Above average — CMS composite of the measures below.
The next survey window likely opens around March 2027
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Garden View Care Center At Dougherty Ferry during CMS and state inspections, most recent first.
Failure to maintain an effective grievance process: the admission agreement did not explain how to file a grievance anonymously and did not identify a specific Grievance Officer or provide contact information. Seven alert and oriented residents said they did not know who the Grievance Officer was or how to file an anonymous complaint, and one resident reported a concern to a CNA but never received a follow-up. The DON said residents could come to her and the Administrator said she was the Grievance Officer, but the facility had no grievance posting because the topic was only discussed at admission and during care plan meetings.
Unsafe Hoyer Lift Transfers: Staff did not use appropriate two-person Hoyer lift techniques for multiple residents who were dependent on mechanical lift transfers. During observations, residents were raised and moved while unsupported in the sling, with staff turning away, pulling wheelchairs away, and allowing residents to swing side to side in the air. One resident later reported a transfer in which staff failed to maintain a secure hold, causing swinging and pain when a CNA physically held and carried the resident to bed.
Failure to Use Gowns During EBP High-Contact Care: Staff did not wear gowns during high-contact care for two residents who required EBP. One resident had a suprapubic catheter and wounds, and an LPN performed catheter and wound care without a gown. Another resident had wounds, hemiplegia, and required Hoyer lift transfers; CNAs provided perineal care and assisted with transfers without gowns. The care plans for both residents did not show EBP use during high-contact care.
A facility failed to ensure the State Survey Agency and LTC Ombudsman contact information was prominently posted and accessible to residents and resident representatives. The numbers were placed in hard-to-see locations at the reception desk and in the library, with very small or illegible print, and residents and a CNA reported they did not know where to find the abuse/neglect reporting information or how to contact the LTC Ombudsman.
A cognitively impaired resident with dementia reported alleged sexual abuse to a family member, which was then communicated to the facility staff. Despite the facility's policy requiring timely reporting of such allegations, the incident was not reported to the Department of Health and Senior Services. An internal investigation deemed the allegations unsubstantiated, but the failure to report constitutes a deficiency.
A facility failed to thoroughly investigate a resident's allegation of sexual abuse, as required by their policy. The cognitively impaired resident reported the incident to a family member, who informed the facility. The investigation was concluded within two hours without interviewing other residents or suspending the accused staff member. The facility did not report the allegations to DHSS, and the ADON and DON did not follow the facility's abuse policy.
Failure to Maintain Effective Grievance Process
Penalty
Summary
The facility failed to maintain an effective grievance process for residents and family members to file grievances anonymously and failed to post information on how to file a grievance, as required by its grievance policy. The admission agreement listed key administrative personnel and stated that a staff person would be designated to receive grievances, but it did not explain how a grievance could be filed anonymously. It also did not identify a specific Grievance Officer or provide contact information for that person. During a group interview, seven alert and oriented residents said they did not know who the Grievance Officer was or how to file a complaint anonymously. One resident stated that after reporting a concern to a CNA, no one ever got back with him/her about it. Two residents said they would prefer to file concerns anonymously because they did not want staff to be mad or upset with them. The DON stated residents could come to her with issues and that she would keep their identity private if the complaint was anonymous. The Administrator stated she was the Grievance Officer and said residents could file a grievance online at the company website or call the front desk, and also stated there was no posting about grievances because the topic was discussed at admission and during care plan meetings.
Unsafe Hoyer Lift Transfers
Penalty
Summary
The facility failed to ensure staff used appropriate techniques during two-person Hoyer lift transfers for four residents. Resident #23 had severe cognitive impairment, generalized muscle weakness, gait and mobility abnormalities, syncope and collapse, and was totally dependent on two or more staff for transfers with a wheelchair for mobility. His/her care plan and physician order required a two-person mechanical lift transfer. During observation, one staff member operated the lift while the other stood at the foot of the resident, then turned away as the resident was raised and moved, leaving the resident unsupported in the sling and swinging side to side in the air. Resident #36 had severe cognitive impairment, senile degeneration of the brain, arthritis, and osteoporosis, and was also totally dependent on two or more staff for transfers with wheelchair mobility. The care plan and physician order required a two-person Hoyer lift transfer. During observation, one CNA raised the resident in the air while the other pulled the wheelchair away, leaving the resident unsupported and slightly swinging side to side with neither CNA keeping hands on the resident. Resident #34 had severe cognitive impairment, unspecified dementia, and insomnia, and was totally dependent on two or more staff for transfers with wheelchair mobility. The care plan and physician order required a two-person Hoyer lift transfer. During observation, one CNA raised the resident while the other pulled the wheelchair away, leaving the resident unsupported and swinging side to side as the lift moved toward the bed. Resident #14 was cognitively intact and had arthritis, osteoporosis, abnormal posture, gait and mobility abnormalities, muscle weakness, kyphosis, anxiety disorder, and bilateral lower extremity impairment. The care plan and physician order required a mechanical lift with two-person assist for all transfers. During interview, the resident stated that staff had failed to maintain a secure hold during a mechanical transfer and that he/she swung from side to side in the lift, requiring a CNA to physically hold and carry him/her to bed, which caused pain. Staff interviews stated that two staff were required for Hoyer transfers and that one staff member should keep hands on the resident throughout the transfer, while the DON and Administrator stated that all mechanical lift transfers required two staff members and physical contact with the resident throughout the transfer.
Failure to Use Gowns During EBP High-Contact Care
Penalty
Summary
The facility failed to follow infection prevention and control standards for Enhanced Barrier Precautions (EBP) when staff did not wear gowns during high-contact resident care activities for two residents. The facility’s EBP policy stated that gloves and gowns are applied before high-contact care activities such as transferring, hygiene, changing briefs, device care, and wound care, and that PPE should be available in residents’ rooms. The report also noted that staff interviews reflected an understanding that gowns and gloves were required for residents on EBP during direct care. One resident had severe cognitive impairment, an indwelling suprapubic catheter, diabetes, dementia, an unspecified open wound of the penis, and an unstageable pressure ulcer described as a deep tissue injury. The resident’s care plan addressed pressure ulcer risk and the suprapubic catheter, but did not show that staff should use EBP during high-contact care. During observation, an LPN performed suprapubic catheter care and wound care to the resident’s foot after putting on gloves, but did not wear a gown while providing the high-contact care. The second resident had moderate cognitive impairment, impairment of both upper and lower extremities, heart failure, anemia, kidney failure, diabetes, arthritis, dementia, hemiplegia or hemiparesis, and diabetic foot ulcers. The resident’s care plan addressed ADL assistance and an unstageable pressure ulcer to the left lateral ankle, but did not show that staff should use EBP during high-contact care. Observations showed staff providing perineal care and transferring the resident with a Hoyer lift without gowns, and on another occasion multiple CNAs assisted with a Hoyer transfer without wearing gowns while touching and assisting the resident.
State Survey and Ombudsman Contact Information Not Prominently Posted
Penalty
Summary
The facility failed to ensure that contact information for the State Survey Agency and the State Long-Term Care Ombudsman was prominently posted in a form and manner accessible to all residents and resident representatives. Review of the Resident Rights policy showed residents have the right to communicate with outside agencies, including State and Federal surveyors, the State Long-Term Care Ombudsman, and protection and advocacy organizations, regarding any matter. Observations throughout the survey found the State Survey Agency and LTC Ombudsman information posted in locations that were difficult to see and read. At the receptionist desk, the phone numbers were placed at the far right side, behind other literature, on a small 8.5-inch by 11-inch sign with very small print; the Ombudsman number was illegible unless standing directly in front of it. In the library, a poster with the Ombudsman phone number was located behind bookshelves and was not visible from the main corridor, and the number was illegible unless standing directly across from the poster. During interview, seven alert and oriented residents said they did not know where to find abuse/neglect reporting information for the State Survey Agency or how to contact the LTC Ombudsman, and a CNA said he/she did not know where to find the DHSS abuse/neglect hotline number. The Administrator stated the DHSS abuse poster was at the reception desk and the LTC Ombudsman sign was in the library, and that resident rights were discussed during care plan meetings.
Failure to Report Alleged Abuse Timely
Penalty
Summary
The facility failed to adhere to its abuse policy by not reporting an allegation of sexual abuse in a timely manner. A resident, who was cognitively impaired and diagnosed with dementia, anxiety, and depression, allegedly reported to a family member that someone was being sexually inappropriate with them in the shower. The family member relayed this information to the nurse, who then spoke with the resident. The resident denied the allegations, stating that their family member was making things up. Despite the denial, the facility's policy required that such allegations be reported to the appropriate authorities within two hours if they involved serious bodily injury or within 24 hours otherwise. The facility conducted an internal investigation, which included interviewing the resident and staff. The resident continued to deny the allegations, and the staff member involved, a CNA, stated that they only touched the resident's knees and back during the shower. The investigation concluded that the allegations were unsubstantiated, and the resident was placed on frequent checks as a precaution. However, the facility did not report the incident to the Department of Health and Senior Services (DHSS) as required by their policy. Interviews with facility staff, including the ADON, DON, and Administrator, revealed a lack of clarity and adherence to the reporting protocol. The ADON and DON both indicated uncertainty about whether the incident should have been reported to DHSS, and the Administrator confirmed that the allegations were not reported. The facility's failure to report the incident to the appropriate authorities constitutes a deficiency in following their abuse policy and regulatory requirements.
Failure to Thoroughly Investigate Abuse Allegation
Penalty
Summary
The facility failed to conduct a thorough investigation into an allegation of sexual abuse reported by a resident to a family member. The resident, who was cognitively impaired and diagnosed with dementia, anxiety, and depression, reported the incident to a family member, who then informed the facility. The facility initiated an investigation but did not interview other residents who might have been involved or witnessed the incident, as required by their abuse policy. The facility's policy mandates that all reports of abuse be thoroughly investigated, including interviewing other residents who received care from the accused employee. However, the investigation was concluded within two hours, and the facility determined the allegations were unsubstantiated without interviewing other residents or suspending the accused staff member. The resident's family was informed, and the resident was placed on frequent checks, but the facility did not report the allegations to the Department of Health and Senior Services (DHSS). Interviews with staff revealed that the Assistant Director of Nursing (ADON) and the Director of Nursing (DON) did not follow the facility's policy for reporting and investigating abuse allegations. The ADON did not suspend the accused staff member, and the DON concluded the investigation without further interviews. The Administrator also did not report the allegations to DHSS, as they believed the allegations were unsubstantiated. This lack of thorough investigation and reporting constitutes a deficiency in the facility's handling of abuse allegations.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Valley Park
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Big Bend Woods Healthcare Center | 0.9 mi | ★★★★★ | 0 | 0 |
| Quarters At Des Peres, The | 2.5 mi | ★★★★★ | 6 | 0 |
| Lutheran Senior Services At Meramec Bluffs | 2.8 mi | ★★★★★ | 2 | 0 |
| Aberdeen Heights | 2.9 mi | ★★★★★ | 0 | 0 |
| Manchester Rehab And Healthcare Center | 3.2 mi | ★★★★★ | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.