Original Inspection report

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0678

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Provide basic life support, including CPR, prior to the arrival of emergency medical
personnel , subject to physician orders and the resident’s advance directives.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to ensure
residents’ code status was accessible to staff in the event of an emergency for three
residents (Resident #61, #96, and #209); failed to ensure residents’ code status
information was consistently documented throughout the residents’ electronic health record
(EHR) and paper medical records for three residents (Resident #39, #61, and #209); and
failed to have physician orders [REDACTED].#61 and #96). A sample of 21 residents was
selected for review in a facility with a census of 102.
Record review of the facility’s policy, dated [DATE], Advance Directives and Refusal of
Treatment-Missouri, showed the following information:
-Only when the resident’s medical status and the resident’s or family’s wishes indicate,
can DNR (Do Not Resuscitate) and WD/WH (Withdraw and Withhold) forms be completed. This
could be at any point in the resident care-admission, readmission, change in status, etc.;

-These forms and related attachments should be placed in the front of the medical record
housed in a plastic sheath;
-Orders should be written in the physician orders [REDACTED]. The physician must enter the
order personally; no orders for DNR or WD/WH will be taken via telephone. Fax or email
orders are acceptable.
1. Record review of Resident #61’s discharge Minimum Data Set (MDS – a federally mandated
assessment instrument completed by facility staff), dated [DATE], showed the resident
discharged from the facility, return not anticipated on [DATE].
Record review of the resident’s EHR physician order [REDACTED].
Record review of the resident’s EHR face sheet (brief information sheet about the
resident) showed the following information:
-Readmitted to the facility on [DATE];
-[DIAGNOSES REDACTED].
-Code status of DNR.
Record review of resident’s social service notes, dated [DATE], showed the resident had a
signed DNR.
Record review of the resident’s admission MDS, dated [DATE], showed the resident as
cognitively intact.
Record review of the resident’s EHR POS, on [DATE] at 10:14 A.M., did not show a current
order for a DNR code status.
Record review of the resident’s paper medical record showed a signed DNR order dated
[DATE] (one month after the resident returned to the facility).
Record review of the resident’s care plan, dated [DATE], showed end of life wishes to be
honored/DNR added to the resident’s care plan on [DATE]. (The resident’s care plan did not
previously address the resident’s code status.)
Record review of the resident’s paper face sheet, dated [DATE], did not list a code
status.
Observation on [DATE], at 10:14 A.M., showed Registered Nurse (RN) E entered an physician
order [REDACTED].>During an interview on [DATE], at 10:14 A.M., RN E said when a
resident is discharged to the hospital, their orders are discontinued. Once they return
back from the hospital, the orders are re-entered by a nurse. The resident’s DNR order was
not re-entered upon his/her return.
2. Record review of Resident #209’s EHR face sheet showed the following information:

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0678

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 1)
-admitted to the facility on [DATE];
-[DIAGNOSES REDACTED].
-Code status was DNR.
Record review of the resident’s paper medical record, showed a signed DNR order dated
[DATE].
Record review of resident’s social service notes, dated [DATE], showed the resident was
full code.
Record review of the resident’s EHR POS showed an order for [REDACTED].>Record review
of the resident’s care plan, last revised on [DATE], showed the resident to have a DNR.
Record review of the resident’s admission MDS, dated [DATE], showed the resident as
cognitively intact.
Record review of the resident’s paper face sheet, dated [DATE], did not list a code
status.
3. Record review of Resident #96’s face sheet showed the following information:
-Readmitted to the facility on [DATE];
-[DIAGNOSES REDACTED].
Record review of the resident’s POS, dated (MONTH) 2019, showed the advance directive of
DNR started on [DATE] and discontinued on [DATE].
Record review of the resident’s social services note dated [DATE], at 8:35 P.M., showed
the resident had a signed DNR.
Record review of the resident’s 5 day MDS assessment, dated [DATE], showed the following
information:
-Moderately impaired cognition;
-[DIAGNOSES REDACTED].
Record review of the resident’s care plan, last revised on [DATE], did not include the
advanced directive wishes for the resident.
Record review of the resident’s paper chart, on [DATE], showed no signed DNR order.
4. Record review of Resident #39’s face sheet (basic resident information) showed the
following information:
-Original admission date of [DATE];
-[DIAGNOSES REDACTED].
Record review of the resident’s social services note dated [DATE], at 10:33 P.M., showed
the resident as a full code status at that time.
Record review of the resident’s paper chart showed a signed DNR order dated [DATE].
Record review of the resident’s quarterly MDS, dated [DATE], showed the resident as
moderately cognitively impaired.
Record review of the resident’s care plan, last revised on [DATE], did not include the
advanced directive for the resident.
Record review of the resident’s POS, dated (MONTH) 2019, showed the advance directive DNR.
5. During an interview on [DATE], at 8:41 A.M., Certified Nursing Assistant (CNA) H said
he/she would locate the code resident’s code status in the care plan or in the electronic
chart where staff document the activities of daily living (ADL’s).
6. During an interview on [DATE], at 4:01 P.M., CNA L said the following:
-He/she would check in the resident’s chartat the nurses’ station to see if the resident
is DNR;
-If the resident is a DNR code status, then there is a purple sheet put into the front of
the chart;
-If the purple sheet is not in the chart, then he/she is not certain what their code
status is and would have to ask a nurse;
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0678

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 2)
-There is no other place to check for code status that he/she is aware of;
-When in doubt, he/she would perform CPR.
7. During an interview on [DATE], at 4:03 P.M., CNA C said the following:
-If there is a resident in distress, he/she would immediately start CPR;
-If there is time, he/she would check the chart for code status or send someone else to
check the chart;
-When in doubt, he/she will always perform CPR.
8. During an interview on [DATE], at 8:40 A.M., Certified Medication Technician (CMT) G
said he/she would locate a resident’s code status in the Medication Administration Record
[REDACTED]
9. During an interview on [DATE], at 10:14 A.M., Licensed Practical Nurse (LPN) I said
full code and DNR status can be found in the electronic orders. The code status can also
be found in the paper chart.
10. During an interview on [DATE], at 10:14 A.M., Registered Nurse (RN) E said the fastest
way to find a code status is to look at the electronic orders. Full code status is not
listed in the orders.
11. During an interview on [DATE], at 3:40 P.M., the Director of Nursing (DON) and
Assistant Director of Nursing (ADON) said the following:
-The code status is discussed with the resident upon entry into the facility at the 72
hour meeting;
-It is discussed with the residents quarterly;
-If a resident is a code status of DNR, then there is a purple sheet placed in their chart
at the nurses’ station, they get a physician’s orders [REDACTED].
-Every resident is a full code unless they have a signed DNR paper and full code wishes
are not addressed in the resident’s care plan, does not require a physician’s orders
[REDACTED].
-When the resident leaves the facility for a hospital stay, the DNR order should go with
the resident;
-Once the resident returns from the hospital, the code status is discussed again and
updated per the resident’s preference;
-The first place to look for code status is in the physician’s orders
[REDACTED].>-There is no code status listed on the resident’s face sheet;
-A CNA should never look for a code status, they should get a nurse;
-They did not know that the facility policy said to obtain a physician’s orders
[REDACTED].
12. During an interview on [DATE], at 3:40 P.M., the administrator said the following:
-The code status DNR should be put in the resident’s care plan, have a physician’s orders
[REDACTED].
-If the resident does not have a signed DNR, then by default they are considered a full
code;
-He/she did not know that the facility policy said to obtain a physician’s orders
[REDACTED].

F 0690

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Provide appropriate care for residents who are continent or incontinent of
bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract
infections.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0690

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to ensure staff
monitored catheters (a sterile tube inserted into the bladder to drain urine) according to
acceptable standards of practice for two residents (Resident #9 and #34), with history of
urinary tract infections [MEDICAL CONDITION], when the residents’ catheter collection bags
laid on the floor. A sample of 21 residents was selected for review. The facility census
was 102.
Record review of the Center for Disease Control and Prevention’s (CDC) Guideline for
Prevention of Catheter-Associated Urinary Tract Infections, last updated 2/15/17, showed
the following:
-Do not rest the catheter bag on the floor.
Record review of the facility’s catheter care policy titled, Urinary Catheter Care, dated
11/10/14, showed the following information:
-The urine drainage bag should be kept lower than the bladder or an anti-reflux bag should
be used to prevent urine in the tubing and drainage bag from flowing back into the
resident’s bladder;
-Catheter tubing and drainage bags are to be kept off the floor to prevent contamination;
-Secure the catheter with a leg bag or loop to the bed sheet in a comfortable position for
the resident.
1. Record review of Resident #9’s face sheet (basic resident information) showed the
following information:
-Original admission date of [DATE];
-[DIAGNOSES REDACTED].
Record review of the resident’s quarterly Minimum Data Set (MDS), a federally mandated
comprehensive assessment instrument, completed by facility staff, dated 11/23/18, showed
the following information:
-Cognitively intact;
-Required limited assistance with bed mobility, transfers, and dressing;
-Required supervision with toileting and hygiene;
-Indwelling catheter not marked.
Record review of the resident’s care plan, last revised on 3/1/19, showed the following
information:
-Foley (indwelling urinary) catheter;
-Pericare after each incontinent episode;
-Evaluate for medical necessity;
-Observe for signs and symptoms of infections;
-Observe for changes in consistency and color of urine;
-Wear leg band as tolerated and Foley care per shift.
Record review of the resident’s (MONTH) 2019 physician order [REDACTED].
-Foley catheter may use leg band;
-Change catheter with insertion tray or bag and band as needed (PRN);
-May flush Foley as needed for sediment;
-Indwelling Foley catheter with routine catheter care every shift;
-[MEDICATION NAME] (antibiotic) 100 milligram (mg) tablet for UTI prevention related to
personal history of UTI.
Observation on 3/11/19, at 10:23 A.M., showed the following information:
-Resident laid in the bed on the right side;
-Catheter bag attached to the lowest rail of the bed;
-Catheter drain tubing and catheter bag lay on the floor.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0690

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 4)
Observation on 3/13/19, at 10:11 A.M., showed the following information:
-Resident sat up in the bed;
-Catheter bag attached to the lowest rail of the bed;
-Catheter tubing lay on the floor.
Observation on 3/15/19, at 9:38 A.M., showed the following information:
-Resident laid on his/her back in the bed;
-Catheter bag clipped to the lowest rail of the bed;
-Catheter bag touching the floor.
Observation on 3/15/19, at 10:48 A.M., showed the following information:
-Resident laid in the bed on his/her back;
-Catheter bag clipped to the lowest rail of the bed;
-Catheter bag touching the floor.
2. Record review of Resident #34’s face sheet showed the following information:
-Original admission date of [DATE];
-[DIAGNOSES REDACTED].
Record review of the resident’s quarterly MDS, dated [DATE], showed the following
information:
-Severely cognitively impaired;
-Required extensive assistance with bed mobility, transfers, dressing, toileting, and
hygiene;
-Indwelling catheter marked.
Record review of the resident’s care plan, last revised on 3/1/19, showed the following
information:
-Foley catheter;
-Pericare after each incontinent episode;
-Observe for signs and symptoms of infections;
-Observe for changes in consistency and color of urine;
-Foley catheter care every shift, use leg band as tolerated to secure catheter tubing.
Record review of the resident’s (MONTH) 2019 POS showed the following information:
-Foley catheter may use leg band;
-Change catheter with insertion tray or bag and band as needed (PRN);
-May flush Foley as needed for sediment;
-Indwelling Foley catheter with routine catheter care every shift.
Observation on 3/11/19, at 10:23 A.M., showed the following information:
-Resident laid in the bed on his/her back;
-Bed in the lowest position;
-Catheter bag attached to the lowest rail of the bed;
-Catheter tubing and catheter bag rested on the floor.
Observation on 3/12/19, at 9:15 A.M., showed the following information:
-Resident laid in the bed on his/her left side;
-Bed in the lowest position;
-Catheter bag attached to the lowest rail of the bed;
-Catheter bag rested on the fall mat.
Observation on 3/12/19, at 4:24 P.M., showed the following information:
-Resident laid on his/her left side in the bed;
-Bed in the lowest position;
-Catheter bag clipped to the lowest rail of the bed;
-Catheter bag touching the fall mat on the floor.
Observation on 3/13/19, at 9:38 A.M., showed the following information:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0690

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 5)
-Resident laid in the bed on his/her left side;
-Bed in the lowest position;
-Catheter bag clipped to the lowest rail of the bed;
-Catheter bag touching the floor.
Observation on 3/13/19, at 10:16 A.M., showed Certified Nursing Assistant (CNA) K lowered
the resident’s bed, allowing the resident’s catheter collection bag to rest on the floor.
CNA K placed the fall mat next to the bed, but did not reposition the catheter bag off the
floor before leaving the room.
3. During an interview on 3/15/19, at 3:15 P.M., CNA J said the following:
-The catheter bag should be clipped to the bed below the bladder;
-The tubing and the bag should be off the floor at all times;
-Even if the bed is in the lowest position, the catheter bag and tubing should not touch
the floor;
-He/she was told that it was acceptable to place a towel on the floor and then lay the
catheter bag and tubing on top of the towel because it would not be touching the floor.
4. During an interview on 3/15/19, at 12:21 P.M., Registered Nurse (RN) F said the
following:
-He/she expects the CNAs to clip the bag to the bed below the bladder;
-Even when using a high/low bed, the catheter bag and tubing should remain off the floor;
-The CNAs should not use a towel on the floor and then place the catheter bag and tubing
on top of the towel. The bag and tubing would still be considered lying on the floor.
5. During an interview on 3/15/19, at 12:23 P.M., the Assistant Director of Nursing (ADON)
said the following:
-The catheter bag should be clipped to the bed;
-Catheter bags should be hung below the bladder;
-When using high/low beds, the catheter bag should be clipped up higher but still be below
the bladder;
-The catheter bag and tubing should never touch the floor;
-It is not acceptable to lay a towel down and then place the catheter bag and tubing on
the floor on top of the towel, this would still be considered lying on the floor;
-It is not acceptable for the catheter bag or tubing to lie on the fall mat;
-When the CNAs walk by or are in the room, they should check the catheter bag and tubing
and adjust it so that it is off the floor if needed.
6. During an interview on 3/15/19, at 3:40 P.M., the administrator and Director of Nursing
(DON) said the following:
-Catheter bags and tubing are expected to be kept off the floor;
-The catheter bag should be hung below the bladder;
-The CNAs should not use a towel on the floor and then place the catheter bag and tubing
on top of it, that is the same as it lying directly on the floor;
-Even when using high/low beds, the catheter bag and tubing should remain off the floor;
-CNAs should check the bag and tubing every time they walk by or enter the resident’s room
and adjust the bag and tubing if needed.

F 0700

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Try different approaches before using a bed rail. If a bed rail is needed, the
facility must (1) assess a resident for safety risk; (2) review these risks and benefits
with the resident/representative; (3) get informed consent; and (4) Correctly install and
maintain the bed rail.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0700

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to complete a side
rail evaluation form for four residents (Resident #4, #39, #51, and #79); failed to care
plan the use of side rails for three residents (Resident #51, #79, and #212); failed to
obtain physicians orders regarding side rails for four residents (Resident #4, #51, #79,
and #212); and failed to obtain consent and complete safety check for side rails for five
residents (Resident #4, #39, #51, #79, and #212). A sample of 21 residents was selected
for review in a facility with a census of 102.
Record review of the facility’s policy, dated 1/1/19, titled Bedrail Use showed the
following information:
-Bedrails are used to enable a resident/guest to become more functionally independent, and
when the medical condition of the resident/guest requires the use of a bedrail;
-Bedrails could be considered a form of physical restraint; therefore, the need for
bedrails should be identified in the resident/guest assessment, and the care plan, per
resident assessment instruction (RAI) guidelines and regulatory requirements;
-Bedrails may be used to help a resident/guest position or turn him/herself. Provide
instructions to resident/guest as needed. The interdisciplinary team should determine if
the clinical benefits outweigh the risk of a device/bedrail;
-Possible hazards and clinical benefits of the bedrail use should be explained to the
resident/guest and his/her family/legal representative, during the admission process and
upon initial implementation;
-Continued use of bedrails requires documentation of the presence of a medical symptom,
which would necessitate the use of bedrails, or that the bedrails assist the
resident/guest with mobility and transfer abilities and that clinical benefits still
outweigh the risks of use;
-Complete the Enabler/Assistive Device/Side Rail Review upon admission/readmission, upon
initially implementing side rail, with a significant change, and with OBRA assessments.
Side rails should be addressed in the care plan;
-This review includes evaluations for entrapment risk which should also be completed when
mattress or bed type are changed;
-The resident/guest and the resident/guest representative should give informed consent to
the use of the device, prior to its use.
Record review of the facility’s policy (no effective date, currently being reviewed),
titled Resident Beds and Bed Safety Rails Program, showed the following information:
-To establish mitigation and preventative requirements and activities that maintain a
constant state of safety related to resident care beds and bed safety rails;
-Maintain resident beds and to perform bed safety rail audits;
-Preventative maintenance should be conducted on resident beds and bed safety rails on a
monthly and annual basis;
-Monthly resident room checks- each room is to be inspected once a quarter. Every month,
the maintenance supervisor is to divide out the total rooms by three to split the work
evenly across the whole quarter;
-Beds, side rails, cranks, floor locks, bed frames, and mattresses (check for
compatibility of all components to verify that there is no risk of entrapment);
-Bed Safety Rails Audit is schedule to be performed when it is determined that the use of
hand rails is an appropriate application for the resident or when a component/item (i.e.
mattress, etc .) is changed during an existing utilization of the appropriate use of a
hand rail;
-Nursing is responsible for conducting bed audits on the full bed system (frame, mattress,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0700

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 7)
bed rails, and assist devices);
-Audits will be conducted as needed with a change of bed or mattress using the Bed Safety
Action Grid;
-Documentation of audits will be maintained.
1. Record review of Resident #51’s face sheet (basic information sheet) showed the
following information:
-admitted to the facility on [DATE];
-[DIAGNOSES REDACTED].
Record review of the resident’s admission Minimum Data Set (MDS – a federally mandated
comprehensive assessment instrument completed by facility staff), dated 1/23/19, showed
the following information:
-Severe cognitive impairment;
-Total dependence with transfers, toileting, hygiene, and dressing;
-Side rails not used.
Record review of the resident’s care plan, last revised on 02/14/19,showed staff did not
indicate the use of side rails.
Record review of the resident’s (MONTH) 2019 physician order [REDACTED].
Record review of the resident’s medical record, on 03/12/19, showed the record did not
included the following:
-Bed rail assessment/evaluation;
-Bed rail consent form;
-Bed rail safety check form or completion of a regular inspection of the bed frame or bed
rails.
Observation on 03/12/19, at 4:15 P.M., showed round grip rails on both sides of the
resident’s bed in the up position.
During an interview on 03/12/19, at 4:15 P.M., the resident’s responsible party said the
resident cannot use the grip rails on the bed.
2. Record review of Resident #79’s face sheet showed the following information:
-admitted to the facility on [DATE];
-[DIAGNOSES REDACTED].
Record review of the resident’s care plan, last revised on 1/31/19, showed staff did not
indicate the use of side rails.
Record review of the resident’s admission MDS, dated [DATE], showed the following
information:
-Moderate cognitive impairment;
-Required extensive assistance with transfers, toileting, hygiene, and dressing;
-Resident used wheelchair;
-One fall since admission;
-Side rails not used.
Record review of the resident’s (MONTH) 2019 POS showed there was no order for side rails.
Record review of the resident’s medical record, on 03/12/19, showed the record did not
include the following:
-Bed rail assessment/evaluation;
-Bed rail consent form;
-Bed rail safety check form or completion of a regular inspection of the bed frame or bed
rails.
Observation on 03/13/19, at 11:24 A.M., showed the resident’s bed with rounded grip rails,
in the up position, on both sides of the bed.
During an interview on 03/15/19, at 1:19 P.M., Certified Nursing Assistant (CNA) D said
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0700

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 8)
the resident is able to position him/her self, but has to have assistance to get out of
bed.
3. Record review of Resident #212’s face sheet showed the following information:
-admitted to the facility on [DATE];
-[DIAGNOSES REDACTED].
Record review of the resident’s admission MDS, dated [DATE], showed the following
information:
-Severe cognitive impairment;
-Required extensive assistance with transfers, toileting, hygiene, and dressing;
-Total dependence on staff for transfers;
-Resident used wheelchair;
-No falls since admission;
-Side rails not used.
Observation on 03/12/19, at 11:15 A.M., showed half bed rails in the up position on both
sides of the resident’s bed.
During an interview on 03/12/19, at 11:15 A.M., the resident said he/she uses the side
rails to position him/her self. He/she did not request the rails, they were already on the
bed when the resident came to the room.
Record review of the resident’s care plan, dated 03/15/19, showed side rails added as a
care plan goal with interventions on 03/15/19. Prior to 3/15/19, the care plan did not
address side rails.
Record review of the resident’s (MONTH) POS showed an order for [REDACTED].
Record review of the resident’s medical record, on 3/15/19, showed an enabler/assistive
device/side rail review form completed on 03/15/19. Staff did not complete a bed rail
consent form, bed rail safety check form, or completion of a regular inspection of the bed
frame or bed rails.
4. Record review of Resident #4’s face sheet showed the following information:
-Original admission date of [DATE];
-[DIAGNOSES REDACTED].
Record review of the resident’s quarterly MDS, dated [DATE], showed the following
information:
-Moderately cognitively impaired;
-Required extensive assistance with bed mobility, transferring, toileting, and bathing.
-Side rails not used.
Record review of the resident’s care plan, last revised on 3/11/19, showed the following
information:
-Inform resident or responsible party of risk of using enabler;
-Observe for change in ability to release the enabler on command;
-Review need for enabler quarterly as needed;
-Ask family or responsible party for additional approaches as alternative for enabler use;
-Therapy consult as needed.
Record review of the resident’s (MONTH) 2019 POS did not include an order for
[REDACTED].>Observation on 3/11/19, at 10:23 A.M., showed the resident’s bed had
one-fourth side rails attached to the bed on both sides and were in the raised position.
During an interview on 3/13/19, at 2:43 P.M., the resident’s responsible party said due to
the resident’s decline, the resident cannot use the side rails on the bed.
Record review of the resident’s medical record, on 3/14/19, showed staff did not have the
following in the record:
-Quarterly bed rail assessment/evaluation;
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0700

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 9)
-Bed rail consent form;
-Bed rail safety check form;
-Monthly inspection/evaluation of the bed frame or bed rails.
5. Record review of Resident #39’s face sheet showed the following information:
-Original admission date of [DATE];
-[DIAGNOSES REDACTED].
Record review of the resident’s quarterly MDS, dated [DATE], showed the following
information:
-Moderately cognitively impaired;
-Required extensive assistance with bed mobility, transferring, toileting, hygiene, and
dressing.
-Side rails not used.
Record review of the resident’s care plan, last revised on 11/29/18, showed the following
information:
-Inform resident or responsible party of risk of using enabler;
-Observe for change in ability to release the enabler on command;
-Review need for enabler quarterly as needed;
-Ask family or responsible party for additional approaches as alternative for enabler use;
-Therapy consult as needed.
Observation on 3/11/19, at 10:23 A.M., showed the resident’s bed had one-fourth side rails
attached to the bed on both sides and were in the raised position.
Record review of the resident’s medical record, on 3/14/19, showed the record did not
include the following:
-Quarterly bed rail assessment/evaluation;
-Bed rail consent form;
-Bed rail safety check form;
-Monthly inspection/evaluation of the bed frame or bed rails.
6. During an interview on 03/15/19, at 10:14 A.M., Registered Nurse (RN) E said when a
resident is admitted , they use the bed that is in the room, unless the resident needs a
special bed like a bariatric or air mattress.
7. During an interview on 3/15/19, at 9:29 A.M., the Assistant Director of Nursing said
the side rail assessments, are located in the computer for the initial assessment under
enabler assessments. The side rails are not considered restraints and are only considered
enablers to allow residents to assist with turning and bed mobility. The facility obtains
an order for [REDACTED].
8. During an interview on 3/15/19, at 9:29 A.M., the Director of Nursing said the side
rails are only used as enablers and because they are only enablers they do not obtain a
signed consent form for them. The enabler assessment is completed, they obtain an order
from the physician, and then add them to the care plan. He/she did not know where the bed
measurement sheets were kept.
9. During an interview on 3/15/19, at 9:31 A.M., the administrator said they do not do
measurements on beds that use enablers, they only do measurements for side rails and there
is only one resident who utilizes side rails in the facility.
10. During an interview on 3/15/19, at 3:40 P.M., the administrator said the staff should
have taken the following steps:
-Completed the initial assessment and quarterly assessments;
-Completed the measurement sheets;
-Obtained a signed consent form signed by the resident or the resident’s representative;
-Received a physician’s orders [REDACTED].>-Added the enablers to the care plan for all
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0700

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 10)
residents who have enablers or side rails on their beds.

F 0812

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

Procure food from sources approved or considered satisfactory and store, prepare,
distribute and serve food in accordance with professional standards.

Based on observation, interview, and record review, the facility failed to protect food
from possible contamination when staff used potentially contaminated gloves to touch ready
to eat food; when staff ate food while working in the kitchen; when staff stored food on
the floor of the cooler and freezer; prepared food and drinks were stored uncovered; when
dishes were put away wet; and when staff did not ensure dishes, carts, utensils, and
drawers were free from debris. The facility had a census of 102 residents.
1. Record review of the facility’s policy titled Use of Gloves and Hairnets, dated
8/15/09, showed the following information:
-The purpose is prevent the spread of bacteria that may cause food borne illnesses;
-Gloves should be worn when handling food items or irritating chemicals;
-Use utensils such as tongs, serving spoons, etc. to handle food;
-Wear gloves when direct contact between the hands and food occurs;
-Change gloves when activities are changed, or when the type of food being handled is
changed, or when leaving the work station.
Observation of the kitchen on 3/14/19, at 11:18 A.M., showed the following:
-Dietary Aide (DA) L put on gloves and began to cut hard-boiled eggs;
-While still wearing the gloves, he/she opened the cooler door (potentially contaminating
the gloves);
-Removed a bag of lettuce salad;
-Closed the door;
-Opened the bag of lettuce salad;
-Placed gloved hands into the bag of lettuce salad, removed the lettuce salad from the
bag, and placed it on a Styrofoam plate(potentially contaminating the lettuce);
-Closed the bag of salad;
-Picked up the sliced hard-boiled eggs and placed them on top of the lettuce salad
(potentially contaminating the eggs);
-Pulled off a sheet of plastic wrap;
-Covered the lettuce salad plate with the plastic wrap;
-Removed the gloves.
During an interview on 3/15/19, at 2:11 P.M., DA K said the following:
-Wash hands between food preparation, before putting on gloves, after removing gloves, and
after cleaning;
-Do not touch food with bare hands, always use utensils when available and gloves when
utensils are not available;
-Gloves should be changed between tasks and you always wash hands prior to putting on
gloves and after removing gloves.
During an interview on 3/15/19, at 2:21 P.M., the Dietary Manager, Corporate Dietary
Manager, and the Registered Dietitian said the following:
-Hands should be washed upon entry into the kitchen, between tasks, when you leave the
immediate area, when hands become soiled, before putting on gloves, after removing gloves,
and any other time you think about it;

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0812

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 11)
-Gloves are a one use item and should be discarded and another set of gloves applied after
the task is completed.
2. Record review of the 2013 Food and Drug Administration (FDA) Food Code showed the
following:
-An employee shall eat, drink, or use any form of tobacco only in designated areas where
the contamination of exposed food; clean equipment, utensils, and lines; unwrapped
single-service and single-use artciles; or other items needing protection can not result.
Observation of the kitchen on 3/14/19, at 10:28 A.M., showed the dietary manager prepared
food in the kitchen with a Slim(NAME)hanging out of his/her mouth.
Observation of the kitchen on 3/15/19, beginning at 1:47 P.M., showed the following:
-Dietary Manager completed several tasks in the kitchen, including food preparation and
overseeing staff, with a Slim(NAME)hanging out of his/her mouth and while occasionally
chewing on the Slim Jim.
During an interview on 3/15/19, at 2:21 P.M., the Dietary Manager, Corporate Dietary
Manager, and the Registered Dietitian said staff should not eat food in the kitchen area;
there is a small break area right outside of the kitchen for this purpose.
3. Record review of the 2013 FDA Food Code showed the following:
-Food shall be protected from contamination by storing the food in a clean, dry location;
where it is not exposed to splash, dust, or other contamination; and at least 15 cm (6
inches) above the floor;
-Food in packages and working containers may be stored less than 15 cm (6 inches) above
the floor on case lot handling equipment;
-Pressurized beverage containers, cased food in waterproof containers such as bottles or
cans, and milk containers in plastic crates may be stored on a floor that is clean and not
exposed to floor moisture.
Record review of the facility’s policy titled Food Receipt and Storage, dated 8/23/17,
showed foods should be checked for freshness when received and stored in accordance with
Food and Drug Administration (FDA) Food Code recommendations.
Observation of the kitchen on 3/11/19, beginning at 9:59 A.M., showed the following:
-Five stacks of milk crates stacked three high with assorted milk in them, stored directly
on the floor in the walk-in cooler;
-One milk crate of tortilla shells and one crate of a bag of diced potatoes, a bag of
diced green peppers, a bag of diced onions, and a bag of cheddar cheese were stored
directly on the floor under a shelf in the walk-in freezer.
Observation of the kitchen on 3/13/19, beginning at 10:44 A.M., showed the following:
-Five stacks of milk crates stacked five high with assorted milk in them stored directly
on the floor in the walk-in cooler;
-One milk crate of tortilla shells and one crate of a bag of diced potatoes, a bag of
diced green peppers, a bag of diced onions, and a bag of cheddar cheese were stored
directly on the floor under a shelf in the walk-in freezer.
Observation of the kitchen on 3/14/19, at 10:28 A.M., showed the following:
-Five stacks of milk crates stacked five high with assorted milk in them stored directly
on the floor in the walk-in cooler;
-One milk crate of tortilla shells and one crate of a bag of diced potatoes, a bag of
diced green peppers, a bag of diced onions, and a bag of cheddar cheese were stored
directly on the floor under a shelf in the walk-in freezer.
Observation of the kitchen on 3/15/19, beginning at 1:47 P.M., showed the following:
-Five stacks of milk crates stacked five high with assorted milk in them stored directly
on the floor in the walk-in cooler;
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0812

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 12)
-One milk crate of tortilla shells and one crate of a bag of diced potatoes, a bag of
diced green peppers, a bag of diced onions, and a bag of cheddar cheese were stored
directly on the floor under a shelf in the walk-in freezer.
During an interview on 3/15/19, at 2:21 P.M., the Dietary Manager, Corporate Dietary
Manager, and the Registered Dietitian said the following:
-Milk stored in milk crates in the walk-in cooler should be stored on top of an empty
crate that has been flipped upside down;
-Food items stored in the walk-in freezer should never be stored in milk crates on the
floor.
4. Record review of the 2013 FDA Food Code showed food shall be protected from cross
contamination by storing the food in packages, covered containers, or wrappings.
Record review of the facility’s policy titled Food Receipt and Storage, dated 8/23/17,
showed the following information:
-Foods should be checked for freshness when received and stored in accordance with Food
and Drug Administration (FDA) Food Code recommendations;
-Open food items should be covered, labeled, and dated.
Observation of the kitchen on 3/11/19, beginning at 9:59 A.M., showed the following:
-Five trays of 40 cups of assorted liquids including water, milk, and juice, were stored
in the cooler, uncovered and with trays stacked directly on top of open cups;
-Fourty-eight Styrofoam bowls of white cake with cherries and whipped topping and a full
sheet pan of white cake sat on a tiered food cart uncovered.
Observation of the kitchen on 3/13/19, beginning at 10:44 A.M., showed the following:
-Four trays of 38 cups of assorted liquids including water, milk, and juice, were stored
in the cooler, uncovered and with trays stacked directly on top of open cups.
Observation of the kitchen on 3/14/19, beginning at 11:11 A.M., showed the following:
-Four trays of 39 cups of assorted liquids including water, milk, and juice, were stored
in the cooler, uncovered and with trays stacked directly on top of open cups;
-Three trays, each containing 35 Styrofoam bowls of apple crisp and one tray of 12
Styrofoam bowls of apple crisp were stored on the food storage cart uncovered.
Observation of the kitchen on 3/15/19, beginning at 1:47 P.M., showed the following:
-Three trays of 31 plastic cups of assorted liquids including water, juice, and milk were
stored in the cooler uncovered and with trays stacked on top of open cups.
During an interview on 3/15/19, at 2:11 P.M., DA K said the following:
-Open drinks stored in the cooler for lunch should be covered;
-All prepared food on the food storage cart should be kept covered.
During an interview on 3/15/19, at 2:21 P.M., the Dietary Manager, Corporate Dietary
Manager, and the Registered Dietitian said the following:
-Prepared cups of assorted liquids should always be covered with paper sheets and trays
should never be stacked on top of open cups;
-Prepared food items should be covered at all times with paper sheets.
5. Record review of the 2013 FDA Food Code showed items must be allowed to drain and to
air-dry before being stacked or stored. Stacking wet items such as pans prevents them from
drying and may allow an environment where microorganisms can begin to grow.
Record review of the facility’s policy titled, Cleaning of Miscellaneous Equipment and
Utensils, dated 8/23/17, showed staff to air dry dishes.
Observation of the kitchen on 3/11/19, beginning at 9:59 A.M., showed the following:
-Four 1/8 size steam pan and three half size steam pans stacked wet;
-Three gallon plastic pitchers placed in the cabinet still wet.
Observation of the kitchen on 3/14/19, beginning at 11:45 A.M., showed the following:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/31/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265309

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

JOPLIN HEALTH AND REHABILITATION CENTER

STREET ADDRESS, CITY, STATE, ZIP

2218 W 32ND STREET
JOPLIN, MO 64804

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 0812

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 13)
-DA M placed one plastic gallon pitcher in the cabinet, two butcher knives in the knife
holder, and serving spoons in the drawer wet.
During an interview on 3/15/19, at 2:11 P.M., DA K said dishes should be completely dry
before being put away.
During an interview on 3/15/19, at 2:21 P.M., the Dietary Manager, Corporate Dietary
Manager, and the Registered Dietitian said dishes should be completely dry prior to being
put away.
6. Record review of the 2013 FDA Food Code showed non food-contact surfaces of equipment
shall be kept free of an accumulation of dust, dirt, food residue, and other debris.
Observation of the kitchen on 3/11/19, beginning at 9:59 A.M., showed the following:
-Three washed full steam table pans stored with food particles still on them;
-One hundred plastic bowls stacked on serving trays on a tiered shelf, the bowls had been
washed, dried, and covered. Staff stored the bowls with food particles still on them;
-Utensil storage drawers contained small food particles and crumbs.
Observation of the kitchen on 3/13/19, beginning at 10:44 A.M., showed the following:
-Three washed plastic bowls, ready to use for lunch, were covered in food particles.
Observation of the kitchen on 3/14/19, beginning at 11:45 A.M., showed the following:
-DA M placed one metal spatula in the drawer with food debris still on it;
-Black plastic cart used to store clean dishes covered in food debris and dust.
Observation of the kitchen on 3/15/19, beginning at 1:47 P.M., showed the following:
-Six bowls ready to be used for dinner covered in food debris;
-Black plastic cart used to store clean dishes covered in food debris and dust;
-Utensil storage drawers contained small food particles and crumbs.
During an interview on 3/15/19, at 2:11 P.M., DA K said if something is dirty the
expectation is to clean it.
During an interview on 3/15/19, at 2:21 P.M., the Dietary Manager, Corporate Dietary
Manager, and the Registered Dietitian said the following:
-Dishes should be spot checked for residual food particles after being washed;
-The dietary manager checks the daily and weekly staff cleaning schedules, the expectation
is that if something is dirty, the staff will clean it every time even if it has already
been completed for the day or week.