Grove At Kirkwood, The

During an interview on 1/27/26 at 10:12 A.M., Maintenance Associate E said the shower had been broken for about a month.

When the shower was turned on, it leaked into the lobby below.

During an interview on 1/28/26 at 1:09 P.M., CNA CCC said the shower in the shower room on 200 hall should have been fixed because it was inconvenient for the residents to go further down the hall.

During an interview on 1/29/26 at approximately 12:30 P.M., the Maintenance Director said he was aware of the broken shower in the 200 hall shower room. It had been broken for about a month. He had not gotten around to fixing it.

During an interview on 1/29/26 at 1:43 P.M., Administrator B said he/she was not aware that the shower on the 200 hall was broken and it should be fixed immediately.

The residents should have a shower that is easily accessible to them. 26883552727896

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increase of residents who were discharged , but they were admitting a lot of short-term residents.

as few changes as possible.

During an interview on 1/29/26 at 1:43 P.M., Administrator B said the

ownership. He/She was not aware of the deposit; however, the corporate BOM was aware.

The corporate BOM put in a request to refund the deposit. 2716294

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During an interview on 1/29/26 at 1:43 P.M., the Administrator B and DON C said the resident's shower room on the second floor should be clean, odor free and with adequate supplies.

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their families should have free access to grievance forms and a secure box to place them in.

The

grievances to be acted on immediately and to have a conclusion of the findings reported to the family

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Grove at Kirkwood, The 711 South Kirkwood Road Kirkwood, MO 63122

Review of the facility's

refunded within 45 days after discharge, less balances from Medicare, insurance and hospice

charges to qualify for Medicaid.

The monthly charge for room and board starts the first day a bed is held in reserve. If the resident passes away before the admission, charges will be assessed for every day the room was held in reserve.

Review of the Facility's current admission agreement, received 1/23/26, showed: -Nursing Facility, Financial, and Resource Agreement:---Receipt of Agreement: Resource hereby acknowledges that Resource has received a complete copy of the Agreement, together with all Exhibits thereto;--Disclosure of Income and Resources: Resources hereby represents and warrants that Appendix 1 which is attached to and hereby made a part of this Resource Agreement constitutes a complete, full and accurate list of all the income and other resources of resident which are known to Resource;-Payment from Residents: Resources hereby agree to pay Facility all charges incurred by resident under the terms of the Agreement only to the extent of the income or resources of Resident;-Limitation: Nothing in this Agreement shall be interpreted to require Resource to make any payment to Facility out of the personal assets of Resource or to incur other financial liability to Facility except as provided in paragraph three;-Miscellaneous:-Agreement: This agreement contains and merges all agreements, representations and understandings of the parties;-Notices: All notices under this Agreement shall be in writing and shall be deemed given when mailed or delivered in person to a party at the address shown above, or at another address as may be designated in writing by that party;-No documentation that addressed the previous contract, and previous deposits made under the previous management's contract/agreement. 6.

Review of the Resident #129's admission MDS, a federally mandated assessment instrument completed by facility staff, dated 7/5/25, showed:-Severe cognitive impairment;-Diagnoses included hypertension, acid reflux, thyroid disorder, hyperlipidemia, non-Alzheimer's dementia, and asthma.

Review of the resident's application and invoices, received from family on 1/15/26, showed:-Date of application: 4/2/25;-Payment receipt deposit: $6,000.00;--Room and Board: $7,398.00;--Total due at signing: $13,398.00.

Review of the resident's progress notes, showed:-On 10/29/25 at 6:00 P.M., staff documented spoke with family member regarding resident transferring tomorrow and pick up at 10:00 A.M.;-On 10/20/25 at 10:36 A.M., resident was transported via at 10:10 A.M.

Report was called to transferring facility at 8:30 A.M.

Resident's daughter followed via personal transportation with resident's medications as well as resident's belongings.

Review of the resident's invoices, received 1/29/26, showed no documentation of a deposit refund of $6,000.00.

During an interview on 1/28/26 at 12:59 P.M., Regional Nurse Consultant said Business Office Manager's (BOM) last day at the facility was yesterday.

There was a Regional BOM. He was unaware of the contract under the previous management company that required a deposit of $6,000 and the refund of the $6,000 upon being discharged from the facility.

The new management does not require a deposit. If a resident had a $6,000 deposit and they were discharged from the facility, he would try and get that deposit back to them.

They could contact the previous management company. He was not aware of the resident's situation and the attempts to refund the deposit.

There was an increase of residents who were discharged , but they were admitting a lot of short-term residents.

They had 10-15 skilled residents and they bumped it up to 30.

Regional Nurse Consultant said they are still under the previous management company until the change in ownership was completed.

They were still honoring the original contract.

They wanted to make as few changes as possible.

During an interview on 1/29/26 at 1:43 P.M., Administrator B said the funds were not turned over during acquisition by the new ownership.

They have requested all information from the previous ownership. He/She was not aware of the resident's deposit; however, the corporate BOM was aware.

The corporate BOM put in a request to refund the deposit. 27162942712809

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During an interview on 1/28/26 at 9:29 A.M., the Director of Physical and Occupational Therapy (Director of PT/OT) said in her expertise, she was not sure how the resident could get up the steps to his/her home. In reading the evaluation for the resident's home, there are approximately 12+ stairs.

When she saw the resident, he/she could only take six or seven steps.

The resident did therapy on some days while having COVID, and other days was too sick to participate in therapy. He/She missed two days of therapy.

The resident had 15 days of therapy. He/She could walk with one person and a gait belt. He/She would benefit from more therapy. He/She would be unsafe with stairs.

His/Her legs were extremely weak. He/She still required assistance with toileting and dressing.

The Director of PT/OT did not feel it was safe to discharge the resident back to his/her home.

During an interview on 1/28/26 at 1:30 P.M., the Admissions Coordinator said the resident changed his/her discharge plan and his/her new plan was unsafe.

They attempted to contact the resident's family member, who would not return phone calls. At 2:56 P.M., the Admissions Coordinator said when they realized the resident would not have 24/7 care at home, they realized it would be an unsafe discharge.

The Admissions Coordinator was told staff could not appeal discharges for residents.

Review of the resident's medical record, showed he/she was discharged from the facility on 1/28/26.

During an interview on 1/29/26 at 12:11 P.M., the SW said she had not received any education or guidance regarding her job duties at the facility.

She had experience with discharge planning from working in assisted living facilities (ALFs), but NOMNCs were new to her since they were not done in ALFs. If a resident wanted to appeal their NOMNC or discharge, to her knowledge, she was not allowed to do it for them.

She could not recall who informed her of not being able to assist with the appeal.

She had never done a home assessment for a resident who is going to be discharged . 2.

Review of Resident #11's admission Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 11/24/25, showed:-admission date 11/17/25;-Cognitively intact;-Diagnoses included high blood pressure, peripheral vascular disease, diabetes, hyperlipidemia, depression, and asthma.

Review of the resident's Physician Order Sheets, dated December 2025, showed no physician order to discharge the resident from the facility.

Review of the resident's progress note, dated 12/20/25, showed resident discharged home with medications.

Nurse management aware.

Further review of the resident's medical record, showed:-discharge date [DATE];-No documentation of the resident's discharge planning, referrals and/or resources;-No documentation of a discharge summary. 3.

During an interview with Administrator B and Director of Nursing (DON) C on 1/29/26 at 1:47 P.M., DON C said he/she expected the SW to assist residents with discharge planning.

All services to be provided upon discharge should be documented in the resident's medical record. A discharge summary should be documented in the resident's medical record. 2715118

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During an interview on 1/29/26 at

the reason the resident was not being assisted with oral hygiene.

The resident required staff assistance with showers and personal hygiene. 5.

During an interview on 1/29/26 at 10:22 A.M., LPN H said CNAs and nurses can trim residents' toenails unless the resident is diabetic, and then only the nurse or podiatrist can trim them. He/She expected CNAs to document on the shower sheet and alert the nurse if the resident needs his/her nails trimmed. He/She expected CNAs to assist residents with oral hygiene.

During an interview on 1/29/26 at 9:49 A.M., DON C said he/she expected residents to have clean, trimmed toenails. He/She expected staff to assist residents with oral hygiene. 6.

Review of Resident #13's quarterly MDS, dated [DATE], showed:-Cognitively intact;-No rejection of care behavior exhibited;-Substantial to maximum assistance from staff required for rolling from left to right and movement from bed to chair and chair to bed;-Diagnosis included heart disease, kidney disease, and high blood pressure.

Review of the resident's medical record, showed no care plan completed.

Observation 1/22/26 at 10:00 A.M. and 1/27/26 at 8:55 A.M., showed the resident in bed on his/her back, wearing a green hospital gown.

During an interview on 1/27/26 at 8:55 A.M., the resident said he/she would like to get out of bed and wear clothing. He/She was reluctant to ask staff to place him/her in a chair because they leave him/her up in the chair for too long. He/She had a special chair but did not know where it was.

Observation on 1/28/26 at approximately 2:00 P.M., showed the resident in bed, wearing a green hospital gown.

During an interview, the resident said he/she had not gotten out of bed today and thought he/she was too much work for the staff since he/she required a Hoyer lift (full body mechanical lift).

The resident would like to see things outside of his/her four walls.

During an interview on 1/28/26 at approximately 2:30 P.M., the Director of Therapy said the resident had no restrictions and staff were to use a Hoyer lift to get the resident out of bed. A special high-back wheelchair had been ordered and was in the resident's room.

During an interview on 1/29/26 at 10:05 A.M., CNA BB said the resident was offered to get out of bed, but the resident would refuse.

The resident required a Hoyer lift to get out of bed.

During an interview on 1/29/26 at 2:14 P.M., the DON said the resident was expected to get out of bed every day and as requested. If the resident refused, then the nurse should be notified. He/She expected refusals of care to be documented in the medical record and on the resident's care plan.

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During an interview on 1/28/26 at 1:40 P.M. and on 1/29/26 at 11:55 A.M., LPN KK said the nurses are responsible to complete treatments and dressing changes. LPN KK said the resident should have compression stockings on if there is an active order.

During an interview on 1/29/26 at 1:41 P.M., Director of Nurses (DON) C said he/she expected the nurses to follow physician orders and complete the wound treatments as ordered. He/She expected staff to order supplies if they were not available. He/She expected staff to document accurately in the resident's medical record when the treatment was completed.

Staff should not document a treatment as completed when it was not administered. He/She expected compression stockings to be on a resident as per physician orders. 2.

Review of Resident #123's medical record, showed:-admission date 1/16/26;-Diagnoses included congestive heart failure (heart inability to pump), pneumonia (infection effecting the lungs filling with fluid or pus), glaucoma (impaired vision), and diabetes;-No baseline care plan to direct staff on the care needs of the resident.

Review of the electronic physician order sheet (ePOS) and treatment administration record (TAR) for January 2026, showed:-An order, dated 1/22/26, to cleanse skin tear to left lower leg with normal saline, apply xeroform, and dry dressing daily and as needed (PRN);-From 1/22/26 through 1/26/26, staff did not document the treatment as completed.

During an interview on 1/22/26 at 11:00 A.M., the resident said he/she had a wound on his/her left leg/ankle.

During an interview on 1/23/26 at 12:46 P.M., Certified Nurse Aide (CNA) ZZ said he/she was transferring the resident with Physical Therapist (PT) AA and during the transfer, the resident's leg got caught, causing the wound to the resident's leg/ankle.

Observation on 1/26/26 at 2:01 P.M., showed the dressing on the resident's left leg dated 1/22/26.

During an interview on 1/29/26 at 1:04 P.M., the Regional Nurse Consultant said nurses are responsible for documenting completion of wound treatments in the resident's electronic medical record.

Staff should follow physician orders for completion of wound treatments. 2681713

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Review of the facility's Gait Belt Transfer policy, dated 7/1/25, showed;-Policy: The facility will utilize a gait belt for residents who require one assist with transfers to promote safety during resident transfers.

Review of Resident #11's quarterly MDS, dated [DATE], showed:-Severe cognitive impairment;-Dependent on staff for personal and toilet hygiene;-Requires maximum assistance from staff for dressing lower and upper body, staff for chair to bed and bed to chair transfers;-Diagnoses included dementia, heart disease, and heart failure.

Review of the resident's care plan, in use at the time of survey, showed:-Problem: The resident required limited assist with ADL care to meet their needs;-Intervention: Provide assistance with one person with transfers.

Observation on 1/26/26 at 8:26 A.M., showed LPN Y entered the resident's room. LPN Y assisted the resident with changing his/her brief and clothing. LPN Y sat the resident on the side of the bed and positioned the resident's wheelchair next to the bed. LPN Y lifted the resident under his/her arms and pulled the resident up off the bed using the resident's pants and pivoted the resident to his/her wheelchair. A gait belt was not used to transfer the resident from his/her bed to his/her wheelchair.

Two gait belts were hanging above the resident's bed.

During an interview on 1/28/26 at 2:16 P.M., CNA NN said gait belts should be used on all residents requiring assistance with transferring and ambulating.

During an interview on 1/29/26 at 10:15 A.M. CNA PP said staff should be using a gait belt on the resident when transferring because he/she did not stand very well. A gait belt was used in case the resident's legs gave out, and they could be safely lowered to the floor or chair.

During an interview on 1/29/26 at 2:14 P.M., DON C said he/she expected staff to use a gait belt on all residents that required assistance from staff with walking and transferring from bed to chair.

Pulling on the resident's pants to transfer a resident is not acceptable. 5.

Review of Resident #7's quarterly MDS, dated [DATE], showed:-Severe cognitive impairment;-Upper/lower extremity: No impairment;-Diagnoses included dementia, anxiety disorder, and depression.

Review of the resident's ePOS, dated 1/23/26, showed no order for Dakins (topical antiseptic solution) 0.125% solution.

Review of the Safety Data Sheet for Dakin's solution products, undated, showed a warning: Do NOT take internally, for external use only. If swallowed, get medical help or contact Poison Control right away.

Observations of the resident's room on 1/27/26, showed:-At 11:16 A.M. and 1:36 P.M., the resident lay in his/her bed. A bottle of Dakins 0.125% solution without a cap sat on the television stand beside the television;-At 5:12 P.M, the not in his/her room.

The bottle of Dakins 0.125% solution without a cap sat on the television stand beside the television.

Observations of the resident's room on 1/28/26 at 8:32 A.M., showed the resident sat in his/her bed, eating breakfast.

The bottle of Dakins 0.125% solution without a cap sat on the television stand beside the television.

During an interview with Administrator B and DON C on 1/29/26 at 2:14 P.M., DON C said the bottle of Dakins solution should not have been in the resident's room. It would be removed and destroyed. 2722224

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Review of the facility's Pouch Changes - Ileostomy policy, dated 7/1/25, showed:-Policy: It is the policy of this facility to ensure that residents who require colostomy services receive pouch changes consistent with professional standards of practice to minimize occupational exposure and the resident's skin exposure to fecal matter or urine;-Policy Explanation:-Ostomy care will be provided by licensed nurses under the orders of the attending physician.

The order should include the type of ostomy, frequency of pouch change, and type of equipment.

The nurse will allow the resident to perform as much care as possible in accordance with the resident's goals and preferences.

Review of Resident #93's admission Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 11/8/25, showed:-Moderately impaired cognition;-Diagnoses included Chron's disease (inflammatory bowel disease causing chronic inflammation of the gastrointestinal tract), ileostomy status, chronic kidney disease, major depressive disorder, and anxiety;-Had ostomy appliance.

Review of the resident's physician order summary (POS), reviewed 1/26/26, showed no orders for ostomy care.

Review of the resident's medical record, showed no baseline or comprehensive care plan to direct staff on the resident's care needs.

During an interview on 1/22/26 at 8:49 A.M., the resident said he/she felt shaky and did not feel good. He/She was unable to answer specific questions regarding his/her medical needs.

During an interview on 1/22/26 at 9:43 A.M., the resident's family member, Family Member UUU, said he/she and another family member had been coming to the facility to assist the resident with ostomy care.

Staff were not assisting the resident with emptying his/her ostomy bag, resulting in the resident having to wait for his/her family member to help. He/She informed Director of Nursing (DON) D his/her concerns but had not heard back from any facility staff.

During an interview on 1/22/26 at 2:00 P.M., Licensed Practical Nurse (LPN) FFF said today the resident had an unwitnessed fall. LPN FFF was in the hallway with another staff member when they heard a bang come from the resident's room.

They went immediately to the resident's room where they found the resident on the floor.

The floor around the resident was covered in feces.

The resident was holding his/her ostomy bag up, trying to keep feces from coming out more.

The resident reported that he/she had been trying to walk to the bathroom to empty his/her ostomy bag.

The resident was sent out to the hospital due to shoulder pain after the fall and having an altered cognitive status. LPN FFF had not known the resident had an ostomy bag.

During an interview on 1/23/26 at 9:03 A.M., LPN O said he/she was unaware the resident had an ostomy bag.

The resident did not have any physician orders for ostomy care. He/She was unaware if the resident was able to care for his/her ostomy him/herself.

During an interview on 1/29/26 at 2:00 P.M., DON C said he/she expected staff to assist the resident with his/her colostomy care. He/She expected staff to be informed of the presence of the resident's colostomy. He/She expected for the resident to have a care plan indicating interventions for the resident's ostomy care level needs. He/She expected the resident to have physician orders for ostomy care. He/She expected DON D to have reached out to the resident or the resident's family upon being informed of care concerns. 2661256

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During an interview on 1/28/26 at 2:22

not feel comfortable doing it via telehealth.

The facility did not have a restorative program.

There had

1:43 P.M., Director of Nursing (DON) C was aware of the lack of therapy and was looking for one therapist.

The facility ensured therapy was delivered by completing an assessment, and if they did not have appropriate staff, they would contract a staff member.

There was no restorative therapy program.

They had a program, but it was not in place. 5.

During an interview on 1/26/26 at 8:37 A.M., Licensed Practical Nurse (LPN) LL said he/she was a brand-new nurse who did not receive any orientation. He/She was employed by an agency but became a direct hire by the facility and was unaware of the staffing level being terrible. 6.

During an interview on 1/26/26 at 11:13 A.M., LPN GGG said this was his/her first day at the facility. He/She never came here for agency work. He/She should be training with someone but there was no one here. He/She had been solo since 7:00 A.M. this morning. He/She had to familiarize with the residents by reading their charts. If he/she had questions, he/she would refer to another LPN. 7.

During an interview on 1/28/26 at 2:39 P.M., LPN Z said since the new management took over, the facility had been short staffed.

They recently hired night nurses and more aides.

There was only one night nurse before last week. LPN Z and one other nurse were the only nurses on the bottom floor.

There was one nurse on the second floor. If the census increased, it would be challenging because residents had critical care needs, such as intravenous medications and wound vacuums (therapeutic device that helps a wound heal faster by removing fluid and bacteria with suction).

The admissions LPN did not work the floor, even when short-staffed.

The wound nurse quit several weeks ago because they were at the facility for 20 hours.

The nurses did not know if they will have relief, so they do not come in.

They call management and ask when they can leave. If the nurses leave, management says it is job abandonment.

The facility lost so many nurses because they do not know when they can go home.

Staff had trouble with pay checks bouncing and the management company took an hour out of his/her paycheck daily. He/She worked 12 hours a day, and they took an hour from him/her. He/She used to work regularly at the facility until he/she was stuck for 23 hours.

After that occurred, he/she switched to PRN.

Another LPN got stuck overnight. DON D worked the floor more than doing the DON duties. He/She got burned out.

Due to all the changes, staff had to keep adjusting to new ideas and new things over and over again.

The residents complained about it.

After the change in ownership, the company wanted to change the restorative aide to a certified nurse Aide (CNA), but he/she retired and the company got rid of the other restorative aide. 8.

During an interview on 1/29/26 at 1:43 P.M., Administrator B said DON C had a daily staffing sheet for nurse hours. He/She did not know if it was tracked.

The past weekend was an issue for the Registered Nurses (RNs).

The facility used quite a bit of agency staff and spent approximately $20,000 a month on agency staff.

They currently had two RNs on staff, who just started working at the facility.

Since the change in ownership, there had been three Administrators and two DONs.

The Assistant Administrator or Administrator would be responsible for compliance during each transition, as well as corporate staff.

Regulatory duties were not handed off between Administrators.

They used agency staffing to ensure minimum staffing requirements were met.

Administrator B said DON C is currently working on a system for everyone to abide by to ensure continuity of care with frequent staff turnover.

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status forms were reviewed quarterly.

Residents were expected to have care plan meetings at least

plan meeting and take the lead on them.

Administrator JJJJ agreed that care plans were necessary

medical issues, need for hearing aids or dentures, and code status. If a resident was admitted to the facility without the capacity to make decisions, staff was to confirm that the resident could not make decisions and identify a surrogate to make decisions.

The IDT was responsible, but social services could lead it.

Administrator JJJJ said he/she would expect social services to know how to start or seek the resource of obtaining a public administrator for a resident.

There had been no update regarding Resident #507's need for POA or guardianship.

They reached out with his/her family members, but no returned call.

The neurosurgeon had gone back and forth on the urgency. It was believed to be important but could not say life threatening or detrimental.

The facility emailed the neurosurgeon, and it was debated whether or not to send the resident to the hospital to see if there was an ethics committee for decision making, but the hospital decided it was not appropriate.

They were not consistent with urgency. It would take several months for a public administrator.

They were talking to the resident's friend who could make small decisions.

The friend helped with medication decisions; however, this magnitude was too big.

Administrator JJJJ would have expected the resident to have had a decision maker. 2809357

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medication was unavailable, the nurse should document this in the resident's medical record and call

medication was not given. If medication was out or unavailable, the nurse should go to the Pyxis (a

not, the nurse should call the pharmacy and ask for STAT (urgent) delivery. If the medication is on backorder, the nurse should contact the physician and get a substitute order. DON C said he/she expected medication to be reordered timely and the medication be administered accurately and timely.

He/She expected staff to notify the pharmacy and physician after one dose was not given and not wait until multiple doses were missing. 27164582712809268622426849812681691

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Review of the facility's temperature log for [NAME] Wing, dated [DATE], showed no staff member check on the refrigerator's temperature from [DATE] through [DATE].

During an interview on [DATE] at 8:59 A.M., Director of Nursing (DON) C said everything needs to be pulled from the [NAME] Wing refrigerator and reordered. 2.

Observation on the [NAME] Hall nurse cart on [DATE] at 8:40 A.M., showed:-Dry erase markers in the top drawer;-Kwik Pen (insulin) without an open date, and resident name handwritten on the cap;-Solar Star Pen (insulin) without an open date;-Boudreaux's Butt Paste cream tube without an open date or resident name;-Desitin cream without a resident's name or open date.

Observation of the [NAME] Hall CMT cart on [DATE] at 8:40 A.M., showed half of a white circular pill in the pill cutter, marked PLI-4, for trazadone 50 milligrams (mg). 3.

Observation on the Med A Hall nurse cart on [DATE] at approximately 5:00 P.M., showed:-13 insulin pens with handwritten names and no patient labels;-Betamethasone valerate ointment (topical ointment used to help relieve redness, itching, swelling, or other discomfort caused by skin conditions) without an open date;-Aspercreme (topical cream used to relieve minor pain) without an open date;-A biohazard bag contained 24 urine tubes, expired dated [DATE], and urine culture tubes;-A plastic bag with a sticker labeled refrigerator contained two syringes of glatopa (used to treat multiple sclerosis (autoimmune disease) 40 mg/milliliters (mL).

Observation on the Med A Hall CMT cart on [DATE] at approximately 5:00 P.M., showed:-Loperamide (treats diarrhea) blister pack 2 mg without a patient label;-Cetirizine (treats allergies) blister pack contained four pills, without an open date or patient label;-A loose oval, white pill.

During an interview on [DATE] at 5:07 P.M., DON C said insulin should have a patient label on the pen and the resident's name should not be handwritten on the caps of the insulin pens.

When a resident is discharged , the nurse is primarily responsible for removing the medication no longer used and destroying it.

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Review of the facility's therapy minutes, dated 9/1/25 through 1/22/26, showed no ST evaluations, ST minutes or services offered to residents.

During an interview on 1/28/26 at 12:20 P.M., the Dietary Manager said ST was supposed to be telehealth and there is a new person starting. 3.

During an interview on 1/29/26 at 1:43 P.M., Director of Nursing (DON) C said he/she was aware the resident received therapy outside of the facility.

The facility was looking to hire one therapist.

The facility ensured therapy was delivered by completing an assessment, and if they do not have appropriate staff, they contracted a staff member.

There was no restorative therapy program in place. If a resident received outside therapy services, he/she expected staff to arrange transportation to and from, and set the schedule and arrange it. He/She expected there to be communication between the facility and the outside therapy company.

There should be progress notes, proper documentation, and it should be care planned. 265250126464812724850

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Grove at Kirkwood, The 711 South Kirkwood Road Kirkwood, MO 63122

During an interview on

He/She was responsible for getting money from private pay residents, but the facility would not help

representative from Vendor C, an oxygen supply company, said the facility had a current balance of $789.11. It was well beyond the 60 day term.

The last payment made by the facility was 8/26/25, before the new management acquired the facility.

They have not made a payment. 6.

During an interview on 2/10/26 at 11:35 A.M., a representative from Vendor G, a food vendor, said the facility had an unpaid balance of $8,053.13. It included September 2025 through the end of January 2026. No payment had been made for September 2025 through January 2026. 7.

During an interview on 2/10/26 at 1:50 P.M. a representative from Vendor I, a pest control company, said they provided service to the facility twice a month.

The facility had two outstanding bills for the months of November 2025, December 2025, and January 2026.

The facility owed a balance of $1,050.00. 8.

During an interview on 1/28/26 at 2:05 P.M., the Plant Operations Manager said housekeeping and maintenance staff got cut.

There were three additional maintenance staff, but now there was one.

Everything was ordered from corporate, including the floor cleaner. He was also filling in for housekeeping.

Staffing and supplies were an issue.

There was so much going on and he was pulled in different directions.

The transition has been hard on the residents and families.

Some of the residents have been there for years.

There are multiple vendors that had not been paid.

Pest control and snow removal services did not receive a payment; however, the snow removal service came today.

They were paid, but they are waiting for another payment. 9.

During an interview on 1/29/26 at 1:43 P.M., Administrator B said the DON had a daily staffing sheet for nurse hours. He/She did not know if it was tracked.

The past weekend was the issue for the Registered Nurses (RNs).

They use quite a bit of agency staff and spend approximately $20,000.00 a month.

They currently have two RNs on staff that just started.

Since the change in ownership, there had been three Administrators and two DONs.

The Assistant Administrator or Administrator would be responsible for compliance during each transition as well as corporate staff.

Regulatory duties were not handed off between Administrators.

They used agency staffing to ensure minimum staffing requirements were met.

Administrator B said the DON was currently working on a system for everyone to abide by to ensure continuity of care with frequent staff turnover. 10. On 2/5/26 at 10:08 A.M. and 2/6/25 at 11:05 A.M., Department of Health and Senior Services (DHSS) attempted to reach the facility's Corporate Business Office Manager.

Messages were left requesting returned calls, but the calls were unreturned. 272126227209122684730

265833 01/29/2026

Grove at Kirkwood, The 711 South Kirkwood Road Kirkwood, MO 63122

Based on interview and record review, the facility failed to have a complete and thorough facility-wide

both day-to-day operations and emergencies.

The facility assessment did not include a monthly average number of residents who required assistance with activities of daily living.

The census was

Review of the facility's Facility Assessment, updated 12/18/25, showed:-People involved in completing: Administrator A, Director of Nursing (DON) C, and Director of Maintenance;-Date reviewed with Quality Assurance Performance Improvement (QAPI) committee: 12/18/25;-Number of licensed beds: 117;-Average daily census: 100;-Average weekday admissions by shift: 3-4;-Average weekend admissions by shift: 0-1;-Average weekday discharges by shift: 3-4;-Average weekend discharges by shift: 0-1;-Assistance with activities of daily living monthly average:-Bed mobility sit to lying: --Set up: blank;--Supervision/partial/moderate assistance: blank;--Dependent/max assistance: blank;-Mobility sit to stand: --Set up: blank;--Supervision/partial/moderate assistance: blank;--Dependent/max assistance: blank;-Bathing: --Set up: blank;--Supervision/partial/moderate assistance: blank;--Dependent/max assistance: blank;-Transfer: --Set up: blank;--Supervision/partial/moderate assistance: blank;--Dependent/max assistance: blank;-Eating: --Set up: blank;--Supervision/partial/moderate assistance: blank;--Dependent/max assistance: blank;-Toileting: --Set up: blank;--Supervision/partial/moderate assistance: blank;--Dependent/max assistance: blank;-Other care, describe: blank;-Staff assignments: Describe how you determine and review individual staff assignments for coordination and continuity of care for residents within and across these staff assignments: -The facility meets this requirement by considering census, individual and overall unit acuity, routine/consistent staffing assignments per unit for both licensed nurses and Certified Nursing Assistants (CNAs), and resident preferences for staff assignments.-Describe how you evaluate if your infection prevention and control program includes effective systems for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement, that follow accepted national standards: -Utilize acceptable infection control program, tracking and trending program infections by type, location, and antibiotic used. We provide transmission-based precautions.

Annual infection control and handwashing competency training and as needed.

Staff and volunteers participate in annual training.

Visitors are observed for signs and symptoms of contagious infections.

Signage is used to communicate isolation and any other necessary information to visitors and/or vendors.

During the course of the survey process, problems were identified which included:-Staffing and training, to include:--No required CNA 12-hour in competencies abuse and neglect and/or dementia care training for 10 out of 10 CNAs who were employed for more than one year;--Insufficient nursing staff available to meet the needs of residents, as evidenced by staff interviews, residents with missed treatments, and residents with missed activities of daily living (ADL) care;-No restorative program or speech therapy;-Infection control practices, to include:--Tuberculosis testing not completed for 5 out of 5 residents sampled;--Residents on enhanced barrier precautions (EBP) did not have signage or a supply of personal protective equipment (PPE);--Housekeeping staff failed to have Environmental Protection Agency (EPA)-registered hospital disinfectant solution to clean floors.

During an interview on 1/28/26 at 1:43 P.M., Administrator B said he/she expected the facility assessment to be fully completed with the total numbers of all residents who required assistance.

The Administrator is responsible for ensuring the facility assessment is completed.

265833 01/29/2026

Grove at Kirkwood, The 711 South Kirkwood Road Kirkwood, MO 63122

During an interview on 1/29/26 at 1:43 P.M., Administrator B and DON C said Human

of TB, so they do not infect residents. 13.

Review of the facility's Cleaning Procedures policy,

The Environmental Protection Agency (EPA)-registered hospital disinfectant (disinfecting solution) used is approved by Quality Assurance Committee in accordance with CDC guidelines;-Procedures: Mop buckets: Mop buckets are cleaned after each shift;---Scrub inside and outside of bucket with clean pad, appropriately diluted disinfectant and hot water;--Rinse and dry with cloth.

Review of the facility's Cleaning Resident Rooms policy, undated, showed:-Resident rooms at the facility are maintained in a clean and sanitary manner and are cleaned on a daily and weekly schedule.

Cleaning procedures are detailed in separate policies;-Daily Cleaning: Equipment needed:--EPA-registered hospital disinfectant (disinfecting spray).

Observation and interview on 1/26/26 at 945 A.M., showed Housekeeper F said the facility stopped purchasing the mop water stuff, so now they use an all-purpose cleaner.

They used to have a hook up that would pour the cleaner out into a bucket.

Housekeeper F lifted an empty container of the brand P&G Proline 3.78 liter/1 gallon container.

He/She said they ran out of it a while ago, but he/she kept the bottle.

Housekeeper K pointed to a bottle that read, Medorra Limpreza All Purpose Cleaner Lavender scent.

The facility purchased Medorra Limpreza all-purpose cleaner.

Without using the hook up, Housekeeper F was not sure how much to use. He/She poured cleaner into the cap and put it into the bucket. He/She said bottle of the Medorra Limpreza is the last one they had.

During an interview on 1/26/26 at 10:24 A.M., DON C said the facility did not have a Housekeeping Director.

During an interview on 1/26/26 at 11:35 A.M., the Plant Operations Manager said staff gave their supply order to corporate and they ordered the supplies.

The facility staff did not have a say of what is approved and ordered for them by corporate.

During an interview on 1/26/26 at 3:04 P.M., the Dietary Manager said they had a corporate person that ordered supplies for them.

During observation and interview on 1/28/26 at 2:19 P.M., Housekeeper T said he/she used the Medorra Limpreza All Purpose Cleaner Lavender scent for the floors. He/She poured enough cleaner to cover the bottom of the bucket.

They used to have a hook up that poured water and cleaner out of a hose. He/She liked that set up better.

Observation on 1/28/26 at 3:11 P.M., showed a bottle of Medorra Limpreza All Purpose Cleaner Lavender scent.

There was no EPA-registered number on the bottle.

There was no documentation of EPA approved or hospital grade disinfectant.

Review of EPA-approved, certified products on EPA.gov, reviewed 2/6/25, showed no result for Medorra Limpreza All Purpose Cleaner Lavender scent.

Review of the Medorra Limpreza official website, reviewed1/28/26, 1/29/26, 2/5/26, and 2/6/26, showed the website had a critical error.

The product or EPA registration could not be verified on the website.

During an interview on 1/29/26 at 10:00 A.M., Central Supply PPP said he/she worked in the building for several years. On 9/1/25, when the new management took over, he/she was given duties of medical records and accounts payable in October 2025. He/She tried to do everything, but it is a lot.

They never had issues with the supplies, but it changed drastically.

Before the management change, there was never a problem with supplies.

When they took over, there was a budget issue, and the facility went from having supplies to limited supplies.

During an interview on 1/29/26 at 1:09 P.M., the Regional Nurse Consultant said housekeeping did their own ordering.

They did not have a Housekeeping Director.

There was no training for staff on how much floor chemicals to use.

During an interview on 1/29/26 at 1:43 P.M., Administrator B said there were extra supplies in the basement, so he/she told staff to educate someone on where to find it. He/She expected housekeeping to use appropriate supplies to clean all areas of the facility. He/She expected housekeeping staff to know how much chemicals to use. 27209122703232271295626798782724850

265833 01/29/2026

Grove at Kirkwood, The 711 South Kirkwood Road Kirkwood, MO 63122

Review of the facility's Antibiotic Stewardship policy, dated, 7/1/25, showed:-Intention: It is

overall infection prevention and control program.

The purpose of the program is to optimize the treatment of infections while reducing the adverse events associated with antibiotic use;-Policy: The Medical Director, Director of Nursing (DON), Infection Prevention Control (IPC) Nurse, and Consultant Pharmacist serve as leaders of antibiotic stewardship program and receive support from the Administrator and governing officials at the facility.

During an interview on 1/23/26 at 2:19 P.M., Administrator A said the antibiotic stewardship program had not been updated since March 2025.

The IPC Nurse recently quit, and the facility just started the program back up on 1/22/26.

Administrator A said he/she expected the antibiotic stewardship program to be in place.

265833 01/29/2026

Grove at Kirkwood, The 711 South Kirkwood Road Kirkwood, MO 63122

Based on interview and record review, the facility failed to offer the COVID-19 vaccine for five out of

facility's COVID Vaccine policy, dated, 7/1/25, showed:-Policy: The facility will offer the COVID vaccine to assist in mitigating the spreads of COVID-19;-Procedure: COVID-19 vaccinations shall be offered to all residents unless such immunization is medically contraindicated; Residents shall be educated on the COVID-19 vaccine they are offered, in a manner they can understand, including the information of the benefits and risks with the Centers for Disease Control and Prevention (CDC) or Food and Drug administration (FDA); Residents shall be offered the opportunity to ask questions about the risk and benefits of the vaccination; The facility shall maintain documentation of COVID-19 vaccine for all residents in the medical record. 1.Review of Resident #12's medical record showed:-Diagnoses that included heart failure and kidney disease;-No documentation that the resident was offered or received the COVID-19 vaccine. 2.Review of Resident #13's medical record showed:-Diagnoses that included asthma and kidney disease;-No documentation that the resident was offered or received the COVID-19 vaccine. 3.Review of Resident #8's medical record showed:-Diagnoses that included diabetes and osteomyelitis (bone infection) of the foot;-No documentation that the resident was offered or received the COVID-19 vaccine. 4.Review of Resident #9's medical record showed:-Diagnoses that included heart failure and stroke;-No documentation that the resident was offered or received the COVID-19 vaccine. 5.Review of Resident #6's medical record showed:-Diagnoses that included stroke, dysphagia (difficulty swallowing) and kidney disease;-No documentation that the resident was offered or received the COVID-19 vaccine. 6.

During an interview on 1/29/26 at 12:57 P.M., the Regional Nurse Consultant said he is also the facility's Infection Preventionist (IP). He would expect the COVID-19 vaccinations be offered to the residents on admission or when the resident requests one.

Refusals of the vaccines and any education provided is expected to be documented in the resident's medical record.

All vaccines administered to the resident are expected to be documented in the resident's medical record.