Based on interview and record review, the facility failed to notify the state mental health authority promptly after a significant change in the mental condition of a resident who has mental illness for one resident (Resident #4) in a review of 17 sampled residents. The facility census was 40. Review of the Resident Assessment Instrument (RAI) Manual, dated October 2025, showed the following:-Guidelines for Determining When a Significant Change Should Result in Referral for a Preadmission Screening and Resident Review (PASRR) Level II Evaluation:-If a Significant Change in Status Assessment (SCSA) occurs for an individual known or suspected to have a mental illness, intellectual disability, or related condition (as defined by 42 CFR 483.102), a referral to the State Mental Health or… …
F646 citations in Missouri
Resident Assessment and Care Planning Deficiencies
Notify the appropriate authorities when residents with MD or ID services has a significant change in condition.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Missouri cites F646 less often than its own record predicts
0.41 times the national share — cited less often here than elsewhere.
Of every deficiency written in Missouri in 2025, this is the portion that was F646.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Missouri surveyors wrote
F646 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.
The short window
Recent years
| Year | Share of Missouri citations | vs expected |
|---|---|---|
| 2023 | 0.09% | 1.76× |
| 2025 | 0.03% | 0.41× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Missouri surveyors cite →
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