Sarcoxie Health Care Center

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who needs tracheostomy (an opening surgically created through the neck into the trachea to allow an airway and to remove secretions from the lungs) care received the care consistent with professional standards of practice when the facility failed to accurately assess the resident's tracheostomy type, failed to document and implement physician orders related to tracheostomy disposable inner cannulas (a removable inner insert used inside a tracheostomy tube to clear mucus, prevent airway blockage, and simplify care), and failed to ensure the facility was able to obtain necessary supplies for tracheostomy treatment for one resident (Resident #1). The facility census was 35. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide residents with an approved call light system when the facility failed to have process in place to notify staff of sounding call lights when call lights notifications could not be heard on the hall and the facility did not provide staff with pagers for notification of call lights. The facility census was 33. Review of the facility Call light Accessibility and Timely Response Policy, revised [DATE], showed the following:-The purpose of this policy is to assure the facility is adequately equipped with a call light at each resident's bedside, toilet, and bathing facility to allow residents to call for assistance. [...]

Inspectors wroteBased on interview and record review, the facility failed to implement their abuse and neglect prevention policies, when the facility failed to complete a criminal background check (CBC), an employee disqualification list (EDL - a list of individual prohibited from working in a long-term care facility in Missouri due to a finding of abuse or neglect) check, a Nurse Aide (NA) Registry (list of individual with a Federal Indicator (a marker given to a potential employee who has committed abuse, neglect, or misappropriation of property against residents) prohibiting them from working in a certified facility) check, and the Nurse License Verification Report (provides official, board-of-nursing-approved details on a nurse's license) check for four sampled staff (Licensed Practical Nurse (LPN) A, LPN B, LPN C, and LPN D). The facility census was 39. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain sufficient nursing staffing at all times when the facility failed to schedule for and document nurse staffing 24 hours daily resulting in nurse staff working extended shifts to provide coverage due to lack of nursing staff. The facility census was 39. [...]

Inspectors wroteBased on record review and interview, the facility failed to maintain an effective infection prevention and control program when the facility failed to have processes in place to ensure all new staff were screened prior to employment for tuberculosis (TB - a serious illness that mainly affects the lungs and can be spread when a person with the illness coughs, sneezes or sings) when the facility did not complete TB testing for four staff (Licensed Practical Nurse (LPN) A, LPN B, LPN C, and LPN D). The facility census was 39. Review of the facility policy titled, Tuberculosis Testing, revised 06/29/23, showed the following:-Upon hire, a new employee will receive a two-step PPD (purified protein derivative - the protein solution used in the TB skin test to detect exposure to the tuberculosis bacterium). [...]

Inspectors wroteBased on interview and record review, the facility failed to provide the services of a registered nurse (RN) for at least eight consecutive hours per day seven days per week. The facility census was 39. Review of the facility's Registered Nurse Policy, dated 04/30/24, showed the following information:-The facility will utilize the services of a RN for at least eight consecutive hours per day, seven days per week;-The Director of Nursing (DON) may serve as a charge nurse only when the facility has average daily occupancy of 60 or fewer residents.1. Review of the facility's provided nurse schedules, dated 08/07/25 through 08/26/25, showed no RN coverage on any shift for the following dates:-08/07/25;-08/08/25;-08/09/25;-08/10/25;-08/16/25;-08/17/25;-08/25/25;-08/26/25. [...]

Inspectors wroteBased on interview and record review, the facility failed to report an allegation of abuse involving two residents (Resident #1 and Resident #2) to the Department of Health and Senior Services (DHSS) within two hours of receiving the allegation. The facility census was 39. Review of the facility's Abuse and Neglect Policy, dated 06/12/24, showed the facility must ensure that all alleged violations involving abuse, neglect, exploitation, mistreatment, or sexual assault, including injuries of unknown source and misappropriation of resident property, are reported immediately, but no later than two hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury to the State Survey Agency. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement interventions to prevent weight loss and failed to notify the physician of weight loss for one resident (Resident #15) in a selected sample of 13 residents. The facility's census was 33. Review of the facility's weight monitoring policy, revised 05/07/24, showed the following information: -Based on the resident's comprehensive assessment, the facility will ensure that all residents maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise. -Weight can be a useful indicator of nutritional status. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pain management to all residents when staff failed to implement an effective routine pain management program, failed to accurately assess pain and medication effectiveness according to standards of practice, and failed to identify, develop, and implement interventions related to pain management for for one resident (Resident #26) who expressed severe and constant pain in his/her hands and arms in a selected sample of 13 residents. The facility had a census of 33 residents. Review of the facility's pain management policy, revised 06/26/24, showed the following information: -The facility will utilize a systemic approach for recognition, assessment, treatment and monitoring of pain. -Recognize when the resident is experiencing pain and identify circumstances when the pain can be anticipated. [...]

Inspectors wroteBased on record review and interview, the facility failed to hold the required quarterly quality assessment committee (QAA) meetings when the facility failed to meet in the fourth quarter of 2024. The facility census was 33. Review of the facility's Quality Assurance Process Improvement (QAPI) policy, dated 05/14/21, showed the following: -A QAPI meeting with be held on a monthly basis; -All department heads, the Administrator, the Director of Nursing, Antibiotic Steward, the Infection Control and Prevention Officer, Medical Director, and Consulting Pharmacist will be on the QAPI committee; -Records of the actions taken at each meeting will be kept using the attached form; -Minutes should document what was reviewed, issues/problems addressed, plan of correction, the monitoring process, and the results. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide necessary behavioral health care and services to attain the highest practicable physical, mental and psychosocial well-being when the facility failed to notify the physician when one resident (Resident #26) exhibited continued signs and symptoms of psychosocial distress and failed to identify, develop, and implement resident specific interventions to address the resident's psychosocial needs in a selected sample of 13 residents. The facility's census was 33. 1. Review of Resident #26's face sheet (a document that provides a quick snapshot of an individual's medical and personal information) showed the following information: -admission date of 01/24/25. [...]

Inspectors wroteBased on interviews and record review, the facility failed to act as a fiduciary and properly manage residents' funds when the facility failed to ensure resident fund balances over $100.00 (or over $50.00 if the resident received Medicaid) were placed in an interesting bearing account for four residents (Resident #1, #2, #3, and #6) and when the facility failed to maintain a petty cash fund on hand that ensured all resident could receive requests of less than $100.00 (or less then $50.00 if the resident received Medicaid) same day for three residents (Resident #1, #4, and #5). The facility census was 35. 1. Review of the facility policy 'titled Anew Healthcare Management, dated 2019, showed the following: -The facility does not require residents to deposit their personal funds with the facility. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to maintain an effective pest control program regarding flies for five of 15 sampled residents (Resident #5, #27, #14, #16, and #6). This failure had the potential to affect all 28 residents residing in the facility. 1. Observations during the survey. dates of 08/21/23 to 08/24/23, revealed an excessive number of flies. The flies were throughout the facility including the kitchen, dining room, on residents' food, persons, and equipment. Observations were made from 9:00 A.M. to 5:00 P.M. on 08/21/23; 9:00 A.M. to 4:30 P.M. on 08/22/23; 8:00 A M. to 3:00 P.M. on 08/23/23; and 9:30 A.M. to 2:15 P.M. on 08/24/23. During the initial observation of the kitchen on 08/21/23, at 10:30 A.M., flies were observed throughout the kitchen. [...]

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure ongoing tracking and trending of residents' infections and related antibiotic use during three of three months of tracking and trending documentation reviewed. The facility failed to ensure infection type, pathogen identification, and/or criteria met or unmet for 11 of 11 infections identified during the months of May 2023 and July 2023. No tracking at all was provided for the month of June 2023. The facility census was 28. Review of the facility's Infection Control-Antibiotic Stewardship Policy, dated 11/01/22, showed the following: -It is the policy of the facility to support the judicious use of antibiotics in accordance with State and Federal Regulations, and national guidelines; [...]

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure the medical necessity of psychotropic medication administration for one resident (Resident #16) of five residents reviewed for Psychotropic Medication Administration out of a total of 15 sampled residents. The facility failed to ensure risk and benefit review for the administration of psychotropic medications for the resident. The facility census was 28. 1. During an interview the facility's policy related to the administration of psychoactive medication was requested by the survey team on 08/23/23, at 3:30 P.M. During an interview with the Director of Nursing (DON) on 08/24/23, at 1:15 PM, she stated the facility did not have a policy related to the administration of psychotropic medication. [...]

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure medications were appropriately labeled and dated for two resident (Residents #5 and #15) of four residents reviewed during medication administration observations. The residents' insulin pens, in use for blood sugar control, were not labeled and/or dated to indicate the date opened. There was a total of 20 residents in the sample. The facility census was 28. 1. During an interview the facility's policy related to labeling and dating medications, including insulin, was requested by the survey team on 08/23/23, at 3:30 P.M During an interview with the Director of Nursing (DON) on 08/24/23, at 1:15 P.M., she stated the facility did not have a policy related to the storage and labeling of medication. 2. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to document and attempt to use alternatives prior to installing a side or bed rail, failed to complete resident specific assessments of residents for risk of entrapment from bed rails prior to installation and/or reassess routinely; failed to review the risks and benefits of bed rails with the resident or resident representative; and failed to obtain informed consent prior to installation of side rails for six residents (Resident #8, #9, #14, #18, #21, and #22) out of a sample of 15 residents with a census of 30. Record review of the guidance for industry and Food and Drug Administration (FDA) staff, Hospital Bed System Dimensional And Assessment Guidance To Reduce Entrapment, issued on 3/10/2006, from the FDA, Center for Devices and Radiological Health, showed the following information: [...]

Inspectors wroteBased on record review and interview, the facility failed to provide a Skilled Nursing Facility Advance Beneficiary Notice (SNFABN, form Center for Medicare and Medicaid Services (CMS)-10055) or a denial letter at the initiation, reduction, or termination of Medicare Part A benefits for two residents (Resident #8 and #14) out of a sample of two residents reviewed, who remained in the facility after discharge from Medicare Part A services. The facility census was 30. Record review of the Centers for Medicare and Medicaid Services (CMS) Survey and Certification memo (S&C -09-20), dated [DATE], showed the following information: [...]

Inspectors wroteBased on interview and record review, the facility failed to notify the resident and/or the resident's representative in writing of a transfer or discharge to a hospital, including the reasons for the transfer, for two residents (Resident #8 and Resident #34) out of a sample of 15 residents. The facility census was 30. Record review of the facility's policies showed the facility did not have policies regarding the provision of written notices to residents or representatives, or to the ombudsman, when an emergency transfer to the hospital had occurred. 1. Record review of Resident #34's significant change Minimum Data Set (MDS), a federally mandated comprehensive assessment instrument, completed by facility staff, dated [DATE], showed the following information: -Cognitively intact; -Required extensive assistance for bed mobility, toilet use, and personal hygiene; [...]

Inspectors wroteBased on interview and record review, the facility failed to notify the resident and/or the resident's representative in writing of the bed hold policy at the time of transfer to the hospital for two residents (Resident #34 and #8). The facility census was 30. Record review of the facility's policies showed the facility had no policies regarding the provision of written notice of the bed hold policy to residents or representatives, or the ombudsman, when an emergency transfer to the hospital had occurred. 1. Record review of Resident #34's significant change Minimum Data Set (MDS), a federally mandated comprehensive assessment instrument, completed by facility staff, dated [DATE], showed the following information: -Cognitively intact; -Required extensive assistance for bed mobility, toilet use, and personal hygiene; -Required total dependence on staff for transfers; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff transferred residents safely to prevent accidents for one resident (Resident #9) out of a sample of 15 residents in a facility with a census of 30. Record review of the facility's (undated) policy titled, transferring residents, showed the following information: -Never transfer a resident by lifting him/her under the arms. This can cause nerve damage, fractures, and shoulder dislocation; -Do not attempt to transfer a resident who cannot bear any of his/her own body weight by yourself; -Determine beforehand how many people are needed for the transfer. If it takes more than two persons to transfer the resident, use a mechanical lift; -Resident should wear footwear with nonskid soles; -Resident's feet should be flat on the floor approximately 12 inches apart; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide ongoing communication and/or documentation of communication with the dialysis (the cleaning of blood with a machine due to kidneys not working) center for one resident ( Resident #6) who received dialysis out of a sample of 15 residents selected for review in a facility with a census of 30. Record review of the facility's policy titled, care of resident receiving dialysis, dated January 2003, showed the following general documentation guidelines: -Frequency of documentation should follow the facility policy; -Staff should document any communication with the physician or the dialysis center; -Staff should document any unusual signs or symptoms; -Staff should document the frequency of dialysis, shunt site, diet in the nursing summary documentation; [...]