Pillars Of North County Health & Rehab Center, The

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

taking care of him/her, so he/she made the allegation. The DON said she interviewed CNA G, CNA H, and CNA I separately and they all responded that they felt like the situation had been resolved and they knew nothing had happened. CNA G said, I just left the room and walked out, and they walked in, and I felt like it was over. The DON started the investigation immediately, reported the incident to the state and started education with staff on abuse reporting. She expected staff to have reported this incident immediately and not have waited over 24 hours to report the incident. During an interview on 9/8/25 at 10:01 A.M., the resident's family member said while he/she was visiting the resident, he/she called the police on 9/4/25 around 8:00 P.M. for a wellness check because the resident was soiled, and he/she had asked the staff several times to come and change the resident. When police arrived, CNA H told the resident's family member about the resident accusing CNA G of sexual abuse and it was not true. 2608912

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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

09/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Pillars of North County Health & Rehab Center, The

13700 Old Halls Ferry Road Florissant, MO 63033

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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

not aware of the resident's enteral tube feeding issues, loss of weight, and the facility not following standard practices and procedures for residents requiring nutritional support through a g-tube. Standard practices and procedures should be part of the facility's policy and procedures or standing orders. Standard practices and procedures for residents on continuous tube feedings include checking for g-tube placement, injecting air into the tube and listening for a growl sound in the stomach. This should happen when the nutritional feeding is changed once a day along with twice a day residual checks (check remaining contents of stomach by using a syringe) during the 24-hour feeding. If the entire feeding did not get completed, this amount should be documented along with the reason why it was not completed, and the Medical Director should be informed. If the resident has a bolus feeding, tube placement should be checked prior to feeding along with residual before and after feeding. The Medical Director should always be informed of difficulties with feeding. The Medical Director was not aware the resident's g-tube feedings have not been managed per policy and procedures of standard practice of care, and that the resident has not been receiving all his/her nutrition due to difficulty with the feeding pump. The Medical Director was also not aware the facility does not have standing orders on how to manage tube feedings. The Medical Director did not write out the standard practice orders when writing an order for tube feedings. This should be part of the facility policy and procedures or standing orders to follow standard of practice for residents requiring tube feeding. The facility should always follow standard of practice. During an interview on 9/11/25 at 10:21 A.M., the Administrator and DON said they were not aware of issues with the resident's enteral feeding pump with Fibersource HN not infusing completely, the resident's weight loss, and the physician orders were not entered for care of enteral feeding. They were also not aware the physician assumed the facility policy and procedure for standing orders for enteral feeding were automatically entered. They said the facility does not

record total amount of enteral feeding a resident receives but expected staff to let the physician know if the resident had not received or tolerated the total feeding and this should be documented in progress notes.

They expected nursing staff to know how to care for enteral tube feedings and to report issues when they arise.

Event ID:

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