Avenir at Mark Twain: CNA Training Records Missing - MO
That's what inspectors documented at Avenir at Mark Twain, a 75-bed facility in Bridgeton, following a complaint inspection completed August 20, 2025. The finding: four of six sampled certified nursing aides had no verifiable documentation showing they'd completed the 12 hours of annual training required of every CNA working in a licensed facility. The sample was drawn from 18 CNAs on staff.
The aides who care for residents every day, in a facility whose name signals a focus on dementia care, may or may not have received the training they were supposed to get. Nobody can say for certain. The records are gone.
At 8:52 in the morning on August 19, the Director of Nursing sat down with inspectors and told them she was unable to locate annual education logs for four of the six CNAs they'd asked about. She also said she had no access to any training records completed before January 2025. Her explanation: the previous administration had walked out of the facility with numerous documents, and she believed CNA training records were among them.
The phrasing matters. She believed they were among them. She did not know. That's the state of the training record system at a facility caring for 75 residents, many of them among the most vulnerable people in any nursing home population.
Two of the six aides, identified in inspection records as CNA E and CNA Z, had logs showing they'd completed one hour of in-service training each month from January through June 2025. Six hours total, for a requirement of twelve. The inspectors noted no record of any training completed before January of this year for either of them. Whether they received training before January, nobody could document.
The other four were starker. CNAs AA, BB, CC, and DD had no record of any completed in-service training for the past year, from hire date to hire date. Not a partial log. Not a gap with some entries. Nothing at all.
The Director of Nursing acknowledged to inspectors that ensuring annual education is completed by CNAs is her responsibility. She acknowledged that all CNAs at the facility should receive 12 hours of education annually. She said she expected that. She just couldn't show it.
The following afternoon, at 1:48 p.m. on August 20, the Administrator joined the Director of Nursing for a second interview. Both told inspectors they expected all CNAs to receive the required 12 hours annually. Both said they believed the previous Director of Nursing took in-service records and education documentation when resigning from the position.
Resigned and took the paperwork. That is the account the current leadership offered to explain why they cannot demonstrate that the people providing hands-on care to residents with dementia have been trained on dementia care, on abuse prevention, on the clinical and human skills that annual in-service requirements are designed to reinforce.
The inspection report does not say when the previous Director of Nursing resigned. It does not say how long the current DON has been in the role, or how long the facility has been operating under what the current leadership calls the previous administration. It does not say whether anyone attempted to reconstruct the missing records, contacted the previous DON, or asked the CNAs themselves to document what training they'd received elsewhere. What the report contains is the outcome: inspectors asked, and the facility could not provide.
The deficiency was cited at a level of minimal harm or potential for actual harm, the lower end of the harm scale. That classification reflects what inspectors could determine about consequences at the time of the inspection, not a judgment that the gap doesn't matter. CNAs are the staff members residents see most. They provide the bathing, the repositioning, the feeding assistance, the moment-to-moment physical care that defines daily life in a nursing home. In a dementia unit, they are also the people most likely to be in the room when a resident becomes frightened, agitated, or at risk of harm. The training requirement exists because that work requires skills that have to be taught and refreshed.
Whether those skills were taught at Avenir at Mark Twain, for four of the six CNAs inspectors examined, is a question the facility's own records cannot answer.
The inspection was triggered by a complaint. The report does not describe what the complaint alleged or whether it was substantiated. The training documentation failure was what inspectors found and cited.
Seventy-five residents live at Avenir at Mark Twain. The facility's name, and the framing of the violation's context in the inspection report, both point toward a population that includes people living with dementia, people who cannot always speak for themselves about the quality of care they receive, people whose safety depends on the preparation of the aides assigned to them.
The Director of Nursing told inspectors she does not have access to training records from before January 2025. That means there is a period of unknown length, covering the tenure of an unknown number of CNAs, for which the facility has no documentation of required education. The current administration's explanation is that someone took those records. The records are not there. Those are the two facts that coexist in the inspection report, and neither one changes the other.
What the facility does have, as of the inspection date, is a Director of Nursing who knows the records are missing, an Administrator who confirmed the same account, and four CNAs whose training history for the past year is entirely undocumented. For two others, the documented training runs exactly half the required length, with no record of what came before.
The inspection report ends where it began: with a gap in the paper trail and an explanation that someone walked out the door with what would have filled it.
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.
Download the official CMS inspection PDF from Medicare.gov
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.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 22, 2026 · Our methodology
AVENIR AT MARK TWAIN in BRIDGETON, MO was cited for violations during a health inspection on August 20, 2025.
That's what inspectors documented at Avenir at Mark Twain, a 75-bed facility in Bridgeton, following a complaint inspection completed August 20, 2025.
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.