Sarcoxie Health Care Center

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

background checks;-Recently, the corporate office employed new people to conduct background checks, and they did not have the proper access to complete the checks;-Prior to the new corporation, background checks were conducted in-house. The facility would check the EDL, FCSR (family care safety registry completes multiple checks including EDL and CBC), NA registry, and Nurse License Verification Report;-Current as needed staff (LPN A, LPN B, LPN C, and LPN D) had not had a background check complete. During an interview on 09/17/25, at 3:35 P.M., the Social Services Director said the following:-Prior to the new corporation, he/she used to complete the pre-employment background checks for the facility;-He/she would check the EDL, the NA registry, the FCSR, and Nurse License Verification Report, if applicable. During an interview on 09/17/25, at 3:45 P.M., the Administrator said the following:-Corporate staff conducts the background checks;-The Business Manager works with corporate to ensure the checks are complete;-He/she was not familiar with the process of when all checks need to be complete. Complaint #2616644

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

11/14/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sarcoxie Health Care Center

1505 Miner Sarcoxie, MO 64862

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 0725 Level of Harm - Minimal harm or potential for actual harm

worked a 20-hour shift but does not remember the exact date.During an interview on 09/17/25, at 3:45 P.M.,

the Administrator said the following:-Nursing staff works long hours;-The facility is meeting the resident's needs however he/she is concerned about nurses caring for the residents when they are tired;-The corporation will not provide agency staff. #2609923 and #2616644

Residents Affected - Some

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

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

11/14/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sarcoxie Health Care Center

1505 Miner Sarcoxie, MO 64862

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

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

Based on record review and interview, the facility failed to maintain an effective infection prevention and control program when the facility failed to have processes in place to ensure all new staff were screened prior to employment for tuberculosis (TB - a serious illness that mainly affects the lungs and can be spread when a person with the illness coughs, sneezes or sings) when the facility did not complete TB testing for four staff (Licensed Practical Nurse (LPN) A, LPN B, LPN C, and LPN D). The facility census was 39.Review of the facility policy titled, Tuberculosis Testing, revised 06/29/23, showed the following:-Upon hire, a new employee will receive a two-step PPD (purified protein derivative - the protein solution used in

the TB skin test to detect exposure to the tuberculosis bacterium).Review of 19 CSR 20-20.100 Tuberculosis Testing for Residents and Workers in Long-Term Care Facilities showed the following: -Long-term care facilities shall screen their residents and staff for tuberculosis using the Mantoux method purified protein derivative (PPD) five tuberculin unit (5 TU) test;-Each facility shall be responsible for ensuring that all test results are completed, and that documentation is maintained for all residents, employees, and volunteers;-All new long-term care facility employees and volunteers who work ten or more hours per week are required to obtain a Mantoux PPD two-step tuberculin test within one month prior to starting employment in the facility;-If the initial test is zero to nine millimeters (mm, the second test should be given as soon as possible within three weeks after employment begins, unless documentation is provided indicating a Mantoux PPD test in the past and at least one subsequent annual test within the past two (2) years;-It is the responsibility of each facility to maintain a documentation of each employee's and volunteer's tuberculin status.1. Review of Licensed Practical Nurse (LPN) A personnel record showed the following:-Hire date of 09/07/25;-Start date on the floor of 09/11/25;-Staff did not have documentation of completion of the 2-step TB skin test. 2. Review of LPN B personnel record showed the following:-Hire date of 09/05/25;-Start date on the floor of 09/05/25;-Staff did not have documentation of completion of the 2-step TB skin test. 3. Review of LPN C personnel record showed the following:-Hire date of 09/05/25;-Start date on the floor of 09/04/25;-Staff did not have documentation of completion of the 2-step TB skin test. 4.

Review of LPN D personnel record showed the following:-Hire date of unknown;-Start date on the floor of 09/06/25;-Staff did not have documentation of completion of the 2-step TB skin test. 5. During an interview

on 09/17/25, at 1:58 P.M., the Director of Nursing (DON) said the following: -TB testing needs to be complete prior to the staff's start date;-Any nurse can administer the TB test;-He/she did not complete TB testing on the new hires.During an interview on 09/17/25, at 3:15 P.M., the Business Office Manager (BOM) said the following:-TB testing is normally completed before staff start working;-TB testing has not been complete on the new as needed staff;-All the as needed staff work in other long-term care facilities but have not provided verification of their TB testing from their other facility.During an interview on 09/17/25, at 3:45 P.M., the Administrator said the following:-Any nurse can complete TB testing;-TB testing should be done

before they start and can be read the day the start on the floor. Complaint #2616644

Residents Affected - Some

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

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

11/14/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sarcoxie Health Care Center

1505 Miner Sarcoxie, MO 64862

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)

Federal health inspectors cited SARCOXIE HEALTH CARE CENTER in SARCOXIE, MO for a deficiency under regulatory tag F-F0919 during a complaint investigation conducted on 2025-11-14.

Category: Environmental Deficiencies

The facility was found deficient in the following area: Make sure that a working call system is available in each resident's bathroom and bathing area.

Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 4 deficiencies cited during this inspection of SARCOXIE HEALTH CARE CENTER.

Correction Status: Deficient, Provider has no plan of correction.