AMERICAN HOUSE TOWN & COUNTRY.

“Protective oversight shall be provided twenty-four (24) hours a day. For residents departing the premises on voluntary leave, the facility shall have, at a minimum, a procedure to inquire of the resident or resident ' s guardian of the resident ' s departure, of the resident ' s estimated length of absence from the facility, and of the resident ' s whereabouts while on voluntary leave. 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 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: (H) Reviews the ISP with the resident, or legal representative of the resident, at least annually or when there is a significant change in the resident ' s condition which may require a change in services; 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.

“Only activities necessary to the administration of the facility shall be contained in any building used as a long-term care facility except as follows: (A) Related activities may be conducted in buildings subject to prior written approval of these activities by the Department of Health and Senior Services (hereinafter-the department). Examples of these activities are Home Health Agencies, physician ' s office, pharmacy, ambulance service, child day care and food service for the elderly in the community; 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.

“Medications that are not in current use shall be disposed of as follows: (E) Medications may be returned to the pharmacy that dispensed the medications pursuant to 20 CSR 2220-3.040 or returned pursuant to the Prescription Drug Repository Program, 19 CSR 20-50.020. All other medications, including all controlled substances and all expired or otherwise unusable medications, shall be destroyed within thirty (30) days as follows: 1. Medications shall be destroyed within the facility by a pharmacist and a licensed nurse or by two (2) licensed nurses or when two (2) licensed nurses are not available on staff by two (2) individuals who have authority to administer medications, one (1) of whom shall be a licensed nurse or a pharmacist; and 2. A record of medication destroyed shall be maintained and shall include the resident ' s name, date, medication name and strength, quantity, prescription number, and signatures of the individuals destroying the medications; 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.

“Poisonous or toxic materials consist of the following categories: insecticides and rodenticides; disinfectants, sanitizer and related cleaning or drying agents; and caustics, acids, polishes and other chemicals. Each of these three (3) categories set forth shall be stored and physically located separate from each other. All poisonous or toxic materials shall be stored in locked cabinets or in a similar physically separate place used for no other purpose which is not accessible to residents. 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 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: (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 is the rule that was cited, not the inspector’s specific finding. The detailed Statement of Deficiencies is in the official report below.

“Protective oversight shall be provided twenty-four (24) hours a day. For residents departing the premises on voluntary leave, the facility shall have, at a minimum, a procedure to inquire of the resident or resident ' s guardian of the resident ' s departure, of the resident ' s estimated length of absence from the facility, and of the resident ' s whereabouts while on voluntary leave. 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.

“Based on record review and interview on January 27, 2025, the facility failed to insure the complete fire alarm system was tested and maintained in accordance with NFPA 72, 1998 edition. The facility census was 55, This deficiency affects 55 out of 55 residents. Record review at 10:45A.M., showed no semi-annual inspection had been done on the fire alarm system as required by National Fire , Protection Association (NFPA) 72, 1999 ed. Table 7-3.1 and 7.3.2. No dacumentation of the semi-annual fire alarm inspection was available. This defictency was noted during an inspection on February 22, 2024, event ID N80C11. APOC dated March 5, 2024 showeda semi-annual was scheduled for September of 2024, but that documentation was not available. During an interview on January:27,:2025 at the time of discovery, the Operationsns.Coordinator stated he/she would contact-the fire alarm company. P22U11 {continuation sheet 7 of 1 Aes 1] 31/ 2s PLAN OF CORRECTION Provider/Supplier Name: The Town and Country Senior Living City, Zip: Town and Country, MO 63017 Date of Survey: 01-27-2024 PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER PROVIDER'S PLAN OF CORRECTION: (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) DATE This plan of correction is submitted as required under State and/or Federal law. The submission of this Plan of Correction does not constitute an admission on the part of the community as to the accuracy of the surveyors’ findings or the conclusions drawn therefrom. Submission of this Plan of Correction also does not constitute an admission that the findings constitute a deficiency cited are correctly applied. Any changes to the community policies and procedures should be considered subsequent remedial measures as that concept is employed in Rule 407 of the Federal Rules of Evidence, corresponding state rules of civil procedure and should be inadmissibie in any proceeding on that basis. The community submits this plan of correction with the intention that it be inadmissible by any third party in any civil or criminal action against the community or any employee, agent, officer, director, attorney, or shareholder of the community or affiliated companies. Correction of Cited Deficiency: The Fire Alarm test took place on 9/26/2024, as required per the communhity’s inspection schedule; however, a copy of the test results was not readily available in the Life Safety Book during A2249 the fire marshal's inspection on 1/27/2025, A call was made to Marmic Fire and Safety to obtain a copy of the September 2024 Fire Alarm Test report. Executive Director received the report on 1/31/2025 and ensured it was filed in the community’s Life Safety Book. 1/31/2025 Assessment to Identify other Residents that may be affected: The Executive Director reviewed with Plant Operations to ensure that all tests are current and recorded in the community's Life Safety Binder. Compliance was verified and all tests are current. Procedure to ensure on-going compliance: The Executive Director will audit the Life Safety Binder with the Plant Operations Director or their designee weekly for three 1/31/2025 months to ensure compliance. Additionally, the Executive 1/31/2025 Director will be included in email communications with vendors who conduct inspections and any findings. Monitoring for on-going compliance: 1/31/2025 The Plant Operations Director will submit & review audit results during the community’s weekly Department Head Meeting for the next 3 months to ensure ongoing compliance.”

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

“Protective oversight shall be provided twenty-four (24) hours a day. For residents departing the premises on voluntary leave, the facility shall have, at a minimum, a procedure to inquire of the resident or resident ' s guardian of the resident ' s departure, of the resident ' s estimated length of absence from the facility, and of the resident ' s whereabouts while on voluntary leave. 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 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: (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 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 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.

“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.

“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 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: (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 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.

“Based on observation and interview on Feburary 22, 2024, the facllity failed to ensure all trash cans in the facility were metal, UL or FM-fire-resistant rated. The census was (67). This deficiency affects 67 out of 67 residents. Observation between 10:00 A.M. and 2:30 P.M. showed non-fire rated trash cans in the following 1020 WOODS MILL ROAD TOWN AND COUNTRY, MO 63017 DEFICIENCY} TOWN & COUNTRY SENIOR LIVING THE A2286| Continued From page 3 resident rooms: See Artbactre of Plan 401, 103 (2) 109, 115 ol & 303, 309, 310, 322, 324, 325, 326 (2), 329, 330 ecrection 201, 214, 216, 217 (2), 228, 229 (3) During an interview on Feburary 22, 2024 at the time of discovery, the Maintenance Director stated he/she would remove the non-compliant trash cans. If continuation sheat 4 of 4 —_ PLAN OF CORRECTION Provider/Supplier Name: Town and Country Senior Living , . 1020 Woods Mill Road | Town and Country, MO 63017 City, Zip: Date of Survey: 02/22/2024 PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION: (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) This plan of correction is submitted as required under State and/or Federal law. The submission of this Plan of Correction does not constitute an admission on the part of the community as to the accuracy of the surveyors’ findings or the conclusions drawn therefrom. Submission of this Plan of Correction also does not constitute an admission that the findings constitute a deficiency cited are correctly applied. Any changes to the community policies and procedures should be considered subsequent remedial measures as that concept is employed in Rule 407 of the Federal Rules of Evidence, corresponding state rules of civil procedure and should be inadmissible in any proceeding on that basis. The community submits this plan of correction with the intention that it be inadmissible by any third party in any civil or criminal action against the community or any employee, agent, officer, director, attorney, or shareholder of the _| community or affiliated companies. oo COMPLETION DATE Correction of Cited Deficiency:”

“Based on observation and interview on Feburary 22, 2024, the facility failed to ensure the range hood and its extinguishing system shail be certified at least twice annually in accordance with NFPA 96, 1998 edition. The facility census was 67. This deficiency potentially affects 67 of 67 residents. Observation of the inspection tag on the range hood extinguishing system between 10:00 A.M. and 2:30 P.M. showed the last inspection was conducted in January of 2023, During an interview on Feburary 22, 2024, at the time of discovery, the Maintenance Director said he/she was not aware the system needed semi-annual certification.”

“Based on observation and Interview on Feburary | 22, 2024, the facility failed to ensure the locks on | resident room doors did not require the use special knowledge or effort to open the door from inside the room, The facility census was 67. This deficiency affects 1 out of 67 resisents, Observation between 10:00 A.M. and 2:30 P.M. showed the twist lock on the inside of the door handle to resident room 116 was in a locked position and would not release when the handle was depressed requiring the resident to manually unlack the door, The door could be unlocked with a key from the hallway side, but this could potentially create a delay in the ressidents ability to self-exit in case of an emergency. During an Interview on Feburary 22, 2024 at the time of discovery,the Maintenance Director stated he/she would make sure the door locks were changed. A2249)”

“Based on record review and Interview on Feburary 22, 2024, the facility failed to insure the plan of Correc ayn, complete fire alarm system was tested and maintained in accordance with NFPA 72, 1999 edition. The facility census was 67. This deficiency affects 67 out of 67 residents. Record review between 10:00 A.M. and 2:30 P.M. showed no semi-annual inspection had been done on the fire alarm system as required by National Fire Protection Assaciation (NFPA) 72, 1999 ed. Table 7-3.1 and 7.3.2. No documentation of the semi-annual fire alarm inspection was available. During an interview on Feburary 22, 2024 at the time of discovery, the Maintenance Director stated he/she would contact the fire alarm company.”