Stonebridge Florissant

F 0635 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

the Administrator said if a resident is admitted for respite care, the family will bring in the orders or the facility will take the orders from the family. They also often bring the medications from home. The nurse should call the physician to verify orders and document it. During an interview on 8/22/25 at 3:13 P.M., the Administrator said the admission assessment should be completed upon admission. The Regional Nurse said any residents' documents should be part of the medical records. During an interview on 8/22/25 at 4:30 P.M., the Regional Nurse said the resident was here for a very short time. They talked with the staff and the resident did not bring in any paperwork with physician orders. He/She brought a bag with his/her medications in it. If the physician changed the medications when they were verified, the old order would not be on the physician order sheet. The nurse did an assessment when the resident was admitted and it was documented in the progress notes. Review of the progress notes, dated 7/24/25 at 7:30 P.M., showed the patient is [AGE] years old with past medical history of diabetes, anoxic brain injury, polysubstance abuse, stroke history, seizure disorder, hyperlipidemia, hypertension and chronic end stage renal failure. Patient is here at the facility for respite care 7/24 through 7/28. Daughter takes care of patient at home regularly.

Patient arrived at the facility in the hour of 1300. Resident was given a lunch tray and insulin was given after intake of 100%. Patient was calm and toileted soon after. In the hour of 1700 patient became combative and repeatedly trying to get out of chair without assistance. The nurse and other nursing staff tried to redirect patient, patient was not directable. The nurse tried to call family and let them know that patient was not taking the change of environment well. Family stated, what do you expect me to do. This nurse stated that,

we do not want your (father/mother) to fall, what are some alternatives that you try at home to help redirect (him/her). Family stated to give patient his/her atarax, the nurse proceeded to give patient medication along with trazodone. Patient refused to sit down in the chair and threated to hit this nurse, and verbally got violent with the nurse, patient stood up and urinated on the floor in front of the nurse. Patient presumed to walk to down the hall and had a fall, and it was unwitnessed. Patient then was redirected to have a seat, where he/she then fell again by the central bathroom. Patient refused initial vital signs, the nurse, redirected patient, patient is now sitting at the nurse's station, no further report at this time 2573803

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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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stonebridge Florissant

6768 North Highway 67 Florissant, MO 63034

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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

to report to the nurse any medications held and to document in the MAR and progress notes. During an

interview on 8/22/25 at 11:35 A.M., the physician said he could not recall if the facility called to report the resident's medications were not administered. During an interview on 8/22/25 at 11:52 A.M., the Administrator said residents who are admitted on respite care usually bring their medications from home.

He expected staff to follow physician orders. If staff was unable to follow the orders, they should notify the physician and document it. Fingerstick blood sugars results should be documented. During an interview on 8/22/25 at 3:13 P.M., the Director of Nursing (DON) said she expected staff to notify the physician if medications were held or not given and to document appropriately. The Regional Nurse said fingerstick results should be documented anywhere in the residents' medical record, typically in the MAR.

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