HICKORY MANOR

CCN 265632 · LICKING NO 1 LLC · Texas · MO · For profit - Individual · 60 certified beds


Certified for Medicare and Medicaid since 1996-04-03, HICKORY MANOR is a 60-bed nursing home in LICKING, Missouri, averaging 37.1 residents a day.

Has HICKORY MANOR been cited for violations?

CMS lists 38 health-inspection deficiencies for HICKORY MANOR, all of them in the three years to 2026-08-01: the highest scope-and-severity letter on record is F; the most recent health inspection was 2026-04-30.

Survey dateTagDeficiencySeverity
2026-04-30F0582, F0584, F0604, F0607, F0637, F0641, F0656, F0657, F0658, F0689, F0699, F0741, F0880, F0925Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. / Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. / Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. / Develop and implement policies and procedures to prevent abuse, neglect, and theft. / Assess the resident when there is a significant change in condition / Ensure each resident receives an accurate assessment. / Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. / Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. / Ensure services provided by the nursing facility meet professional standards of quality. / Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. / Provide care or services that was trauma informed and/or culturally competent. / Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. / Provide and implement an infection prevention and control program. / Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.D
2025-05-28F0677Provide care and assistance to perform activities of daily living for any resident who is unable.D
2025-01-23F0607Develop and implement policies and procedures to prevent abuse, neglect, and theft.E
2025-01-23F0655, F0656, F0658, F0692, F0755, F0758, F0880Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted / Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. / Ensure services provided by the nursing facility meet professional standards of quality. / Provide enough food/fluids to maintain a resident's health. / Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. / Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. / Provide and implement an infection prevention and control program.D
2024-09-24F0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.D
2024-06-04F0658Ensure services provided by the nursing facility meet professional standards of quality.D
2024-01-11F0814Dispose of garbage and refuse properly.F
2024-01-11F0641, F0656, F0658, F0684, F0700, F0732, F0756, F0758, F0883, F0887, F0947Ensure each resident receives an accurate assessment. / Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. / Ensure services provided by the nursing facility meet professional standards of quality. / Provide appropriate treatment and care according to orders, resident’s preferences and goals. / 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. / Post nurse staffing information every day. / Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. / Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. / Develop and implement policies and procedures for flu and pneumonia vaccinations. / Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. / Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.D
2023-10-30F0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.D

How is HICKORY MANOR staffed?

MeasureThis facilityMO average
Total nurse staffing hours per resident per day3.698973.43324
Total nursing staff turnover (%)78.856.0
Average number of residents per day37.173.0

Who owns HICKORY MANOR?

HICKORY MANOR is registered with CMS as For profit - Individual, operates under the legal business name LICKING NO 1 LLC.

RoleOwnerAssociation date
DIRECT OWNERSHIP INTERESTTHE LICKING EXEMPT TRUSTsince 05/24/2017
OPERATIONAL/MANAGERIAL CONTROLAGH1 LLC, SOVEREIGN HEALTHCARE GROUP LLC, BEAIRD, TODD, BEDELL, DONALD, BEERS, JONATHAN, CAUDILL, TINA, SCHMITT, LINDI, WARNER, ANGIEsince 01/01/2022
INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFBEDELL, BRYANsince 05/12/2025
TRUSTEE OF THE SNFTHE LICKING EXEMPT TRUSTsince 05/24/2017
ADP OF THE SNFAGH1 LLC, FG LLC, FORVIS MAZARS LLP, MID STATES INC, SOVEREIGN HEALTHCARE GROUP LLC, THE CITY OF LICKING, VAN DE VEN LLC, BEAIRD, TODD, BEERS, JONATHAN, CAUDILL, TINA, SCHMITT, LINDI, WARNER, ANGIEsince 01/01/2022

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