Sunterra Springs Dardenne Prairie

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

catheter care, the resident said he/she had not had catheter care in several days;-The ADON and RN helped the resident come to a standing position and the ADON performed catheter care. There was no anchor securing the tubing to the resident's leg and the tubing pulled as the resident stood. The resident said he/she felt the catheter tube pulling down;-RN A said that the catheter tubing should not be on the floor, and he/she was going to call the physician about the sediment in the tubing. During an interview on 11/5/25 at 4:30 P.M. the Director of Nursing said the following:-She would expect staff to follow physician orders;-Resident #4's dressing should have been changed as ordered by the physician and Resident #5's indwelling catheter should have an anchor. 265881

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If continuation sheet

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

11/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sunterra Springs Dardenne Prairie

7275 State Highway N Dardenne Prairie, MO 63368

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

there was sediment in the tubing. The catheter bag did not have a dignity cover, the drainage bag was visible from the door. Observation on 11/5/25 at 2:35 P.M. with the ADON and RN A showed the following:-The resident sat in a wheelchair with an indwelling urinary catheter. The catheter tubing hung down and touched the floor; there was sediment in the tubing;-The ADON offered the resident catheter care, the resident said he/she had not had catheter care in several days;-The ADON and RN helped the resident come to a standing position and the ADON performed catheter care. There was no anchor securing the tubing to the resident's leg and the tubing pulled as the resident stood. The resident said he/she felt the catheter tube pulling down;-RN A said that the catheter tubing should not be on the floor, and he/she was going to call the physician about the sediment in the tubing. During an interview on 11/5/25 at 9:30 A.M. the Director of Nursing said the following:-Catheter care should be done every shift;-The indwelling catheter tubing should be anchored to the resident's leg to prevent the tubing from pulling and should be changed weekly and dated when changed;-Indwelling catheter tubing should not be on the floor and the catheter bag should be covered;-She would expect staff to provide catheter care every shift, place

a catheter tubing anchor in place and date when applied. Catheter tubing should not be on the floor.

Event ID:

Facility ID:

If continuation sheet

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

11/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sunterra Springs Dardenne Prairie

7275 State Highway N Dardenne Prairie, MO 63368

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

trash can, and with the same soiled gloves, removed a clean brief from a package of briefs and placed the brief on the resident; --Wearing the same soiled gloves CNA D then pulled the resident's pants up and assisted the resident to sit down in the wheelchair, then pushed the resident in the wheelchair to the side of

the bed, picked up the resident's call light, grabbed the resident's clothing, attached the call light to the resident's clothing, moved the resident's water pitcher, cell phone and television remote on the over the bed table all with soiled gloves; -CAN D then pick up the plastic trash can liner out of the trash can, removed his/her gloves and put them in the plastic bag and tied the bag;-Without washing his/her hands or performing hand hygiene CNA D walked out of the resident's room, tossed the bag with the soiled wipes and gloves onto the floor in the hall, and walked to the nurses station and began looking at paperwork. 4.

Review of Resident #10's face sheet showed the resident admitted to the facility on [DATE REDACTED] with diagnoses of urinary retention (the inability to completely empty the bladder), and dementia. Review of the resident's admission nurses note dated 11/4/25 showed the following:-Alert and oriented, difficulty making decisions;Had an indwelling catheter;- Incontinent of bowel. Review of the resident's care plan for indwelling catheter dated 11/4/25 showed the following:-The resident has an indwelling catheter due to urinary retention;-Catheter care every shift and as needed. Observation on 11/5/25 at 4:00 P.M. showed the following:-CNA D was in the resident's and said the resident need to have catheter care and had been incontinent of feces;-CNA D wore a pair of gloves;-CNA D wet a washcloth in the resident's bathroom sink then returned to the resident's bedside;-CAN D rolled the resident over to his/her side and with the wet washcloth removed fecal matter from the resident buttocks, then threw the soiled washcloth on the floor.

Feces remained on the resident's buttocks;-Wearing the same soiled gloves, CNA D opened the drawers of

the resident's nightstand to look for more washcloths or wipes and could not find any;-Without removing his/her soiled gloves and washing his/her hands or performing hand hygiene, CNA D left the and returned with a package of wipes. He/She did not wash his/her hands or change gloves before removing a clean wipe and cleaning the remaining feces from the resident's buttocks;-With the same soiled gloves, he/she touched the resident's exposed skin on the resident's back and rolled the resident over to his/her back;-With the same soiled gloves, CNA D removed another wipe from the package and wiped around the resident's meatus (the external opening of the urethra, through which urine exits the body), and with the same soiled wipe, wiped the catheter tubing inside of the meatus. Using the same soiled wipe CAN D then wiped down the catheter tubing, placed the wipe in a plastic bag and put the plastic bag on the floor;-Without changing gloves or washing hands he/she then picked up the plastic bag and the soiled washcloth, moved the over the bed table, using the remote to the bed, lowered the bed, touched the doorknob to open the door and left the room. During an interview on 11/5/25 at 11:30 A.M. CNA D said the following:-Gloves should be changed every few residents unless there was fecal matter on the gloves;-Hands are washed when gloves are changed. During an interview on 11/5/25 at 5:30 P.M. the Director of Nursing said the following:-Staff should wash their hands or perform hand hygiene before providing care and after providing care, and between clean and dirty tasks;-Soiled linen should not be thrown on the floor, staff should bag the soiled linen and take it to the laundry. 2655993

Event ID:

Facility ID:

If continuation sheet