Below average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Steelville Senior Living during CMS and state inspections, most recent first.
Staff failed to provide consistent ADL assistance with bathing, personal hygiene, and grooming to multiple dependent residents, despite facility policies and care plans requiring such care. Over several months, some residents received only one or two showers, with long gaps between bathing, while others reported going weeks without showers and having to perform their own bed baths. Surveyors repeatedly observed residents with strong body or urine odors, oily or disheveled hair, unchanged clothing, and unshaven facial hair, while care plans often lacked individualized grooming preferences. Staff interviews, including CNAs, a CMT, an RN, the DON, and the administrator, confirmed that residents were not receiving scheduled showers due to chronic staffing shortages, lack of dedicated shower aides, and difficulty managing residents who resisted care, particularly on a special care unit.
Staff failed to consistently document and follow physician‑ordered wound care for a resident with a Stage 3 sacral pressure ulcer, with multiple missed entries on the TAR for daily sacral treatments. Another resident, who was severely cognitively impaired and fully dependent for mobility, had orders and a care plan requiring being laid down after meals and use of heel protectors and positioning wedges for pressure relief. Observations showed this resident repeatedly sitting in a mechanical chair with bare heels pressed into the footrest and heel protectors left unused in the room, with no repositioning over an extended period. A subsequent skin assessment identified a new, facility‑acquired Stage 1 pressure injury on the resident’s heel, and interviews with CNAs and an RN confirmed they were unaware of the orders for heel protectors and positioning between meals.
Staff failed to follow hand hygiene protocols in the kitchen, including not washing hands between glove changes, after touching the trash can lid, and when moving between tasks during meal service. These actions were observed despite staff being aware of facility policy, and the deficiency was acknowledged by both the Dietary Manager and administrator.
The facility did not ensure RN coverage for at least eight consecutive hours daily, as required. Multiple dates in June, July, and August 2024 lacked RN presence, with the DON covering shifts when possible. The administrator cited scheduling challenges and an RN's recent surgery as contributing factors.
The facility failed to manage and store medications properly, leading to deficiencies such as expired medications in storage, loose pills in medication carts, and non-medication items in the medication refrigerator. Staff interviews revealed a lack of awareness and responsibility for these issues, despite existing policies requiring regular checks and proper storage practices.
The facility failed to maintain proper food storage and serving temperatures, with refrigerator logs showing temperatures above safe limits and no corrective actions documented. Observations confirmed high temperatures in the walk-in refrigerator and cold table items, which were served to residents. Additionally, kitchen wares were not fully submerged in sanitizer, contrary to policy, indicating inadequate sanitization practices.
Facility staff failed to follow proper infection control procedures, including hand hygiene and glove use, during resident care. An LPN did not wash hands between glove changes during catheter and wound care, while a CNA failed to change gloves during perineal care. A CMT improperly handled blood glucose monitoring equipment, risking contamination. Staff acknowledged these oversights, citing nervousness, and the DON and administrator reiterated the importance of proper procedures.
Facility staff failed to update care plans for two residents regarding catheter use and did not document a fall for another resident. Despite observations confirming catheter use, care plans lacked this information. Additionally, a resident's fall was not documented or addressed in their care plan. Interviews revealed unclear responsibilities for updating care plans.
The facility failed to provide residents with access to their trust fund accounts on weekends, affecting three residents. Interviews revealed that staff were unaware of the need for weekend access, and no formal policy was in place. Residents expressed frustration over the lack of access to their own money during weekends.
A facility's water management program was found lacking in comprehensive policies and procedures for the inspection, testing, and maintenance of water systems to prevent Legionella growth. The program did not document specific testing protocols, responsible staff, or acceptable control measure ranges. Positive Legionella test results for a resident and poorly controlled Legionella growth in water samples indicated lapses in monitoring and mitigation. Observations revealed water fixtures turned off due to Legionella presence, and interviews with staff highlighted gaps in knowledge regarding chlorine levels, testing protocols, and corrective actions.
Failure to Provide Required ADL Assistance With Bathing and Hygiene
Penalty
Summary
Facility staff failed to provide required assistance with activities of daily living (ADLs), particularly bathing, hygiene, and grooming, to multiple dependent residents, despite facility policies requiring appropriate support with hygiene, bathing, dressing, and grooming in accordance with each resident’s care plan. The facility’s ADL and bathing policies required staff to provide care for residents unable to carry out ADLs independently, to document showers and refusals, and to explore causes of care resistance rather than assuming refusal. Record review showed significant gaps in shower documentation for several residents over a multi‑month period, and care plans often lacked individualized details such as facial hair preferences and behavioral approaches for residents with dementia or behavioral issues. One cognitively intact resident with lower extremity impairment and osteoporosis reported receiving only one shower since admission in January, with staff using wipes only in the diaper area and not offering bed baths or shaving assistance, despite the resident’s inability to manage facial hair. Observations over several days showed persistent upper lip and chin hair, and shower records reflected only a single shower in more than two months. Another resident with dementia, TBI, bipolar disorder, and schizophrenia, who was fully dependent for bathing and hygiene, had only one partial bed bath documented over a three‑month period. Repeated observations showed disheveled, knotted hair and long chin hair. Staff interviews indicated the resident was combative with care, required two to three staff for showers, and sometimes needed PRN medication beforehand, but there was usually only one staff member on the special care unit, making it difficult to complete showers or facial care, and behavior details were not consistently documented. Additional residents who were dependent or required maximal assistance for bathing and dressing also did not receive showers as planned or preferred. One cognitively intact resident dependent for bathing had no ADL assistance needs documented in the care plan; this resident’s room and person had a strong sour body odor, and the resident reported not getting enough showers, with weeks between some showers and never receiving the expected twice‑weekly showers. Another cognitively intact resident dependent for bathing and dressing had only two showers documented over nearly three months and was repeatedly observed with several white chin hairs, stating it had been a while since the last shower and that shaving usually occurred during showers. A resident with dementia, TBI, and physical impairments, fully dependent for bathing and hygiene, had only two showers documented over a similar period and was repeatedly observed with disheveled hair, the same clothing, and facial hair about 0.5 inches long, reporting a preference to be clean shaven but not having been shaved due to lack of showers. Further, a cognitively intact resident requiring maximal assistance for bathing and lower body dressing, and who occasionally rejected care, had a care plan specifying at least one shower per week, yet records showed a refused shower followed by a gap of several weeks before the next shower, and the resident reported being “lucky” to get one shower a week and sometimes going at least two weeks without one. Observations noted strong urine odor in the room and on the resident, and oily, clumped hair. Another cognitively intact, fully incontinent resident requiring extensive assistance for bathing and dressing had only two showers per month documented over three months and reported not having had a shower in about a month, with a recent request for a shower not fulfilled, leading the resident to perform self‑bed baths. Multiple CNAs, a CMT, an RN, the DON, and the administrator acknowledged that residents were not receiving scheduled showers, citing chronic staffing shortages, lack of dedicated shower aides, and missed showers for weeks at a time, with staff reporting residents going up to 16 days or more without showers and noticing body odors in the halls. Across these cases, care plans often omitted specific grooming preferences such as facial hair management and did not consistently address behavioral approaches for residents who resisted care. Shower sheets and documentation showed infrequent showers, missed weekly showers, and limited recording of refusals or interventions. Staff interviews consistently described inadequate staffing, absence of assigned shower staff, and difficulty providing showers and hygiene care, particularly on the special care unit and on shifts with only one aide. Residents’ own reports and repeated surveyor observations of body odor, urine odor, disheveled hair, oily hair, unchanged clothing, and unshaven facial hair corroborated that ADL assistance with bathing, personal hygiene, and grooming was not being provided as required for multiple residents who were dependent on staff for these services.
Failure to Follow Wound Care Orders and Heel Offloading Interventions Resulting in Pressure Injury
Penalty
Summary
Facility staff failed to ensure physician‑ordered wound care was consistently documented and provided for one resident with an existing pressure ulcer and failed to implement ordered pressure‑relief interventions for another resident, resulting in a new in‑house pressure injury. For the first resident, the admission MDS documented existing pressure injury risk, including a scar over a bony prominence, at least one unhealed pressure injury, and a Stage 1 pressure injury, with orders for nonsurgical dressings and topical treatments. The care plan identified a Stage 3 sacral pressure ulcer and directed staff to administer treatments as ordered and monitor for effectiveness. The physician’s orders specified daily sacral wound care on the day shift, including cleansing with wound cleanser, patting dry, applying skin prep to the peri‑wound, fitting calcium alginate to the wound bed, and covering with a bordered gauze dressing. Review of the Treatment Administration Records (TARs) for this resident showed multiple dates where the ordered sacral wound treatment was not documented as given. In March, there was no documentation of treatment on two specific dates, and in April, there were additional missed entries on several dates. The report does not state that the treatment was provided but simply not recorded; it only establishes that staff did not document that the ordered wound care was administered on those days, despite the resident’s identified risk and existing Stage 3 sacral ulcer. For the second resident, the Quarterly MDS documented severe cognitive impairment, bilateral lower extremity ROM issues, total dependence on staff for bed mobility and transfers, and risk for pressure injuries, with a turning/repositioning program in place. The care plan and physician orders required weekly skin assessments, that the resident be laid down after meals if agreeable, and that heel protectors and positioning wedges be used for turning and repositioning. The MAR showed nurses signed that the resident was laid down after meals with heel protectors on for some days, but one day’s after‑breakfast and after‑lunch entries were not signed. Multiple observations over several days showed the resident sitting in a mechanical chair with heels pressed firmly against a depressed footrest, without shoes and without heel protectors, which were seen in the corner of the room instead of on the resident. Continuous observation on one morning showed the resident remained in the same position without turning or repositioning by staff. A subsequent weekly skin assessment documented a new, in‑house acquired Stage 1 pressure injury on the right heel, with non‑blanchable erythema and intact surrounding tissue. Interviews with CNAs and an RN revealed they were unaware of the orders to lay the resident down between meals and to use heel protectors, and they reported that heel protectors had not been used for approximately a year, despite the existing orders and documentation on the MAR.
Failure to Perform Hand Hygiene in Kitchen During Meal Service
Penalty
Summary
Facility staff failed to perform proper hand hygiene in the kitchen during meal service, as observed on multiple occasions. Staff were seen applying gloves, handling food, wiping counters, removing dirty gloves, touching the trash can lid with bare hands, and then donning new gloves without washing their hands in between these activities. These actions were in direct violation of the facility's policy, which requires handwashing whenever entering or re-entering the kitchen, before contact with food surfaces, after handling soiled utensils or equipment, after activities that contaminate the hands, and after glove removal. Staff interviews confirmed awareness of these requirements, yet staff admitted to not following them due to being behind, feeling stressed, or having no specific reason. The Dietary Manager and administrator both acknowledged that staff are expected to wash their hands at the required times and that the Dietary Manager is responsible for ensuring compliance. Despite this, staff were observed repeatedly failing to perform hand hygiene between glove changes, after touching the trash can lid, and when moving between tasks, which could lead to cross-contamination. The facility census at the time was 41 residents.
Failure to Maintain RN Coverage
Penalty
Summary
The facility failed to provide the services of a Registered Nurse (RN) for at least eight consecutive hours per day, seven days a week, as required. The facility's RN staff schedule and payroll details for June, July, and August 2024 revealed multiple dates where no RN was present in the building. Specifically, there was no RN coverage on several weekends and holidays, including dates in early June, July 4th and 5th, and early August. The facility census at the time was 41, indicating a significant oversight in staffing requirements. Interviews with the Director of Nursing (DON) and the administrator highlighted the facility's reliance on the DON to cover shifts when no RN was available. The DON mentioned that they would cover shifts unless on vacation, while the administrator noted that the DON was on call every other weekend and served as a backup. The administrator also mentioned that scheduling was done a month in advance, but unforeseen events like call-ins or no-shows were managed through a messaging system. Despite these measures, the administrator believed the DON covered the missed shifts, attributing the absence of RN coverage to the other RN's recent surgery.
Medication Storage and Management Deficiencies
Penalty
Summary
The facility staff failed to properly manage and store medications, leading to several deficiencies. Observations revealed expired medications, specifically four bottles of Vitamin D with an expiration date of 5/24, were found in the medication storage cabinet. Interviews with various staff members, including Certified Medication Technicians (CMTs), Licensed Practical Nurses (LPNs), the Assistant Director of Nursing (ADON), and the Director of Nursing (DON), indicated a lack of awareness and responsibility for checking and discarding expired medications. The facility's policy requires that discontinued, outdated, or deteriorated drugs be returned to the pharmacy or destroyed, but this was not adhered to. Additionally, the facility failed to ensure medications were stored safely and effectively, as evidenced by the presence of loose pills in two medication carts. Observations noted loose pills of various colors and shapes in the [NAME] Way hall and Yadkin Lane hall medication carts. Interviews with CMTs and LPNs revealed that while it is the CMTs' responsibility to check for loose pills, there was no consistent schedule for these checks, leading to the oversight. The DON and Administrator were also unaware of the issue, despite the expectation that CMTs maintain the carts and check for loose pills regularly. Furthermore, the medication room refrigerator contained non-medication items such as lemon juice, energy drinks, cream soda, pudding, fruit dessert, and water, which is against the facility's policy. The policy states that medications requiring refrigeration should be stored separately from food to prevent cross-contamination. Interviews with staff, including CMTs, LPNs, the ADON, the DON, and the Administrator, showed a lack of awareness and adherence to this policy. The presence of food and drinks in the medication refrigerator was not known to the staff responsible for maintaining it, indicating a failure in monitoring and enforcing the facility's storage policies.
Food Safety and Sanitization Deficiencies
Penalty
Summary
The facility staff failed to maintain proper storage and serving temperatures for food, which could lead to foodborne illnesses. The refrigerator temperature logs showed multiple instances where temperatures exceeded the maximum allowable limit of 41 degrees Fahrenheit, with no corrective actions documented. Observations confirmed that the walk-in refrigerator consistently displayed temperatures above the safe threshold, and staff interviews revealed a lack of awareness and communication regarding the issue. The Dietary Manager was unaware of the high temperatures, and maintenance was not informed due to the absence of a work order. Additionally, the facility staff did not ensure that food items on the cold table were kept at safe temperatures. Observations showed that the temperatures of milk and pudding were above the recommended 41 degrees Fahrenheit, and these items were served to residents. The Dietary Aide responsible for checking these temperatures was new and still learning the procedures, while the Dietary Manager acknowledged the responsibility of aides to monitor and maintain correct temperatures. The facility's sanitization practices were also inadequate, as kitchen wares were not fully submerged in the sanitizer solution as required. Observations showed that items like a food processor bowl, pot, and steam table pan were not completely immersed in the sanitizer, contrary to the facility's policy and the manufacturer's instructions. Staff interviews indicated a misunderstanding of the proper sanitization process, with the Dietary Manager unaware of the non-compliance.
Inadequate Infection Control Practices
Penalty
Summary
The facility staff failed to adhere to proper infection control procedures, as evidenced by multiple observations of inadequate hand hygiene and glove use during resident care. In one instance, an LPN did not wash or sanitize hands between glove changes while providing catheter and wound care to a resident with pressure ulcers. The LPN acknowledged the oversight, attributing it to nervousness, which could potentially lead to cross-contamination and infection. Another incident involved a CNA who did not change gloves or wash hands between performing perineal care and other tasks for a resident with moderate cognitive impairment and frequent incontinence. The CNA admitted to not following proper procedures due to nervousness. Both the Director of Nursing and the facility administrator confirmed that staff are expected to wash or sanitize hands between glove changes to prevent infection. Additionally, a CMT was observed not following proper procedures during blood glucose monitoring for two residents with diabetes. The CMT handled used test strips with soiled gloves and touched clean surfaces without removing gloves or performing hand hygiene. The CMT acknowledged the mistake, and both the DON and administrator emphasized the importance of proper glove use and hand hygiene to prevent contamination and infection.
Failure to Update Care Plans for Catheters and Falls
Penalty
Summary
The facility staff failed to document and update care plans for two residents regarding their use of catheters. Resident #19, who was assessed with moderate cognitive impairment and dependency on toileting, had an indwelling catheter that was not documented in the care plan dated 07/16/24. Similarly, Resident #22, who was cognitively intact and independent in toileting, also had a catheter that was not documented in the care plan. Observations on multiple dates confirmed the presence of the catheter, yet it was not reflected in the care plans. Additionally, the facility staff did not update the care plan for Resident #11 after a fall. The resident, who had severe cognitive impairment and used a wheelchair for mobility, was found on the floor on 07/30/24. However, the care plan dated 05/21/24 did not include documentation of this fall or any updated fall interventions. Interviews with the Care Plan Coordinator, Director of Nursing, and the administrator revealed that while fall interventions are discussed in weekly IDT meetings, the responsibility for updating care plans was not clearly defined, leading to these omissions.
Inadequate Access to Resident Funds on Weekends
Penalty
Summary
The facility failed to ensure that residents had appropriate access to their trust fund accounts during weekends, affecting three residents out of twelve sampled. The facility did not provide a policy for resident funds, which contributed to the issue. Resident #19, assessed with moderate cognitive impairment, expressed frustration about not being able to access money on weekends, feeling that it was unfair as it was their own money. Resident #22, who was cognitively intact, mentioned the inconvenience of having to request money on Fridays to have cash for the weekend. Similarly, Resident #37, also cognitively intact, reported that if they did not access money by Friday afternoon, they would not have any for the weekend. Interviews with facility staff revealed a lack of awareness and procedures for providing residents access to their funds on weekends. An LPN was unsure of the protocol if a resident requested money on weekends, while the Business Office staff stated they were only available Monday through Friday and were unaware of the need for weekend access. The Director of Nursing confirmed that access was only available during weekdays and was unsure of the weekend protocol. The administrator mentioned that residents were encouraged to withdraw extra money on Fridays and could call him if they needed money on weekends, but this was not a formalized process.
Deficiency in Water Management Program for Legionella Control
Penalty
Summary
The deficiency identified in the report pertains to the facility's failure to develop and implement complete policies and procedures for the inspection, testing, and maintenance of the water systems to prevent the growth of waterborne pathogens, specifically Legionella bacteria. This deficiency was highlighted following a positive Legionella test result for one resident on 02/20/24. The facility's water management program lacked documentation of specified testing protocols, responsible staff for testing, and acceptable ranges for control measures, despite having identified risk areas and control measures for those areas. The facility's water inspection and testing records revealed instances of poorly controlled Legionella growth in water samples, indicating a lapse in monitoring and mitigation efforts. Observations during a facility tour on 03/01/24 revealed signs posted to notify occupants not to use the water due to Legionella presence, with water fixtures turned off except for two fountains. The facility's water management team quarterly meeting minutes did not document corrective actions for identified Legionella growth in water samples, and the facility was recommended to engage a water management company to update the water management plan. Interviews with the administrator and maintenance director revealed gaps in knowledge regarding acceptable chlorine levels, testing protocols, and corrective actions following positive Legionella results.
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Illustrative
What surveyors actually found near you
We read the 30 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
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Illustrative
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Nursing homes near Steelville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Cuba Manor Inc | 7.3 mi | ★★★★★ | 0 | 0 |
| St James Living Center | 14 mi | ★★★★★ | 10 | 0 |
| Meramec Nursing | 18.7 mi | ★★★★★ | 1 | 0 |
| Life Care Center Of Sullivan | 19 mi | ★★★★★ | 1 | 0 |
| Aurora Health And Rehabilitation | 21.1 mi | ★★★★★ | 10 | 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 July 2026) and official state health department websites.