St Elizabeth Care Center
649 South Walnut · Saint Elizabeth, MO · 65075 · 5734932215
63 certified beds For profit - Corporation Chain: Reliant Care Management
- Inspection results have improved across recent cycles.
Red flags
1 abuse-related citation at the actual-harm level
Inspectors cited failures in the abuse-prevention rules (F600–F610) that resulted in actual harm to a resident.
If someone you love was harmed at a facility with findings like these, you have options — read this.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 1 of 5 Inspections: 3 of 5 Staffing: 1 of 5 Quality measures: 1 of 5
| Total nurse hours / resident-day | 3.39 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.39 | 0.55–0.75 |
| Weekend hours / resident-day | 3.17 | ≈ weekday level |
| Nursing turnover / year | 54% | median 45% |
| Fines (3-yr window) | 1 · $37,733 |
Inspection citations (42 in the current record)
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Potential for harm · E February 6, 2025
Ensure residents have reasonable access to and privacy in their use of communication methods.
Corrected March 14, 2025 · Resident Rights
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Potential for harm · E February 6, 2025
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected March 14, 2025 · Resident Assessment and Care Planning
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Potential for harm · E February 6, 2025
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected March 14, 2025 · Resident Assessment and Care Planning
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Potential for harm · E February 6, 2025
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.
Corrected March 14, 2025 · Quality of Life and Care
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Potential for harm · E February 6, 2025
Provide and implement an infection prevention and control program.
Corrected March 14, 2025 · Infection Control
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Potential for harm · E February 6, 2025
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.
Corrected March 14, 2025 · Infection Control
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Potential for harm · D November 7, 2024 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected December 1, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D November 7, 2024 · found via complaint
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected December 1, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · E October 20, 2023
Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.
Corrected December 1, 2023 · Resident Rights
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Potential for harm · E October 20, 2023
Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
Corrected December 1, 2023 · Resident Rights
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Potential for harm · E October 20, 2023
Keep residents' personal and medical records private and confidential.
Corrected December 1, 2023 · Resident Rights
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Potential for harm · E October 20, 2023
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.
Corrected December 1, 2023 · Resident Rights
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Potential for harm · E October 20, 2023
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected December 1, 2023 · Resident Rights
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Potential for harm · E October 20, 2023
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Corrected December 1, 2023 · Resident Rights
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Potential for harm · E October 20, 2023
Ensure each resident receives an accurate assessment.
Corrected December 1, 2023 · Resident Assessment and Care Planning
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Potential for harm · E October 20, 2023
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected December 1, 2023 · Resident Assessment and Care Planning
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Potential for harm · E October 20, 2023
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected December 1, 2023 · Resident Assessment and Care Planning
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Potential for harm · E October 20, 2023
Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training.
Corrected December 2, 2023 · Nursing and Physician Services
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Potential for harm · D October 20, 2023
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected December 2, 2023 · Pharmacy Service
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Potential for harm · E October 20, 2023
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.
Corrected December 1, 2023 · Pharmacy Service
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Potential for harm · F October 20, 2023
Provide and implement an infection prevention and control program.
Corrected December 2, 2023 · Infection Control
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Potential for harm · E October 20, 2023
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected December 1, 2023 · Infection Control
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Potential for harm · E October 20, 2023
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Corrected December 1, 2023 · Nursing and Physician Services
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No harm found · C October 20, 2023
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.
Corrected December 1, 2023 · Resident Rights
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Actual harm · G August 10, 2023 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected September 20, 2023 · Freedom from Abuse, Neglect, and Exploitation
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| August 10, 2023 | Fine | $37,733 |
Family & resident reviews — a separate signal, never mixed into the score
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 265676 · certified since August 1, 1997. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.