Life Care Center of St. Louis

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection prevention and control program when staff failed to change gloves, wash or sanitize hands and wear gowns during care for residents on enhanced barrier precautions (EBP, precautions for use during high-contact resident care activities for residents infected with a multidrug-resistant organism (MDRO, microorganisms that are resistant to one or more classes of antimicrobial agents) for four residents (Residents #101, #81, #9 and #56). The staff failed to change gloves and wash hands during perineal care (cleaning the genital and anal areas) for one resident observed during care (Resident #63). In addition, laundry staff failed to separate dirty linens from clean and washed linens. The sample was 23. The census was 90. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure five out of 10 randomly selected Certified Nurse Aide (CNA)/Certified Medication Technicians (CMT), employed by the facility for over 12 months received their annual 12 hours of in-service training. The census was 90. Review of the facility's CNA 12 Hours of Inservice Training policy, dated 12/17/25, showed the Staff Development Coordinator (SDC) will develop, implement, and maintain an effective in-service program for all nurse aides to ensure they have received the necessary in-services and education to meet the federal requirement. CNAs have a requirement of at least 12 hours of continuing competency every 12 months and must include dementia management training and resident abuse training. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to create an environment that supported and respected the right of a resident to make choices about significant aspects of daily life. The failure affected one resident (Resident #66) who requested to get out of bed for meals. Resident #66 required extensive assistance with activities of daily living (ADLs) due to left-side paralysis and required staff assistance for transfers out of bed. The facility utilized a get-up list to determine which residents would be assisted out of bed in the morning. This process did not consider or honor the resident stated preference to be out of bed for all meals. The facility census was 90. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents or the resident's Durable Power of Attorney - Healthcare (DPOA-Healthcare) were invited to participate in all aspects of person-centered care planning for one resident (Resident #67) who was not notified in spending down the resident's resources on medical requirement in the amount of $2,725.80 and did not authorize the funds to be spent. The sample was 23. The census was 90. Review of the facility's Policy for Resident Rights, dated 6/8/20, showed:-The resident has the right to be informed of, and participate in, his or her treatment, including the right to be fully informed in language that he or she can understand of his or her total health status, including but not limited to, his or her medical condition; [...]

Inspectors wroteBased on observation and interview, the facility failed to post in a place readily accessible to residents, family members and legal representatives of residents, the results of the most recent survey and complaint investigations of the facility in a location where they would not be required to ask staff for assistance. The census was 90. Observations on 1/12/26 through 1/15/26, showed no survey results maintained at the entrance of the building, in the lobby of the building or at the desk with the receptionist. No signs were posted for the location of the survey results and/or availability of the last survey or complaint investigations. During a group interview on 1/13/26 at 10:00 A.M., six residents, who the facility identified as alert and oriented, attended the group meeting. All six residents said they were unaware of where the state survey results were located. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure services provided meet professional standards when one resident's physician order was not transcribed onto the physician order sheet timely (Resident #91). The sample was 23. The census was 90. Review of Resident #91's admission Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 10/30/25, showed:-Moderately impaired cognition;-No rejection of care;-Resident had an indwelling catheter (a sterile tube inserted into the bladder to drain urine);-Diagnoses included renal (kidney) insufficiency, renal failure or end stage renal disease (ESRD, chronic irreversible kidney failure) and obstructive uropathy (disorder of the urinary tract that occurs due to obstructed urinary flow). Review of the resident's care plan, in use at the time of survey, showed:-Focus: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident who required assistance with activities of daily living (ADL) received showers and personal care in accordance with their personal needs, for one of 23 sampled residents (Resident #56). The census was 90. Review of the facility's Activities of Daily Living (ADLs) policy, reviewed 9/10/24, showed:-Policy: The resident will receive assistance as needed to complete ADLs. Any change in the ability to perform ADLs will be reported to the nurse;-A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. [...]

Inspectors wroteBased on interview and record review, the facility failed to follow physician orders for x-rays for one of seven sampled residents (Resident #1) who had fallen from his/her bed on 9/6/24. The x-ray order was not completed for nine days, during which time the resident experienced pain and refused care, which he/she had not done prior. The resident was diagnosed with a fractured hip. The sample was 7. The census was 86. The Administrator was notified on 10/21/24 at 3:46 P.M., of the Immediate Jeopardy (IJ) past non-compliance, which occurred on 09/06/24. Facility staff were inserviced beginning on 9/13/24 and a system was implemented to monitor the completion of ordered x-rays. The IJ was corrected on 9/16/24. Review of Resident #1's annual Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 6/13/24, showed the following: [...]

Inspectors wroteBased on interview and record review, the facility failed to submit facility initiated transfers (such as an emergency transfer to the hospital with intent to take the resident back) to the Ombudsman on a monthly basis. The census was 92. During an interview on 4/16/24 at 11:07 A.M., Ombudsman F said the facility had not sent their monthly transfer notifications to the ombudsman office since November of 2022. Review of the email communication between the facility Social Service Director and the ombudsman office, dated 4/18/24 at 9:13 A.M., showed an admission/discharge log dated 4/1/24 through 4/18/24. During an interview 4/18/24 at 9:35 A.M., the Administrator said the social worker will be responsible to submit hospital transfer logs monthly to the Ombudsman. It has not been done since she started two weeks ago and that is about the same time the Social Service Director started. [...]

Inspectors wroteBased on interview and record review, the facility failed to encode and transmit resident assessment data within 7 days after a facility completes a resident's assessment for 12 of 19 residents investigated for MDS encoding and transmission, as indicated by the MDS showing in progress (Residents #22, #51, #54, #6, #53, #43, #2, #7, #29, #14, #30, and #23). The census was 92. Review of the Minimum Data Set (MDS, a federally mandated assessment instrument completed by facility staff) version 3.0 Resident Assessment Instrument (RAI) User's Manual, showed: -For all non-admission assessments, the MDS completion date must be no later than 14 days after the Assessment Reference Date (ARD); -For the admission assessment, the MDS Completion Date must be no later than 13 days after the entry date; -Encoding Data: [...]

Inspectors wroteBased on interview and record review, the facility failed to complete quarterly resident assessments for nine of 19 residents investigated for quarterly assessment completion (Residents #54, #6, #53, #43, #2, #7, #29, #14 and #23). The census was 92. Review of the Minimum Data Set (MDS, a federally mandated assessment instrument completed by facility staff) version 3.0 Resident Assessment Instrument (RAI) User's Manual, showed: -For all non-admission assessments, the MDS completion date must be no later than 14 days after the Assessment Reference Date (ARD); -For the admission assessment, the MDS Completion Date must be no later than 13 days after the entry date; -Encoding Data: Within 7 days after completing a resident's MDS assessment or tracking record, the provider must encode the MDS data (i.e., enter the information into the facility MDS software). 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure eight of 10 randomly selected Certified Nurse Aides (CNAs) received the required annual 12 hour resident care training. The census was 92. Review of the facility assessment, showed: -Staff training/Education and Competencies: Facility provides staff training/education and competencies through a variety of methods such as new employee orientation, impromptu small group training during the regular course of business, scheduled in-house in-services, webinars, classes, seminars, memos, Healthcare Academy, etc. on subjects that are either required for continued certification or in areas determined to need education or re-education. The facility provides or arranges for personnel to receive outside education to meet staff certification and re-certification requirements as applicable. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to post the required nurse staffing in a prominent place, readily accessible to residents and visitors on a daily basis. The census was 92. Review of the facility assessment, showed: -Scheduling plan: 8 + full-time per unit on 6:30 A.M. to 2:30 P.M. shift; -8 + full-time per unit on 2:30 P.M. to 10:30 P.M. shift; -6 + full-time per unit on 10:30 P.M. to 6:30 A.M. shift. Observations from 4/17/24 through 4/19/24 and 4/22/23 and 4/23/24, showed a board on the wall behind the front desk reception desk. The board contained categories for date, census, total number and actual hours worked by Registered Nurses (RN), Licensed Practical Nurses (LPN), and Certified Nurse Aides (CNA) per shift; -On 4/17/24 at 10:10 A.M., 4/18/24 at 6:20 A.M., and 4/19/24 at 6:44 A.M., showed a date of 4/4/24 and census of 92. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow acceptable standards of practice for infection prevention and control when staff failed to change gloves while administering medication via an enteral nutrition device (feeding tube) and left suction equipment at the bedside uncovered for one resident (Resident #1), and not testing new hire employees for Tuberculosis (TB) per their policy for eight of eight employees sampled. The census was 92. 1. Review of the facility's Administration of Medications policy, dated 8/24/23, showed: -The facility will ensure medications are administered safely and appropriately per physician order to address residents' diagnoses and signs and symptoms. Review of the facility's Enteral Nutrition Therapy policy, dated 8/8/23, showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to complete a comprehensive resident assessment for one of 12 residents investigated for comprehensive assessment completion (Resident #30). The census was 92. Review of the Minimum Data Set (MDS, a federally mandated assessment instrument completed by facility staff) version 3.0 Resident Assessment Instrument (RAI) User's Manual, showed: -For all non-admission assessments, the MDS completion date must be no later than 14 days after the Assessment Reference Date (ARD); -For the admission assessment, the MDS Completion Date must be no later than 13 days after the entry date; -Encoding Data: Within 7 days after completing a resident's MDS assessment or tracking record, the provider must encode the MDS data (i.e., enter the information into the facility MDS software). Review of Resident #30's medical record, showed: -admitted [DATE]; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents had complete, accurate and individualized care plans to address specific needs of the residents for two of 19 sampled residents (Residents #175 and #59) and one of three sampled closed records (Resident #174). The census was 92. 1. Review of Resident #175's medical record showed: -admitted on [DATE]; [...]

Inspectors wroteBased on interview and record review, the facility failed ensure a safe resident discharge to the community by failing to ensure referrals to local contact agencies and orders for medical equipment were sent timely for one of two residents reviewed with an order to discharge home (Resident #174). The resident was discharged without home health set up or durable medical equipment after a change in the discharge date . This has the potential to affect all residents who discharge from the facility. The census was 92. Review of the facility's Discharge Plan policy, reviewed 8/9/23, showed: -Policy: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide care and services related to communication, by failing to provide speech assistive devices for one of one sampled resident (Residents #32) who is deaf. The facility also failed to ensure staff were knowledgeable on how to locate information regarding how the resident communicated with staff. The census was 92. Review of Resident #32's quarterly assessment Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 1/14/24, showed: -Hearing highly impaired- absence of useful hearing; -Diagnoses included stroke, high blood pressure, and seizures; -No hearing aid or other hearing appliances used. Review of the resident's care plan, dated 5/30/19, showed: -Focus: I have a hearing deficit/deaf and I have difficulty understanding. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice for one resident with chronic wounds (Resident #4). The resident readmitted from the hospital on 3/29/24. Hospital records indicated wounds present to the left knee. The facility admission nursing assessment identified open areas on the left knee and lower extremities. The facility did not complete a full wound assessment until 4/3/24. Treatment orders were not obtained for the left plantar (foot) until 4/11/24 and left knee until 4/19/24. The census was 92. Review of the facility's Skin Integrity and Pressure Ulcer/Injury prevention and Management policy, dated 10/3/19 and last revised 8/25/21, showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that residents receive proper treatment to maintain vision when staff failed to make transportation arrangements for one sampled resident (Resident #224) out of 19 sampled residents, to go to a follow-up appointment for eye surgery and failed to reschedule the appointment after it was missed. The census was 92. Review of the facility's Transportation Coordination and Services Policy, issued 1/27/23 and reviewed on 7/17/23, showed: -Policy: The facility will assist residents in making necessary appointments for services not provided in the facility and arranging for transportation to and from appointments; -Procedure: The facility will assist the resident and or resident representative in the making of necessary appointments, such as, but not limited to Medical Specialists, Laboratory and Vision Services; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents were free from significant medication errors for one resident who did not receive his/her ordered routine insulin (Resident #29). The census was 92. Review of the facility's Administration of Medications policy, dated 4/24/19 and last revised 2/13/23, showed: -The policy will ensure medications are administered safely and appropriately per physician order to address residents' diagnoses and signs and symptoms; -Medication error- this means the observed or identified preparation or administration of medications or biologicals which is not in accordance with: -Physician order; -Manufacturer's specifications regarding the preparation and administration of the medication or biologicals; -Accepted professional standards and principals which apply to professionals providing services; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure drugs and biologicals were stored per acceptable standards of practice for one of four medication carts reviewed and one of one treatment cart reviewed. The medication cart contained insulin pens not labeled when removed from refrigeration to indicate when they expire. The treatment cart contained ointments for 2 residents (Residents #74 and #224) with the cap off. The facility had 10 medication/treatment carts. The census was 92. Review of the facility's Storage and Expiration Dating of Medications, Biologicals policy, dated 12/1/07 and last revised 8/7/23, showed: -This policy sets forth the procedures relating to the storage and expiration dates of medications, biologicals, syringes, and needles; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents received care consistent with professional standards. One resident (Resident #4) did not have his/her treatments completed as per physician orders to his/her vascular wounds, and one resident (Resident #3) did not have a treatment on his/her breasts and no follow up skin assessments were completed to ensure the resident's wound was healing. The sample was five. The census was 87. Review of the facility's Skin Integrity and Pressure Ulcer/Injury Prevention and Management Policy, review date, 3/31/23, showed: -Based on the comprehensive assessment of a resident, the facility must ensure that: -A skin assessment/inspection occurs on admission/readmission. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure two residents (Resident #5 and Resident #1) with pressure wounds (skin or soft tissue injury that develops with prolonged periods of pressure over specific areas of the body) received the necessary treatments and services to promote healing. The sample size was five. The census was 87. Review of the facility's Skin Integrity and Pressure Ulcer/Injury Prevention and Management Policy, review date, 3/31/23, showed: -Based on the comprehensive assessment of a resident, the facility must ensure that: -A resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual's clinical condition demonstrates that they were unavoidable; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to protect residents' rights to be treated with dignity and respect for one resident (Resident #8) who was talked to in a harsh tone and told to go to his/her room and had tissues grabbed out of his/her hand. In addition, staff failed to provide privacy during care for three residents (Residents #38, #25, #23). The census was 52. Review of the Resident Rights, [NAME] of Rights, provided to residents upon admission to the facility, showed: -The resident has a right to a dignified existence, self-determination, and communication with the access to persons and services inside and outside the facility; -The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States; [...]

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 Social Security (SSI) limit ($4,835.00) or when the resident's account was over the SSI limit ($5,035.00). This affected 10 residents reviewed who received Medicaid benefits (Residents #303, #304, #27, #43, #8, #305, #26, #306, #307 and #17). The census was 52. Review of the facility's Management of Resident's Funds policy, undated, included: -Policy: It is the policy of the facility that residents may choose the facility to manage all or part of their financial affairs; -Procedure: The facility will notify each resident that receives Medicaid benefits when the amount in the account reaches $200 less than that which is allowed by the state Medicaid regulations. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to follow their transfer/discharge policy by not providing the resident and/or their representative the written transfer notice at the time of the resident's facility initiated transfer, for three of five residents investigated for discharge. (Residents #252, #36 and #45). The census was 52. Review of the facility's Transfer/Discharges Policy, dated 5/6/19, showed: -Before a facility transfers or discharges a resident, the facility must-notify the resident and the resident's representative(s) of the transfer or discharge and the reason for the move in writing and in a language and manner they understand 1. Review of Resident #252's medical record, showed: -admission date: 9/29/21; -discharged to the hospital: 10/8/21; -readmission to the facility: 10/14/21. [...]

Inspectors wroteBased on interview and record review, the facility failed to inform the resident and/or resident representative of the bed hold requirements at the time of transfer to the hospital for various medical reasons for three of the five residents investigated for bed hold notices. (Resident #252, #36 and #45). The census was 52. Review of the facility's Bed-hold/Room Reservation Policy, dated 5/2/19, showed: -Policy: The Bed-hold policy should be given upon admission, upon transfer of a resident to the hospital (if in an emergency within 24 hours), or if the resident goes on therapeutic leave of absence; -Procedure: Bed hold policies will be provided and explained to the resident or responsible party upon admission and explained to the patient before each temporary absence; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff followed physician's orders and/or facility standing orders by failing to notify physicians when resident's blood glucose levels exceeded the parameters. The facility identified 14 residents with orders for routine blood glucose levels. Of those 14, two had blood glucose levels that exceeded physician orders and/or facility standing orders and problems were identified with both. (Residents #26 and #10). Problems were identified with one of one discharged resident with orders for routine blood glucose levels. (Resident #301). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities, designed to meet the interests and preferences for one resident, Resident #13. The facility failed to ensure there was a current activities scheduled in the evenings and on weekends and failed to ensure scheduled activities occurred. The facility also failed to provide meaningful and appropriate one on one (1:1) activities. The facility identified 16 residents that received 1:1 activities. Of those 16, five were sampled and problems were identified with three residents (Residents #32, #23, and #17). The census was 52. Review of the facility Therapeutic Activities Program policy, reviewed on 5/18/20 and revised on 11/2/21, showed: Federal Regulation: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a medication error rate of less than 5%. Out of 26 opportunities observed, 3 errors occurred resulting in a 11.53% error rate (Residents #251, #41 and #26). The census was 52. Review of the facility's Administration of Medications policy, revised 7/14/21, showed -All medications are administered safely and appropriately per physician order to address residents' diagnoses and signs and symptoms; -Medication error means the observed or identified preparation or administration of medications or biologicals are not in accordance with: -The prescriber's orders; -Manufacturer's specifications regarding the preparation and administration of the medication or biological; -Acceptable professional standards and principles, which apply to professionals providing services; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure drugs and biologicals were labeled and stored in accordance with currently accepted practices to include storage of insulin, dating medications when opened, and ensuring prescription medications were labeled with the residents name and stored with the cap on the medication, and treatment carts locked when not in use. The facility identified two medication rooms, four medication carts and three treatment carts at the time of survey. Issues were found with one of one medication room observed, two of two medication carts observed and three of three treatments carts observed. The census was 52. Review of the facility's Storage and Expiration Dating of Medications, Biologicals, Syringes and Needles policy, dated 10/28/19, showed: -Procedure: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow their policy on communicable disease by failing to ensure newly hired staff received the Mantoux tuberculin skin test (TST, used to test for latent tuberoses (TB) infection) two step as required for eight of 10 sampled staff hired within the past year. The census was 52. Review of the facility's tuberculosis testing and screening policy, revised 5/7/21, showed: -Purpose: To promote resident/associate safety and wellbeing by screening associates for TB and initiating appropriate follow-up; -New associates or volunteers who have been made a conditional offer shall be screened for the presence of infection through the following measures; -The facility should perform the TST two-step procedures; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents wore positioning devices as ordered to prevent loss in range of motion for one resident with limited range of motion. The staff failed to ensure one resident wore splint as ordered and/or document and address when the resident refused to wear the devices (Resident #17). For one of four residents sampled for restorative services. The census was 52. Review of the facility's Restorative Nursing policy, revised 8/7/21, showed: -The facility is responsible for providing maintenance and restorative programs as indicated by the resident's comprehensive assessment to achieve and maintain the highest practicable outcome; -Restorative Nursing Functions can be within one of the following categories: -Range of Motion (Active and Passive); -Splint or brace assistance; -Bed mobility; -Transfers; -Walking; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents are free of any significant medication errors for one resident (Resident #251) who missed a blood pressure medication for three days when it was not reordered from pharmacy timely. This resulted in the resident's blood pressure being elevated. The census was 52. Review of the facility's Administration of Medications policy, revised 7/14/21, showed -All medications are administered safely and appropriately per physician order to address residents' diagnoses and signs and symptoms; -The facility must ensure that its residents are free of any significant medication errors; -Medication error means the observed or identified preparation or administration of medications or biologicals are not in accordance with: -The prescriber's orders; [...]

Inspectors wroteBased on interview and record review, the facility failed to maintain medical records on each resident in accordance with accepted professional standards and practices to ensure a resident's closed medical record was readily accessible for one resident. (Resident #301). This failure resulted in a delay of the survey process due to being unable to fully complete a complaint investigation. The census was 52. Review of Resident #301's medical record, reviewed on 3/25/22, showed an April 2020 laboratory result not found in the electronic medical record (EMR). During an interview on 3/25/22 at 2:00 P.M., administrator was asked to provide the resident's medical record. The administrator said the laboratory would not give the facility the requested information. The resident's full closed record was at their contracted medical records facility. [...]

Inspectors wroteBased on interview and record review, the facility failed to follow their staff vaccination policy for COVID-19. The facility had 66 employees. Of those 66, two employees were not fully vaccinated and without an exemption or medical delay, by the March 15, 2022 deadline. This resulted in 3.1% of facility staff who did not meet the requirement for staff vaccination. The facility did not have any positive resident cases in the four weeks preceding the onsite survey. Additionally, the facility failed to implement their policy related to additional precautions to mitigate the spread of COVID-19 for unvaccinated employees when two unvaccinated employees failed to wear an N-95 mask as directed by facility policy. The census was 52. 1. Review of the facility's Covid-19 (Sars-CoV-2) Vaccination Program Policy for Associates Policy, revised 2/23/22, showed: [...]