FOUNTAINS OF WEST COUNTY AL, LLC THE.

“Based on record review and interview on, the | facility failed to conduct fire drills with at least one (1) fire drill every three (3) months on each shift. The facility census was 60. This deficiency affects 60 out of 60 residents. Record review on November 3, 2025, at 12:00 P.M. showed no documentation of a fire drill being performed on the first shift from April, 2025 through October 2025. This could impede the first shift's ability to perfform an evacuation in case of emergency During an interview on November 3, 2025, at the time of discovery, the Maintenance Director said that he/she was new and was not aware the drills had not been performed properly. TITLE / /, {X8) DATE PLAN OF CORRECTION Provider/Supplier Name: The Fountains of West County Assisted Living 15822 Clayton Rd Ellisville, Mo. 63011 City, Zip: Date of Survey: 41/4/2025 PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) DATE {t will be placed on the maintenance directors calendar to complete a fire drill each month with the times rotating each month between day shift, evening shift and night shift. So by the end of the year 4 fire drills will be completed on each shift by the end of the year. The Administrator will ensure the drills have been completed by the end of each month following the same calendar the maintenance director follows. A2217 11/5/2025 11/5/2025 The Administrator signing and dating the first page of the CMS-2567/State Form is indicating their approval of the plan of correction being submitted on this form. yom a Ue hs”

“In facilities that are constructed or have plans approved after July 1, 2005, electrical wiring shall be installed and maintained in accordance with the requirements of the National Electrical Code, 1999 edition, National Fire Protection Association, Inc., incorporated by reference, in this rule and available by mail at One Batterymarch Park, Quincy, MA 02269, and local codes. This rule does not incorporate any subsequent amendments or additions to the materials incorporated by reference. Facilities built between September 28, 1979 and July 1, 2005 shall be maintained in accordance with the requirements of the National Electrical Code, which was in effect at the time of the original plan approval and local codes. This rule does not incorporate any subsequent amendments or additions. In facilities built prior to September 28, 1979, electrical wiring shall be maintained in good repair and shall not present a safety hazard. All facilities shall have wiring inspected every two (2) years by a qualified electrician. II/III”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“Based on record review and interview on October 31, 2024, the facility faited to insure the complete fire alarm system was inspected and the facility had written certifications for the annual inspections. The facility census was51. This deficiency affects 51 out of 51 residents. Record review at 11:35 A.M.., showed no documentation that an inspection and written certification of the complete fire alarm system had been completed in the previous twelve (12) months. During an interview on October 31, 2024 at the time of discovery, the Maintenance Director stated he/she would contact the fire alarm company. | 49CSR 30-86,032(13) Electrica! Wiring, Maintained, Inspected | In facilities that are constructed or have plans approved after July 1, 2005, electrical wiring shall | be installed and maintained in accordance with | the requirements of the National Electrical Code, 1999 edition, National Fire Protection Association, Inc., incorporated by reference, in this rule and available by mail at One Batterymarch Park, 11/01/2024 15822 CLAYTON ROAD ELLISVILLE, MO 63011 TAG; REGULATORY OR LSC IDENTIFYING INFORMATION} CROSS-REFERENCED TO THE APPROPRIATE DATE ! DEFICIENCY) FOUNTAINS OF WEST COUNTY AL, LLC, THE A3214. Continued From page 1 ; Quincy, MA 02269, and local codes. This rule i does not incorporate any subsequent ! amendments or additions to the materials incorporated by reference. Facilities built between September 28, 1979 and July 1, 2005 shall be maintained in accordance with the requirements of the National Electrical Cade, which was in effect at the time of the original plan approval and local codes. This rule does not incorporate any subsequent amendments or additions. In facilities built prior to September 28, 1979, electrical wiring shail be maintained in good repair and shail net present a safety hazard. All facilities shall have wiring inspected every two (2) years by a qualified electrician. H/III This regulation is not met as evidenced by: Class III Based on document review and interview on October 31, 2024, the facility failed to insure the facility's electric wiring was inspected every two (2} years by a qualified electrician. The facility census was 51. This deficiency affects 51 out of 51 residents, Document review at 11:00 A.M. showed the facility failed to have the electric wiring inspected every 2 years. Further review showed the last electrical inspection was done on August 7, 2022. During an interview on October 31, 2024 at the time of discovery, the Maintenance Director stated he/she would have the inspection done. PLAN OF CORRECTION Provider/Supplier / Name: p Fountain o est Co t AL LLC. City, Zip: 58; } tna (2). All isu; 4 Yd g 20 Date of Survey: we hal PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER — ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION: (EACH CORRECTIVE ACTION COMPLETION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) DATE J pedip UL lay yo 17 a it? AML A £4 av. The Administrator signing and dating the first page of the CMS-2567/State Form is indicating their approval of the plan of correction being submitted on this form.”

“The administrator shall develop and implement a safe and effective system of medication control and use, which assures that all residents ' medications are administered by personnel at least eighteen (18) years of age, in accordance with physicians ' instructions using acceptable nursing techniques. The facility shall employ a licensed nurse eight (8) hours per week for every thirty (30) residents to monitor each resident ' s condition and medication. Administration of medication shall mean delivering to a resident his or her prescription medication either in the original pharmacy container, or for internal medication, removing an individual dose from the pharmacy container and placing it in a small cup container or liquid medium for the resident to remove from the container and self-administer. External prescription medication may be applied by facility personnel if the resident is unable to do so and the resident ' s physician so authorizes. All individuals who administer medication shall be trained in medication administration and, if not a physician or a licensed nurse, shall be a certified medication technician or level I medication aide. I/II”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“Medication Orders. (A) No medication, treatment or diet shall be administered without an order from an individual lawfully authorized to prescribe such and the order shall be followed. II/III”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“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 is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“Exits, Stairways, and Fire Escapes. (D) An " area of refuge " shall have- 1. An area separated by one- (1-) hour rated smoke walls, from the remainder of the building. This area must have direct access to the exit stairway or access the stair through a section of the corridor that is separated by smoke walls from the remainder of the building. This area may include no more than two (2) resident rooms; 2. A two- (2-) way communication or intercom system with both visible and audible signals between the area of refuge and the bottom landing of the exit stairway, attendants ' work area, or other primary location as designated in the written plan for fire drills and evacuation; 3. Instructions on the use of the area during emergency conditions that are located in the area of refuge and conspicuously posted adjoining the communication or intercom system; 4. A sign at the entrance to the room that states " AREA OF REFUGE IN CASE OF FIRE " and displays the international symbol of accessibility; 5. An entry or exit door that is at least a one and three-fourths inch (1 3/4") solid core wood door or has a fire protection rating of not less than twenty (20) minutes with smoke seals and positive latching hardware. These doors shall not be lockable; 6. A sign conspicuously posted at the bottom of the exit stairway with a diagram showing each location of the areas of refuge; 7. Emergency lighting for the area of refuge; and 8. The total area of the areas of refuge on a floor shall equal at least twenty (20) square feet for each resident who is blind or requires the use of a wheelchair or walker housed on the floor. II”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“General Requirements. (A) If the facility admits or retains any individual needing more than minimal assistance due to having a physical, cognitive or other impairment that prevents the individual from safely evacuating the facility, the facility shall: 6. At a minimum the evacuation plan shall include the following components: A. The responsibilities of specific staff positions in an emergency specific to the individual; II”

This is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.