South Hampton Place

F 0689 Level of Harm - Actual harm Residents Affected - Few

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

He/She said he/she did not recall if he/she cared if a staff member was in the shower room with him/her prior to the fall in the shower room.During an interview on 09/22/25 at 12:08 P.M., Certified Nurse Aide (CNA) G said the resident refused to allow anyone in the shower with him/her, so staff did not stay in the shower room or monitor the resident while the resident showered. He/She said he/she was in-serviced after

the resident fell to remain in the shower room while the resident showered. During an interview on 09/22/25 at 12:20 PM, Registered Nurse (RN) D said the resident was not independent with showers and should have been supervised during showers. He/She said he/she did not know staff left the resident unattended

during showers. During an interview on 09/22/25 at 1:08 P.M., the administrator said the resident was a private and independent person, so there was not a staff member constantly present in the shower room with him/her. He/She said staff were following his/her request to have privacy while in the shower room.

He/She said staff did periodically check on the resident while he/she was in the shower room. He/She said staff thought standing outside the door was protective oversight. The administrator said the resident will now be supervised while in the shower.During an interview on 09/22/25 at 1:09 P.M., the Director of Nursing (DON) said the resident preferred to have privacy while in the shower, so staff left him/her unattended while in the shower room. The DON said the resident told him/her, he/she did not want staff in

the shower room with him/her. He/She said staff did check on the resident while in the shower room and

they stood outside the closed door while he/she showered, so he/she believed staff were providing protective oversight. He/She said the resident will now be supervised during showers. 3. Review of Resident #4's admission Sheet, dated 09/17/25, showed the resident admitted to the facility on [DATE REDACTED].Review of the resident's care plan, dated 09/22/25, showed the resident required assistance from two staff members for toileting. Review showed the care plan did not contain direction for staff to use a gait belt during transfers.Observation on 09/22/25 at 11:18 A.M., Certified Nurse Aide (CNA) E and Nurse Aide (NA) F entered the resident's room to provide toileting assistance. Observation showed the resident wanted

the bathroom door closed, when CNA E and NA F opened the door, the resident sat on the toilet without a gait belt around his/her waist.During an interview on 11:21 A.M., CNA E said the resident required two staff members to transfer the resident to the toilet. He/She said he/she did not use a gait belt when he/she transferred the resident and staff were not required to use a gait belt to transfer him/her. During an interview

on 09/22/25 at 1:08 P.M., the administrator said the resident required assistance from two staff members

during transfers and staff should have used a gait belt. He/She said the concern with not using a gait belt was the potential for injury. He/She said he/she did not know the staff did not use a gait belt while transferring the resident.During an interview on 09/22/25 at 1:09 P.M., the DON said staff are required to use two members to transfer the resident and to utilize a gait belt during the transfer to prevent potential injury. He/She said he/she did not know staff did not use a gait belt when transferring the resident.Complaint #2622664

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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

11/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

South Hampton Place

4700 Brandon Woods Columbia, MO 65203

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 0728 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training.

Based on interview and record review, facility staff failed to ensure two Nurse Aides (NA)'s (NA B and NA C) out of three sampled NAs completed the required nurse aide training program within four months of employment in the facility. The facility census was 69.1. Review showed the facility did not provide a policy

in regard to requirements for NA's training program completion within four months of employment. 2.

Review of NA B's personnel file showed a hire date of 04/08/25. The file did not contain documentation the NA completed the required nurse aide training program. 3. Review of NA B's personnel file showed a hire date of 04/14/25. The file did not contain documentation the NA completed the required nurse aide training program.During an interview on 09/22/25 at 10:56 A.M., Registered Nurse A said he/she was responsible to conduct the nurse aide training courses. He/She said nurse aides are required to be certified within three months. He/She said there was a period when the facility was not permitted to provide nurse aide training classes, since the facility lost their license from April until August. RN A said he/she did not know if the administration reached out to find other available classes. He/She said he/she met with the Director of Nursing (DON) weekly to discuss the status of each nurse aide in the program, but did not meet during the timeframe when the facility did not offer classes. He/She said the DON was responsible to ensure nurse aides were certified within the three months.During an interview on 09/22/25 at 12:20 P.M., RN D said NA's are required to be certified within three months of working at the facility. He/She the NA's are not allowed to work the floor after the three months if he/she was not certified.During an interview on 09/22/25 at 1:08 P.M. the administrator said NA's are required to be certified within one hundred and twenty days from the first date of employment. He/She said RN A conducts the classes and training and then discuss the status of the NA's with the DON. He/She said the facility did not provide classes from April to June, but he/she did not know what the facility was doing for the NA's during that time since he/she did not work at the facility.

He/She said NA B and NA C were not certified, but still providing direct care after the one-hundred-and-twenty-day period. He/She said he/she did not know the staff were not certified but should not have been providing care until they were certified.During an interview on 09/22/25 at 1:09 P.M.

the DON said NA's are required to be certified within one hundred and twenty days from the first day of employment. The DON said he/she met with RN A to go over the start dates and classes. The DON said he/she and RN A are responsible to ensure staff are certified, but there have been issues with classes.

He/She said the facility was not able to conduct classes for about three weeks. He/She said the corporate office was supposed to get the NA's signed into courses at a different location. He/She said NA B and NA C were not certified but were providing direct care after the one hundred and twenty days of employment.

He/She said he/she should not have been providing care for the residents when they were not certified

after one hundred and twenty days. He/She said he/she was looking at terminating the NA's for not attending classes.Complaint #2615926

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Facility ID:

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