Carrie Elligson Gietner Health Care Center

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

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

During an interview on 9/22/25 at 10:23 A.M., Nurse C said he/she works with the urologist. When the urologist called the facility and made the recommendation for the resident to be seen immediately, the facility should have called and scheduled an appointment for the resident to be seen as soon as possible.

Nurse C said without an appointment, the resident will not be seen. The resident was seen on 9/12/25.

During an interview on 9/8/25 at 2:30 P.M., the DON said he/she expected the facility's policy to be followed. The Charge Nurse is to make the appointment and chart the date and time in the resident's medical record. The Charge Nurse should notify Social Services to set up the transportation. The Administrator was present at that time and agreed with the DON. 2609855

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

09/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Carrie Elligson Gietner Health Care Center

5000 South Broadway Saint Louis, MO 63111

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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on

a full time basis.

Based on interview and record review, the facility failed to provide the services of a Registered Nurse (RN) seven days a week. This had the potential to affect all residents of the facility. The sample was five. The census was 86. Review of the facility's Sufficient Staffing Policy, dated February 2023, showed the following:-Purpose: It is the policy of this facility to provide sufficient staff with appropriate competencies and skill sets to assure resident safety and attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident. The facility's census, acuity and diagnoses of the resident population will be considered based on the facility assessment.-Policy: -The facility is required to provide licensed nursing staff 24 hours a day, 7 days a week;- Except when waived, the facility must use the services of a Registered Nurse for at least 8 consecutive hours a day, 7 days a week. Review of the facility's daily staffing sheets showed the following:-8/20 through 8/22/25, no RN scheduled;-8/25 through 8/31/25, no RN scheduled;-9/1 through 9/5/25, no RN scheduled. During an interview on 9/8/25 at 12:42 P.M., the Director of Nursing (DON) said the facility currently only has two RNs in the building. The DON said he/she has been working as an RN on the floor but did not know he/she could not be the DON and the RN on the floor at the same time. The Administrator was present at the time and agreed with the DON.

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

09/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Carrie Elligson Gietner Health Care Center

5000 South Broadway Saint Louis, MO 63111

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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

Based on observation, interview and record review, the facility failed to ensure recipes were followed while preparing pureed meals for one of one observed mealtime preparation. The census was 86.Observation on 9/22/25 at 11:05 A.M. of the kitchen, showed [NAME] D took one breaded chicken breast, placed it in a blender and added approximately one tablespoon of water and blended for approximately 45 seconds.

Observation after blending, the breaded chicken breast appeared to be of ground meat consistency and not smooth. [NAME] D portioned the mixture into tin pans and placed it on the steamtable. Review of the facility's Pureed Breaded Chicken Breast recipe, dated 2025, showed the following:-One Serving: One breaded chicken breast, four tablespoons and two teaspoons of water and one fourth teaspoon of chicken base;-Combine chicken base and water to make chicken broth. Place prepared breaded chicken breasts in

a sanitized food processor. Add broth and blend until smooth. During an interview on 9/22/25 at 11:15 A.M., [NAME] D said he/she should have followed the recipe for the pureed breaded chicken breast. [NAME] D said he/she looked at the recipe and thought he/she was following the recipe. Observation on 9/22/25 at 11:17 A.M., showed [NAME] D took one and one half four-ounce (oz) scoop of mixed vegetables and placed in a blender and blended for approximately 45 seconds. Observation after blending, showed the mixed vegetables were smooth with small lumps of vegetables. During an interview on 9/22/25 at 2:04 P.M.,

the Dietary Manager (DM) said he/she did not have a recipe for pureed mixed vegetables. They are just pureed until smooth. They never had a recipe for mixed vegetables. The DM expected the cooks to follow

the recipes as written to ensure the proper nutrition for the food. The DM did not know why the cooks did not follow the recipes. The Administrator was present and said he/she agreed with the DM. 2619550

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

09/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Carrie Elligson Gietner Health Care Center

5000 South Broadway Saint Louis, MO 63111

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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Based on observation, interview and record review, the facility failed to keep the kitchen walls clean and floors free of grease, dirt and grime for one of one day of observation. The census was 86.Review of the facility's Dietary Cleaning Duties, undated, showed the following:-Morning Crew: Wipe down all stainless surfaces, clean ovens and stove top, mop kitchen and dining room;-Evening Crew: Wipe down all stainless surfaces, clean ovens and stove top, mop kitchen and dining room;All employees must clock out with work completed at designated time. The cook on duty is responsible for checking that above duties are completed before they clock out. Manager is to assure this process is carried out. Observation on 9/22/25 of the kitchen, showed the following:-9:00 A.M., the floor under the refrigerator and along the back wall had dirt built up and grime;-9:02 A.M., the floor under the stove and fryer had built up grease and grime and the walls next to the fryer had built up grease and grime;-9:04 A.M., the floor under the coffee station had built up dirt and grime;-11:04 A.M., the walls behind and alongside the three sinks had built up grease and grime. During an interview on 9/22/25 at 2:15 P.M., the Dietary Manager (DM) said the cooks and the servers should deep clean the kitchen each day. The DM said the dietary staff are not allowed to have overtime, so the kitchen has not been cleaned properly. The DM said his department did not have labor hours for deep cleaning. During an interview on 9/22/25 at 2:20 P.M., the Administrator said she was aware of the concerns with the cleanliness of the kitchen. 2606159

Event ID:

Facility ID:

If continuation sheet