Riverview Nursing Center

F 0567 During an interview on 05/21/25 at 10:10 A.M., the Administrator said he/she reviews the accounts receivable aging report monthly with the BOM. The Administrator said he/she is aware there are outstanding Level of Harm - Minimal harm or credits that need to be refunded. The Administrator said after they review the report if they find any credits potential for actual harm the BOM will submit a refund request to the Recovery Specialist. The Administrator said once the refund request is submitted the Recovery Specialist is responsible to ensure all the claims are paid and supply a Residents Affected - Some refund check for the resident and/or responsible party. The Administrator said once the Recovery Specialist gets the refund check he/she is responsible for updating the accounts receivable report in the computer system and sending a copy of the check to the BOM for the facility records. The Administrator said resident refunds should be issued within 30 days of discharge from the facility and he/she is not sure why the Recovery Specialist is not doing this within the timeframe. The Administrator said he/she is aware the facility has credits more than 30 days old that need to be refunded and he/she said the only reason he/she knows

they aren't refunded within 30 days is due to the Recovery Specialist not processing the requests timely after

the facility submits them. The Administrator said the facility does not have written permission to hold the resident money after discharge.

During an interview on 05/21/25 at 10:30 A.M., the Regional Director of Operations said the the facility BOM is responsible to review the accounts receivable aging report each month and submit any credits to the Recovery Specialist for a refund. Once the Recovery Specialist gets a refund request the Recovery Specialist is responsible to ensure all claims are paid, and request a check for the amount left to refund. Once the Recovery Specialist has the refund check it is his/her responsibility to update the acccounts receivable aging report, mail the check to the resident and/or responsible party, and send the facility BOM a copy of the check. Refunds are to be issued within 30 days of a resident discharge and he/she expects this to be done. It is corporate policy to pay refunds out by the 17th of each month. The Regional DOP said he/she is aware refunds were not being completely timely has determined they were not being processed timely by the recovery specialist.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 6 265434 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 265434 B. Wing 05/21/2025

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

Riverview Nursing Center 10303 State Road C Mokane, MO 65059

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 0761 -One half tablet of 500 mg metformin (used for diabetes);

Level of Harm - Minimal harm or -Two white, round tablet, unmarked and unidentifiable; potential for actual harm -One tablet of 200 mg Ibuprofen (analgesic); Residents Affected - Some -One tablet of 15 mg Mirtazapine (anti-depressant medication);

-One pink, round tablet, unmarked and unidentifiable.

During an interview on [DATE REDACTED] at 10:48 A.M., the ADON said the CMT's should ensure the cart is clean and free of loose pills at the end of every shift. The ADON said it is the responsibility of the ADON and DON to ensure the CMT's are cleaning the medication carts. There should not be loose pills in the medication carts.

During an interview on [DATE REDACTED] at 11:00 A.M., the DON said the CMT's should ensure the cart is clean and free of loose pills at the end of very shift during their narcotic medication count. He/she did not know why staff are not doing it, he/she has told them several times to do that. The DON said it is the responsibility of

the ADON and the DON to make sure the staff check and clean the carts. The DON said he/she has not consistently been checking the carts as he/she should. It is not okay to have 21 loose pills in the medication cart drawers.

During an interview on [DATE REDACTED] at 11:13 A.M., the administrator said the CMT's should clean and check the medication carts for loose pills every shift. The administrator said he/she did not know why the CMT's are not checking their medication carts every shift. The loose pills should not have been in the medication cart. The administrator said he/she, the ADON and DON are ultimately responsible for checking the medication carts.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 6 of 6 265434