Original Inspection report

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0550

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Honor the resident’s right to a dignified existence, self-determination, communication,
and to exercise his or her rights.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to maintain and/or
enhance the dignity for four residents (Resident #5, #43, #47, and #76) out of 18 sampled
residents and 22 residents (Resident #1, #17, #22, #23, #26, #27, #28, #30, #31, #35, #39,
#40, #42, #44, #53, #64, #74, #78, #84, #101, #102, and #103) outside of the sample. The
facility did not serve meals to residents sitting at the same table, at the same time and
caused the residents to wait extended periods of time. The facility failed to ensure one
resident (Resident #73) was clothed while in the dining room. The facility’s census was
88.
1. Observation on 6/4/19 of the 300 Hall Dining Room showed:
– Scheduled dinner time from 5:00 P.M. to 5:30 P.M.;
– Residents #30, #39 and #47 sat at a table together. Resident #39 received his/her meal
at 5:43 P.M. and Resident’s #30 and #47 received their meals eight minutes later at 5:51
P.M.;
– Residents #53, #74 and #101 sat at a table together. Resident #101 received his/her meal
at 5:45 P.M. and Resident’s #53 and #74 received their meals eight minutes later at 5:53
P.M.;
– Residents #1 and #5 sat at a table together. Resident #5 received his/her meal at 5:46
P.M., and Resident #1 received his/her meal nine minutes later at 5:55 P.M.;
Observation on 6/4/19 of the 400 Hall Dining Room showed:
– Residents #22 and #44 sat at a table together.
– Resident #44 received his/her meal at 5:20 P.M. and Resident #22 received his/her meal
nine minutes later at 5:20 P.M.
Observation of the 300 Hall dining room on 6/5/19 from 7:30 A.M. through 8:05 A.M. showed:
– Scheduled breakfast meal time to be 7:00 A.M. to 7:30 A.M.;
– At 7:32 A.M., 13 residents sat waiting for breakfast;
– At 7:39 A.M., Resident #30 said, I’ve been down here for an hour and a half and still no
breakfast. They wake us up early and then we sit and wait;
– At 7:47 A.M., the first meal served to Resident #102;
– At 7:48 A.M., Resident #39 served meal. Resident #39 said, Resident #47 needs to eat.
His/her tablemates Resident #23 and #47 served at 7:58 A.M.,10 minutes later, and Resident
#30 served at 7:59 A.M., 11 minutes later;
– At 7:57 A.M., Resident #74 yelled out Can I have some breakfast? This is ridiculous.;
– At 8:00 A.M., Resident #74 served. His/her tablemate Resident #53 served the last meal
at 8:02 A.M.
Observation of the 100 Hall dining room on 6/05/19 from 7:30 A.M. to 8:15 A.M., showed:
– Scheduled breakfast meal time to be 7:30 A.M. to 8:00 A.M.;
– At 7:42 A.M., the first meal served to Resident #58. His/her tablemate Resident #76
served at 7:43 A.M.;
– At 7:44 A.M., Resident #31 served meal. His/her tablemate Resident #27 served at 7:49
A.M., five minutes later;
– At 7:47 A.M., Resident #42 served meal. His/her table mate Resident #84 served at 7:48
A.M.;
– At 7:48 A.M., Resident #43 served meal. His/her tablemate Resident #78 served at 7:49
A.M.;
– At 7:49 A.M., Resident #64 became agitated, had a verbal altercation with another
resident and went to his/her room, food taken to his/her room at 7:49 A.M.; His/her

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0550

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 1)
tablemate Resident #28 served the last meal at 8:04 A.M.
During an interview on 6/5/19 at 3:59 P.M., the Dietary Manager said they serve both ends
of the building at the same time. One cook serves at each end. The staff take the
resident’s order while they’re seated in the dining room waiting on the meal. Staff
transport the pans of food in hot boxes to the halls and put them in pre-heated wells.
During an interview on 6/6/19 at 4:03 P.M., the Dietary Manager said she would expect:
– Meal times and menus to be posted in the dining areas;
– Residents at the same table to be served at the same time.
Record review of the facility’s policy, titled Resident Nutrition Services, dated (MONTH)
2010, showed:
– A schedule of meal times and snacks shall be posted in resident areas;
– Did not address serving residents seated at the same table at the same time.
2. Record review of Resident #73’s physician’s orders [REDACTED].
– [DIAGNOSES REDACTED]. [MEDICAL CONDITION] (causes [MEDICAL CONDITION]), unspecified
intellectual disabilities, and dementia (impairment of memory loss and judgment).
Record review of the residents annual Minimum Data Set (MDS; a federally mandated
comprehensive assessment instrument, completed by the facility staff) dated 5/18/19
showed:
– Brief Interview for Mental Status (BIMS; a screening tool to assess cognition) a score
of 99, the resident unable to be understood or understand others;
– Short and long term memory issues;
– Activities of Daily Living (ADLs)-dressing requires limited assistance with one staff
and decreased functional range of motion on both upper and lower extremities.
Observation on 6/4/19 at 5:40 P.M. in the 200 Hall dining room showed:
– Resident #73 sat in his/her wheelchair at the dining table with Resident #17 and
Resident #103;
– Certified Nursing Assistant (CNA) C helped Resident #17 with his/her meal.
During an interview on 6/4/19 at 5:41 P.M. Resident #73 grinned and pointed down towards
his/her lap. The resident did not have any type of clothing from the waist down, which
left bare skin exposed, including the groin area. Resident #73’s verbal speech very
difficult to understand and non-interviewable.
During an interview on 6/4/19 at 5:42 P.M. CNA C said he/she knew Resident #73 did not
have any bottoms on and was naked. You have to pick your battles with Resident #73.
Sometimes he/she will go to his/her room when told and other times not. The other
residents will tell him/her to go put on clothes.
Observations on 6/5/19 at 5:43 P.M., showed CNA C stopped feeding Resident #17. CNA C
removed Resident #73 from the dining room and took him/her down to his/her room. None of
the staff took over with assisting Resident #17 with his/her meal.
Observation on 6/5/19 at 7:23 A.M. in the 200 Hall dining room showed:
– Resident #73 yelled as he/she entered the dining area in his/her wheelchair;
– Resident #73 did not have any type of clothing and his/her entire body exposed;
– CNA D stopped feeding Resident #17 and took Resident #73 to his/her room;
– None of the staff took over assisting Resident #17 with his/her meal.
During an interview on 6/5/19 at 7:24 A.M., CNA D said Resident #73 is fed his/her food
first. If he/she hears the dining room residents eating before he/she received food, then
he/she will come out naked. CNA D said the staff tells the resident to stay in his/her
room if he/she wants to be naked. The CNA said the other residents will tell him/her to go
put on clothes. Sometimes he/she will listen.
Observation on 6/6/19 at 10:20 A.M. in the 200 Hall dining room showed:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0550

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 2)
– Resident #73 yelled as he/she sat in his/her wheelchair and only wore an incontinent
brief;
– Someone in the dining room yelled at Resident #73 and told the resident to go to his/her
room;
– Resident #73 turned around and went into his/her room.
During an interview on 6/6/19 at 10:20 A.M., Resident #35 said it bothers me when Resident
#73 comes in the dining room without his/her clothes on.
During an interview on 6/6/19 at 10:30 A.M., Resident #26 said he/she doesn’t want to see
Resident #73 naked. He/she said they have told the staff and the resident keeps doing it.
During an interview on 6/6/19 at 10:45 A.M., Resident #40 said Resident #73 comes out
naked a lot. The staff makes him/her put his/her clothes on.
During an interview on 6/6/19 at 4:03 P.M., the Director of Nursing (DON) said she would
not expect a resident to be allowed in the dining room without pants or without clothes.
3. Record review of the facility’s policy, titled Dignity, revised (MONTH) 2009, showed:
– Each resident shall be cared for in a manner that promotes and enhances quality of life,
dignity, respect and individuality;
– Treated with dignity means the resident will be assisted in maintaining and enhancing
his or her self-esteem and self-worth.

F 0561

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Honor the resident’s right to and the facility must promote and facilitate resident
self-determination through support of resident choice.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation and interview, the facility failed to consider and accommodate
resident’s preferences for one resident (Resident #78) out of 18 sampled residents. The
facility’s census was 88.
1. Record review of Resident #78’s physician’s orders [REDACTED].
– [DIAGNOSES REDACTED].
– Order dated 5/6/19 for urinary catheter (a tube inserted in the bladder to drain urine).
Record review of the resident’s admission Minimum Data Set (MDS; a federally mandated
assessment instrument completed by the facility staff) dated 4/25/19, showed a Brief
Interview for Mental Status (BIMS; a screening tool to assess cognition) score of 15
(cognition intact).
Record review of the resident’s Comprehensive Care Plan, last updated 5/6/19, showed:
– The resident with a urinary catheter;
– The resident will be free from catheter related trauma;
– Check for kinks in tubing every shift;
– Monitor for signs and symptoms of a urinary tract infection.
Observation on 6/03/19 at 12:34 P.M. showed the resident appeared to be angry, frowning,
jerking his/her chair around to move about. Observation showed the resident wearing a
catheter leg bag attached to his/her right upper leg.
During an interview on 6/3/19 at 12:35 P.M., the resident said the facility is out of
regular catheter bags, and he/she has to wear leg bag until they get some regular bags in.
The resident said he/she does not like leg bags and is mad about having to wear it.
Observation on 6/4/19 at 12:00 P.M. showed the resident wore shorts and an uncovered

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0561

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 3)
urinary leg bag which contained urine.
Observation 6/5/19 at 7:46 A.M., showed the resident wore shorts and an uncovered urinary
leg bag which contained urine.
During an interview on 6/5/19 at 4:15 P.M., the resident said he/she does not like leg
bags because they fill up too fast. The resident said the facility is out of regular
catheter bags and has to wear the leg bag until others are available.
During an interview on 6/5/19 at 4:18 P.M., Licensed Practical Nurse (LPN) A said the
facility was out of regular bags but will look to see if any have come in.
During an interview on 6/5/19 at 4:19 P.M., the Administrator said the employee who does
the orders is off but the Administrator will check on the bags. At 5:22 P.M. the
Administrator said the facility did have regular catheter bags and one has been put on the
resident.
During an interview on 6/6/19 at 4:03 P.M., the Director of Nursing (DON) said she would
expect a resident’s choice of catheter bag to be honored.
The facility did not provide a policy for resident choices.

F 0624

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Prepare residents for a safe transfer or discharge from the nursing home.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on interview and record review, the facility failed to document preparation and
orientation for transfer to the hospital for eight residents (Resident #12, #38, #46, #51,
#56, #62, #71, and #76) out of 18 sampled residents. The facility’s census was 88.
1. Record review of the facility’s policy, titled Orienting Residents to Transfers and
Discharges, dated 5/1/12, showed:
– Our facility shall prepare a resident for a transfer or discharge;
– The purpose of the orientation is to provide the resident and family with sufficient
preparation and to ensure a safe and orderly transfer or discharge from the facility;
– Inquiries concerning our orientation program should be referred to the Director of
Nursing Services.
2. Record review of Resident #12’s Progress Notes showed the resident transferred to the
hospital:
– On 3/7/19 and readmitted to the facility on [DATE];
– On 4/10/19 and readmitted to the facility on the same date.
Record review of the resident’s medical record did not contain documentation which showed
the resident was prepped and oriented for transfer out of the facility.
3. Record review of Resident #38’s Progress Notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Record review of the resident’s medical record did not contain documentation which showed
the resident was prepped and oriented for transfer out of the facility.
4. Record review of Resident #46’s Progress Notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Record review of the resident’s medical record did not contain documentation which showed
the resident was prepped and oriented for transfer out of the facility.
5. Record review of Resident #51’s Progress Notes showed the resident transferred to the
hospital:
– On 2/23/19 and readmitted to the facility on the same date;

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0624

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 4)
– On 3/25/19 and readmitted to the facility on the same date.
Record review of the resident’s medical record did not contain documentation which showed
the resident was prepped and oriented for transfer out of the facility.
6. Record review of Resident #56’s Progress Notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Record review of the resident’s medical record did not contain documentation which showed
the resident was prepped and oriented for transfer out of the facility.
7. Record review of Resident #62’s Progress Notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Record review of the resident’s medical record did not contain documentation which showed
the resident was prepped and oriented for transfer out of the facility.
8. Record review of Resident #71’s Progress Notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on [DATE].
Record review of the resident’s medical record did not contain documentation which showed
the resident was prepped and oriented for transfer out of the facility.
9. Record review of Resident #76’s Progress Notes showed the resident transferred to the
hospital on [DATE] and readmitted to the facility on the same day.
Record review of the resident’s medical record did not contain documentation which showed
the resident was prepped and oriented for transfer out of the facility.
10. During an interview on 6/6/19 at 4:03 P.M., the Director of Nursing (DON) said
depending what is going on, she would expect them to be oriented and it should be
documented.

F 0657

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Develop the complete care plan within 7 days of the comprehensive assessment; and
prepared, reviewed, and revised by a team of health professionals.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to revise and
update comprehensive care plans with specific interventions to meet the individual needs
of three residents (Resident #12, #64, and #73) out of 18 sampled residents. The
facility’s census was 88.
1. Record review of Resident #12’s physician’s orders [REDACTED].
– [DIAGNOSES REDACTED].
– Orders written on 5/17/19 for regular diet with regular consistency.
Record review of the resident’s care plan, revised on 3/10/19, showed:
– Resident is on a regular diet, changed to puree consistency on 3/12/19;
– Returned from hospital on mechanical soft diet 3/20/19;
– Current diet was not updated.
2. Record review of Resident #64’s POS, dated 6/4/19, showed:
– [DIAGNOSES REDACTED].(sudden feelings of terror when there is no real danger), Type I
Diabetes (a chronic condition in which the pancreas produces little or no insulin).
Record review of the resident’s health status note, dated 5/14/19, shows [DIAGNOSES
REDACTED].
Record review of the resident’s care plan, revised on 5/11/19, showed no updates for
antibiotic treatment and UTI.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0657

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 5)
Record review of the resident’s health status notes showed:
– Dated 5/9/19, verbal behaviors;
– Dated 6/5/19, argumentative behaviors;
– Dated 6/6/19, confrontational behavior with staff and residents and verbal agitation.
During an interview on 6/6/19 at 2:30 P.M., Licensed Practical Nurse (LPN) A said the
resident becomes more aggressive as the day goes on because he/she seeks out sugar and
sugary drinks, the resident’s blood sugar (BS) becomes elevated and he/she becomes
aggressive. His/her BS is always elevated because he/she is non-compliant with his diet
and eating sugar. He/she is his/her own responsible party and is well aware of his/her
rights to make his/her own decisions.
Record review of the resident’s care plan, revised on 5/11/19, showed:
– Potential fluid deficit related to increase urination, caused by increased blood sugars;
– Dietary consult for nutritional regimen and ongoing monitoring, identify areas of
non-compliance or other difficulties in resident diabetic management;
– No documentation of behaviors of seeking sugar and sugary drinks;
– No documentation of behaviors of non-compliance with diet.
During an interview on 6/6/19 at 4:03 P.M., the Minimum Data Set (MDS, a federally
mandated comprehensive assessment instrument, completed by the facility staff) Coordinator
said she would expect non-compliance of seeking sugar and surgery items to be in the care
plan.
3. Record review of Resident #73’s POS, dated 6/5/19, showed:
– [DIAGNOSES REDACTED].
Observations showed the following for Resident #73:
– On 6/4/19 at 5:40 P.M., the resident sat at the dining table with other residents while
they were eating. The resident was naked from the waist down;
– On 6/5/19 at 7:23 A.M., the resident came out of his/her room in his wheelchair
completely naked;
– On 6/6/19 at 10:20 A.M., the resident was in his/her wheelchair wearing only an
incontinent brief and yelling.
Record review of the resident’s care plan, revised on 5/30/19, showed:
– Focus- the resident is/has potential to be physically aggressive of hitting, scratching,
throwing objects, and biting staff related to anger, history of harm to others, poor
impulse control;
– No interventions for when resident is naked.
During an interview on 6/6/19 at 4:03 P.M. the MDS coordinator said she would expect a
behavior of nudity to be in the care plan.
4. Record review of the facility’s policy, titled Comprehensive Care Plan Policy &
Procedure, dated 10/11/16, showed:
– Implement a comprehensive person-centered care plan for each resident. Include
measurable objectives and timeframes to meet the medical, nursing, mental, psychosocial
needs;
– In consultation with the resident and their representatives, the resident’s goals for
admission and desired outcomes;
– The resident’s preference and potential for future discharge. The facilities must
document whether the resident’s desire to return to the community was assessed and any
referrals to any local contact agencies and/or other appropriate entities for this
purpose;
– The comprehensive care plan must be developed within seven days after completion of the
comprehensive assessment;
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0657

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 6)
– The care plan must be prepared by an interdisciplinary team.

F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Ensure services provided by the nursing facility meet professional standards of
quality.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on interview and record review, the facility failed to follow physician’s orders for
one resident (Resident #50) outside of the sample. The facility’s census was 88.
Record review of Resident #50’s Physician’s Order Set (POS), dated 6/6/19, showed:
– [DIAGNOSES REDACTED].
– An order dated 4/18/19 for neurology (a branch of medicine dealing with disorders of the
nervous system) consult for [DIAGNOSES REDACTED].
During an interview on 6/4/19 at 5:20 P.M., the resident said the doctor wanted him/her to
see a neurologist (a doctor with specialized training in diagnosing and treating diseases
of the brain and spinal cord) and he/she does not have an appointment.
During an interview on 6/6/19 at 2:25 P.M., the Social Worker said an appointment with the
neurologist has not been made.
During an interview on 6/6/19 at 4:03 P.M., the Director of Nursing (DON) said she would
expect an appointment for a consult to be made within five days of receiving the order.

F 0660

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Plan the resident’s discharge to meet the resident’s goals and needs.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on interview and record review, the facility failed to ensure a discharge plan which
focused on the resident’s discharge goals and effective transition to post-discharge care
for one resident (Resident #56) out of the 18 sampled residents. The facility’s census was
88.
Record review of Resident #56’s physician’s orders [REDACTED].
Record review of the resident’s admission Minimum Data Set (MDS; a federally mandated
assessment instrument completed by the facility staff), dated 3/4/19, showed a Brief
Interview for Mental Status (BIMS; a screening tool to assess cognition) score of 15
(cognition intact).
During an interview on 6/3/19 at 11:50 A.M., the resident said:
– He/she was admitted to this facility from a hospital and was not given a choice of a
private or semi-private room;
– His/her Medicare benefits ended on 5/27/19 and he/she cannot afford to stay in the
facility;
– He/she told the doctor and the Social Worker (SW) about not being able to afford to stay
in the facility but they told the resident that he/she had an infection andcould not go
home;
– They said the resident would have to stay at least another week or two;
– He/she has requested to talk to the SW but the SW has not been available;

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0660

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 7)
– He/she gave his/her debit card to the SW over a week ago to buy a cell phone for the
resident;
– He/she has not gotten a phone and the SW still has the debit card.
Record review of the resident’s care plan, updated 6/3/19, showed:
– The resident wishes to return home upon discharge but may decide to stay in the
facility;
– Upon therapy discharge last covered day 5/30/19;
– Resident decided to stay in facility for long term care needs;
– Resident spoke to medical doctor about this;
– Resident to remain in facility for care through next review;
– Intervention updated 5/30/19 showed resident has decided to stay in facility for long
term care needs per his/her own request.
During an interview on 6/5/19 at 8:34 A.M., the SW said:
– The resident begged the doctor to stay here, to not go home;
– The resident said he/she would rather go to the hospital than stay here or go home;
– The facility is working on getting the resident Medicaid qualified for this stay;
– The resident will not qualify for regular Medicaid and requires additional financial
help through the state;
– He/she believed the resident may have [MEDICAL CONDITIONS], (a bacterium that can cause
symptoms ranging from diarrhea to life-threatening inflammation of the colon);
– The SW has the resident’s debit card and has not had time to get the resident a phone.
During an interview on 6/5/19 at 9:20 A.M., the SW said he/she talked to the resident and
the resident wants to go home tomorrow. They are working on getting discharge orders and
arranging home health now. He/she has returned the resident’s debit card, but did not get
a phone for the resident.
During an interview on 6/5/19 at 10:29 A.M., the resident said he/she is happy with
discharge plan now but still would like phone before he/she leaves the facility.
During an interview on 6/5/19 at 10:33 A.M., the SW said he/she would talk to the resident
again about the phone.
During a telephone interview on 6/5/19 at 10:35 A.M., Physician E said:
– It wasn’t appropriate for the resident to go home last week, with a [DIAGNOSES
REDACTED].>- The resident was unable to stand or bathe him/herself;
– It would have been a poor decision to send him/her home;
– The resident said he/she could not afford to stay at the facility;
– The SW said they would try to get a few more days paid for by Medicare;
– He/she saw the resident yesterday and does not feel like the best decision is for the
resident to go home;
– The resident said he/she wanted to go home when Physician E saw him/her a week ago but
the resident was having up to eight bowel movements a day;
– He/she didn’t feel like the resident could go home and be safe;
– The resident said he/she could not afford to stay at the facility once Medicare stopped
paying but the resident did eventually agree to stay for another week or two;
– He/she will discharge the resident because that is what the resident wants.
During an interview on 6/6/19 at 4:03 P.M., the Director of Nursing (DON) said she would
not expect choices about discharge to be honored because a lot of them (residents) want to
go home but they may not be able to get their meals. They just want to get out of here.
During an interview on 6/6/19 at 4:03 P.M., the MDS Coordinator said the discharge care
plans reflect what the resident and family says.
Record review of the facility’s policy, titled Comprehensive Care Plan Policy &
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0660

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 8)
Procedure, dated 10/11/16, showed:
– Implement a comprehensive person-centered care plan for each resident. Include
measurable objectives and timeframes to meet the medical, nursing, mental, psychosocial
needs;
– In consultation with the resident and their representatives, the resident’s goals for
admission and desired outcomes;
– The resident’s preference and potential for future discharge. The facilities must
document whether the resident’s desire to return to the community was assessed and any
referrals to any local contact agencies and/or other appropriate entities for this
purpose;
– The comprehensive care plan must be developed within seven days after completion of the
comprehensive assessment;
– The care plan must be prepared by an interdisciplinary team.
Record review of the facility’s policy, titled Discharge Planning/Recapitulation of Stay,
dated 10/11/16, showed:
– Prepare the residents to be discharged from long-term care facility back into their
community, and to have the proper education for family members to meet their needs;
– Assess the resident’s continuing care needs;
– How care should be coordinated between multiple care giver, as applicable;
– Recap/summary of the resident’s stay;
– Post discharge plan of care;
– Assist the resident to help safely adjust to their new living environment and any
changes in medication therapy.

F 0677

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Provide care and assistance to perform activities of daily living for any resident who
is unable.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to provide
assistance with personal hygiene for two residents (Resident #12 and #38) out of 18
sampled residents. The facility’s census was 88.
Record review of the resident’s physician’s orders [REDACTED].
– [DIAGNOSES REDACTED].
– Shower schedule for Monday/Wednesday/Friday, no bedbaths.
Record review of the resident’s quarterly Minimum Data Set (MDS, a federally mandated
comprehensive assessment instrument, completed by the facility staff) dated 3/21/19
showed:
– Brief Interview for Mental Status (BIMS; a screening tool to assess cognition) a score
of 14 (cognition intact);
– Activities of Daily Living (ADLs) showed total dependence for all ADLs, including
personal hygiene;
– Functional range of motion decreased on upper and lower extremities.
Record review of the resident’s care plan, dated 6/2/19, showed the resident is total
dependence for all care from the staff every shift and as needed.
Observation on 6/3/19 at 12:15 P.M. showed Resident #12 lay in bed after his/her shower.
The resident’s hair was not combed.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0677

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 9)
During an interview on 6/3/19 at 12:15 P.M., the resident said the staff told him/her they
did not have time to do his/her hair or brush the resident’s teeth.
During an interview on 6/5/19 at 5:15 P.M., the Director of Nursing (DON) said staff help
the residents brush their teeth with morning and evening care. The staff do not help brush
teeth during shower time.
During an interview on 6/6/19 at 11:15 A.M., the resident said he/she did not get help to
brush his/her teeth yesterday or today.
During an interview on 6/6/19 at 1:35 P.M., Certified Nurse Assistant (CNA) C said they
help with oral care in the morning and evening.
Record review of the facility’s policy, titled Teeth, Brushing, revised (MONTH) 2010,
showed:
– The purposes of this procedure are to clean and freshen the resident’s mouth, to prevent
infections of the mouth, to maintain the teeth and gums in a healthy condition, to
stimulate the gums, and to remove food particles from between the teeth;
– Review the resident’s care plan to assess for any special needs of the resident;
– Assemble the equipment and supplies as needed;
– A resident should be assisted with brushing his or her teeth based on his or her
individual needs;
– Floss, as necessary and desired by the resident, between the teeth before bedtime.
Record review of the facility’s policy, titled Mouth Care, revised (MONTH) 2010, showed:
– The purposes of this procedure are to keep the resident’s lips and oral tissues moist,
to cleanse and freshen the resident’s mouth and to prevent infections of the mouth;
– The following information should be recorded in the resident’s medical record;
– The date and time the mouth care was provided;
– The name and title of the individual who provided the mouth care. All assessment data
obtained concerning the resident’s mouth;
– The certified nursing assistant should report to the licensed nurse to record in the
medical record.
2. Record review of Resident #38’s POS, dated 6/4/19, showed [DIAGNOSES REDACTED].
Record review of the resident’s admission MDS, dated [DATE], showed a BIMS score of 15
(cognition intact).
Record review of the resident’s Comprehensive Care Plan, last updated 3/10/19, showed one
staff assist with shower two times a week and as needed.
During an interview on 6/3/19 at 11:12 A.M., the resident said between 2/19/19 to 5/2/19
he/she never got a shower or bath. The CNAs said the resident refused all baths. The
resident said he/she didn’t refuse.
During an interview on 6/5/19 at 5:11 P.M., the DON said the resident is supposed to get
showers on Saturdays and Wednesdays. They have had problems with evening shift CNAs not
giving showers and charting that the resident refuses them. The CNAs have been instructed
to have the resident sign the sheet if they refuse. She believes the problem with this
resident is part of the time refusing and part of the time it is the CNA not giving the
shower.
Record review of shower sheets dated (MONTH) 2019 through (MONTH) 2019, showed:
– The month of (MONTH) with nine opportunities for showers. Three out of nine showers
missed: On 3/9 no reason documented; on 3/23 no reason documented; and on 3/30 refused
without a resident signature;
– The month of (MONTH) with eight opportunities for showers. Three out of eight showers
missed: On 4/6 no reason documented; on 4/13 no reason documented; and on 4/20 refused
without a resident signature;
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0677

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 10)
– The month of (MONTH) with nine opportunities for showers. Three out of nine missed: On
5/11 refused without a resident signature; on 5/22 refused without resident signature; and
on 5/29 refused without a resident signature;
– The facility did not provide shower sheets for (MONTH) 2019.
Record review of the facility’s policy, titled Shower/Tub Bath, undated, showed the
purposes of this procedure are to promote cleanliness, provide comfort to the resident and
to observe the condition of the resident’s skin.

F 0730

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Observe each nurse aide’s job performance and give regular training.

Based on interview and record review, the facility failed to complete a performance review
of every nurse aide at least once every 12 months and failed to provide in-service
education based on the outcome of these reviews. The facility’s census was 88.
Record review of the facility’s in-services and educational reviews showed the facility
administrative staff did not complete performance reviews for the nurse aides.
During an interview on 6/6/19 at 11:05 A.M., the Director of Nursing (DON) said the
facility does not do routine performance appraisals. She has done a few so that some
Certified Nurse Aides (CNAs) could get a raise but they do not normally do them.
During an interview on 6/6/19 at 4:03 P.M., the DON said she likes to do abuse and
neglect, dementia and behavioral training yearly for everybody as a reminder and if
anything new comes up, it is good to have that refresher. It is hard to remember because
we have a lot of aides go on leave so it is easier to do it all for all of them, that way
they aren’t missed. They might think we don’t like them, not anything wrong just keeping
you up to date.
The facility did not provide a policy for Certified Nurse Aide education and training.

F 0732

Level of harm – Potential for minimal harm

Residents Affected – Many

Post nurse staffing information every day.

Based on observation and interview, the facility failed to post the nurse staffing data in
a clear and readable format in a prominent place readily accessible to residents and
visitors on a daily basis at the beginning of each shift. The facility’s census was 88.
Observations on 6/3/19 through 6/6/19 showed the facility did not post the nurse staffing
data in a prominent place.
During an interview on 6/6/19 at 4:00 P.M., the Director of Nursing (DON) said she did
expect staffing hours to be posted. She did try to have it in the box outside of the
activity room and then two or three weeks ago got busy and quit putting it in there.
The facility did not provide a policy for posting nurse staffing.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0761

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Ensure drugs and biologicals used in the facility are labeled in accordance with
currently accepted professional principles; and all drugs and biologicals must be stored
in locked compartments, separately locked, compartments for controlled drugs.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to label and store
drugs in accordance with accepted professional standards of practice. This deficient
practice had the potential to affect all residents in the facility. The facility’s census
was 88.
Observation on [DATE] at 3:30 P.M., showed the ,[DATE] Medication Room had an
unlabeled/dated apple pie in the medication refrigerator. The medication refrigerator did
not have a temperature log to track temperatures. The Medication Room had clothes lying on
the counter.
Observation on [DATE] at 3:45 P.M., showed the ,[DATE] medication cart had a bottle of
Aspirin [MEDICATION NAME] coated regular strength 325 mg (milligram) which expired
,[DATE]. The bottle contained a total of 19 tablets out of the 100 tablet bottle. The
Certified Medication Technician (CMT) B walked away from the medication cart and left it
unlocked.
During an interview on [DATE] at 4:03 P.M., the Director of Nursing (DON) said she would
expect the refrigerator to be free of food. The DON said the night shift is responsible
for the refrigerator log and should record the temperature each night. She said she would
expect the medication in the medication cart to not be expired and the cart to be locked
when not in attendance.
Record review of the facility’s policy, titled Storage of Medications, revised (MONTH)
2007, showed:
– The facility shall store all drugs and biologicals in a safe, secure, and orderly
manner;
– The nursing staff shall be responsible for maintaining medication storage AND
preparation areas in a clean, safe, and sanitary manner;
– The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals.
All such drugs shall be returned to the dispensing pharmacy or destroyed;
– Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators,
carts, and boxes) containing drugs and biologicals shall be locked when not in use, and
trays or carts used to transport such items shall not be left unattended if open or
otherwise potentially available to others;
– Medications requiring refrigeration must be stored in a refrigerator located in the drug
room at the nurses’ station or other secured location. Medications must be stored
separately from food and must be labeled accordingly.

F 0790

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Provide routine and 24-hour emergency dental care for each resident.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, record review, and interview, the facility failed to provide or
arrange for dental services for two residents (Resident #36 and #38) out of 18 sampled
residents. The facility’s census was 88.
1. Record review of Resident #36’s physician’s orders [REDACTED].
– admission date of [DATE];

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0790

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 12)
– [DIAGNOSES REDACTED].
– Order dated 1/23/19 to arrange for resident to see oral surgeon for multiple dental
caries (tooth decay).
Record review of the resident’s admission Minimum Data Set (MDS; a federally mandated
assessment instrument completed by the facility staff), dated 10/8/18, showed:
– A Brief Interview for Mental Status (BIMS; a screening tool to assess cognition) score
of 15 (cognition intact);
– Section L0200 Dental showed broken or loosely fitting full or partial denture, chipped,
cracked, uncleanable or loose teeth.
Record review of the resident’s Comprehensive Care Plan, last updated 4/15/19, showed:
– Coordinate arrangements for dental care, transportation as needed/as ordered;
– Monitor/document/report as needed any signs or symptoms of oral/dental problems needing
attention; pain (gums, toothache, palate), abscess, debris in mouth, lips cracked or
bleeding, teeth missing, loose, broken, eroded, decayed, tongue, ulcers in mouth, [MEDICAL
CONDITION].
Observation on 6/319 at 1:00 P.M. showed the resident to have several broken and missing
teeth.
During an interview on 6/3/19 at 1:00 P.M., the resident said he/she has asked to see a
dentist several times and the Social Worker (SW) hasn’t made an appointment for him/her.
Record review of the resident’s dental status notes, dated 2/4/19, showed recommendation
for primary care physician to refer to an oral surgeon.
Record review of the resident’s medical chart showed no documentation of any follow-up for
dental care recommendations.
During an interview on 6/5/19 at 1:45 P.M., the SW said the resident was seen by the
dental service who visits the facility. The dental service recommended Resident #36 see an
oral surgeon three hours away. No appointment request has been made for the resident
because the SW hasn’t had time to do it.
2. Record review of Resident #38’s POS, dated 6/4/19, showed:
– admission date of [DATE];
– [DIAGNOSES REDACTED].
– Order dated 2/19/19 for dental care as needed.
Record review of the resident’s Admission MDS, dated [DATE], showed:
– A BIMS score of 15;
– Section L0200 Dental showed obvious or likely cavity or broken natural teeth.
Record review of the resident’s Admission MDS, dated [DATE], showed:
– A BIMS score of 15;
– Section L0200 Dental shows no dental problems.
Record review of the resident’s Comprehensive Care Plan, last updated 3/10/19, showed no
dental care plan.
During an interview on 6/3/19 at 11:29 A.M., the resident said he/she needs to go to the
dentist but the SW said the dentist comes about every six months and she won’t make an
outside appointment.
Review of the medical chart showed no notes related to dental services.
During an interview on 6/5/19 at 8:40 A.M., the SW said the resident does not currently
have an appointment with dental services but she can put him/her on the list to be seen by
the dentist when he/she visits the facility.
During an interview on 6/6/19 at 4:03 P.M., the Director of Nursing (DON) said she would
think dental appointments should be made within three days of the recognized need. If
there is an order for [REDACTED].
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0790

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 13)
The facility did not provide a policy for dental services.

F 0804

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Ensure food and drink is palatable, attractive, and at a safe and appetizing
temperature.

Based on observation, interview, and record review, the facility failed to provide
palatable, attractive food at a safe and appetizing temperatures for four residents
(Resident #25, #38, #62, and #78) out of 18 sampled residents and four residents (Resident
#50, #53, #74, and #101) outside the sample. This deficient practice had the potential to
affect all residents in the facility. The facility’s census was 88.
Record review of the facility’s Resident Council minutes showed:
– On 3/5/19, residents asked if a menu could be hung in the activity room every day with
the meals of the day. Resident #50 said he/she is not getting enough food and when he/she
wants double, they don’t always give it to him/her. No old business documented;
– On 4/2/19, Resident #74 said breakfast has been late and they need more scrambled eggs.
There was nothing left from breakfast on 4/2/19. No old business documented;
– On 5/7/19, Resident #53 said they need more help in the kitchen. Old business showed
memorial service on 5/5/19;
– The facility did not document follow up for concerns and did not address the issues.
During an interview on 6/3/19 at 11:24 A.M., Resident #38 said:
– The food is usually served cold;
– The food itself is poor quality frozen food;
– The food served is not always what is posted on the menu;
– Kitchen staff say they don’t have the budget for extra things like condiments;
– Sometimes they run out of food.
Interviews on 6/3/19 showed:
– At 11:48 A.M., Resident #53 said the food isn’t always good;
– Resident #101 said he/she got a hamburger on 6/1/19 that wasn’t done. When he/she
complained, the cook got an attitude and said to eat it anyway;
– At 12:40 P.M., Resident #78 said the food isn’t good, he/she mostly eats cereal and
bananas;
– At 1:33 P.M., Resident #25 said food is not hot and not very good.
During an interview on 6/4/19 at 5:15 P.M., Resident #62 said sometimes the food isn’t fit
to eat. The food is cold when you get it.
Observation on 6/4/19 at 12:45 P.M. showed a test tray with a lid to cover the food:
– Oven baked chicken with soggy breading with a temperature of 140.2 degrees Fahrenheit
(°F);
– Mashed potatoes and gravy (not cheesy mashed potatoes as stated on menu) with a
temperature of 111.3 °F;
– Unseasoned, shriveled/dried-up looking green peas with a temperature of 113.7 °F.
During an interview on 6/5/19 at 3:59 P.M., the Dietary Manager (DM) said they serve both
ends of the building at the same time. One cook serves at each end. Staff take their order
while they’re seated in the dining room waiting on the meal. Staff transport the pans of
food in hot boxes to the halls and put them in pre-heated wells. One of our hot boxes
isn’t currently working and takes each tray to each resident. When asked how she knows how

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0804

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 14)
much food to prepare, she said they have about 90 residents, so she just makes enough for
about 50 people for both the main meal and the alternate. If we have food leftover, we
serve it to the staff for lunch the next day. The DM said he/she can always make grilled
cheese, a hamburger, or chef salad.
During an interview on 6/6/19 at 4:03 P.M., the Dietary Manager and Administrator said
they would expect meals to be palatable and served at the appropriate temperature.
Record review of the facility’s policy, titled Resident Food Preferences, dated (MONTH)
2008, showed:
– The Food Services department will offer a limited number of food substitutes for
individuals who do not want to eat the primary meal;
– The facility’s Quality Assurance and Assessment (QAA) program will periodically review
issues related to food preferences and meals to try to identify more widespread concerns
about meal offerings, food preparation, etc.;
– Did not address holding/serving temperatures of food.

F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Provide and implement an infection prevention and control program.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on interview and record review, the facility failed to maintain an infection
prevention and control program by not properly assessing the results and standardized
testing methods of the [MEDICATION NAME] Skin Test (TST), also known as a purified protein
derivative (PPD) (a screening method developed to evaluate an individual’s status for
active TB or latent TB infection) for five residents (Residents #38, #46, #51, #56 and
#61) out of 18 sampled residents. The facility’s census was 88.
1. Record review of the facility’s policy, titled [MEDICAL CONDITION] Control Policy,
dated 5/18/16, showed:
– All new facility admission/residents shall receive a 2-step Mantoux PPD skin test,
unless they have a documented past positive PPD;
– Step one should be administered with one month prior to admission or within 24 hours
after admission;
– Step one should be read within 48 to 72 hours after administration, following the
criteria outlined:
– Result is negative of less than 10 mm induration;
– Result is positive if more than 10 mm induration:
– Results must be documented in the resident’s clinical record (electronic) in the
immunization tab;
– If step one is negative, step two should be administered within 2-3 weeks after step
one;
– The step 2 PPD should be read within 48 to 72 after administration and the results
documented in the resident’s clinical electronic record;
– If step one is positive, the resident’s physician should be notified and orders obtained
to discharge the resident to an acute hospital/facility with a negative pressure isolation
room until active [MEDICAL CONDITION] is ruled out or the resident is no longer
infectious;
– The Local Public Health Department shall be notified;

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 15)
– If the resident is allergic to the Mantoux PPD or has had a past positive result, do not
administer a PPD, Obtain an order for [REDACTED].>Record review of the facility’s
policy, titled Annual TB Screening, dated 5/18/16, showed:
– Licensed nursing personnel shall be responsible to screen residents living at the
facility at least annually for [MEDICAL CONDITION];
– A licensed nurse will complete an annual [MEDICAL CONDITION] screen on each resident in
the facility;
– If the screening is positive, the resident will be placed on transmission based
precautions;
– The primary physician shall be notified immediately for orders to transfer the resident
to the hospital for further testing.
2. Record review of Resident #38’s immunization record showed:
– Resident admitted to facility on 2/19/19;
– Step one of TST administered on 2/19/19;
– Results as negative, no millimeters (MM) documented;
– Results not dated:
– Step two of TST administered 3/5/19;
– Results as negative, no MM;
– Results not dated.
3. Record review of Resident #46’s immunization record showed:
– Resident admitted to facility on 9/7/18;
– Step one of TST not performed;
– Step two of TST administered 9/7/18;
– Results not dated.
4. Record review of Resident #51’s immunization record showed:
– Resident admitted to facility on 2/19/19;
– Step one of TST administered 2/19/19;
– Results as negative, no MM;
– Step two of TST not performed.
5. Record review of Resident #56’s immunization record showed:
– Resident admitted to facility on 2/25/19;
– Step one and step two of TST not performed.
6. Record review of Resident #61’s immunization record showed:
– Resident admitted to facility on 5/29/14;
– Last TST administered in (YEAR).
7. During an interview on 6/6/19 at 4:03 P.M., the Director of Nursing (DON) said she
would expect the TST to be completed with step one and step two for new admissions and
annually for everyone. She would expect the results to be dated and recorded in MM.

F 0881

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Implement a program that monitors antibiotic use.

Based on interview and record review, the facility failed to include all core elements of
an antibiotic stewardship program. This deficient practice had the potential to affect all
residents in the facility. The facility’s census was 88.
Record review of the facility’s Infection Prevention and Control Program (IPCP) dated

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265743

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR

STREET ADDRESS, CITY, STATE, ZIP

1100 PROGRESS PARKWAY
SAINTE GENEVIEVE, MO 63670

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0881

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 16)
(YEAR), showed the facility’s Antibiotic Stewardship Program did not include all core
elements for antibiotic use protocols. The IPCP did not address:
– A process for periodic review of antibiotic use by prescribing practitioners;
– A system for the provision of feedback reports on antibiotic use, antibiotic resistance
patterns based on lab data, and prescribing practices for the prescribing practitioners
and for the Quality Assurance and Assessment (QAA) committee.
Record review of the facility’s Census and Conditions of Residents, dated 6/4/19, showed
11 residents currently receiving antibiotics.
During an interview on 6/4/19 at 4:50 P.M., the Infection Control Registered Nurse said
he/she didn’t realize the Antibiotic Stewardship Program should include those additional
elements and will add these to their program.
Record review of the facility’s Antibiotic Stewardship Policy, dated (YEAR), showed:
– It is the policy of the facility to maintain an Antibiotic Stewardship Program with the
mission of promoting the appropriate use of antibiotics to treat infections and reduce
possible adverse events associated with antibiotic use;
– The facility’s Antibiotic Stewardship Program will incorporate all seven core elements
outlined by the Centers for Disease Control and Prevention (CDC);
– This policy will be reviewed yearly to ensure that all objectives and conditions are
being met, to streamline procedures, and to identify opportunities for enhancement of the
Antibiotic Stewardship Program.