Missouri Department of Health and Senior ServicesP.O. Box 570, Jefferson City, MO 65102-0570 Phone: 573-526-8523 FAX: 573-526-8797RELAY MISSOURI for Hearing and Speech Impaired 1-800-735-2966 VOICE 1-800-735-2466Margaret T. DonnellyDirector

Jeremiah W. (Jay) NixonGovernor

MEMORANDUM FOR MATT YOUNGER, SECTION ADMINISTRATORSECTION FOR LONG-TERM CARE REGULATION

Kathryn Wolfe, Interim Program ManagerSection for Long-Term Care Regulation

Parkview Estates1300 East 24th St.Sedalia, MO 65301

Administrator/Manager -- John CollinsOperator -- Walter & Frances Clark

26-Bed, Residential Care FacilityUncorrected Class II Notice of Noncompliance:.

At the revisit, the facility still failed to employ a licensed nursing home administrator tobe in charge when the Administrator is absent from the facility more than 60 days duringa calendar year. The facility census was 13.

State Senator -- Mike ParsonState Representative -- Stanley Cox

cc: Teresa Generous, Matt Younger, Larry Smith, CRU, Lieutenant Governor's Office,Central Files, Health Education Unit, SLCR Region 6, DSDS Region 4, Ombudsman,BNHA, Family Support Division, DMH, VA Medical Center, LTC Associations, S&C,DHSS Office Of General Counsel

www.health.mo.govHealthy Missourians for life.

The Missouri Department of Health and Senior Services will be the leader in promoting, protecting and partnering for HealthAN EQUAL OPPORTUNITY I AFFIRMATIVE ACTION EMPLOYER: Services provided on a nondiscriminatory basis.

Missouri Department of Health and Senior ServicesP.O. Box 570, Jefferson City, MO 65102-0570 Phone: 573-526-8523 FAX: 573-526-8797RELAY MISSOURI for Hearing and Speech Impaired 1-800-735-2966 VOICE 1-800-735-2466

Margaret T. DonnellyDirector

Jeremiah W. (Jay) NixonGovernor

John Collins, AdministratorParkview Estates1300 East 24th St.Sedalia, MO 65301

On 01/20/2012, The Section for Long-Term Care Regulation (SLCR) completed aninspection and found Parkview Estates, a 26 bed Residential Care Facility, not incompliance with Sections 198.003 to 198.096, RSMo, and the standards establishedthereunder. A revisit of the facility was completed by the SLCR staff on 04/23/2012. Itwas determined the facility is not in substantial compliance in the area of Administrative,Personnel and Resident Care Requirements as a result of the uncorrected Class IIviolation which is listed in the enclosed Statement of Deficiencies.

The SLCR is hereby issuing Parkview Estates a Notice of Noncompliance inaccordance with Section 198.026.3, RSMo. The SLCR may seek the imposition of anyof the sanctions and remedies provided in Section 198.066 and Section 198.067,RSMo, or any other action authorized by law. The violation will be presumed tocontinue until you notify the SLCR in writing that it has been corrected and the SLCRstaff verifies that it has been corrected. Sign, date, and return the Statement ofDeficiencies with the plan of correction to the SLCR Region 6, 3418 Knipp Drive,Jefferson City, MO 65102 within ten (10) calendar days of receipt. Your Plan ofCorrection MUST NOT INCLUDE THE NAMES OF RESIDENTS. In addition, your planof correction should not include other resident specific information such as medicalrecords. You are required by Section 198.026.6, RSMo, to pnst a copy of the mostrecent inspection report in a conspicuous location in your facility.

The SLCR will send a copy of this Notice of Noncompliance to all concerned federal,state and local government agencies, as required by Section 198.026.6, RSMo.

Action must be taken to correct the violation set out in the attachment to this noticewithin thirty (30) days from the date of delivery of this notice. Representatives of theSLCR will be conducting a revisit after thirty (30) days to determine whether theviolation in the Statement of Deficiencies has been corrected. If at the time of the revisitany violations in the Notice of Noncompliance are found not corrected, the SLCR mayseek the imposition of any sanctions and remedies authorized by federal or state law orregulations. These sanctions may include the recommendation of a state civil monetarypenalty (CMP) of not less than $250.00 per day for each uncorrected class II violation,retroactive to the date of the 04/23/2012 revisit.

www.health.mo.govHealthy Missourians for life.

The Missouri Department of Health and Senior Services will be the leader in promoting, protecting and partnering for HealthAN EQUAL OPPORTUNITY I AFFIRMATIVE ACTION EMPLOYER: Services provided on a nondiscriminatory basis.

· - .. .. -cited deficiencies through an informal dispute resolution process. To be given such anopportunity, you are required to send your written request (separate from the plan ofcorrection), along with the specific deficiencies being disputed, and an explanation ofwhy you are disputing those deficiencies to:

Carla JenningsProgram ManagerRegion 63418 Knipp DriveP.O. Box 570Jefferson City, MO 65102

Nicole MeyerPrimaris200 N. Keene StreetColumbia, MO 65201573-817 -8300nmeyer@primaris.org

Please include a copy of the statement of deficiencies being disputed with yourcorrespondence to Primaris.

This request must be sent during the same ten (10) calendar days you have forsubmitting a plan of correction for the cited deficiencies. The informal dispute resolutionmay be conducted by telephone, in writing or in a face-to-face meeting. An incompleteinformal dispute resolution process will not delay the effective date of any enforcementaction.

If you have any questions, please contact Kathryn Wolfe, Interim Program Manager at573-526-3247.

Matt Younger, Section AdministratorSection for Long-Term Care Regulation

cc: Lieutenant Governor's OfficeFamily Support DivisionDepartment of Mental HealthCentral FilesArea Hospitals PettisLTC Associations