Lutheran Senior Services At Meramec Bluffs

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Note: The nursing home is disputing this citation.

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Based on observation, interview and record review, the facility failed to notify Next of Kin (NOK) of a resident fall for one resident (Resident #1). The sample size was three. The census was 67. Review of the facility's Event Reporting Policy, revised 7/29/21, showed: -Policy statement: Event reporting is essential to providing resident and client care. Events involving a resident, visitor, or other person (non-employee) that are outside of usual or normal happenings and present a potential liability, and events that are not in keeping with standards, policies, procedures or practices and may have an adverse outcome will be documented. The documentation of an event and its investigation, outside of what is documented in the medical chart, is confidential. Applicable authorities will be notified as appropriate. -A fall is an unintentional coming to rest on the ground, floor, or other lower level but not the result of an overwhelming external force (e.g. resident pushes another resident). An episode where a resident lost his/her balance and would have fallen, if not for staff intervention. Is considered a fall. A fall without injury is still a fall. Unless there is evidence suggesting otherwise, when a patient or resident is found on the floor, and there is no witness to account for the event. -Procedures: Resident's physician shall be informed of any event concerning the physical care and wellbeing of the resident. Family or power of attorney (POA) shall be informed of all events defined in this policy. Review of Resident #1's electronic medical record (EMR), showed diagnoses included late onset Alzheimer's dementia with other behavior disturbances, short term memory loss, status post right femur fracture surgery 12/17/25, weight bearing as tolerated, fall, and muscle weakness. Review of a video tape, dated 12/21/25 at 10:34 P.M., showed Resident #1 sat on the floor next to bed, with his/her left arm resting on top of the bed. Certified Nursing Assistant (CNA) A approached resident and said, Oh he/she is on the floor. Did you hit your head? How did you fall out. Review of the resident's progress notes, showed no documentation of a fall on 12/21/25 and not documentation the physician and NOK were notified. During an interview on 12/23/25 at 1:48 P.M., CNA A said, he/she discovered the resident with their elbows resting on the bed and buttocks off the floor. He/She told the resident to sit down onto the floor so he/she can get him/her up. He/she does not consider it a fall and did not report it as a fall. During an

interview on 12/23/25 at 2:01 P.M., CNA B said CNA A followed him/her into the resident's room and discovered the resident sitting on the floor next to their bed. The resident denied falling. CNA B said he/she does not consider this a fall, just a slide off the bed. He/she does not know if a report was completed.

During an interview on 12/23/25 at 3:15 P.M., the Director of Nursing (DON) and Executive Director (ED) said they would consider a resident sliding off the bed onto the floor and a resident holding themselves up by their elbows off the floor as a fall and should be reported. When a fall/incident happens, the physician is notified along with the NOK, and the DON or Administrator. 2698306

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Lutheran Senior Services at Meramec Bluffs

50 Meramec Trails Drive Ballwin, MO 63021

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689

(DON) and Executive Director (ED) said they would expect staff to use a gait belt when transferring a resident from the floor to the wheelchair after a fall. 2698306

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Note: The nursing home is disputing this citation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet