Average — CMS composite of the measures below.
A standard survey is most likely before around November 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Hunter Acres Caring Center during CMS and state inspections, most recent first.
Unsafe and Unclean Resident Rooms and Common Areas: Surveyors observed multiple resident rooms and a common area with dirt and debris, spiderwebs, missing trim, peeled flooring, holes in a bathroom door, urine odor, and black or gray/black substances on walls and vents. The Maintenance Director described daily housekeeping checklists and biweekly deep cleaning, while Housekeeping Staff L said a chart guided daily tasks and only housekeeping staff was scheduled on day shift. The Administrator stated all residents should have a clean and homelike environment.
Ineffective pest control allowed flies in the dining room. The facility’s pest control invoices targeted roaches and mice, but not flies, and an insect light trap was observed plugged in but not turned on. Residents were seen eating while flies crawled on their tables, buzzed around them, and in one case crawled on food. A CNA said flies were sometimes a problem and staff used a fly swatter to keep them down, while the DON and Administrator said they expected the facility to be free of pests, including flies.
The facility failed to keep code status documentation consistent for one resident and failed to obtain a code status order for another resident. One resident had conflicting records showing Full Code and DNR information, including an unclear OHDNR copy in the DNR binder, while the resident's RP said the resident was Full Code and had not discussed a change. Another resident had no code status order or advance directive in the chart, although the care plan listed Full Code and the resident stated a desire for CPR if needed.
Failure to Address Psychotropic GDRs and PRN Duration Requirements: The facility did not ensure physician response to pharmacist-recommended GDRs for two residents receiving psychotropic medications, and one resident had PRN psychotropic orders that remained active beyond 14 days without adequate patient-specific review and documentation. One resident had diagnoses including vascular dementia and major depressive disorder with an Abilify GDR request left unanswered, while another resident with anxiety, depression, bipolar disorder, insomnia, and chronic pain had repeated unanswered review requests for hydroxyzine, Ambien, buspirone, and Rexulti.
Failure to complete CBC and EDL checks before hire: The facility did not follow its abuse prevention and background screening policies for three of ten sampled employees. Personnel records for three employees showed no documentation of CBC or EDL checks completed before the hire date, and the Administrator stated that these checks should be done prior to employment.
MDS assessments for two residents did not accurately reflect PASRR Level II status. Both residents had significant psychiatric diagnoses and PASRR Level II screenings showing serious mental illness, but their annual MDSs were coded as not evaluated by a Level II PASRR. The MDS Coordinator stated the PASRR Level II determination should be documented on the MDS, and the Administrator and DON said they expected the MDS to accurately reflect resident status.
Care plans for two residents did not include their current respiratory support needs. One resident had COPD, sleep-related hypoventilation, BiPAP at bedtime, and PRN oxygen for COPD, while another resident had asthma, wheezing, and CPAP at night and with naps for sleep apnea. In both cases, the revised care plans did not address the BiPAP/oxygen or CPAP use, even though the residents’ MDS assessments showed use of a non-invasive mechanical ventilator and the devices were observed at the bedside.
Failure to follow physician orders for Seroquel: A resident with CHF, DM2, schizophrenia, bipolar disorder, major depressive disorder, generalized anxiety disorder, mild cognitive impairment, and morbid obesity continued to receive Seroquel after it had been discontinued. The MAR showed multiple doses were administered after the discontinuation order, and the behavioral PA later discovered the medication was still being given. An LPN said orders were received by the nurse on duty and entered into the EMR, and the Administrator and DON expected physician orders to be entered accurately.
Dietitian recommendations were not implemented for a resident with significant weight loss and diagnoses including cerebrovascular disease, vascular dementia, anxiety, and depression. The resident was observed eating with a divided plate but without extra portions, a house supplement, or staff encouragement, and food intake was not documented. The POS did not include the ordered house supplement twice daily, despite the dietitian’s plan for a mechanical soft diet with extra portions, a divided plate, and supplements.
The facility failed to maintain a safe, clean, and homelike environment, with observations of scratched paint, holes in walls, and brown/black substances on vents and ceiling tiles in resident areas. The Maintenance Director was unaware of these issues, and the facility lacked a policy on environmental maintenance.
A facility failed to promptly notify a physician of a significant change in a resident's condition, delaying necessary medical intervention. The resident, with multiple chronic conditions, was eventually hospitalized with severe complications. In another case, a resident with severe cognitive impairment was found unresponsive, but emergency services were delayed due to staff prioritizing personal care over immediate transport. Both incidents reflect a failure to provide timely medical and emergency care.
A resident with dementia and other health conditions experienced severe weight loss due to inadequate dietary interventions and refusal of meals and medications. Despite the facility's policy, the resident's care plan did not address the weight loss, and the RD's involvement was limited. The resident's delusional beliefs about being poisoned contributed to the refusal of food and medication, yet the facility failed to implement effective interventions.
The facility failed to maintain a medication error rate below five percent, with errors involving two residents. An LPN did not administer Novolog insulin to a resident due to unavailability, and a CMT failed to provide Crestor to another resident because it was out of stock. Both the Administrator and DON expected medications to be ordered before depletion.
Unsafe and Unclean Resident Rooms and Common Areas
Penalty
Summary
The facility failed to provide a safe, clean, comfortable, homelike environment. During multiple observations, surveyors found room conditions including a bathroom door with a smeared brown substance, dirt and debris on the floor, a spider web in a window seal, peeled and separated bathroom flooring, a black substance on the upper bathroom walls with a musty smell, a baseball-sized hole in a wooden bathroom door, missing trim around an air conditioner, spiderwebs in room corners, a strong smell of urine, paint peeled and chipped on the walls, a return vent covered in a gray/black substance, and a black substance on the top of bathroom walls. In the 400 Hall common area, surveyors also observed missing trim around an air conditioner and spiderwebs in the corner of the room to the left of the TV. During interview, the Maintenance Director said housekeeping staff used a daily checklist, turned it in at the end of the shift, and performed a deep clean every two weeks that included dusting. He/she stated he/she would not expect spiderwebs to be in the facility and did not know of any current issues. Housekeeping Staff L said there was a chart in the housekeeping closet used to determine daily cleaning tasks and that only housekeeping staff was scheduled on the day shift. The Administrator said she would expect all residents to have a clean and homelike environment.
Ineffective pest control program allowed flies in the dining room
Penalty
Summary
The facility failed to maintain an effective pest control program to control the insect population in the building. The facility’s policy stated that it maintains an ongoing pest control program to keep the building free of insects and rodents, and that maintenance services assist with pest control when appropriate and necessary. However, review of pest control invoices for May through August 2025 showed services targeted German roaches and house mice, and no services targeted flies. Observations in the 200 Hall dining room showed an insect light trap plugged in but not turned on on two separate occasions. During meals, residents were observed eating while flies crawled on their dining tables, buzzed around them, and in one instance crawled on a resident’s food. A CNA stated that flies were sometimes a problem this time of year and that staff used a fly swatter to keep them down, and did not know why the light trap was not turned on. The DON and Administrator both stated they expected the facility to be free of pests, including flies.
Incorrect and Missing Code Status Documentation
Penalty
Summary
The facility failed to ensure the correct code status for one resident and failed to address and obtain an order for code status for another resident. For one resident, the medical record contained conflicting documentation: a Full Code order was discontinued and a DNR order was entered, while the resident's OHDNR form had Full Code handwritten on it and was signed by the resident and resident representative. The care plan also listed Full Code status. In the DNR binder, the resident's OHDNR copy was dark and difficult to read, and an LPN reviewing the scanned form could not determine whether the resident was Full Code or DNR. The DON stated she did not know why the resident's code status was changed to DNR, and the resident's responsible party said the resident was Full Code and that the facility had not discussed changing the code status. For another resident, the medical record contained no code status order and no advance directive, yet the care plan listed Full Code status. During interview, the resident stated he/she wanted to be Full Code and wanted CPR performed if breathing stopped or the heart stopped beating. Staff interviews showed that nurses were checking the electronic chart for code status by looking at the advance directive link or the top of the face sheet, and the Administrator and DON stated they would expect residents' code status orders to match the signed advance directive.
Failure to Address Psychotropic GDRs and PRN Duration Requirements
Penalty
Summary
The facility failed to attempt and ensure physician response to gradual dose reductions (GDRs) for psychotropic medications for two residents, and failed to limit one resident’s as-needed (PRN) psychotropic medication orders to 14 days. The deficiency was identified through interview and record review involving five sampled residents in a facility census of 87. Resident #4 had diagnoses including cerebrovascular disease, vascular dementia, generalized anxiety disorder, and major depressive disorder. The resident’s physician order sheet showed an order for Abilify 5 mg daily for mood disorder that was later changed to Abilify 5 mg daily for major depressive disorder. The resident’s medication regimen review dated 10/02/24 included a pharmacist request for a GDR of the Abilify 5 mg daily dose, but the physician did not respond. During interview, the resident’s PA stated he/she received GDR requests directly from the pharmacist and did not receive any GDR request to reduce Resident #4’s Abilify on 10/02/24. Resident #19 had diagnoses including anxiety, major depressive disorder, opioid dependence, chronic pain, nausea, bipolar disorder, insomnia, and restless leg syndrome. The resident had orders for Ambien 5 mg, 1.5 tablets every 24 hours PRN for insomnia; hydroxyzine 50 mg every eight hours PRN for anxiety; buspirone 10 mg three times a day; and Rexulti 1 mg daily for depression. The medication regimen review showed repeated pharmacist requests for physician review of the hydroxyzine PRN order extended beyond 14 days without adequate patient-specific review and documentation, with no physician response on several occasions. One review resulted in a physician signature to maintain the PRN order, but the rationale for the resident’s need for the PRN medication beyond 14 days was not documented. The pharmacist also requested physician review of the Ambien PRN order extended beyond 14 days, and requested GDR review of buspirone and Rexulti, but the physician did not respond. During interviews, the DON stated the resident saw an outside physician monthly and that the facility sent pharmacy requests to the physician’s office but never received anything back. The DON and Administrator stated they expected PRN psychotropic medications to have an acceptable end date and be reevaluated at the appropriate time frames, and expected medication regimen review recommendations to be addressed by the appropriate physician when irregularities were identified or when GDRs needed to be addressed. The pharmacist stated he/she completed GDRs for psychotropic medications twice in the first year and then yearly, and that PRN medications lasting longer than 14 days should be reviewed for appropriate use and duration, with the facility maintaining the paper trail and provider response.
Failure to Complete CBC and EDL Checks Before Hire
Penalty
Summary
The facility failed to follow its policy and procedure for abuse prevention by not completing Criminal Background Checks (CBC) and Employee Disqualification List (EDL) checks prior to the hire date for three of ten sampled employees. Review of the facility’s Background Screening Investigations policy showed that background checks, reference checks, and criminal conviction checks on all potential direct access employees and contractors should be conducted, with background and criminal checks initiated within two days of an offer of employment and completed prior to employment. The Abuse Prevention Program policy also stated that the administration would conduct employee background checks as part of resident abuse prevention. Review of the personnel files for Employee A, Employee B, and Employee C showed hire dates of 08/30/24, 11/04/24, and 12/20/24, respectively, with no documentation that a CBC or EDL check had been completed prior to each hire date. During an interview on 08/07/25 at 3:10 PM, the Administrator stated that the CBC and EDL should be done prior to employment.
MDS assessments did not accurately reflect PASRR Level II status
Penalty
Summary
The facility failed to accurately code the MDS for two residents out of 19 sampled residents. Facility policy titled, Resident Assessments, stated that information in the MDS assessments would consistently reflect information in the progress notes, plans of care, and resident observations/interviews, and that the resident assessment coordinator was responsible for ensuring timely and appropriate resident assessments. Review of the records showed that both residents had serious behavioral health diagnoses and PASRR Level II screenings on file, but their annual MDS assessments were coded as not evaluated by a Level II PASRR. Resident #38 was admitted on 11/13/19 and had diagnoses including schizophrenia, bipolar disorder, major depressive disorder, intellectual disabilities, anxiety disorder, and PTSD. A PASRR Level II screening dated 12/09/22 showed the resident had a serious mental illness and intellectual developmental disability or related condition, yet the annual MDS stated the resident was not evaluated by a Level II PASRR. Resident #46 was admitted on 10/28/21 and had diagnoses including schizophrenia, paranoid personality disorder, delusional disorders, bipolar disorder, anxiety disorder, violent behavior, hallucinations, and homicidal ideations. A PASRR Level II screening dated 11/22/21 showed the resident had a serious mental illness, but the annual MDS also stated the resident was not evaluated by a Level II PASRR. During interview, the MDS Coordinator said the PASRR Level II determination should be documented on the MDS, and the Administrator and DON said they would expect the MDS to accurately reflect the resident's status.
Care Plans Did Not Address Respiratory Support Needs
Penalty
Summary
The facility failed to establish comprehensive care plans for two residents whose records showed ongoing respiratory support needs. One resident had diagnoses including COPD, morbid obesity, sleep-related hypoventilation, shortness of breath, and nicotine dependence, with orders for BiPAP at bedtime for sleep apnea and oxygen at 2 liters per minute as needed for COPD. The resident’s quarterly MDS showed use of a non-invasive mechanical ventilator, but the revised care plan did not address BiPAP or oxygen use. During observation, the resident’s BiPAP machine was on the bedside table and the oxygen concentrator was at the head of the bed, and the resident stated BiPAP was used at night and oxygen when short of breath. A second resident had diagnoses of asthma, wheezing, pleural effusion, and insomnia, with an order to apply CPAP at a pressure of 14 at night and with naps for sleep apnea. The annual MDS showed use of a non-invasive mechanical ventilator, but the revised care plan did not address CPAP use. During observation, the resident’s CPAP machine was at the bedside, and the resident stated the CPAP was worn at night and sometimes applied independently and sometimes with staff assistance. The Care Plan Coordinator stated oxygen needs, including BiPAP and CPAP use, should be on the care plan, and the Administrator and DON stated the care plan should accurately reflect the resident’s current condition, needs, and care areas.
Failure to Follow Physician Orders for Seroquel
Penalty
Summary
The facility failed to follow physician written orders for one resident out of 19 sampled residents. Resident #2 was admitted with diagnoses including CHF, type II diabetes mellitus, schizophrenia, bipolar disorder, major depressive disorder, generalized anxiety disorder, mild cognitive impairment, and morbid obesity. The resident's physician order sheet showed multiple Seroquel orders, including an order to discontinue Seroquel 12.5 mg at bedtime dated 05/20/25 and another order to discontinue Seroquel 12.5 mg at bedtime dated 06/17/25. The resident's behavioral health note dated 06/17/25 stated the resident continued to receive Seroquel 12.5 mg even though the medication had been discontinued during the prior visit on 05/20/25. The MAR for May 2025 through June 2025 showed the resident received Seroquel 25 mg, 1/2 tablet at bedtime from 05/20/25 to 06/01/25 and again from 06/03/25 to 06/18/25, with 29 doses given after the medication had been discontinued. During interviews, the behavioral PA stated he discovered on 06/17/25 that the resident was still being administered Seroquel and had written another discontinuation order. An LPN stated the nurse on duty received orders for residents on the hall and entered them into the EMR, and the Administrator and DON stated they expected physician orders to be entered accurately.
Dietitian Recommendations Not Implemented for Resident With Weight Loss
Penalty
Summary
The facility failed to implement dietitian recommendations for a resident with excessive weight loss. The resident was admitted with diagnoses of cerebrovascular disease, vascular dementia, generalized anxiety disorder, and major depressive disorder. The resident’s weight decreased from 136.4 pounds in May 2025 to 124.2 pounds in June 2025, an 8.94% loss in 30 days, and later reflected a 5.56% loss in less than 180 days. The dietitian’s assessment documented a plan to continue a mechanical soft diet with extra portions as needed, use a divided plate, add a house supplement twice daily, and provide encouragement at meals. The physician order summary did not include the house supplement twice daily that the dietitian recommended. During observations, the resident used a divided plate but was not provided extra portions or a house supplement, staff did not encourage the resident to eat, and staff did not document food intake. An LPN stated the dietitian gave order recommendations to the nurse on duty and they entered the orders into the electronic medical record. The DON and Administrator stated they would expect dietitian recommendations to be implemented. The dietitian stated the nutrition recommendations were provided to the DON and Dietary Manager, and the DON or nurse designee was responsible for changing the diet orders in the resident’s electronic medical record.
Environmental Deficiencies in Resident Areas
Penalty
Summary
The facility failed to provide a safe, clean, and comfortable homelike environment for its residents, as evidenced by multiple observations of environmental deficiencies. On two separate occasions, the bathroom wall in a resident's room was observed to have a three-foot area of scratched and/or peeled-off paint. In the common area of the 300/400 Hall, a ceiling tile and vent were covered in a brown/black substance, and a wall near the exit door had a four-foot by one-inch hole above the cove base. Additionally, a brown substance was noted on the ceiling vent outside the 300/400 Hall. Another observation revealed a hole at the bottom of the outside bathroom door in a resident's room. During interviews, the Maintenance Director was unaware of any current issues, and the Administrator expressed an expectation for all residents to have a homelike environment. The facility did not provide a policy on maintaining the environment.
Delayed Medical Intervention and Emergency Response
Penalty
Summary
The facility failed to ensure timely notification of a physician regarding a significant change in condition for a resident with multiple chronic conditions, including COPD, stroke, diabetes mellitus, and hypertrophic cardiomyopathy. On the evening of June 22, 2024, the resident was found lethargic with low oxygen saturation and an elevated temperature. Despite these critical signs, the physician was not contacted until several hours later, delaying necessary medical intervention. The resident was eventually sent to the hospital and admitted to the ICU with severe conditions, including acute and chronic respiratory failure and septic shock. In another incident, the facility failed to provide timely emergency treatment for a resident with severe cognitive impairment and multiple diagnoses, including Alzheimer's disease, dementia, heart failure, diabetes mellitus, and asthma. The resident was found unresponsive, and although the DON was notified, there was a delay in calling an ambulance. The LPN instructed CNAs to clean the resident before calling for emergency transport, which took approximately 20 minutes. The resident was later admitted to the ICU with acute metabolic encephalopathy, septic shock, and acute kidney failure. Both incidents highlight the facility's failure to adhere to professional standards of practice by not providing timely medical intervention and emergency treatment. The delay in notifying physicians and calling for emergency services contributed to the residents' deteriorating conditions and subsequent hospital admissions.
Failure to Address Significant Weight Loss in Resident
Penalty
Summary
The facility failed to timely and effectively address significant weight loss for a resident, who experienced a 24.2% weight loss in less than 90 days. The resident, diagnosed with dementia, congestive heart failure, hypertension, and diabetes mellitus, was admitted with a weight of 215 lbs. Over the course of several months, the resident's weight dropped to 163 lbs, indicating severe weight loss. Despite the facility's policy requiring immediate action for significant weight changes, the resident's care plan did not address interventions related to the weight loss. The resident's dietary needs were not adequately met, as evidenced by the change from a mechanical soft diet to a regular diet without addressing the resident's complaints of bad teeth and inability to eat. The resident frequently refused meals and medications, expressing delusional beliefs that staff were trying to poison him/her. Despite these behaviors, the facility did not implement effective interventions to ensure the resident received adequate nutrition and hydration. Interviews with facility staff revealed a lack of consistent monitoring and intervention for the resident's weight loss. The Registered Dietician (RD) only saw the resident once during the period of significant weight loss, and the Director of Nursing (DON) acknowledged that the RD was scheduled to visit every two weeks but was only required to see residents monthly. The resident's physician attributed the weight loss to the resident's refusal of medications and meals, yet the facility did not take sufficient action to address these refusals and ensure the resident's nutritional needs were met.
Medication Error Rate Exceeds Acceptable Threshold
Penalty
Summary
The facility failed to maintain a medication error rate of less than five percent, with two errors occurring out of 36 opportunities, resulting in an error rate of 5.56%. This deficiency involved two residents. For Resident #12, the facility did not administer the prescribed Novolog insulin before lunch as ordered. The LPN responsible for administering the medication reported that the insulin was not available in the building and needed to be ordered from the pharmacy. This oversight occurred despite the resident's blood sugar level being checked and recorded as 102. For Resident #30, the facility failed to administer the prescribed Crestor medication for hyperlipidemia. The CMT responsible for the medication pass noted that the resident was out of Crestor and that it needed to be ordered from the pharmacy. The medication had still not arrived by the following day. Both the Administrator and the DON expressed that they expected medications to be ordered before running out, indicating a lapse in the facility's medication management process.
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Illustrative
What surveyors actually found near you
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
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Illustrative
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Nursing homes near Sikeston
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Clearview Nursing Center | 0.5 mi | ★★★★★ | 14 | 0 |
| Sikeston Convalescent Center | 1.2 mi | ★★★★★ | 9 | 0 |
| Annie's Garden Skilled Nursing | 1.7 mi | — | 0 | 0 |
| Delta South Nursing & Rehabilitation | 2.2 mi | ★★★★★ | 8 | 0 |
| Bertrand Nursing And Rehab Center | 8.1 mi | ★★★★★ | 0 | 0 |
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