St Peters Post Acute

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

to get hurt. The resident then loudly told CNA B to get out of his/her room. CNA B said No, I am going to change you and asks the resident to roll over again. The resident said No and began to swing at the aide.

CNA B tapped the resident's fist with his/her fist again, then grabbed the pad under the resident. The resident yelled, Get out of my house! and grabbed at the aide's shirt. CNA B yelled, Why are you grabbing for me! and rolled the resident onto his/her side. The resident yelled out loudly Help! CNA B continued to provide peri-care;- At 6:11 A.M. the resident was on his/her back with CNA B on his/her right side of the bed, pulling the blankets back onto the resident. CNA B said, Don't you think this is pointless and who is going to help you? then laughed at the resident. The resident told CNA B to get out of his/her house. CNA B laughed at the resident again and with a gloved hand, tapped his/her fingers to the resident's lips and walked away. During an interview on 12/2/25 10:15 A.M. the Director of Nursing said the following:-After viewing the video's, CNA B acted very inappropriately towards the resident;-CNA B should have explained to the resident what he/she was doing before pushing on him/her and when the resident became upset, the aide should have removed him/herself and notified the nurse;-Staff need to treat residents with dignity and respect and not argue with the residents. During an interview on 12/2/25 at 10:15 A.M. the Administrator said the following:-It was obvious from the videos staff were not treating the residents with dignity and respect; -All staff are expected to treat all residents with dignity and respect, and to take their time with the residents. 2676560 26743972649705

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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

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

St Peters Post Acute

5400 Executive Centre Parkway Saint Peters, MO 63376

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

to make decisions;-No behaviors;-Dependent upon staff for all ADL's. Review of the resident's care plan for ADL's/Mobility with a revision date of 10/13/25 showed the following:-At risk for ADL/mobility decline and requires assistance related to chronic disease progression, cognitive impairment;-Assist with transfers and bed mobility. Review of the resident's ring camera footage from the resident's room supplied by the resident's family member dated 11/20/25 at 3:36 P.M. showed the following:-CNA F and CNA G were in the resident's room and provided the resident with incontinent care while the resident was in bed;-CNA G positioned a mechanical lift sling under the resident;-CNA F got the mechanical lift and pushed it under the resident's bed; CNA F and CNA G secured the sling to the mechanical lift;-CNA G got a wheelchair and then sat in a chair with the wheelchair in front of him/her while CNA F attempted to pull the mechanical lift out from under the bed, the lift legs were caught under the bed. CNA F pulled back on the lift several times, causing the resident to swing while he/she was up off the bed. The resident was off the bed approximately one foot;-CNA F moved the mechanical lift away from the bed, while CNA G sat in the chair and did not participate in moving the lift and resident to the wheelchair. When CNA F was close to the wheelchair, CNA G got up and moved the wheelchair, so the resident was hovering over the wheelchair. As CNA F lowered

the resident, CNA G pulled back on the sling and guided the resident down into the wheelchair. During an

interview on 11/25/25 at 4:25 P.M. CNA G said the following-There should always be two people when transferring a resident using a mechanical lift, one person works the controls of the lift, and the other person guides the resident;-He/She did not remember the transfer of 11/20/25 with Resident #2. During an

interview on 11/25/25 at 5:00 P.M. the Director of Nursing said the following:-Two staff are needed when using a mechanical lift, one person should be guiding the resident while the other staff is working the controls and pushing the machine;-She would expect that two staff members be used, one in guiding the resident while in the sling and the other working the controls of the mechanical lift for every resident who required a mechanical lift for transfers. 264977526743972676560

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

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

St Peters Post Acute

5400 Executive Centre Parkway Saint Peters, MO 63376

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

the residents brief which appeared to be urine soaked. CNA F then enters the resident's room with a pair of gloves on and a mechanical lift. CNA F took the soiled brief off the bed and tossed into a trashcan, then took the controls of the mechanical lift and raised the lift up, while with the same gloves on, CNA G pulled up the resident's pants, picked up the cell phone again, looked a the phone then placed the phone down on

the night stand, then pulled a wheelchair up to a chair in the room, sat down in the chair and held onto the handles of the wheelchair;-With the same gloves on CNA F transferred the resident from the bed to the wheelchair using the mechanical lift, lowered the resident into the chair, and removed the mechanical lift from the room;-Without removing his/her soiled gloves, CNA G took the resident out of the room. During an

interview on 11/25/25 at 4:25 P.M. CNA G said gloves should be changed and hands washed when care was completed and before touching anything else. During an interview on 11/25/25 at 5:00 P.M. the Director of Nursing said the following:-Staff should wash their hands before providing care and change their gloves and wash hands between clean and dirty tasks;-Staff should not wear the same gloves after providing peri care and touch items in the resident's room;-Staff should remove their gloves, perform hand hygiene and apply a new pair of gloves after peri care. 26765602674397

Event ID:

Facility ID:

If continuation sheet