Heritage Care Center

F 0568 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.

Based on interview and record review, the facility failed to maintain a system to ensure the resident trust fund account was managed in accordance with proper accounting principles by not maintaining an accurate accounting of all monies held in the resident trust fund account by not reconciling each month. The facility managed funds for 98 residents. The census was 105. Review of the facility's Resident Trust policy, dated 6/12/25, showed Resident Trust clerk must reconcile the cash left in the box with the receipts in the box by completing the Resident Trust Petty Cash Reconciliation Form. Attach all receipts in the petty cash box to

the Resident Trust Petty Cash Reconciliation form. The administrator signs reconciliation form for approval.Review of the facility-maintained bank statements for the months 4/25 through 7/25, showed no documentation of reconciliations.Review of the facility-maintained attempted reconciliation forms, dated 4/25 through 7/25, showed the attempted reconciliations did not reconcile to the residents' current balance at the time of the attempted reconciliation.Observation and interview on 9/5/25 at 11:40 A.M., showed the Business Office Manager (BOM) counted the resident petty cash that was in the safe. The cash totaled $163.00. The BOM said he/she had been at the facility since July, 2016 and he/she did not know if the petty cash was accounted for on the reconciliation on the bank statement. The corporate office determines the set amount of petty cash that is withdrawn at the beginning of each month which is added to the existing petty cash. The BOM counts the resident petty cash every time he/she replenishes the cash. The BOM said

the petty cash comes from the resident trust. There is running total on the petty cash sheet for tracking. The BOM said he/she has never had over $4,000.00 cash on hand and does not know why the bank reconciliation reports showed cash on hand in the amount of $6,626.00 in May 2025, $16,971.00 in June and $16,941.00 in July 2025.During an interview on 9/8/25 at 11:53 A.M., the Activity Director (AD) said every morning, he/she counts the petty cash envelope with the BOM, verifying the cash balances with the receipt book. The AD said each individual withdrawal with the resident signature is recorded in the receipt book. At the end of the day, the petty cash envelope cash is reconciled with the BOM and AD.During an

interview on 9/5/25 at 11:45 A.M., the Corporate Business Office Manager (CBOM) said he/she expected

the petty cash to be accounted for on the monthly reconciliation sheet and the actual cash itself is counted and documented to ensure accuracy. The petty cash is residents' money.During an interview on 9/9/25 at 9:45 A.M., the Administrator said she expected the facility to ensure the resident trust fund account is reconciled each month.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Heritage Care Center

4401 North Hanley Road Saint Louis, MO 63134

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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Based on observation, interview and record review, the facility failed to maintain a safe, clean, comfortable and homelike environment for resident areas throughout the building. The census was 105. 1. 1.

Observation on 9/3/2025 at 11:00 A.M., 9/5/2025 at 1:15 P.M., and 9/9/2025 at 9:30 A.M., showed the following:-Room C1, behind the door, showed drywall mudding, measuring 30 inches () by 4 in length, unpainted;-Shared bathroom, located between C1 -C3, with missing cove base along the doorway of C1, exposing a large hole in the wall 8x4;-Shared bathroom, located between C1 -C3, with missing cove base along the doorway of C3 and behind the toilet;-Between room C1 and C3, in the hallway, a section measuring 4x4 of unpainted area, exposing four 1/2 holes;-Shared bathroom, located between C5 -C7, with cove base pulled away from wall along the doorway of C5, exposing crumbling drywall;-Room C7 bed 1, overhead bed light plastic cover laying on top of the fixture, exposing the light bulb;-Room C6 bed 1, approximate 14x4 unpainted section with two 1/2 circle holes;-Room C9 bed 1, 3x3 hole near the door approximately 6 from the floor and two additional circle areas measuring 2x2, exposing drywall;-Room C9, air conditioning unit (AC) with a 2 gap between the AC unit and the wall;-Shared bathroom, located between C10 -C12, with chipped and cracked paint along the length of the bottom of mirror with brown stains. The sink pulled away from wall with cracked paint and caulk;-Room C10, a hole measuring 2x2 behind the door;-Room C10, foot of bed 2, showed a hole in the corner of room measuring 1x1 with black hairy-like substance coming out of the hole with visible mice droppings;-Room C10, side of bed 2, showed

a 1 x 1/2 hole in cove base that went through the wall exposing pieces of drywall. In front of the hole was a pest control bug glue trap;-Room C12 bed 1, 4 1/2 holes in wall. 2. Observation on 9/3/25 at 1:24 P.M., and

on 9/5/25 at 2:47 P.M., of bedroom and bathroom A-10, showed the floor was dirty and sticky upon walking.

In addition, in the bathroom, the baseboard was pulled out from the wall on the bottom left-hand side and

the plaster was peeled away from the wall on the top right-side corner above the sink. 3. Observation on 9/3/25 at 1:46 P.M., and on 9/5/25 at 2:50 P.M., of room A-7, showed the floor was dirty and sticky upon walking. In the bathroom, the paint was peeled away from the wall behind the commode. 4. Observations on 9/3/25 at 2:17 P.M., and on 9/5/25 at 2:56 P.M., of room B-4, showed the floor was dirty and sticky upon walking. In in addition, the baseboard was pulled away from the wall behind the bedroom door. 5.

Observation on 9/3/25 at 10:41 A.M., showed the floors of room D-3 were sticky upon walking and what appeared to be an opaque, dirty film on the tiles near the doorway. 6. Observation on 9/3/25 at 11:09 A.M., near the D-hall entrance, showed a broken ceiling tile above the doorway to the beautician's office, leaving

an approximate 5 inch by 7 inch gap, exposing the electrical wires and space above the ceiling tiles. 7.

During an interview on 9/8/25 at 9:30 A.M., the Maintenance Assistance (MA) said the staff fills out the facility's work order sheet when repairs are needed. Once the staff completes the form, the form is placed

in the wall mounted box that is located at the entrance of each hall. The MA said every morning he gathers all the completed forms so the issues can be address. The MA said due to budget cuts, the supplies needed to make the repairs are slow.

Event ID:

Facility ID:

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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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Heritage Care Center

4401 North Hanley Road Saint Louis, MO 63134

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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

had got word of what was happening on the hall. After the situation with his/her family member, everyone told him/her to let the resident go. So, he/she let the resident go. It was at that time, the Administrator was walking up the hall and Floor Tech N and the resident were walking down the hall. As soon as he/she let the resident go, he/she attacked the Administrator. That's when Floor Tech N stepped in the middle of them.

He/She didn't touch the resident. Floor Tech N just stepped between the resident and the Administrator and moved him/her away from the Administrator. They actually terminated him/her. Floor Tech N was originally sent home after the incident on that Sunday. On Monday, he/she called off work. He/She returned to work

on that Tuesday, and they let him/her work his/her entire shift, 8:00 A.M. to 4:00 P.M. Later that night, around 11:00 P.M, he/she received a voice message from the Administrator saying he/she was suspended pending investigation, then he/she was officially terminated about one week later. Floor Tech N completed abuse and neglect in-services. They were passed around very often. He/She signed one probably a couple of weeks prior to the incident. During interviews on 9/5/25 at 3:25 P.M., 9/9/25 at 9:52 A.M., and 9/10/25 at 12:50 P.M., the Administrator said the resident had a resident to resident earlier that day. He/She was placed on a1:1 as a result. The resident had been hearing voices and had gotten delusional, so had gone up and hit another resident. With his/her 1:1 status, it was already determined he/she wouldn't smoke with

the other residents. His/her 1:1 staff, Floor Tech N, was behind him/her. The resident went up to CNA O, which happened to be Floor Tech N's family member, and had begun to hit him/her in his/her head and pulling his/her hair. Floor Tech N pulled the resident off CNA O. By that time, she heard some noise, maybe

a code green call, so she went to the hall and staff were there. Floor Tech N was walking down the hall. She told staff to get residents into their rooms. Normally, they would have had a de-escalator. Floor Tech N was supposed to have deescalated the situation, which was include making sure everyone was safe, de-escalate, making sure the resident was safe, and making sure nothing was in the way. Floor Tech N was more focused on the resident getting off the unit and wasn't following her directive (to de-escalate). She told Floor Tech N to get his/her family member off the hall but deescalate and make sure all the residents were

in their rooms. Floor Tech N finally followed the directive. By that time, she had told the staff to let the resident have the hall. She told one of the nurses to call the Physician to get an IM for the resident. At that point, Floor Tech N said he/she would do what was asked and that what was to escalate. The Administrator was the closet one to the resident. The resident started hitting her in the head. Mostly, the right side of her head and then when she leaned over to try to protect her face, he/she started hitting her on both sides of her head and other parts of her body. The Administrator was yelling out to get the residents to their rooms.

Floor Tech N made sure his/her family member was off the unit and out the door. Then he/she grabbed the resident's arms (wrist area) to stop the resident from hitting her. After that, Floor Tech N tried to deescalate

the resident, so he/she had the resident in a CPI hold by his/her wrists and walked him/her off the unit to

the dining room area. Floor Tech N never had the resident in a head lock. She didn't think Floor Tech N did

the CPI hold correctly. The hold was correct although it would have normally been two people to do the hold. Floor Tech N was terminated because he/she did not follow her directives regarding the de-escalation.

It was her expectation for all the residents to be free from abuse and neglect. It is everyone's responsibility to ensure residents are free from abuse and neglect. This would include leaders, managers, supervisors, directors as well as front line staff.2606143

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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Heritage Care Center

4401 North Hanley Road Saint Louis, MO 63134

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 0602

Protect each resident from the wrongful use of the resident's belongings or money.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review, facility staff failed to prevent the misappropriation of one resident's patient trust funds, which was used without authorization of the resident. The funds were withdrawn from resident's patient trust account between the dates of 4/10 and 4/17/25, with total withdrawals of $7,877.01 (Resident #20). The census was 105. Review of the facility's policy titled, Abuse and Neglect, dated 6/12/24, showed:-Misappropriation of resident property is the deliberate misplacement, exploitation, or wrongful, temporary or permanent, use of resident's belongings or money without the resident's consent;-Theft of money from bank accounts;-Unauthorized or coerced purchases from resident's funds;-The Administrator will conduct all investigations. A formal investigation shall begin immediately and include interviews with all staff, interview facility residents and document that interviews were completed. Review of Resident #20's Mental Status Exam, dated 8/18/25, showed:-No cognitive impairment;-Diagnoses included schizophrenia (a disorder that affects a person's ability to think, feel, and behave clearly), anxiety disorder, depression and dementia. Review of the resident's Trust Statement, dated 6/30/25, showed: -On 4/10/25, a $500.00 cash withdrawal with description, money for shopping with family;-On 4/17/25, a $5,756.16 (invoice #81466) and $1,620.85 (invoice #82089) withdrawal with description, Resident Essentials Clothing. Review of the Resident Essentials Clothing invoice #81466, dated 4/17/25, showed:-Various sweatpants, shirts and other clothing items;-[NAME] two drawer nightstand for $550.00;-[NAME] five drawer chest for $1,260.00;-Home music system for $135.00;-Two twin bed sets for a total of $270.00;-Pep talk recliner for $945.00. Review of

the Resident Essentials Clothing invoice #82089, dated 4/30/25, showed:-Various t-shirts, socks and other clothing items;-Two comforters for a total of $170.00. Observation on 9/8/25 at 3:30 P.M showed the resident sat on the edge of his/her bed with a large unopened box (24x18x24) marked Resident Essentials

on the floor, in front of the closet and a blue roller walker. There were black tote boxes filled with various t-shirts, sweatpants and tops. There were numerous baseball hats laying around the room. The style and color of the resident's bedding, dresser and nightstand were seen throughout the facility. The Pep talk recliner, [NAME] nightstand, [NAME] dresser, twin bed sets, and comforters were not present. Observation

on 9/9/25 at 9:04 A.M., showed the home music system in the unopened box in the resident's room and the Pep talk recliner were located in room A15. During an interview on 9/8/25 at 2:30 P.M., the resident said he/she did not give the facility permission to use his/her funds to make any purchases on his/her behalf.

The resident said he/she received some clothes and a recliner but requested those items be returned because he/she only wears Adidas clothing and the recliner was a waste of money. The resident said he/she never received a new dresser, nightstand, twin bed sets and comforters. During an interview on 9/8/25 at 3:30 P.M., the Business Office Manager (BOM) said when the corporate office reports a resident is over resources (Medicaid eligibility maximum resource is $5,909.25), he/she will ask the Certified Nurse Aides (CNA) what the resident needs, then will make those purchases on the resident's behalf. The BOM said he/she remembers giving the resident $500 to go shopping with his/her family but forgot to have the resident sign the ledger receipt book. The BOM said she did not speak to the resident prior to making purchases and was unaware the resident did not want the items or requested for the items to be returned.

During an interview on 9/9/25 at 9:30 A.M., the Administrator said she expected staff to follow the facility's patient withdrawal policy. The resident must sign the receipt for all withdrawals. The facility should not make purchases for a resident without first obtaining their permission and signature.

Residents Affected - Few

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

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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Heritage Care Center

4401 North Hanley Road Saint Louis, MO 63134

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 0684 Level of Harm - Minimal harm or potential for actual harm

staff became aware the resident was not enrolled in hospice, the nurse should have notified the physician.

The physician may have elected to send the resident to the hospital. All assessments and vital signs should be in the medical records. 2591480

Residents Affected - Few

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

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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Heritage Care Center

4401 North Hanley Road Saint Louis, MO 63134

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 - Some

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 a full time Director of Nursing (DON), who did not serve as a charge nurse, when the facility had a census over 60. The census was 105.Review of the facility's Registered Nurse (RN) policy, dated 4/30/24, showed:-Purpose: It is the intent of the facility to comply with Registered Nurse staffing requirements;-Full-time is defined as working 40 or more hours a week;-Charge Nurse is a licensed nurse with specific responsibilities designed by the facility that may include staff supervision, emergency coordinator, physician liaison, as well as direct resident care;-Policy:

The facility will utilize the services of a Registered Nurse for at least eight consecutive hours per day, seven days per week;-The facility will designate a Registered Nurse to serve as the Director of Nursing on a full time basis;-The Director of Nursing may serve as charge nurse only when the facility has average daily occupancy of 60 or fewer residents;-The facility is responsible for submitting timely and accurate staffing data through the CMS Payroll-Based Jornal (PBJ) system. Review of the facility's census, showed 105 residents. Review of the facility's staffing roster, showed the facility had a DON. Review of the facility's handwritten RN coverage, received on 9/9/25, showed the RN Supervisor provided RN coverage on 9/3/25, 9/4/25, 9/5/25, 9/8/25, and 9/9/25. During an interview on 9/3/25 at 10:52 A.M., the Administrator confirmed

the facility had a full time DON. During an interview on 9/9/25 at 12:25 P.M., Assistant Director of Nursing (ADON) B said the DON is on medical leave. He/She was unsure of when the DON would return. The RN Supervisor was the interim DON to his/her knowledge, but he/she was not sure if the RN provided RN coverage or the interim DON. During an interview on 9/9/25 at 12:41 P.M., the Administrator said the current DON was supposed to notify her of when he/she would return. The RN Supervisor is the interim DON and he/she started last week. On 9/8/25 and 9/9/25, he/she provided RN coverage. They did not have

an interim DON on 9/8/25 and 9/9/25. RN staff from corporate also provide eight hours of coverage. Some provide coverage every other weekend. It was discussed during their Quality Assurance and Quality Improvement (QAPI) meeting. It was discussed if the DON would be able to complete some tasks from home. During an interview on 9/9/25 at 1:40 P.M., the RN supervisor confirmed he/she was the RN supervisor.

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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Heritage Care Center

4401 North Hanley Road Saint Louis, MO 63134

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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

services are available to meet a wide range of nursing and rehabilitative needs. Residents shall be assessed for admission to Facility based on the following criteria:-Medical Status: The resident has an acute or longstanding unpredictable medical condition which requires intermittent emergency nursing services;-Social Behavior: The resident does not exhibit or suffer from any significant psychiatric or behavioral problems which may put himself/herself or others at risk of physical or emotional harm;-Personal Care: The resident requires on-going daily assistance with some or all activities of daily living (ADLs): dressing, eating, bathing, transferring, grooming, continence care, etc.;-Nursing Services: The resident requires daily monitoring of a health and/or medical condition by professional staff;-Skilled Services: The resident requires skilled medical services including but not limited to: physical, occupational, speech, and/or intravenous therapy, wound care. Review of the facility's Matrix (form used to track resident conditions and care needs), received on 9/3/25, showed:-Residents with diagnoses of Alzheimer's/Dementia: 20;-Hospice: 3;-Dialysis: 1;-Intravenous therapy: 1;-Indwelling catheter;-Post Traumatic Stress Disorder (PTSD)/Trauma: 7;-Insulin: 13;-Anticoagulant: 4;-Antianxiety: 24;-Antipsychotic: 85;-Antidepressant: 46;-Hypnotic: 5. During

the course of the survey process, problems were identified which included:-No full time Director of Nursing (DON);-No full time Social Worker or social service designee. During an interview on 9/9/25 at 12:31 P.M.,

the Administrator said she is responsible for ensuring the facility assessment is completed. She was supposed to do it but did not have maintenance or nursing information to add to the assessment. The only thing that was documented in the facility assessment was who they were supposed to call or when to use another facility, and contact information. She did not want to give a partial facility assessment. It was not a complete assessment.

Event ID:

Facility ID:

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