4 health deficiencies
Top issue: Pharmacy Service (2 deficiencies)
1 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Saint Peters, MO
2-star overall rating with 3-star inspections with 4 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
3801 Mcclay Road, Saint Peters, MO
(636) 244-3323
Overall
2 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
1 / 5
RN + nurse staffing
Quality measures
2 / 5
Resident outcomes and process measures
Quick facts
Beds
60
Certified beds
Average residents
52
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
2019-01-10
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
RN hours / resident day
0.00
Registered nurse staffing
LPN hours / resident day
0.00
Licensed practical nurse staffing
Aide hours / resident day
0.00
Nurse aide staffing
Total nurse hours
0.00
All reported nurse hours
Licensed hours
0.00
RN + LPN hours
Weekend hours
0.00
Weekend nurse staffing
Weekend RN hours
0.00
Weekend registered nurse coverage
Physical therapist
0.00
Reported PT staffing
Adjusted RN hours
0.00
CMS adjusted RN staffing hours
Adjusted total hours
0.00
CMS adjusted total nurse staffing hours
Case-mix index
0.00
Higher values indicate more complex resident acuity
RN turnover
0%
Annual RN turnover
Total nurse turnover
38%
Annual nurse turnover · state 57% · national 46%
SNF VBP
Program rank
8,880
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
25.39
Composite VBP score used to determine payment impact.
Payment multiplier
0.9838
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
1.09
Baseline 21.23% · Performance 20.93% · Measure score 1.09 · Achievement 1.09 · Improvement 0.22
Healthcare-associated infections
0
Baseline 7.98% · Performance 8.91% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
3.57
Performance 49.09% · Measure score 3.57 · Achievement 3.57 · This facility did not have sufficient data to calculate a baseline period measure result.
Adjusted total nurse staffing
5.50
Baseline 4.47 hours · Performance 4.64 hours · Measure score 5.50 · Achievement 5.50 · Improvement 0.82
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.59% |
10.72%
0.1 pts better
|
No Different than the National Rate · Eligible stays 139 · Observed rate 10.79% · Lower 95% interval 7.86% |
| Discharge to community | 41.72% |
50.57%
8.9 pts worse
|
No Different than the National Rate · Eligible stays 125 · Observed rate 32.8% · Lower 95% interval 33.11% |
| Medicare spending per beneficiary | 0.82 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 82 · Denominator 82 |
| Falls with major injury | 2.44% |
0.77%
1.7 pts worse
|
Numerator 2 · Denominator 82 |
| Discharge self-care score | 45.45% |
53.69%
8.2 pts worse
|
Numerator 25 · Denominator 55 |
| Discharge mobility score | 45.45% |
50.94%
5.5 pts worse
|
Numerator 25 · Denominator 55 |
| Pressure ulcers or injuries, new or worsened | 1.22% |
2.29%
1.1 pts better
|
Numerator 1 · Denominator 82 · Adjusted rate 1.49% |
| Healthcare-associated infections requiring hospitalization | 8.91% |
7.12%
1.8 pts worse
|
No Different than the National Rate · Eligible stays 78 · Observed rate 11.54% · Lower 95% interval 5.51% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 73 |
| Staff flu vaccination coverage | 7.37% |
42%
34.6 pts worse
|
Numerator 7 · Denominator 95 |
| Discharge function score | 52.73% |
56.45%
3.7 pts worse
|
Numerator 29 · Denominator 55 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 26 · Denominator 26 |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 38 · Denominator 38 |
| Resident COVID-19 vaccinations up to date | 35.42% |
25.2%
10.2 pts better
|
Numerator 17 · Denominator 48 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 3.2 |
2.1
1.1 pts worse
|
1.9
1.3 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 3.2 · Observed 2.0 · Expected 1.2 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.3 |
2.3
1 pts better
|
1.8
0.5 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.3 · Observed 0.8 · Expected 1.1 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 93.0% |
84.8%
8.2 pts better
|
93.4%
0.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 95.2% · Q2 89.2% · Q3 91.9% · Q4 95.1% · 4Q avg 93.0% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 85.7% |
90.9%
5.2 pts worse
|
95.5%
9.8 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 85.7% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 6.4% |
4.1%
2.3 pts worse
|
3.3%
3.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 4.8% · Q2 5.4% · Q3 8.1% · Q4 7.3% · 4Q avg 6.4% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
14.7%
14.7 pts better
|
11.4%
11.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents who lose too much weight | 7.6% |
5.5%
2.1 pts worse
|
5.4%
2.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.7% · Q2 4.0% · Q3 11.5% · Q4 11.1% · 4Q avg 7.6% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 1.0% |
25.3%
24.3 pts better
|
19.6%
18.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 3.7% · 4Q avg 1.0% |
| Percentage of long-stay residents who received an antipsychotic medication | 20.7% |
25.0%
4.3 pts better
|
16.7%
4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 14.3% · Q3 22.7% · Q4 25.0% · 4Q avg 20.7% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.0%
About the same
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 25.3% |
20.3%
5 pts worse
|
16.3%
9 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 25.3% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 12.9% |
19.8%
6.9 pts better
|
14.9%
2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 14.8% · Q2 20.0% · Q3 16.7% · Q4 0.0% · 4Q avg 12.9% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.2% |
1.4%
0.2 pts better
|
1.0%
0.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 3.0% · Q3 2.1% · Q4 0.0% · 4Q avg 1.2% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.0% |
2.6%
2.6 pts better
|
1.7%
1.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 12.5% |
18.1%
5.6 pts better
|
19.8%
7.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 14.3% · Q2 10.8% · Q3 14.6% · Q4 10.3% · 4Q avg 12.5% |
| Percentage of long-stay residents with pressure ulcers | 5.6% |
5.0%
0.6 pts worse
|
5.1%
0.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.0% · Q2 2.7% · Q3 11.4% · Q4 6.5% · 4Q avg 5.6% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 55.9% |
66.4%
10.5 pts worse
|
81.7%
25.8 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 31.4% · Q2 38.5% · Q3 68.9% · Q4 84.3% · 4Q avg 55.9% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 17.9% |
13.4%
4.5 pts worse
|
12.0%
5.9 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 17.9% · Observed 16.9% · Expected 10.5% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
2.2%
2.2 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 43.3% |
63.5%
20.2 pts worse
|
79.7%
36.4 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 43.3% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 28.4% |
25.3%
3.1 pts worse
|
23.9%
4.5 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 28.4% · Observed 25.4% · Expected 21.2% · Used in QM five-star |
Survey summary
Top issue: Pharmacy Service (2 deficiencies)
1 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Top issue: Quality of Life and Care (5 deficiencies)
18 fire-safety deficiencies
Top issue: Emergency Preparedness (8 deficiencies)
Top issue: Quality of Life and Care (6 deficiencies)
1 fire-safety deficiencies
Top issue: Smoke (1 deficiency)
Fire safety
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2024-05-17
Fire Safety
Address subsistence needs for staff and patients.
Corrected 2022-10-06
Fire Safety
Establish policies and procedures including evacuation.
Corrected 2022-10-06
Fire Safety
Establish policies and procedures for sheltering.
Corrected 2022-10-06
Fire Safety
Establish policies and procedures for volunteers.
Corrected 2022-10-06
Fire Safety
Establish roles under a Waiver declared by secretary.
Corrected 2022-10-06
Fire Safety
Provide a means of sharing information on occupancy/needs.
Corrected 2022-10-06
Fire Safety
Provide family notifications of emergency plan.
Corrected 2022-10-06
Fire Safety
Develop and maintain an Emergency Preparedness Program (EP).
Corrected 2022-10-06
Fire Safety
Ensure that testing and maintenance of electrical equipment is performed.
Corrected 2022-10-06
Fire Safety
Meet other general requirements.
Corrected 2022-10-06
Fire Safety
Use approved construction type or materials.
Corrected 2022-10-06
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2022-10-06
Fire Safety
Have an enclosure around a vertical opening shaft.
Corrected 2022-10-06
Fire Safety
Provide properly protected cooking facilities.
Corrected 2022-10-06
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2022-10-06
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2022-10-06
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2022-10-06
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2022-10-06
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2020-01-05
Inspection history
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2025-05-12
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-05-17
Health
Ensure that residents are free from significant medication errors.
Corrected 2024-05-17
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2024-05-17
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2023-10-25
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2023-10-25
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-10-25
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2022-10-06
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2022-10-06
Health
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Corrected 2022-10-06
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2022-10-06
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2022-10-06
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2022-10-06
Health
Provide and implement an infection prevention and control program.
Corrected 2022-10-06
Health
Make sure that a working call system is available in each resident's bathroom and bathing area.
Corrected 2022-10-06
Health
Keep residents' personal and medical records private and confidential.
Corrected 2022-10-06
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2022-10-06
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2022-10-06
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2022-10-06
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2022-10-06
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2022-10-06
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2020-01-05
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2020-01-05
Health
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected 2020-01-05
Health
Honor the resident's right to manage his or her financial affairs.
Corrected 2020-01-05
Health
Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.
Corrected 2020-01-05
Health
Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
Corrected 2020-01-05
Health
Assess the resident when there is a significant change in condition
Corrected 2020-01-05
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2020-01-05
Health
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected 2020-01-05
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2020-01-05
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2020-01-05
Health
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.
Corrected 2020-01-05
Health
Provide and implement an infection prevention and control program.
Corrected 2020-01-05
Health
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected 2020-01-05
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2020-01-05
Health
Respond appropriately to all alleged violations.
Corrected 2020-01-05
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2020-01-05
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2020-01-05
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2020-01-05
Health
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.
Corrected 2020-01-05
Health
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected 2020-01-05
Penalties and ownership
5% Or Greater Direct Ownership Interest · Individual
5% Or Greater Direct Ownership Interest · Individual
Corporate Director · Individual
Corporate Officer · Individual
W-2 Managing Employee · Individual
Corporate Officer · Individual
Nearby options
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1-star overall rating with 1-star inspections with $69,999 in total fines with 19 recent health deficiencies with 9 fire-safety deficiencies in the latest cycle
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