Avenir At Mark Twain
AVENIR AT MARK TWAIN in BRIDGETON, MO — inspection on August 20, 2025.
Found 6 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Review of the
within the resident's reach.
Ensure the resident's call light is within reach for the resident to use in
ago a member of the night shift, CNA P, got into a power struggle with him/her over the call light.
The resident said CNA P attempted to pull the call light away from him/her in order to prevent him/her from using it for the rest of the night.
The resident said the staff member told him/her this would prevent the resident from pressing it all night and bothering staff on the hall.
The resident said he/she felt disrespected by the staff member during that interaction, and these undignified interactions happen with other staff members as well.
During an interview on 8/18/25 at 8:39 A.M., the Administrator said the resident came to his office on 8/17/25 to discuss the alleged incident with CNA P.
The resident was assessed and found without injury.
The resident did not allege abuse occurred and did not state he/she was in pain but felt the treatment given to him/her by CNA P was undignified. CNA P was removed from the future schedule at that time while the facility investigated the incident.
The Administrator had not been able to successfully contact CNA P to discuss the alleged incident. 2588074 25793742572384161199516119822591662
265236 08/20/2025
Avenir at Mark Twain 11988 Mark Twain Lane Bridgeton, MO 63044
Review of Resident #68's medical record showed diagnoses that included stroke, high blood pressure, edema (swelling), breast cancer, cardiomegaly (weakened and enlarged heart), atrial fibrillation, and lumbar (lower back) radiculopathy (nerve irritation or compression that causes pain).
Review of the resident's request transportation forms showed:-On 5/15/25, primary care doctor appointment;-On 5/20/25, eye doctor appointment;-On 6/13/25, pain management doctor appointment;-On 6/17/25, neurology (brain and nervous system) doctor appointment;-On 7/10/25, pain management doctor appointment.
Review of the resident's progress notes showed:-On 5/15/25, no documentation related to the primary care doctor's appointment;-On 5/20/25, no documentation related to the eye doctor's appointment;-On 6/13/25, no documentation related to the pain management doctor's appointment;-On 6/17/25, no documentation related to the neurology doctor's appointment;-On 7/10/25, no documentation related to the pain management doctor's appointment.
During an interview on 8/19/25 at approximately at 10:15 A.M., the resident said he/she has many doctor appointments due to his/her many medical conditions.
Some of his/her appointments are missed due to transportation delays. 5.
During an interview on 8/19/25 at 9:25 A.M., LPN J said when the residents go out to any appointments, there should be a note that the resident left for the appointment and when the resident returned.
The return note should contain the condition of the resident, any information the resident said about the appointment and any new orders related to the appointment and when the next appointment is scheduled; all that information should be documented in the progress notes. 6.
During an interview on 8/20/25 at 1:27 P.M., the Administrator and DON said a progress note is expected to be added every time the resident leaves for an appointment and when they return.
The notes are expected to include when the resident left and where they were going.
When the resident returns, a note is expected to include what time the resident returned and if there are any new recommendations, orders or appointments that need to be added to the resident's medical record. If the resident does not go to the appointment a note is expected to be added related to the missed appointment. 1611982
265236 08/20/2025
Avenir at Mark Twain 11988 Mark Twain Lane Bridgeton, MO 63044
Review of Resident #28's admission
hemiparesis (muscle weakness or partial paralysis) affecting the dominant right side, diabetes, and acute kidney failure.
Review of the resident's care plan, in use at the time of the survey, showed:-Focus: Resident has an ADL self-care performance deficit;-Goal: The resident will maintain current level of function through the next review date;-No interventions for eating assistance listed.
Observation on 8/18/25 at 8:40 A.M., showed the resident in the dining room for breakfast.
The resident struggled to open a carton of juice with one hand. He/She poked a hole in the seal with a finger in order to open his/her drink.
During an interview on 8/18/25 at 9:52 A.M., the resident said no staff ever help him/her in the dining room.
Observations on 8/19/25 during lunch, showed:-At 12:30 P.M., while in the dining room for lunch, the resident picked up his/her napkin and his/her fork fell on the ground;-At 1:10 P.M., the resident started to eat his/her pasta with his/her hands.
During an interview on 8/20/25 at 7:48 A.M., CNA M said he/she would expect staff to assist the resident with any needs he/she might have during meals.
The resident is someone who needs help due to low mobility in his/her right arm.
During an interview on 8/20/25 at 8:01 A.M., RN C said he/she would expect staff to assist the resident during meals with opening drinks and positioning the resident's wheelchair up to the table. He/She would expect the resident's care plan to reflect his/her ADL needs.
During an interview on 8/19/25 at 12:46 P.M., the DON said she would expect all staff in the dining room for meals to assist residents with opening drinks and bringing residents new silverware.
She would expect nursing staff to inform her if residents are having a hard time feeding themselves so the residents can be evaluated for ADL care needs. 25880741612001
265236 08/20/2025
Avenir at Mark Twain 11988 Mark Twain Lane Bridgeton, MO 63044
Observation on 8/18/25 at 8:46 A.M., showed the resident in bed with a tray of breakfast on
get served enough to eat. He/She is upset, tired and hungry. 7.
Review of Resident #54's medical
depression.
During an interview on 8/14/2025 at 12:03 P.M., the resident said the food is horrible.
He/She said food temperatures are cold when food is delivered. He/She said two months ago, the kitchen served raw meat to the residents. 8.
Review of Resident #60's comprehensive MDS, dated [DATE], showed:-Moderate cognitive impairment;-Setup or clean-up assistance required for eating;-Diagnoses included diabetes, adult failure to thrive, heart disease, chronic obstructive pulmonary disease (lung disease) and dementia.
Observation on 8/18/25 at 8:47 A.M., showed the resident eating breakfast in his/her room.
Breakfast consisted of one donut and one scoop of scrambled eggs. No dietary slip was on the tray.
During an interview, the resident said his/her breakfast was not good.
The donut was not sweet and it was dry.
The food served at the facility does not taste good. It is always served cold when it should be hot. 9.
Review of Resident #64's quarterly MDS, dated [DATE], showed:-Cognitively intact;-Diagnosis included type two diabetes, muscle weakness and major depressive disorder.
During an interview on 8/14/2025 at 1:48 P.M., the resident said the food is awful.
The coffee is not hot when served.
Staff do not offer refills. 10.
Review of Resident #68's quarterly MDS, dated [DATE], showed:-The resident is cognitively intact;-Diagnoses include stroke, high blood pressure and heart failure.
During an interview on 8/14/25 at 5:58 P.M., the resident said he/she does not eat the food in the facility.
The food does not look appetizing, and it is often cold.
The food is not nutritious and does not provide the 5 food groups.
The resident's family brings in meals for him/her every day. 11.
Observation on 8/14/25 at 5:37 P.M., of dinner on the [NAME] hallway, showed:-Baked beans measured 103.2 degrees F;-Barbeque (BBQ) burger measured 92.3 degrees F.
The meat was chewy.
Observation on 8/14/25 at 5:53 P.M., of dinner on the East hallway, showed:-BBQ burger measured 95.6 degrees F.
The meat was bland and chewy. 12.
During a group interview on 8/18/25 at 11:03 A.M., six out of six residents, whom the facility identified as alert and oriented, said there are ongoing issues with dietary.
Food that is supposed to be hot is served cold.
Food is served that is not cooked all the way through.
They have discussed this in resident council meetings and the dietary issues have continued.
During an interview on 8/14/25 at 11:43 A.M., CNA B said the food served at the facility is terrible, not good.
The residents don't like the food and won't eat it.
The portions are small and residents do not get enough to eat.
The food is always served cold when it should be hot.
During an interview on 8/19/25 at 1:03 P.M., Dietary Aide F said food should be served at a safe and palatable temperature and should taste good.
During an interview on 8/19/25 at 12:44 P.M., the Dietary Manager said food should be delivered to residents at a safe and palatable temperature to prevent illness.
She said the food has not been served at the required temperature due to broken kitchen appliances not warming the food.
During an interview on 8/20/2025 at 2:12 P.M., the Administrator and Director of Nursing (DON) said they expected food to be served to residents at a safe and palatable temperature.
They expected food to be palatable.
They expected staff to heat up food if it is not at the appropriate temperature. 161200116119951611992
265236 08/20/2025
Avenir at Mark Twain 11988 Mark Twain Lane Bridgeton, MO 63044
During an interview on 8/19/25 at 1:56 P.M., the DM she would expect for all items on the alternate menu to be available for the residents.
She would expect all alternate menu requests made by residents to be respected.
During an interview on 8/20/25 at 10:08 A.M., the DM said dietary staff should refer to dietary slips when plating food for residents.
Dietary slips show if the resident has allergies.
Ideally, the slips should include the resident's likes/dislikes.
Currently, the slips to not include this information.
She does not have access to print the dietary slips at this time.
The kitchen is out of hot dogs and tuna.
They have cream of chicken soup, but no other soups.
The kitchen should be stocked with all items that are available on the alternate menu. At this time, the DM is unable to place food orders.
Food orders are currently placed by an outside company that is contracted to provide dietician services.
The outside company sticks to a budget and only orders the items listed on each recipe for meals on the planned menu.
The outside company is not ordering extra items for alternate meals. 16.
During an interview with the Director of Nurses (DON) and Administrator on 8/20/25 at 1:48 P.M., they said they expected menus to be posted daily.
Dietary staff should be sending dietary slips out with trays during meals.
The DM has access to the dietary slips, and she should print them out at meals.
Dietary slips should show the resident's name, room number, diet type, and other information, such as allergies and likes/dislikes.
Dietary staff should follow the dietary slips when plating food.
Nursing should check the dietary slips and make sure the correct items are there before delivering to the resident.
The DM should complete assessments with each resident to determine their likes/dislikes.
Dietary should have all items available that are listed on the alternate menu.
Traditionally, the DM places food orders but since she is new, food orders are placed by an outside company contracted by the facility for dietician services.
Residents have the right to ask for and receive alternative meal options. 16119952588074
265236 08/20/2025
Avenir at Mark Twain 11988 Mark Twain Lane Bridgeton, MO 63044
Review of CNA E's CNA Annual In-Service Training Log, showed:-Inservices completed each month from January 2025 to June 2025, with each inservice totaling one hour;-No record of inservices completed prior to January 2025. 2.
Review of CNA Z's CNA Annual In-Service Training Log, showed:-Inservices completed each month from January 2025 to June 2025, with each inservice totaling one hour;-No record of inservices completed prior to January 2025. 3.
Review of CNA AA's CNA Annual In-Service Training Log, showed:-No record of inservices completed for the past year, from hire date to hire date, while employed at the facility. 4.
Review of CNA BB's CNA Annual In-Service Training Log, showed:-No record of inservices completed for the past year, from hire date to hire date, while employed at the facility. 5.
Review of CNA CC's CNA Annual In-Service Training Log, showed:-No record of inservices completed for the past year, from hire date to hire date, while employed at the facility. 6.
Review of CNA DD's CNA Annual In-Service Training Log, showed:-No record of inservices completed for the past year, from hire date to hire date, while employed at the facility. 7.
During an interview on 8/19/25 at 8:52 A.M., the Director of Nursing (DON) said she was unable to find annual education logs for four of the six sampled CNAs and does not have access to any annual trainings completed by employees prior to January, 2025.
The DON said the previous administration walked out of the building with numerous documents and believes CNA trainings may have been among them.
Ensuring annual education is completed by CNAs is the responsibility of the DON, and all CNAs at the facility should receive 12 hours of education annually per regulation guidelines.8.
During an interview on 8/20/25 at 1:48 P.M the Administrator and DON said they expected all CNAs at the facility to receive 12 hours of ongoing education annually per regulation guidelines. It is believed the previous DON took inservice records and education documentation with them when resigning from the position.
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.