Sylvia G Thompson Residence Center, Inc

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

milliliters (ml) suspension, by mouth, give 30 ml daily as needed for constipation, start date 05/23/25; -Polyethylene Glycol Powder 17 grams (gm) mixed in juice or water by mouth, every other day for constipation, start date 07/31/25. During an interview on 08/26/25 at 11:37 A.M., the resident said he/she has issues with constipation and takes medications to help provide relief. The resident said he/she recently started increasing fruits in his/her diet to help provide added relief from constipation.During an interview on 08/26/25 at 2:33 P.M., the Care Plan Coordinator said he/she uses information from the resident's POS, nurses' notes, and the Interdisciplinary Team meetings to add interventions to the resident's care plan, but would have only included interventions for constipation if the resident had triggered or expressed constipation in the seven-day review period of the MDS assessment dated [DATE REDACTED] 5. During an interview on 08/26/25 at 2:09 P.M., Licensed Practical Nurse (LPN) D said nurses use care plans to help guide each resident's care, and the Care Plan Coordinator is responsible to update the residents' care plans per schedule and with changes regarding specific care needs for the residents. The LPN said interventions to address pain, treatment for injuries, bowel and bladder incontinence and constipation should be included

on the residents' care plans if applicable. During an interview on 08/26/25 at 2:33 P.M., the Care Plan Coordinator said he/she is responsible to update the residents care plans quarterly, after an injury/fall, and with significant changes. He/She said he/she usually updates the care plans within a week, usually on Fridays after an injury or change in condition. He/She said he/she was not sure if anyone double checks that the care plans are updated. During an interview on 08/26/25 at 3:39 P.M., the administrator said the Care Plan Coordinator is responsible to update residents' care plans quarterly, and within seven days after

a fall or other injury. The administrator said the residents' medical chart is a part of the residents' care plan.

Complaint #2596159 and 2599788

Event ID:

Facility ID:

26A378

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

26A378

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sylvia G Thompson Residence Center, Inc

3333 W Tenth Street Sedalia, MO 65301

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 0689 Level of Harm - Actual harm Residents Affected - Few

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

resident.During an interview on 08/26/25 at 3:19 P.M., the Assistant Director of Nursing (ADON) said CNAs can administer warm packs to a cognitive resident, but after consulting with the nurse so the nurse can further assess the resident's need/request for the warm pack, and the CMT or nurse to follow up with the resident. The ADON said staff should monitor a resident within 15 minutes if they apply a warm/cold pack to

a resident's skin. During an interview on 08/26/25 at 3:57 P.M., Nursing Assistant (NA) F said he/she was training with CNA G when the incident occurred. The NA said CNA G placed a washcloth with warm water

in a plastic bag and heated the bag in the microwave for about 15 seconds. The NA said he/she mentioned to CNA G that the bag was probably too hot, and CNA G wrapped the bag into a towel and placed it on the resident's shoulder. The NA said he/she found out the next day the resident had sustained burns to his/her shoulder, and he/she has not received any in-services regarding how to use a warm pack since the incident. During an interview on 08/26/25 at 5:32 P.M., Licensed Practical nurse (LPN) C said he/she reported to work at 10:30 P.M., and the evening shift staff did not report to him/her that staff had placed a warm pack on the resident's shoulder. The LPN said when he/she went to assess the resident shortly after midnight, he/she found the resident laying on a plastic bag with a wet washcloth under his/her left arm between his/her upper back/side. The LPN said he/she removed the towel and plastic bag, assessed the resident's skin with redness and blisters, measured the areas, applied an initial treatment, administered pain meds to the resident, notified the resident's family and Primary Care Physician (PCP). The LPN said

the CNAs can apply warm packs if they have been educated and directed by the nurse to do so, and the nurse is responsible to monitor the resident's skin. The LPN said he/she would prefer to apply a warm pack to the resident him/herself, particularly since the resident has decreased sensation due to his/her diagnosis and would need to be monitored more closely.During an interview on 08/27/25 at 1:07 P.M., the resident's physician said he/she would expect facility staff to be educated on the proper application of warm packs if

they should use it on a resident in the future. Complaint #2596159

Event ID:

Facility ID:

26A378

If continuation sheet