VERONICA HOUSE.

PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES {X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C B.WING 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) 1D SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE A4724| 19 CSR 30-86.047(19) TB Screen Residents & Staff The facility shall screen residents and staff for tuberculosis as required for long-term care facilities by 19 CSR 20-20.100. Il This regulation is not met as evidenced by: Based on interview and record review, the facility failed to ensure the required two step TB test was completed prior to admission for seven of eight sampled residents (Residents #8, #3, #1, #4, #2, #7 and #5). The census was 83. General requirements for TB testing for staff and residents in Long Term Care Facilities, 19 CSR 20-20.100, reads as follows: -Long-term care facilities shall screen their residents and staff for tuberculosis. Each facility shall be responsible for ensuring that all test results are completed, and that documentation is maintained; -Within one month prior to or one week after admission, all residents new to long-term care are required to have the initial test of a two-step TB test; -If the resident's initial test is negative, the second test should be given one to three weeks later. The CDC (Centers for Disease Control) states TB tests should be read 48 to 72 hours after administration; -All long-term care facility residents shall have a documented annual evaluation to rule out signs and symptoms of TB disease; -All positive findings shall require a chest X-ray to rule out active pulmonary disease; -Individuals with a positive finding need not have repeat annual chest X-rays. They shall have a documented annual evaluation to rule out signs and symptoms of tuberculosis disease; -Within one month prior to starting employment, Missouri Department of Health and Senior Services LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNA (X6) DATE STATE FORM If continuation sheet 1 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C B. WING 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (x4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION PREFIX {EACH DEFICIENCY MUST BE PRECEDED BY FULL | PREFIX (EACH CORRECTIVE ACTION SHOULD BE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) VERONICA HOUSE A4724| Continued From page 1 all new to long-term care employees are required to have the initial test of a two-step TB test; -All employees and volunteers are required to obtain Mantoux PPD (purified protein derivative) two-step TB test within one month prior to starting employment in the facility. If the initial test is zero to nine millimeters (mm), the second test should be given three weeks after employment begins, unless documentation is provided indicating a PPD test in the past and at least one subsequent annual test within the past two years; -If the initial test is negative, the second test should be given as soon as possible within one to three weeks after employment begins. The CDC states TB tests should be read 48 to 72 hours after administration; -Employees with an initial zero to nine millimeters TB two step test shall have one step tuberculin testing annually and the results recorded in a permanent record. 1. Review of Resident #8's medical record, showed the following: -Admit date 11/7/24; -Diagnoses included muscle weakness. difficulty in walking, high blood pressure; | -No documented two-step TB/PPD test. 2. Review of Resident #3’s medical record, showed the following: -Admit date 2/13/25; -Diagnoses included diabetes, high blood pressure, high cholesterol and major depressive disorder, -A one-step TB/PPD test administered on 2/14/25, with O mm of induration documented, but no read on date documented _ -No documented second step. 3. Review of Resident #1's medical record, Missouri] Department of Health and Senior Services STATE FORM 6698 EF2G11 If continuation sheet 2 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C B.WING 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES | PROVIDER'S PLAN OF CORRECTION (x5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE A4724| Continued From page 2 showed the following: -Admit date 6/27/24; -Diagnoses included heart failure, gastro-reflux disease and heart disease: -A two-step TB/PPD test administered on 6/27/24, with 0 mm of induration documented, but no read on date documented; -A second-step TB/PPD test administered on 7/4/24, with 0 mm of induration documented, but no read on date documented; -A one-step TB/PPD test administered on 2/14/25, with O mm of induration documented, but no read on date documented: -A second-step TB/PPD test administered on 2/21/25, with 0 mm of induration documented, but no read on date documented. 4. Review of Resident #4's medical record, showed the following: -Admit date 3/23/20; -Diagnoses included diabetes, restless leg syndrome, and high cholesterol; -A one-step TB/PPD test administered on 3/5/25, with O mm of induration documented, but no read on date documented; -A second-step TB/PPD test administered on 6/6/24, with O mm of induration documented, but | no read on date documented and the second step was administered too late. 5. Review of Resident #2's medical record, showed the following: -Admit date 2/6/24: -Diagnoses included diabetes, dementia, high blood pressure, and chronic kidney disease: -A one-step TB/PPD test administered on 5/30/24, with O mm of induration documented, but no read on date documented; -A second-step TB/PPD test administered on 6/6/24, with O mm of induration documented, but Missouri Department of Health and Senior Services STATE FORM 6899 EF2G11 If continuation sheet 3 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C ee 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE Continued From page 3 no read on date documented; -A screening dated 1/1/25. 6. Review of Resident #7's medical record, showed the following: -Admit date 9/5/24; -Diagnoses included anorexia, heart failure, chest and back pain; -A one-step TB/PPD test administered on 9/5/24, with 0 mm of induration documented, but no read on date documented; -A second-step TB/PPD test administered on 9/12/24, with O mm of induration documented, but no read on date documented; -Ascreening dated 1/1/25. 7, Review of Resident #5's medical record, showed the following: -Admit date 12/23/24: -Diagnoses included kidney failure, high blood pressure and fatigue; -A two-step TB/PPD test administered on 12/23/24, with O mm of induration documented, but no read on date documented; -A second-step TB/PPD test administered on 12/30/24, with 0 mm of induration documented, but no read on date documented. 8. During an interview on 3/28/25 at 2:47 P.M., the Administrator said all TB/PPD tests should have the read on date documented on the test and the induration of reaction should be documented. The Administrator said all residents require a two-step TB/PPD test upon admission. 19 CSR 30-86.047(28)(G) Individual Service Plan - Develop The facility may admit or retain an individual for Missouri Department of Health and Senior Services STATE FORM ban EF2G11 If continuation sheet 4 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C B. WING 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x8) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG | REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE | DEFICIENCY) VERONICA HOUSE A4754 Continued From page 4 residency in an assisted living facility only if the individual does not require hospitalization or skilled nursing placement as defined in this rule, and only if the facility: (G) Develops an individualized service plan (ISP), which means the planning document prepared by ' an assisted living facility which outlines a resident ‘s needs and preferences, services to be provided, and goals expected by the resident or the resident's legal representative in partnership with the facility; II This regulation is not met as evidenced by: Based on interview and record review, the facility failed to develop individualized service plans which included resident falls, for five of eight sampled residents (Residents #6, #4, #2, #1 and #7). The census was 83. 1. Review of Resident #6's medical record, showed the facility admitted the resident on 12/3/19, with diagnoses of overactive bladder, bipolar, depression and history of falling. Review of the resident's ISP dated 11/21/24, showed the resident was at risk for falls due to medication, pain and overactive bladder. The resident would be encouraged to call for assistance when needed. The resident will not sustain major injury due to fall through the review date. The staff were to encourage and remind the resident to call for assistance immediately if he/she fell. The staff were to notify the resident's physician and treat injuries per the physician's orders. Review of the resident's progress notes dated 2/28/25 at 11:33 A.M., showed the resident said he/she walked along the path outside in the back of the building getting ready to feed the birds, Missouri Department of Health and Senior Services STATE FORM 6699 EF2G611 If continuation sheet 5 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES {X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C 8. WING ____ 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZiP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE Continued From page 5 when he/she spotted a fresh, crisp, one dollar bill in the grass. The resident said he/she took two steps and immediately fell down because he/she left his/her walker behind on the path. The staff sent the resident to the hospital. The Nurse notified the resident's responsible party and the resident's physician. During an interview on 3/28/25 at 1:00 P.M.., Registered Nurse (RN) F said the resident was found outside on his/her knees, leaning on a window sill. A resident who lived in the room, of the window sill the resident was leaning against, called for help. RN F went outside and assessed the resident and assisted the resident off the ground. RN F sent the resident to the hospital because the resident had a fractured wrist. During an interview on 3/28/25 at 2:15 P.M., the _ resident said he/she fell outside when he/she tried to feed the birds. The resident said he/she went to the hospital because he/she fractured his/her wrist. Review of the resident's ISP dated 11/21/24, showed the ISP did not address the resident's most recent fall and did not address a new intervention related to the fall to prevent future falls. 2. Review of Resident #4's medical record, showed the facility admitted the resident on 3/23/20, with diagnoses which included diabetes, restless leg syndrome, and high cholesterol. Review of the resident's ISP dated 12/2/24, showed the resident was at risk for falls due to impaired mobility, nocturia (frequent need to urinate during the night) and use of assistive device for ambulation. The resident would be Missouri Department of Health and Senior Services STATE FORM 6899 EF2G11 If continuation sheet 6 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C B. WING 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE Continued From page 6 encouraged to call for assistance when needed through the next review date. The staff were to ensure the residents room was free of clutter and the resident had a clear path to the bathroom. Review of the resident's progress notes dated 3/26/25 at 12:55 A.M., showed the resident alerted the Nurse when the resident turned on his/her call light. The Nurse found the resident on | the floor, on his/her buttocks beside his/her chair. | He/she said he/she lost his/her balance while he/she tried to plug in a cord to the socket. Range of motion was done to upper and lower extremities with no difficulties, and no bruises or redness were noted. Two staff members assisted the resident up. Review of the resident's ISP dated 12/2/24, showed the ISP did not address the resident's | mast recent fall and did not address a new intervention related to the fall to prevent future falls. 3. Review of Resident #2's medical record, _ showed the facility admitted the resident on 2/6/24, with diagnoses which included diabetes, dementia, high blood pressure, and chronic ' kidney disease. Review of the resident's ISP dated 2/4/25, showed the resident was at risk for falls due to unsteady gait. The resident would be encouraged to be free of injury through the next review date. The staff were to remind the resident to call for assistance and make sure the call light was in reach. Review of the resident's progress notes dated 3/26/25 at 7:00 A.M., showed the Nurse was alerted that the resident was found on the floor Missouri Department of Health and Senior Services STATE FORM ne EF2G11 If continuation sheet 7 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1} PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3} DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C ee 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (%5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE Continued From page 7 after a housekeeper heard someone yelling out. The resident was found laying on his/her left side, a head to toe assessment was completed. The resident complained of hitting the back of his/her head on a wheelchair petal. When the resident was being assisted up, he/she complained of of lower right leg pain, back pain, paramedics were called, family was notified and resident was transported to the hospital. Review of the resident's ISP dated 2/4/25, showed the ISP did not address the resident's most recent fall and did not address a new intervention related to the fall to prevent future falls. 4. Review of Resident #1's medical record, showed the facility admitted the resident on 6/27/24, with diagnoses which included heart disease and gastro-esophageal reflux disease. Review of the resident's ISP dated 12/31/24, showed the resident was at risk for falls due to unsteady gait. The resident would be encouraged to call for assistance when needed through the next review date. The staff were to remind the resident to call for assistance and to keep the call light within reach. | Review of the resident's progress notes dated 12/15/24 at 12:11 A.M., showed the Nurse entered the unit and saw the resident was sitting on the floor with staff in the room. The resident voiced pain while on the floor and said he/she slid from the bed onto the floor. The resident was able to move both legs and arms per nurses request, and able to bend knees. The resident was assisted to his/her feet and assisted with his/her walker. The resident was informed to walk forward and then backwards with his/her Missouri Department of Health and Senior Services STATE FORM 6899 EF2G611 If continuation sheet 8 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING: COMPLETED 22460C B. WING 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL {EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE Continued From page 8 walker. The resident did not complain of pain and no bruising was noted. The Nurse called the responsible party and Physician to inform them of | the fall. Review of the resident's ISP dated 12/31/24, showed the ISP did not address the resident's most recent fall and did not address a new _ intervention related to the fall to prevent future falls. | §. Review of Resident #7's medical record, showed the facility admitted the resident on | 9/5/24, with diagnoses which included anorexia, | heart failure, chest and back pain. Review of the resident's ISP dated 3/5/25, showed the resident was at risk for falls due to | his/her gait. The resident would be encouraged to call for assistance when needed through the next review date. The staff were to remind the resident to call for assistance. | Review of the resident's progress notes dated 3/26/25 at 6:00 A.M., showed the Nurse was called and alerted the resident was found on the floor laying on his/her left side. The Nurse assessed the resident from head to toe. The resident denied hitting his/her head or having any pain. There were no skin issues noted. The resident was assisted up to his/her feet and observed walking to the bathroom without any difficulty. The Nurse notified the supervisor and the resident's power of attorney. During an interview on 3/28/25 at 2:00 P.M., the resident said he/she remembered falling in his/her apartment. The resident said he/she reached for something and then next thing he/she knew, he/she was on the floor. The resident said Missouri Department of Health and Senior Services STATE FORM S899 EF2G11 If continuation sheet 9 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X%1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C i 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL : (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE A4754| Continued From page 9 "he/she called for help and help came. Review of the resident's ISP dated 3/5/25, showed the ISP did not address the resident's most recent fall and did not address a new intervention related to the fall to prevent future falls. 6. During an interview on 3/28/25 at 1:20 P.M., Licensed Practical Nurse (LPN) G said the way the online system was, it was hard to put falls on the ISPs. He/she did not know if the system could put that information on there but said the falls should be on the ISPs and any new interventions for that fall, should be documented on the ISP. 7. During an interview on 3/28/25 at 2:44 P.M., the Administrator said he did not know falls should be documented on the ISP but knew if there was a change of condition, the change of condition should be documented on the ISP. 19 CSR 30-86.047(63)(A) Alz/Dementia Training-Direct Care Staff, 3 hr In addition to the orientation training required in section (62) of this rule any facility that provides care to any resident having Alzheimer 's disease or related dementia shall provide orientation training regarding mentally confused residents such as those with Alzheimer ' s disease and related dementias as follows: (A) For employees providing direct care to such persons, the orientation training shall include at least three (3) hours of training including at a minimum an overview of mentally confused residents such as those having Alzheimer 's disease and related dementias, communicating with persons with dementia, behavior Missouri Department of Health and Senior Services STATE FORM G69 EF2G11 If continuation sheet 10 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C B.WING_ 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE Continued From page 10 management, promoting independence in activities of daily living, techniques for creating a safe, secure and socially oriented environment, provision of structure, stability and a sense of routine for residents based on their needs, and understanding and dealing with family issues; and IWIN This regulation is not met as evidenced by: Class II* Based on interview and record review, the facility failed to ensure all employees providing direct care to residents had at least three hours of Alzheimer's disease and/or dementia training recorded in the employee's file for two of two sampled employees. The census was 83. 1. Review of Licensed Practical Nurse A's personnel file, showed the following: -Hire date 7/22/24; -No documentation of at least three hours of Alzheimer's disease and/or dementia training. 2. Review of Certified Medication Technician B's personnel file, showed the following: -Hire date 3/3/25; -One hour of Alzheimer's disease training completed 3/3/25; -No additional Alzheimer's disease and/or dementia training. 3. During an interview on 3/28/25 at 3:00 P.M., the Administrator said he knew the direct care staff required three hours of Alzheimer's training, and he thought he had the training documented in the employees' personnel files. *The higher classification merited due to the extent of the violation. Missouri Department of Health and Senior Services STATE FORM ci EF2G11 If continuation sheet 11 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C ——— 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EAGH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE 19 CSR 30-87.030(2) Wash Hands/Arms & Clean Fingernails Employees shall thoroughly wash their hands and the exposed portions of their arms with soap and warm water before starting work, during work as often as is necessary to keep them clean and after smoking, eating, drinking or using the toilet. Employees shall keep their fingernails clean and trimmed. I/II! | This regulation is not met as evidenced by: Class II* Based on observation and interview, the facility failed to ensure all staff washed their hands and/or wore gloves when plating and serving food in the kitchen. The census was 83. Observation on 3/28/25 between 7:42 A.M. and 8:00 A.M., of the breakfast plating and service, showed the following: -At 7:42 A.M., Cook C donned a pair of gloves, with his/her right hand grabbed a scoop and placed eggs on a plate, with same gloved hand, grabbed another scoop and put oatmeal into a bowl, and with same gloved hand, grabbed bacon from the warming table and placed it onto the plate. He/she put the plate into the window for service and removed his/her gloves; -At 7:45 A.M., Cook C donned a new pair of gloves, with his/her right hand, grabbed the scoop for the eggs and put eggs on the plate. He/she used the same gloved hand, picked up bacon from warming table, and placed the bacon onto the plate. He/she removed his/her gloves and washed his/her hands; -At 7:47 A.M., Cook C donned a new pair of gloves and with his/her right hand, picked up bacon from the warming table and placed it on a Missouri Department of Health and Senior Services STATE FORM saga EF2G11 If continuation sheet 12 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C B.WING 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (x4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE A7002) Continued From page 12 plate. With same gloved hand, scooped eggs onto a plate, grabbed more bacon from the warming table, and placed it on a plate. With same gloved hand, grabbed the scoop and put oatmeal into a bowl, and with same gloved hand picked up bacon from the warming tray and placed it onto the plate. With the same gloved hand, he/she used a scoop to put cream of wheat into a bowl, then used a different scoop to put eggs onto a plate, and then used his/her gloved hand to grab bacon from the warming table and placed the bacon onto the plate. He/she placed a plate into the window, removed his/her gloves and washed his/her hands; -At 7:50 A.M., Cook C donned a new pair of gloves and with his/her right hand, grabbed a | Scoop and placed eggs onto a plate. He/she used the same gloved hand to grab bacon from the warming table and placed it onto the plate. With his/her same gloved hand, he/she grabbed a scoop and placed eggs on the plate, grabbed another scoop and placed oatmeal into a bowl, grabbed the previous scoop and placed eggs onto another plate, grabbed a scoop and placed oatmeal into a bowl, grabbed another scoop and placed cream of wheat into a bowl, grabbed a scoop and placed eggs onto a plate, and with same gloved hand, grabbed bacon from the warming table and placed it onto the plates. With the same gloved hand, the Cook grabbed the scoop for the eggs and placed the eggs on the plate, and grabbed bacon from the warming table and placed the bacon on to the plate. With the same gloved hand, grabbed a scoop for the eggs, placed the eggs onto the plate, grabbed a scoop for cream of wheat and placed it into a bowl, grabbed a scoop for oatmeal and placed the oatmeal into the bowl, grabbed a scoop for the eggs and placed the eggs on the plate. With same gloved hand, he/she grabbed bacon from Missouri Department of Health and Senior Services STATE FORM 5898 EF2G11 If continuation sheet 13 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C B. WING 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (x4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE Continued From page 13 the warming table and placed it onto the plates. He/she removed his/her gloves and washed his/her hands. During an interview on 3/28/25 at 2:43 P.M., the Dining Services Director said she expected the cook to change gloves between surfaces that may contaminate the food. She said she expected the cook not to plate bacon with his/her hand but to use tongs when plating. She said she was not aware the cook was not using the correct utensils when plating food. During an interview on 3/28/25 at 2:55 P.M., the Administrator said he expected the cook to wash his/her hands before handling any food items, before he/she starts another task. He said he did not expect the cook to touch food with same gloved hands that were used to touch other surfaces in the kitchen. He said he also did not expect the cook to plate bacon with his/her hands. “The higher the classification merited due to the extent of the violation. 19 CSR 30-87.030(3) Clean Clothing, Hair Restraints The outer clothing of all employees shall be clean and employees shall use effective hair restraints to prevent the contamination of food or food-contact surfaces. III This regulation is not met as evidenced by: Based on observation and interview, the facility failed to ensure the proper use of hair restraints, when two employees who did not wear hair restraints, and one employee who failed to keep Missouri Department of Health and Senior Services STATE FORM 6090 EF2G11 If continuation sheet 14 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES {X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C Be WING 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE Continued From page 14 his/her hair fully within the hair restraint, served food for meal preparation and service. The census was 83. 1. Observation on 3/28/25 at 7:44 A.M., showed an unknown Server who stood at the servery counter, opened a bag of shredded cheese and poured it into a plastic bag. The Server resealed the bag and walked the cheese to the refrigerator without wearing a hair restraint. 2. Observation on 3/28/25 at 7:50 A.M., showed Server E walk through the kitchen from the back hallway to the dining room two times, passed by the servery area with the resident's plates of food, without wearing a hair restraint. 3. Observation on 3/28/25 at 7:55 A.M., showed | Server D stood at the servery counter, plated | toast for resident's plates, and carried them to the dining roam. Server D's bangs were not contained within the hair restraint on the front of his/her forehead. 4. During an interview on 3/28/25 at 2:43 P.M., the Dining Services Director said she expected all of her staff to wear hair restraints in the kitchen when food is being served. She said she was not aware that some staff were not wearing hair restraints. | 5. During an interview on 3/28/25 at 2:55 P.M., the Administrator said he expected hair restraints to cover all loose hair and he expected all dietary staff to have on hair restraints with no loose hair coming out of the restraints. ; 19 CSR 30-87.030(13) Food-Protected, Temp, Need to Contact DHSS Missouri Department of Health and Senior Services STATE FORM 6399 EF2G11 If continuation sheet 15 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER; A. BUILDING: COMPLETED 22460C B. WING 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE | COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE | DEFICIENCY) VERONICA HOUSE Continued From page 15 At all times, including while being stored, prepared, displayed, served or transported to or from the facility, food shall be protected from potential contamination, including dust, insects, rodents, unclean equipment and utensils, unnecessary handling, coughs and sneezes, flooding, drainage and overhead leakage or overhead drippage from condensation. The temperature of potentially hazardous food shall be forty-five degrees Fahrenheit (45°F) or below or one hundred forty degrees Fahrenheit (140°F) or above at all times, except as otherwise provided in this section. In the event of a fire, | flood, power outage or similar event that might result in the contamination of food, or that might prevent potentially hazardous food from being held at required temperatures, the person in charge shall immediately contact the Department of Health and Senior Services (the department). Upon receiving notice of this occurrence, the department shall take whatever action that it deems necessary to protect the residents. II/III This regulation is not met as evidenced by: Class II* Based on observation and interview, the facility failed to ensure stored food was maintained free from potential contamination and foods requiring refrigeration, were refrigerated between meals. The census was 83. 1. Observation on 3/28/25 between 8:09 A.M. and 1:26 P.M., of the dry storage, showed the following: -A 6 pound 11 ounce can of crushed pineapple, on the floor and propped open the door to the room; -A 1/2 one gallon bottle of teriyaki sauce, one 1/4 Missouri Department of Health and Senior Services STATE FORM 6089 EF2G611 If continuation sheet 16 of 17 PRINTED: 04/09/2025 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION (IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C ji. 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) VERONICA HOUSE A7015| Continued From page 16 full one gallon bottle of soy sauce, one 1/8 full 1/2 gallon bottle of soy sauce, one 1/2 full 1/2 gallon bottle of sweet and sour sauce, and one 3/4 full 1/2 gallon bottle of sweet and sour sauce. The bottles read, "refrigerate after opening." 2. Observation on 3/28/25 between 8:06 A.M. and 1:29 P.M., of the walk in freezer, showed one 6 1/2 pounds, unopened case of fried potatoes, and three 3 gaflon tubs of ice cream on the floor. 3. During an interview on 3/28/25 at 2:43 P.M., the Dining Services Director said there should not be any food stored on the floor and if something says it is supposed to be refrigerated, she expected it to be refrigerated. She was aware there was a can propping open the door to the dry storage but was not aware there were condiments that required refrigeration an the shelves and not in the refrigerator. 4. During an interview on 3/28/25 at 2:55 P.M., the Administrator said he expected all food to be stored appropriately. He was not aware food was stored on the floor or that items that required refrigeration were not being refrigerated. He said they should all be stored correctly. *The higher classification is merited due to the extent of the violation. Missouri Department of Health and Senior Services STATE FORM 6899 EF2G611 If continuation sheet 17 of 17 PLAN OF CORRECTION The Sarah Community - Veronica House be iv Provider/Supplier Name: Street Address, “ae 12284 DePaul Drive, Bridgeton, Missouri 63122 City, Zip: Date of Survey: March 28, 2025 PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION: (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) | 2 3 4, | The submission of this response and Plan of Correction is not legal admission that a deficiency was correctly cited. This Plan of Correction is not to be construed as admission against interest by The Sarah Community Administration or any employee agents or other individuals who may draft or who may be discussed in the response and Plan of Correction. In addition, preparation and submission of this Plan of Correction does not constitute any admission or agreement of any kind by The Sarah Community of the truth of any facts alleged or correctness of any conclusion set forth in this allegation by the Survey Agency. Pe 1. Resident Care Director gave Resident #8, #4, and #3 their two-step TB test. Administration date, results, and read dates have been recorded in the EMR. Residents #2, #7, and #5 were updated to include the dates they were read. . Resident Care Director will audit all resident files to ensure A4724 appropriate TB, results, and documentation. Resident Care Director will coordinate with IT to ensure EMR has an appropriate place to document read date, as well as results. Resident Care Director will monitor TB completion and documentation and report monthly at QAP!| meetings for three months. CO 1. Resident Care Director updated individualized service plans for residents #6, #4, #2, #1, and #7, to include risk of falls and interventions. 2. Resident Care Director audited all resident individualized service plans to ensure comprehensiveness, specifically regarding falls and fall risks. 3. Resident Care Director will provide in-service training to all nursing staff inputting individualized service plans. A4754 COMPLETION DATE 5/20/2025 5/20/2025 A4856 Training will include thoroughness specifically with fall risk and interventions. Resident Care Director will monitor individualized service plans for all new admissions and periodic updates and report monthly at QAPI meetings for three months. The Education Coordinator has provided the required three hours of dementia training for LPN A and CMT B and documented the training in the respective personnel files, Human Resources Manager will audit all current employee files to ensure appropriate documentation of Alzheimer's/dementia training including duration. Human Resources Manager will create a checklist to outline all state required criteria that must be completed prior to the first day of employment. Human Resources Manager will report on audit results at monthly Quality Assurance and Performance Improvement (QAPI) meetings, on all employees hired in that timeframe for 3 months. A7002 A7003 5/20/2025 Director of Dining Services provided 1:1 in-service training to Cook C regarding handwashing and cross contamination. Director of Dining Services will provide in-service training to all dining/kitchen employees on handwashing and cross contamination prevention. Director of Dining Services will post signage reminding staff about cross contamination and hand hygiene. Director of Dining Services will conduct visual rounds to ensure staff are complying. Director of Dining Services will monitor ongoing and report monthly at QAPI meetings for three months. 5/20/2025 Director of Dining Services provided 1:1 in-service training to Server E and Server D regarding the proper use of hair restraints. Director of Dining Services will provide in-service training to all dining/kitchen employees on proper use of hair restraints. Director of Dining Services will post signage reminding staff about properly wearing hair restraints. Director of Dining Services will conduct visual rounds to ensure staff are complying. Director of Dining Services will monitor ongoing and report monthly at QAPI meetings for three months. A7015 5/20/2025 Director of Dining Services removed the can of crushed pineapple that was being used as a door stop and placed the unopened potatoes and ice cream on the floor of the freezer on the shelf. Director of Dining Services removed and disposed of all partial bottles of teriyaki sauce, soy sauce, and sweet and sour sauce, that were not refrigerated after opening. 5/20/2025 Director of Dining Services audited all food storage areas to ensure proper food storage. Director of Dining Services will provide all dining/kitchen staff in-service training on reading labels and proper food storage. 3. Director of Dining Services and Director of Facilities installed doorstops where needed, and ensured ample shelving for storage is available. 4. Director of Dining Services will monitor proper food storage techniques ongoing and report monthly at QAPI meetings for three months. the plan of correction being submitted on this form.

PRINTED: 05/09/2024 FORM APPROVED Missouri Department of Heaith and Senior Services STATEMENT OF DEFICIENCIES {X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (%3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C B.WING 05/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12284 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) 1D SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION {X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL {EACH CORRECTIVE ACTION SHOULD BE | COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) i VERONICA HOUSE 19 CSR 30-86.022(9)(C) Fire Alarm System-Test/Maintain Complete Fire Alarm Systems. (C) All facilities shall test and maintain the complete fire alarm system in accordance with NFPA 72, 1999 edition. I/II This regulation is not met as evidenced by: Class Il Based on record review and interview on May 02, 2024, the facility failed to ensure the complete fire alarm system was tested and maintained in accordance with National Fire Protection Association (NFPA) 72, 1999 edition. The facility census on May 02, 2024 was 67. This deficiency potentially affects 67 of 67 residents. Record review on May 02, 2024, at 3:15 P.M. | showed no semi-annual inspection had been | conducted of the fire alarm system as required by (NFPA) 72, 1999 edition. Table 7-3.1. Records . show the last semi-annual fire alarm system was completed on March 17, 2023. During an interview on May 02, 2024, at 3:58 : P.M. the facility Director of Plant Operations said i he/she would schedule a semi-annual fire alarm inspection to be completed six months after an annual inspection is completed. 19 CSR 30-86.022(9)(D) Fire Alarm System Inspections/Certifications Complete Fire Alarm Systems. (D) All facilities shall have inspections and written certifications of the complete fire alarm system completed by an approved qualified service representative in accordance with NFPA 72, 1999 edition, at least annually. |Al Missouri Department of Health and Senior Services PLL 'S OR PROYIDER/SUPPLIER REPRESENTATIVE’S SIGNATURE TITLE - (X6) DATE hee f i a , wf. se . “eG ey be an Hamiunistrates 2 LLG / 202, 8898 JO¥211 If continuation sheat 1 of 2 PRINTED: 05/09/2024 FORM APPROVED Missouri Department of Heaith and Senior Services STATEMENT OF DEFICIENCIES (Xt) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 22460C B.WING 05/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12234 DEPAUL DRIVE BRIDGETON, MO 63044 (X4) (D SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION ; (X5} PREFIX (EACH DEFICIENCY MUST 8E PRECEDED 8Y FULL (EACH CORRECTIVE ACTION SHOULD BE : COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE i DATE i DEFICIENCY) | VERONICA HOUSE Continued From page 1 This regulation is not met as evidenced by: Class II | Based on record review and interview on May 02, 2024, the facility failed to have inspections and written certifications of the complete fire alarm system completed by an approved qualified | Service representative in accordance with : National Fire Protection Association (NFPA) 72, | 1999 edition, at least annually. The facility census | on May 02, 2024 was 67. This deficiency | potentially affects 67 of 67 residents. Record review on May 02, 2024, at 3:15 P.M. showed no annual fire alarm system inspection ' had been completed of the fire alarm system as _ required by (NFPA) 72, 1999 edition. Records | show the last annual fire alarm system inspection ' was completed on October 22, 2022. During an interview on May 02, 2024, at 3:58 P.M. the facility Director of Plant Operations said he/she would have an annual fire alarm system inspection scheduled. Missouri Department of Health and Senior Services STATE FORM 6898 JDY211 if continuation sheet 2 of 2 PLAN OF CORRECTION P . rovider/Supplier Veronica House Name Street Address, 12284 DePaul Dr. City, Zip: : Bridgeton, MO 63044 Date of Survey: Tay 2, 2024 PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER 22460C ID PREFIX | PROVIDER'S PLAN OF CORRECTION: (EACH CORRECTIVE ACTION SHOULD BE | COMPLETION TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) DATE The submission of this response and Plan of Correction is not legal admission that a deficiency was correctly cited. This Plan of Correction is not to be construed as admission against interest by Veronica House Administration or any employee agents or other individuals who may draft or who may be discussed in the response and Plan of Correction. In addition, preparation and submission of this Plan of Correction does not constitute any admission or agreement of any kind by Veronica House of the truth of any facts alleged or correctness of any conclusion set forth in this allegation by the Survey Agency. The facility will ensure the fire alarm system is tested and maintained in accordance with the requirements of the National Fire Protection Agency (NFPA) 72, 1999 edition. The Director of Plant Operations and/or designee will ensure proper semi-annual inspection/testing of the fire alarm system is scheduled or completed by qualified contractor and personnel within six months 06/08/24 following the completed annual fire alarm system inspection. The Director of Plant Operations and/or designee will ensure receipt of the personnel qualifications are obtained. Going forward, the Director of Plant Operations will report testing and inspection dates to the Quality Assurance Committee for monitoring and performance improvement at their monthly meetings, which are overseen by the administrator. The facility will ensure the fire alarm system is tested and maintained in accordance with the requirernents of the National Fire Protection Agency (NFPA) 72, 1999 edition. A2249 The Director of Plant Operations and/or designee will ensure that inspections and written certifications of the complete fire alarm system A2250 | is scheduled and completed by a qualified contractor and personnel by 06/08/24 | the compliance date. The Director of Plant Operations and/or designee will ensure qualifications of the personnel are obtained. Going forward, the Director of Plant Operations will report testing and inspection dates to the Quality Assurance Committee for monitoring and performance improvement at their monthly meetings which are overseen by the administrator. The Administrator signing and dating the first page of the CMS 2567/State Form is inatcating their approval of A the plan of correction being submitted on this form. KL b / f j pis . ht | w A n “str oO. tet ra 5[p§/acad