Aspire Senior Living Moberly

F 0584 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many

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

investigation letter and photo documentation;-The communication from the engineering consultants was acknowledged and then forwarded as an email to the administrator on 08/22/25 at 5:14 P.M.; -He was under

the impression the Administrator received a copy of the same letter he received from the engineering consultants (on 8/22/25); -He did not recall making specific contact with the Administrator related to the letter that referenced the structural issue; -After he received the letter, dated 08/22/25, from the engineering consultants he understood that residents were not allowed in that area. It was his assumption that no one was allowed in that area. He did not ask that specific question of the Administrator or follow-up with her as to what was being done related to this area and probably should have; -He assumed when he asked the engineer if people should stay out of the central nursing station area, that would include not only staff but residents too; -He was not sure why the contractor's comments from the 08/27/25 report was not addressed by the facility to keep residents and staff out of the identified areas of concern; -It would have been his expectation the Administrator reviewed his forwarded emails and communication that included the letters from the engineer and contractors and to implement any recommendations addressed in that communication; -He did not follow-up with the Administrator at any time related to those emails or communication and he probably should have as the project manager;-If the area was unsafe for the employees, it should have also been restricted to residents and visitors. During an interview on 09/09/25 at 10:11 A.M. and 09/18/25 at 11:18 A.M., the Administrator said the following: -The ceiling issue was originally reported by the maintenance director, to the corporate project manager by phone, around the beginning of August;-She did not have written documentation of when the corporate project manager was initially contacted about the ceiling issues;-She did not review the reports/letters from the contractors or the engineer until 09/04/25;-The original reports were forwarded to her on 08/22/25; -When the engineer said

the area was unsound and employees should continue to avoid the area, this should have been addressed at that time;-The facility site report, dated 08/27/25, showed both contractors indicated that employees should continue to avoid working in the area. This should have been addressed for not only the employees but for the residents at that time and it was not because she did not read the report until 09/04/25. NOTE: At the time of the recertification survey, the violation was determined to be at the immediate jeopardy level L. Based on interview and record review completed during the onsite visit, it was determined the facility had implemented corrective action to remove the IJ violation at the 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 F level. This statement does not denote that the facility has complied with State law (Section 198.026.1 RSMo.) requiring that prompt remedial action to be taken to address Class I violation(s). 26044822607524

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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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aspire Senior Living Moberly

700 East Urbandale Drive Moberly, MO 65270

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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on

a full time basis.

Based on interview and record review, the facility failed to provide a Registered Nurse (RN) eight consecutive hours a day, seven days a week, for 15 of 32 days reviewed. The facility census was 70.

Review of the facility policy, Registered Nurse, dated 01/30/24, showed the following: -Purpose: ensure that

an RN is available for supervision in the facility;-Procedure: except when waived, the facility must use the services of an RN for at least eight consecutive hours a day, seven days a week. 1. Review of the facility assessment, revised 05/14/25, showed a staffing plan of eight RN hours per a resident day on the day shift.

1. 2. Review of the facility posted staffing sheets, from 08/05/25 through 09/05/25, documenting staff who

worked each day, showed the following: -No RN coverage on 08/05/25;-No RN coverage on 08/06/25;-No RN coverage on 08/09/25;-No RN coverage on 08/10/25;-No RN coverage on 08/16/25;-No RN coverage

on 08/17/25;-No RN coverage on 08/19/25;-No RN coverage on 08/23/25;-No RN coverage on 08/24/25;-No RN coverage on 08/30/25;-No RN coverage on 08/31/25;-No RN coverage on 09/02/25;-No RN coverage on 09/03/25; -No RN coverage on 09/04/25;-No RN coverage on 09/05/25. During an

interview on 09/04/25 at 2:12 P.M., the staffing coordinator said the following: -She had been doing the scheduled since 08/22/25;-There was supposed to be a RN at least eight hours every day;-She was responsible for ensuring there was adequate nursing staff;-She reported the lack of a RN on the schedule for multiple days to the administrator since the prior Director of Nurses (DON) quit and a new one was hired. During an interview on 09/09/25 at 2:25 P.M., the DON said the following:-She was aware there had been an issue with RN coverage;-The staffing coordinator was responsible for ensuring a RN was on the schedule for eight hours each day;-The facility did not have enough RN's to staff as required. During an

interview on 09/09/25 at 10:11 A.M., the administrator said the following: -There should be an RN scheduled eight hours every day to meet regulation;-The facility utilized the DON and facility nurses that worked as needed (PRN) to fill shifts; -At present the facility was not meeting the requirement for an RN eight hours of every day;-If the staffing coordinator has concerns related to the schedule, she will report those concerns to the DON or herself;-She was not aware there were so many days of no RN coverage.

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