Below average — CMS composite of the measures below.
The next survey window likely opens around April 2027
Estimate from public CMS data, current as of October 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Riverdell Care Center during CMS and state inspections, most recent first.
Failure to Follow Standardized Recipe and Portion Sizes: A cook did not prepare spaghetti with meat sauce according to the standardized recipe, using less ground beef than directed and combining the noodles and sauce instead of serving them separately. Residents on regular diets and pureed diets were both served portions that did not match the recipe, and the cook stated he/she did not realize the separate portion sizes were required.
Incomplete Person-Centered Care Plans: Staff failed to develop and implement comprehensive, person-centered care plans for multiple residents with assessed cognitive, visual, and functional impairments. Care plans omitted specific needs and preferences such as bed signage, activity interests, bathing and nail care, facial hair care, and meal assistance, even though observations showed signs posted above beds, poor nail hygiene, and a visually impaired resident struggling to eat when served without the planned divided plate or direct assistance.
Failure to provide needed ADL grooming and hygiene care: Four residents who required assistance with personal hygiene were observed with long, jagged fingernails, dark debris under the nails, and/or unshaved facial hair, while shower sheets lacked documentation of nail care, shaving, or refusals. Care plans and facility records showed some residents were cognitively impaired or resistive with care, but the required grooming services were not consistently documented or provided as expected.
Mechanical lift not cleaned between resident transfers. Staff transferred residents with the same lift and did not disinfect it between uses, despite the facility policy calling for lift surfaces to be disinfected and wiped dry. CNAs and the ADON were observed using the lift for multiple residents without cleaning it, and one CNA stated he/she should have cleaned it to prevent infection. The DON said staff were expected to clean the lift between residents, while the Administrator said purple wipes were available but was not sure the cleaning was being done.
Failure to assist a visually impaired resident during meals occurred when staff did not consistently follow the resident’s care plan and facility policy. The resident had severe cognitive and visual impairment and needed meal setup assistance, divided plates, and verbal orientation to food placement. Observations showed staff placing non-divided plates in front of the resident, giving limited assistance, and leaving the resident to eat with hands and struggle to locate utensils. The CNA later stated the resident should be assisted at all times during meals and did not know divided plates were required.
Expired and undated medications were found in storage and on a medication cart. Surveyors observed opened vials of Aplisol and Tubersol past their expiration dates, along with unopened Teriparatide vials that were expired. They also found multiple opened, undated eye drops, inhalers, and nasal spray products, including Lantaprost, Spiriva, Albuterol, Advair, and Flonase. The ADON said he/she checked the med room monthly but was unaware the expired meds were present, and a CMT said these items were not dated when opened.
Facility staff failed to operate the dishwashing machine according to the manufacturer's instructions, resulting in inadequate sanitization. The machine consistently operated below the required 120 degrees Fahrenheit, with staff unaware of the correct temperature requirements. Interviews revealed misunderstandings about the necessary operating temperatures, and the administrator was unaware of the issue.
The facility failed to implement a comprehensive water management plan to prevent Legionella growth, with inaccuracies in the plan and lack of maintenance documentation. Additionally, a resident's indwelling catheter was repeatedly found on the floor, risking infection. Staff interviews confirmed the need for proper catheter positioning, and the DON admitted to a lack of recent training.
The facility failed to ensure wheelchair safety for two residents by propelling them without footrests, and conducted unsafe mechanical lift transfers for three residents by not keeping the leg base open for stability. Additionally, hazardous materials were not stored safely, with unlocked shower rooms and dining areas containing accessible items like razors and nail polish remover, posing risks to residents.
The facility failed to maintain a homelike environment, with observations of black stains, lifted tiles, damaged sheetrock, and strong odors in resident rooms. Staff interviews revealed a maintenance log exists, but repairs have not kept pace with needs, partly due to full capacity preventing resident relocation during repairs.
Facility staff failed to store medications safely, with expired medications found in a storage room. The facility's policy requires expired medications to be returned or destroyed, but observations revealed expired Aspirin, Magnesium Oxide, Vitamin D, and Diclofenac Sodium Gel. Interviews showed inconsistent responsibility among staff, with a CMT, LPN, administrator, and DON all indicating different roles in monitoring medication storage.
Failure to Follow Standardized Recipe and Portion Sizes
Penalty
Summary
The facility staff failed to prepare and serve spaghetti with meat sauce in accordance with the standardized recipes and portion sizes. The recipe directed staff to use 12.5 pounds of ground beef for 50 servings, but during the lunch meal the cook said he/she used 10 pounds of beef because that was what was thawed, even though he/she knew the recipe called for 12.5 pounds. The cook also served the spaghetti noodles and meat sauce combined rather than separately as directed by the recipe. Observation showed residents on regular diets were served a #6 scoop of the combined spaghetti and meat sauce instead of the directed four ounces of spaghetti noodles and six ounces of meat sauce. For residents on pureed diets, the cook added an unmeasured amount of combined spaghetti noodles and meat sauce to a food processor, blended it, and served a #6 scoop of the pureed combined product instead of the directed four ounces of pureed spaghetti noodles and a #6 scoop of pureed meat sauce. The cook stated he/she always combines the spaghetti and meat sauce because residents preferred it that way and did not realize the recipe had separate portion sizes. The administrator stated all cooks are responsible for preparing and serving food according to the standardized recipes and portion sizes, and said he/she did not know kitchen staff were not following the recipes.
Incomplete Person-Centered Care Plans
Penalty
Summary
Facility staff failed to develop and implement person-centered comprehensive care plans for five sampled residents. The facility policy stated comprehensive care plans are to be based on resident assessments and developed by an interdisciplinary team. Review of the records and observations showed that the care plans did not consistently reflect assessed needs, preferences, or specific interventions that were being used or needed for daily care and support. For a cognitively impaired resident, staff had placed signage above the bed with dining and transfer instructions, but the care plan did not include the signage. For another cognitively impaired resident who valued music, group activities, going outside, and religious services, the care plan only stated the resident needed assistance with ADLs and did not include activity preferences, bathing preferences, or nail care needs. A third cognitively impaired resident with limited range of motion and dependence for bathing, dressing, and personal hygiene had a care plan that did not include fingernail or shower preferences, while observations showed long, jagged fingernails with dark debris under the nails. A fourth cognitively impaired resident who was dependent for bathing, toileting, transfers, and personal hygiene had a care plan that did not include bathing, facial hair, nail care preferences, or the signage above the bed, even though a sign with splint schedule and wheelchair positioning was observed above the bed and the resident had long fingernails and facial hair. A severely cognitively and visually impaired resident had a care plan that addressed divided plates for meals but did not address feeding assistance; during observation, staff placed a non-divided plate in front of the resident and did not sit with the resident, and the resident poked at food, brought an empty fork to the mouth, and then ate with the hands. The DON and Administrator stated visually impaired residents should be assisted with meals and that resident-centered items should be care planned, while the MDS Coordinator stated care plans should include resident preferences and specific needs.
Failure to Provide Needed ADL Grooming and Hygiene Care
Penalty
Summary
Facility staff failed to ensure four of eight sampled residents who were unable to perform ADLs received the necessary services to maintain good personal hygiene and grooming. The cited policies for shaving, nail care, and bathing described the purpose of these services, but the bathing policy did not give direction for shower frequency and the shaving policy did not give direction for when to shave a resident. The facility census was 47.1. Resident #8 was assessed as cognitively impaired and needing substantial to maximal assistance with personal hygiene. The care plan stated the resident needed ADL help, sometimes resisted care, and was to be appropriately groomed and presentable. Shower sheets documented nail care on 05/01/26, but no additional nail care or refusals were documented. Observations on 05/26/26 and 05/27/26 showed long, jagged fingernails with dark debris under the nails, and the resident was observed chewing on the nails. Resident #14 was assessed as cognitively impaired, dependent on staff for toileting, personal hygiene, and showers, and requiring assistance from one to two staff for ADLs. The shower sheets for May 2026 did not document nail care provided or refused. Observations on 05/26/26 and 05/27/28 showed long, jagged fingernails with dark debris under the nails. Resident #17 was assessed as cognitively intact and needing assistance with personal hygiene; the care plan noted the resident could be resistive with showers and refusals should be documented, but it did not address shaving or showering preferences. Shower sheets from March through May 2026 did not document shaving, and observations on 05/26/26 through 05/28/26 showed long chin hair and oily hair. Resident #20 was assessed as cognitively impaired, did not reject care, and required substantial to maximal assistance with personal hygiene. The care plan did not address facial hair preferences or nail care, and observations on 05/26/26 through 05/28/26 showed long facial hair and long, jagged fingernails with dark debris under the nails.
Mechanical Lift Not Cleaned Between Resident Transfers
Penalty
Summary
Facility staff failed to use appropriate infection control procedures when a mechanical lift was not cleaned after use between residents. The facility’s Using a Mechanical Lifting Machine Policy, dated 2001, stated staff are to disinfect lift surfaces and wipe them with a clean towel until dry, but it did not include guidance for when to cleanse the lift. During observation on 05/26/26 at 1:14 P.M., CNA E and the ADON transferred Resident #14 from a wheelchair to bed with the mechanical lift, and then transferred Resident #36 from a wheelchair to bed with the same lift without cleansing it in between. During interview, CNA E said he/she did not clean the lift but thought the ADON did between residents, and stated staff should clean the lift between residents to keep from spreading germs. During observation on 05/27/26 at 10:02 A.M., CNA C and the Activity Director transferred Resident #20 from a wheelchair to bed with the mechanical lift and then wheeled the lift to the storage room without cleaning it after use. During interview, CNA C said he/she did not clean the lift as he/she should have to prevent infection and said he/she was in a hurry and nervous, just trying to get it done. The DON later stated he/she expected staff to clean the lift between residents to maintain infection control, and the Administrator said it would be nice if staff would clean the lifts between residents for infection control reasons and that purple wipes were available, but he/she was not sure if it was being done.
Failure to Assist a Visually Impaired Resident During Meals
Penalty
Summary
Failure to reasonably accommodate the needs and preferences of a resident with severe visual impairment occurred during mealtimes when staff did not consistently provide the level of assistance documented in the resident’s assessment and care plan. The resident’s MDS showed severe cognitive impairment, severe visual impairment, and a need for set up or clean up assistance with meals. The care plan directed staff to serve meals in divided plates, tell the resident what food was being served and where it was placed, and support independence. Facility policies also directed staff to describe the place setting and food location using the clock-face method and to assist residents who required help with meals. During observation, a CNA placed a non-divided plate of food in front of the resident and only oriented the resident to the food, without sitting down to assist. The resident poked at the food, brought an empty fork to the mouth several times, ate with the hands, and unsuccessfully tried to locate utensils. On another observation, staff again placed a non-divided plate in front of the resident; a CMT described the food locations, and a CNA briefly sat down, guided the coffee cup, helped place food on the fork, and fed the resident before leaving to help others. The resident then could not locate utensils and ate with the hands. In interview, the CNA said the resident should be assisted at all times during meals and did not know the resident’s meals should be served on a divided plate. The DON stated visually impaired residents should be assisted with meals and that the assistance needs should be on the care plan, and the administrator stated visually impaired residents are expected to be assisted during meals according to their abilities.
Expired and Undated Medications Found in Storage and on Medication Cart
Penalty
Summary
Medications and biologicals were not stored and labeled in accordance with accepted professional principles. During observation of the medication room on 05/26/26, surveyors found one opened vial of Aplisol with an expiration date of 05/24/26, one opened vial of Tubersol with an expiration date of 05/24/26, and two unopened vials of Teriparatide with expiration dates of 05/01/26 and 05/05/26. Facility policy required opened multi-dose vials to be dated and discarded within 28 days unless the manufacturer specified otherwise, and the FDA package inserts for Aplisol, Tubersol, and Teriparatide gave specific in-use discard instructions. The ADON stated he/she was responsible for ensuring medications were not expired, outdated, or discontinued and said the medication room was checked monthly, but was unaware the expired medication was present. Surveyors also observed a medication cart containing multiple opened, undated eye drops, inhalers, and nasal spray products, including three opened, undated bottles of Lantaprost eye drops, three undated and unlabeled plastic vials, two opened, undated boxes of Spiriva inhaler tablets, two opened undated Albuterol inhalers, one opened undated Advair inhaler, one opened undated Advair discus inhaler, and four opened undated Flonase nasal sprays. A CMT stated he/she did not date eye drops, inhalers, nasal sprays, or ear drops and said staff would not know if the items were still safe to administer if they were not dated when opened. The DON stated medication storage should be checked weekly, preferably daily, and the administrator stated CMTs should check and pull expired medications while the ADON and DON performed periodic audits.
Dishwashing Machine Not Meeting Manufacturer's Temperature Requirements
Penalty
Summary
The facility staff failed to ensure the dishwashing machine operated according to the manufacturer's instructions, which led to inadequate sanitization of kitchen wares. The facility's policy required dishwashing machines to operate with a wash temperature of 120 degrees Fahrenheit and a final rinse with 50 parts per million hypochlorite. However, the Dish Machine - PPM Sanitizer Record Logs showed consistent documentation of machine temperatures at 98 degrees Fahrenheit, below the required temperature. Observations confirmed that the maximum water temperatures reached during various dishwashing cycles were between 101 and 109 degrees Fahrenheit, which did not meet the manufacturer's specified minimum of 120 degrees Fahrenheit. Interviews with facility staff revealed a lack of awareness and understanding of the correct operating temperatures for the dishwashing machine. Dietary Dish Aide M and another staff member believed the water temperature should be between 98 and 100 degrees Fahrenheit, while the Dietary Manager thought it should be 110 degrees Fahrenheit. The maintenance director acknowledged that the dish machine gauge never reached 120 degrees but assumed it was acceptable due to the use of low-temperature sanitizer chemicals. The administrator was unaware of the discrepancy and relied on the Dietary Manager to ensure compliance with the manufacturer's instructions.
Deficiencies in Water Management and Catheter Care
Penalty
Summary
The facility staff failed to develop and implement comprehensive policies and procedures for the inspection, testing, and maintenance of the facility's water systems to prevent the growth of waterborne pathogens, specifically Legionella bacteria. The Legionella Water Management Plan was found to be incomplete and inaccurate, with references to another facility and incorrect descriptions of the facility's water system. The plan lacked a building water system flow diagram and did not document semiannual water heater flushes or quarterly cleaning and descaling of showerheads and spray nozzles. The maintenance director admitted to not thoroughly reviewing the plan and was unaware of the need to clean showerheads or flush water heaters. Additionally, the facility's Urinary Catheter Care policy, dated 2001, did not provide guidance on the proper positioning of an indwelling catheter to prevent contamination. Observations revealed that a resident's indwelling catheter was repeatedly found on the floor, which poses a risk of infection due to potential bacterial contamination. Interviews with staff, including a CNA, the Assistant Director of Nursing (ADON), and the Infection Preventionist, confirmed that catheters should be kept off the floor to prevent infection. The facility's administrator and Director of Nursing (DON) acknowledged the deficiencies in the Legionella Water Management Plan and the improper handling of indwelling catheters. The administrator was unaware of all the required components of a water management plan, and the DON admitted that there had not been recent catheter training. The DON and ADON were responsible for ensuring staff followed proper procedures, but daily hall checks did not prevent the observed deficiencies.
Deficiencies in Wheelchair Safety, Mechanical Lift Transfers, and Hazardous Material Storage
Penalty
Summary
The facility staff failed to ensure wheelchair safety for two residents, as they were propelled without footrests, leading to potential injury risks. One resident, who was cognitively intact and independent in a wheelchair, was observed being propelled by a CNA without footrests because they could not be found. Another resident, with severe cognitive impairment and substantial assistance needs, was also propelled by the administrator without footrests, causing the resident's feet to slide on and off the floor. The facility staff also failed to conduct safe mechanical lift transfers for three residents. These residents, who were either cognitively intact or severely impaired and dependent on staff for transfers, were transferred using a mechanical lift with the leg base closed, contrary to safety protocols. Staff interviews revealed that the leg base should be open for stability, but space constraints in rooms were cited as a reason for not following this procedure. Additionally, the facility did not have a policy for the storage of hazardous materials, leading to unsafe conditions. Observations showed unattended and unlocked shower rooms and dining areas with accessible hazardous materials, such as disposable razors and nail polish remover, posing a risk to residents. Staff interviews confirmed that hazardous materials should be locked to prevent resident access, but this was not consistently practiced.
Failure to Maintain a Homelike Environment
Penalty
Summary
The facility failed to provide a comfortable and homelike environment for its residents, as evidenced by multiple observations of poor maintenance in resident-occupied rooms. Observations revealed black stains and lifted tiles around toilets, damaged sheetrock with exposed metal edges, sticky dried yellow substances on bathroom tiles, broken tiles with exposed concrete and sharp edges, and strong odors in several rooms. Additionally, a ceiling near a window was observed to have cracks, brown stains, and black material protruding from a hole. Interviews with facility staff, including a Certified Medication Technician, a Housekeeper, the Maintenance Director, and the Administrator, revealed that there is a maintenance log for reporting damage, but the facility has been unable to keep up with repairs. The Maintenance Director acknowledged awareness of the damage and stated efforts were being made to address it. The Administrator noted that the facility's full capacity has hindered the ability to move residents for repairs, and the Maintenance Director is responsible for ensuring repairs are completed.
Medication Storage Deficiency Due to Expired Medications
Penalty
Summary
Facility staff failed to store medications in a safe and effective manner in one of the two medication storage rooms. The facility's policy, dated February 2023, requires that discontinued, outdated, or deteriorated medications be returned to the pharmacy or destroyed. However, during an observation, it was found that the 100 hall medication storage room contained expired medications, including a bottle of Aspirin, Magnesium Oxide, Vitamin D, and a tube of Diclofenac Sodium topical Gel, all past their expiration dates. Interviews with facility staff revealed a lack of consistent responsibility and oversight regarding medication storage. A Certified Medication Technician stated that expired medications are either returned to the pharmacy or destroyed. An LPN indicated that the night shift nurse is responsible for monitoring the medication storage room and ensuring expired medications are handled appropriately. The administrator and the Director of Nursing both emphasized that all nursing staff are responsible for checking and managing medication storage to prevent expired medications from being available, highlighting a discrepancy in the execution of these responsibilities.
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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 Boonville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Lakeview Health Care & Rehabilitation Center | 2.3 mi | ★★★★★ | 7 | 0 |
| Ashley Manor Health & Rehabilitation | 2.7 mi | ★★★★★ | 0 | 0 |
| Katy Manor | 12 mi | ★★★★★ | 0 | 0 |
| Glasgow Gardens | 19.5 mi | ★★★★★ | 0 | 0 |
| Parkside Manor | 20 mi | ★★★★★ | 9 | 0 |
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