Cassville Health Care Center

Practical Nurse (LPN) F said the following:-If the nurse aides had questions about a resident's care

ensure the resident's care plan addressed a resident's open wound or a resident with a

had access to the resident care plans;-The facility should ensure the care plans were updated to include resident showering preferences and how much assistance the resident required from staff;-Facility staff should ensure the care plan included information regarding any open wounds and care of a colostomy.

During an interview on 09/24/25, at 12:48 P.M., the Administrator said the following:-The facility should have quarterly care plan meetings with residents and or families, if they choose to attend;-The Administrator said he/she was aware the facility did not currently have a clinical person to attend/participate in the care plan meetings;-The Administrator said the new corporation was basically starting from scratch with new staff.

265460 09/24/2025

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

nurse described the appearance of the resident's toe as macerated (white appearance from prolonged

present;-The nurse said the resident asked earlier in the day for the nurse to change the dressing, but

following:-He/she recently came back to work for the facility and worked three to four shifts in the past week; -He/she determined nurses were not completing the resident wound assessments and were not consistently completing the resident skin assessments;-Over the weekend, 09/20/25 to 09/21/25, he/she attempted to identify residents with open wounds and measure the wounds, but was unsure where to document the measurements;-He/she had not documented the wound assessments in the resident's EHR;-He/she was unable to determine if resident ?swounds were better or worse, due to not being able to find recent wound or skin assessments in the medical records;-He/she was unsure who was responsible for wound assessments in the past, but did not think the facility staff were completing the wound assessments;-He/she sent the resident out to the hospital over the weekend due to his/her right fourth toe had a black area on the underside and the toe was draining yellow and green odorous drainage.

During an interview on 09/23/25, at 11:50 A.M., the Senior Director of Regulatory Affairs (RN E) said the following:-When the physician ordered an X-ray, facility staff should contact the mobile X-ray company the same day.

The resident should have his/her X-ray the day ordered or the next day, if ordered late in the day;-He/she did not think the facility had completed weekly skin or wound assessments consistently.

During an interview on 09/24/25, at 11:35 A.M., LPN F said the following:-He/she was the charge nurse for the day;-He/she was unsure who was responsible for resident skin assessments;-The nurses were responsible for completing wound treatments;-If the physician or NP ordered an X-ray, the facility should ensure completion of the X-ray within 24 hours.

During an interview on 09/24/25, at 11:50 A.M., Certified Medication Tech (CMT) G said the following:-On 09/18/25, the resident's family member was looking at the resident's toe and asked the CMT to look at the toe;-The CMT said the resident's toe looked like a chewed up hot dog.

The toe was swollen, the top of the toe appeared white in color and the underside was open;-The physician started the resident on antibiotics that same day.During an interview on 09/24/25, at 12:48 P.M., the Administrator said the following:-He was unsure who was responsible for completing for weekly skin assessments;-Nurses should obtain physician ordered X-rays within 24 hours.Complaint #2621753

265460 09/24/2025

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

During an interview and observation on 09/23/25, starting at 2:20 P.M., the Dietary Manager (DM) said the following: -Staff should check and record refrigerator temperatures every shift (twice a day) and record them on the logs taped to each refrigerator.

She said ideal temperatures for all refrigerators is 32-40 degrees F.

Staff should check temperatures with the thermometer continuously kept inside each refrigerator;-The Avanti-brand reach-in refrigerator sometimes gets warmer due to staff placing pitchers of hot (fresh-brewed) tea inside. If any refrigerator is noted to be above ideal temperatures, the protocol is to move all items to another refrigerator; -Referring to the open gallon of milk in the large chest refrigerator, the DM said she did not know why the best by date was covered with tape of a more recent date;-The DM took the temperature of the sliced bologna - which had been stored in the small Magic Chef refrigerator.

Using a thermometer from the dietary department, the DM took the temperature of the bologna as 53.4 degrees F;-The DM took the temperature of the two-door stainless steel refrigerator.

She took the temperature of the interior as 46 degrees F, which was above the preferred temperature.

She said staff may have to work on moving the food in that refrigerator to a different refrigerator that is working properly;-The DM said she has had some struggle with some dietary staff not cleaning as directed;-The DM said residents like to leave bottles of condiments on the tables in the main dining room.

She said most of the bottles were purchased by residents, and the residents have requested the condiments be always kept at the tables.

During an interview 09/23/25, starting at 3:51 P.M., the Administrator said temperatures for refrigerators should be posted, and dietary staff should be logging the temperatures every shift. He didn't know if staff were recording temperatures every shift. He didn't know if all refrigerators were keeping appropriate temperatures (41 degrees F or below). He also said the kitchen should be kept clean by dietary staff, and cleaning schedules should be completed every day.

Complaint #26515205

265460 09/24/2025

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

During an interview on 09/23/25, at 2:19 P.M., the Maintenance Director said the following:-The facility had not had any complaints about flies;-He/she believed the flies were coming into the facility via an external courtyard door into the resident dining room;-He/she believed residents were propping the courtyard door open;-He/she told the residents in resident council approximately one week ago, not to prop the courtyard door;-Since he/she instructed residents not to prop the courtyard door open, he/she was checking to ensure the door was closed;-The courtyard door would freely swing shut, close, and latch;-The courtyard door was currently broken, and someone had to open from the inside if someone completely closed the door;-He noticed the courtyard door was broken on Monday morning (09/22/25);-A pest control company came to the facility monthly;-He/she discussed the flies with the pest control representative, but the facility did not change their pest control treatment plan;-The flies were drawn to cooler inside temperature when the weather was hot outside.

During an interview on 09/24/25, at 12:48 P.M., the Administrator said the following:-He/she called the pest control company about the flies, but was unsure if they had visited the facility or not;-All external doors in the facility should close all the way;-When asked if the facility's flying insect lights should all be operational, the Administrator said not necessarily. e been no recommendations made for pests or unmet needs.