Average — CMS composite of the measures below.
A standard survey is most likely before around August 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 Shirkey Nursing And Rehabilitation Center during CMS and state inspections, most recent first.
During a survey, it was observed that the facility did not adhere to food storage and labeling protocols. Open and undated food items were found in the kitchen, including a bag of yellow cake mix, thickener with scoops inside, loaves of bread, and a bag of frozen chicken breasts. The Dietary Manager acknowledged that scoops should not be kept in containers and that staff were expected to label and date items properly. The deficiency had the potential to impact all 86 residents consuming food from the facility's kitchen, posing possible health risks due to compromised food safety standards.
The facility failed to have the Medical Director or designee attend the last two quarterly QAPI meetings. The QAPI Nurse confirmed the absence and acknowledged the regulatory requirement for attendance.
The facility failed to update Care Plans for two residents, one with Alzheimer's disease exhibiting undocumented behaviors and another with chronic conditions requiring continuous oxygen, leading to deficiencies in care.
The facility failed to provide scheduled showers to two residents who preferred showers, leading to a diminished quality of life. Both residents, who were cognitively intact and required substantial assistance, missed multiple showers due to staffing shortages, as confirmed by documentation and staff interviews.
The facility failed to assess and monitor a resident's falls, leading to multiple incidents without proper intervention. Additionally, the facility did not provide necessary safety equipment in smoking areas and failed to conduct proper smoking assessments, increasing the risk of harm to residents.
The facility failed to ensure proper respiratory care for two residents, leading to deficiencies in the management of oxygen and C-PAP equipment. Oxygen tubing was not dated or labeled, C-PAP machines were improperly placed, and there was no evidence of regular cleaning or changing of equipment. Staff admitted to inconsistent maintenance, and the DON confirmed the lack of proper documentation and adherence to protocols.
The facility failed to ensure sufficient nurse staffing, resulting in two residents not receiving scheduled showers and a lack of meaningful activities for residents in the secured dementia unit. Observations and staff interviews confirmed that the unit was understaffed, affecting the quality of care and engagement for the residents.
The facility failed to complete AIMS assessments for residents on antipsychotic medications, including a resident with heart failure and diabetes, another with Alzheimer's disease, and a third with dementia and bipolar disorder. This oversight placed residents at risk for unrecognized side effects.
The facility failed to prepare, store, and label medications according to standard nursing practice. A CMA was observed leaving a medication cart unattended with unlabeled medications and admitted to premixing medications against facility policy. The DON confirmed that medications should not be prepared in advance or left unattended.
The facility failed to document the completion of 12 hours of required in-service training, including dementia care and abuse prevention, for five CNAs. Despite conducting annual trainings, there was no evidence that the required hours were met, and the facility did not track the actual hours completed.
The facility failed to inform a resident and/or their representative about the risks and benefits of prescribed psychotropic medications. The resident, who was cognitively intact, was not informed about the medications Seroquel and Rexulti, and the documentation in the Progress Notes was incomplete. Interviews with staff confirmed that the process for informing residents was not properly followed.
The facility failed to investigate an injury of unknown source for a resident with a history of osteoarthritis, falls, and heart failure. Despite the resident's complaints of knee pain and a reported femur fracture, no investigation was initiated by the nursing staff or the Director of Nursing Services. The resident was later sent to the hospital, where an x-ray revealed a femur fracture. Interviews revealed that the facility did not follow its policy for investigating injuries of unknown source.
The facility failed to provide a program of meaningful activities for a resident with Alzheimer's disease, who was often left without engaging activities and seen wandering or sitting on the floor. The CNA/CMA was unaware of the resident's preferences, and the Activity Director admitted to delays in developing the Activity Care Plan and acknowledged that residents were spending more time in bed.
The facility failed to ensure that a CMA had the necessary skills and competency to safely perform medication administration. CMA 3 had not been assessed for medication competency since 2023 and was only observed for insulin, eye drops, and inhalers.
Non-Compliance with Food Storage and Labeling Requirements
Penalty
Summary
The facility failed to comply with food storage and labeling requirements during the survey. Observations revealed open and undated food items in the kitchen, including an open bag of yellow cake mix, thickener with scoops inside, undated loaves of bread, and an undated bag of frozen chicken breasts. The Dietary Manager acknowledged that scoops should not be kept in containers, and staff were expected to label and date items properly. The DM also mentioned the expectation for staff to close items after use and ensure proper labeling and dating procedures were followed. The deficiency had the potential to impact all 86 residents who consumed food prepared in the facility's kitchen. The lack of proper labeling and dating of food items could compromise food safety standards and potentially lead to health risks for the residents. The facility's policy on Resident Food Storage required labeling and dating of food brought into the facility for monitoring food safety, emphasizing the importance of following these procedures to ensure the well-being of the residents.
Medical Director Absence from QAPI Meetings
Penalty
Summary
The facility failed to have the Medical Director and/or designee attend the last two quarterly QAPI (Quality Assurance and Performance Improvement) committee meetings. Review of the QAPI sign-in sheets for the meetings on 11/28/23 and 02/20/24 revealed that the Medical Director did not attend and was marked as 'unable to attend' for both meetings. During an interview on 04/05/24, the QAPI Nurse confirmed that the Medical Director did not attend the last two meetings and acknowledged awareness of the regulatory requirement for the Medical Director or their designee to attend these meetings.
Failure to Update Care Plans for Two Residents
Penalty
Summary
The facility failed to ensure resident Care Plans were updated and revised for two residents, leading to deficiencies in care. Resident 84, diagnosed with Alzheimer's disease, exhibited behaviors such as sitting on the floor, which were not documented in her Care Plan. Despite observations and staff acknowledgment of this behavior, it was not included in the Care Plan, leaving staff without guidance on how to address it safely. The Unit Manager confirmed that the behavior was reported but not documented in the Care Plan, indicating a lapse in updating the resident's Care Plan to reflect her current status. Resident 6, with diagnoses including chronic congestive heart failure and chronic atrial fibrillation, had a continuous oxygen order that was not included in their Care Plan. Despite the resident using oxygen since their last hospital visit, the Care Plan did not address this need. The Assistant Director of Nursing, responsible for updating Care Plans, admitted to missing the oxygen requirement during the last significant change assessment. This oversight left staff without proper instructions on managing the resident's oxygen needs.
Failure to Provide Scheduled Showers Due to Staffing Shortages
Penalty
Summary
The facility failed to provide showers to two residents who preferred showers, leading to a diminished quality of life. Resident 8, who was admitted with diagnoses including Parkinson's disease, dementia, and anxiety, had a BIMS score indicating she was cognitively intact and required substantial assistance with showering. Despite her care plan specifying she should receive showers twice weekly, there were multiple instances where she did not receive a shower, which she attributed to staffing shortages. Documentation confirmed the lack of showers on specific dates in January, February, and March 2024. Similarly, Resident 73, admitted with cerebral palsy and mental illness, also had a BIMS score indicating cognitive intactness and required substantial assistance with showering. Her care plan indicated she should receive showers twice weekly, but she reported not receiving them due to staffing issues. Documentation confirmed missed showers on specific dates in January, February, March, and April 2024. An LPN confirmed that staffing shortages were likely the reason for the missed showers, as the facility could not always assign a CNA to assist with showers when understaffed.
Failure to Assess Falls and Provide Smoking Safety Measures
Penalty
Summary
The facility failed to adequately assess and monitor a resident's falls, leading to multiple incidents without proper intervention. Resident 23, who was admitted with various diagnoses including dementia and epilepsy, experienced fourteen falls over a six-month period. Despite these frequent falls, there was no documentation of fall assessments or root cause analysis. Interviews with staff and family members revealed a lack of consistent interventions and monitoring, with the resident often found in unsafe conditions such as a raised bed without proper supervision or safety measures in place. The Director of Nursing (DON) admitted that no root cause analysis or evaluations had been conducted for the resident's falls, and the facility's records did not indicate when or what interventions were implemented to prevent further falls and injuries for Resident 23. The facility also failed to provide necessary safety equipment in designated smoking areas and did not conduct proper smoking assessments for residents. Observations revealed that the three designated smoking areas lacked fire blankets and fire extinguishers, posing a significant risk to residents who smoke. One resident, who was supposed to be supervised while smoking, was observed smoking unsupervised for several minutes before a staff member arrived. The DON admitted that smoking assessments were not conducted, and there was no documentation to show that the resident's smoking abilities had been assessed. This lack of assessment and supervision increased the risk of harm to residents who smoke. Interviews with staff and review of facility policies highlighted systemic issues in the facility's approach to resident safety and risk management. The facility's policies on unusual occurrences and smoking were not adequately followed, leading to repeated incidents and potential hazards. The DON and other staff members were often unaware of the specific interventions or assessments required to ensure resident safety, indicating a need for improved training and adherence to established protocols.
Deficiencies in Respiratory Care Management
Penalty
Summary
The facility failed to ensure proper respiratory care for two residents, leading to deficiencies in the management of oxygen and C-PAP equipment. For one resident, the oxygen tubing was not dated or labeled, and the C-PAP machine was improperly placed on the floor. Additionally, there was no evidence that the C-PAP mask, tubing, and water chamber were cleaned or changed as per physician orders. Interviews with the resident and staff revealed inconsistencies in the maintenance and documentation of respiratory equipment, with staff admitting to changing the equipment on an 'as needed' basis rather than following a set schedule. Another resident was observed with a nasal cannula that was not properly positioned in both nares, and the oxygen concentrator filter was found to be dirty. The resident was also seen without her oxygen on multiple occasions, and staff were unsure why the oxygen was not being used. The facility's Director of Nursing (DON) and other staff members confirmed that the oxygen tubing and C-PAP equipment were not being maintained as required, and there was a lack of proper documentation to verify that the necessary cleaning and changes were being performed. The facility's policy required weekly cleaning and changing of oxygen and C-PAP equipment, but observations and interviews indicated that these tasks were not being consistently carried out. The DON acknowledged the deficiencies and stated that the night shift aides were responsible for these tasks, but the lack of documentation suggested that the procedures were not being followed. This failure to adhere to established protocols placed the residents at risk for respiratory illnesses and contamination of their respiratory equipment.
Staffing Shortages Lead to Unmet Resident Needs
Penalty
Summary
The facility failed to ensure sufficient nurse staffing to meet the needs of the residents, resulting in residents not receiving showers and a lack of meaningful activities in the secured dementia unit. Specifically, two residents, R73 and R8, did not receive their scheduled showers due to staffing shortages. R8 reported not having a shower for seven days, and R73 confirmed that showers were missed because of short staffing. Both residents were cognitively intact and expressed concerns about the lack of care. Additionally, the facility's quarterly Minimum Data Set (MDS) confirmed these residents' cognitive status and their unmet needs for showers. The facility also failed to provide a program of meaningful activities for residents in the secured dementia unit. Observations revealed that residents were often lying in bed or wandering without engagement. Only one staff member was available to assist nine residents with activities of daily living (ADL), medication administration, behavior management, and activities. Interviews with staff, including a Certified Nurse Aide (CNA), Licensed Practical Nurse (LPN), and the Activities Director (AD), confirmed that the unit was understaffed and that the move to a new hall had further limited the residents' access to outdoor activities and adequate care. The facility assessment indicated that the previous staffing levels were higher, but the current staffing was insufficient to meet the residents' needs.
Failure to Complete AIMS Assessments for Residents on Antipsychotic Medications
Penalty
Summary
The facility failed to complete Abnormal Involuntary Movement Scale (AIMS) assessments for residents who were administered antipsychotic medications, placing them at risk for unrecognized side effects. Resident 65 was admitted with diagnoses including heart failure, diabetes, and pulmonary disease. Despite being prescribed Seroquel and later Rexulti, there was no documentation of an AIMS assessment being completed. The Director of Nursing (DON) confirmed that AIMS assessments were the responsibility of Unit Managers and should be done upon admission and every six months thereafter, but could not confirm if these assessments were completed for Resident 65. Resident 84, admitted with Alzheimer's disease, was also not assessed using AIMS upon admission or when prescribed Olanzapine and Risperidone. The Unit Manager acknowledged that the AIMS assessment was not done and could not provide a reason. This oversight was confirmed during an interview, highlighting a gap in the facility's protocol for monitoring residents on antipsychotic medications. Resident 4, diagnosed with unspecified dementia, bipolar disorder, and anxiety, was observed exhibiting tongue thrusting, a potential side effect of antipsychotic medication. Despite a care plan that included AIMS assessments every three months, there was no documentation of these assessments being completed. The DON could not provide any records of AIMS evaluations or routine assessments for Resident 4's psychotropic medication use, indicating a failure to follow the care plan and monitor for side effects effectively.
Failure to Properly Label and Store Medications
Penalty
Summary
The facility failed to prepare, store, and label medications according to standard nursing practice, as observed during a medication pass. Certified Medication Aide (CMA3) was seen leaving a medication cart unattended with three individual plastic cups containing unlabeled medications. CMA3 admitted to premixing medications, including Lactulose, liquid protein, and Miralax, and leaving them on the cart. This practice was against the facility's policy, which mandates that medications should never be left unattended and should be locked inside the cart if the cart is left unattended. Further observations revealed that CMA3 continued this practice with another medication cart, which also had five individual plastic cups of unlabeled medications on top. CMA3 admitted to premixing these medications about an hour prior and stated that she could identify the medications without labels. The Director of Nursing (DON) confirmed that the expectation was for medications not to be prepared in advance and not to be left unattended on the carts.
Failure to Document Required In-Service Training Hours
Penalty
Summary
The facility failed to document the completion of a minimum of 12 hours of required in-service training, including dementia care and abuse prevention, for five Certified Nursing Assistants (CNAs). Despite annual trainings being conducted, there was no evidence that the required 12 hours were completed for CNAs 1, 2, 4, 6, and 7. Interviews with CNAs revealed that while they received some training on abuse and neglect, dementia care training was either minimal or non-existent. The facility's Facility Assessment indicated the need for 12 hours of annual training, but this requirement was not met or documented properly. The Infection Preventionist (IP) and Director of Nursing (DON) confirmed that they did not track the actual hours of training completed by staff. The IP mentioned that while they conducted various trainings, they did not document the number of hours. Similarly, the DON stated that although staff signed in for trainings, there was no system in place to ensure the 12-hour requirement was met. This lack of documentation and tracking led to the deficiency, putting residents at risk of not receiving adequate care from properly trained staff.
Failure to Inform Resident of Psychotropic Medication Risks and Benefits
Penalty
Summary
The facility failed to ensure that a resident and/or their representative was informed of the risks and benefits of physician-ordered psychotropic medications. Specifically, Resident 65, who was cognitively intact with a BIMS score of 14 out of 15, was not informed about the risks and benefits of Seroquel and Rexulti, which were prescribed for increased behaviors, hallucinations, paranoia, and depression. The documentation in the Progress Notes did not show that the resident or their representative was informed prior to the initiation of these medications. During interviews, it was revealed that the facility's process for informing residents or their representatives about new psychotropic medications involved a phone call, which was then documented in the Progress Notes. However, in this case, the documentation was incomplete, and the Licensed Practical Nurse and Director of Nursing confirmed that if it was not documented, it did not happen. This failure placed the resident and/or representative at risk of not knowing the risks and benefits of the medications being administered.
Failure to Investigate Injury of Unknown Source
Penalty
Summary
The facility failed to investigate an injury of unknown source for a resident, which placed the resident at risk for potential abuse. The resident, who had a history of osteoarthritis, falls, and heart failure, reported being unable to stand due to knee pain. Subsequent progress notes indicated that the resident mentioned breaking her femur and experiencing pain, but no falls were reported by the staff. Despite the resident's complaints and the family's concerns, no investigation was initiated by the nursing staff or the Director of Nursing Services (DNS) when the injury was first reported. The resident was later sent to the hospital at the family's request, where an x-ray revealed a femur fracture. The acuity of the fracture was uncertain, but it could not be excluded as an acute fracture. Upon readmission to the facility, the resident's condition had deteriorated, and she was no longer able to walk. The resident and her family reported that the resident had been dropped by staff, which was not documented or investigated by the facility. Interviews with the resident, family member, and staff revealed that the facility did not follow its policy for investigating injuries of unknown source. The Director of Nursing (DON) was unaware of the x-ray report and the resident's statements, and no investigation was conducted. This lack of action and communication among the staff led to the failure to investigate the resident's injury, which is a violation of the facility's policy and federal and state laws regarding the treatment of residents.
Failure to Provide Meaningful Activities for Resident
Penalty
Summary
The facility failed to consistently provide a program of meaningful activities in accordance with a resident's preferences. The resident, diagnosed with Alzheimer's disease and severely impaired in cognition, was admitted to the facility and had a documented preference for activities such as attending church, watching specific TV shows, hiking, and enjoying chocolate and Mountain Dew. However, observations revealed that the resident was often left without engaging activities, seen sitting on the floor or wandering around, with minimal staff intervention. The CNA/CMA on duty was unaware of the resident's specific activity preferences and there was no activity logbook available to guide staff in providing appropriate activities. The Activity Director admitted to delays in developing the resident's Activity Care Plan and acknowledged that the residents were spending more time in bed. The AD also noted that the aide on the dementia unit was supposed to conduct activities with the residents, but this was not happening consistently. The recent move of residents to a new unit had also impacted the availability of outdoor activities and other engagement opportunities. The AD mentioned attempts to engage residents with activities like bingo, but overall, the facility's efforts to provide meaningful activities were insufficient, leading to a diminished quality of life for the resident.
Failure to Ensure Medication Competency of Certified Medication Aide
Penalty
Summary
The facility failed to ensure that a Certified Medication Aide (CMA) had the necessary skills and competency to safely perform medication administration. Specifically, CMA 3, who was hired on 07/11/02, had not been assessed for medication competency since 04/11/23. The Skills and Drills sheet provided by an LPN showed that CMA 3 was only observed for insulin, eye drops, and inhalers, and had not been assessed for any other medication pass requirements. During an interview, the LPN confirmed that CMA 3 had not undergone a comprehensive medication pass observation since 2023.
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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 Richmond
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Riverbend Heights Health & Rehabilitation | 8.5 mi | ★★★★★ | 1 | 0 |
| Aspire Senior Living Excelsior Springs | 16 mi | ★★★★★ | 21 | 0 |
| Valley Manor And Rehabilitation Center | 16.3 mi | ★★★★★ | 27 | 0 |
| Meyer Care Center | 17.7 mi | ★★★★★ | 1 | 0 |
| Lawson Manor & Rehab | 18 mi | ★★★★★ | 4 | 0 |
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