St James Living Center

In the surveyor’s words

From the most serious findings on record at St James Living Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Jul 9, 2025

  Based on observation, interview, and record review, facility staff failed to ensure one resident (Resident #1) remained free from accidents when facility staff failed to remove his/her oxygen and supervise him/her while smoking to ensure his/her safety. On 7/6/25, the resident failed to remove his/her oxygen while smoking in the courtyard and caught fire to his/her nasal cannula which resulted in severe burns to his/her nares and the right side of his/her head. The facility census was 45.The administrator was notified on 7/8/25 of the Past Non-Compliance Immediate Jeopardy (IJ) which occurred on 7/6/25. Upon discovery, the administrator conducted an investigation, notified appropriate parties, and educated Housekeeper A. […]

• No harm, potential for more than minimal, widespreadF812Dec 8, 2021

  Based on observation, interview, and record review, the facility staff failed to maintain kitchen equipment, food related items, and food preparation areas in a clean and sanitary manner to prevent cross-contamination and outdated use. Facility staff also failed to allow serving containers to dry before used for food storage, cover trash cans when not in use, and to change water filters in accordance with manufacturer's instructions. The facility census was 60. 1. Review of the facility's Cleaning Schedule policy, dated May 2015, showed: - It is the responsibility of the Dining Services Manager (DSM) to enforce the cleaning schedules and to monitor the completion of assigned cleaning tasks; - Daily, weekly, and monthly cleaning schedules prepared by the DSM; - Developing cleaning… […]

• No harm, potential for more than minimal, patternF657Nov 17, 2025

  Based on observation, interview, and record review, facility staff failed to review and revise the care plan after falls for five residents (Resident #4, #5, #16, #20, and #42) out of 13 sampled residents. The facility census was 43.1. Review of the facility policy titled Care Plan Comprehensive, undated, showed an individualized comprehensive care plan that includes measurable goals and time frames will be developed to meet the resident's highest practicable physical, mental, and psychosocial well-being. The comprehensive care plan will be based on a thorough assessment that includes but is not limited to the Minimum Data Set (MDS), a federally mandated assessment tool. […]

• No harm, potential for more than minimal, patternF658Nov 17, 2025

  Based on interview, and record review, facility staff failed to document the neurological assessments (an assessment completed to determine if the nervous system is impaired) for six residents (#4, #5, #8, #16, #20, and #42) out of 13 sampled residents. Facility staff failed to complete the event documentation for four residents (Resident #4, #8, #20 and #42) out of 13 sampled after falls. The facility census was 43. 1. Review of the facility policy titled Event Investigation, undated, showed the purpose is to investigate the cause of all injuries which have not been witnessed, and to identify any injuries after a resident sustains an event. […]

• No harm, potential for more than minimal, patternF584Jul 17, 2024

  37131 Based on observation, interview and record review, facility staff failed to provide a comfortable and homelike environment for residents, when the staff failed to maintain walls, floors, windows, showers and equipment in resident rooms clean and in good repair. Facility staff failed to provide an environment free of pests. The facility census was 48. 1. Review of the facility's policy's showed the facility did not provide a policy for staff to report environmental concerns. 2. Observation on 07/14/24 at 10:00 A.M., showed the water station in front of the nurse's station between the memory care unit and 400 hall contained a dried orange/brown spot on the wall behind and above the trash can. 3. […]