Loving Arms Memory Care and Assisted Living.

“The facility shall screen residents and staff for tuberculosis as required for long-term care facilities by 19 CSR 20-20.100. II”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“Each resident admitted to the facility, or his or her next of kin, legally authorized representative or designee, shall be fully informed of the individual's rights and responsibilities as a resident. These rights shall be reviewed annually with each resident, and/or his or her next of kin, legally authorized representative or designee, either in a group session or individually. II/III”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“The facility shall screen residents and staff for tuberculosis as required for long-term care facilities by 19 CSR 20-20.100. II”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“Records shall be maintained upon receipt and disposition of all controlled substances and shall be maintained separately from other records, for two (2) years. (A) Inventories of controlled substances shall be reconciled as follows: 1. Controlled Substance Schedule II medications shall be reconciled each shift; II”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“All persons who have any contact with the residents in the facility shall not knowingly act or omit any duty in a manner that would materially and adversely affect the health, safety, welfare, or property of residents. No person who is listed on the Employee Disqualification List (EDL) maintained by the department as required by section 198.070, RSMo, shall work or volunteer in the facility in any capacity whether or not employed by the operator. For the purpose of this rule, a volunteer is an unpaid individual formally recognized by the facility as providing a direct care service to residents. The facility is required to check the EDL for individuals who volunteer to perform a service for which the facility might otherwise have to hire an employee. The facility is not required to check the EDL for individuals or groups such as scout groups, bingo leaders, or sing-along leaders. The facility is not required to check the EDL for an individual such as a priest, minister, or rabbi visiting a resident who is a member of the individual ' s congregation. However, if a minister, priest, or rabbi serves as a volunteer facility chaplain, the facility is required to check the EDL since the individual would have potential contact with all residents. I/II”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“The facility may admit or retain an individual for residency in an assisted living facility only if the individual does not require hospitalization or skilled nursing placement as defined in this rule, and only if the facility: (E) The premove-in screening shall be completed prior to admission with the participation of the prospective resident and be designed to determine if the individual is eligible for admission to the assisted living facility and shall be based on the admission restrictions listed at section (29) of this rule; II”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“The facility may admit or retain an individual for residency in an assisted living facility only if the individual does not require hospitalization or skilled nursing placement as defined in this rule, and only if the facility: (F) Completes a community based assessment conducted by an appropriately trained and qualified individual as defined in section (4) of this rule: 1. Time frame requirements for assessment shall be: A. Within five (5) calendar days of admission; II”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“In facilities that are constructed or have plans approved after July 1, 2005, electrical wiring shall be installed and maintained in accordance with the requirements of the National Electrical Code, 1999 edition, National Fire Protection Association, Inc., incorporated by reference, in this rule and available by mail at One Batterymarch Park, Quincy, MA 02269, and local codes. This rule does not incorporate any subsequent amendments or additions to the materials incorporated by reference. Facilities built between September 28, 1979 and July 1, 2005 shall be maintained in accordance with the requirements of the National Electrical Code, which was in effect at the time of the original plan approval and local codes. This rule does not incorporate any subsequent amendments or additions. In facilities built prior to September 28, 1979, electrical wiring shall be maintained in good repair and shall not present a safety hazard. All facilities shall have wiring inspected every two (2) years by a qualified electrician. II/III”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“Fire Drills and Emergency Preparedness. (A) All facilities shall have a written plan to meet potential emergencies or disasters and shall request consultation and assistance annually from a local fire unit for review of fire and evacuation plans. If the consultation cannot be obtained, the facility shall inform the state fire marshal in writing and request assistance in review of the plan. An up-to-date copy of the facility ' s entire plan shall be provided to the local jurisdiction ' s emergency management director. II/III”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“Protection from Hazards. (A) In assisted living facilities and residential care facilities licensed on or after November 13, 1980, for more than twelve (12) beds, hazardous areas shall be separated by construction of at least a one- (1-) hour fire-resistant rating. In facilities equipped with a complete fire alarm system, the one- (1-) hour fire separation is required only for furnace or boiler rooms. Hazardous areas equipped with a complete sprinkler system are not required to have this one- (1-) hour fire separation. Doors to hazardous areas shall be self-closing and shall be kept closed unless an electromagnetic hold-open device is used which is interconnected with the fire alarm system. When the sprinkler option is chosen, the areas shall be separated from other spaces by smoke-resistant partitions and doors. The doors shall be self-closing or automatic-closing. Facilities formerly licensed as residential care facility I or II, and existing prior to November 13, 1980, shall be exempt from this requirement. II”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“Based on interview and record review, facitity staff failed to provide twenty-four (24) hour protective oversight for one resident (Resident #1), who was assessed as an elopement risk, when the resident left the secured memory care unit, the alarm sounded and staff did not respond. The facility census was 16. Review of facility Elopement/Missing Person policy, undated, showed staff are to respond immediately to door alarms or other | monitoring/alert system. If no resident found near | monitored door, all residents in the secured area are to be accounted for and to start with wandering risk residents. : 1. Review of Resident #1's medical record showed the resident admitted on 02/11/2023 with a diagnosis of dementia (decline in memory and social symptoms which interferes with daily function). , Review of the resident's monthly summary, dated 01/24/24 and 02/29/24, showed staff assessed the resident as an elopement risk and he/she , wanders. a ‘spud aes a) S47 ony a POY COCARUPR OL BO) a PLE QoettTON port raph hiner CONTAC NUMER ere —— Ee STREET ARES! Or stark PY CoCe LOVING ARMS MEMORY CARE AWO AttiETED uve = WOR EAST a o BNET SAIEMEM] OF OO CENOTS ar ee PROCES Ph OF CCMECTON | sles mie | Os CEPCERY MATE PTSD FALL map| otomegemeas ie OHA “et ALT 19 CSR 3006 047135) Protective Overnight | Aarne # I9CSK- O.7b. ee rarcermmpmmmeeannnss | Keesident m/ has Dent - ring Pesenaes Of voluntary learn tho tacitly ehall | ent ied a6s an iat | nee, at « minimum, » peocedure to inquire of the | Peekdans oc reaicett'® guarclen of the revidani's Gapurture, of the tesident 5 estmeted langyn of elopement risk. The. absence rom the Uncility, and cf the reaiient'* | whereabouts while on voluntary leave iM! resident ps ov 50° | This reputation bt nal mates evidenced by. neva Safety chee } Ouse I AH-hours tw clay. Th toil Continue as hie as the -esident is | Based on intenrirar and recoed reyuge, tocdty tal tated to orowkhe teanty—fou (24) hour protectve crermghi hor ony resident (Rosdant | 81), who won 2aeeeted as en elopomenl ask, when Dye roudard fell the secured memory aare eet, She aterm sounded 2nd staff Sd not reacond The tackty census wos 16 | re srelinig wt -Fhis Review af lacity Bopemantidasing Person | | Le lity policy, undated showed atail are te rorpond ( “ immodiataly bb Od0¢ alarma oF other The Ades. igef car th monlonnofaien syziem ff me resident found new mordored door, afl residents In the secured aise }he Diefesy Tes, ow wie Wo be accounted for end to start wth y WRNGonAY (ith resedent i Rrview of Resisent rts modical record | showed the residect adeutiod on 02 11/2073 vith | SEApnees of tomadin Sterita in meme we toom tympiome whch Sh 2es4 to review palicy, the jneident nad ta | | identify diebary staff, intarleres with duly | probeehve. oversight | HOME ceotere | responsibilities, on Pa see The tdausy reet wrth . ‘Cook C" “ook Cr" individ walt ; . bear and f UY- 2e- hoay Crusoe tend | at c 15971C B. WING 04/04/2024 1300 EAST 24TH SEDALIA, MO 65301 LOVING ARMS MEMORY CARE AND ASSISTED LIVIN: A4776 Continued From page 1 Review of the facitity video footage, dated 02/29/24, showed starting at 3:22 P.M., the resident walking down the hallway and gets to the west door and pushes on the door and a staff member redirects the resident multiple times and , then the resident tries other exit doors to leave. The resident pushed on the west exit door for 15 | seconds and it opened with the alarm going off ; and then got to the second door that was unlocked and opened it at 3:38 P.M. The resident headed towards the road. At 3:46 P.M. the , footage showed Cook G came dawn the hallway, shut the alarm off, and turn around and walk back down the hallway without checking outside for a resident. | Review of the facility incident report, dated 02/29/24 from 3:38 P.M. to 5:30 P.M., showed the | facitity administrator documented the administrator was notified that staff could not find Resident #1. The administrator left his/her office to review the video footage, had staff search the facility, and search the neighborhood. At 5:02 P.M. the administrator contacted the owner and asked him/her to help. After calling the owner, the administrator received a phone call from a police department that the resident was safe, and a concerned motorist had picked the resident up ‘ a block from the facility. The resident could tell _ the officer his/her name and the officer called the family. The administrator called the owner who picked the resident up from the police station. | The resident returned to the facility at 5:33 P.M. and was assessed for injuries and thirty-minute ' checks were initiated because the resident was now an elopement risk. Around 6:15 P.M. the | administrator watched the video footage, and the resident left the facility by leaning on the alarmed exit door at the west end of the facility and if door is leaned on long enough it will open and the PRINTED Ova ved BSCE My dt 8 St De Baek Pe Os OMMETON (13) QYPE crs BUC) re 4 RACH — STALE) OCP BS Oe etary, Fe OW wae CF PRONTCER OF SUP TR {MN BART TH OVINO ATM MEMORY tuudt a0 ASD Uw 7 SEDALA, MO Or301 fre Rr BOM OF Der Co o POON PLAN OF COO CO | PREY. KATH OGRGENCY MUST It PROD a FA, rear BACH CONPROTIVE ACTON BHOULD 8€ | Ommurrs CORORS att DCE 70 bet AOS cure Mw FRCULATONY OAL. CONTIFTING NACRNANCHY mad i i ! } } @ wt MT) Coriued From page | ATTY ty review #he polley™ " | Rewen of the tnciity video Inotage, dated toldvnt mista Bde en eeevenin eee. a And ine rf) ‘at resident waiking down the haltwiry and poste to the RN ' . | wet doot and pushes on the dott and 2 stat Dieté, staf f (s awd a | Member tecescts ie resident multcle times and ;} “then Bye reaident then. othar axit doora,to fawe | ypereludetL ands trosn Slee | The reedant puthed on Ihe wert eal doo? for 13 | to utilime He ol Kid - | HeGONs BNR Cpaned with Ihe alarm gang off i ad wand than ol lo the second Goo that was “ , e | uniocked BNO coaned Mat 338A WM The resicent talkie systen h _ heeded towards ha reed ALJ4EPM he tH) Sees the Car , oolags Bhowed Cook G came down the halhway, all staff rf whut the earn off, asd barn atousd and welt beck ah alarm Seun F1NG , Gown the halwoy wehout checking cuiside Ip 9 : ra building | rrexdent i | i sea | Rewew of the faality inadere report, daled | & adel re re | O22824 trom 335 PAL to 830 PIR, whowed tne sing, The fin cf the | a ere micident, Acadenk wl | ecrriristrator wae ootited tha! eta could not find ' Resdent #1. Tha adminntatos led Washoe ofice lea beea, sign Fr cantly | te review the vided loctepa, hid stat aeerch the ; : | feciity, and search the naignborhood Al 5102 | (*4s ¢ wit hea due. | PAA Dw edriniatsior contacted Ihe owner and | picked Himes to hetp Atos calling tha owner | _ fom lication ¢€ ranges ihe aximiniatrator received @ phone cal fiom a police depariment thal ite resident wea safe, and | at the Cree te on of | = Concerned motors! hed pickad Ive reaidant up | : ui =. of . 2 Bock from the tecility. The resident coud tall | | feestden TS phy sectan a offcad his/her name 2nd the offices cated iho Admin psPrafran also tumily The soiminetrato: called the canat who Pi 4 packed the reeident up Sam the poboe atation | as Thee seaicant ratusrard to the tacwity a1 837 Po met nth Fee eS “fF ard was saagagad for inguies 8nd thiny-mainig on B-b ~ ee vi Th reiperate. checks were uitated because the resident was ; | now an stopement tinh Arpund O15 PM ina | phe? elopement polity admin uratos walched We video 1ootape, and the eteoernt Left the taciay by lasting on the atgiined wall door ef fie weet end of the fecitzy and |} door he Wansd an long enough & wit open amd) the “O | 4 me Rad iniolacte 4. 24-9024 | moran thea] 2 eu ANDO PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED C 45971¢ B. WING : 04/04/2024 1300 EAST 24TH SEDALIA, MO 65301 (X%4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (5) ' DEFICIENCY} LOVING ARMS MEMORY CARE AND ASSISTED LIVIN: 44776 Continued From page 2 alarm does sound. The resident went across the foyer and out an unlocked door to go outside. Review of the video footage showed the resident had been redirected several tines away from the west exit door by staff. At 3:38 P.M. when the resident eloped staff were helping other residents in their rooms and the alarm sounded for eight minutes without staff or administrator hearing it. At 3:46 P.M. a kitchen staff member heard the alarm and went and shut if off. The kitchen staff went back to his/her duties. During an interview on 03/15/24 at 11:25 A.M., the administrator said his/her expectation of staff when an alarm goes off that staff investigate why the door alarm is going off and to make sure no resident has Jeft the facility. The administrator said the cook in the kitchen shut off the alarm and went back to work in the kitchen. The administrator said he/she has had meetings before the elopement and it had been discussed and staff are trained on what to do for an elopement. The administrator said he/she did an . investigation, and the resident is exit seeking. , The administrator said he/she was in his/her ' office, a staff member was changing a resident, ‘ and two staff members where helping a resident _ shower and they did not hear the alarm. The administrator said the cook should not have shut off the alarm. During at interview an 03/15/24 at 1:00 P.M., , Level One Medication Aide (LIMA) A said he/she i was working the day of the incident and was in ' with resident and did not hear the alarm go off. : During a interview on 03/15/24 at 2:51 P.M., LIMA D said he/she was in a resident's room helping : with a shower and did not hear the alarm go off. LIMA D said when staff hear the door alarm they hayouri Desartmen| of Megin & Saniot Services OF DEROiNC At FROFOERALA AL ARO 4 eel PDN OF CONTE DN 12s DU Meroe , aoe _ w97 a a wel OF PEOVER OF SUPT Fm WeeU ACTOS city stat oe Cone , 136 BART HTH LOWNO ARNE MEMORY CARE ANO AZSIETED UNIN SEDALIA Ma £8501 © i BMMARY OATOMENT OF DEPCRIIOCD c me | ADI EORNCY ULAT BB PROCEED BY a [aa a ma FARULAI CEN OF LSS CEMTEVED AOITON) tad AdITS slat Goes round The heaident wert scrote the Toye and out an unlocked door to po cuteka | Review of the video footage showed Ihe resident had Deen recicectad ¢evernl Smee away loom Ine vers! Gx Goot by etal AD SORES P.M when the teeter sloped sta were helping other reaicents | i Reet roores and the xterm gourded for eight : enue wohoul staff or acmingewutor hearing A AQD4OP M a eichen cial member hoard the | ghm and wont and abd ot The kitchen ata3 | werd back to hiv/her duties | Oufiag an intervie on OD1SO4 wt WIS Ald. | We aceinterstor sad he/her axpoctation of want when an alarm goes of (rat stall inveetigate wry the Goor glarm 4 going off ahd lo make gure no | Posiderd hor lef the fealty” The atiminaiimtc: aid the cock in the Wichen shut off thé alatm and wort back to work in the kiichan The aosicicrator said hehe has had meetings batore the slopemnent and it had been Gecunesd aod clad are vained on what fe do for pn wopement The sdministrater ¢aid he/she od on kweetgaton, and the reside i ext BoeND The sdminist pics gaig hetthe was in hide ofee, » tall memo was changing a teticert, | and ten tal members whete helping A réaldent ‘ghowe! ond they did acl baat the astm =Ths sores ced the 000% should not have tA cf the alem Duning of jntarriew on O216/24 of 1°00 PM | Level One Medication Arde (LIMA) A waid hafebe wae Working the day of the incidhnt and wen i with redidert pd did nod hens the plaim go cll During a interdiow on O142d ar 251 PM LIMA D sald be/ehe wes In & residents room alging WAN @ thowe? and did nol har the alarm go oF | LDKA D wand when stad heey tne dod alarm they Lira 1 weeetn ard Lerus Serves STAYE FOAM AD MATTIE Ot SPL PRINTED OV22r7T24 ——$—_—_<—_ PROVOE TE Pia OF CORIETEN EAD CORRE TINE ACTH SCHILD BE COHCES PEF UMEACED 10 Tre APE RCPRAYE OmnceNcy | lie hiave schedele & | ap elopsine nt drill lor ant Staff to fake i ple ce on ff 4 ng Mary lo, D244 =v’ A, BUILDING: COMPLETED Cc 04/04/2024 15971C 1300 EAST 24TH SEDALIA, MO 65301 LOVING ARMS MEMORY CARE AND ASSISTED LIVIN: A4776 Continued From page 3 | AA776 are expected to go and see if any residents are outside, if no residents are outside then staff can clear the alarm, us the walkie talkie to do an all clear, and also do a head count of residents. LIMA D said the cook shut off the alarm and not sure if the cook told anyone. LIMA D said it was supper time when they realized the resident was not there. During an interview on 03/18/24 at 2:36 P.M., LIMA E said he/she heard the door alarm go off at the west door exit and went to check. LIMAE said he/she redirected the resident and shut off the alarm. LIMAE said he/she heard the alarm go off at the west door exit he/she went ta check, redirected the resident again, and shut off alarm. ; LIMA E said he/she was cleaning up a resident : and did not hear the door alarm again. He/she : heard it was a dietary person who shut the alarm off. LIMAE said when a door alarm goes off staff are to check outside to see if any resident is outside, use walkie to give all clear, shut off ‘ alarm, and do a head count of residents. | During a interview on 03/19/24 at 12:59 P.M., ' Gook G said he/she was in the kitchen with the | door closed, because the resident likes to come : in the kitchen and go out the back door. Cook G _ said the resident likes to walk the facility and exit | seeks. Cook G said he/she heard the alarm | going off and went to shut it off. Cook G said | he/she looked outside and did not see anyone. He/She told a staff member about it. Cook G _ said he/she does not think he/she has had any | training on elopement. i During an interview on 03/19/24 at 4:09 P.M., LIMA C said the resident does exit seek. LIMA C | said the same day of the elopement he/she had ‘ to redirect the resident the first time he/she asked | Cc 15971C 8, WING : . 04/04/2024 1300 EAST 24TH SEDALIA, MO 65301 { DEFICIENCY) LOVING ARMS MEMORY CARE AND ASSISTED LIVIN: A4776 : Continued From page 4 , the resident "what he/she was doing” and the ‘ resident to him/her "| am gaing home.” LIMA C said the second time he/she redirect the resident _ was in the sunroom trying to open the exit door. LIMA C said when the resident eloped, he/she did not hear the alarm and was helping another resident in their room at the time. After the incident happened the administrator told him/her to check alarm and to check outside to make sure no resident or residents were outside. LIMA , C said he/she had training at his/her previous job , on haw to redirect residents and had worked at a skilled facility for nine years. During an interview on 03/25/24 at 6:24 P.M., Cook G said he/she was not aware that a : resident had went out the west exit door and - he/she did not go outside and check to see if a resident was outside. ; During an interview on 03/15/24 at 9:50 A.M., : Cook F said the resident did exit seek. Cook F . said he/she has been trained on what to do when ‘ a resident elopes. Cook F said when staff hear ' the alarm go off staff should check to see ifa resident is outside and if there is he/she tries to . get the resident back in and uses the walkie to call for other staff. Cook F said the alarm should not be shut off until you have check to see if a | resident is outside and do a head count until before giving the all clear. During an interview on 03/15/24 at 10:00 A.M., ' LIMA B said the resident trying to teave the facility is an everyday event because the resident was i always asking what door he/she needs to go out ' tago home. LIMAB said when he/she is working he/she always aware of where the resident is. LIMA B said he/she has been trained on what to do when a resident elopes. LIMAB said when Cc 15971C 04/04/2024 1300 EAST 24TH SEDALIA, MO 65301 j | DEFICIENCY) LOVING ARMS MEMORY CARE AND ASSISTED LIVIN: A4?76 Continued From page 5 _ the door alarms go off, they are to check to see if ‘a resident is outside, and then do a head count. - During an interview on 03/15/24 at 10:54 A.M., LIMA C prior to incident he/she had no training on elopement prior to the resident's elopement. LIMA C said when the atarm goes off staff are expected to check to see if a resident is outside and do a head count of residents. During an interview on 03/15/24 at 11:25 A.M., the administrator said his/her expectation of staff when an alarm goes off that staff is to go and investigate why the door alarm is going off and to ; Make sure no resident has left the facility. The i administrator said the cook in the kitchen shut off ' the alarm and went back to work in the kitchen. ‘ The administrator said he/she has had meetings ; and it has been discussed and staff are trained : on what to do for an elopement. The | administrator said he/she is not sure if the cook _ was trained since he/she is a cook. The : administrator said he/she was in his/her office, a _ staff member was changing a resident, and two staff members where helping a resident shower and they did not hear the alarm. The ‘ administrator said the cook should not have shut : off the alarm. During a telephone interview on 03/18/24 at 2:36 P.M., LIMA E said he/she heard the door alarm go off at the west door exit and went to check. LIMA E said he/she redirected the resident and shut off the alarm. LIMA E said he/she hear the , alarm go off at the west door exit and went to check and redirected the resident again and shut off alarm. During a telephone interview on 03/19/24 at 12:59 : P.M., cook G said he/she was in the kitchen with issouri Department of Health and Senior Services (X3} DATE SURVEY COMPLETED Cc 04/04/2024 159716 Punic 1300 EAST 24TH SEDALIA, MO 65301 LOVING ARMS MEMORY CARE AND ASSISTED LIVIN: TAG | REGULATORY OR LSC IDENTIFYING INFORMATION) | TAG | CROSS-REFERENCED TO THE APPROPRIATE DATE A4776. Continued From page 6 : the door closed because the resident likes to . come in the kitchen and go out the back door. | : Cook G said the resident likes to walk the facility and is exit seeking. Cook G said he/she heard | the alarm going off and went to shut it off. Cook j | G said he/she looked outside and did not see | anyone, and he/she told a staff member about it. | . Cook G said he/she does not think he/she has i "had any training on elopement. During a telephone interview on 03/22/24 at 4:23 | P.M., LIMA D said he/she had training before the incident but did not remember the date. LIMA D said he/she saw the resident once that day and redirected the resident away from the exit door. During a telephone interview on 03/25/24 at 6:24 , P.M., cook G said there was a meeting on ; 03/01/24 and did sign a piece of paper at meeting or the meeting might have been on 03/06/24 for the elopement. Cook G said he/she did not know why his/her name was not on the sign in sheet. *The higher classification merited due to the extent of the violation and the violation's effect on . the residents. . NOTE: At the time of the complaint investigation, - the violation was determined to be at an imminent : danger Class | level. Based on observation, | interview and record review completed during the : onsite visit it was determined the facility had . implemented corrective action to address and ’ lower the violation at the time. A final revisit will - be conducted to determine if the facility is in substantial compliance with participation . requirements. At the time of exit, the severity of the deficiency : was lowered fo the Class II level. ‘ MPLETED Cc 459716 B. WING _ 04/04/2024 1300 EAST 24TH SEDALIA, MO 65301 TAG | REGULATORY OR LSC IDENTIFYING INFORMATION) \ TAG CROSS-REFERENCED TO THE APPROPRIATE DATE ! DEFICIENCY) LOVING ARMS MEMORY CARE AND ASSISTED LIVIN: 44776: Continued From page 7 MO00232546”