Baptist Homes of Shelbina

In the surveyor’s words

From the most serious findings on record at Baptist Homes of Shelbina, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Jul 1, 2025

  Based on observation, interview and record review, the facility failed to provide protective oversight to ensure one additional resident (Resident #33), followed facility policies regarding smoking. Resident #33, who utilized oxygen, was assessed by the facility to be a safe smoker and could smoke independently. Observation on 06/24/25 at 12:30 P.M., showed the resident outside smoking a cigarette. His/Her portable oxygen concentrator (a device that delivers oxygen) was turned on and running at three liters per minute. The resident had removed his/her oxygen tubing from his/her nose and laid the tubing across the right armrest of his/her wheeled walker. […]

• Immediate jeopardy, isolatedF600Apr 27, 2023

  Based on observation, interview, and record review, the facility failed to protect one resident (Resident #1) in a review of five sampled residents, from abuse and neglect with care when Certified Medication Technician (CMT) A recorded the resident on his/her personal cellular phone without the resident's consent while the resident cried out and attempted to get out of bed, wearing only a shirt, incontinence brief and pants up to his/her knees. The resident's arm was through the middle of the grab bar of the bed and his/her legs hung off the side of the bed. CMT A did not provide the resident any assistance or care for approximately three minutes and continued to record as the resident cried out and struggled to get up in an unsafe situation. […]

• Immediate jeopardy, isolatedF740Apr 27, 2023

  Based on observation, interview, and record review, the facility failed to ensure one resident (Resident #1), in a review of five residents, a resident with diagnosis of dementia and anxiety ,received the necessary behavioral health care services to maintain the highest practicable physical, mental and psychosocial well-being. Staff failed to investigate underlying causes of the resident's agitation and anxiety. Staff failed to develop and implement individualized interventions for the resident which caused the resident emotional distress when staff routinely woke him/her prior to 6:00 A.M. against the resident's wishes and for the purpose of staff convenience. […]

• Actual harm, isolatedF689Feb 22, 2024

  Based on interview and record review, the facility failed to ensure staff transferred one resident (Resident #6), in a review of seven sampled residents, who required staff assistance and use of a gait belt (belt used to help safely transfer a person from a bed to a wheelchair, assist with sitting and standing, and ambulation). Both staff and the resident fell . The resident had a history of falls and a left hip fracture. The resident sustained a skin tear, muscle/ligament tears, and had increased pain after the fall. The facility census was 59. Review of the facility policy Gait Belt for Transfer dated 10/10/12 showed gait belts are provided to assist staff to safely transfer or ambulate residents. 1. […]

• Actual harm, isolatedF760Feb 22, 2024

  Based on interview and record review, the facility failed to ensure one resident (Resident #7). in a review of seven sampled residents, remained free of significant medication error. The resident had an order for a Fentanyl patch (a powerful opiod medication for pain control). The resident became nauseated and unresponsive requiring two doses of Narcan (a medication used to reverse opioid overdose) before becoming responsive again. The resident was then transferred to the hospital for evaluation where hospital records showed the resident had two Fentanyl (narcotic pain medication) patches on the resident's skin (the resident's physician order was for one patch). The facility census was 59. The facility did not provide a policy for following physician's orders. […]