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Citizens Memorial Home Health

(417) 326-3585111 W Broadway, Bolivar, MO 65613
CMS Certification Number 267196 · Proprietary · Medicare-certified since 03/05/1984
11deficiencies since 2018
0serious
2inspections
2.5CMS quality stars
Data from CMS inspection reports (Form 2567), 2018-01-02 to 2026-10-15, downloaded 2026-10-21; CMS agency list file dated 2026-09-21. What the labels mean

Inspection 2023-11-01

· Recertification · 7 deficiencies · CMS source report (PDF)
Moderate Authentication

The home health provider failed to ensure that all documentation in the clinical record was submitted in a timely manner in, but not limited to, two of six records reviewed (Records/Patients #5 and #6).

Source: CMS Form 2567, inspection 2023-11-01, tag G1024 · view on CMS
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Minor Written Notice Within 4 Business Days

The home health provider failed to ensure the patient rights information included the verbiage that the provider would provide written notice of the patient's rights and responsibilities and the provider's transfer and discharge policies to a patient-selected representative within 4 business days…

Source: CMS Form 2567, inspection 2023-11-01, tag G0422 · view on CMS
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Minor A Review Of All Current Medications

The home health provider failed to maintain an updated medication profile in, but not limited to, two of five full records reviewed (Records/Patients #1 and #3).

Source: CMS Form 2567, inspection 2023-11-01, tag G0536 · view on CMS
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Minor Promptly Alert Relevant Physician Of Changes

The home health provider failed to ensure that the physician was notified of changes in one of five full records reviewed (Record/Patient #5).

Source: CMS Form 2567, inspection 2023-11-01, tag G0590 · view on CMS
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Minor Patient Medication Schedule/Instructions

The home health provider failed to ensure all patients received a written medication schedule in two of three home visits conducted (Records/Patients #1 and #3).

Source: CMS Form 2567, inspection 2023-11-01, tag G0616 · view on CMS
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Minor Interdisciplinary Assessment Of The Patient

The home health provider failed to ensure that wound measurements were completed in one of two discharged records (Record/Patient #6).

Source: CMS Form 2567, inspection 2023-11-01, tag G0706 · view on CMS
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Minor Discharge And Transfer Summaries

The home health provider failed to complete a discharge summary for one of two discharge records reviewed (Record/Patient #6).

Source: CMS Form 2567, inspection 2023-11-01, tag G1022 · view on CMS
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Inspection 2021-01-25

· Focused Infection Control, Other-Fed, Recertification · 4 deficiencies · CMS source report (PDF)
Moderate Infection Prevention

The agency failed to assure the staff followed accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases in one (Record/Patient #2) of three home visits performed.

Source: CMS Form 2567, inspection 2021-01-25, tag G0682 · view on CMS
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Moderate Home Health Aide Assignments And Duties

The registered nurse (RN) failed to provide an individualized, patient specific home health aide plan of care in one (Record/Patient #3) of three records reviewed.

Source: CMS Form 2567, inspection 2021-01-25, tag G0798 · view on CMS
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Minor A Review Of All Current Medications

The agency failed to review all medications the patient was currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy…

Source: CMS Form 2567, inspection 2021-01-25, tag G0536 · view on CMS
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Minor Interdisciplinary Assessment Of The Patient

The agency failed to complete an ongoing interdisciplinary assessment of the patient in two (Record/Patient #2 and #5) of six records.

Source: CMS Form 2567, inspection 2021-01-25, tag G0706 · view on CMS
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