St Louis Altenheim

In the surveyor’s words

From the most serious findings on record at St Louis Altenheim, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF584Oct 10, 2025

  Based on observation and interview, the facility failed to provide a clean, comfortable, and homelike environment for residents when the facility failed to address a large water stain on the ceiling of one resident's room and bathroom (Resident #41). The facility also failed to ensure lights were in working order for one hallway on the 300 unit. The census was 47.1. Review of Resident #41's medical record, showed his/her diagnoses included arthritis, anxiety, depression and diabetes. Observation and interview on 10/7/25 at 11:10 A.M., showed the resident lay in bed. He/She said he/she has no concerns except for the underside of the soffit next to his/her television. […]

• No harm, potential for more than minimal, patternF684Oct 10, 2025

  Based on interview and record review, the facility staff failed to obtain treatment orders timely and thoroughly document a new skin issue for one resident (Resident # 34) found with an untreated wound. The sample was 12. The facility census was 47.Review of the facility's, Pressure Ulcer/Skin Breakdown- Clinical Protocol Policy, dated April 2018, showed:-The nursing staff and practitioner will assess and document an individual's significant risk factors for developing pressure ulcers (injury to the skin and/or underlying tissue, as a result of pressure or friction); for example, immobility, recent weight loss, and a history of pressure ulcer(s);-In addition, the nurse shall describe and document/report the following:a. […]

• No harm, potential for more than minimal, patternF689Oct 10, 2025

  Based on observation, interview and record review, the facility failed to ensure each resident receives adequate supervision and assistance to prevent accidents when staff failed to follow facility policy regarding resident alcohol storage. One resident had several bottles of drinking alcohol, four mini wine bottles and a 16 ounce (oz) open beer in his/her mini fridge (Resident #25). The census was 47. The sample was 12.Review of the facilities Alcoholic Beverages Policy revised February 2023, showed purpose: This procedure is to establish uniform guidelines concerning the administration of alcoholic beverages.-A physician's order must be received before any alcoholic beverages may be administered to a resident;-Should such an order be received, the nurse supervisor receiving the order… […]

• No harm, potential for more than minimal, patternF812Oct 10, 2025

  Based on observation, interview and record review, the facility failed to ensure two residents' personal refrigerators had routine temperature tracking (Residents #1 and #30). The facility also failed to ensure the kitchen ceiling above the food preparation station was free from dust accumulation and failed to ensure the walk- in freezer was free from ice buildup. The sample was 12. The census was 47. Review of the facility's sanitation policy, revised 11/22, showed:-Policy statement: the food service area is maintained in a clean and sanitary manner;-Policy implementation: all kitchens, kitchen areas and dining areas are kept clean, free from garbage and debris, and protected from rodents and insects. […]

• No harm, potential for more than minimal, isolatedF550Oct 10, 2025

  Based on observation, interview and record review the facility failed to provide resident(s) the right to be informed and make choices about their care, when staff failed to inform a resident with dementia of the care to be provided and stop providing care when he/she yelled stop. Staff continued to provide care and mimicked or repeated residents' words the resident said during this time (Resident #35). The sample was 12. The census was 47. Review of the facility's Resident's Right Policy, dated February 2021, showed employees shall treat all residents with kindness, respect and dignity. Federal and state laws guarantee certain basic rights to all residents of this facility. […]