31/100

KIRKWOOD WELLNESS & REHABILITATION Inspection Report, Violations & Safety Grade (KIRKWOOD, Missouri)

711 SOUTH KIRKWOOD ROAD, KIRKWOOD, Missouri 63122

Phone: 3149650864

CMS Overall:1/5

Overview & Bed Count

Certified Beds

117

Avg Residents/Day

71.2

Ownership

For profit - Limited Liability company

Provider Type

Medicare and Medicaid

County

St. Louis

Sprinkler Systems

Yes

Special Focus

SFF Candidate

Abuse Icon

CMS Star Ratings

Overall1/5

Health1/5

Staffing1/5

Quality1/5

Nurse Staffing Check

Metric	This Facility	Missouri Avg	Difference
RN Hours per Resident per Day	0.18	0.46	-0.28
Total Nurse Hours per Resident per Day	4.35	3.40	+0.95
CMS Staffing Rating	1/5	2.2/5	-
Nursing Staff Turnover	N/A	56.9%	-

Health Citation History

69 health citations on record

Date	Category	Description	Severity
2026-04-02	Quality of Life and Care Deficiencies	Provide appropriate treatment and care according to orders, resident’s preferences and goals.	G – Actual Harm
2026-04-02	Quality of Life and Care Deficiencies	Provide enough food/fluids to maintain a resident's health.	G – Actual Harm
2026-04-02	Quality of Life and Care Deficiencies	Provide medically-related social services to help each resident achieve the highest possible quality of life.	G – Actual Harm
2026-04-02	Nursing and Physician Services Deficiencies	Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.	E – Moderate Harm Potential
2026-04-02	Resident Rights Deficiencies	Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.	D – Moderate Harm Potential
2026-04-02	Resident Rights Deficiencies	Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.	D – Moderate Harm Potential
2026-04-02	Resident Rights Deficiencies	Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.	D – Moderate Harm Potential
2026-01-29	Pharmacy Service Deficiencies	Ensure that residents are free from significant medication errors.	J – Immediate Jeopardy
2026-01-29	Quality of Life and Care Deficiencies	Provide appropriate treatment and care according to orders, resident’s preferences and goals.	G – Actual Harm
2026-01-29	Quality of Life and Care Deficiencies	Provide appropriate pressure ulcer care and prevent new ulcers from developing.	G – Actual Harm
2026-01-29	Quality of Life and Care Deficiencies	Provide enough food/fluids to maintain a resident's health.	G – Actual Harm
2026-01-29	Quality of Life and Care Deficiencies	Provide medically-related social services to help each resident achieve the highest possible quality of life.	G – Actual Harm
2026-01-29	Resident Rights Deficiencies	Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide.	F – Moderate Harm Potential
2026-01-29	Administration Deficiencies	Administer the facility in a manner that enables it to use its resources effectively and efficiently.	F – Moderate Harm Potential
2026-01-29	Administration Deficiencies	Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.	F – Moderate Harm Potential
2026-01-29	Administration Deficiencies	Have a plan that describes the process for conducting QAPI and QAA activities.	F – Moderate Harm Potential
2026-01-29	Infection Control Deficiencies	Provide and implement an infection prevention and control program.	F – Moderate Harm Potential
2026-01-29	Infection Control Deficiencies	Implement a program that monitors antibiotic use.	F – Moderate Harm Potential
2026-01-29	Infection Control Deficiencies	Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.	F – Moderate Harm Potential
2026-01-29	Nursing and Physician Services Deficiencies	Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.	F – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.	E – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.	E – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Honor the resident's right to organize and participate in resident/family groups in the facility.	E – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.	E – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.	E – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.	E – Moderate Harm Potential
2026-01-29	Freedom from Abuse, Neglect, and Exploitation Deficiencies	Develop and implement policies and procedures to prevent abuse, neglect, and theft.	E – Moderate Harm Potential
2026-01-29	Resident Assessment and Care Planning Deficiencies	Ensure services provided by the nursing facility meet professional standards of quality.	E – Moderate Harm Potential
2026-01-29	Quality of Life and Care Deficiencies	Provide care and assistance to perform activities of daily living for any resident who is unable.	E – Moderate Harm Potential
2026-01-29	Quality of Life and Care Deficiencies	Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.	E – Moderate Harm Potential
2026-01-29	Nursing and Physician Services Deficiencies	Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.	E – Moderate Harm Potential
2026-01-29	Pharmacy Service Deficiencies	Ensure medication error rates are not 5 percent or greater.	E – Moderate Harm Potential
2026-01-29	Resident Assessment and Care Planning Deficiencies	Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.	E – Moderate Harm Potential
2026-01-29	Administration Deficiencies	Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.	E – Moderate Harm Potential
2026-01-29	Infection Control Deficiencies	Develop and implement policies and procedures for flu and pneumonia vaccinations.	E – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Reasonably accommodate the needs and preferences of each resident.	D – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Honor the resident's right to manage his or her financial affairs.	D – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.	D – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.	D – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Keep residents' personal and medical records private and confidential.	D – Moderate Harm Potential
2026-01-29	Freedom from Abuse, Neglect, and Exploitation Deficiencies	Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.	D – Moderate Harm Potential
2026-01-29	Freedom from Abuse, Neglect, and Exploitation Deficiencies	Respond appropriately to all alleged violations.	D – Moderate Harm Potential
2026-01-29	Resident Rights Deficiencies	Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.	D – Moderate Harm Potential
2026-01-29	Resident Assessment and Care Planning Deficiencies	Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted	D – Moderate Harm Potential
2026-01-29	Resident Assessment and Care Planning Deficiencies	Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.	D – Moderate Harm Potential
2026-01-29	Quality of Life and Care Deficiencies	Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.	D – Moderate Harm Potential
2026-01-29	Quality of Life and Care Deficiencies	Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.	D – Moderate Harm Potential
2026-01-29	Quality of Life and Care Deficiencies	Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.	D – Moderate Harm Potential
2026-01-29	Quality of Life and Care Deficiencies	Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.	D – Moderate Harm Potential
2026-01-29	Pharmacy Service Deficiencies	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.	D – Moderate Harm Potential

Showing 50 of 69 citations.

Fire Safety Citation History

24 fire safety citations on record

Date	Category	Description	Severity
2026-01-29	Emergency Preparedness Deficiencies	Develop and maintain an Emergency Preparedness Program (EP).	F – Moderate Harm Potential
2026-01-29	Emergency Preparedness Deficiencies	Conduct risk assessment and an All-Hazards approach.	F – Moderate Harm Potential
2026-01-29	Emergency Preparedness Deficiencies	List the names and contact information of those in the facility.	F – Moderate Harm Potential
2026-01-29	Emergency Preparedness Deficiencies	Establish staff and initial training requirements.	F – Moderate Harm Potential
2026-01-29	Emergency Preparedness Deficiencies	Conduct testing and exercise requirements.	F – Moderate Harm Potential
2026-01-29	Emergency Preparedness Deficiencies	Implement emergency and standby power systems.	F – Moderate Harm Potential
2026-01-29	Smoke Deficiencies	Inspect, test, and maintain automatic sprinkler systems.	F – Moderate Harm Potential
2026-01-29	Gas, Vacuum, and Electrical Systems Deficiencies	Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.	F – Moderate Harm Potential
2026-01-29	Gas, Vacuum, and Electrical Systems Deficiencies	Have generator or other power source capable of supplying service within 10 seconds.	F – Moderate Harm Potential
2026-01-29	Construction Deficiencies	Use approved construction type or materials.	E – Moderate Harm Potential
2026-01-29	Egress Deficiencies	Install emergency lighting that can last at least 1 1/2 hours.	E – Moderate Harm Potential
2026-01-29	Smoke Deficiencies	Properly select, install, inspect, or maintain portable fire extinguishes.	E – Moderate Harm Potential
2026-01-29	Smoke Deficiencies	Install smoke barrier doors that can resist smoke for at least 20 minutes.	E – Moderate Harm Potential
2026-01-29	Services Deficiencies	Have properly installed electrical wiring and gas equipment.	E – Moderate Harm Potential
2026-01-29	Gas, Vacuum, and Electrical Systems Deficiencies	Have proper medical gas storage and administration areas.	E – Moderate Harm Potential
2024-05-07	Gas, Vacuum, and Electrical Systems Deficiencies	Have generator or other power source capable of supplying service within 10 seconds.	F – Moderate Harm Potential
2024-05-07	Smoke Deficiencies	Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.	E – Moderate Harm Potential
2024-05-07	Smoke Deficiencies	Install an approved automatic sprinkler system.	E – Moderate Harm Potential
2024-05-07	Smoke Deficiencies	Install corridor and hallway doors that block smoke.	E – Moderate Harm Potential
2024-05-07	Services Deficiencies	Ensure that gas fire places are out of the reach of patients and can be shut off if unit is working improperly.	E – Moderate Harm Potential
2022-11-17	Egress Deficiencies	Install emergency lighting that can last at least 1 1/2 hours.	E – Moderate Harm Potential
2022-11-17	Smoke Deficiencies	Have approved installation, maintenance and testing program for fire alarm systems.	E – Moderate Harm Potential
2022-11-17	Smoke Deficiencies	Inspect, test, and maintain automatic sprinkler systems.	E – Moderate Harm Potential
2022-11-17	Gas, Vacuum, and Electrical Systems Deficiencies	Ensure proper usage of power strips and extension cords.	E – Moderate Harm Potential

Total Penalties & Fines

$172,400

Total Fine Amount (CMS)

Number of Fines

Total Penalties

Date	Type	Fine Amount	Payment Denial
2026-01-29	Fine	$172,400	-
2026-01-29	Payment Denial	-	57 days starting 2026-04-29

Need Help Finding Safe Care?

Our family advisors can help you find vetted, top-rated facilities in the KIRKWOOD area at no cost.

Find Safe, Vetted Facilities Near KIRKWOOD
(Free Family Advisor Call)Download Inspection & Tour Checklist PDF
3-Year Complete Report ($19)

Advisor service is free for families. We may receive referral compensation.

Need Help Finding Safe Care?

Our family advisors can help you find vetted, top-rated facilities in the KIRKWOOD area at no cost.

Find Safe, Vetted Facilities Near KIRKWOOD
(Free Family Advisor Call)Download Inspection & Tour Checklist PDF
3-Year Complete Report ($19)

Advisor service is free for families. We may receive referral compensation.