Union Nursing

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

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

to complete a questionnaire or written statement. CNA A said the DON did not notify him/her the resident had made a sexual allegation against him/her or informed him/her of a suspension from work, and he/she returned to the facility on [DATE REDACTED] and worked for 12 hours on day shift. During an interview on 10/24/25 at 3:02 P.M., Licensed Practical Nurse (LPN) D said he/she was the charge nurse on the night of 10/21/25,

the DON contacted him/her the morning of 10/22/25 with questions about CNA A's interactions with the resident during the night shift on 10/21/25, but he/she was not asked to complete a questionnaire or written statement. During an interview on 10/28/25 at 11:54 A.M., Certified Medication Technician (CMT) C said he/she worked on 10/21/25 from 6:15 A.M. until 12:21 A.M., but he/she was not interviewed or asked to complete a questionnaire or written statement regarding the resident's allegations. During an interview on 10/28/25 at 3:33 P.M., the resident's physician said he/she was at the facility on 10/23/25, but facility staff did not notify him/her of the resident's allegation of sexual abuse until 10/24/25 and he/she would expect staff to notify him/her when the incident occurred if the policy directed staff to do so. During an interview on 10/28/25 at 12:53 P.M., the administrator said in his/her absence from the facility, the DON was in charge and should have placed CNA A on suspension until he/she completed the investigation, the physician should have been notified shortly after the allegation was made, and all staff who worked the night shift on 10/21/25 should have been interviewed or asked to provide a statement. Complaint #2651547

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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

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Union Nursing

1080 Marie Lane Union, MO 63084

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Based on record review and interview, facility staff failed to contact local law enforcement and failed to report an allegation of sexual abuse for one resident (Resident #1) out of one sampled resident to the Department of Health and Senior Services (DHSS) within the two-hour required timeframe. The facility's census was 58.1. Review of the facility's Abuse, Prevention and Prohibition policy, revised 2021, showed staff are directed as follows: -Abuse includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled using technology;-The person made aware of allegations of abuse or neglect OR the administrator will report the allegations of abuse and neglect to the mandated state agency and law enforcement;-The allegation will be reported no later than two hours after the allegation is made if the events that cause the allegation involve abuse or result in serious bodily injury. 2.

Review of Resident #1's admission Minimum Data Set (MDS), a federally mandated assessment tool, dated 10/03/25, showed staff assessed the resident as cognitively intact, and diagnoses to include urinary tract infection (UTI), fractures and other multiple trauma. Review of the facility's initial investigation report, dated 10/22/25, showed the Director of Nursing (DON) documented the resident reported to staff and his/her family that he/she had been sexually abused the night before by the male aide. The report did not contain documentation facility staff reported the allegation to DHSS within the two-hour timeframe after the resident and his/her family member reported the allegation of sexual abuse, and did not notify the local law enforcement. Review of the DHSS complaint/facility self-report database did not contain documentation of a facility report in regard to resident's allegation of sexual abuse to DHSS. During an interview on 10/24/25 at 10:20 A.M., the DON said the administrator was out, and he/she was responsible to report any abuse allegations to DHSS within two hours after the allegation is made. The DON said he/she did not report to DHSS or local law enforcement because after he/she spoke with the resident and family, he/she determined it was not a true allegation. During an interview on 10/28/25 at 12:53 P.M., the administrator said in his/her absence, the DON was responsible to report any allegations of abuse to DHSS within two hours after the allegation is made, and to local law enforcement. He/She said he/she was not sure why the DON did not report the allegation to DHSS. Complaint# 2651547

Event ID:

Facility ID:

If continuation sheet