01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-05-15 | 2 | 2025-05-15 | 0 |
| Cycle 2 | 2024-02-23 | 4 | 2024-02-23 | 1 |
| Cycle 3 | 2022-12-01 | 11 | 2022-12-01 | 3 |
CMS CCN 0454712026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Hiram Shaddox Health And Rehab
1100 Pinetree Lane · Mountain Home, AR 72653 · Baxter County
Certified beds140CMS provider file
Recent citation rows21current 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
21 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 1 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-05-15 · HEALTHF0759Severity E · pattern; 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 · 2025-06-092025-05-15 · HEALTHF0812Severity E · pattern; 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 · 2025-06-092024-02-23 · HEALTHF0554Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Correction field: Deficient, Provider has date of correction · 2024-03-232024-02-23 · HEALTHF0582Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Correction field: Deficient, Provider has date of correction · 2024-03-232024-02-23 · 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 · 2024-03-232024-02-23 · HEALTHF0865Severity E · pattern; potential for more than minimal harm
Administration Deficiencies
Have a plan that describes the process for conducting QAPI and QAA activities.
Correction field: Deficient, Provider has date of correction · 2024-03-232024-02-23 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2024-03-222022-12-01 · HEALTHF0553Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · HEALTHF0554Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · HEALTHF0637Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Assess the resident when there is a significant change in condition
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · HEALTHF0641Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · HEALTHF0677Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · HEALTHF0700Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · HEALTHF0757Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · HEALTHF0761Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · HEALTHF0883Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · HEALTHF0885Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Report COVID19 data to residents and families.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · FIREK0741Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · FIREK0761Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2022-12-292022-12-01 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2022-12-2903 / 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
- DVORAK, NORAIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2017
- LOCKARD, TIFFANYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 12/31/2021
- SPEAKS, KATHYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2021
- DVORAK, NORAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2017
- ADAMS, ANTHONYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/01/2014
- ADAMS, BRYANIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/01/2014
- ELLIS, JOHNIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/01/2014
- KOEHLER, TOBEYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/01/2014
- LOCKARD, TIFFANYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/20/2021
- HEALTH CARE SOLUTIONS, LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 04/01/2014
- INCITE REHAB, LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 04/01/2014
- LTC SYSTEMS/RX, LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 04/01/2014
- PHARMACY CONSULTS, LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 04/01/2014
- RELIANCE HEALTH CARE, INC.Organization · ADP OF THE SNFNOT APPLICABLE · since 04/01/2014
- COOPER, BENJAMINIndividual · ADP OF THE SNFNOT APPLICABLE · since 04/01/2014
- COOPER, JAMESIndividual · ADP OF THE SNFNOT APPLICABLE · since 04/01/2014
- COOPER, ROBERTIndividual · ADP OF THE SNFNOT APPLICABLE · since 04/01/2014
- DVORAK, NORAIndividual · ADP OF THE SNFNOT APPLICABLE · since 01/01/2017
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 hours3.08per resident day
RN hours0.30per resident day
Weekend nurse hours2.42per resident day
Staff turnover57.8%CMS reported field
06 / LOCAL RECORDS
Open the Mountain Home ledger →