Estates of St. Louis: Hepatitis C Labs Ignored - MO
The inspection, a complaint survey completed this fall, documented a single citation for professional standards of care. The level of harm was listed as minimal or potential. But the details behind that citation describe a system where orders could be written, entered into the record, and then simply disappear — with no one accountable for making sure they were carried out.
The resident's chart showed only two lab draws on file. Inspectors found that orders from an ARNP and a physician to check blood levels for hepatitis C had not been followed. The referral notes in the chart showed the facility had also failed to act on a previous facility's referral to send the resident to a hepatitis clinic. That referral had been sitting in the record.
When inspectors interviewed LPN E, the picture that emerged was one of genuine confusion about who was responsible for anything beyond the immediate shift. LPN E said he or she mainly worked in a different area of the facility and had only been with this resident's care for a short time. When an ARNP or physician visited, LPN E wasn't sure who was supposed to order the resulting labs. LPN E said they would only make medication or treatment changes, and would order labs only if a phone order came in during their shift for something acute. Chronic hepatitis C, LPN E acknowledged, was a condition nursing staff should know about.
LPN E offered one explanation for how things had broken down: there had been several changes in administration over the past year. During that period, LPN E believed the previous director of nursing or assistant director of nursing had been responsible for reviewing ARNP and physician orders. That assumption, it turned out, was not written down anywhere.
The current director of nursing confirmed it during her interview at 12:43 p.m. that same day. She said she was unaware the resident had not received labs per ARNP and physician orders. She was unaware the referral notes showed the facility had not followed up on sending the resident to the hepatitis clinic. She was unaware staff had failed to check labs at all.
She described the system as it was supposed to work: after an ARNP or physician completed their visit, they would give orders to the nurse they were rounding with. Some providers might enter orders themselves. The facility had no standard procedure because, she said, every ARNP and physician was different.
She said she ran a 24-hour report every morning that listed all orders and notes entered into the electronic medical records, and she reviewed it to confirm orders were completed. She also said it was the responsibility of nursing staff to review ARNP and physician notes in the system daily for every resident they were responsible for.
What she could not explain was how, under that system, a nurse had gone without reviewing progress notes or care plans and had never been responsible for ordering labs after provider visits — and how that had gone undetected. She said she was not sure how the previous administration had handled lab orders.
She also said she was unaware of updated CDC guidance from July 2023 recommending complete, automatic HCV RNA testing on all HCV antibody-reactive samples, a change designed to reduce the number of patient visits required and increase the number of people actually diagnosed and treated for hepatitis C.
The resident had hepatitis C. The orders existed. The referral from a previous facility existed. Two labs had been drawn. Everything else that was supposed to happen had not, and the gap between what the chart required and what the facility delivered had gone unnoticed through at least one full turnover of nursing leadership.
The director of nursing found out the same morning inspectors did.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Estates of St Louis, LLC, The from 2025-09-03 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: August 5, 2026 · Our methodology
ESTATES OF ST LOUIS, LLC, THE in SAINT LOUIS, MO was cited for violations during a health inspection on September 3, 2025.
The inspection, a complaint survey completed this fall, documented a single citation for professional standards of care.
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.