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Nursing HomeMedicaid Investigative

James River Nursing and Rehabilitation

Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.

3550 East Battlefield, Springfield, MO 65809120 bedsLicensed & Active
2/5
Medicare
Inspection
Quality
Staffing
Google rating
3.8/5

based on 80 Google reviews

5
4
3
2
1
James River Nursing and Rehabilitation Nursing Home in Springfield, MO — Street View
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3/ 10
moderate Risk

Quality Concerns Identified

Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.

  • Low staffing rating (2/5 stars)
  • Above-median deficiencies (17 vs median 10)
  • High staff turnover (58%)

Above average in MO · Critically understaffed (RN) · Below chain average · No penalties on record

Source: Medicare data

What this means for your family

While some families report excellent end-of-life care, the recurring reports of severe understaffing and neglect are deeply concerning. If you consider this facility, perform unannounced visits during weekends and evenings to verify if staff response times meet your loved one's needs.

Google Reviews

Google Reviews

80 reviews on Google
James River Nursing and Rehabilitation presents a stark contrast between its well-maintained physical appearance and the quality of care reported by families. While many reviewers praise the compassionate staff and supportive environment during end-of-life care, a significant number of families report severe neglect, including delayed response times, poor hygiene, and medication management failures. The facility appears to struggle heavily with staffing levels, which directly impacts the consistency and safety of resident care.

Quality Themes

Tap a score for details
Food6.0Staff4.0Clean5.0Activities7.0Meds2.0MemoryN/AComms3.0Value3.0

Strengths

  • Compassionate end-of-life and hospice care
  • Clean and aesthetically pleasing facility
  • Friendly and dedicated individual staff members
  • Effective rehab therapy department

Concerns

  • Severe understaffing leading to neglect (mentioned by 9 reviewers)
  • Slow or non-existent response to call lights (mentioned by 4 reviewers)
  • Poor hygiene and lack of assistance with basic needs (mentioned by 5 reviewers)
  • Medication errors or late administration (mentioned by 3 reviewers)
  • Poor communication from management and billing (mentioned by 3 reviewers)

Rating Trends

Tap a year to see what changed

234'13(1)'16(7)'18(2)'20(1)'22(7)'24(17)'26(3)

Distribution · 86 analyzed

5
56
4
2
3
2
2
4
1
22

How They Respond to Reviews

10%response rate

This facility rarely responds to reviews.

Questions for Your Tour

  • 1Given the current staffing levels, what specific protocols are in place to ensure that call lights are answered promptly and basic hygiene needs are met consistently?
  • 2I noticed the facility has had a high number of recent state violations; what concrete steps is management taking to address these findings and improve the overall quality of care?
  • 3How does your nursing team coordinate with the pharmacy and clinical staff to ensure that medications are administered accurately and on time?
  • 4Since the rehab department is highly regarded, how do you integrate those therapeutic services into the daily routine for residents who are not in active recovery?
  • 5What is your standard process for communicating updates regarding a resident's health or billing changes to family members, and who is our primary point of contact for these concerns?
  • 6Could you walk me through how your staff handles medical emergencies or sudden changes in a resident's condition during evening or weekend shifts?

Personalized based on this facility's data


Key Review Excerpts

The condition of this facility is Not what you see in the reception area. The room was often very dirty and smelled awful.

Family member · 2021☆☆☆☆

I walked into the building tonight and could hear my mother from down the hall crying/yelling for help. When I entered her room she was hanging off her bed with her head on the floor.

Family member · 2015☆☆☆☆

The staff was absolutely amazing to us the whole time. So caring and compassionate.

Family member · 2024☆☆☆☆
Source: 80 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.37hrs
49%
Registered nurses for medical care
Total Nursing
3.21hrs
78%
All nurses + aides combined
Staff Turnover
65%
Lower is better (< 30% = good)
RN Turnover
69%
Lower is better (< 30% = good)

Both RN and total nursing hours are below national benchmarks. This can mean less clinical attention per resident, so ask about their staffing plan.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 17 measures

Medicare Rating
4/ 5
Better Than Avg

12

measures

Worse Than Avg

2

measures

Mixed Results

3

measures

Long-Stay Residents
💊

Residents on antipsychotic medication

↓ Lower is better
This Facility6.1%
Better than Avg
Here
6.1%
US
15.5%
MO
23.6%
Greene
17.2%
💉

Residents vaccinated for pneumonia

↑ Higher is better
This Facility100.0%
Better than Avg
Here
100.0%
US
93.4%
MO
84.4%
Greene
87.7%
😔

Residents with depression symptoms

↓ Lower is better
This Facility3.0%
Better than Avg
Here
3.0%
US
12.1%
MO
16.7%
Greene
12.4%

Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.

🚶

Residents whose walking got worse

↓ Lower is better
This Facility7.4%
Better than Avg
Here
7.4%
US
15.3%
MO
18.9%
Greene
15.0%
💉

Residents vaccinated for the flu

↑ Higher is better
This Facility100.0%
Better than Avg
Here
100.0%
US
95.5%
MO
90.9%
Greene
95.5%
💊

Residents on anti-anxiety or sleep medication

↓ Lower is better
This Facility25.2%
Mixed vs Avgs
Here
25.2%
US
19.5%
MO
25.4%
Greene
27.0%
Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility86.7%
Better than Avg
Here
86.7%
US
81.8%
MO
65.9%
Greene
76.8%
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility59.1%
Worse than Avg
Here
59.1%
US
79.8%
MO
63.5%
Greene
72.7%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility0.4%
Better than Avg
Here
0.4%
US
1.6%
MO
2.2%
Greene
2.0%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

17deficiencies
Above state avg (12.0)
5 complaint-triggered

Families have filed multiple complaints against this facility, triggering investigations that revealed concerning issues with resident rights, medication management, and patient care quality. The facility shows recurring problems with medication errors and food safety across multiple surveys from 2019 to 2024, suggesting persistent operational challenges. While all deficiencies have correction dates, the pattern of repeated violations in critical care areas warrants careful consideration before placement.

Nov 4, 2025Complaint
1
0561Potential for harm · PatternCorrected

Resident Rights Deficiencies

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

Jul 30, 2024Routine
18
0812Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0293Potential for harm · WidespreadCorrected

Egress Deficiencies

Have properly located and lighted "Exit" signs.

0584Potential for harm · PatternCorrected

Resident Rights Deficiencies

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.

0761Potential for harm · PatternCorrected

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.

0880Potential for harm · PatternCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0161Potential for harm · PatternCorrected

Construction Deficiencies

Use approved construction type or materials.

0372Potential for harm · PatternCorrected

Smoke Deficiencies

Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

0561Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

0583Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Keep residents' personal and medical records private and confidential.

0645Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

PASARR screening for Mental disorders or Intellectual Disabilities

0677Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide care and assistance to perform activities of daily living for any resident who is unable.

0678Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.

0690Potential for harm · IsolatedCorrected

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.

0695Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide safe and appropriate respiratory care for a resident when needed.

0700Potential for harm · IsolatedCorrected

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.

0759Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure medication error rates are not 5 percent or greater.

0760Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure that residents are free from significant medication errors.

0623Minimal · PatternCorrected

Resident Rights Deficiencies

Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

Jul 30, 2024Complaint
1
0550Potential for harm · PatternCorrected

Resident Rights Deficiencies

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Feb 9, 2024Complaint
3
0602Potential for harm · PatternCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from the wrongful use of the resident's belongings or money.

0842Potential for harm · PatternCorrected

Resident Assessment and Care Planning Deficiencies

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

0697Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide safe, appropriate pain management for a resident who requires such services.

Sep 23, 2022Routine
3
0812Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0363Potential for harm · WidespreadCorrected

Smoke Deficiencies

Install corridor and hallway doors that block smoke.

0732Minimal · WidespreadCorrected

Nursing and Physician Services Deficiencies

Post nurse staffing information every day.

Oct 9, 2019Routine
5
0761Potential for harm · PatternCorrected

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.

0812Potential for harm · PatternCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0558Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Reasonably accommodate the needs and preferences of each resident.

0759Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure medication error rates are not 5 percent or greater.

0880Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

Ownership & Operations

Who Operates This Facility

Owner / Operator

James River Nursing and Rehabilitation

Organization Type

for profit

Chain Affiliation

Chain Name

Anthony & Bryan Adams

Chain Size

38 facilities nationwide

Chain avg rating: 3.8/5 · Rank 25 of 37

Ownership & Management

Key personnel

Dvorak, NoraManaging Control - Governing BodyLong, KelseyManaging Control - Governing BodyScroggins, JesseManaging Control - Governing BodyAdams, AnthonyOfficer / DirectorAdams, BryanOfficer / Director
Source: Medicare provider data

Contact

Get in Touch

Contact this facility directly and verify the details that matter most to your family.

References & Resources

EveryPlace is a research directory. Facility information is compiled from public sources — Medicare.gov, state licensing portals, Google Places, and publicly available street-level imagery. Listings do not constitute endorsement, recommendation, or advertisement, and we do not accept payment for placement. Families should verify all details directly with the facility and the original sources linked above before making any care decisions. See our Research Policy for our editorial standards, correction process, and image-removal policy.

Safer Alternatives Nearby

Based on current clinical data, we identified 6 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.

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