Above average — CMS composite of the measures below.
The next survey window likely opens around October 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 Puxico Nursing And Rehabilitation Center during CMS and state inspections, most recent first.
Unsafe food storage, sanitation, and hot-holding practices were observed in the kitchen. Surveyors found dented and unlabeled food items, loosely covered and undated bulk containers, dirty equipment including the ice machine, dishwasher, range, and can opener, and no dietary cleaning log. During meal service, a DA served food from the steam table onto room-temperature plates while roast beef, gravy, and other items were held well below proper hot-holding temperatures; a resident also reported that food was sometimes cold when served.
Infection control practices were not followed during incontinent care, catheter care, wound care, and glucose monitoring/insulin administration. Staff repeatedly failed to perform hand hygiene, changed gloves inconsistently, reused wipes across soiled and clean areas, and moved between residents and body sites without proper aseptic technique. The laundry area also had dirty and damaged conditions, including leaking hoses, dust on clean linen carts, a damaged wall, and evidence of pests.
Urinary Catheter Drainage Bags Left on the Floor: Two residents with urinary catheters, including one with a suprapubic catheter, were observed with drainage bags hanging from the bed frame and touching the floor on multiple occasions. During catheter care for one resident, an LPN placed the bag above the level of the bladder, and the bag later fell onto the floor with tubing touching the floor. Staff interviews confirmed the bag and tubing should remain below the bladder and off the floor.
The facility failed to follow physician's orders for three residents, resulting in improper medication administration and unprocessed lab work. A resident with diabetes refused prescribed insulin dosages without physician notification, another continued receiving a discontinued medication, and a third had lab work orders that were not completed. Staff interviews confirmed these deficiencies.
A facility failed to document ongoing assessment and monitoring of a resident's dialysis access site, including the thrill and bruit, after treatments. Despite the facility's policy and the DON's expectations, an LPN confirmed that these assessments were not performed every shift. The resident had multiple diagnoses, including end-stage renal disease, and was dependent on dialysis.
The facility failed to ensure two nurse aides completed their training within four months of employment, as required by policy. One aide began training well past the deadline, and another was scheduled to start even later. The DON and Administrator were aware of the oversight, which could impact all 31 residents.
The facility failed to reconcile narcotics at each shift change for one medication cart, missing 51 out of 79 documentation opportunities. Despite policy requirements, a nurse admitted to forgetting to sign the log after counting with the off-going nurse. The DON and Administrator expected proper documentation, highlighting a deficiency in pharmaceutical services.
The facility failed to maintain a medication error rate below five percent, resulting in a 7.69% error rate. Two residents were affected: one received a discontinued diabetes medication, and another received a calcium tablet with Vitamin D instead of the prescribed calcium only. RN A administered both incorrect medications, acknowledging the errors during interviews. The DON and Administrator expected a lower error rate.
The facility failed to date two opened vials of Aplisol, used for tuberculosis testing, as required by their policy and the manufacturer's recommendations. The vials were found undated in the medication room's locked refrigerator. Interviews with an RN and the DON revealed inconsistencies in their understanding of the discard period for multi-dose vials.
Unsafe Food Storage, Equipment Sanitation, and Improper Hot Food Holding
Penalty
Summary
Food was stored and served under unsanitary conditions in the kitchen and food service area. On observation, surveyors found dented cans of mixed fruit, spaghetti sauce, and green beans that had been received and kept in storage, along with four clear plastic cereal containers that were unlabeled and undated. An approximate 10-gallon container of cornmeal was loosely covered, undated, and mislabeled as fish, and another 10-gallon container of sugar was loosely covered and undated. The kitchen also had a nonfunctioning plate warmer with a damaged electrical cord, an ice machine with grime and debris buildup, a dishwasher with grime buildup, a gas range with oily grime and food debris, dusty ceiling diffusers, and a commercial can opener with an oily film and grime buildup. The 3-compartment sink hot water faucet measured 88 F, and there was no cleaning log. During meal service, a dietary aide dipped food from steam table trays onto room temperature plates. The steam table held ground roast beef at 115 F and gravy at 80 F. A test tray observed later showed a plate cool to the touch, sliced ham at 108 F, spinach at 110 F, diced potatoes at 104 F, and roast beef at 115 F. A resident stated that food was sometimes cold when received in the dining room. The dietary aide said the plate warmer had not worked during the four months he or she had worked at the facility and had not been used. The dietary manager stated the steam table food temperatures should have been around 165 F and that the gravy was probably warmed in the microwave but not heated enough. The dietary manager also stated the food should have been warmer on the steam table, the bins should have been labeled, the dented cans should have been discarded or placed on a dented can shelf, the ice machine and drainpipes should have been clean, the air vents should have been kept clean, the can opener was damaged and dirty, and there had been no cleaning logs for dietary staff. The administrator and DON stated the kitchen should have been run according to facility policy and regulations, that more deep cleaning was needed, and that hot meals should not be served cool.
Infection Control Failures During Resident Care and Laundry Room Maintenance
Penalty
Summary
The facility failed to implement proper infection control practices during incontinent care, catheter care, wound care, and blood glucose monitoring and insulin administration. During incontinent care for one resident, two nursing assistants entered the room without hand hygiene, put on gloves, and handled supplies and the resident’s clothing and blanket. They repeatedly wiped fecal material with the same areas of wipes, did not change gloves or perform hand hygiene when moving between soiled and clean areas, and touched the resident’s clothing and body while continuing care. Barrier cream was retrieved from a pocket and applied while glove and hand hygiene practices were not followed, and staff later moved between the resident’s room, hall linen cart, and other tasks without hand hygiene. For another resident, staff performed incontinent care, catheter care, and wound care while wearing gowns and gloves but did not consistently perform hand hygiene or change gloves between tasks. One CNA cleaned the peri area and catheter without changing gloves, another CNA cleaned the buttocks and an open area multiple times with the same area of the washcloth, and the LPN performed wound care without changing gloves or performing hand hygiene between treatments. Supplies were placed on the bedside table after it was wiped, but staff continued care across multiple body sites and wound areas without the hand hygiene and glove changes described in the facility’s policy. For a third resident, catheter care was performed with the tubing dried toward instead of away from the insertion site, and wound treatments were completed across multiple wounds and body areas without hand hygiene or glove changes between sites. During blood glucose monitoring and insulin administration, an LPN did not perform hand hygiene before or after resident contact, did not remove gloves after glucose monitoring before leaving the room, and moved between residents without hand hygiene. The LPN touched a resident’s glucose receiver after the resident had removed it from clothing, then later administered insulin to multiple residents with inconsistent hand hygiene practices between rooms and after glove removal. The facility also failed to maintain the laundry building in good condition for infection control: the laundry room had a dirty AC unit and vent, dust on clean linen carts, leaking hoses, wet towels, a large hole in the wall with insulation and daylight showing, black substance on the wall, and a dead mouse on a sticky pad. Staff reported the leak had been present for months, and facility leadership acknowledged the building, pipes, and AC needed repairs.
Urinary Catheter Drainage Bags Left on the Floor
Penalty
Summary
The facility failed to ensure urinary indwelling catheter drainage bags were maintained in the proper position for two residents. The facility policy titled, Urinary Catheter Care, stated that catheter tubing and drainage bags should be kept off the floor and that the drainage bag should remain lower than the bladder at all times. Resident #3 had diagnoses including neuromuscular dysfunction of the bladder, BPH, other obstructive and reflux uropathy, and urinary retention, and had an order for a suprapubic catheter and drainage bag changes monthly and as needed. Resident #35 had similar diagnoses, used a urinary catheter, and had orders for catheter care every shift and monthly catheter and drainage bag changes as needed. Observations of both residents on multiple occasions showed the catheter drainage bags hanging from the bed frame with a cover that opened at the bottom and the drainage bags touching the floor. During catheter care for Resident #35, an LPN placed the drainage bag on the bed in a position that was not below the level of the bladder, and when the resident was rolled, the bag fell onto the floor with the bottom of the bag and one inch of tubing touching the floor. The bag was then rehung, but later the bottom of the drainage bag again rested on the floor when the bed was lowered. Staff interviews confirmed that the catheter drainage bag and tubing should not touch the floor and should remain below the level of the bladder, and the DON and Administrator stated the same expectation.
Failure to Follow Physician's Orders for Medication and Lab Work
Penalty
Summary
The facility failed to adhere to physician's orders for three residents, leading to deficiencies in medication administration and order processing. Resident #21, diagnosed with type 1 diabetes mellitus, frequently refused the prescribed dosage of Humalog insulin, opting for a different dosage instead. Despite the resident's refusals, there was no documentation indicating that the physician was notified of these deviations from the prescribed orders. The Medication Administration Record (MAR) showed multiple instances where the resident's blood sugar levels were elevated, yet the insulin dosage administered did not align with the physician's orders. Resident #23, who had multiple diagnoses including diabetes mellitus and congestive heart failure, continued to receive Actos despite a physician's order to discontinue the medication. The MAR indicated that the resident received 28 doses of Actos after the discontinuation order. Additionally, Resident #33, with diagnoses including heart failure and diabetes mellitus, had lab work ordered that was not processed or completed. Interviews with the Director of Nursing (DON) and other staff confirmed that the orders were not followed as written, contributing to the deficiencies observed during the survey.
Failure to Document Dialysis Monitoring
Penalty
Summary
The facility failed to provide adequate documentation and monitoring for a resident receiving dialysis care. Specifically, the facility did not document ongoing assessment and monitoring of the resident's dialysis access site, including the thrill and bruit, after returning from treatments. The facility's policy requires checking for signs of infection, assessing the color and temperature of the fingers, and checking the patency of the site at regular intervals. However, the resident's medical record lacked documentation of these assessments, and there was no current order for hemodialysis or for assessing the thrill and bruit of the fistula site. The resident involved had multiple diagnoses, including end-stage renal disease and dependence on renal dialysis, and was admitted with a right arm fistula for dialysis access. Despite the facility's policy and the Director of Nursing's expectations, the Licensed Practical Nurse confirmed that the thrill and bruit were not assessed or documented every shift. This oversight indicates a failure to adhere to the facility's policy and ensure comprehensive monitoring of the resident's dialysis access site.
Failure to Ensure Timely Completion of Nurse Aide Training
Penalty
Summary
The facility failed to ensure that two nurse aides completed a nurse aide training program within four months of their employment, as required by the facility's policy and federal regulations. The policy mandates that any nurse aide employed for more than four months must be competent to provide nursing care and have completed a state-approved training and competency evaluation program. However, the records showed that one nurse aide, hired on October 26, 2023, only began training on May 7, 2024, well beyond the four-month requirement. Another nurse aide, hired on December 28, 2023, was scheduled to start training on August 14, 2024, also exceeding the four-month timeframe. Interviews with the Director of Nursing and the Administrator revealed that both were aware of the lapse in ensuring timely completion of the training program. The Director of Nursing acknowledged the oversight, while the Administrator confirmed the expectation that nurse aides should complete their training within the stipulated four months. This deficiency had the potential to affect all residents in the facility, which had a census of 31 at the time of the survey.
Failure to Reconcile Narcotics at Shift Change
Penalty
Summary
The facility failed to ensure that staff reconciled narcotics at each shift change for one of the two medication carts, potentially affecting all residents. The facility's policy on controlled substances, last revised in November 2022, mandates that nursing staff count controlled medication inventory at the end of each shift, with both the incoming and outgoing nurses conducting the count together and documenting any discrepancies. However, a review of the Nurse Medication Cart Eight Hour/Shift Verification of Controlled Substances Count log revealed that there were 51 missed opportunities for documentation out of 79, indicating a significant lapse in adherence to the policy. Interviews conducted during the investigation revealed that a registered nurse admitted to counting the narcotics with the off-going nurse but forgot to sign the log. Both the Director of Nursing and the Administrator confirmed their expectation that nurses should count and document narcotics at each shift change. This oversight in documentation and reconciliation of narcotics inventory represents a deficiency in the facility's pharmaceutical services, as it failed to comply with its own policies and procedures designed to prevent loss or diversion of controlled substances.
Medication Error Rate Exceeds Acceptable Threshold
Penalty
Summary
The facility failed to maintain a medication error rate of less than five percent, resulting in an error rate of 7.69%. This deficiency was identified through observation, interview, and record review, affecting two residents out of five sampled. The first incident involved a resident with a diagnosis of diabetes mellitus, who was administered Actos, a medication that had been discontinued according to the physician's order. Despite the order to discontinue Actos being noted in the resident's medical record, the medication was still given by RN A, who later acknowledged the error during an interview. The second incident involved another resident with diagnoses of dorsalgia and vitamin deficiency, who was prescribed calcium 500 mg twice a day. However, RN A administered a calcium tablet combined with Vitamin D, which was not in accordance with the physician's order. This deviation from the prescribed medication regimen was also confirmed by RN A during an interview. The Director of Nursing and the Administrator expressed their expectation for a medication error rate of less than five percent, highlighting the facility's failure to meet this standard.
Failure to Date Opened Vials of Aplisol
Penalty
Summary
The facility failed to ensure that two vials of Aplisol, a solution used for tuberculosis testing, were dated when opened. This oversight was identified during an observation of the locked refrigerator in the medication room, where the two opened vials were found without dates. The facility's policy, revised in February 2023, mandates that multi-dose vials be dated when opened and discarded within 28 days unless the manufacturer specifies otherwise. The manufacturer's recommendations for Aplisol, revised in November 2013, state that the medication should be discarded 30 days after being opened. Interviews with a Registered Nurse and the Director of Nursing revealed inconsistencies in their understanding of the policy, with the RN stating that vials should be discarded if not used in 28 days, while the DON mentioned a discard period of 20 to 30 days after opening.
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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.
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Nursing homes near Puxico
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Prairie View Skilled Nursing | 13.1 mi | ★★★★★ | 0 | 0 |
| Crowley Ridge Care Center | 14.7 mi | ★★★★★ | 0 | 0 |
| Cypress Point-skilled Nursing By Americare | 15.5 mi | ★★★★★ | 7 | 0 |
| Memory Lane Of Dexter | 15.8 mi | ★★★★★ | 0 | 0 |
| Aspire Senior Living Advance | 16.6 mi | ★★★★★ | 13 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.