Cassville Health Care Center

During an interview on 09/07/25, at 3:46 P.M., the Former Administrator said RN A was placed on suspension pending investigation and was terminated on 09/05/25 after seeing an overwhelming amount of evidence against her for misappropriation of narcotics and resident funds.Complaints #2608924, #2609968, #2609971, #2609989, #2609995, #2610122, #2610146, and #2610229

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

nurse aide (NA);.-The LPN was observed working as the charge nurse.Observation on 09/08/25, at

or LPN G;-He/she did not conduct a CBC, EDL, FCSR, or NA Registry on the LPNs prior to the LPNs

were required to complete onboarding, orientation, and the appropriate background and licensure checks prior to working a shift;-Nurses should not be allowed to work the floor prior to checking their license because the facility would not know if they had a valid nurses license that was unencumbered, and this would not be safe for the residents.

During an interview on 09/10/25, at 11:58 A.M., Certified Medication Technician (CMT) J said the following:-Upon hire, the facility completed background checks, NA registry, and checked the potential employees license;-No one should have access to the residents prior to these being completed and he/she did not believe they could work on the floor before these were completed.

During an interview on 09/10/25, at 11:04 A.M., the Medical Director said in the case of emergency staffing, he/she still expected the facility staff to check the status of the nurses' license, check the EDL list, and perform a CBC.During interviews on 09/09/25, at 10:50 A.M., and on 09/10/25, at 3:36 P.M., the Administrator said the following:-When the facility hired staff they conducted a NA registry, EDL, CBC, FCSR checks, and confirmed nurses' licenses;-He/she did not know if LPN F or LPN G completed applications for employment prior to starting their shifts;-The facility did not conduct a CBC, FCSR, NA Registry, or EDL checks and did not check the status of their nursing licenses prior to the LPNs starting their shifts;-He/she did not set the LPNs up to work their shifts and did not know who did this.Complaint #2611677

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

of DHSS records showed the facility did not self-report related to the misappropriation of

they felt the allegation was not reportable, so they did not report to DHSS.

During an interview on

to the Administrator immediately.

The Administrator reported to DHSS within two hours.During an interview on 09/09/25, at 12:10 P.M., LPN D said the following:-If a certified nurse aide (CNA) or certified medication technician (CMT) received an allegation of misappropriation, they reported to their charge nurse immediately and the charge nurse reported to the DON, Social Services Designee (SSD), or Administrator immediately;-Any staff member can report to DHSS, but usually the DON, SSD, or Administrator reported to DHSS within two hours.

During an interview on 09/09/25, at 2:49 P.M., CNA M said if he/she received an allegation of misappropriation, he/she reported to the charge nurse immediately.

The Administrator reported to DHSS within two hours.

During an interview on 09/10/25, at 8:46 A.M., CNA L said if he/she received an allegation of misappropriation, he/she reported to the charge nurse immediately. If the allegation was against the charge nurse or the DON, he/she reported to the Administrator.

The Administrator reported to DHSS within two hours.

During an interview on 09/10/25, at 11:58 A.M., CMT J said if he/she received a report of misappropriation, he/she reported to the charge nurse immediately and then followed up with the Administrator to ensure it was reported to them.

The Administrator reported to DHSS within two hours.

During an interview on 09/10/25, at 3:36 P.M., the Administrator said he/she reported any allegations of misappropriation to DHSS immediately.Complaint #2608924, #2609968, #2609971, #2609989, #2609995, #2610122, #2610146, and #2610229.

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

During an interview on 09/08/25, at 11:00 A.M., CNA L said when he/she arrived at work on 09/08/25, at 5:45 A.M., RN A was working in

on 09/08/25, at 6:00 A.M., RN A was the nurse.

During an interview on 09/09/25, at 2:49 P.M., CNA M said if an employee was accused of misappropriation, they should be suspended pending investigation not allowed to be in the facility.

During an interview on 09/10/25, at 11:04 A.M., the Medical Director said he/she would not expect a staff member under investigation to be brought back to the facility unsupervised and the staff member should not have access to the resident.

During an interview on 09/10/25, at 3:36 P.M., the Administrator said the following:-If a staff member was accused of misappropriation, they were suspended pending an investigation;-The staff member should not have access to the resident;-Resident #1 was not protected when RN A was allowed back into the facility on [DATE].Complaint #2608924, #2609968, #2609971, #2609989, #2609995, #2610122, #2610146, and #2610229NOTE: At the time of the abbreviated survey, the violation was determined to be at the immediate and serious jeopardy level J.

Based on observation, interview, and record review completed during the onsite visit, it was determined the facility had implemented corrective action to address and lower the violation at the time. A final revisit will be conducted to determine if the facility is in substantial compliance with participation requirements.At the time of exit, the severity of the deficiency was lowered to the D level.

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

During an interview on 11/25/25, at 9:58 A.M., LPN D the if he/she observed a large bruise on a resident, he/she would complete an incident report in the electronic medication record, notify the resident's physician, the DON and would report the bruise to the next shift nurse to monitor.

During interviews on 11/24/25 at 12:50 P.M. and on 11/25/25 at 1:32 P.M., the DON said the following:-LPN F reported the bruise to him/her on 10/24/25. -LPN F notified the physician and obtained any order to rule out a blood clot to the left leg.-He/she did not know what the delay in entering the order in for the x-ray and ultrasound. -The x-ray and ultrasound order originally was entered incorrectly, and the lab technician brought the wrong equipment on 10/27/25 and had to reschedule the visit.-The resident had a multicolored bruise to the left inner leg that was smaller than a softball, but larger than an apple.-Since the resident complained of pain with movement of the leg and walking, the DON suspected a blood clot.-The resident required stand by assistance with showers but was independent with all other cares.-There was no indication the resident had a fall.-He/she does not know why the nurse documented the resident had a fall.-The nurse should have completed a skin assessment upon discovery of the bruise on 10/24/25.-The bruise should have been monitored every shift until it resolved. -The nurse should document notification to the physician regarding ultrasound and x-ray results.

During an interview on 11/25/25 at 11:34 A.M., the ultrasound company representative said the following:-There were no notes showing a technician brought the wrong equipment and had to reschedule the appointment.-The only order for the resident was on 10/27/25 for an x-ray and ultrasound.-The only visit recorded for the resident was on 10/28/25.

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

Review of the resident's September 2025 MAR showed on 09/10/25, staff documented administering acetaminophen 325 mg two tablets at 10:51 A.M.During an interview on 09/10/25, at 11:58 A.M., CMT J said the following:-The resident did complain of pain to the charge nurse this morning.

The resident asked the CMT to look at the resident's PRN tramadol;-The CMT had access to give the resident acetaminophen so that is what he/she did;-He/she did not have access to the medication dispensing machine to pull the resident's tramadol;-Pain should be addressed immediately.

Observation and interview on 09/10/25, at 12:13 P.M., showed the resident speaking with CMT J.

The CMT told the resident he/she would check with the nurse regarding his/her tramadol.

The resident reported his/her pain level to be rated at an 8 out of 10. He/she did not get his/her medicine on 09/09/25, as well as hasn't received it today and he/she was tired of asking for it;-LPN I came out of the medication room and administered the tramadol at 12:32 P.M.

Review of the resident's September 2025 MAR showed on 09/10/25, staff documented administration of tramadol 50 mg tablet at 12:22 P.M.

During an interview on 09/10/25, at 11:04 A.M., the Medical Director said the following:-He expected nurses to have access to the medication dispensing machine prior to starting their shift;-If a resident requested a PRN pain medication, they should receive it per orders.

During an interview on 09/10/25, at 3:36 P.M., the Administrator said the following:-He was not aware residents were not receiving their medication;-He was not familiar with the medication dispensing system, but access should have been provided to the nurses prior to starting their shifts. If the nurses did not have access or the ability to perform their jobs, they should have contacted him.

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

of time;-He/she expected the facility to have a schedule and a working staffing sheet.During an

recruiting staff for nursing;-The facility had a contract with a staffing agency but they were not going

staffing emergency at the time.

During an interview on 09/10/25, at 3:36 P.M., the Administrator said the following:-He/she was getting nurse staffing covered, but the facility did not have enough staff, so he/she was bringing staff from other facilities to assist;-Two staff was not enough to care for the residents at night;-It was not appropriate for the RN to send the CNA for a drink during the night leaving only one staff in the building and the RN should have stayed in the facility;-He/she had worked on a schedule since he/she arrived on 09/08/25 and all the staff were instructed to get with the Regional Nurse Consultant (RNC) about their schedules.Complaint #2598186, #2609971, #2609968, #2609989, #2609995, #2610146, #2610182, and #2610229

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

residents and visitors.

The facility census was 44.

Review of the facility's policy titled Nurse Staffing

make nurse staffing information readily available in a readable format to residents and visitors at any given time;-The Nurse Staffing Sheet will be posted on a daily basis and will contain facility name; the current date; facility's current census; the total number and the actual hours worked by the licensed and unlicensed nursing staff directly responsible for resident care per shift;-The facility will post the Nurse Staffing Sheet at the beginning of each shift;-The information posted will be presented in a clear and readable format and in a prominent place readily accessible to residents and visitors;-A copy of the schedule will be available to all supervisors to ensure the information posted is up-to-date and current.

The information shall reflect staff absences on that shift due to callouts and illness.

Staffing shall include all nursing staff who are paid by the facility (including contract staff).

Any staff not paid for by the facility, such as hospice staff or individuals hired by families, shall not be included;-Nursing schedules and posting information will be maintained in the Human Resources Department for review for a minimum of 18 months or as required by State law, whichever is greater;-The facility will, upon oral or written request, make the nurse staffing data available to the public for review at a cost not to exceed the community standard.1.

Observations on 09/08/25, at 11:03 A.M. and 4:41 P.M., 09/09/25, at 9:03 A.M., and 09/10/25, at 12:27 P.M., showed staff did not have the Nurse Staffing Posting displayed in the entry hall, at the nurses' station, or by the time clock.

During an interview on 09/08/25, at 11:06 A.M., Certified Nursing Assistant (CNA) S said he/she did not know where the Nurse Staffing Sheet was posted, but thought it should be posted.During an interview on 09/08/25, at 11:52 A.M., Registered Nurse (RN) A said the following:-The Nurse Staffing Sheet should be posted behind the nurses' station under the white board on the wall visible to anyone that came to the facility;-The Director of Nursing (DON) was responsible for the Nurse Staffing Sheet;-He/she did not know the last time it was posted, and the sheet was not posted today;-He/she was the former DON and was responsible for posting the Nurse Staffing Sheet, but had not posted it for at least four months.

During an interview on 09/08/25, at 1:03 P.M., Licensed Practical Nurse (LPN) C said the following:-The Nurse Staffing Sheet should be posted daily;-He/she had not seen the Nurse Staffing Sheet posted and did not know where the DON posted it;-RN A (the former DON) was responsible for posting it.

During an interview on 09/08/25, at 7:12 P.M., LPN E said the following:-He/she had not seen the Nurse Staffing Sheet in at least three months; -RN A (the former DON) filled the Nurse Staffing Sheet out and posted it.

During an interview on 09/09/25, at 12:10 P.M., LPN D said the following:-He/she had not seen the Nurse Staffing Sheet posted in a long time;-The night nurse was responsible for filling out the Nurse Staffing Sheet.

During an interview on 09/10/25, at 12:00 P.M., the Business Office Manager said the facility had not completed the Nurse Staffing Sheet in a long time, so he/she was unable to provide any copies.

During an interview on 09/10/25, at 3:36 P.M., the Administrator said the Nurse Staffing Sheet should be posted daily.

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

During an interview on 11/19/25 at 11:00 A.M., LPN B said he/she

when he/she found the errors.

During an interview on 11/24/25 at 9:38 A.M., Certified Medication Technician (CMT) E said the following:-The facility had an issue with some of the medications appearing twice on resident MARs;-He/she was unsure why the resident had two separate Trelegy orders;-The CMT said he/she gave the resident Trelegy and then if the resident needed the medication for shortness of breath, he she would give the resident a second dose at 9:00 A.M.

During an interview on 11/24/25 at 11:03 A.M., the DON said the following:-Staff should be giving the resident Trelegy one puff (inhalation) every day, per the current order dated 10/06/25;-The resident's MAR contained a duplicate Trelegy order.

Nursing staff should not have administered a second inhalation of Trelegy per day;-During medication pass, the CMT or nurse administering the medication should have realized the Trelegy duplicate order and documented not administered on the second order, and then he/she should have notified the nurse on duty of the duplicate order;-The nurse on duty should have then discontinued the duplicate order from the MAR.

During an interview on 11/25/25, at 4:10 P.M., the Administrator said nursing should verify the order/MAR matched the prescription on the medication before administering the medication.

Complaint 2659592

265460 09/10/2025

Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

Review of the resident's quarterly MDS, dated [DATE], showed the following: -Cognitively intact.-Diagnoses including CHF and orthostatic hypotension.

Review of the resident's current November 2025 Physician Orders showed an order, dated 03/05/25, for Entresto (heart failure medication) tablet 24-26 mg, give one tablet by mouth two times a day for CHF.

Hold if SBP was less than 100 mm/Hg.

Review of the resident's November 2025 MAR showed the following: -An order, dated 03/05/25, for Entresto tablet 24-26 mg, give one tablet by mouth two times a day for CHF.

Hold if standing blood pressure (SBP) was less than 100 mm/Hg.-Staff administered the resident's Entresto medication without checking the resident's blood pressure from 11/01/25 through 11/19/25, twice daily at 7:00 A.M. and 3:00 P.M., except on 11/05/25 and 11/18/25 at 7:00 A.M. due to resident's refusal of medication.

Review of the resident's vital sign summary for November 2025 showed staff documented the resident's blood pressure was taken one time on 11/11/25.

During an interview on 11/24/25, at 12:40 P.M., Certified Medication Technician (CMT) E said the following:-The resident did not need his/her blood pressure checked prior to administering his/her medications.-He/she did not know what the resident's blood pressure that morning was prior to administering his/her medication.

During an interview on 11/24/25 at 12:40 P.M., CMT E said the following:-If a medication required a blood pressure or pulse to be taken it would be indicated on the MAR.-The blood pressure or pulse should be checked prior to medication administration to make sure it was within the ordered parameters.-There was no place to document residents' blood pressure on the MAR.

During an interview on 11/25/25 at 1:47 P.M., Licensed Practical Nurse (LPN) F said a resident's blood pressure and pulse should be checked prior to administering medication if there are parameters.

The vital signs should be documenter on the MAR.

During an interview on 11/24/25 at 12:50 P.M., the Director of Nursing said staff should check the resident's blood pressure or pulse if it was indicated on the MAR.

There should be a spot to document vital signs on the MAR.

During an interview on 11/25/25 at 4:10 P.M., the Administrator said blood pressure and pulse should be listed in the MAR if indicated.

Staff should follow physician orders, including any parameters ordered, when administering medication.

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

expected to be notified.

During an interview on 09/10/25, at 9:49 A.M., LPN I said the following:-If a

physician's order;

During an interview on 09/10/25, at 11:04 A.M., the Medical Director said the

their shift;-If a resident has an order for insulin, he expected them to receive it.

During an interview on 09/10/25, at 11:58 A.M., Certified Medication Technician J said the following:-LPN F did not have any access to the resident's records;-LPN F made several calls in attempts to get access and the ability to pass resident medications; -If a resident had an order for medication, they should be receiving that medication.

During an interview on 09/10/25, at 3:36 P.M., the Administrator said the following:-He was not aware residents were not receiving their medication;-He was not familiar with the medication dispensing system, but access should have been provided to the nurses prior to starting their shifts. If the nurses did not have access or the ability to perform their jobs, they should have contacted him.Complaints #2598186, #2609971, #2611677

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

During an interview on 01/30/26, at 11:25 A.M., Licensed Practical Nurse (LPN) C said the following:-The lab did not always send results to the facility. If the lab result went to the hospital, the nurses had to call and request the result;-He/she tried to keep track of the pending labs when he/she was working or wrote a note on the report sheet for other nurses to watch for lab results;-He/she was not very familiar with how the lab portal worked for ordering or looking up lab results;-He/she tried to check each day he/she worked at the facility for lab results and would send results to the physician the same day.

During an interview on 02/02/26, at 1:40 P.M., LPN H said labs should be sent to the physician as soon as they receive the results.

Nursing staff should monitor the lab website for results.

During an interview on 02/02/26, at 4:23 P.M., Registered Nurse (RN) G said the following: -The urinalysis and culture and sensitivity are checked once the results are received by a nurse;-The results are sent to the physician;-The physician reviews the results and makes an order to treat as appropriate;-The culture and sensitivity is checked sometimes if the resident was initially placed on a broad-spectrum antibiotic while waiting on the culture and sensitivity results.

During an interview on 01/30/26, at 1:36 P.M., the DON said the following:-If the physician ordered a stat lab or UA, the specimen went to the hospital lab for analysis.

The facility then had to call and get the results;-Pending labs should be passed on in report from shift to shift. He/she also tried to follow up with the nurses on any pending labs daily; -He/she tried to ask the nurses daily if the labs have been completed or if they had the results.

During an interview on 02/02/26, at 4:15 P.M., the Medical Director said he/she expected the staff to call or text him/her with lab results in a timely manner.

During an interview on 02/02/26, at 4:25 P.M., Physician #1 said he/she would expect the nursing staff to send lab results to physician in a timely manner.

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

During an interview on 01/30/26, at 2:20 P.M., Restorative Nurses Assistant (RNA) M said the following: -Dietary staff do not follow the menu and do not serve what was on the menu at times;-The meat portions were often small, and residents complained the food was not good;-He/She had reported to dietary staff and administrative staff regarding the food, but it has not improved.

During an interview on 01/30/26, at 2:22 P.M., the RD said the following:-The facility utilizes a four-week seasonal menu cycle;-The recipes were made to reflect preparation according to the facility census;-The facility staff should follow the recipes and report any concerns or issues to her.

During an interview on 01/30/26, at 3:18 P.M., the Dietary Manager said the following: -The recipe book calls for 46 servings;-The cooks can add or take out spice based on resident preference;-The cook was responsible for ensuring the food is properly prepared and served.

During an interview on 02/02/26, at 2:53 P.M., the Administrator said the following: -She was unaware of any concerns with the meals;-The recipes should be followed;-There would be concerns related to weight and skin integrity if meals were not properly prepared and protein servings were not met;-The Dietary Manager was responsible for ensuring the meals were properly prepared and served;-The RD should be contacted for approval for any changes to the menu.

Complaint 2700845 and

265460 09/10/2025

Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

During an interview on 09/09/25, at 10:50 A.M., the Administrator said the following:-The

jeopardy to resident health or but they were not going to use the agency unless they had an emergency with staffing. He/she did safety not feel the facility had a staffing emergency at the time.

During an interview on 09/10/25, at 3:36 P.M., the Administrator said the following:-He/she was getting nursing staffing covered, but the

staff was not enough to care for the residents at night;-He/she had worked on a schedule since he/she arrived on 09/08/25 and all staff were instructed to get with the Regional Nurse Consultant (RNC) about their schedules.4.

Based on observation, interview, and record review, the facility failed to prevent any future potential abuse, neglect, exploitation, or mistreatment while an investigation of misappropriation was in progress, when the facility allowed one staff member (RN A) to return to the facility to work as the only nurse on duty causing one resident (Resident #1) to be fearful of retaliation and taking steps to leave the facility due to the fear.

During an interview on 09/10/25, at 3:36 P.M., the Administrator said the following:-If a staff member was accused of misappropriation, they were suspended pending an investigation;-The staff member should not have access to the resident;-Resident #1 was not protected when RN A was allowed back into the facility on [DATE].5.

Interview and record review, \showed the facility failed to provide services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards and principles that apply to professionals providing services in such a facility, when the Transport Driver transported four residents (Resident #1, #9, #11, and #12) in the facility's van to physician appointments when his/her driver's license was suspended.

During an interview on 09/08/25, at 6:43 P.M., the BOM said when he/she found out about the transport driver's license being suspended, he/she had no one to tell, because there was no Administrator at that time and the Administrator was the transport driver's supervisor.6,

During an interview on 09/08/25, at 10:06 A.M., Housekeeper (HK) U said the facility had an Administrator (Former Administrator), but he/she was let go last night and he/she did not know if the facility had a new Administrator.

During an interview on 09/08/25, at 10:42 A.M., the HK Supervisor said the facility did not have an Administrator at this time.

During an interview on 09/08/25, at 1:03 P.M., Licensed Practical Nurse (LPN) C said the following:-The facility's old Administrator's last day was 08/29/25;-He/she found out they had a second Administrator other than the Former Administrator when the state surveyor entered on 09/07/25, but had never seen another Administrator.

During an interview on 09/08/25, at 7:12 P.M., LPN E said he/she believed the Former Administrator was the Administrator.

During an interview on 09/09/25, at 12:10 P.M., LPN D said the Former Administrator had left and now he/she did not know who the new Administrator was.

During an interview on 09/10/25, at 11:04 A.M., the Medical Director said the Administrator for the facility should be licensed in Missouri.NOTE: At the time of the abbreviated survey, the violation was determined to be at the immediate and serious jeopardy level K.

Based on observation, interview, and record review completed during the onsite visit, it was determined the facility had implemented corrective action to address and lower the violation at the time. A final revisit will be conducted to determine if the facility is in substantial compliance with participation requirements.At the time of exit, the severity of the deficiency was lowered to the E level.Complaints #2610146, #2610182, and #2611677

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Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

would not expect anyone with a suspended license to drive or be the transport driver for the

the BOM found out the driver's license was suspended, the BOM told the driver they could not drive

265460 09/10/2025

Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

Review of the facility's policy titled Tuberculosis Testing, revised 06/29/23, showed the following:-The purpose of the policy was to ensure each resident and employee of the facility is tested for tuberculosis (TB) after entering the facility to prevent the spread of infection;-Upon hire, a new employee will receive a two-step PPD skin test (a test used to determine exposure to TB);-Each employee will also have an annual one-step TB test to ensure that any possible infections can be triggered proactively to prevent further spread;-All TB tests will be kept on file in the according areas (employee files).1.

Reviewed showed the facility did not provide personnel files for LPN F and LPN G upon request.

Observation on 09/08/25, at 7:46 P.M., showed LPN G was working as the charge nurse.During an observation and interview on 09/09/25, at 9:09 A.M., LPN F said the following:-He/she was not currently employed by the facility. He/she used to work for the facility but left in August or October 2024;-He/she worked the floor last night with a certified nursing assistant (CNA) and a nurse aide (NA);-He/she did not have a TB test prior to working on the floor with the residents.-The LPN was working as the charge nurse.During an interview on 09/09/25, at 8:50 A.M., the Business Office Manager (BOM) said the following:-He/she did not have personnel files for LPN F and LPN G;-LPN F and LPN G were not employees of the corporation and were not employees of a staffing agency;-He/she did not have TB tests for the LPNs.

During an interview on 09/09/24, at 12:10 P.M., LPN D said staff should have a negative TB test prior to working the floor and if they did not, this was not safe for the residents.

During an interview on 09/09/25, at 4:33 P.M., the facility physician said staff should have a negative TB test prior to working with the residents.

During an interview on 09/10/25, at 11:04 A.M., the Medical Director said staff should have a negative TB test prior to working the floor but in the case of emergency staffing needs, he believed if the staff wore a mask that would be sufficient to protect the residents.During interviews on 09/09/25, at 11:02 A.M. and 09/10/25, at 3:36 P.M., the Administrator said the following:-Upon hire, staff should have their first TB skin test read prior to working on the floor;-He did not know who had LPN F and LPN G come to the facility to work and did not know if they were employees of the corporation or a staffing company;-LPN F and LPN G did not have a negative TB test prior to working the floor.Complaint #2611677

265460 09/10/2025

Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

Review of the resident's January 2026 MAR showed the following: -An order, dated 01/31/26, for Macrobid 100 mg, one capsule, twice daily for UTI;-Staff did not document administration on 01/31/26.

Review of the resident's progress notes dated 01/31/26, at 12:51 P.M., Licensed Practical Nurse (LPN) C documented an order note regarding a recommended dose of Macrobid 100 mg, one capsule to be given twice daily for 10 days as outside of the recommended dose or frequency. (The nurse did not document regarding the bacteria being resistant to the Macrobid.)

Review of the resident's progress notes showed on 01/31/26, at 6:24 P.M., LPN C documented Macrobid was started for a UTI with no adverse reaction noted.

The resident had a temperature of 98.1 degrees Fahrenheit (F). (The nurse did not document regarding the bacteria being resistant to the Macrobid.)

Review of the resident's February 2026 MAR showed the following: -An order for Macrobid 100 mg, one capsule, twice daily for UTI for 10 days, with a start date of 01/31/25 at 8:00 P.M.;-Staff administered the medication as ordered on 02/01/26 and 02/02/26.

During an interview on 02/02/26, at 4:23 P.M., Registered Nurse (RN) G said the following: -The urinalysis and culture and sensitivity are checked once the results are received by a nurse;-The results are sent to the physician;-The physician reviews the results and makes an order to treat as appropriate;-The culture and sensitivity is checked sometimes if the resident was initially placed on a broad-spectrum antibiotic while waiting on the culture and sensitivity results;-The DON and physician would be made aware of any resistance at that time and would be provided the culture and sensitivity results for review.

During an interview on 02/02/26, at 2:25 P.M., the DON said he/she did not know who was monitoring the labs results to ensure the bacteria was not resistant to the antibiotic prescribed and notifying the physician with that information.

During an interview on 02/02/26, at 4:15 P.M., the Medical Director said he/she expected the nursing staff to call or text him/her with final lab results timely and review the lab results to the antibiotics ordered. He/she said treating a resident with an antibiotic the bacteria was resistant to was how antibiotic resistance is created.

During an interview on 02/02/26, at 4:25 P.M., Physician #1 said nursing staff should review lab results and compare to the antibiotic ordered.

265460 09/10/2025

Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

265460 09/10/2025

Cassville Health Care Center 1300 County Farm Road Cassville, MO 65625

During interviews on 11/25/25 at 12:00 P.M., Certified Nurse Assistants (CNA) H and CNA I said the following:-The CNAs began working in the facility in August 2025 and both worked the night shift 6:00 P.M. to 6:00 A.M.

Both aides said they saw one to two mice every night in the facility;-The CNAs said they have seen mice droppings in Resident #9's room;-Mice were frequently seen on the back hall near Resident #2's room and Resident #3's room.

During an interview on 11/25/25 at 12:30 P.M., CNA N said he/she witnessed a mouse running in the hallway on Friday. He/she had seen mice in the back hall rooms on more than one occasion.

During an interview on 11/25/25 at 12:50 P.M., CNA M said he/she saw mice on the back hall all the time.

Several residents had complained about seeing mice in the rooms.

During an interview on 11/25/25 at 12:40 P.M., Certified Medication Technician (CMT) C said the following the facility had a pest log for staff documentation of pest sightings.

The log was a blue binder from the pest company and was kept in a file cabinet behind the nurses' station. He/she said they wrote pest issues in the binder and that was the end of their part.

During an interview on 11/25/25, at 1:10 P.M., the Activity Director said the following:-He/she saw a mouse running down the hall last month, but had not seen one for a few weeks.

Observation on 11/25/25 at 1:10 P.M., of the activity area showed the following: -This surveyor observed the library/activity area at the end of the back hall (located on the northwest wing) of the facility;-The surveyor opened a lower cabinet containing boxes of jigsaw puzzles for resident use.

Mouse droppings (approximately 20) were visible along the front edge of the cabinet;-The surveyor opened a drawer containing boxes of playing cards for resident use.

The drawer contained mouse droppings.

During an interview on 11/25/25 at 1:32 P.M., the Director of Nursing said the following:-One of the night shift staff reported seeing mouse droppings one to two days ago and he/she notified the Administrator;-He/she had not observed any mice.

During an interview on 11/25/25 at 1:54 P.M., Pest Control Service Technician L said the following:-He/She serviced the facility for pest control monthly;-He/She only provided rodent control measures for the exterior of the facility;-He/She completed monthly pest service on 11/18/25 and noted heavier activity at the exterior rodent traps;-He/She was unaware of any reports of rodents inside the facility until 11/25/25;-He/she was not aware of a logbook;-He/She was scheduled to return to the facility on [DATE].

During an interview on 11/25/25 at 4:10 P.M., the Administrator said the following:-He/she was unsure if the pest control company reviewed the pest logbook located in the nurses' station;-He/she observed that the pest control company had not signed the logbook;-If staff observe or receive reports of pests in the facility, he/she would expect the staff to notify the Administrator, so that he/she could mention areas of concern to the pest control company.

Complaint 2652499