Based on interviews, record reviews, and facility policy review, it was determined the facility failed to honor an advance directive for one resident (Resident #174) of 13 residents reviewed for code status. Resident #174 had a Durable Power of Attorney (DPOA) advance directive indicating the resident's wish for do not resuscitate (DNR) if the resident was found unresponsive. On [DATE], the facility called 911 and initiated cardiopulmonary resuscitation (CPR), despite Resident #174's advance directive. Subsequently, Resident #174 received CPR for 17 minutes against the resident's wishes. It was determined the facility's non-compliance with one or more requirements of participation caused, or was likely to cause, serious injury, harm, impairment, or death to residents. …
F578 citations in Missouri
Advance directives · Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Missouri cites F578 less often than its own record predicts
0.67 times the national share — cited less often here than elsewhere.
Of every deficiency written in Missouri in 2025, this is the portion that was F578.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Missouri surveyors wrote
F578 findings written in Missouri, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on observation, interview and record review, the facility failed to ensure residents' advance directive decisions, including code status, were documented and readily available in the medical record for three residents (Residents #27, #28, and #36) out of 12 sample residents. The facility census was 29. Review of the facility policy titled, Advance Directives, dated [DATE], showed:- Advance care planning - a process of communication between individuals and their healthcare agents to understand, reflect on, discuss, and plan for future healthcare decisions for a time when individuals are not able to make their own healthcare decisions;- Advance directive - a written instruction, such as a living will or durable power of attorney for health care, recognized by state law, relating to the… …
The short window
Recent years
| Year | Share of Missouri citations | vs expected |
|---|---|---|
| 2023 | 0.78% | 0.73× |
| 2024 | 0.68% | 0.69× |
| 2025 | 0.64% | 0.67× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Missouri surveyors cite →
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