F0585

E

Failure to Designate Grievance Official and Provide Accessible Grievance Process

Saint Louis, Missouri Survey Completed on 02-04-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to implement its grievance policy by not identifying a grievance official responsible for overseeing the grievance process and not making grievance information and forms readily accessible. The written policy, dated 4/1/2022, specified that the facility would have grievance forms available 24/7 in an unsecured common area, notify residents via postings of their right to file grievances orally, in writing, and anonymously, and identify a Grievance Official (normally the Social Services Director) with name, business address, email, and phone number posted in prominent locations. The policy also stated that staff would assist individuals who could not or chose not to write, and that grievances noted verbally would be recorded on the facility’s grievance form or in the electronic tracking system.

During a group interview with eight alert and oriented residents, all residents reported they did not know where grievance forms were located, and six did not know how to file a grievance even if a form were available. All eight residents stated they did not know who the Grievance Official was. The previous Grievance Official had been the Social Worker, but the facility did not have a Social Worker at the time, and six residents reported they did not know who else to go to with grievances or concerns. These resident reports demonstrated a lack of awareness of the grievance process and the designated grievance contact.

Surveyor observations over multiple days showed that grievance forms were not readily accessible in unsecured common areas and that there was no visible information posted identifying the Grievance Officer, the location of forms, or how to file grievances orally, in writing, or anonymously. Grievance forms were found in the receptionist’s office, behind a desk in an unmarked folder, and were only provided upon request; the receptionist’s office was locked at night. The front desk staff stated that residents requesting to file a grievance were directed to the receptionist desk for a form and, if assistance was needed, were referred to the Social Worker, who was not employed at that time, and then to the HR office. The HR Manager reported that grievance forms were turned in to her because there was no Social Worker, that she sometimes sought help from the Activity Director, and that unresolved grievances were forwarded to the Administrator or DON. The HR Manager stated she did not know who was designated as the grievance officer and assumed it would be the Social Worker. The Administrator stated she expected signage identifying the Grievance Officer and freely accessible grievance forms, and that the process should allow anonymous grievances, confirming that these elements were not in place during the survey period.