Ratliff Care Center

Inspectors wroteBased on interview and record review, the facility failed to maintain the surety bond (a purchased bond for security of resident's personal funds) for at least one and one half times the average monthly balance of the resident's personal funds for the last 12 consecutive months from May 2024 through April 2025. The facility census was 35. The facility did not provide a policy regarding surety bonds. Review of the Residents' Personal Funds Account for the last 12 consecutive months from May 2024 through April 2025 showed: - The facility's approved bond amount equaled $35,000.00; - The average monthly balance of the residents' personal funds equaled $31,517.90; - An average monthly balance of $31,517.90 rounded to the nearest thousand equaled $32,000.00, at one and one half times will equal the required bond amount of at least $48,000.00. [...]

Inspectors wroteBased on interview and record review, the facility failed to monitor the drug regimen for unnecessary medications by not ensuring the as needed (PRN) psychotropic (medications that affect a persons mental state) medication orders were limited to 14 days unless specific duration and clinical rationale were provided for one resident (Resident #17) out of five sampled residents. The facility census was 35. Review of the facility's policy titled, PRN Medications, undated, showed: - Ensure PRN orders are evaluated for diagnosis, continuing need, and relevant documentation; - To provide guidelines to ensure proper diagnosis and documented need and effectiveness of PRN medications; - When receiving an order for a PRN medication, make sure the appropriate diagnosis is received. Document the need for the medication and effectiveness of the medication. [...]

Inspectors wroteBased on interview and record review, the facility failed to follow per the facility policy to complete criminal background checks (CBC) for two employees (Employee A and Employee B) of 10 sampled employees prior to hire. The facility census was 35. Review of the facility's policy titled, Employee Disqualification List (EDL) Procedures, dated July 1, 2019, showed: - As a licensed facility, we are required to use the EDL Automated System and investigate criminal background on all new hires; - Prior to working, the facility will check criminal background through the Missouri Highway Patrol or the Family Safety Registry on all new employees prior to contact with any resident. 1. Review of Employee A's personnel file showed: - A hire date of 09/29/24; - No documentation the CBC was completed before the employee's hire date. 2. Review of Employee B's personnel file showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to complete a thorough facility investigation that included all of the elements outlined in the facility policy related to a bruise of unknown origin involving one resident (Resident #21) out of one sampled resident. The facility census was 35. Review of the facility's policy titled, Abuse Prohibition Protocol Manual, undated, showed: - It is the policy of this facility to prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident's property. The facility defines abuse as the willful infliction of injury, unreasonable restriction, threat or punishment with resulting physical harm or pain, or mental pain or deprivation by an individual, including a caretaker, of goods or services that are necessary to achieve or maintain physical, mental and social well being; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to update and revise care plans with specific interventions tailored to meet individual needs for two residents (Residents #3 and #35) out of 12 sampled residents. The facility census was 35. Review of the facility's policy titled, Care Plan, undated, showed: - Care plans will be developed by the interdisciplinary team (IDT), in collaboration with the resident and family in order to make reasonable goals and interventions to achieve obtainable goals per resident ability; - The care plan will include resident's current abilities and will continue the goals of care. It will include measurable objectives and timetables for individualized interventions. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure two Certified Nursing Assistants (CNAs)/Certified Medication Technicians (CMTs) (CNA/CMT D and CNA/CMT E) maintained active CNA and CMT certificates while performing CMT duties. The facility census was 35. The facility did not provide a policy in regards to maintaining certification for CNAs. 1. Review of CNA/CMT D's personnel record showed: - Hire date of 01/16/25; - Missouri Certified Nurse Aide Certification issued on 01/01/23, and inactive on 01/01/25. Review on 05/30/25, of CNA/CMT D's Missouri CNA Registry showed: - CNA/CMT certifications became inactive on 01/01/25. Observations on 05/29/25 at 8:44 A.M., 8:48 A.M., and 8:57 A.M., showed: - CNA/CMT D administered medications to residents. 2. Review of CNA/CMT E's personnel record showed: - Hire date of 09/04/12; [...]

Inspectors wroteBased observation, interview, and record review, the facility failed to follow enhanced barrier precautions (EBP) during wound care for one resident (Resident #20) out of one sampled resident. The facility failed to implement proper infection control practices during a gastrostomy tube (g-tube - a tube inserted in the stomach to provide nutrition and medications) dressing change for one resident (Resident #32) out of two sampled residents. The census was 35. Review of the facility's policy titled, Enhanced Barrier Precautions, dated April 2024, showed: - EBP is designed to prevent transmission of multidrug resistant organisms (MDRO's) during high contact resident care activities where contact precautions do not apply; - Personal protective equipment (PPE) including gown and gloves are used; - EBP are indicated for residents with any of the following: [...]

Inspectors wroteBased on interview and record review, the facility failed to conduct at least twelve hours of certified nurse aide (CNA) in-service education per year and failed to provide the required annual competencies of Abuse and Neglect Prevention and Dementia Care (care of a resident with an impaired ability to remember, think, or make decisions) for one CNA F out of two sampled CNAs. The facility census was 35. Review of the facility's policy titled, Training and Implementation Guideline, undated, showed: - All staff will be provided ongoing education related to their position; - Have a consistent and effective process for education for employees about the policies and procedures in a matter that enables effective and consistent implementation and ongoing adherence at all levels care of care; [...]

Inspectors wroteBased on interview and record review, the facility failed to electronically submit to The Center of Medicare and Medicaid Services (CMS) complete and accurate direct care staffing information no less frequently than quarterly, for the quarter immediately preceding the annual survey. The census was 40. The facility did not provide a policy for direct care staffing information. Review of the facility's Payroll Based Journal (PBJ) staffing Data Report, for fiscal year quarter 1, 2024 (October 1 through December 31), showed the facility triggered for failing to submit data for the quarter. During an interview on 05/14/24 at 10:30 A.M.,, the Administrator said that he had not been submitting the PBJ information and he knew it should be submitted quarterly.

Inspectors wroteBased on interview and record review, the facility failed to notify the resident and/or the resident's representative in writing of a facility-initiated transfer when four residents (Resident #4, #9, #30, and #32) out of four sampled residents transferred to the hospital. The facility's census was 40. Review of the facility's policy titled, Bed Hold, undated, showed the resident and/or representative will be notified, in writing of the resident transfer. 1. Review of Resident #4's medical record showed: - Transferred to the hospital on [DATE], and readmitted to the facility on [DATE]; - No documentation the resident or resident representative was informed in writing of the transfer/discharge to the hospital. 2. Review of Resident #9's medical record showed: - Transferred to the hospital on [DATE], and readmitted to the facility on [DATE]; [...]

Inspectors wroteBased on interview and record review, the facility failed to inform the resident and/or legal representative in writing of their bed hold policy at the time of transfer to the hospital for four residents (Residents #4, #9, #30, and #32) out of four sampled residents. The facility's census was 40. Review of the facility's policy titled, Bed Hold, undated, showed: - If a resident is discharged to the hospital or goes out of the facility for an overnight leave of absence, the bed may be held by paying the current room rate for the bed being reserved; - Will notify all residents and/or their representatives of the bed hold policy upon admission; - Resident and/or representative will be notified, in writing of a resident transfer; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess residents for the use of bed rails, and failed to obtain an informed consent from the resident or the resident's representative for four residents (Resident #7, #25, #28, and #41) out of four sampled residents with bed rails. The facility's census was 40. Review of facility's policy titled, Restraints - Seatbelts - Side Rails, not dated, showed residents with side rails in place will be assessed for the need and safety of such devices upon admission, quarterly, and with any change in condition. 1. Review of Resident #7's medical record showed: - An admission date of 02/10/22; [...]

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to conduct regular inspections of all bed frames, mattresses and bed rails as part of a regular maintenance program for four residents (Resident #7, #25, # 28, and #41) out of four sampled residents with bed rails. The facility's census was 40. Review of facility's policy titled, Restraints - Seatbelts - Side Rails, not dated, showed residents with side rails in place will be assessed for the need and safety of such devices upon admission, quarterly, and with any change in condition. 1. Review of Resident #7's medical record showed: - admitted on [DATE]; - No documentation of maintenance assessments for the bed rails. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store and distribute food under sanitary conditions, increasing the risk of cross-contamination and food-borne illness. These deficient practices had the potential to affect all residents. The facility census was 43. Record review of the facility's Kitchen Cleaning policy, revised 11/30/20, showed: - All workers are expected to use good hygiene practices at all times and to follow all established sanitation procedures; - It is the responsibility to ensure they are providing a clean/safe environment for their residents; - The cleaning program may be shared responsibilities between different workers of the cleaning team to provide the cleaning program. Observations of the kitchen on 3/20/23 at 8:33 A.M., and 3/20/23 at 3:43 P.M., showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to implement a baseline care plan upon admission with specific interventions for one resident (Resident #195) outside the sample of 12 sampled residents. The facility census was 43. Record review of the facility's Care Plan policy, revised 1/3/18, showed: - A care plan will be developed by the interdisciplinary team in collaboration with the resident or the resident's representative in order to develop individualized, person-centered interventions; - It will include measurable objectives and timetables for individualized interventions; - It will also include a resident's baseline, specific goals for monitoring of all interventions for effectiveness, and medication indication/rationale for use based on clinical guidelines. 1. Record review of Resident #195's medical record showed: - An admission date of of 3/8/23; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure comprehensive care plans were in place for two residents (Resident #15 and #17) out of 12 sampled residents and three residents (Resident #19, #23, and #194) outside the sample. The facility census was 43. Record review of the facility's Care Plan policy, revised 1/3/18, showed: - A care plan will be developed by the interdisciplinary team in collaboration with the resident or the resident's representative in order to develop individualized, person-centered interventions; - It will include measurable objectives and timetables for individualized interventions; - It will also include a resident's baseline, specific goals for monitoring of all interventions for effectiveness, medication indication/rationale for use based on clinical guidelines. 1. Record review of Resident #15's medical record showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain a physician's order for a Foley catheter (a flexible tube placed in the bladder to drain and collect urine) for one resident (Resident #15) out of twelve sampled residents. The facility census was 43. Record review of the facility's Physician Orders policy, not dated, showed: - All physician orders must be entered into the chart/processed by a Licensed Practical Nurse (LPN)/Registered Nurse (RN); - Telephone and verbal orders to be signed by the physician within 48 hours; - Admission/readmission orders verified with the physician within two hours of admission. 1. Observations on 3/20/23 at 10:44 A.M., 3/21/23 at 11:43 A.M., and 3/22/23 at 11:01 A.M., showed Resident #15 lay in bed with a Foley catheter in place with a drainage bag attached to the bed frame. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide nurse aide's annual individual performance review or evaluation for two out of two nurse aides sampled. The facility census was 43. 1. Record review of the facility's personnel records showed: - Certified Nursing Assistant (CNA) E with a hire date of 3/7/06; - CNA E did not receive an annual individual performance review or evaluation for the year of 2022. - CNA F with a hire date of 7/20/16; - CNA F did not receive an annual individual performance review or evaluation for the year of 2022. During an interview on 3/22/23 at 11:11 A.M., the Administrator said the facility did not provide employee evaluations on an annual basis, but try to do them when time and finances permit. During an interview on 3/22/23 at 3:20 P.M., the Director of Nursing (DON) said at this time, they did not provide staff evaluations. [...]

Inspectors wroteBased on interview and record review, the facility failed to conduct at least twelve hours of nurse aide in-service education per year and failed to provide the required annual competencies of Abuse Prevention and Dementia Care for two out of two nurse aides sampled. The facility census was 43. Record review of the facility's Nurse Aide In-services policy, not dated, showed: - The purpose is to ensure nurse aides receive continued education; - Nurse aides will attend/complete one hour of in-service education per month; - Include training on how to care for residents with cognitive impairment, dementia, and resident abuse prevention; - Ensure competence of all nurse aides and address areas of weakness as determined in the nurse aide's performance review and the facility assessment. 1. Record review of the facility's 2022 in-service records showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to provide the residents the opportunity to meet for council meetings. This practice affected six of six residents (Resident #16, #20, #22, #24, #32, and #38) present at the group interview, with the potential to affect all residents. The facility census was 43. Record review of the Resident Council Policy, not dated, showed: - The purpose is to ensure resident's are provided a forum to discuss their concerns, identify problems and propose solutions to a designated staff member on a regular basis; - The council will meet monthly; - All residents will be invited to attend; - Designated staff to make notes and provide them to administration. Record review of the Resident Council meeting minutes showed: - Resident Council meetings held in October 2022 and March 2023. [...]