Golden Years Center: Resident Rights Violations - MO
That was one of two residents whose doctor's orders went unfulfilled during a complaint inspection completed January 30, 2026. The other had a urine sample ordered that staff never collected, and never documented why they hadn't.
The CT scan order for Resident 75 was placed on January 23, 2026. When inspectors interviewed the Director of Nursing six days later, on January 29, the director said he or she did not have any documentation confirming the order had been sent to the receiving facility before January 27. That is a four-day gap, at minimum, with no paper trail.
The director said staff should have sent the order the same day it was written, waited for confirmation it was received, and then documented a progress note with the confirmation number. None of that happened, or if it did, nobody could produce the record.
An agency Licensed Practical Nurse interviewed that same morning said the same thing: the CT scan order should have been sent on the day it was ordered. When asked about the timeline, the nurse said he or she was unsure when the order had been placed and when it was sent to the local hospital. The nurse added that if the order was placed on January 23, the facility should have had the scan scheduled by the time inspectors arrived.
It had not been scheduled. Or if it had, the facility couldn't show it.
The second case involved Resident 44 and a urine analysis that was ordered but never completed. The Director of Nursing said the order would have appeared on the nurse medication administration record, and that he or she expected nurses to document in that record, or in a progress note, if a sample could not be collected. There was no such note in Resident 44's electronic medical record.
"He/She was unsure why staff did not document a note that indicated that a UA could not be completed as ordered," inspectors wrote, summarizing what the director told them.
That uncertainty ran through every interview inspectors conducted. The agency LPN said a note should have been somewhere in the resident's record if the sample couldn't be collected. The director agreed. Nobody had written one.
What the inspection captured, across multiple interviews on a single afternoon, was a facility where the expected response to a missed physician order was unanimous and clear, and the actual practice was neither. Every nurse and manager interviewed said the same things: orders must be followed as written, failures must be documented, confirmations must be recorded. The Director of Nursing said it. The agency LPN said it twice, in two separate interviews an hour apart.
The documentation showing any of it had been done did not exist.
The Director of Nursing could not explain why no one had noted the failed urine collection in Resident 44's chart. The director could not confirm when, or whether, the CT scan order for Resident 75 had gone out before January 27. The agency LPN, when pressed on the CT scan timeline, said only that if the order was placed on January 23, the facility should have acted on it that day.
CMS rated the harm level for these violations as minimal harm or potential for actual harm, affecting few residents.
For Resident 75, the practical consequence of a delayed or unconfirmed CT scan order is that whatever the physician was looking for, the scan ordered to find it, was not confirmed to be scheduled for at least four days. What the physician had ordered it to evaluate, and what the delay meant for that resident's care, is not recorded in the inspection report.
The facility had no answer for that either.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Golden Years Center For Rehab and Healthcare from 2026-01-30 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: August 4, 2026 · Our methodology
GOLDEN YEARS CENTER FOR REHAB AND HEALTHCARE in HARRISONVILLE, MO was cited for violations during a health inspection on January 30, 2026.
That was one of two residents whose doctor's orders went unfulfilled during a complaint inspection completed January 30, 2026.
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.