Stonebridge Adams Street
Inspection Findings
F-Tag F0695
F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
an interview on 08/22/25 at 9:13 A.M., the resident said he/she wears oxygen via his/her BiPAP at nights. 5.
Review of Resident #3's Quarterly MDS, dated [DATE REDACTED], showed staff assessed the resident as severe cognitive impairment and received oxygen therapy. Review of the resident's care plan, revised 07/10/25, showed staff documented the resident should wear oxygen at two LPM continuously via nasal cannula, and to change oxygen tubing and water cannister weekly. Review of the resident's POS, dated 08/22/25, showed physician orders as followed: -Oxygen two LPM via nasal cannula for oxygen saturation below 90% or shortness of breath every shift;-Change oxygen tubing/nebulizer mask and tubing every Sunday night shift for prevention of infection;-Ipratropium-Albuterol Inhalation Solution 0.5-2.5, three mg/three ml vial, inhale orally every six hours for productive cough. Review of the resident's TAR, dated 08/01/25 through 08/22/25, showed staff were directed to change oxygen tubing/nebulizer mask and tubing every Sunday night shift for prevention of infection. Observation on 08/22/25 at 9:32 A.M., showed the resident wore his/her oxygen via nasal cannula. Observation showed the oxygen tubing undated, and the humidifier bottle, dated 07/29/25. Observation showed a nebulizer mask on the floor, unbagged, and the tube dated 07/29/25. During an interview on 08/22/25 at 9:32 A.M., the resident said he/she wears oxygen all the time, and staff administers a breathing treatment to him/her a few times per day. 6. Review of Resident #4's Quarterly MDS, dated [DATE REDACTED], showed staff assessed the resident as severe cognitive impairment and received oxygen therapy. Review of the resident's care plan, revised 06/12/25, showed staff were directed
the resident to wear oxygen at all times. Review of the resident's POS, dated 08/22/25, showed an order to change oxygen tubing and humidifier weekly on Sunday night shift for infection control. The POS did not contain an order for oxygen. Review of the resident's TAR, dated 08/01/25 through 08/22/25, showed staff were directed to change oxygen tubing and humidifier weekly every Sunday on night shift for infection control. Observation on 08/22/25 at 8:40 A.M., showed the resident wore his/her oxygen. Observation showed the nasal canula undated. Observation on 08/22/25 at 11:22 A.M., showed the oxygen concentrator next to the resident's bed and the humidifier bottle undated. During an interview on 08/22/25 at 2:26 P.M.,
the Director of Nursing (DON) said he/she did not know why the resident did not have an order for oxygen therapy on his/her POS. The DON said the nurses are responsible to enter orders for oxygen therapy on the resident's POS and Treatment Administration Record (TAR), and he/she ensures that the orders are entered. 7. During an interview on 08/22/25 at 1:34 P.M., Licensed Practical Nurse (LPN) A said the nurses are responsible to change residents' oxygen tubing and nebulizer mask and tubing. He/She said the schedule would be documented on the resident's POS and TAR. During an interview on 08/22/25 at 2:26 P.M., the DON said the night shift nurse is responsible to change oxygen tubing, humidifier bottles, and nebulizer masks/tubing on Sundays for all residents with oxygen therapy, and date the tubing when changed. The DON said he/she is responsible to ensure the oxygen and nebulizer masks, and tubing's are being changed weekly, but he/she had not had a chance to audit. During an interview on 08/22/25 at 3:00 P.M., the administrator said the nurses are responsible to document the order for oxygen therapy on the POS and TAR on admission or when received, and the DON to ensure the orders have been entered. The administrator said he/she did not know why the oxygen tubing, humidifier bottles and nebulizer masks and tubing's are not being changed weekly, but they should be changed by the charge nurse on Sunday nights, and the DON should ensure they are being changed. Complaint# 2587511
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
08/22/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Stonebridge Adams Street
1024 Adams Street Jefferson City, MO 65101
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-Tag F0804
Federal health inspectors cited STONEBRIDGE ADAMS STREET in JEFFERSON CITY, MO for a deficiency under regulatory tag F-F0804 during a complaint investigation conducted on 2025-08-22.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 2 deficiencies cited during this inspection of STONEBRIDGE ADAMS STREET.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-16.
STONEBRIDGE ADAMS STREET in JEFFERSON CITY, MO inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in JEFFERSON CITY, MO, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from STONEBRIDGE ADAMS STREET or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.