CEDARHURST OF DES PERES.

“Based on observation and interview , the facility failed to store portable oxygen cylinders in accordance with NFPA 99, 1999 Edition. The facility census was fifty-one. This deficiency Missouri Depariment of Health and Senior Services 12826 DAYLIGHT CIRCLE SAINT LOUIS, MO 63131 CEDARHURST OF DES PERES affected fifty-one of fifty-one residents. Observation on December 9, 2025 at 1:21 PM revealed four oxygen cylinders, standing upright and not stored in an approved rack, or secured by chain or band in the wellness office. During the exit interview on December 9, 2025 at 4:15 PM, the environmental controls person stated that the bottles were in the office waiting for pickup from an oxygen supplier. PLAN OF CORRECTION Name: Provider/Supplier Cedarhurst of Des Peres City, Zip: 12826 Daylight Circle Date of Survey: December 9" 2025 ID PREFIX TAG PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER PROVIDER'S PLAN OF CORRECTION: (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY} COMPLETION DATE This plan is prepared and executed because it is required by the provisions of the State and Federal regulations and not because Cedarhurst of Des Peres agrees with the allegations and citations listed on the statement of deficiencies. Cedarhurst of Des Peres maintains that the alleged deficiencies do not individually and collectively jeopardize the health and safety of the residents, nor are they of such character as to limit our capacity to render adequate care as prescribed by regulation. This plan of correction shall operate as Cedarhurst of Des Peres written credible allegation of compliance. By submitting this plan of correction, Cedarhurst of Des Peres does not admit to the accuracy of the deficiencies. This plan of correction is not meant to establish any standard of care, contract, obligation or position and Cedarhurst of Des Peres reserves all rights to raise all possible contentions and defenses in any civil or criminal claim, action or proceeding. A2222 How will you identify other residents having the potential to be affected by the deficient practice? All in house resident are at risk to be affected by the alleged deficient practice; however, no residents or staff were negatively affected by the practice or incident. What corrective action(s) will be accomplished for those residents found to have been affected by the alleged deficient practice? 1). The exit door on Willow was inspected by the Company “Door Company” that shimmed the hinges to stop rubbing in the frame on 12/9/2025 and door was confirmed to be in working order. What measures will be put into place or what systemic changes will you make to ensure the deficient practice does not recur? The Maintenance Director will continue to check doors upon his walking rounds. 12/22/2025 How the corrective action will be monitored to ensure the alleged deficient practice will not recur? The Maintenance Director will check this door on walking rounds for 30 days. A2286 How will you identify other residents having the potential to be affected by the deficient practice? All in house resident are at risk to be affected by the alleged deficient practice; however, no residents or staff were negatively affected by the practice or incident. What corrective action(s) will be accomplished for those residents found to have been affected by the alleged deficient practice? 1). All trashcans have been replaced with Rubbermaid 12/22/2025 Commercial Fire-Resistant wastebasket on December 11%. What measures will be put into place or what systemic changes will you make to ensure the deficient practice does not reoccur? New residents will be informed upon move in that Fire Resistant trash cans are required. How will the corrective action be monitored to ensure the alleged deficient practice will not recur? Weekly checks will be performed for 30 days. A2298 How will you identify other residents having the potential to be affected by the deficient practice? All in house resident are at risk to be affected by the alleged deficient practice; however, no residents or staff were negatively affected by the practice or incident. What corrective action(s) will be accomplished for those residents found to have been affected by the alleged deficient practice? 1). All oxygen tanks have been picked up from the Community 12/22/2025 on December 11®. What measures will be put into place or what systemic changes will you make to ensure the deficient practice does not reoccur? All oxygen tanks will be stored in an approved rack or secured chain or band. How will the corrective action be monitored to ensure the alleged deficient practice will not recur? Director or Nursing will monitor weekly for 30 days. LLL : : : | 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.”

“Based on observation and interview , the facility failed to maintain unobstructed exits remote from each other. The facility census was fifty-one. This deficiency affected fifty-one of fifty-one residents. Observation on December 9, 2025 at 2:32 PM, revealed the exterior exit door at the base of the stairs on Willow wing beyond room 116 is sticking, and excessive force was required to open the door. During the exit interview on December 9, 2025 at 4:00 PM, the environmental controls person stated that he wauld have the door repaired.”

“Based on observation and interview, the facility failed to ensure only metal or UL- or FN-fire-resistant rated wastebaskets were being used for trash. The facility census was fifty-one. This deficiency affected fifty-one of fifty-one LABORATOR)| DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE (8) BATE agkKait coke 30351 BWING =n 12/09/2025 12826 DAYLIGHT CIRCLE SAINT LOUIS, MO 63131 CEDARHURST OF DES PERES residents. Observation on December 3, 2025, between 1:00 PM and 3:00 PM, 2:21 PM, reveated the follawing: -2 non-metal or UL-FM-fire-resistant rated wastebaskets in use in raom 101; -2 non-metal or UL-FM-fire-resistant rated wastebaskets in use in room 107; -2 non-metal or UL-FM-fire-resistant rated wastebaskets in use in room 118; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in the first floor living room; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in room 228; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in room 233; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in the second floor employee breakroom restroom; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in the Dogwood Cafe: -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in the dogwood hall public restroom; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in the Magnolia Cafe; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in the magnolia laundry; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in the Physical Therapy roam; -1 non-metal or UL-FIM-fire-resistant rated wastebasket in use in use in the magnolia hall public restroom; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in the Rosewood Cafe; -1 non-metal or UL-FM-fire-resistant rated 30354 BMG, 42/09/2025 12826 DAYLIGHT CIRCLE SAINT LOUIS, MO 63131 CEDARHURST OF DES PERES wastebasket in use in use in the rosewood hall faundry; -1 non-metal or UL-FNM-fire-resistant rated wastebasket in use in use in the rosewood hall public restroom; -1 non-metal or UL-FN-fire-resistant rated wastebasket in use in use in the spa; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in the Physical Therapy office; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in the willow hall men's room; -1 non-metal or UL-FM-fire-resistant rated wastebasket in use in use in the willow hall women's room, During the exit interview on December 9, 2025 4:10 PM, the environmental controls person stated he would remove and replace the wastebaskets.”

“Residents shall receive proper care as defined in the individualized service plan. 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.

“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.

“In case of behaviors that present a reasonable likelihood of serious harm to himself or herself or others, serious illness, significant change in condition, injury or death, staff shall take appropriate action and shall promptly attempt to contact the person listed in the resident ' s record as the legally authorized representative, designee or placement authority. The facility shall contact the attending physician or designee and notify the local coroner or medical examiner immediately upon the death of any resident of the facility prior to transferring the deceased resident to a funeral home. 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.

“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.

“The facility shall maintain a record in the facility for each resident, which shall include the following: (A) Admission information including the resident ' s name; admission date; confidentiality number; previous address; birth date; sex; marital status; Social Security number; Medicare and Medicaid numbers (if applicable); name, address and telephone number of the resident ' s physician and alternate; diagnosis, name, address and telephone number of the resident ' s legally authorized representative or designee to be notified in case of emergency; and preferred dentist, pharmacist and funeral director; 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.

“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. 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.

“The administrator shall maintain on the premises an individual personnel record on each facility employee, which shall include the following: (I) Written statement signed by a licensed physician or physician ' s designee indicating the person can work in a long-term care facility and indicating any limitations; 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 facility shall screen residents and staff for tuberculosis as required for long-term care facilities by 19 CSR 20-20.100. 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.

“Staffing Requirements. (A) The facility shall have an adequate number and type of personnel for the proper care of residents, the residents ' social well being, protective oversight of residents and upkeep of the facility. At a minimum, the staffing pattern for fire safety and care of residents shall be one (1) staff person for every fifteen (15) residents or major fraction of fifteen (15) during the day shift, one (1) person for every twenty (20) residents or major fraction of twenty (20) during the evening shift and one (1) person for every twenty-five (25) residents or major fraction of twenty-five (25) during the night shift. I/II Time Personnel Residents 7 a.m. to 3 p.m. (Day)* 1 3-15 3 p.m. to 9 p.m. (Evening)* 1 3-20 9 p.m. to 7 a.m. (Night)* 1 3-25 *If the shift hours vary from those indicated, the hours of the shifts shall show on the work schedules of the facility and shall not be less than six (6) hours. 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.

“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.

“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: C. The plan shall evaluate the resident for his or her location within the facility and the proximity to exits and areas of refuge. The plan shall evaluate the resident, as applicable, for his or her risk of resistance, mobility, the need for additional staff support, consciousness, response to instructions, response to alarms, and fire drills; 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.

“Each resident shall be permitted to retain and use personal clothing and possessions as space permits. Personal possessions may include furniture and decorations in accordance with the facility's policies and shall not create a fire hazard. The facility shall maintain a record of any personal items accompanying the resident upon admission to the facility, or which are brought to the resident during his or her stay in the facility, which are to be returned to the resident or responsible party upon discharge, transfer, or death. 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 facility may admit or retain an individual for 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: (F) Completes a community based assessment conducted by an appropriately trained and qualified individual as defined in section (4) of this rule: 1. Time frame requirements for assessment shall be: A. Within five (5) calendar days of admission; 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.

“Each resident shall be treated with consideration, respect, and full recognition of his or her dignity and individuality, including privacy in treatment and care of his or her personal needs. All persons, other than the attending physician, the facility personnel necessary for any treatment or personal care, or the department or Department of Mental Health staff, as appropriate, shall be excluded from observing the resident during any time of examination, treatment, or care unless consent has been given by the resident. 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.

“Residents shall receive proper care as defined in the individualized service plan. 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.

“The facility shall develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of any resident and misappropriation of resident property and funds, and develop and implement policies that require a report to be made to the department for any resident or to both the department and the Department of Mental Health for any vulnerable person whom the administrator or employee has reasonable cause to believe has been abused or neglected. 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.