Cassville Health Care Center

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

the CNAs were supposed to complete all showers for the residents on their assigned halls;-Residents should have at least two showers per week or per their preference.During an interview on 09/24/25, at 11:35 A.M., Licensed Practical Nurse (LPN) F said the following:-The aides should chart showers in the point of care (POC) section of EHR;-He/she said the aides were responsible for assisting the residents on their assigned halls with showers;-He/she was unsure what type of shower schedule the staff were supposed to use.During an interview on 09/24/25, at 12:20 P.M., the Chief Nursing Officer for the facility's corporation said the following:-Staff should document showers given in POC section of the electronic health record;-Residents should be offered two showers per week, unless requested otherwise.During an

interview on 09/24/25, at 12:48 P.M., the Administrator said the following:-The facility's plan for completing showers was decided daily, if the facility had extra aides working on day shift, then he/she expected staff to try to assist residents with showering;-The facility had or should have a shower schedule somewhere;-He/she was unsure where the shower schedule was located or who was responsible for making a shower list;-He/she had not created a resident shower schedule;-Staff should complete residents showers;-He/she would like to see staff assisting residents with showers two times per week.Complaint Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Cassville Health Care Center

1300 County Farm Road Cassville, MO 65625

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

but he/she thought a regional corporate person planned to start working on resident care plans;-He/she was unsure if staff had completed recent resident care plans;-Each resident should have a care plan meeting quarterly, and the care plan should address any open areas to the resident's skin and colostomy care.During an interview on 09/24/25, at 11:35 A.M., Licensed Practical Nurse (LPN) F said the following:-If

the nurse aides had questions about a resident's care needs, they looked at the resident's care plan;-The facility should ensure each resident's care plan addressed the resident's care needs and should update the care plans as needed;-The facility should ensure the resident's care plan addressed a resident's open wound or a resident with a colostomy.During an interview on 09/24/25, at11:50 A.M., CMT G said the following: -Facility staff 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.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Cassville Health Care Center

1300 County Farm Road Cassville, MO 65625

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

resident's foot and placed a gauze dressing on the resident's toe and gave an order for a dry dressing to be applied to the resident's toe daily;-The nurse called the mobile X-ray company and notified the company of

the resident's X-ray order and prepared the paperwork for the X-ray company.During an interview on 09/19/25, at 5:02 P.M., the resident's family member said the following:-He/she was the resident's responsible party;-The resident reported on 09/14/25 or 09/15/25, one of the other resident's backed over his/her toe in a wheelchair;-The resident spoke to the nurses each day this week about needing an X-ray;-The family member was worried about the condition of the resident's toe.During an interview on 09/22/25, at 4:42 P.M., Certified Medication Technician (CMT) B said the following:-He/she was unsure why

the facility delayed in obtaining an X-ray of the resident's foot;-The resident had asked the nurse to do a treatment to his/her toe, but was still waiting on his/her treatment;-The hospital reported the resident's toe was broken.Observation and interview on 09/22/25, at 5:28 P.M., showed the following:-Registered Nurse (RN) C removed the dressing from the resident #1's right fourth toe;-The nurse described the appearance of the resident's toe as macerated (white appearance from prolonged moisture) toe, with the toenail coming loose at the base, and an open necrotic (blackened, dead tissue) area to the underside of the toe, approximately 1.0 centimeter in size with no drainage or odor present;-The nurse said the resident asked earlier in the day for the nurse to change the dressing, but the nurse did not have time until now. During an

interview on 09/22/25, at 6:00 P.M., LPN D said the 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

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Cassville Health Care Center

1300 County Farm Road Cassville, MO 65625

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

sliced cheese labeled 09/19/25. A thermometer placed inside and left inside with door closed for 5 minutes confirmed the refrigeration temperature to be 51.9 degrees F;-In a large, chest-style, refrigerator, staff placed one gallon of milk, which appeared to have been open. The best by date on the milk was 09/19/25 (four days prior). Over the best by date, staff had placed a piece of tape dated 9/23/25;-A two-door stainless steel, reach-in refrigerator present. The exterior thermometer for this refrigerator read 50 degrees F. Staff last logged the temperature as 40 degrees F on 09/19/25. A thermometer placed inside and left inside with door closed for 5 minutes confirmed the refrigeration temperature to be 48.7 degrees F. Inside this refrigerator there were many items, including: 1 gallon container of mustard, opened (partially used); 1 gallon of mayonnaise, opened; 1 gallon of Italian dressing, opened; sliced cheese; grated cheese; 1 gallon jar of pickles, opened; eggs; pre-cooked sausage patties; butter; large jar of tomato sauce, opened; three five-pound containers of sour cream; and cooked pork in a steam bin dated 09/13/25 (ten days prior);-The griddle area had significant food debris and grease build-up left on the surface of the grill. Below the griddle,

the oven exterior appeared heavily soiled with grease and food debris. The handles of the ovens appeared discolored and were tacky to the touch;-Below a food prep area, staff stored cutting boards and pots and pans on a shelf. On the shelf, around the pots, pans, and cutting boards, there was numerous crumbs, small pieces of food debris, and small pieces of trash. In the dry-storage area, in a locked room across from

the kitchen, there was a bulk bin with breadcrumbs which staff had labeled with the date 4/18 (at least five months prior). 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

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Cassville Health Care Center

1300 County Farm Road Cassville, MO 65625

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

During an interview on 09/24/25, at 11:23 A.M., CNA J said the following:-The facility had a current fly problem. He/she had informed the nurses of the pest problem and had observed the nurses reporting the fly issue to the Maintenance Director and observed nurses reporting the courtyard door issue to the Maintenance Director;-The flies were coming into the facility when the courtyard door was open, and that door frequently got stuck;-Staff left the courtyard door cracked open so the residents could get back inside

the building because the outside door release would not work properly;-Staff and residents sometimes propped the door open with a rock to keep the door from closing all the way.

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.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet