Golden Years Center For Rehab And Healthcare

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

know.-He/She told the resident that it would be ok and went to the Administrator immediately. Review of the witness statement, dated 10/28/25, from CNA D showed: -He/She and LPN D were laying the resident down.-LPN D was arguing with the resident telling the resident that he/she was saying things to the corporate people about him/her, and he/she did not appreciate it.-The resident became upset. -He/She told LPN D that he/she had it and that LPN D needed to leave the room.-LPN D then looked at the resident

before leaving and said what are you dumb?-LPN D said I know what you have been saying. -The resident said I have been called dumb my whole life.-He/She finished the resident cares, but the resident was upset.

During an interview and observation on 10/29/25 at 9:46 A.M. Resident #13 said:-LPN D had called him/her dumb.-He/She did not want LPN D to be his/her nurse anymore. -He/She wanted to move rooms so the LPN would not be his/her nurse.-He/She really liked his/her roommate and hated to move rooms, but he/she did not want LPN D to be his/her nurse ever.-The LPN had really hurt his/her feelings.-The LPN had treated him/her mean.-The resident was upset, but was not crying about the situation with the LPN.-The resident appeared hurt by the event. -He/She told the administrator when asked about the incident. During

an interview on 10/29/25 at 10:30 A.M., LPN D said:-The resident started to get agitated.-When the nurse walked down the hall the resident was yelling. -CNA D said the resident was yelling and being disrespectful.-The resident was yelling and saying that cares were not being done. -The resident said the CNA was lying and he/she never said that. -The resident said he/she was dumb and called the LPN dumb.-He/She responded sarcastically yeah you are dumb, but did not mean it.-The resident said he/she did not want to be LPN D's friend anymore. -The resident came and told the LPN later that the resident was sorry. During an interview on 10/29/25 at 10:50 A.M., Admissions Coordinator said:-He/She did not witness

the event, he/she just filed out the grievance. -The resident reported that LPN D called him/her dumb and would not give him/her any medications or bring the resident anymore puzzles. -The resident was really hurt and would not be LPN D's friend anymore. -The resident wanted to move rooms so he/she would not have LPN D as a nurse. -It was never appropriate to call a resident dumb.-The resident was visibly upset and crying. -The behaviors were out of character for the resident. During an interview on 10/29/25 at 11:01 A.M., CMT C said:-He/She came into the resident's room after the incident.-The resident was visibly upset and crying.-The resident said that LPN D had called him/her dumb.-The resident reported to him/her the LPN told the resident to not ask him/her for anything.-The resident had issue with being called dumb, because the resident said that is what his/her father had always called the resident. -The resident was visibly angry and upset when telling them about the incident.-The resident did not complain about staff.

During an interview on 10/29/25 at 11:50 A.M., CNA D said:-After lunch the resident wanted to be laid down.-He/She told the resident that he/she needed to find another person to help.-He/She found LPN D to help lay the resident down.-When the LPN got in the room and started to help the resident into bed, the nurse started to yell at the resident that the resident was trying to get him/her fired. -Once the resident was

in bed he/she told the LPN to leave the room that he/she could finish.-The LPN kept talking to the resident and said what are you dumb.-He/She got the LPN out in hall and the LPN said the bitch (referring to the resident) was trying to get him/her in trouble. During an interview on 10/29/25 at 12:01 P.M., Interim Director of Nursing said:-If a staff member called a resident dumb that would be a violation of the resident's dignity. -An investigation had been started regarding the incident with LPN D and Resident #13.-If LPN D violated Resident #13's dignity then the LPN would be terminated. -No staff member should have ever violated the resident's dignity.

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Golden Years Center for Rehab and Healthcare

2001 Jefferson Parkway Harrisonville, MO 64701

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 0600 Level of Harm - Actual harm Residents Affected - Few

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

in his/her wheelchair on 10/14/25. -Resident #6 was scared and waving his/her arms to get someone's attention to help.-Resident #6 was nonverbal and could not ask for help.-He/she intervened and stopped Resident #4 from pushing Resident #6.-He/She told Resident #4 to stop, and then Resident #4 karate chopped Resident #6 on his/her shoulder hard.-The hard hit hurt Resident #6. Resident #6 moaned in pain and had a painful look on his/her face after he/she was hit. Resident #6 had tears in his/her eyes after he/she was hit.-Resident #4 hit Resident #6 with clear intent and left a red mark on Resident #6. He/She saw the red marks on Resident #6.-Resident #4 was clearly agitated and angry when he/she Karate chopped Resident #6.-Resident #6 was scared, waving his/her hands in the air to get someone's attention, and needed help.-Resident #6 was sent to the hospital for evaluation per family request after he/she was hit. During an interview on 10/20/25 at 4:00 P.M., Certified Medication Technician (CMT) B said:-He/She witnessed the event with Resident #4 and Resident #6.-Resident #4 was running and pushing Resident #6

in his/her wheelchair through the hallway and around a corner.-Resident #6 was scared and waving his/her arms.-Housekeeper B intervened to stop Resident #4 from pushing Resident #6.-Resident #4 became angry and hit Resident #6 hard on the back of the head and the shoulders.-Resident #4 hit Resident #6 two or three times. During an interview on 10/21/25 at 11:14 A.M., Resident #6's responsible party said:-He/She was unhappy about Resident #6 being abused in the facility by another resident.-He/She witnessed Resident #4's behaviors and they were scary.-Resident #6 feared Resident #4.-Other residents

in the facility feared Resident #4.-He/She was in a wheelchair himself/herself due to a recent health problem. He/she would have been terrified if what happened to Resident #6, happened to him/her.-He/She believed the physical contact made to Resident #6 by Resident #4 caused the resident pain.-He/She believed the incident caused the resident caused emotional sadness and the resident trauma. -He/She knew Resident #6 well and knew that he/she was scared and traumatized by the incident.-Resident #6 suffered from depression and he/she felt the incident could make the resident's depression worse. During

an interview on 10/28/25 at 9:13 A.M., Interim Administrator A and the Corporate DON said:-He/She would expect all residents to be kept safe and free from abuse in the facility.-It was the responsibility of all staff members to ensure the safety and wellbeing of each resident.-He/She would expect all residents to free from abuse in the facility. 2645193, 2646488, 2642955, 2633865, 2636127, 2640626, 2646855

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Golden Years Center for Rehab and Healthcare

2001 Jefferson Parkway Harrisonville, MO 64701

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 - Immediate jeopardy to resident health or safety Residents Affected - Few

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

transplant team member was trying to reach a clinical nurse in the facility to coordinate care for the transplant resident.-He/She would have expected good communication to occur between the transplant team and the facility staff.-The administrator never told him/her that anyone from the transplant team or hospital staff was trying to reach a clinical nurse-He/She denied receiving a message from staff regarding

the communication with the resident's transplant nurse. -He/She would expect residents to receive their wound care as ordered.-He/She was not aware that the resident was not receiving his/her wound care as ordered. -He/She was not sure who was responsible for completing wound care for the residents. During an

interview on 10/22/25 at 4:50 P.M., DON said:-He/She never received a message from the administrator on Whats App or any other means asking him/her to check up on the transplant resident.-He/She was never instructed in person by the administrator to contact the resident's transplant team for coordination of care.

Note: When it was told to the DON that an email was observed from transplant team and the resident's family member that was addressed to the administrator and then forwarded to him/her, the DON said:-He/She was working the floor on the day the administrator sent the emails about the resident and was flustered.-The resident was still in the building on the day the emails were received, but he/she forgot to take care of it because he/she worked the floor that day.-He/She felt bad and knew that he/she dropped the ball.-The administrator never followed up with him/her to ensure that the clinical team reached out to the transplant team. During an interview on 10/23/25 at 10:42 A.M., the ADON said:-He/She was never instructed to contact the resident's transplant team.-He/She was not aware that the resident was not receiving his/her medication.-He/She was not aware that the resident was not receiving his/her wound care orders.-He/She would expect wound c

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Golden Years Center for Rehab and Healthcare

2001 Jefferson Parkway Harrisonville, MO 64701

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 0741 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

other residents.-The resident was yelling that he/she wanted to die.-The resident attempted to throw his/her urinary catheter bag at staff.-The resident was sitting naked in the front lobby and refused to put clothes on.-The resident was threatening to put his/her fist through the glass door and cut herself.-The DON was notified of the resident's behaviors. Review of the resident's EMR on [DATE REDACTED], showed:-No care plan updates or interventions were completed by staff on [DATE REDACTED].-No behavior monitoring documented by staff on [DATE REDACTED].-No nonpharmacological intervention documented by staff on [DATE REDACTED].-No increased supervision (15 minute or one-on-one) interventions were initiated on [DATE REDACTED] after the resident reporting having suicidal ideation and increased behaviors. Review of the resident's behavior note, dated [DATE REDACTED] at 4:10 A.M., showed:-The resident refused to take medication and eat meals.-The resident yelled and cussed at staff.-The resident attempted to leave out of the door next to his/her room at the end of the hall.-The resident attempted to go out of the front door.-The resident attempted to throw his/her catheter bag at staff.-The resident yelled, I want to die. Review of the resident's behavior note, dated [DATE REDACTED] at 8:25 A.M., showed:-The resident had behaviors throughout the entire night.-The resident requested to go to the hospital.-Staff informed the resident that he/she could not go to the hospital.-Staff informed the resident that he/she needed something medically wrong with him/her to go the hospital.-The resident stated, Well then maybe I will just kill myself. Review of the resident's EMR on [DATE REDACTED], showed:-No care plan updates or interventions were completed by staff on [DATE REDACTED].-No behavior monitoring documented by staff on [DATE REDACTED].-No nonpharmacological intervention documented by staff on [DATE REDACTED].-No increased supervision (15 minute or one-on-one) interventions were initiated on [DATE REDACTED] after the resident reporting having suicidal ideation and increased behaviors.During an interview on [DATE REDACTED] at

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Golden Years Center for Rehab and Healthcare

2001 Jefferson Parkway Harrisonville, MO 64701

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 0742 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

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

placement.-The resident had a legal guardian through the public administrator's office-The resident had the following diagnoses:--Major depressive disorder--General anxiety disorder with panic attacks--Post-traumatic stress disorder (PTSD- a mental health condition caused by very stressful, frightening or distressing events).--Schizoaffective disorder (a mental health condition that combines symptoms of schizophrenia and a mood disorder, such as depression or bipolar disorder).--Bipolar disorder (a mental health condition characterized by extreme mood swings, alternating between periods of mania (elevated mood) and depression (low mood).--Schizophrenia--Borderline personality disorder (a mental health condition that affects the way people feel about themselves and others, making it hard to function in everyday life. It includes a pattern of unstable, intense relationships, as well as impulsiveness and an unhealthy way of seeing themselves).-The resident was diagnosed with PTSD at the age of 19 which causes him/her to constantly worry and be anxious.-The resident had a history of auditory and visual hallucinations.-The resident had nightmares and flashbacks of prior traumatic events that happened in his/her life.-The resident reported frequent worry, muscle tension, impaired concentration, and difficulty focusing.-The resident had suicidal ideation dating back to the age of 25.-The resident attempted to commit suicide in November of 2020 when he/she overdosed on a whole bottle of Valium (benzodiazepine- a group of medications classified as central nervous system (CNS) depressants, meaning they slow down the nervous system).-The overdose attempt required hospitalization.-The resident had multiple inpatient psychiatric admissions through the years dating back to 1993.-The resident became physically and verbally aggressive towards others and herself when he/she had a urinary tract infection.-The resident was an elopement risk.-The resident required 24 hour per day nursing supervision oversight to assure his/her safety.-The resident required ongoing medical and psychiatric follow[TRUNCATED]

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Golden Years Center for Rehab and Healthcare

2001 Jefferson Parkway Harrisonville, MO 64701

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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

was responsible for ensuring the resident's medication were ordered STAT and at the facility upon admission. During an interview on 10/23/25 at 11:15 A.M., the Corporate DON said: -He/She would expect high level medication such as anti-rejection medications to be on site when a patient arrived on site.-He/She would not expect a resident to miss doses of anti-rejection medication. During an interview on 10/23/25 at 4:17 P.M., LPN F said: -He/She cared for the resident at the facility as the charge nurse.-The resident's medications were not administered on 10/15/25 or 10/16/25 as reported to him/her by the CMT. -The DON was aware that the resident's medication were not being administered because he/she told the DON that meds were not available and being administered. -He/She never saw the resident's medication

during his/her shifts on 10/15/25 or 10/16/25. During an interview on 10/23/25 at 8:05 A.M., Resident #12 said he/she did not remember receiving any medications while at the facility. During an interview on 10/23/25 at 8:15 A.M., hospital Registered Nurse (RN) said:-Resident #12 was admitted to the hospital with sepsis. -That would mean that the resident was severely sick.-Missing antirejection medication was bad and could cause the transplanted organ to be rejected. During an interview on 10/23/25 at 8:32 A.M., Transplant Doctor said:-The resident received a kidney transplant last month. -From the laboratory results obtained in

the hospital from current admission it has appeared that the resident had not received any antirejection medication.-The resident not getting the antirejection medication as ordered could cause the body to reject

the transplanted organ requiring another surgery to remove the organ. During an interview on 10/23/25 at 12:57 P.M., the Administrator said: -He/She was responsible for ensuring that the facility was managed in a manner to maintain the highest practicable, physical, mental, and psychosocial wellbeing for all of the residents.-He/She was not aware that the resident was a post-transplant patient.-He/She was not aware that the resident was not receiving his/her medication.-He/She would have expected all medication to be administered and no doses to be missed. During an interview on 10/23/25 at 12:55 P.M., the Chief Operating Officer (COO) said: -He/She would expect that all residents received their medication and treatments as ordered.-He/She would expect the clinical team and the administrator ensured safe medication administration of all of a resident's medication.-He/She expected staff to coordinate care with transferring facilities to ensure that resident's medication were all transcribed and continued.Note: At the time of the abbreviated survey, the violation was determined to be at the immediate 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 remove the IJ violation at that 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. This statement does not denote that the facility has complied with State law (Section 198.026.1 RSMo.) requiring that prompt remedial action be taken to address the Class I violation(s).Complaint numbers: 2645193, 2646488, 2642955, 2633865, 2636127, 2640626, 2646855, 2648264

Event ID:

Facility ID:

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