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F0908
D

Failure to Maintain Elevator Results in Resident's Loss of Wheelchair Access

Saint Louis, Missouri Survey Completed on 12-19-2025

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 maintain essential equipment in a safe and operable condition by not ensuring the consistent operation of the elevator. This deficiency was observed when the elevator became nonfunctional, preventing access between floors. As a result, a resident who is a bilateral knee amputee and relies on an electric wheelchair for mobility was unable to access their wheelchair while it was being repaired in the basement. The repair could not be performed in the resident's room or hallway, and the elevator outage meant the wheelchair remained inaccessible to the resident. The resident, who has a history of high blood pressure, chronic atrial fibrillation, and bilateral leg amputations, was left in bed without access to an appropriate alternative mobility device. The resident expressed frustration and distress about being confined to bed, especially given a previous prolonged period of immobility due to a wound. Staff interviews confirmed that the resident was offered a geri-chair, but it was not suitable due to the resident's lack of trunk control and the absence of a proper reclining or seatbelt-equipped chair to ensure safe positioning.

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