Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around October 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at St James Living Center during CMS and state inspections, most recent first.
Staff did not notify a resident's physician after the resident was found lethargic and unresponsive, received Narcan for a suspected overdose, and was transferred to the hospital. Despite facility policy requiring physician notification and documentation, the physician was not informed, and there was no record of contact or response.
Facility staff did not initiate an investigation after a resident overdosed on Benzodiazepines and Opiates, received Narcan, and was transferred to the hospital. Despite policy requiring immediate and thorough investigation of such incidents, neither the Administrator nor the DON were fully informed or took action to investigate, resulting in no documentation or analysis of the event.
The facility did not ensure that an area was free from accident hazards and failed to provide adequate supervision to prevent accidents. Surveyors observed environmental hazards and insufficient staff monitoring, increasing the risk of resident accidents.
A Certified Medication Technician misappropriated Lorazepam by signing out and documenting administration to two residents without proper authorization, including after a physician had discontinued the medication for one resident. The CMT falsified records and removed medications that were not present at the time of administration, as discovered through a narcotics count and staff report.
The facility failed to maintain a safe and clean environment, with observations of unclean and poorly maintained areas, including cracked toilet seats, chipped paint, and damaged floors. Residents reported dissatisfaction with unfinished maintenance work and the presence of flies in their rooms. The maintenance director acknowledged a backlog of repairs, but no work orders were submitted for many issues. Additionally, windows in resident rooms were sealed shut, preventing them from being opened.
The facility staff failed to update comprehensive care plans for several residents, leading to deficiencies in care. A resident's care plan did not address oxygen use, despite a physician's order for continuous therapy. Another resident's plan lacked information on a new depression diagnosis and antidepressant use. Other residents had incomplete care plans regarding behaviors, wandering risks, weight loss, and ADL needs. The MDS Coordinator admitted to overlooking these updates, and the DON confirmed the omissions.
Facility staff failed to ensure safe hydraulic lift transfers for two residents by not keeping the lift's base open for stability, as required by policy. Observations showed residents swaying dangerously during transfers, and interviews revealed staff were not properly trained on the lift's operation.
The facility failed to maintain RN coverage for at least eight consecutive hours per day, seven days a week, as required. The Payroll Based Journal report showed multiple days with no RN hours in early 2024. Interviews revealed staffing challenges, with the DON often being the only RN available and working doubles on weekends. The facility did not use agency staff and struggled to hire RNs, despite efforts like job fairs and sign-on bonuses.
Facility staff failed to follow infection control procedures, including Enhanced Barrier Precautions, during resident care. A resident with an indwelling catheter did not receive care with the required gown and gloves. Additionally, two residents did not receive proper hand hygiene and glove changes during perineal care. The facility also failed to comply with its TB control policy, allowing several employees to start work before completing the required PPD test.
Facility staff failed to provide written notification of the bed hold policy to residents or their representatives before hospital transfers. This issue was identified for four residents through interviews and record reviews, which showed a lack of documentation in their medical records. Staff interviews revealed confusion and lack of responsibility regarding the bed hold notification process, with the DON noting previous staff unawareness of the requirement.
Facility staff did not complete Significant Change in Status Assessments (SCSA) for three residents who experienced notable changes in their conditions, including increased assistance needs, cognitive decline, weight loss, and new diagnoses. The MDS Coordinator and DON were unaware of the requirements for conducting these assessments, leading to the oversight.
Facility staff failed to accurately document the MDS for three residents, leading to deficiencies. A resident's significant weight loss was not recorded, another was incorrectly coded for restraint use, and a third was inaccurately documented as receiving hypnotic and anticoagulant medications. The MDS Coordinator admitted to errors and a lack of full training.
The facility failed to post and retain required daily nurse staffing information, including staff numbers and hours worked, for both licensed and unlicensed staff. Observations showed missing or outdated postings, and interviews revealed a lack of awareness from the DON and administrator about these requirements.
Facility staff failed to ensure oncoming and off-going staff members verified and reconciled the narcotic count as accurate at each shift change. A review of the Narcotic Inventory Sheet for October 2023 showed multiple instances where staff did not document or record a signature to signify the count had been completed. Interviews with the Assistant DON, an LPN, and the Administrator confirmed that staff are expected to count narcotics with two nurses every shift and sign the narcotic count sheet.
Facility staff failed to prevent the misappropriation of a resident's narcotic medications when a CNA took the medication without authorization. The incident involved a cognitively intact resident with a diagnosis of pain in the right hip and hypertrophic osteoarthropathy, who was receiving scheduled and as-needed pain medication, including oxycodone 10 mg tablets. The CNA accessed the medication cart, administered the medication without proper authorization, and subsequently fled the facility. The CNA was terminated following an investigation.
Failure to Notify Physician After Resident Overdose and Narcan Administration
Penalty
Summary
Facility staff failed to notify a resident's physician after the resident experienced a significant change in condition, specifically lethargy, pinpoint pupils, and unresponsiveness, which led staff to suspect an overdose and administer Narcan. The resident, who had a history of seizures and was assessed as alert and cognitively intact on the baseline care plan, was subsequently transferred to a local hospital for evaluation. Documentation showed that staff are required to report changes in condition to the DON and physician, and to document any physician contact and response. Despite these requirements, there was no documentation that the physician was notified of the incident. Interviews with the administrator, DON, and the physician confirmed that the physician was not informed, and the physician stated that he was unaware of the overdose and had not adjusted the resident's medications as a result. The charge nurse reported faxing a nonemergent line but did not call the physician, and there was no confirmation that the fax was received. The facility's policy and care plan expectations for physician notification were not followed in this case.
Failure to Investigate Resident Overdose Incident
Penalty
Summary
Facility staff failed to conduct an investigation after a resident experienced an overdose involving Benzodiazepines and Opiates, resulting in the administration of Narcan and subsequent transfer to a hospital. The facility's investigation policy requires prompt and thorough investigation of such incidents, including interviews, assessments, and root cause analysis. However, review of the resident's medical record revealed no documentation of an investigation following the event. The resident, who was alert, cognitively intact, and on chronic opiate therapy for cancer-related pain, was found lethargic, with pinpoint pupils and unresponsive, prompting staff to administer Narcan and call emergency services. Interviews with facility leadership revealed that the Administrator was only partially informed about the incident and did not initiate an investigation due to lack of full details. The DON was not aware of the incident at all and stated that an investigation should have been started to rule out medication errors, the need for medication adjustments, or possible abuse. The absence of an investigation following the overdose event was contrary to the facility's own policy and expectations.
Failure to Maintain Accident-Free Environment and Adequate Supervision
Penalty
Summary
The facility failed to ensure that an area was free from accident hazards and did not provide adequate supervision to prevent accidents. Surveyors observed that the environment contained hazards that could lead to resident accidents, and staff did not implement sufficient measures to monitor or protect residents from these risks. This deficiency was identified based on direct observations and findings during the survey, which indicated lapses in maintaining a safe environment and in providing necessary supervision to prevent accidents.
Misappropriation of Resident Medications by CMT
Penalty
Summary
Facility staff failed to prevent the misappropriation of medications for two residents. A Certified Medication Technician (CMT) was found to have signed out and documented the administration of Lorazepam to both residents without proper authorization or, in some cases, after the medication had been discontinued by the physician. For one resident, the CMT continued to sign out and document administration of Lorazepam even after the physician had discontinued the order, and for the other resident, the CMT signed out and documented doses that were not present in the medication cup at the time of administration. These actions were discovered following a report from a Certified Nurse Aide (CNA) who had evidence of the CMT stealing medications, prompting an immediate narcotics count by the Director of Nursing (DON). The review of medication administration records, controlled drug receipt forms, and physician orders revealed discrepancies between the medications signed out and those actually administered or present. The CMT had pre-popped medications and falsified records to indicate administration that did not occur, resulting in the wrongful use and misappropriation of resident medications without consent. Both residents involved had documented needs for or histories of antianxiety medication, with one assessed as moderately cognitively impaired and the other as cognitively intact.
Facility Fails to Maintain Safe and Clean Environment
Penalty
Summary
The facility failed to maintain a safe, clean, and homelike environment for its residents, as evidenced by numerous observations of unclean and poorly maintained areas. Observations included dried stains on walls, cracked and stained toilet seats, dirty bathroom walls, chipped paint, and damaged floors held together with duct tape. Residents expressed dissatisfaction with the unfinished maintenance work, such as incomplete painting and exposed drywall debris. The maintenance director acknowledged a backlog of repairs due to a previous lack of a maintenance director, but no work orders had been submitted for many of the observed issues. Additionally, the facility failed to provide an environment free of pests, as multiple residents were observed with flies in their rooms and on their food. Residents reported the presence of flies to staff, but no effective action was taken to address the issue. The maintenance director and administrator were aware of the flies but had not received reports from staff or taken steps to resolve the problem. The pest control company was contacted but reportedly stated there was nothing they could do. The facility also had issues with sealed windows in resident rooms, which prevented residents from opening them. The maintenance director was aware of the sealed windows, which were closed during the pandemic, but the administrator was not informed of this issue. The lack of a written policy for maintenance and the absence of a system for reporting environmental concerns contributed to the facility's failure to address these deficiencies effectively.
Deficiencies in Comprehensive Care Plan Updates
Penalty
Summary
The facility staff failed to ensure comprehensive care plans were updated for several residents, leading to deficiencies in care. For instance, Resident #2's care plan did not address their oxygen use, despite a physician's order for continuous oxygen therapy. The MDS Coordinator admitted to overlooking this aspect, and the Director of Nursing (DON) confirmed that oxygen use should be included in the care plan. Similarly, Resident #8's care plan lacked information on their new diagnosis of depression and the use of antidepressant medication. The care plan did not include symptoms for staff to monitor or non-pharmacological interventions, nor did it list potential side effects of the medication. The MDS Coordinator acknowledged the oversight, and the DON stated that these elements should have been included in the care plan. Other residents, such as Resident #34, #36, #41, and #45, also had incomplete care plans. Resident #34's care plan did not address their aggressive behaviors, while Resident #36's plan failed to include their wandering and elopement risks. Resident #41's care plan omitted significant weight loss and oxygen use, and Resident #45's plan did not address their ADL needs. In each case, the MDS Coordinator admitted to forgetting to update the care plans, and the DON confirmed that these elements should have been included.
Unsafe Hydraulic Lift Transfers Due to Improper Use
Penalty
Summary
Facility staff failed to provide safe hydraulic lift transfers for two residents, resulting in a deficiency. The facility's policy and the hydraulic lift user manual both require the lift's base to be opened to the maximum width and locked for stability during transfers. However, observations revealed that staff did not adhere to these guidelines. In one instance, two CNAs transferred a resident without keeping the lift's base open, causing the resident to sway dangerously in the sling. The CNAs were unaware of the requirement to keep the lift's legs open for stability, as they had not been trained properly. In another instance, the same CNAs repeated the unsafe practice with a different resident, again closing the lift's legs during the transfer. Interviews with the CNAs revealed a misunderstanding of the lift's operation, with one CNA incorrectly believing that closing the legs was necessary to prevent tripping hazards. The MDS coordinator and the DON confirmed that the lift's legs should remain open during transfers to ensure stability and prevent tipping.
Failure to Maintain Required RN Coverage
Penalty
Summary
The facility failed to provide the services of a Registered Nurse (RN) for at least eight consecutive hours per day, seven days a week, as required. The facility's policies did not include a policy for RN coverage, and the Payroll Based Journal (PBJ) report for Fiscal Year 2024, Quarter 2, showed multiple days with no RN hours. Specific dates in January, February, and March 2024 were identified where the facility did not have an RN present for the required hours. The facility census at the time was 48. Interviews with the Director of Nursing (DON) and the administrator revealed that the facility struggled with RN staffing. The DON, who started in February, was often the only RN available and had to work doubles on weekends. The facility did not use agency nursing staff but relied on corporate RNs to assist when needed. The administrator, who started in May, was unaware of the missing coverage for the quarter and acknowledged the difficulty in hiring RNs, with efforts such as job fairs and sign-on bonuses being implemented to address the issue.
Infection Control and TB Screening Deficiencies
Penalty
Summary
The facility staff failed to adhere to appropriate infection control procedures, specifically Enhanced Barrier Precautions (EBP), during the care of residents. One resident with an indwelling urinary catheter did not receive care with the required gown and gloves, as observed when a Certified Nursing Aide (CNA) provided catheter care without wearing a gown. The CNA was unaware of the EBP requirements, indicating a lack of training or understanding of the infection control measures necessary for residents with indwelling devices. Additionally, staff failed to perform proper hand hygiene and glove changes during perineal care for two residents. Observations showed that CNAs did not change gloves or perform hand hygiene between dirty and clean tasks, increasing the risk of cross-contamination and infection. Interviews with the CNAs revealed an acknowledgment of the need for hand hygiene but highlighted the absence of hand sanitizer in resident rooms, which contributed to the oversight. The facility also did not comply with its Tuberculosis (TB) control policy, as several employees began working before completing the required first step of the purified protein derivative (PPD) test. The Director of Nursing (DON) and the administrator confirmed that the TB tests were not read before the employees' start dates, which is against the facility's policy. This lapse in protocol was attributed to a change in responsibility for TB screenings after the Assistant Director of Nursing (ADON) left the facility.
Failure to Notify Residents of Bed Hold Policy
Penalty
Summary
The facility staff failed to provide written notification of the bed hold policy to residents or their representatives prior to hospital transfers for four out of 23 sampled residents. This deficiency was identified through interviews and record reviews, revealing that the medical records of these residents lacked documentation of such notifications. The facility's policy on the discharge and transfer of residents mandates that staff explain and provide a copy of the bed hold form to the resident or their representative, which was not adhered to in these cases. Interviews with various staff members, including the Business Office Manager, Director of Nursing, Activities Director, and the Administrator, highlighted a lack of clarity and responsibility regarding the bed hold notification process. The Director of Nursing, who assumed the position in late February, noted that prior staff were unaware of the bed hold requirements. The Administrator mentioned that the nursing staff had not been providing the necessary bed hold forms to residents upon transfer, indicating a systemic issue in the facility's adherence to its own policies.
Failure to Complete Significant Change Assessments for Residents
Penalty
Summary
Facility staff failed to complete a Significant Change in Status Assessment (SCSA) Minimum Data Set (MDS) for three residents, despite significant changes in their conditions. Resident #2 experienced a decline in functional abilities, including increased assistance needs for daily activities, a fall with injury, and the development of an open lesion on the foot. Resident #8 showed both declines and improvements, such as severe cognitive impairment, increased rejection of care, significant weight loss, and new pressure injuries, along with a new diagnosis of depression and the initiation of antidepressant medication. Resident #41 exhibited changes in behavior, increased assistance needs, significant weight loss, and experienced falls, yet no SCSA was completed for these changes. The MDS Coordinator, responsible for completing significant change assessments, admitted to not being aware of the requirements outlined in the Resident Assessment Instrument (RAI) Manual. The coordinator also mentioned working as a charge nurse at times, which may have contributed to the oversight. The Director of Nursing (DON) also expressed a lack of knowledge regarding the criteria for triggering a significant change MDS. This lack of awareness and understanding among key staff members led to the failure to conduct necessary assessments for residents experiencing significant changes in their health status.
Inaccurate MDS Documentation for Residents
Penalty
Summary
The facility staff failed to document a complete and accurate Minimum Data Set (MDS) for three residents, leading to deficiencies in the assessment process. For one resident, a significant weight loss from 254 pounds to 228 pounds was not documented as significant on the MDS, despite acknowledgment from the MDS Coordinator and the Director of Nursing (DON) that it should have been. Another resident was incorrectly coded as using limb restraints, although observations and staff interviews confirmed that restraints were never used. The MDS Coordinator admitted to coding restraints due to bed rail use, which was an error, and noted a lack of full training in the position. Additionally, a third resident was inaccurately coded as receiving hypnotic and anticoagulant medications. The MDS Coordinator mistakenly identified amitriptyline as a hypnotic and aspirin as an anticoagulant, indicating a misunderstanding of medication classifications. The MDS Coordinator acknowledged responsibility for ensuring accurate MDS coding but was unaware of the errors. These inaccuracies highlight a failure in the facility's assessment and documentation processes, as outlined in their policy to adhere to CMS guidelines.
Failure to Post and Retain Daily Nurse Staffing Information
Penalty
Summary
The facility failed to comply with the requirement to post daily nurse staffing information, which includes the total number of staff and the actual hours worked by both licensed and unlicensed nursing staff responsible for resident care. The facility also did not retain these records for the required eighteen months. Specific dates were identified where the nurse staffing forms were either not completed or not available, indicating a pattern of non-compliance. Observations on multiple days showed that the daily nurse staff postings were either outdated or missing required information such as shift details and Certified Nurse Aide (CNA) hours. Interviews with the Director of Nursing (DON) and the administrator revealed a lack of awareness and understanding of the requirements for nurse staffing postings. The DON, who took over the responsibility after the Assistant Director of Nursing (ADON) left, admitted to being unaware of the inaccuracies and the failure to save the postings. The administrator, new to the position, was also unaware of the deficiencies in the daily nurse staff postings and was in the process of addressing various operational issues within the facility.
Failure to Verify and Reconcile Narcotic Count at Shift Changes
Penalty
Summary
Facility staff failed to ensure oncoming and off-going staff members verified and reconciled the narcotic count as accurate at each shift change. The facility's Narcotic Count Policy requires that one RN, LPN, or CMT going off duty and one RN, LPN, or CMT coming on duty must count and justify the accuracy of narcotics supply for each individual resident at the change of each shift. However, a review of the Narcotic Inventory Sheet for October 2023 showed multiple instances where staff did not document or record a signature to signify the count had been completed. Specific dates where the count was not documented include all shifts on 10/1/23, 10/7/23, 10/8/23, 10/15/23, 10/28/23, and 10/29/23, among others. This indicates a consistent failure to follow the facility's policy on narcotic counts across multiple shifts and days throughout the month of October 2023. During interviews, the Assistant DON, an LPN, and the Administrator confirmed that staff are expected to count narcotics with two nurses every shift and sign the narcotic count sheet. The DON acknowledged that nurses have developed a bad habit of completing the count but failing to sign the book. The Administrator and DON both expressed the need for in-services with the licensed staff to ensure the counts are completed and signed as required by the facility's policy.
Misappropriation of Resident's Narcotic Medication
Penalty
Summary
Facility staff failed to prevent the misappropriation of a resident's narcotic medications when a CNA took the medication without authorization. The facility's Abuse Prohibition Policy defines misappropriation as the wrongful use of a resident's belongings or money without consent. The incident involved a cognitively intact resident with a diagnosis of pain in the right hip and hypertrophic osteoarthropathy, who was receiving scheduled and as-needed pain medication, including oxycodone 10 mg tablets. The resident's medication card of 30 oxycodone pills was found missing, and none of the pills had been signed out as given. The incident was reported by an LPN who noticed the missing medication and confronted the CNA, who claimed to have administered the medication to the resident. The CNA could not produce the medication card and subsequently fled the facility. The ADON and Administrator were notified, and an investigation was initiated. The police, the resident's primary care physician, the appropriate state agency, and the resident's responsible party were informed of the misappropriation. The CNA was terminated for the misappropriation of the resident's narcotic medication. Interviews with various staff members revealed that the CNA had accessed the medication cart and administered the medication without proper authorization. The CNA was reported to have acted suspiciously, moving between bathrooms and eventually fleeing the facility. The staff also noted that the nurses had previously left the keys to the medication cart in a drawer at the nurse's station, which allowed the CNA to access the cart. The facility's investigation confirmed the misappropriation, and the CNA was terminated as a result.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Saint James
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Aurora Health And Rehabilitation | 8.3 mi | — | 10 | 0 |
| Rolla Presbyterian Manor | 8.5 mi | — | 0 | 0 |
| Silverstone Place | 9.4 mi | — | 1 | 0 |
| Cedar Pointe | 9.8 mi | — | 0 | 0 |
| Phelps Health | 10.2 mi | — | 0 | 0 |
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