01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-12-22 | 11 | 2025-12-22 | 0 |
| Cycle 2 | 2023-12-08 | 8 | 2023-12-08 | 1 |
| Cycle 3 | 2021-04-16 | 6 | 2021-04-16 | 2 |
CMS CCN 2655452026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Citizens Memorial Healthcare Facility
1218 West Locust · Bolivar, MO 65613 · Polk County
Certified beds111CMS provider file
Recent citation rows28current CMS citation release
Penalty rows0current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
28 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 8 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-02-10 · HEALTHF0557Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Correction field: Past Non-Compliance · complaint2025-12-22 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2026-02-032025-12-22 · HEALTHF0689Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2026-02-032025-12-22 · HEALTHF0690Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Correction field: Deficient, Provider has date of correction · 2026-02-032025-12-22 · HEALTHF0697Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2026-02-032025-12-22 · HEALTHF0698Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2026-02-032025-12-22 · HEALTHF0759Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2026-02-032025-12-22 · HEALTHF0760Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2026-02-032025-12-22 · HEALTHF0804Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Correction field: Deficient, Provider has date of correction · 2026-02-032025-12-22 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2026-02-032025-12-22 · HEALTHF0880Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2026-02-032025-07-07 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2025-08-16 · complaint2025-07-07 · HEALTHF0690Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Correction field: Deficient, Provider has date of correction · 2025-08-16 · complaint2024-10-24 · HEALTHF0755Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has date of correction · 2024-12-08 · complaint2023-12-08 · HEALTHF0558Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
Correction field: Deficient, Provider has date of correction · 2024-01-212023-12-08 · HEALTHF0658Severity E · pattern; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Correction field: Deficient, Provider has date of correction · 2024-01-212023-12-08 · HEALTHF0690Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Correction field: Deficient, Provider has date of correction · 2024-01-212023-12-08 · HEALTHF0698Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2024-01-212023-12-08 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2024-01-212023-12-08 · FIREK0920Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Correction field: Deficient, Provider has date of correction · 2024-01-212023-09-26 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Deficient, Provider has date of correction · 2023-11-10 · complaint2023-09-26 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2023-11-10 · complaint2021-04-16 · HEALTHF0565Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to organize and participate in resident/family groups in the facility.
Correction field: Deficient, Provider has date of correction · 2021-05-042021-04-16 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2021-05-3103 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- CALHOUN, MICHAELIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 01/01/2022
- DERRICKSON, BEVERLYIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 01/27/2020
- FINNELL, HEATHERIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 01/01/2022
- FRANCKA, TIMIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 08/16/1998
- MEYER, RENEEIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 07/01/1997
- ASHWORTH, JAMESIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/17/2021
- BABB, DONALDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/19/2019
- DERRICKSON, BEVERLYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 11/21/2016
- DONNELL, WILLIAMIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/14/2012
- HANCOCK, JANIECAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/15/2018
- JOHNSON, BRADIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2022
- KALLENBACH, JOHNIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/20/2019
- MEENTS, DANAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/14/2010
- CALHOUN, MICHAELIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2022
- DERRICKSON, BEVERLYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/27/2020
- HANCOCK, JANIECAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2022
- KALLENBACH, JOHNIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2022
- MEYER, RENEEIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2022
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours3.16per resident day
RN hours0.59per resident day
Weekend nurse hours2.58per resident day
Staff turnover42.5%CMS reported field
06 / LOCAL RECORDS
Open the Bolivar ledger →