspectors wroteBased on interview, observation, and record review, the facility failed to ensure that seven of 12 sampled residents (Residents #1, #20, #12, #2, #16 #19, #23), who required staff assistance, were provided with adequate assistance for activities of daily living (ADL's: tasks completed to care for oneself daily such as bathing, dressing, moving from a chair to bed, and personal hygiene), as well as failed to provide proper incontinence care for Residents #16, #23, The facility census was 22. Review of the facility ADL policy dated March 2018, showed: -Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming, personal and oral hygiene; [...]
Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff used proper techniques to reduce the possibility accidents or injuries when transferring two sampled residents (Resident #11 and Resident #12) during the use of a mechanical lift transfer. The facility census was 22. Review of the manufactures instructions for the Drive mechanical lift, dated July 2020 showed: -Keep the legs of the lift in the closed position while transferring the resident; -Do not lock the rear casters of the patient lift when lifting an individual; -Locking the rear castors could cause the patient lift to tip. 1. Review of Resident #23's quarterly MDS (a federally mandated assessment tool completed by facility staff), dated 5/17/23, showed: -Severe cognitive impairment; -Extensive assistance of two staff with bed mobility, transfers, toileting and personal hygiene; [...]
Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure staff provided proper respiratory care for two of 12 sampled residents (Residents #14 and #19) when staff failed to: effectively clean oxygen concentrator filters, properly install oxygen concentrator humidifier bottles, properly label and date oxygen concentrator tubing bags, and additionally failed to follow a physician order by providing the accurate amount of ordered oxygen liters. The facility census was 22. Review of the facility's oxygen administration policy, dated October 2010, showed: - The purpose of the policy is to provide guidelines for safe oxygen administration; - Staff is to review the physician's order for oxygen administration; - A humidifier bottle is necessary when performing this procedure; [...]
Inspectors wroteBased on observations, interviews and record review, the facility failed to provide adequate staffing to meet the needs of residents due to extended call light response times, which affected seven of 12 sampled residents, (Resident #1, #2, #5, #9, #11, #16 and #19), failed to provide showers for Resident #1, #2, #16 and #19, and failed to provide a bedtime snack for Resident #1, #2, #4, #9, #12 #16 and #19, and other residents who attended the resident group interview. The facility census was 22. Review of the facility's policy for answering call lights, revised March 2021, showed, in part: - The purpose of this procedure is to ensure timely responses to the resident's requests and needs; - If the resident needs assistance , indicate the approximate time it will take for you to respond; - If the resident's request requires another staff member, notify the individual; [...]
Inspectors wroteBased on interview and record review, the facility failed to provide a Registered Nurse (RN) for eight consecutive hours per day seven days a week. This had the potential to affect all residents. Facility census was 22. The facility did not provide a policy for RN coverage. Review of the facility's Payroll Based Journal data (PBJ- a report that provides staffing data set information submitted by nursing homes on a quarterly basis) for Quarter 2 2023 (January 1 to March 31) showed no RN hours on 1/1, 1/14, 1/15, 2/6, 2/11, and 2/12. Review of staffing sheets confirmed there was no RN hours on 1/1, 1/14, 1/15, 2/6, 2/11, and 2/12. Review of staffing schedules for May 2023 showed no RN on the following days: 5/3, 5/4, 5/8, 5/10, 5/11, 5/12, 5/13, 5/14, 5/16, 5/18, 5/19, 5/22, 5/26, and 5/30. [...]
Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure staff administered medications with a medication error rate of less than 5%. Facility staff made nine medication errors out of 25 opportunities for error which resulted in a medication error rate of 36%, which affected five sampled residents, (Resident #2, #6, # 9, #18, and #19). The Facility census was 22. Review of the facility's policy for administering medications, revised April 2019, showed: - Medications are administered in a safe and timely manner, and as prescribed; - The individual administering the medication checks the label three times to verify the right resident, right medication, right dosage, right time and right method (route) of administration before giving the medication. Review of the facility's policy for nasal administration, revised 8/20, showed in part: [...]
Inspectors wroteBased on observations, interviews, and record review, the facility failed to have a Quality Assurance and Performance Improvement (QAPI) plan and failed to have a plan that contained all required elements. Facility census was 22. Review of the facility Quality Assurance and Performance Improvement (QAPI) Program Policy dated February 2020, showed: - The facility shall develop, implement, and maintain an ongoing, facility-wide, data-driven QAPI program that is focused on indicators of the outcomes of care and quality of life for residents; - The QAPI program will provide a means to measure current and potential indicators for outcomes of care and quality of life; - The QAPI program will provide a means to establish and implement performance improvement projects to correct identified negative or problematic indicators; [...]
Inspectors wroteBased on interview and record review, the facility failed to develop a comprehensive, data-driven quality assessment and assurance (QAA) activities and a quality assurance performance improvement (QAPI) program that focused on outcomes of care and quality of life when they failed to provide documentation and evidence of its ongoing QAA/QAPI program. The facility census was 22. Review of the facility Quality Assurance and Performance Improvement (QAPI) Program Policy dated February 2020, showed: - The facility shall develop, implement, and maintain an ongoing, facility-wide, data-driven QAPI program that is focused on indicators of the outcomes of care and quality of life for residents; - The QAPI program will provide a means to measure current and potential indicators for outcomes of care and quality of life; [...]
Inspectors wroteBased on interviews and record review, the facility failed to maintain a quality assessment and assurance (QAA) committee that meets at least quarterly and as needed and contains the minimum required members. The facility census was 22. Review of the facility Quality Assurance and Performance Improvement (QAPI) Program Policy dated February 2020, showed: - The facility shall develop, implement, and maintain an ongoing, facility-wide, data-driven QAPI program that is focused on indicators of the outcomes of care and quality of life for residents; - The QAPI program will provide a means to measure current and potential indicators for outcomes of care and quality of life; - The QAPI program will provide a means to establish and implement performance improvement projects to correct identified negative or problematic indicators; [...]
Inspectors wroteBased on observation, interview, and record review, the facility failed to follow and review their infection control polices at least annually, and additionally failed to provide care in a manner to prevent infections or the possibility of acquiring infections when they did not change their gloves or wash hands between dirty and clean tasks which affected Resident #23. The facility additionally failed to ensure that new staff received tuberculin skin testing and that it was completed prior to new employees working, which could have an an negative impact on all residents. The facility census was 22. Review of the facility's Infection Prevention and Control Policy, with a revision date of October 2018, showed: [...]
Inspectors wroteBased on observations, interviews and record review the facility failed to provide appropriate treatment and services to maintain the ability to communicate for one of 12 sampled residents, (Resident #9). The facility census was 22. The facility did not provide a policy related to scheduling appointments for residents. 1. Review of Resident #9's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 6/5/23 showed: - Cognitive skills intact; - Minimal difficulty with hearing; - Required extensive assistance of two staff for bed mobility; - Dependent on the assistance of two staff for transfers; - Upper and lower extremity impaired on both sides; [...]
Inspectors wroteBased on observation, record review and interviews, the facility failed assess one resident (Resident #24) for a history of trauma and provide trauma informed care for a diagnosis of Post Traumatic Stress Disorder (PTSD, a mental health condition that is triggered by a terrifying event). The facility census was 22. Review of the facility's Trauma Informed Care policy, revised March 2019, showed: -The purpose of this policy is to guide staff in appropriate and compassionate care specify to individuals that have experienced trauma; -All staff are provided in-service training about trauma and its impact on health and Post Traumatic Stress Disorder (PTSD, a mental health condition that is triggered by a terrifying event); -Nursing staff are trained on trauma assessment and how to identify triggers associated with re-traumatizing the resident; [...]
Inspectors wroteBased on interview and record review, the facility failed to submit the Payroll Based Journal data (PBJ- a report that provides staffing data set information submitted by nursing homes on a quarterly basis) for Quarter 2 2023 (January 1 to March 31) which had the potential to affect all residents. The facility census was 22 residents. Review of facility policy, Reporting Direct-Care Staffing Information (Payroll-Based Journal), dated October 2017, showed: -Staffing and census information will be reported electronically to Centers for Medicare and Medicaid Services (CMS) through the payroll-based journal system in compliance with 6106 of the Affordable Care Act; -Direct-care staffing and census information will be reported electronically to CMS through the payroll-based journal system; [...]
Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to provide residents with Saturday mail delivery. This affected all of the residents residing in the facility. The facility census was 30. 1. Review of the undated Resident Rights policy showed: - The right to have communication with and access to people and services inside and outside of the facility. - The right to exercise his/her rights as a resident of the facility and as a resident of the United States. - The right to have access to a telephone, email, and mail. - The right to communication in person, by mail, email, and telephone with privacy. 2. No mail delivery policy was provided. 3. During the resident council meeting on 8/25/21 at 2:30 P.M. the resident's said: - They do not regularly get their mail delivered on Saturday's. [...]
Inspectors wroteBased on interview and record review, the facility failed to provide the services of a Registered Nurse (RN), other than the Director of Nursing (DON), for eight consecutive hours per day, seven days a week. This affected all the residents in the facility. The facility census was 30. The facility did not provide a policy. 1. Review of the staffing schedule dated, July, 2021, showed two days where the facility did not have an RN working. Review of the staffing schedule dated, August, 2021, showed six days where the facility did not have an RN working. During an interview on 8/24./21, at 11:12 A.M., the Administrator said: - The Interim DON is the Corporate Nurse; - The new DON will start on 9/1/21. During an interview on 8/27/21, at 4:39 P.M., the Interim DON said: - The facility does not have an RN to work eight hours a day, seven days a week.
Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure store food in a sanitary manner and failed to maintain the kitchen and dry storage area in a sanitary manner. This affects all residents who receive their food from the facility's kitchen. The facility census was 30. Observation on 8/24/2021 at 12:31 P.M. of the kitchen showed: [...]
Inspectors wroteBased on record review and interview, the facility failed to ensure they conducted a complete criminal background check (CBC) through the Missouri State Highway Patrol (MSHP) for one of five staff members hired since the last full survey and who were selected for review. The facility census was 30. Review of the facility's Abuse Prevention Program policy, dated August 2006, showed: -The facility is committed to protecting the residents from abuse by anyone including, but not necessarily limited to: facility staff, other residents, consultants, volunteers, staff from other agencies providing services to our residents, family members, legal guardians, surrogates, sponsors, friends, visitors, or any other individual. -The facility conducts employee background checks and will not knowingly employ any individual who has been convicted of abusing, neglecting, or mistreating individuals. [...]
Inspectors wroteBased on record review and interviews, the facility failed to, within 14 days after a facility completes a resident's assessment, electronically transmit encoded, accurate, and complete Minimum Data Set (MDS, a federally mandated assessment instrument completed by facility staff) data to the Centers for Medicare and Medicaid Services (CMS) System for quarterly reviews as well as upon a resident's transfer, reentry, discharge and death, which affected one of 12 sampled residents (Resident #1) and three additionally sampled residents (Residents #235, #236 and #237). The facility census was 30. Review of the facility's MDS Completion and Submission Timeframes, revised July 2017, showed the facility will conduct and submit resident assessments in accordance with current federal and state submission timeframes. [...]
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that staff developed, implemented and updated, person-centered care plans that included measurable objectives to meet the residents needs, condition and risks for 4 out of 12 sampled residents, (Resident #4, #5, #7, #23.)The facility census was 30. Review of the care plan policy dated 2001 and revised December 2016 showed: - The Interdisciplinary Team (IDT) 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 developed as a result of the comprehensive assessment. - The comprehensive, person-centered care plan will include: a. Measurable objectives and goals. b. [...]
Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure that the residents remained free from accident hazards because water from the tap is to hot, which affected 2 (Resident #7 and #19) out of 12 sampled residents, and staff did not use proper technique during transferring with a gait belt (a belt placed around the waist to aid in transferring the residents from one area to another), which affected two of 12 residents, (Resident #19 and #23). The facility census was 30. Review of the policy regarding checking water temperatures included: - The policy was not dated. - The dial thermometer is accurate to 1 to 2 degrees Fahrenheit, however should be calibrated on a regular basis. - The water being tested should run 3 to 5 minutes. - Insert the stem of the thermometer into the stream of running water, fully immersing the sensor. [...]
Inspectors wroteBased on observation, interviews and record review, the facility failed to assure that staff provided proper respiratory care when the staff failed to date oxygen tubing, failed to properly clean oxygen concentrator filters, and failed to cover nebulizer masks and bilevel positive airway pressure (BiPAP) masks. Which affected four of 12 sampled residents, (Resident #7, #19, #17 and #21) . The facility census was 30. 1. The facility did not provide a policy . 2. Review of Resident #7's admission Minimum Data Set (MDS, a federally mandated assessment instrument completed by the staff), dated 5/16/21 showed: - Brief Interview for Mental Status (BIMS, an assessment tool used to determine the resident's cognitive status), score of 15, indicating that the resident is cognitively intact. [...]
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure staff properly stored and discarded resident medications, stock medications, and treatment supplies. Staff failed to date medications when opened and failed to ensure medications are kept in a secure manner. Staff failed to ensure insulin Flexpens were dated when opened, which affected three of 12 sampled residents, (Resident #5, #10 and #28). The facility census was 30. 1. Review of the facility's policy for administering medications , revised April 2019, showed, in part: - Medications are administered in a safe and timely manner, and as prescribed; - The expiration/beyond use date on the medication label is checked prior to administering.; - When opening a multi-dose container, the date opened is recorded on the container. [...]
Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure each resident received foods prepared in a way to conserve nutritive value, flavor and appearance and failed to serve foods that are a safe and appetizing temperature. The facility census was 30. The facility did not provide dietary policies. An observation of the lunch meal service on 8/26/2021 at 12:11 P.M. showed: -The lunch meal consisted of a marinated chicken breast, cooked broccoli, garlic breadstick, cottage cheese. -The broccoli was very mushy and had little flavor. An observation of the evening meal tray on 8/26/2021 at 5:28 PM showed: -The meal consisted of cheesy ham hashbrown casserole, garlic breadstick, lettuce salad with ranch dressing, and chocolate pudding with vanilla wafer cookies. [...]
Inspectors wroteBased on observation and interviews the facility failed to provide a safe, functional and comfortable environment for residents, staff and the public when they did not keep the parking lot in good repair and failed to maintain all areas of the facility. The facility census was 30. Observation on 8/24/21 starting at 11:00 A.M., through 8/27/21 showed: - The facility's front parking lot with large areas of missing concrete and only gravel. Some areas measured approximately three feet wide in some spots and at least 6 feet long. The concrete had deteriorated from around the joints in the concrete. - Window sill outside rotted on all windows on the west front outside of the building. The two located the furthest from the facility's entrance actually had wood missing, crumbling when touched and peeling away. [...]
Inspectors wroteBased on observations, interviews and record review, the facility failed to promote an environment respectful of the rights of each resident to make choices about significant aspects of their lives when staff did not honor a resident's preferences for bedtime which affected one of 12 sampled residents (Resident #26) and failed to honor a resident's preference for smoking which affected Resident #5. The facility census was 30. Review of the facility's smoking policy for employees, revised May, 2019, showed, in part: - It is the policy of this facility to provide our employees with as near a smoke-free environment as possible and to ensure safe smoking practices for those who smoke; - Residents and visitors: While this policy applies primarily to our staff, certain smoking restrictions apply to our residents and visitors. [...]
Inspectors wroteBased on record review and interviews, the facility failed to ensure they notified one of 12 sampled residents' (Resident #26) family when the resident fell. The facility's census was 30. Review of the facility's Falls-Clinical Protocol policy, revised March 2018, showed the plan did not direct staff when or who to notify when the resident falls. Review of the Resident Incident Review form, part of the facility's electronic medical record program, showed staff should document in the Actions Taken section of the form the name of the physician and family members they notified of the fall, the date/time contact initiated and the date/time responded. Staff also had a line on the form to put the name of the person completing the form. Review of Resident #26's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 7/5/21, showed: [...]
Inspectors wroteBased on record review and interviews, the facility failed to ensure staff notified residents and/or their representative when there was a change in one sampled resident's (Resident #9) covered services when he/she was discharged from skilled nursing services and remained in the facility. The facility census was 30. The facility did not provide a policy for providing Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN). Review of information provided surrounding Resident #9's discharge from skilled nursing services showed: - Episode start date of skilled nursing services: 5/28/21; - The resident's last covered date of skilled nursing services was 7/15/21; - The facility initiated the resident's discharge from physical therapy and the resident remained in the facility. [...]
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that an entrapment assessment was done prior to installing quarter side rails on the both sides of the resident's bed, and failed to do quarterly entrapment assessments. This affected one resident (Resident #7) of 12 sampled residents. The facility census was 30. 1. Review of the Bed Safety Policy dated 2001 and revised December 2007 showed: -To prevent deaths/injuries from the bed and related equipment, the facility shall: a. Maintenance staff shall inspect all of the resident beds and related equipment to identify risks and problems including potential entrapment risks. b. Review that gaps within the bed system are within the dimension regulation. The resident's weight, movement and bed position shall be considered as well. c. [...]
Inspectors wroteBased on observation, interview and record review, the facility failed to ensure they used residents' comprehensive, person-centered assessment to develop and update residents' care plans to ensure the plan directed staff on how to provide care for each resident which affected one of 12 sampled residents (Resident #234). The facility census was 30. Review of the facility's Care Plans, Comprehensive Person-Center policy, revised December 2016, showed a comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. - Each resident's comprehensive person-centered care plan will be consistent with the resident's rights to participate in the development and implementation of his/her plan of care. [...]
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that the physician order for eye drops matched the mediation label on the eye drops. This affected one resident (Resident #5) out of 12 sampled residents. The facility census was 30. Review of the medication administration policy dated 2001 and revised April 2019 said: - Medications are administered according to the prescribers' orders, including any required timeframe. - Medication errors are documented, reported, and reviewed by the Quality Assurance and Performance Improvement (QAPI) committee to inform process changes and/or the need for additional staff training. - The person administering the medication will check the label 3 times to verify the right resident, right medication, right dosage, right time, and right method/route of administration before giving the medication. [...]
Inspectors wroteBased on interview and record review, the facility failed to provide documentation of the pharmacist's recommendations for two of 12 sampled residents, Resident #5 and Resident #21. The facility census was 30. The facility did not provide a policy for drug regimen reviews. 1. Review of Resident #5's quarterly Minimum Data Set (MDS), a federally mandated assessment completed by facility staff, dated 8/10/21, showed: - Cognitive skills intact; - Limited assistance of one staff for bed mobility, transfers, dressing and personal hygiene; - Upper and lower extremity impaired on both sides; - Had seven insulin injections in the last seven days; - Had seven antidepressants in the last seven days; - Had seven diuretics in the last seven days; - Had seven opiods in the last seven days; [...]
Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure staff administered medications with a medication error rate of less than 5%. Facility staff made two medication errors out of 25 opportunities for error, a medication error rate of 8%, which affected two of 12 sampled residents, (Resident #5 and #27). The facility census was 30. Review of the facility's administering medications, revised April 2019, showed, in part: - Medications are administered in a safe and timely manner, and as prescribed. Review of the facility's administering topical medications, revised October 2010, showed, in part: - The purpose of this procedure is to provide guidelines for the safe administration of topical medications; - Prepare the correct dose of medication; - Apply medication: paste, cream, ointment or lotion:removed tongue blade from sterile wrapper. [...]
Inspectors wroteBased on observations, interviews and record review, the facility failed to post accurate and current nurse staffing information, in a clear and readable format in a prominent place readily accessible to residents and visitors, per shift , on a daily basis at the beginning of each shift. This had the potential to affect all the residents in the facility. The facility census was 30. The facility did not provide a policy for posting staffing information. 1. Observations from 8/24/21 through 8/27/21 at various times showed the facility did not post the staffing data in a prominent readily accessible place; - The nurse staffing forms were on a clipboard on a shelf at the nurse's station. During an interview on 8/27/21 at 2:43 P.M., Licensed Practical Nurse (LPN) A said: - He/she had only been working for a couple of weeks; - He/she did not know where the nurse staffing was posted. [...]
27 fire safety citations on file: 4 on March 14, 2025, 7 on August 15, 2023, 16 on September 1, 2021.
CMS lists no fines or payment denials against this home in the last three years. The national average is 0.9 fines per home.
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | Missouri | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 2.99 | 3.43 | 3.86 |
| Registered nurses | 0.92 | 0.46 | 0.69 |
| All nursing staff on weekends | 2.36 | 3.01 | 3.42 |
| Nurse aides | 1.72 | ||
| Licensed practical nurses | 0.35 | ||
| Nursing staff turnover (share who left in a year) | 77.1% | 56.0% | 45.8% |
| Registered nurse turnover | 57.1% | 47.8% | 42.9% |
| Administrators who left | 1 |
CMS expects 3.17 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 3.24 on weekdays and 2.36 on weekends, 27% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 0.0% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.26 in April to June 2025 to 2.99 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 2.99 | 0.92 | 3.24 | 2.36 | 0.0% | 0 of 90 | 30 |
| Oct to Dec 2025 | 3.25 | 0.86 | 3.46 | 2.75 | 0.0% | 0 of 92 | 32 |
| Jul to Sep 2025 | 3.79 | 1.02 | 4.07 | 3.09 | 0.0% | 0 of 92 | 29 |
| Apr to Jun 2025 | 3.26 | 1.03 | 3.45 | 2.78 | 0.0% | 0 of 91 | 27 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| Missouri, Jan to Mar 2026 | 3.34 | 0.40 | 3.50 | 2.93 | 3.9% | 1.1% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Staff pay reports
No staff pay figure for this home has passed review yet. A figure appears only after at least 5 reports from at least 3 different people, sent over at least 60 days, have passed review. If you work here, your report helps start one.
| Job | Median | Middle half | Employed |
|---|---|---|---|
| Missouri, all employers | |||
| CNAs (nursing assistants) | $18.11 | $17.02 to $20.00 | 34,050 |
| LPNs and LVNs | $29.58 | $27.06 to $33.77 | 14,700 |
| Registered nurses | $39.32 | $36.56 to $47.39 | 76,310 |
| United States, nursing care facilities | |||
| CNAs (nursing assistants) | $20.67 | $17.91 to $22.55 | 534,270 |
| LPNs and LVNs | $33.86 | $30.05 to $37.40 | 188,210 |
| Registered nurses | $41.11 | $37.85 to $47.68 | 142,270 |
Hourly wages; the middle half runs from the 25th to the 75th percentile. Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025. BLS has no separate estimate for medication aides. These are survey estimates for whole occupations, not figures for any one home.
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | Missouri | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 11.8 | 18.1 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 3.6 | 1.1 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 2.0 | 2.3 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 9.5 | 4.1 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 0.0 | 2.2 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 12.6 | 17.4 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 2.7 | 4.5 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 21.0 | 23.5 | 15.4 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 3.2 | 2.1 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.9 | 2.3 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Parkdale Manor Health & Rehabilitation's Medicare short-stay residents. On returning residents home or to the community, CMS rates it no different from the national rate (54.4% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.
54.4% this home
No different from the national rate
US median of homes 51.5% · Missouri: 41 better, 31 worse
Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 27 eligible stays.
10.3% this home
No different from the national rate
US median of homes 10.7% · Missouri: 0 better, 7 worse
Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (risk-standardized rate). Lower is better. October 2022 to September 2024. 38 eligible stays.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
US median of homes 7.1% · Missouri: 1 better, 5 worse
Percentage of infections residents got during their SNF stay that resulted in hospitalization (risk-standardized rate). Lower is better. October 2023 to September 2024. 22 eligible stays.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Missouri51.6% · US 56.6%
Percentage of residents who are at or above an expected ability to care for themselves and move around at discharge. Higher is better. October 2024 to September 2025. 7 residents counted.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Missouri0.0% · US 0.0%
Percentage of SNF residents who experience one or more falls with major injury during their SNF stay. Lower is better. October 2024 to September 2025. 17 residents counted.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Missouri2.0% · US 1.7%
Percentage of residents with pressure ulcers or pressure injuries that are new or worsened (adjusted rate). Lower is better. October 2024 to September 2025. 17 residents counted.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Missouri100.0% · US 98.7%
Percentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge. Higher is better. October 2024 to September 2025. 6 residents counted.
Source: CMS Skilled Nursing Facility Quality Reporting Program - Provider Data, released 2026-09-30. Better, no different and worse are CMS's own comparisons with the national rate, after adjusting for how sick residents were. Medians of homes and the state counts are worked out by us from the same file.
Legal business name: PARKDALE MANOR HEALTH & REHABILITATION LLC. CMS links this home to Mo Op Holdco, LLC, a group of 9 nursing homes averaging 2.6 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Lichtenstein, Eli | Indirect ownership interest | Individual | 03/11/2024 | |
| Lichtenstein, Isaac | Indirect ownership interest | Individual | 03/11/2024 | |
| Mandelbaum, Chaim | Indirect ownership interest | Individual | 03/11/2024 | |
| Parkdale Manor Property Holdings LLC | 5% or greater security interest | Organization | 07/01/2023 | |
| Lichtenstein, Eli | Managing control - governing body | Individual | 07/01/2023 | |
| Mandelbaum, Chaim | Managing control - governing body | Individual | 07/01/2023 | |
| Parkdale Manor Property Holdings LLC | Operational/managerial control | Organization | 07/01/2023 | |
| Bomar, Sally | Operational/managerial control | Individual | 07/28/2025 | |
| Jewett, Jennifer | Operational/managerial control | Individual | 07/01/2023 | |
| Kramer, Shmuel | Operational/managerial control | Individual | 07/01/2023 | |
| Lichtenstein, Eli | Operational/managerial control | Individual | 07/01/2023 | |
| Mandelbaum, Chaim | Operational/managerial control | Individual | 07/01/2023 | |
| Parkdale Manor Property Holdings LLC | Adp of the SNF | Organization | 07/01/2023 | |
| Bomar, Sally | Adp of the SNF | Individual | 07/28/2025 | |
| Jewett, Jennifer | Adp of the SNF | Individual | 07/01/2023 | |
| Kramer, Shmuel | Adp of the SNF | Individual | 07/01/2023 | |
| Lichtenstein, Eli | Adp of the SNF | Individual | 03/11/2024 | |
| Lichtenstein, Isaac | Adp of the SNF | Individual | 03/11/2024 | |
| Mandelbaum, Chaim | Adp of the SNF | Individual | 03/11/2024 |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Chosen from this home's own inspection record.
These are the official offices in Missouri. NursingHomeClear cannot take or act on complaints.