Estates of St. Louis, LLC, the

Inspectors wroteBased on observation, interview, and record review, the facility failed to report an allegation of abuse to the Department of Health and Senior Services (DHSS) as required within a two-hour timeframe following a physical altercation between two residents (Residents #3 and #4), in which one resident sustained an eye injury. The sample was four. The census was 73. Based on observation, interview, and record review, the facility failed to report an allegation of abuse to the Department of Health and Senior Services (DHSS) as required within a two-hour timeframe following a physical altercation between two residents (Residents #3 and #4), in which one resident sustained an eye injury. The sample was four. The census was 73. Review of the facility's Abuse, Neglect and Exploitation Policy, dated 4/8/24, showed the following:-Policy: [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure resident funds were placed in an account separate from the facility operating account. The facility did not provide residents with refunds of their personal funds from the operating account in a timely manner for nine residents (Resident #7, #8, #9, #12, #13, #14, #15, #16 and #17). Facility staff failed to provide the Social Security and/or Medicaid monthly allowance in a timely manner, which did not allow the resident/financial guardian the right to manage his/her financial affairs for three residents (Resident #3, #7 and #8) out of a sample of seven. The facility census was 79.1. Record review of the facility-maintained Accounts Receivable Aging Report, dated 12/16/25, showed the following residents with personal funds held in the facility operating account. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide services per acceptable standards of practice for one resident (Resident #1), when the facility failed to provide follow-up care and treatment by not completing a clinical referral for a resident with a diagnosis of chronic hepatitis C infection (viral infection that causes liver swelling that can lead to serious liver damage, liver failure and liver cancer). The sample size was 3. The census was 82. Review of the Centers for Disease Control and Prevention (CDC) website, showed hepatitis C treatment plans typically consisted of 8-12 weeks of oral direct-acting antiviral (DAA) medications. This short course of well-tolerated medication could cure more than 95% of cases and was recommended for virtually everyone diagnosed with hepatitis C. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one resident's right to be informed in advance of treatment and treatment alternatives or treatment options and to choose the alternative or option he/she preferred when staff did not inform the resident's representative prior to the resident having lung surgery (Resident #1). The sample was 4. The census was 80. Review of facility's Change in a Resident's Condition or Status policy, revised 8-24-24, showed: -The facility will assess and identify a change in condition to ensure the resident receives appropriate care; -Procedure: -The nurse supervisor/charge nurse will notify the resident's family or representative when: -There is a significant change in the resident's condition; -It is necessary to transfer the resident to a hospital; [...]

Inspectors wroteSee event ID KU8L12 Based on observation, interview and record review, the facility failed to ensure that residents receive proper treatment to maintain vision when staff failed to reschedule transportation arrangements for one sampled resident (Resident #500) out of 13 sampled residents, who had an eye appointment and was recommended to have retina surgery then cataract surgery. The resident missed the appointment when transportation did not show up and staff failed to reschedule the appointment after it was missed. The facility also failed to follow-up with the resident's routine eye appointment. The census was 77. During an interview on 2/7/25 at 12:50 P.M., the transportation policy was requested. The Administrator said there is no policy. There is just a protocol that staff follow. [...]

Inspectors wroteSee event ID KU8L12 Based on interview and record review, the facility failed to ensure dental care and services were provided to one sampled resident who requested dental services (Resident #500) out of 13 sampled residents. The census was 77. During an interview on 2/7/25 at 12:50 P.M., the transportation policy was requested. The Administrator said there is no policy. There is just a protocol that staff follow. Review of Resident #500's annual Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff dated 1/9/25, showed: -Severe cognitive impairment; -No dental issues present; -Diagnoses include diabetes, dementia, schizophrenia, and anxiety. Review of the resident's provided dental assessments, showed: -Oral assessment, 5/8/24, no natural teeth or tooth fragments (edentulous): Fully edentulous, no appliances. [...]

Inspectors wroteBased on observation, interview and policy review, the facility failed to ensure floors were clean, baking pans and pots were free of carbon build-up, one of one freezer had debris and food on the floor, one of one refrigerator had food and debris on the floor, and 30 of 30 water bottles were expired and two of 30 gallons of water had mouse droppings on them. This failure had the potential to affect all 75 residents who reside in the facility.

Inspectors wroteBased on interview and record review, the facility failed to follow their tuberculosis (TB, a potentially serious infectious bacterial disease that mainly affects the lungs) policy when staff failed to complete a two step and the annual one step of the employee TB screening tests in a timely manner for a total of 10 employees. The facility also failed to implement their water management plan in order to potentially identify where bacterium Legionella and other waterborne pathogens could grow. The census was 78. Review of the facility's TB Employee Testing Policy, dated 8/25/24, showed the following: -Policy: -In order to minimize the risk of resident acquiring, transmitting, or experiencing complications from tuberculosis, it's the policy of this facility to screen our employees upon hire and annually; -Procedure for Screening: -1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that dietary and eight of eight sampled resident's (Resident R) 30, R36, R62, R25, R46, R12, R73, and R56) room were free of pest. Specifically, live mice and mouse droppings were observed in dietary and residents reported mice in their room. This failure had the potential for residents to have food prepared in an unsanitary manner and had the potential to expose residents to diseases caused by being exposed to rodents.

Inspectors wroteBased on interview and record review, the facility failed to ensure newly hired employees were screened to rule out the presence of a Federal Indicator, with the Certified Nurse Aide (CNA) Registry for two staff members. A sample of 10 employees hired were reviewed. The facility hired at least 45 new employees since the last survey. The census was 78. Review of the facility Abuse and Neglect Policy, undated, showed the following: -Policy: -Each resident has the right to be free from verbal, sexual, physical and mental abuse, corporal punishment and involuntary seclusion. The resident has the right to be free from mistreatment, neglect and misappropriation of property. Resident must not be subject to abuse by anyone, including, but not limited to; [...]

Inspectors wroteBased on record review, interview, and policy review, the facility failed to ensure six of six residents (Resident (R) 9, R13, R17, R28, R78, and R129) and their representatives reviewed for facility initiated emergent hospital transfer from a total sample of 24 were provided with written transfer/discharge notice that stated the reason for transfer, the place of transfer, and other information regarding the transfer. This failure had the potential to affect the residents and their Resident Representative (RR) by not having the knowledge of where and why a resident was transferred, and/or how to appeal the transfer, if desired. Additionally, the Ombudsman was not notified of hospital transfers for three of six residents (R9, R13, R17).

Inspectors wroteBased on record review, interview, and policy review, the facility failed to ensure six of six residents (Resident (R) 9, R13, R17, R28, R78, and R129) out of a sample of 24 residents who were reviewed for hospitalization were provided with a bed hold notice within 24 hours of emergent transfer to the hospital to include bed reserve payment. This failure increased the potential that residents would not know to request a bed hold and may be unable to return to the facility.

Inspectors wroteBased on interviews, record reviews, and facility policy reviews the facility failed to ensure that all Interdisciplinary Team Members (IDT) were participated in quarterly care conferences for 12 of 24 sampled residents (Resident (R) 9, R12, R13, R17, R25, R29, R32, R34, R36, R40, R57, and R73). This failure had the potential for the residents to have unmet care needs.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to correctly issue Medicare Part A beneficiaries CMS-10055 (Skilled Nursing Advanced Beneficiary Notice (SNFABN) when resident completed therapy or skilled nursing services for two of three residents (Resident (R) 9 and R68) reviewed for beneficiary notices. This failure had the potential of a resident or responsible party to not make an informed decision related to continuing to receive Medicare A services, by having the facility continue services and bill Medicare A, continue the services, and bill the resident, or not receive the services.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure grievances were resolved in a timely manner for one of 24 sampled residents (Resident (R) 23). This failure has the potential to affect the current residents and/or their family members by not having grievances resolved in a timely manner.

Inspectors wroteBased on interview, record review, and review of facility's policy, the facility failed to timely report a resident to resident alleged physical altercation to the State Agency (SA) involving two residents (Resident (R)13 and R17) of 16 residents reviewed for reporting alleged allegations of abuse. This had the potential for continued resident to resident altercations for the two residents.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to complete a thorough investigation for and resident to resident alleged altercation for two residents (Resident (R) R13 and R17) out of 16 sampled residents reviewed for abuse. This failure had the potential to place the residents to future potential altercations.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to ensure that four (Residents (R)9, R19, R32, and R37) out of 24 sampled residents had an accurate Minimum Data Set (MDS) assessment. Failure to code the MDS correctly could potentially lead to inaccurate federal reimbursements and inaccurate assessment and care planning of the resident.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents receive proper treatment to maintain vision when staff failed to reschedule transportation arrangements for one sampled resident (Resident #500) out of 13 sampled residents, who had an eye appointment and was recommended to have retina surgery then cataract surgery. The resident missed the appointment when transportation did not show up and staff failed to reschedule the appointment after it was missed. The facility also failed to follow-up with the resident's routine eye appointment. The census was 77. During an interview on 2/7/25 at 12:50 P.M., the transportation policy was requested. The Administrator said there is no policy. There is just a protocol that staff follow. [...]

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure that one of 39 residents (Resident (R)13) reviewed for smoking wore a smoking apron while smoking. This failure placed R13 at risk for injury.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to provide oxygen services that included cleaning of the oxygen concentrator for one of one residents (Resident (R)13) reviewed for oxygen therapy. This failure had the potential for the concentrator to not remove all contaminated air and provide adequate oxygenation to the resident.

Inspectors wroteBased on observation, interview, and review of the facility's policy, the facility failed to maintain the cleanliness of two of the two medication rooms. The failure has the potential to contribute to the pest infestation. Additionally, the facility failed to ensure medication refrigerator temperature logs were maintained in two of the two medication rooms. Also, the facility failed to ensure that expired medications and syringes were removed from the medication cart.

Inspectors wroteBased on interview and record review, the facility failed to ensure dental care and services were provided to one sampled resident who requested dental services (Resident #500) out of 13 sampled residents. The census was 77. During an interview on 2/7/25 at 12:50 P.M., the transportation policy was requested. The Administrator said there is no policy. There is just a protocol that staff follow. Review of Resident #500's annual Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff dated 1/9/25, showed: -Severe cognitive impairment; -No dental issues present; -Diagnoses include diabetes, dementia, schizophrenia, and anxiety. Review of the resident's provided dental assessments, showed: -Oral assessment, 5/8/24, no natural teeth or tooth fragments (edentulous): Fully edentulous, no appliances. [...]

Inspectors wroteBased on an interview, a review of the facility's survey notebook, and a review of the Missouri Department of Health and Senior Services website, the facility failed to maintain a posting of its current survey results. The survey sample was 24 residents with a supplemental 25 residents.

Inspectors wroteBased on the interview and a review of the facility's resident council meeting minutes, the facility failed to inform and review with the residents of the facility's survey results. During a group meeting nine of nine residents (Resident (R) 2, 15, 26, 34, 40, 41, 46, 51, and 57) stated that they were unaware of the location of the survey results and that the results were never discussed with them. The total sample was 24 residents with 25 supplement residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free from physical abuse and failed to follow its policies to prevent resident-to-resident abuse when staff failed to consistently monitor Resident #1 during 15-minute face checks as an intervention for wandering. This contributed to three known resident-to-resident altercations, and had the potential to effect the safety and privacy of all other residents on the secured unit. (Residents #2, #3 and #4). The census was 78. Review of the facility's Abuse, Neglect and Exploitation Policy, revised 4/8/24, showed: -Policy: Each resident has the right to be free from verbal, sexual, physical and mental abuse, corporal punishment and involuntary seclusion. The resident has the right to be free from mistreatment, neglect, and misappropriation of property. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one resident, with a diagnosis of Alzheimer's disease and known behaviors, attained or maintained his/her highest practicable, mental, and psychosocial well-being (Resident #1). Staff failed to provide increased behavioral monitoring and failed to update the resident's care plan with identified triggers, personalized interventions, and/or meaningful activities focused on the resident's preferences which resulted in a resident-to-resident altercation. The census was 78. Review of the facility's Supervision and Management of Residents with Behaviors policy, reviewed 1/24/24, showed: -Policy: To provide support to team members to maintain safety and security when providing care to our residents who may exhibit behaviors, while treating our residents with dignity, respect and compassion; -Protocol: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure staff completely and accurately documented neurological checks (neuro checks, assessing mental status and level of consciousness, pupillary response, motor strength, sensation, and gait) for one resident (Resident #2). The sample was three. The census was 84. Review of the facility's Fall Policy, dated 12/1/19, showed the following: -Policy: The staff will identify any resident falls and assess resident's condition and cause of fall. Interventions related to the resident's specific risks and causes will be put in place to prevent the resident from falling and to try to minimize complication from falling; -Assess the resident for changes in level of consciousness and signs or symptoms of injury. Assess the resident immediately after the fall, then frequently throughout the shift. [...]

Inspectors wroteBased on interview and record review, the facility failed to report an allegation of abuse involving one resident (Resident #1) to law enforcement as required. The facility failed to report an allegation staff sold the resident cocaine and Fentanyl (used to treat pain, has a high risk for addiction and dependence, can cause respiratory distress and death when taken in high doses or when combined with other substances, especially alcohol or other illicit drugs such as cocaine). In addition, the facility's Abuse and Neglect policy failed to include guidance to staff on when law enforcement should be notified. The facility census was 84. Review of the facility's undated Abuse, Neglect and Exploitation policy, showed the following: -Policy: Each resident has the right to be free from verbal, sexual, physical and mental abuse, corporal punishment and involuntary seclusion; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident's right to be free from abuse was not violated, when one resident was abused by other resident resulting in a head laceration (Resident #4 and #5). The facility census was 81. The Administrator was notified on 2/26/24 of the past non-compliance. The facility immediately began an investigation into the incident, separated and assessed the residents, as well as contacted all responsible parties and physicians, and sent the residents out for evaluations following the altercation. Upon the residents' return to the facility, the facility had interventions in place to ensure no further altercations would take place, which included: Medication adjustments (while at the hospital), room changes, and care plan meeting scheduled. [...]

Inspectors wroteBased on interview and record review, the facility failed to designate a person to serve as the Director of Food and Nutrition Services with the appropriate certification, when a consultant Registered Dietician (RD) was not employed full-time with the facility. This had the potential to affect all residents who consume meals at the facility. The census was 80. 1. Review of the facility's Director of Food Service's job requirements, showed the following: - Qualifications: Requires a High School diploma or General Educational Development (GED), Prefer a Dietetic Technician, registered by the American Dietetic Association. Or, a Certified Dietary Manager, as certified by the Dietary Manager's Association. Or, a graduate of an associate or baccalaureate degree program in foods and nutrition or food service management 2. During an interview on 8/24/23 at 10:46 A.M. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an effective pest control program to prevent mice, flies and gnats in common areas and resident rooms (Residents #58, #3, #40, #73, #48, and #36). The census was 80. Review of the facility's Pest Control policy, revised 3/2022, showed: -Policy: This facility will ensure facility remains clean and free from pests; -Policy explanation and compliance guidelines included; -Daily cleaning of facility will be monitored; -Monthly contracted pest control company will treat inside and outside of facility. 1. Review of the facility's contracted pest control company pest sighting log, showed: -3/27/23 exterior power spray; -4/11/23, regular service; -5/9/23, regular service; -6/6/23, regular service; -7/11/23, regular service; -8/2/23, regular service; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all resident personal funds in excess of $100.00 were in an interest bearing account. The facility failed to ensure resident requests for less than $100.00 ($50.00 for Medicaid residents) are honored within the same day by not providing residents access to their trust account during consistent hours and on the weekends (Residents #3, #40, #34, #49, #50, #51, #60, and #41). These deficient practices affected all the residents who had a resident trust account. The census was 80. Review of the facility's Management/Protection of Resident Funds policy, updated 1/25/23, showed: -All residents' personal funds shall be deposited in a passbook type interest bearing account and shall be subject to the terms and conditions imposed by the financial institution where such account is located; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide quarterly statements to residents and/or their representatives (Residents #3, #40, #34, #51, #50, #60, #39 and #49). This deficient practice affected 61 residents whose funds were handled by the facility. The census was 80. Review of the facility's Management/Protection of Resident Funds policy, updated 1/25/23, showed: -A record of transactions regarding the resident's funds shall be maintained by the facility in accordance with the generally accepted accounting principles; -The resident shall have reasonable access, upon request, to the above records and shall receive an itemized quarterly statement of his/her account. 1. Review of the facility's resident trust transaction history, showed the facility holds funds for 61 residents, including Residents #3, #40, #34, #51, #50, #60, #39 and #49. 2. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain clean privacy curtains and provide bed linen for four sampled residents (Residents #15, #16, #48 and #64) and failed to ensure one resident's room was free from mouse droppings (Resident #58). The sample was 18. The census was 80. Review of the facility's Maintaining a Safe, Clean, Comfortable and Homelike Environment policy, revised 5/22/22, showed the following: -Policy: This facility will accommodate, to the extent possible, a personalized, homelike environment that recognizes the individuality and autonomy of each resident, while maintaining the safety of all residents and staff. -Policy Explanation and Compliance Guidelines: -Minimize odors by disposing of soiled linens promptly and reporting lingering odors and bathrooms needing cleaning to the Housekeeping Department; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide information to the residents on how to file a grievance or complaint. This had the potential to affect all residents at the facility. The census was 80. Review of the facility's admission Agreement, provided to residents upon admission, showed: -Residents' rights to voice grievances; -The residents may voice concerns and problems, along with recommended changes, to facility staff or outside representatives. Owners and staff of facilities are prohibited by law from retaliating if you complain. The residents should speak with the Director of Nursing or the Administrator of the facility if you encounter problems requiring immediate attention. For non-emergencies, speak to the resident council or Ombudsman; -Instructions on filing a grievance; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure each resident received adequate assistance to prevent accidents by not using a gait belt during transfers (Residents #36, #73, #58 and #31). The facility failed to document a resident's fall in the resident's progress notes (Resident #36). In addition, the facility failed to document fall prevention interventions on the resident's care plan and ensure the resident was able to reach his/her call light (Resident #59). The sample was 18. The census was 80. Review of the facility's Fall policy, reviewed 12/1/22, showed: -The staff will identify any resident fall and assess resident's condition and cause of fall; -Interventions related to the specific risks and causes will be put in place to prevent the resident from falling and try to minimize complication from falling; [...]

Inspectors wroteBased on interview and record review, the facility failed to use the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week. The census was 80. Review of the facility's Facility Assessment Tool, updated 7/16/23, showed: -Average daily census: 80-85; -Staff type: Identify the type of staff members, other health care professionals, and medical practitioners that are needed to provide support and care for residents; -Nursing Services: Director of Nurses (DON), Assistant Director of Nurses (ADON), Minimum Data Set (MDS) Coordinator, Infection Control and Prevention, RN, Licensed Practical Nurse (LPN), Certified Medication Technician (CMT), and Certified Nurse Aide (CNA); -Staffing plan: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection control program designed to provide a safe and sanitary environment and to help prevent the transmission of infections. Staff failed to follow proper hand hygiene during perineum care (peri-care, cleansing of the genitals and buttocks area) observed for three out of three residents (Residents #77, #73 and #58). Additionally, the facility failed to follow their communicable disease policy by failing to ensure newly admitted residents received the Mantoux tuberculin skin test (TST, used to test for latent tuberculosis (TB) infection) two step as required for five out of five sampled residents (Residents #31, #30, #45, #63 and #41). The census was 80. Review of the facility's Peri-Care policy, updated 6/13/23, showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure residents and/or responsible parties were notified in a timely manner when a resident's account was within the $200.00 Social Security (SSI) limit ($5,726.00) or when the resident's account was over the SSI limit. This affected two residents reviewed who received Medicaid benefits (Residents #17 and #1). The census was 80. Review of the facility's Management/Protection of Resident Funds policy, updated 1/25/23, showed: -If the resident receives Medicaid benefits, the facility shall notify the resident when the amount in his/her account has reached $200.00 less than the SSI resource limit for one person, and if the amount in the account in addition to the value of the resident's other non-exempt resources reaches the SSI resource limit for one person, the resident may lose eligibility for Medicaid or SSI. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain privacy and confidentiality of personal and medical records for seven residents (Residents #78, #53, #63, #71, #29, #46 and #30). The census was 80. Review of the facility's Charting and Documentation policy, undated, showed: -Policy: All services provided to the resident, or any changes in the resident's medical or mental condition will be documented in the resident's medical record; -Information documented in the resident's medical record is confidential and may only be released in accordance with state law and facility policy. 1. Review of Resident #78's admission Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 7/10/23, showed: -Moderate cognitive impairment; [...]

Inspectors wroteBased on interview and record review, the facility failed to follow their policy to conduct a complete and thorough investigation of an allegation of staff to resident abuse and failed to suspend the staff accused of threatening a resident, pending an investigation in accordance with their policy. This affected one of eighteen sampled residents (Resident #15). The census was 80. Review of the facility's Abuse, Neglect and Exploitation policy, showed the following: -Policy: Each resident has the right to be free from verbal, sexual, physical and mental abuse, corporal punishment and involuntary seclusion. The resident has the right to be free from mistreatment, neglect and misappropriation of property. Resident must not be subject to abuse by anyone, including, but not limited to: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure services provided met professional standards of practice by not notifying the physician when a resident's blood sugar was elevated, when the resident refused insulin injections, and to have interventions in place for refusals of medications and treatments for one resident (Resident #15). In addition, the facility failed to obtain a physician's order for blood sugar checks prior to administering Levemir (long acting insulin) to one resident (Resident #36). The sample was 18. The census was 80. Review of the facility's Refusal of Treatment policy, updated 5/25/22, showed: -Our facility shall honor a resident's request not to receive medical treatment as prescribed by his or her physician, as well as, care routines outlined on the resident's assessment and plan of care; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents were showered routinely and in clean clothing (Residents #41 and #45) and residents received proper nail care (Residents #16 and #64). The census was 80. Review of the facility's Activities of Daily Living policy, dated 6/22/20, showed: -Purpose: Residents will be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming, and personal and oral hygiene. -Policy: Residents will be provided with care, treatment and services to ensure that their ADLs do not diminish unless the circumstances of their clinical condition demonstrate that diminishing ADLs are unavoidable. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow their skin care policy, resulting in an untreated non-pressure wound for one sampled resident (Resident #31). The sample was 18. The census was 80. Review of the facility's Skin Care Protocol, updated on 1/12/21, showed: -Policy: To ensure that all residents' skin is monitored and assessed to be proactive in preventing skin integrity issues; -Procedure: Certified Nurse Assistants (CNA) will perform a visual assessment of a resident's skin when giving the resident a shower. Immediately report any abnormal looking skin to the charge nurse. Document findings on the Shower Sheet and turn form into the charge nurse. Charge nurse will place their signature on the Shower Sheet after assessing the resident's skin issues. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a medication error rate of less than 5%. Out of 35 opportunities observed, four errors occurred resulting in an 11.43% error rate (Residents # 56, #57, and #78). The census was 80. Review of the facility's Administration Medication policy, updated 1/12/21, showed: -Medications will be administered in a safe and timely manner, and as prescribed; -Medications must be administered in accordance with the orders, including any required time frame; -Medications are to be administered within one hour of their prescribed time, unless otherwise specified; -The individual administering the medication must check the label to verify the right resident, right medication, right dosage, right time, and right route before giving the medication; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medical records were accurately documented in accordance with acceptable professional standards of practice when staff inaccurately documented medications were administered (Residents #56, #57 and #78). The sample was 18. The census was 80. Review of the facility's Charting and Documentation policy, undated, showed: -All services provided to the resident, or any changes in the resident's medical or mental condition will be documented in the resident's medical record; -All observations, medications administered, and services performed will be documented in the resident's medical record; -All incidents, accidents, or changes in the resident's condition must be recorded; -Documentation of procedures and treatments will include care specific details at a minimum, will include: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure they maintained an adequate surety bond for the resident trust fund account in the amount of one and one half times the average monthly balance for the past 12 months. The census was 80. Review of the facility's Management/Protection of Resident Funds policy, updated 1/25/23, showed: -The facility has a surety bond to assure the security of the resident's personal fund deposited with the facility; -The policy failed to provide guidance on how to monitor the facility's surety bond to ensure it was sufficient. Review of the resident trust account for the past 12 months, from August 2022 to July 2023, showed an average monthly balance of $89,000.00 (this would yield a required bond in the amount of $133,500.00 (one and one half times the average monthly balance)). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to post, in a form and manner accessible and understandable to residents and resident representatives, the name, address, and telephone number for the State Survey Agency, the Office of the State Long-Term Care (LTC) Ombudsman program, and a statement that the resident may file a complaint with the State Survey Agency concerning any suspected violation of state or federal nursing facility regulation, including but not limited to resident abuse, neglect, exploitation, and misappropriation of resident property. The census was 80. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to post the results of the most recent survey of the facility in a place readily accessible to residents, family members and legal representatives of residents. The census was 80. Review of the facility's admission Agreement, provided to residents upon admission, showed: -The results of the most recent long term care inspection conducted by Federal or State surveyors and any approved plan(s) of correction in effect with respect to this facility are accessible 24 hours a day to residents and visitors. Observations throughout the survey from 8/20/23 through 8/24/23, showed no survey results posted in an accessible area of the facility. During a group interview on 8/22/23 at 10:20 A.M., six out of six residents, whom the facility identified as alert and oriented, said they did not know where survey results were located. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure residents had access to mail delivered on Saturdays. This had the potential to affect all residents at the facility. The census was 80. Review of the facility's admission Agreement, provided to residents upon admission, showed: -The residents have the right to send and receive unopened mail; -The mail is sorted out by the Business Office and is delivered by Social Services Monday through Friday, on the weekends, it is either delivered by the Manager on Duty or the Nurse on Duty. During a group interview on 8/22/23 at 10:20 A.M., six residents, whom the facility identified as alert and oriented, attended the group meeting. The residents said they did not receive mail on Saturdays. All residents said the Social Worker delivers the mail on weekdays but not on weekends. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the resident trust account statements were accurately reconciled for 12 of 12 months reviewed. The census was 82. Review of the last 12 months of the resident trust account, showed: -January 2019, ending bank balance: $13,429.78, outstanding checks/transfers: $7,891.63, cash on hand: $625.32, adjustments: $3,020.94 (nothing to show what the adjustments were for); ending trust report balance: $9,184.41, difference $0.00. During an interview on 2/10/19 at 12:20 P.M., the business office manager (BOM) said she does not do the reconciliation, it comes from the corporate office. During an interview on 2/10/19 at 1:16 P.M., the corporate office business manager said the adjustments are made at the end of the month. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete and send a Third Party Liability (TPL) form (a form which is sent to MO Healthnet which gives an accounting of the remaining balance of that resident's funds in the resident trust account), which is required to be sent within 30 days after the death, for seven of seven residents who expired in the facility the past year and had money in their trust account (Residents #400, #401, #402, #403, #404, #405, and #406). The census was 82. Review of seven residents trust information, who expired in the past year, showed the facility did not notify the TPL unit. During an interview and record review on [DATE] at 2:15 P.M., the business office manager (BOM) provided information regarding residents who expired in the past year. The forms showed they notified Social Security Administration that the residents had expired. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete comprehensive resident assessments using the Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, within 14 calendar days after admission to the facility, upon a significant change in the resident's status, and not less than every twelve months, for six out of 46 sampled residents (Residents #154, #34, #9, #14, #202 and #204). The census was 82. 1. Review of Resident #154's medical record, showed: -admitted to the facility on [DATE]; -readmitted to the facility on [DATE]; -An entry MDS completed on 11/9/19; -No comprehensive MDS completed, as of 2/11/20. 2. Review of Resident #34's medical record, showed: -admitted to the facility on [DATE]; -A quarterly MDS completed on 9/26/19; -No entry or admission MDS completed between 6/18/19 and 9/26/19. 3. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete quarterly review assessments in a timely manner, no less than once every three months, using the Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, for 15 out of 46 sampled residents (Residents #102, #22, #30, #31, #34 #10, #11, #8, #38, #103, #253, #41, #37, #44 and #204). The census was 82. 1. Review of Resident #102's medical record, showed: -admitted to the facility on [DATE]; -An admission MDS completed on 7/23/19; -No quarterly MDS completed, as of 2/11/20. 2. Review of Resident #22's medical record, showed: -admitted to the facility on [DATE]; -An entry MDS completed on 8/8/19; -No quarterly MDS completed, as of 2/11/20. 3. Review of Resident #30's medical record, showed: -admitted to the facility on [DATE]; -An entry MDS completed on 8/21/19; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement a person centered care plan that addressed the medical, physical and psychosocial needs of two residents (Residents #202 and #31). The facility also failed to address one resident's nutritional needs, including a significant weight loss (Resident #16) and another resident (Resident #102), who received hospice services. The census was 82. 1. Review of Resident #202's Baseline Care Plan, dated 11/15/19, showed -admitted on [DATE]; -Diagnoses included left below knee amputation, impaired brain function and history of alcohol abuse; -Regular diet. Provide diet as ordered and provide supplements. Further review of the resident's medical record, showed no comprehensive care plan completed in the resident's electronic or paper medical record. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medication error rates are not 5 percent or greater. Out of 30 opportunities observed, there were two errors, resulting in a 6.67% medication error rate (Resident #155). The census was 82. Review of the facility's policy on the Administration of Eye Drops, updated 1/6/19, showed: -Policy: Medications are administered as prescribed, in accordance with good nursing principles and practices and only by persons legally authorized to do so. Personnel authorized to administer medication do so only after they have familiarized themselves with the medications; -#5. Instruct resident to close eyes slowly to allow for even distribution over the surface of the eye and apply gentle pressure to the tear duct for one minute or by gently closing the eye for 3 minutes. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete significant change Minimum Data Sets (MDS), a federally mandated assessment instrument completed by facility staff, for two residents enrolled in hospice programs (Residents #102 and #12). The census was 82. 1. Review of Resident #102's medical record, showed: -admitted to the facility on [DATE]; -An admission MDS completed on 7/23/19; -admitted to hospice on 11/18/19; -No significant change MDS completed to reflect admission to hospice. 2. Review of Resident #12's medical record, showed: -admitted to the facility on [DATE]; -admitted to hospice on 1/10/20; -No significant change MDS completed to reflect admission to hospice. 3. During an interview on 2/11/20 at 12:15 P.M., the Assistant Director of Nurses (ADON) said the facility hired a new employee to complete and submit MDSs in January 2020. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete and electronically transmit resident Minimum Data Sets (MDS), a federally mandated assessment instrument completed by facility staff, for six out of 46 sampled residents (Residents #12, #6, #16, #34, #252, and #42). The census was 82. 1. Review of Resident #12's medical record, showed: -admitted to the facility on [DATE]; -discharged from the facility, return not anticipated, on 11/26/19; -No discharge MDS completed or transmitted. 2. Review of Resident #6's medical record, showed: -admitted to the facility on [DATE]; -discharged from the facility, return not anticipated, on 12/18/19; -No discharge MDS completed or transmitted. 3. Review of Resident #16's medical record, showed: -admitted to the facility on [DATE]; -A quarterly MDS completed 5/23/19; -A significant change MDS, completed on 10/15/19, not transmitted. 4. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all physician's orders were followed by not checking blood pressures and pulses as ordered prior to administering medication and ensuring a timely response to a dietary recommendation for a resident with weight loss as ordered for three of 46 sampled residents (Residents #152, #155 and #202). The census was 82. 1. Review of Resident #152's physician's order sheet (POS), dated 1/1/20 through 1/31/20, showed: -Amlodipine (medication used to treat high blood pressure) 10 (milligram) mg one tablet by mouth once daily. Hold if systolic (top number of the blood pressure) blood pressure is less than 100 or pulse less than 60; -Check pulse in the morning and record; -Check blood pressure in the morning and record. Review of the resident's medication administration record (MAR), dated 1/1/20 through 1/31/20, showed: [...]