Inspection Reports for
Sunrise of Webster Groves

19 CSR 30-86.047(46) Safe & Effective Medication System: Based on observation, interview and record review, the facility failed to provide a safe and effective medication system when a Level One Medication Aide (LIMA) administered medication without observing residents consume the medication for four observed residents during the morning medication pass and failed to sanitize an area of residents' skin before administering insulin.

19 CSR 30-86.047(58)(A) Resident Record Admission Info: Based on interview and record review, the facility failed to maintain a record for each resident which included contact information of the resident's preferred funeral director and dentist for four of seven sampled residents (Residents #5, #3, #2 and #6).

19 CSR 30-88.010(36) Personal Clothing/Possessions: Based on interview and record review, the facility failed to ensure personal inventory lists were completed for four of seven sampled residents (Residents #6, #5, #3 and #2), with some inventories marked waived or documented incompletely.

19 CSR 30-86.032(13) Electrical Wiring, Maintained, Inspected: The facility failed to ensure electrical wiring was inspected every two years by a qualified electrician; the deficiency affected all residents.

19 CSR 30-86.047(28)(G) Individual Service Plan - Develop: Based on interview and record review, the facility failed to ensure behaviors, interventions and preventions were documented in residents' Individualized Service Plans; two of four sampled residents had behaviors not documented on the ISP.

19 CSR 30-86.047(34)(A) Disease/Infection Control, Report Category I: Based on observation and interview, the facility failed to follow appropriate infection control when residents infected with COVID-19 were allowed to sit next to uninfected residents and a staff member failed to wear a mask, with potential to affect all residents.

19 CSR 30-88.010(23) Develop/Implement A/N Policies: Based on interview and record review, the facility failed to follow its abuse and neglect policy when an alleged incident occurred and employees did not immediately report the incident to Administration and the alleged perpetrator was allowed to continue contact with residents.

19 CSR 30-86.022(15)(A) Wastebaskets, Metal/UL/FM-Requirements Trash and Rubbish Disposal: Based on observation and interview on July 6, 2023, the facility failed to ensure all trash cans were metal, UL or FM-fire-resistant rated and plastic trash cans were observed in multiple resident rooms affecting fifty-three of fifty-three residents.

19 CSR 30-86.032(18) Extension Cords/Duplex Receptacles: Based on observation and interview on July 6, 2023, the facility failed to supervise use of unapproved multi-plug adapters and piggy-backed surge protectors with adapters observed in multiple resident rooms affecting fifty-three of fifty-three residents.

19 CSR 30-86.047(28)(F)(1)(B) Community Based Assessment - Semi-Annually: Based on interview and record review, the facility failed to complete semiannual community based assessments for three of eight sampled residents (Residents #3, #6 and #5).

19 CSR 30-86.047(28)(I) Individual Service Plan - Signatures: Based on interview and record review, the facility failed to ensure resident individualized service plans included required signatures from facility staff and the resident or legal representative for three of eight sampled residents (Residents #3, #6 and #5).

19 CSR 30-86.047(41) Medication Storage/Accessibility: Based on observation and interview, the facility failed to ensure medications were kept in a secured, locked location and were not accessible to residents during days of observation.

19 CSR 30-86.047(61)(A) Staffing Ration, Resident Care & Fire Safety: Based on interview and record review, the facility failed to ensure adequate personnel were available to assist a resident who fell during the night shift, requiring EMS assistance.

19 CSR 30-87.020(5) Toxic Material Storage: Based on observation and interview, the facility failed to ensure poisonous or toxic materials were kept locked or stored in a place not accessible to residents; several toxic/cleaning products were found in an unlocked cabinet accessible from the activities area.

19 CSR 30-88.010(23) Develop/Implement A/N Policies: Based on interview and record review, the facility failed to follow its abuse/neglect policy when an alleged incident occurred and allowed involved employees to continue contact with residents for two of eight sampled residents.

19 CSR 30-86.047(36) Proper Care Per Individual Service Plan: Based on observation, interview and record review the facility failed to ensure individualized service plans (ISPs) were updated to include residents' needs and required assistance for two of three sampled residents.

19 CSR 30-86.047(58)(B) Resident Condition/Medication Review: Based on interview and record review the facility failed to ensure a record of services provided by an outside provider was maintained in the resident's record for one of three sampled residents.

19 CSR 30-86.047(61)(A) Staffing Ration, Resident Care & Fire Safety: Based on observation, interview and record review the facility failed to ensure adequate staffing to answer call lights and provide care in an acceptable time frame for two of three sampled residents.

19 CSR 30-88.010(29) Dignity/Privacy: Based on interview and record review the facility failed to ensure a resident was treated with full recognition of dignity when staff transferred the resident with a Hoyer lift and left the resident suspended and exposed, causing the higher classification.

19 CSR 30-86.047(34)(A) Disease/Infection Control, Report Category I: Based on observation, interview and record review, staff failed to utilize acceptable infection control measures by not changing gloves and not washing or sanitizing hands during care of Residents #1 and #2 in two observed instances.

19 CSR 30-86.047(36) Proper Care Per Individual Service Plan: Based on observation, interview and record review, staff failed to provide proper care per residents' individualized service plans when wounds for Residents #2 and #1 were not addressed and documentation/treatment was inconsistent.

19 CSR 30-86.047(46) Safe & Effective Medication System: Based on interview and record review, the facility failed to ensure individuals administering medication to Resident #9 were appropriately licensed or certified, with an unqualified staff member administering a suppository.

19 CSR 30-86.047(47)(A) Physicians Orders Followed: Based on interview and record review, the facility failed to follow physician orders requiring weekly weights for Resident #7 and lacked documentation of the required weekly weights.

19 CSR 30-86.022(15)(A) Wastebaskets, Metal/UL/FM-Requirements: Based on observation and interview during a fire safety inspection on April 9, 2019 the facility failed to ensure all wastebaskets in the facility were metal, UL or FM-fire resistant rated; observations identified numerous resident rooms and common areas with plastic, wicker or other noncompliant wastebaskets and the Maintenance Coordinator stated families bring them in.

19 CSR 30-86.047(36) Proper Care Per Individual Service Plan: Based on observation, interview and record review, the facility failed to provide proper care per the resident's individualized service plan (ISP) for a resident who was a fall risk; staff did not assess and manage the resident's pain or notify the physician timely after increased pain and falls, and the resident was later diagnosed with a right femoral neck fracture.

19 CSR 30-86.047(28)(G) Individual Service Plan - Develop: Based on interview and record review, the facility failed to ensure resident individualized service plans (ISP) were updated to address the resident's needs, services to be provided by staff, goals and preferences for five of eight sampled residents.

19 CSR 30-86.047(46) Safe & Effective Medication System: Based on observation, interview and record review, the facility failed to provide a safe and effective medication system; staff failed to administer medications as ordered, failed to ensure residents took their medications, and failed to utilize proper medication administration techniques for five sampled residents.