Marshfield Care Center For Rehab And Healthcare

F 0678 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

resident's room again to return approximately three minutes later and instructed that NA B, NA C, and him/herself would be starting CPR;-The Social Services Director (SSD) generally updates the resident's code status in all the locations. However, he/she does not believe there is someone hired in that position at

this time, so it hasn't been getting done.During an interview on [DATE REDACTED], at 12:45 P.M., NA C said the residents' code statuses should be found in the resident's chart, on their doors, and in the code status book that is located at the nurse's station. All the information should match.During observation and interview on [DATE REDACTED], at 1:20 P.M., LPN D said the following:-Code status should be found in the resident's chart, including the care plan, face sheet, and physician orders;-Code status should also be found in the code status book that can be found in the nurses' station, and on the resident's name tag outside of their room. If

the name tag is blue, that means full code (CPR). If the name tag is white, that means no code (no CPR);-The nurse admitting the resident is who is responsible for putting the orders into the resident's chart.

All the information should match;-He/she had heard there was a delay in a code being started for the resident, due to the status not being found;-LPN D showed the surveyor the book/binder titled Code Status Book. The resident's information was not seen in the book.During an interview on [DATE REDACTED], at 1:37 P.M., LPN

A said the following information:-In the early morning hours, approximately 5:00 A.M., on [DATE REDACTED], an aide came and got him/her and told him/her that the resident was unresponsive. At that time, he/she went and entered the resident's room. He/she cannot remember if the resident was unresponsive at that time or not;-He/she left the resident's room and went to the nurses' station to locate the resident's code status.

He/she looked in the resident's physician orders, face sheet, and the code status book, and was unable to retrieve the resident's code status;-After approximately 5 minutes of looking for the resident's code status and calling EMS, he/she re-entered the resident's room and instructed staff to join him/her in performing CPR;-Approximately 10 minutes later, around 5:30 A.M., EMS showed up and continued performing CPR until they took the resident to the hospital;-Code status should be easily accessible and found on the resident's face sheet, in the physician orders, care plan, and in the code status book.During an interview on [DATE REDACTED], at 2:29 P.M., the SSD said the following:-She had been employed with the facility for only a couple weeks and was currently working on doing audits on all resident's code status as there is some discrepancies due to the facility not having someone in his/her position for some time;-She was responsible for auditing the residents' charts, code status book, and care plans for code status;-All information should match;-Additionally, any resident's code status should also be scanned into the miscellaneous section in

the resident's chart.During an interview on [DATE REDACTED], at 2:48 P.M., the Director of Nursing (DON) said the following:-Code statuses can be found on each resident's face sheet, name tag on the door, and code status book;-She believed code statuses should also be found in the care plan, but has not reviewed those to be sure;-She believed it's the SSD's responsibility to update code status;-She expected those to be accurate across the board and accessible to staff.During an interview on [DATE REDACTED], at 3:19 P.M., the Administrator said the following:-Code statuses can be found in each resident's face sheet, and care plan.

Additionally, there is a code status book that is behind the nurses' station that should have that information;-The SSD is newly employed and working on getting all residents' code statuses updated;-She expected all information to be accurate across the board and accessible to staff. During an interview on [DATE REDACTED], at 11:12 A.M., The Medical Director said the following:-He expected all residents to have an updated code status;-Those code statuses should be found on the resident's face sheet, as well as the care plan;-All information should match and be able to be found in a quick manner for efficiency.2639380

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Marshfield Care Center for Rehab and Healthcare

800 South White Oak Marshfield, MO 65706

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

physician. He/she was not sure why not;-He/she did not contact the resident's family. He/she was not sure why not;-The resident was still able to ambulate with assistance, so he/she did not believe it to be an emergent issue and believed the residents behavior was more related to anxietyDuring an interview on 10/14/25, at 2:29 P.M., the Social Services Director (SSD) said falls should be documented appropriately in

the resident's chart.During an interview on 10/14/25, at 2:48 P.M., the Director of Nursing (DON) said the following:-She expected nurses to go assess the resident for injury after a fall. The aides should obtain a set of vital signs;-During the nurse's assessment, he/she should assess rather an injury occurred or the resident hit their head. If an injury occurred or their head was hit; neurological assessments should be started;-Additionally, the nurse should fill out an incident report, and begin 72-hour monitoring;-The physician, family, and she should be notified of the fall;-She did not believe she was notified of this incident;-If the resident was guarding a body part and experiencing pain, orders for Xray and or to be sent to the hospital should have been obtained;-The physician should have been notified, as well as the family;-She printed off the incident report under risk management tab. The nurse had initiated and showed that showed no assessment were completed other than the progress note.During an interview on 10/14/25, at 3:19 P.M., the Administrator said the following:-She expected the physician to be notified of a fall, as well as herself and the family;-The nurses should document the fall, complete an incident report, and initiate 72-hour monitoring. If it was an injury fall, neurological checks should also be initiated.During an interview

on 10/16/25, at 11:03 A.M., the Medical Director said the following:-He expected to be contacted for all falls.

There is a rule that he needs to be contacted within two hours of any fall;-If the resident experienced an injury with a fall, he expected to be contacted immediately to give appropriate advisement. Complaint #2639380

Event ID:

Facility ID:

If continuation sheet