Original Inspection report

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 0550

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Honor the resident’s right to a dignified existence, self-determination, communication,
and to exercise his or her rights.

Based on observation, interview, and record review, the facility failed to maintain and/or
enhance the dignity of five residents (Residents #30, #37, #84, #95, and #149) out of 32
reviewed residents. The facility did not serve meals as scheduled and caused the residents
to wait extended periods of time. This practice potentially effected all residents in a
facility with a census of 108.
1. Record review of the facility’s posted meal times showed staff served:
– The cognitive unit lunch between 11:45 A.M. and 12:00 P.M.;
– The men’s unit between 12:00 P.M. and 12:15 P.M.;
– The women’s unit between 12:15 P.M. and 12:30 P.M.;
– The open dining (main dining room) between 12:30 P.M. and 1:30 P.M.
Observation on 12/04/18 at 11:40 A.M. showed staff continued to prepare food. The
Certified Dietary manager (CDM) said that staff did not have time to get things done.
Observation on 12/04/18 from 11:47 A.M. to 2:00 P.M., of the women’s unit showed:
– Juices and drinks delivered to the hall at 12:07 P.M., and placed in a locked room;
– Residents getting up and going back and forth to their rooms while waiting on food;
– Residents that smoked wanted to go ahead and smoke but had to wait until food delivered
to them;
– Meal trays delivered at 1:27 P.M.;
– Juices and drinks delivered to residents from the locked room at 1:30 P.M.
Observation on 12/04/18 at 2:10 P.M. showed staff still serving lunch to residents.
During a group interview on 12/05/18 at 10:00 A.M., Residents #30, #37, #84, #95, and #149
said:
– The food is usually late on all meals;
– They were told that the kitchen staff was understaffed.
Interviews with Food Service Staff (FSS) on 12/04/18 showed:
– At 12:55 P.M., the Assistant Dietary Manager (ADM) said they ran out of clean plates;
– At 1:10 P.M., FSS A said they had ran out of clean trays;
– At 1:27 P.M., Certified Medication Technician (CMT) H said the meals are usually
delivered between 12:30 P.M. to 12:45 P.M., on the women’s unit;
– At 1:30 P.M., FSS B said they were running short on clean small bowls because they were
needed for dessert and vegetables;
– At 1:40 P.M., the ADM said she was not sure why staff had not washed all the dishes
before meal services. She said that the staff ran out of carrots, potatoes, and roast beef
at lunch. FSS A said she prepared enough food for 150 but did not allow for all the
residents who received double portions.
– At 1:45 P.M., the CDM said staff should have washed dishes before the meal but did not
get them done. She said meals had been late before but lunch was really bad because staff
did not work together.
– At 4:35 P.M., FSS C said they were out of silverware and had to wash more.
Record review of the facility’s policy on Dining Rooms dated 4/6/17 showed Dietary will
deliver trays at scheduled times or call if the time is going to be different from normal
schedule.

F 0584

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Honor the resident’s right to a safe, clean, comfortable and homelike environment,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 0584

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 1)
including but not limited to receiving treatment and supports for daily living safely.

Based on observation and interview the facility failed to maintain the shower room on the
cognitive unit. The facility census was 108.
1. Observation on 12/05/18 at 8:39 A.M. of the shower room on the cognitive unit showed:
– Seat of shower chair with fecal material;
– Wet cotton material with red substance in shower floor;
– Small pieces of fecal material in three areas of the floor.
Observation on 12/06/18 at 2:13 P.M. of the shower room on the cognitive showed:
– A persistent foul odor throughout the room;
– Water on the floor outside the shower area;
– Dirty towels lay on the floor;
– Clothes hangers and trash lay in the corner of the floor of the dressing area of the
shower room.
Observation on 12/07/18 at 10:11 A.M. of the shower room on the cognitive unit showed:
– A persistent foul odor throughout the room;
– The shower room messy with trash and items on the floor of the dressing area;
– Sink full of body scrubbers in the dressing area.
Observation on 12/07/18 at 11:56 A.M. of the shower room on the cognitive unit showed:
– Shower room floor wet;
– Dirty washcloths and towels on the floor;
– Body scrubbers scattered over the floor.
During an interview on 12/07/18 at 11:35 Certified Nurse Aide (CNA) T said the shower
rooms are supposed to be cleaned after each shower. The shower rooms should be cleaned by
the aides and the disinfectant should be used to clean the shower rooms.
During an interview on 12/07/18 at 1:15 P.M. the Corporate Consultant said the women’s
unit had been allowed to also take showers in the cognitive unit shower, due to the
women’s shower being remodeled.
The facility did not provide a policy on cleaning schedules.

F 0607

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Based on record review and interview, the facility staff failed to check, prior to hire,
the Certified Nurses’ Assistant (CNA) Registry for all staff to ensure they did not have a
Federal Indicator (a marker given by the federal government to individuals who have
committed abuse/neglect), for eight of ten sampled staff. The facility also failed to
complete a Criminal Background Check (CBC) for four of ten sampled staff prior to hiring,
and failed to check the Employee Disqualification List (EDL) for two of ten sampled staff
prior to hire. The facility census was 108.
1. Record review of the facility’s policy and procedure for Applicant, Employee and
Volunteer Background Investigations, revised on 10/5/11, showed:
– Each applicant for a position in the nursing home will complete a Request for Criminal
Record Check and a Request for Consent to Employee Disqualification Check form;
– This form will be completed after an employment application has been completed and
submitted, but before a new hire starts working;

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 0607

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 2)
– Applicants may not start work until the CBC has been completed and reviewed for
eligibility, and the CNA Registry has been completed and found to be acceptable. Licensed
Practical Nurses (LPN’s) and Registered Nurses (RN’s) must be checked with the State of
Missouri Department of professional Registration.
Review of the facility personnel records showed:
– Housekeeping Staff (HSK) I hired on 2/8/18, with an EDL and CNA Registry check on
2/14/18, six days after hire. The facility did not provide evidence of a CBC;
– HSK J hired on 3/6/18. The facility did not provide evidence of a CBC or CNA Registry
check prior to hire;
– Registered Nurse (RN) K hired on 6/6/18, with an EDL and CNA Registry check on 6/11/18,
five days after hire. The facility did not provide evidence of a CBC;
– HSK M hired on 7/27/18. The facility did not provide evidence of checking the CNA
Registry;
– CNA O hired on 9/26/18. The facility did not provide evidence of checking the CNA
Registry;
– CNA P hired on 10/2/18. The facility did not provide evidence of checking the CNA
Registry;
– CNA Q hired on 10/9/18. The facility did not provide evidence of checking the CBC or the
CNA Registry;
– CNA R hired on 10/9/18. The facility did not provide evidence of checking CNA Registry.
During an interview on 12/7/18 at 1:15 P.M., the Administrator said:
– Some of the CBC’s, EDL’s and CNA Registry check were just missed;
– They are working to be sure that new staff do not start work until the required
background checks are completed.

F 0623

Level of harm – Potential for minimal harm

Residents Affected – Many

Provide timely notification to the resident, and if applicable to the resident
representative and ombudsman, before transfer or discharge, including appeal rights.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on interview and record review, the facility failed to notify the
resident/resident’s representative and the Office of the State Long-Term Care Ombudsman
when six residents (Resident #2, # 3, #50, #80, #93, and #99) of six sampled residents
were transferred to the hospital. The facility census was 108.
1. Record review of Resident #2’s nurses notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Review of the resident’s record showed no documentation of notifying the resident, the
resident’s representative or the local Office of Long-Term care Ombudsman in writing of
the reason of Resident #2’s transfer to the hospital.
2. Record review of Resident #3’s nurses notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Review of the resident’s record showed no documentation of notifying the resident, the
resident’s representative or the local Office of Long-Term care Ombudsman in writing of
the reason of Resident #3’s transfer to the hospital.
3. Record review of Resident #50’s nurses notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Review of the resident’s record showed no documentation of notifying the resident, the
resident’s representative or the local Office of Long-Term care Ombudsman in writing of

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 0623

Level of harm – Potential for minimal harm

Residents Affected – Many

(continued… from page 3)
the reason of Resident #50’s transfer to the hospital.
4. Record review of Resident #80’s nurses notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Review of the resident’s record showed no documentation of notifying the resident, the
resident’s representative or the local Office of Long-Term care Ombudsman in writing of
the reason of Resident #80’s transfer to the hospital.
5. Record review of Resident #93’s nurses notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Review of the resident’s record showed no documentation of notifying the resident, the
resident’s representative or the local Office of Long-Term care Ombudsman in writing of
the reason of Resident #93’s transfer to the hospital.
6. Record review of Resident #99’s nurse’s notes showed the resident discharged on [DATE]
and did not return.
Review of the resident’s record showed no documentation of notifying the resident, the
resident’s representative or the local Office of Long-Term care Ombudsman in writing of
the reason of Resident #99’s discharge.
During an interview on 12/06/18 at 1:32 P.M., the Administrator said:
– The facility has not been notifying the resident or the resident’s representative in
writing of the reason of transfer and she was not aware that they were supposed to notify
the ombudsman;
– They will start to notify the resident or the resident’s representative in writing of
the reason for transfer and notify the ombudsman.
Record review of the Transfer to Hospital Policy, dated (MONTH) 6, (YEAR), showed:
– Prior to discharge/transfer, the Social Service Director will notify the resident’s
family, next of kin or legal representative regarding transfer/discharge;
– Location of the transfer/discharge;
– Reason for the transfer discharge.

F 0625

Level of harm – Potential for minimal harm

Residents Affected – Many

Notify the resident or the resident’s representative in writing how long the nursing
home will hold the resident’s bed in cases of transfer to a hospital or therapeutic
leave.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review, the facility failed to inform the resident and
family or legal representative of their bed hold policy at the time of transfer to the
hospital for five residents (Resident’s #2, #3, #50, #80 and #93) of five sampled
residents. The facility census was 108.
1. Record review of Resident #2’s nurses notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Review of the resident’s record showed no documentation the resident or the resident’s
representative was informed in writing of the facility’s bed hold policy at the time of
transfer on 7/05/18.
2. Record review of Resident #3’s nurse’s notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Review of the resident’s record showed no documentation the resident or the resident’s
representative was informed in writing of the facility’s bed hold policy at the time of

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 0625

Level of harm – Potential for minimal harm

Residents Affected – Many

(continued… from page 4)
transfer on 12/02/18.
3. Record review of Resident #50’s nurse’s notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Review of the resident’s record showed no documentation the resident or the resident’s
representative was informed in writing of the facility’s bed hold policy at the time of
transfer on 9/17/18.
4. Record review of Resident # 80’s nurse’s notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Review of the resident’s record showed no documentation the resident or the resident’s
representative was informed in writing of the facility’s bed hold policy at the time of
transfer on 8/15/18.
5. Record review of Resident # 93’s nurse’s notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Review of the resident’s record showed no documentation the resident or the resident’s
representative was informed in writing of the facility’s bed hold policy at the time of
transfer on 11/13/18.
During an interview on 12/06/18 at 1:38 P.M., the Administrator said the facility gives
the bed hold policy on admission, and management has been working on implementing this but
they just didn’t have it in place yet
Record review of the Bed Hold Policy, Revised (MONTH) 27, (YEAR), showed:
– When a resident is admitted to the facility, they receive a copy of the bed hold policy;
– When a resident is discharged to the hospital, the facility will provide to the resident
or their legal representative, a copy of the bed hold policy.

F 0802

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

Provide sufficient support personnel to safely and effectively carry out the functions
of the food and nutrition service.

Based on observation, interview, and record review, the facility failed to have
sufficient, competent food service staff to safely and effectively prepare and serve
palatable food at appropriate times in a sanitary manner. This practice effected all
residents in a facility with a census of 108.
1. Observation of the food service department on 12/4/18 from 10:00 A.M. through 2:10 P.M.
showed:
– Staff did not wash their hands and/or change gloves when contaminated;
– Staff did not wear effective hair restraints;
– Staff did not follow menus and recipes;
– Staff did not appropriately wash or store dishes;
– Staff did not maintain the cleanliness of food carts;
– Staff did not serve meals at the scheduled meal times causing the residents to wait for
extended periods of time.
During an interview 12/4/18 at 11:40 A.M., the Certified Dietary Manager (CDM) said lunch
would be late because staff did not have time to get things done.
Observation on 12/4/18 at 12:18 P.M., 12:55 P.M., 1:10 P.M. showed the ADM, Food Service
Staff (FSS) A, and FSS C commented there were no clean plates, trays, and silverware while
serving lunch. At 2:10 P.M., 40 minutes after the scheduled end of meal service, FSS A
said the facility ran out of food for lunch and would have to prepare hamburgers for the

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 0802

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 5)
remaining residents.
2. Record review of the facility’s undated orientation checklist policy showed the policy
directed orientation be completed for new hires. It did not specify when the orientation
should be completed.
During an interview on 12/4/18 at 1:12 P.M., FSS D said he/she had been at the facility
for two days (hire date of 12/2/18) and had no training.
Observation on 12/5/15 at 9:45 A.M., after requests for orientation checklists, showed the
CDM completing an orientation checklist for FSS D.
During an interview on 12/5/18 at 9:45 A.M., the CDM said she normally completed
orientation on an employee’s first day but she did not provide orientation to FSS D. The
CDM was completing the orientation checklist after a request to see the checklist from
SLCR. The CDM said the policy did not specify when orientation had to be done.
During an interview, the Administrator said she expected orientation to be done before
staff started working.
3. Record review of the facility’s consultant Registered Dietitian’s (RD) report, dated
10/25/18, showed the RD recommended the CDM conduct training on handwashing, glove use,
menus, recipes, infection control, plating and presentation.
Record review of a training sign in sheet, dated 10/30/18, showed the CDM conducted
training on glove use and infection control. The CDM did not conduct training on all areas
recommended.
Record review of the RD’s report, dated 11/28/18, showed the RD recommended the CDM
conduct training on handwashing, food temperatures, production time lines, and staff
responsibility. The RD noted she would follow up the following week with trainings on
menus and recipes and would reinforce the CDM trainings.
During an interview on 12/5/18 at 10:45 A.M., the CDM said she thought she might have done
the training the RD said to do on 10/25/18 but did not do any of the recommended training
from the RD’s 11/28/18 recommendations. The CDM did not do the trainings because she did
not have time.

F 0803

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

Ensure menus must meet the nutritional needs of residents, be prepared in advance, be
followed, be updated, be reviewed by dietician, and meet the needs of the resident.

Based on observation, interview and record review, the facility failed to follow approved
menus and recipes when preparing and serving food to residents. This practice effected all
residents in a facility with a census of 108.
1. Record review of the facility’s approved menu for lunch on 12/4/18 showed the menu
directed staff to serve residents one and one-half inch slices of sponge cake with four
ounces fruit.
Review of the facility’s approved menu for sponge cake with fruit showed the recipe
directed staff to serve slices of sponge cake with four ounces well-drained peaches.
Observation on 12/4/18 at 11:47 A.M. showed Food Service Staff (FSS) B prepared dessert
using a three ounce scoop to dish peaches and juice on cake
During an interview on 12/4/18 at 11:47 A.M., FSS B said the recipe called for a four
ounce scoop of peaches.
Observation on 12/4/18 at 12:10 P.M. and 12:30 P.M. showed FSS D prepared cake with
peaches. FSS D dished less than one-half of a four ounce scoop of undrained peaches on the

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 0803

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 6)
cake.
Observation on 12/4/18 at 12:50 P.M. showed FSS B prepared cake with peaches. FSS B dished
a scant four ounce scoop of undrained peaches on the cake.
During an interview on 12/4/18 at 1:12 P.M., FSS D said he/she had been working at the
facility for only two days and had no training. FSS D did not know scoops should have been
full and level when serving and said he/she was not serving the full amount due to the
juice.
2. Record review of the facility’s approved menu for lunch on 12/4/18 showed the menu
directed staff to serve residents with orders for pureed diets a number (#) 10 scoop of
pureed sponge cake with a #10 scoop of pureed fruit.
Record review of the facility’s approved recipe for pureed sponge cake with fruit showed
the recipe directed staff to puree the cake with whole milk, puree drained fruit
separately, then serve a #10 scoop of pureed cake with a #10 scoop of pureed fruit on top.
The recipe identified the appropriate consistency as smooth, pudding or soft mashed
potatoes.
Observation on 12/4/18 at 11:51 A.M. showed FSS C pureed sponge cake with peaches without
referring to a recipe. FSS pureed seven pieces of cake and six #10 scoops of undrained
peaches. The resulting product had a thin, gravy consistency. FSS C then served residents
one #10 scoop of the combined product.
3. Record review of the facility’s approved menu for lunch on 12/4/18 showed the menu
directed staff to serve residents three ounces of roast beef.
Observation on 12/4/18 at 12:15 P.M. showed the Assistant Dietary Manager (ADM) served
residents one slice of roast beef. Upon request of SLCR staff, the ADM weighed the sliced
roast beef. The portion served to residents was two ounces.
4. Record review of the facility’s recipe for pureed roast beef showed the recipe directed
staff to puree roast beef with sliced bread and prepared beef broth.
Observation on 12/4/18 at 1:05 P.M. showed FSS B pureed an unmeasured amount of roast beef
with beef broth prepared with an unmeasured amount of beef base. FSS B did not refer to
the recipe or add slices of bread. The resulting product had a slightly lumpy, pudding
consistency.
5. Record review of the facility’s undated standardized recipe policy showed the policy
directed staff to use standardized recipes for all food prepared. The policy directed the
CDM to monitor and check for recipe use.
Record review of the facility’s consultant Registered Dietitian (RD) reports showed on
10/25/18 the RD recommended staff training on menu and recipe use. On 11/28/18, the RD
noted he/she would follow up on training for recipe use.
During an interview on 12/4/18 at 1:20 P.M., FSS C said staff had been directed to serve
food using level scoops and to follow recipes.
During an interview on 12/4/18 at 1:40 P.M., the ADM said staff had been directed to use
recipes and serve serve food using level scoops.
During an interview 12/4/18 on 1:45 P.M., the Certified Dietary Manager (CDM) said staff
had been directed to follow recipes and serve portions as per spread sheets.
During an interview on 12/5/18 at 10:45 A.M., the CDM said she thought she might have done
the training the RD said to do on 10/25/18.
Record review showed a sign in-sheet for training completed by the CDM, dated 10/30/18,
showed the CDM did not provide training on recipes and menu use.
Complaint # MO 0

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 0803

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

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.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to store, prepare
and serve food under sanitary conditions increasing the risk of cross-contamination and
food-borne illness. This potentially effected all residents in a facility with a census of
108.
1. Observation on 12/4/18 at 10:15 A.M. showed Food Service Staff (FSS) C stacked and
stored clean, wet dishes. FSS C stored 30 wet glasses inverted on tray.
During an interview on 12/4/18 at 10:15 A.M., FSS C said the facility had trays for
allowing cups and glasses to air dry.
Observation on 12/4/18 at 10:55 A.M. showed FSS C stacked clean, wet bowls. Ten bowls
stuck together due to moisture.
Observation on 12/4/18 at 11:46 A.M. showed FSS D carried clean dishes against his/her
body. FSS D stacked wet bowls without allowing them to air dry.
Observation on 12/4/18 at 12:45 P.M. showed FSS A put wet lids over plates of food.
During an interview on 12/4/18 at 1:25 P.M., FSS D said staff had been directed to allow
dishes to air dry before putting them away.
During an interview on 12/4/18 at 1:45 P.M., the Certified Dietary manager (CDM) said
staff had been directed to allow dishes to air dry.
Record review of the facility’s undated dishwashing policy showed the policy directed
staff to allow dishes to air dry.
2. Observation on 12/4/18 at 10:15 A.M. showed FSS A scratched his/her sides and head,
rubbed his/her mouth, and pulled up pants. FSS A continued to prepare food without
changing gloves and/or washing hands.
Observation on 12/4/18 at 10:25 A.M. showed FSS B pushed up his/her eye glasses with
gloved hands. FSS B continued to prepare food without changing gloves and/or washing
hands.
Observation on 12/4/18 at 10:45 A .M. showed FSS A washed hands and donned gloves. FSS A
then pulled up pants, stuck his/her finger in his/her ear, scratched his/her sides,
touched the recipe book, obtained milk from the walk in refrigerator, and continued to
prepare food without changing gloves and/or washing hands. FSS A then scratched his/her
head, put his/her finger in his/her ear, and obtained margarine from the walk in
refrigerator. FSS A resumed food preparation with out changing gloves and/or washing
hands.
Observation on 12/4/18 at 10:57 A.M. showed FSS A prepared food and set up the steam table
without washing hands. FSS A scratched his/her head, sides, and abdomen, stuck his/her
finger in his/her ear, and rubbed his/her mouth. FSS A continued to prepare food and set
up the steamtable without washing his/her hands.
Observation on 12/4/18 at 11:00 A.M. showed FSS A washed hands then rubbed his/her arm,
touched his/her face and mouth, and touched the trash can. Without washing his/her hands,
FSS A took food temperatures.
Observation on 12/4/18 at 11:06 A.M. showed the Assistant Dietary Manager (ADM) wore
gloves while preparing dinner rolls. The ADM touched touched packages, counters, the oven
door, and continued to touch rolls with gloved hands. The ADM did not change gloves and/or
wash hands.
Observation on 12/4/18 at 11:07 A.M. showed FSS A rubbed his/her head beneath a hair
restraint and rubbed his/her face. Without changing gloves and/or washing hands, FSS A

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 8)
touched the food contact surface of a clean pan.
Observation on 12/4/18 at 11:42 A.M. showed FSS A washed hands, pulled up pants, scratched
sides, and touched counters. FSS A then touched the food preparation area without washing
hands.
Observation on 12/4/18 at 11:47 A.M. showed FSS B touched counters, cans, the can opener,
and other equipment with gloved hands. Without changing gloves and/or washing hands, FSS B
touched prepared cake and the food contact surface of a clean scoop used to dish fruit.
Observation on 12/4/18 at 12:00 P.M. showed FSS D touched his/her back, sides, clothing
and coughed in hand. Without changing gloves and/or washing hands, FSS D touched the food
contact surfaces of clean dishes.
Observation on 12/4/18 at 12:01 P.M. showed the ADM touched counters and equipment.
Without washing hands, the ADM touched the food contact surfaces of clean plates.
Observation on 12/4/18 at 12:10 P.M. showed FSS D touched his/her clothing, the counter,
equipment and a can of food. Without changing gloves and/or washing hands, FSS D touched
the food contact surfaces of dishes and utensils.
Observation on 12/4/18 at 12:20 P.M. showed FSS B washed hands and donned gloves before
opening the refrigerator and obtaining a bag of chopped lettuce. Without changing gloves
and/or washing hands, FSS B used his/her hands to dish lettuce.
During an interview on 12/4/18 at 1:20 P.M., FSS C said staff had been directed to change
gloves and wash hands when leaving the kitchen or station and from dirty to clean.
Observation on 12/4/18 at 12:25 P.M. showed FSS C prepared sandwiches while wearing
gloves. FSS C touched bags, utensils, equipment, and counters. Without changing gloves
and/or washing hands, FSS C touched slices of bread.
Observation on 12/4/18 at 12:30 P.M. showed FSS D touched counters, a can of fruit, and
his/her soiled apron. Without changing gloves and/or washing hands, FSS D touched pieces
of cake.
Observation on 12/4/18 at 12:50 P.M. showed FSS B touched cans of food and counters with
gloved hands. Without changing gloves and/or washing hands, FSS B touched the food contact
surfaces of plates and pieces of cake.
During an interview on 12/4/18 at 1:25 P.M., FSS D said staff had been directed to wash
hands after everything and to wear gloves when washing dishes and messing with food.
During an interview on 12/4/18 at 1:30 P.M., FSS B said staff had been directed to wash
hands after leaving station, touching self, when dirty, and when changing gloves.
During an interview on 12/4/18 at 1:40 P.M., the ADM said staff had been directed to wash
hands and change gloves after leaving their station.
During an interview on 12/4/18 at 1:45 P.M., the CDM said staff d been directed to wash
hands when entering the kitchen, changing work areas, and when changing gloves. The CDM
said she talked to FSS A about scratching and FSS A said he/she had flea bites. FSS A
showed the CDM hundreds of bites on his/her sides.
Record review of the facility’s undated hand washing and glove use policy showed the
policy directed staff to wash hands prior to beginning work, after using the restroom,
after smoking, when working with different food substances, and following contact with any
unsanitary surface; i.e. touching hair, sneezing, opening doors, etc. The policy also
directed staff to change gloves as often as hands needed to be washed.
Record review of the facility’s undated personal hygiene policy showed the policy directed
staff to maintain clean hands.
Record review of the facility’s consultant Registered Dietitian’s (RD) reports showed on
10/25/ and 11/28/18, the RD directed the CDM to train staff on handwashing and glove use.
Record review of an inservice sign in sheet, dated 10/30/18, showed the CDM conducted
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 9)
training on glove use and infection control.
3. Observation on 12418 at 10:50 A.M. showed the ADM washed pots and pans in the three
compartment sink. The ADM did not have soapy water in the first (wash) compartment and
used a wadded up towel as [MEDICATION NAME] in second (rinse) compartment.
Observation on 12/4/18 at 11:12 A.M. showed FSS B dropped a wire whisk on the floor. FSS B
picked up the whisk, swished it in the first (wash) compartment of the three compartment
sinks, The first sink did not contain soapy water. FSS B swished the whisk in the second
(rinse) compartment then dropped it in the third (sanitizing) compartment.
During an interview on 12/4/18 at 1:30 P.M., FSS B said the first compartment of the three
compartment sink should have contained hot, soapy water.
During an interview on 12/4/18 at 1:40 P.M., the ADM said the first compartment of the
three compartment sink should have contained soapy water but that the water was not always
sudsy.
During an interview on 12/4/18 at 1:45 P.M., the CDM said first compartment of the three
compartment sink should have had soapy water but the dispenser was not working properly.
Record review of the facility’s undated pot and pan washing policy showed the policy
directed staff to fill the first tank with water between 110 to 120 degrees Fahrenheit and
an effective concentration of detergent.
4. Observation on 12/4/18 at 11:10 A.M. showed Maintenance Staff (MS) E entered the
kitchen without a hair or beard restraint.
Observation on 12/4/18 at 11:15 A.M. showed Licensed Practical Nurse (LPN) F in the
hallway of the kitchen next to the upright refrigerator, paper products and entry into the
dry food storage area. LPN F had not donned a hair restraint.
During an interview on 12/4/18 at 11:15 A.M., LPN F said staff had been directed to wear
hair restraints when in the kitchen. LPN F said he/she did not know he/she was in the
kitchen.
Observation on 12/4/18 at 11:20 A.M. showed MS F entered the kitchen without a beard
restraint.
During an interview on 12/4/18 at 1:20 P.M., FSS C said everyone who entered the kitchen
had to wear a hair restraint.
During an interview on 12/4/18 at 1:30 P.M., FSS B said everyone had to wear a hair
restraint when in the kitchen.
During an interview on 12/4/18 at 1:45 P.M., the CDM said anyone who entered the kitchen
had to wear hair and beard restraints. The CDM said the the area between the kitchen and
dry storage area was considered part of the kitchen.
Record review of the facility’s undated personal hygiene policy showed it directed staff
to cover hair and beards.
5. Observation on 12/4/18 from, 12:03 P.M. through 12:22 P.M. showed staff placed food for
lunch service on three soiled carts. The carts had dried food and spills on the interior
and exterior surfaces.
During an interview on 12/4/18 at 12:03 P.M., FSS D said the carts were supposed to be
wiped out before meals.
During an interview on 12/4/18 at 1:45 P.M., the CDM said the carts should be cleaned
before use.

F 0883

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Develop and implement policies and procedures for flu and pneumonia vaccinations.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 0883

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Based on interview and record review the facility failed to ensure the residents were
offered the influenza vaccination. This practice affected seven residents (Resident #37,
#40, #46, #47, #72, #80, and #87) of the 12 sampled residents. The facility census was
108.
1. Record review of the facility’s policy on Influenza Immunizations, dated (MONTH) 12,
(YEAR) showed:
– The resident or legal representative will be told the Influenza Immunizations are
provided yearly (between (MONTH) 1 and (MONTH) 31) unless the immunization is medically
contraindicated, the facility has evidence that the resident has already been immunized
during this time period, or the resident or resident’s legal representative has refused
the immunization;
– The resident or their legal representative will be asked to sign the revolving consent
form and will be told this form provides consent for annual influenza immunizations;
– The Customer Service Consultant/designee or the Social Services Director will provide
education information on the immunizations and ensure the consent form is filled out,
placed in the resident’s chart and updated (if needed) before the immunization is given to
the resident;
– The resident’s clinical record will document the resident either received the influenza
immunization or did not receive them due to medical contraindications or refusal.
2. Record review of Resident #37’s medical record showed:
– Consent form for the influenza immunization dated and signed on 10/22/18;
– No documentation of the immunization given.
3. Record review of Resident #40’s medical record showed:
– Consent form for the influenza immunization dated and signed on 10/23/18;
– No documentation of the immunization given.
4. Record review of Resident #46’s medical record showed:
– Consent form for the influenza immunization dated and signed on 10/23/18;
– No documentation of the immunization given.
5. Record review of Resident #47’s medical record showed:
– Consent form for the influenza immunization dated and signed on 10/23/18;
– No documentation of the immunization given.
6. Record review of Resident #72’s medical record showed:
– Consent form for the influenza immunization dated and signed on 10/22/18;
– No documentation of the immunization given.
7. Record review of Resident #80’s medical record showed:
– Consent form for the influenza immunization dated and signed on 10/23/18;
– No documentation of the immunization given.
8. Record review of Resident #87’s medical record showed:
– Consent form for the influenza immunization dated and signed on 10/22/18;
– No documentation of the immunization given.
During an interview on 12/7/18 at 10:45 A.M. Licensed Practical Nurse (LPN) S said the
immunizations requested have not been not given.
During an interview on 12/7/18 at 11:05 A.M. the Social Worker said it was her
responsibility to obtain the consents from the resident or family representative. She said
when the consents are returned, she relays the message to the nursing department.
Interview on 12/7/18 at 11:10 A.M. the Director of Nursing (DON) said the influenza
vaccination was back ordered in (MONTH) and when they got the immunization in stock, they
gave some.
Interview on 12/7/18 at 11:20 A.M. the Corporate Consultant said the nursing department
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265388

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

NAME OF PROVIDER OF SUPPLIER

SENATH HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

300 EAST HORNBECK STREET
SENATH, MO 63876

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 0883

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 11)
was not aware of any consents being returned. She said the nursing department had asked
the social worker several times about the returned consent forms and was told the social
worker did not know which residents forms had been returned.
Telephone interview on 12/13/18 at 11:15 A.M. the DON said the influenza immunization had
been received in the facility on 10/25/18.