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F0584
E

Failure to Maintain Clean, Pest-Free, and Homelike Resident Environment

Saint Louis, Missouri Survey Completed on 09-09-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide a clean, comfortable, and homelike environment for its residents, as evidenced by multiple pest control and maintenance issues in resident rooms. In one instance, a resident with moderately impaired cognition, quadriplegia, and other significant health conditions was found in a room with multiple ants on the floor, in the sink, and on the wall by the sink. The resident's room also had a can of pesticide on the sink, a steadily dripping faucet, dust and debris around storage bins, and a black, fuzzy, wet, and spongy spot on the wall under the air conditioning unit, which transferred residue when touched. Staff interviews revealed a lack of awareness about the ant infestation and uncertainty about the timing of recent pest control visits. The maintenance log at the nurse's station was found to be empty, with no current work orders or requests documented at the time of review. Another resident, who had severely impaired cognition and required substantial assistance with daily activities, was found in a room with several small brown pellets on the floor behind the bed, identified by a family member as rat feces. Observations confirmed the presence of these droppings during multiple visits. Staff interviews indicated that pest control and maintenance issues were not consistently reported or addressed in a timely manner. The housekeeping manager acknowledged awareness of some issues, such as a leaking faucet, but was unaware of the extent of the pest problem and the water damage to the wall. The pest control company was reported to visit frequently, but the last visit could not be recalled. Review of facility policies and procedures for floor care outlined steps for cleaning and maintaining vinyl plank flooring, but observations indicated that these procedures were not being followed, particularly in high-traffic and problem areas. The maintenance log, intended for staff to report issues, was not being utilized effectively, and completed and incomplete work orders were not readily available for review. Interviews with nursing and housekeeping leadership confirmed that cleaning and pest control should be prioritized, but acknowledged delays and lapses in reporting and addressing these deficiencies.

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