The September inspection found that LPN A had been working since September 11 without TB screening. LPN B started September 5 and also lacked testing. LPN C began work September 4 without documentation. LPN D's hire date was unknown, but records showed they started working September 6 without the required two-step tuberculosis skin test.
State regulations are explicit about the timeline. All new long-term care facility employees must obtain tuberculosis testing within one month before starting work. If the initial test measures zero to nine millimeters, a second test must follow within three weeks of employment.
The facility's own policy, revised in June 2023, requires new employees to receive the two-step testing upon hire.
Nobody followed through.
During interviews on September 17, facility leadership acknowledged the failures but offered conflicting explanations. The Director of Nursing said TB testing "needs to be complete prior to the staff's start date" and admitted not completing testing on the new hires. Any nurse can administer the test, the director noted.
The Business Office Manager said testing "is normally completed before staff start working" but had not been finished for the new as-needed staff. All four nurses work at other long-term care facilities, the manager explained, but had not provided verification of their TB testing from those employers.
The Administrator echoed that any nurse could complete the testing and said it "should be done before they start and can be read the day they start on the floor."
The breakdown represents multiple system failures. The facility has a written policy requiring the testing. State law mandates it. Multiple staff members knew the requirement. Yet four nurses began caring for residents without completing the screening designed to detect exposure to tuberculosis bacteria.
Tuberculosis spreads when infected people cough, sneeze, or sing. In nursing homes, where residents often have compromised immune systems and live in close quarters, undetected TB exposure poses particular risks. The Centers for Disease Control considers healthcare workers in long-term care facilities a priority group for tuberculosis screening.
Missouri regulations require facilities to maintain documentation of each employee's tuberculosis status. The state mandates the Mantoux method purified protein derivative test, which involves injecting a small amount of tuberculin under the skin and measuring the reaction after 48 to 72 hours.
For new employees who test negative initially, facilities must administer a second test within three weeks. This two-step process helps identify people with previous TB exposure whose immune systems may not react to the first test.
The four nurses at Sarcoxie Health Care Center received none of this screening before beginning work with residents.
The facility's leadership expressed awareness of the requirements during interviews. The Administrator knew any nurse could perform the testing. The Director of Nursing understood the timeline. The Business Office Manager recognized that testing normally happens before staff start working.
Yet the system broke down completely for four consecutive hires in early September.
The inspection occurred in response to a complaint filed as case number 2616644. Federal inspectors classified the violation as causing minimal harm or potential for actual harm to residents.
The facility operates under administrator oversight and employs multiple licensed practical nurses to provide direct resident care. With 39 residents, the facility serves a significant portion of Sarcoxie's healthcare needs.
State regulations place responsibility squarely on facilities to ensure all test results are completed and documented. The rules apply not just to employees but to volunteers who work ten or more hours per week.
Documentation requirements exist for good reason. Without proper records, facilities cannot track which staff members have been screened, when testing occurred, or whether follow-up tests are needed.
The four nurses continued working with residents while lacking this basic infection control screening. Their employment at other facilities did not excuse the requirement for Sarcoxie Health Care Center to verify their tuberculosis status before allowing patient contact.
The violation occurred during a period when the facility was hiring multiple nurses. September employment records show at least four new licensed practical nurses joining the staff within days of each other.
None received the tuberculosis testing that state law requires and facility policy promises.
The inspection report does not indicate whether the facility has since completed testing for the four nurses or implemented measures to prevent similar oversights. The violation remains documented as affecting some residents at the 39-bed facility.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Sarcoxie Health Care Center from 2025-11-14 including all violations, facility responses, and corrective action plans.