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Brookhaven Nursing & Rehab: Staff Threat Complaint - MO

Healthcare Facility
Brookhaven Nursing & Rehab
Springfield, MO  ·  3/5 stars

The incident unfolded during a medication pass on the 300 hall. CMT F, a certified medication technician, had come out of a resident's room when a nursing aide flagged down a charge nurse. By the time RN C arrived, the immediate confrontation had settled. But the resident hadn't forgotten what was said.

The resident told RN C directly: CMT F had said he or she was going to make the resident the last one to receive medications. RN C told the resident not to worry, that it wouldn't be allowed to happen. Then CNA A came forward with something more specific. CMT F had told the resident: if you bump into my cart, that will be the last time you bump my cart.

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RN C messaged the director of nursing. Then went and got the resident's medications and gave them personally.

RN B had been nearby when it started, close enough to hear CMT F call out from the hall. "This lady is kicking my med cart, I need you to come up here," CMT F said. RN B walked over. The resident was not close to the cart. RN B asked the resident to return to their room, then turned to CMT F. "He/she needed to be professional and could not fight with residents," RN B told inspectors. CMT F got louder. Said RN B didn't understand, that the resident had been kicking the cart.

RN B said: "We have to watch our presentation. We can all get overwhelmed."

As RN B walked away, CMT F kept talking. CNA H was standing there and heard it. The exact words weren't certain, but the meaning was. "He/she thought CMT F said something like, that would be the last time he/she kicked my cart," RN B told inspectors. "He/she was not sure of exact words, but felt it was a threat."

This was not the first time staff had noticed something off about how CMT F spoke to residents.

CNA E told inspectors he or she had seen CMT F be "hateful to residents." LPN G said he or she had witnessed CMT F be disrespectful to residents on prior occasions. Both said that telling a resident if they do something it would be the last time they do it crossed a line.

When the director of nursing questioned CMT F directly about what the statement meant, the CMT offered an explanation: he or she meant that steps could be taken, like notifying the nurse, calling the police, or pursuing medication changes. The director of nursing did not accept the framing. "The statement like that should never be made to a resident," the DON told inspectors, "and it is disrespectful."

The administrator was just as direct. "It is not acceptable to say to a resident if you touch me or my med cart, or hit me or my med cart, I'll be the last person you hit."

The inspection was triggered by a complaint and completed September 4, 2025. The deficiency was cited at a level of minimal harm or potential for actual harm. The resident, whose name was not included in the report, has documented behavioral triggers, according to the director of nursing. Staff had received training on interventions for residents having difficult days.

The resident went outside for a cigarette after the confrontation. That detail appears once in the report, almost in passing, between the moment the charge nurse told the resident not to worry and the moment CNA A came forward with what CMT F had actually said.

Nobody noted whether the resident came back in.

Full Inspection Report

The details above represent a summary of key findings. View the complete inspection report for Brookhaven Nursing & Rehab from 2025-09-04 including all violations, facility responses, and corrective action plans.

Additional Resources


Editorial Standards

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 30, 2026  ·  Our methodology

Quick Answer

BROOKHAVEN NURSING & REHAB in SPRINGFIELD, MO was cited for violations during a health inspection on September 4, 2025.

The incident unfolded during a medication pass on the 300 hall.

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.

Frequently Asked Questions

What happened at BROOKHAVEN NURSING & REHAB?
The incident unfolded during a medication pass on the 300 hall.
How serious are these violations?
Violation severity varies from minor documentation issues to serious safety concerns. Review the inspection report for specific deficiency codes and scope. All violations must be corrected within required timeframes and are subject to follow-up verification inspections.
What should families do?
Families should: (1) Ask facility administration about specific corrective actions taken, (2) Request to see the follow-up inspection report verifying corrections, (3) Check if this represents a pattern by reviewing prior inspection reports, (4) Compare this facility's ratings with other nursing homes in SPRINGFIELD, MO, (5) Report any new concerns directly to state authorities.
Where can I see the full inspection report?
The complete inspection report is available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request a copy directly from BROOKHAVEN NURSING & REHAB or from the state Department of Health. The report includes specific deficiency codes, facility responses, and correction timelines. This facility's federal provider number is 265835.
Has this facility had violations before?
To check BROOKHAVEN NURSING & REHAB's history, visit Medicare.gov's Care Compare and review their inspection history, quality ratings, and staffing levels. Look for patterns of repeated violations, especially in critical areas like abuse prevention, medication management, infection control, and resident safety.


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