Avenir at Mark Twain: Diet Safety Failures Found - MO
What remained in the kitchen was a single set of printed slips from whenever that manager walked out. No updates. No current information. Staff plating meals were working off recipes and, in some cases, their own memory of what individual residents preferred.
Federal inspectors arrived on August 20, 2025, and found the problem still unresolved.
A kitchen staff member told inspectors that without the dietary slips, staff have no reliable way to know what belongs on any given resident's tray — unless they've worked there long enough to learn it themselves. If a resident is allergic to eggs, the expectation is that staff would substitute meat or cold cereal. That substitution depends on staff knowing about the allergy in the first place.
The new dietary manager, who had taken over after the previous one left, told inspectors she does not currently have access to print dietary slips. She knows they're needed. She said dietary staff should be consulting those slips every time they plate a meal, and that ideally the slips would include not just allergy information but each resident's likes and dislikes. Right now, they include neither.
The alternate menu problem runs alongside the missing records, and in some ways it's simpler: the kitchen is out of food it's supposed to have.
Hot dogs, listed on the alternate menu as an option for residents who don't want what's being served, are gone. Tuna is gone. The facility has cream of chicken soup, but no other soups. The new dietary manager said plainly that the kitchen should be stocked with every item on the alternate menu. It isn't.
The reason, she explained, is structural. Traditionally the dietary manager places food orders. Because she is new, that responsibility has shifted to an outside company contracted by the facility to provide dietician services. That company, she said, sticks to a budget and orders only what's needed for the planned menu. It is not ordering extra items for alternate meals. Nobody at the outside company is ensuring that a resident who doesn't want the scheduled entrée has a real alternative available.
Cream of chicken soup, the dietary manager noted, is not a meal.
The Director of Nurses and the Administrator told inspectors on the afternoon of August 20 that they expected menus to be posted daily and dietary slips to go out with every tray. They said the dietary manager has access to the slips and should be printing them. They said nursing staff should be checking trays against the slips before delivering them to residents. They said the dietary manager should be completing assessments with each resident to learn their preferences. They said the kitchen should have everything on the alternate menu in stock.
None of that was happening.
The gap between what the Administrator and DON described as standard practice and what inspectors actually found in the kitchen is the core of this inspection. Leadership articulated a system that functions. The system is not functioning. The outside contractor is ordering to a budget. The dietary slips aren't being printed. The alternate menu items aren't on the shelves. A resident who is allergic to eggs and doesn't want cold cereal for breakfast has limited options, and the staff member plating that tray may not know about the allergy at all.
Inspectors rated the level of harm as minimal or potential for actual harm, with some residents affected.
What that means in practice: a resident with a food allergy sits in their room waiting for a meal, and somewhere in the kitchen, a staff member is plating food without a slip that would tell them what that resident cannot eat.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Avenir At Mark Twain from 2025-08-20 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
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Last verified: October 16, 2026 · Our methodology
AVENIR AT MARK TWAIN in BRIDGETON, MO was cited for violations during a health inspection on August 20, 2025.
What remained in the kitchen was a single set of printed slips from whenever that manager walked out.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.