Based on interview and record review, the facility failed to provide staff access to 15 months of the Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, for 12 of 19 sampled residents (Residents #35, #22, #66, #31, #45, #3, #32, #64, #48, #37, #56 and #42). The census was 90. 1. Review of Resident #35's medical record, showed the following: -An admission date of [DATE]; -Only a quarterly MDS, dated [DATE], and annual MDS, dated [DATE], available to staff. 2. Review of Resident #22's medical record, showed an admission date of [DATE]. Review of the resident's MDS binder, showed one quarterly MDS, dated [DATE]. Further review of the MDS file cabinet, showed no other MDS assessments available to staff. 3. …
F639 citations in Missouri
Resident Assessment and Care Planning Deficiencies
Maintain 15 months of resident assessments in the resident's active clinical record.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2024
Missouri cites F639 more often than its own record predicts
5.02 times the share F639 takes of citations nationally.
Of every deficiency written in Missouri in 2024, this is the portion that was F639.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Missouri surveyors wrote
F639 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 interview and record review facility staff failed to maintain fifteen (15) months of Minimum Data Set (MDS), a federally mandated resident assessment tool, assessments in the resident's active record for eight (Resident #1, #7, #13, #17, #23, #24, #26, and #32) of eight of sampled residents who were admitted greater than 15 months. The census was 54. 1. Review of the facility's MDS completion and submission timeframes policy dated 2010, showed the policy did not contain direction for maintaining MDS assessments. …
What else Missouri surveyors cite →
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