Fair View Health Care: Director Works Illegal Shifts - MO
Federal inspectors found the facility's nursing director had been pulling double duty as both administrator and charge nurse on 14 documented shifts between July 15 and August 20. The facility's own policy, revised in April, explicitly prohibits this arrangement when the average daily occupancy exceeds 60 residents.
Fair View's census ranged from 61 to 65 residents during the violation period. On August 14, with 65 residents in the building, the director of nursing still worked as the charge nurse responsible for direct patient care.
The administrator told inspectors on August 20 that the nursing director "has been working as the RN charge nurse at nights for a few weeks because they do not have another RN." The staffing coordinator confirmed the arrangement, explaining that the facility "only has one other RN on staff."
Federal regulations require nursing homes to have a registered nurse on duty for eight consecutive hours daily, separate from the director of nursing, when the facility houses more than 60 residents. The rule ensures administrative oversight remains distinct from direct patient care responsibilities.
Fair View's violation began in mid-July. On July 20, with 61 residents, the nursing director worked as charge nurse. The pattern continued through July 24 and July 29, both days when the census exceeded the 60-resident threshold.
August brought more frequent violations as the facility's occupancy climbed. The nursing director worked as charge nurse on 11 separate days in August, including six consecutive days from August 14 through August 20 when the census remained at 64 or 65 residents.
The administrator acknowledged awareness of the regulation during the inspection. "He/she is aware that the DON can not be the floor nurse once the census is over 60," inspectors noted. The administrator explained having "only one other RN on staff that takes turns with the DON to cover RN hours."
The nursing director also admitted knowing the arrangement violated regulations. "He/she is aware that he/she can not count as the RN and the DON but he/she does not have another RN due to staffing issues," the inspection report states.
Recruitment efforts have proven unsuccessful. The administrator told inspectors there are job postings "on indeed for nurses in their area," but the facility has been unable to hire additional registered nurses to meet federal requirements.
The staffing shortage forced the facility into a rotating system where the director of nursing alternates floor duties with the facility's only other registered nurse. This arrangement leaves administrative nursing functions unattended when the director works patient care shifts.
Federal inspectors classified the violation as causing "minimal harm or potential for actual harm" affecting "few" residents. The complaint-driven inspection occurred on August 20, the same day the nursing director was documented working as charge nurse with a 64-resident census.
The violation represents a systemic staffing failure rather than an isolated incident. Documentation shows the illegal arrangement persisted for more than a month, with the nursing director acknowledging it had been ongoing "for about a month" by the inspection date.
Fair View's policy clearly outlined the restriction. The facility's Registered Nurse Policy, revised April 30, 2024, states that "the DON may serve as a charge nurse only when the facility has average daily occupancy of 60 or fewer residents."
The facility's census consistently exceeded this threshold throughout the violation period. Even on the lowest-census days documented, July 20, July 24, and July 29, the facility housed 61 residents, one more than the policy allows.
The inspection occurred following a complaint filed under number 2590461. The specific nature of the complaint that triggered the federal investigation was not detailed in the inspection report.
The nursing director's dual role potentially compromises both administrative oversight and direct patient care quality. Federal regulations separate these functions to ensure adequate supervision of nursing staff while maintaining consistent bedside care coverage.
Fair View Health Care Center now faces federal scrutiny over its staffing practices and must develop a plan to correct the violation while addressing its underlying registered nurse shortage.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Fair View Health Care Center from 2025-08-20 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
FAIR VIEW HEALTH CARE CENTER in SEDALIA, MO was cited for violations during a health inspection on August 20, 2025.
The facility's own policy, revised in April, explicitly prohibits this arrangement when the average daily occupancy exceeds 60 residents.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.