F 0607 8. During interview on 05/20/25 at 4:00 P.M., the Human Resources (HR) Manager said the following:

Level of Harm - Minimal harm or -He had been in the position for one month; potential for actual harm -He realized there was a lot of information missing from the new hire files; Residents Affected - Some -If the information was not in the employee's file, then it was not completed and/or there was no record of being completed.

During interview on 05/21/25, at 5:00 P.M., the Administrator said the following:

-She expected staff to check the FCSR, CBC, EDL, and Nurse Aide Registry for all new hires;

-She realized they were not current on the proper documents needed.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 56 265423 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 265423 B. Wing 05/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Nursing Home 301 West Dunlop Street Center, MO 63436

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 0657 -It was the DON's and interdisciplinary team's responsibility at the facility to update the care plans.

Level of Harm - Minimal harm or During an interview on 05/21/25 at 4:58 P.M., the Administrator said the following: potential for actual harm -The care plans were not updated to reflect the current needs of the resident because the MDS Coordinator Residents Affected - Few worked remotely and was not at the facility;

-When the MDS Coordinator was in house and was responsible for completing the care plans, it made it easier because she was here for morning meetings and care plan meetings;

-Now that the facility no longer had an in-house MDS Coordinator, the DON and ADON were working on slowly getting the care plans updated.

45563

Surveyor: [NAME], Konnie

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FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 56 265423 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 265423 B. Wing 05/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Nursing Home 301 West Dunlop Street Center, MO 63436

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 0658 -He/She didn't receive Depakote or Buspar for several weeks after he/she first arrived at the facility;

Level of Harm - Minimal harm or -He/She had behaviors and depressed mood because of not receiving his/her medications; potential for actual harm -He/She told staff about the missing medications and they did nothing about it. Residents Affected - Few

During an interview on 06/03/25 at 8:28 A.M., LPN A said the following:

-He/She entered the physician orders the resident brought with him/her into the electronic medical record;

-He/She wasn't aware the resident was missing any orders for medications;

-The resident nor the SSD reported to him/her that any medications were missing;

-The resident had not reported any increased depression.

During an interview on 06/03/25 at 10:57, the Assistant Director of Nursing (ADON) said the charge nurse (LPN A) was responsible for ensuring the admission paperwork, including the physician orders for the resident's medications, were entered and followed.

During an interview on 05/21/25 at 2:25 P.M., the Medical Director said the following:

-Buspar or Depakote should not be be stopped abruptly;

-If the resident was on the medications at another facility, both of the medications should be continued upon admission;

-If there was any question or discrepancy in orders, he would have expected the nurse to call him to clarify.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 56 265423 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 265423 B. Wing 05/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Nursing Home 301 West Dunlop Street Center, MO 63436

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 0678 -He/She was unsure which color was for which code status;

Level of Harm - Minimal harm or -He/She would look at the dot on the door first in an emergency, then check the EHR, (face sheet and or potential for actual harm care plan) and if they did not match, he/she would go talk to the Director of Nurses (DON).

Residents Affected - Some During an interview on [DATE REDACTED] at 9:08 A.M. and [DATE REDACTED] at 10:41 A.M., the DON said the following:

-A resident's code status should be consisted throughout the resident's medical record and facility documentation;

-He did not know where he would expect staff to look to find a resident's code status.

During an interview on [DATE REDACTED] at 9:06 A.M. and [DATE REDACTED] at 5:00 P.M., the Administrator said the following:

-The facility no longer used the red dots;

-The red dot was a stop system to mean the resident could not be taken down during a behavior emergency;

-The black dot indicated DNR code status;

-She would expect staff to know the the black dot meant DNR code status;

-She would expect all code status communications to match (dot on nameplate/door, DNR binder and EHR);

-Medical Records was responsible for updating the dots and nameplate/door.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 56 265423 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 265423 B. Wing 05/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Nursing Home 301 West Dunlop Street Center, MO 63436

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 0679 During an interview on 05/20/25 at 10:40 A.M., the Activity Director said the following:

Level of Harm - Minimal harm or -She started as Activity Director in March 2025; potential for actual harm -She was very limited on access to supplies for activities. She had to purchase supplies in bulk, and it was a Residents Affected - Some difficult transition to learn how to plan activities;

-If she needed funds for activities, she had to use the administration fund which was shared with other departments;

-If another department needed something more important, then that request would be granted and she would not receive items she needed/requested for an activity;

-The shopping activity consisted of residents filling out a list of what they would like. Activity staff then went to

the store and purchased the residents' requested items. The residents did not physically go shopping;

-Weekend activities consisted of church and a folder located outside his/her office door with activities such as word searches the residents could complete and turn in for prizes out of the treat cart;

-Activity staff were scheduled on weekends, but they had some staffing issues recently.

During an interview on 05/21/25 at 5:00 P.M., the Administrator said the following:

-Staff should follow the activity calendar as written;

-There had been some budget cuts and changes in ordering of supplies which made it challenging to schedule activities due to the limited supplies on hand.

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FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 25 of 56 265423 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 265423 B. Wing 05/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Nursing Home 301 West Dunlop Street Center, MO 63436

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 0692 -He/She would eat more and actually asked for double portions but didn't get it when he/she asked;

Level of Harm - Minimal harm or -He/She was usually still hungry after meals. potential for actual harm

Review of the resident's medical record showed no documentation staff monitored the resident's oral intake Residents Affected - Few from his/her meals on 05/21/25.

During an interview on 05/21/25 at 11:40 A.M., NA C said the resident required more assistance with eating lately.

During an interview on 05/21/25 at 11:40 A.M., NA L said the resident required a lot more assistance with eating recently.

During an interview on 05/21/25 at 2:00 P.M., the Registered Dietician said the following:

-Last month's review did not signal a weight loss for the resident, so she was just now seeing the resident's current weight loss;

-Looking at her notes, she saw a note where staff were unsure of the accuracy of the resident's weight because the resident actually triggered for weight gain last month;

-She always followed up on the following month with any weight gain or weight loss. The resident was on her list to be seen;

-The staff were having issues with the resident wanting regular food and he/she was on a mechanical soft, so they were going to work on a diet waiver;

-The resident started on Boost with meals (three times daily) on 05/07/25;

-She was going to have to look into the resident's percentage of intake and see if double portions would be appropriate.

During an interview on 06/05/25 at 2:00 P.M., the Assistant Director of Nursing (ADON) said the following:

-Meal intake documentation was completed as needed and was a task the Director of Nursing (DON) had to trigger to be completed;

-Once the DON triggered the task, the certified nurse assistants (CNA)s were responsible to chart how much

the resident ate during the meals;

-The resident's meal intake was not charted because the previous DON never triggered the task for the CNAs to chart.

During an interview on 05/21/25 at 4:58 P.M., the Administrator said staff were to assist the resident if he/she needed help with eating.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 32 of 56 265423 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 265423 B. Wing 05/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Nursing Home 301 West Dunlop Street Center, MO 63436

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 0698 During an interview on 05/21/25 at 8:40 A.M., LPN B said he/she was unaware of any specific protocols to follow when a resident returned from dialysis. Level of Harm - Minimal harm or potential for actual harm During an interview on 05/20/25, at 3:00 P.M., the Assistant Director of Nursing (ADON) said the following:

Residents Affected - Few -Resident #1 received dialysis treatments and had a fistula in his/her arm;

-Nursing staff were to obtain weights, vital signs (blood pressure, pulse, temperature, oxygen level) on the day of dialysis treatment and assess for bleeding at the fistula site;

-Nursing staff were not expected to feel for bruit (audible vascular sound associated with turbulent blood flow) and/or thrill (a vibration caused by blood flowing through the fistula) of the fistula.

During an interview on 06/03/25 at 10:20 A.M., the Director of Nursing said staff were to follow the facility's policy and procedure for monitoring residents who received dialysis treatments, including monitoring the site for bleeding, thrill, bruit, and signs of infection.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 35 of 56 265423 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 265423 B. Wing 05/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Nursing Home 301 West Dunlop Street Center, MO 63436

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 0806 -The facility did not have a special milk or gluten-free breads because the resident wasn't drinking/eating them; Level of Harm - Minimal harm or potential for actual harm -When the resident didn't eat/drink what he/she requested, it affected the budget;

Residents Affected - Few -She expected the facility to adhere to the resident's allergies and preferences.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 38 of 56 265423 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 265423 B. Wing 05/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Nursing Home 301 West Dunlop Street Center, MO 63436

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 During an interview on 5/21/25 at 9:31 A.M., [NAME] R said the food preparation sink only had cold water, so he/she had to use the three-compartment dishwashing sink to fill up the pan of vegetables with hot water. Level of Harm - Minimal harm or potential for actual harm During an interview on 5/21/25 at 11:50 A.M., the Dietary Manager said the food preparation sink did not have hot water running to it and never had since she worked at the facility. Residents Affected - Many 9. Observation on 5/21/25 at 9:34 A.M., under the dishwashing machine sink, showed a cloth was inserted into a pipe that went through the wall. An electrical cord with wire nuts on three wires (originating from the cord) lay on the ground.

During an interview on 5/21/25 at 9:33 A.M., Dishwasher S said it would be nice if the garbage disposal was replaced. Staff were to put food waste in the trash can prior to rinsing dishes in the sink but sometimes the sink got clogged.

During an interview on 5/21/25 at 9:25 A.M., the Dietary Manager said there used to be a garbage disposal where the wires and pipe were under the dishwashing sink but it had been removed about a year ago.

During an interview on 5/21/25 at 2:32 P.M., the Maintenance Director said the garbage disposal was removed prior to him starting at the facility in September 2024. The facility was on a septic system and he was told that the plumbing system was unable to support a garbage disposal.

10. Observation on 5/21/25 at 11:50 A.M., of the food preparation sink showed a 1.5-inch drain pipe entered

an approximately 6-inch by 6-inch open floor drain.

During an interview on 5/21/25 at 11:50 A.M., the Dietary Manager said the drain to the food preparation sink overflowed two to three times per month when morning staff arrived to work. When this happened, staff had to clean up the drain water before they could start working and preparing food for the day.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 46 of 56 265423 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 265423 B. Wing 05/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Nursing Home 301 West Dunlop Street Center, MO 63436

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 0880 -NA C and CNA H assisted the resident to bed with the mechanical lift;

Level of Harm - Minimal harm or -The resident was incontinent of bowel and bladder; potential for actual harm -The resident had a small pressure ulcer on his/her left buttock; Residents Affected - Some -NA C and CNA H provided incontinence care without wearing gowns.

During an interview on 05/21/25 at 8:10 A.M., CNA H said the following:

-He/She was not 100% sure if the resident was supposed to be on EBP;

-He/She would look for the germ sticker on the resident's picture by the door, but did not particularly remember if the resident had one or not;

-Residents who had any kind of wound, chronic infection, indwelling devices were on EBP and required use of gown, gloves, booties, and face shields if needed.

During an interview on 05/21/25 at 8:21 A.M., NA C said the following:

-There were signs on residents' doors that directed if the residents were on EBP and required use of PPE

during cares;

-He/She did not think the resident was on EBP. There was no sign on the outside of the resident's door;

-If a resident was on EBP then he/she should wear a gown and gloves when providing care.

Observation on 05/321/25 at 8:25 A.M. showed no signs and/or germ sticker on the resident's door to indicate the resident was on EBP. There was no PPE located outside of the resident's room.

During an interview on 05/21/25 at 2:00 P.M., the administrator said the following:

-The resident was supposed to be on EBP;

-CNAs removed the signs, including the germ sticker from resident's picture, and PPE because they thought

the resident was not on EBP;

-She expected residents to have signage indicating the resident required EBP;

-PPE was readily available near the resident's room if he/she required EBP.

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FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 50 of 56 265423 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 265423 B. Wing 05/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Nursing Home 301 West Dunlop Street Center, MO 63436

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 0883 During an interview on 05/21/25 at 4:58 P.M., the administrator said the following:

Level of Harm - Minimal harm or -All immunizations should be up to date per the CDC guidelines/recommendations; potential for actual harm -The ADON and and Director of Nursing (DON) were responsible to track immunizations and document them Residents Affected - Some in the EHR.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 56 of 56 265423