Mary, Queen And Mother Center
Inspection Findings
F-Tag F0580
F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Based on interview and record review, the facility failed to notify a resident's responsible part after a change
in condition that required an alteration in the resident's treatment plan (Resident #1). The sample size was
- 3. The census was 74.Review of the facility's Notification of Change Policy dated 11/28/17, showed the
purpose of this policy ensures the facility promptly informs the resident, consults the resident's physician; and notifies, consistent with his or her authority, the resident's representative when there is a change requiring notification: -Compliance guidelines: The facility must inform the resident, consult with the resident's physician and /or notify the resident's member or legal representative when there is a change requiring such notification; -Circumstances requiring notification include new treatment. Review of Resident #1's Minimum Data Set (MDS, a federally mandated assessment instrument completed by facility staff), dated 8/22/25, showed:-Intact cognition;-Diagnoses included stroke with hemiplegia and hemiparesis of right dominant side, open wound of left breast subsequent encounter of left breast biopsy, and seizures.
Review of the resident's nursing progress notes, showed:-On 10/16/25 Surgical area of left breast dehisced (opened). Physician and nurse manager notified, received orders for antibiotic times 7 days, triple antibiotic ointment and dry dressing;-On 10/22/25 Resident representative contacted informed of dehisced surgical wound to left breast, current antibiotic and wound care orders. Representative requested resident to be sent to hospital;-No documentation the resident representative was notified of the change in condition prior to 10/22/25. During an interview on 11/3/25 at 8:03 A.M., the Administrator and Registered Nurse (RN) A said the nurse on the floor, Licensed Practical Nurse (LPN) D, called the physician and was supposed to call the family but according to the records, he/she did not call the family about the resident's change in condition. The resident had been on an antibiotic for a couple days when the family texted RN A and said
they were just informed by the resident that the resident's surgical incision was open and infected and the resident was started on an antibiotic. During the text the family requested the resident to be sent to the hospital for follow up. During an interview on 11/4/25 at 12:38 P.M., The administrator and RN B said they would expect staff to notify family as soon as possible when a resident has a change in condition and definitely before their shift is over. 2651240
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
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
11/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mary, Queen and Mother Center
7601 Watson Road Shrewsbury, MO 63119
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-Tag F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
were aware the resident's lumpectomy incisional wound had not been followed up on and physician orders were not entered into resident's orders and treatment administration records. They were aware a nurse applied steri strips and wound dressing to the resident's incisional site without a physician order. They were also aware the resident was given cereal the morning of surgery when there was an ordered for NPO after midnight. The nurse is supposed to inform the CNAs so they remove water cups. They are unsure how this happened because there was a physician order and treatment administration record for resident to be NPO
after midnight. 2651240
Event ID:
Facility ID:
If continuation sheet
MARY, QUEEN AND MOTHER CENTER in SHREWSBURY, MO inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in SHREWSBURY, MO, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from MARY, QUEEN AND MOTHER CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.