St. Louis County, Missouri · Nursing home
Avenir at Mark Twain
1 of 5 overall from CMS
11988 Mark Twain Lane, Bridgeton, MO 63044
At a glance
- Overall rating 1 of 5 Below the state average of 2.5
- Nurse time per resident, per day 3.47 hours Above the state average of 3.43
- Nursing staff who left in a year 71.4% Above the state average of 56.0%
- Health citations, last 3 inspection cycles 63 3 at the harm level or above
- Fines in 3 years $235,300 5 fines
- Certified beds in use 64.2% of 120 beds, on an average day
Arrows only show whether a figure is above or below the state average. They are not a judgment of the home.
Avenir at Mark Twain is a 120-bed nursing home in Bridgeton, Missouri (St. Louis County). CMS rates it 1 of 5 stars overall as of Sep 2026. It reports 3.47 nurse staffing hours per resident per day, above the Missouri average of 3.43. CMS lists 5 fines totaling $235,300 in the past three years.
- Certified beds
- 120
- Residents per day (average)
- 77.1
- Certified since
- 1984 (42 yrs)
For profit - Limited Liability company Participates in Medicare and MedicaidOwnership changed in last 12 months
Bed use is this site's calculation: average residents per day divided by certified beds. It is an average, so it does not show today's openings.
Terms used on this page
- CMS
- The Centers for Medicare & Medicaid Services, the federal agency that publishes the ratings, staffing figures, inspection results and penalties shown here.
- Certified beds
- The number of federally certified beds CMS lists for the home.
- Deficiency or citation
- A federal requirement that inspectors found the home did not meet. Each one gets a letter from A to L for how serious it was and how many residents were affected. What the letters mean
- Actual harm
- Letters G, H and I: actual harm to a resident that is not immediate jeopardy.
- Immediate jeopardy
- Letters J, K and L: the problem caused, or was likely to cause, serious injury, harm, impairment or death to a resident.
- Inspection cycle
- A standard inspection plus the complaint and infection-control citations CMS assigns to it. This page shows the three most recent cycles.
- Special Focus Facility (SFF)
- A home CMS has placed under closer oversight because of its inspection record. More about the program
Questions to ask Avenir at Mark Twain
Chosen from this home's public data.
- CMS lists 5 fines totaling $235,300 in the past three years. What changed after the most recent one?Penalties in CMS data
- CMS counts 30 health deficiencies in the latest inspection cycle (the standard inspection on Aug 20, 2025 plus complaint and infection-control inspections); the Missouri average is 11.4. Which have been corrected?Inspection results in CMS data
- Nursing staff turnover is 71.4%, above the Missouri average of 56.0%. How often would the same aides care for my relative?Turnover in CMS data
More in what to ask on a nursing home tour.
CMS star ratings
- Overall 1 of 5 Missouri average 2.5
- Health inspections 1 of 5 Missouri average 2.8
- Staffing 2 of 5 Missouri average 2.2
- Quality measures 3 of 5 Missouri average 2.7
The vertical line marks the Missouri average. Ratings run from 1 to 5. How to read CMS star ratings
Nurse staffing
Hours of care per resident per day, as the home reported to CMS.
What these roles do
Nurse aides give most hands-on daily care, such as help with bathing, dressing and meals. Licensed practical nurses give medications and routine nursing care. Registered nurses assess residents and direct their care.
- All nursing staff 3.47 h Missouri average 3.43
- Nurse aides 2.51 h Missouri average 2.29
- Licensed practical nurses 0.47 h Missouri average 0.68
- Registered nurses 0.49 h Missouri average 0.46
- All staff, weekends 3.08 h Missouri average 3.01
How much nurse staffing is enough? All bars share one scale, 0 to 10 hours. The vertical line marks the Missouri average; the national average for all nursing staff is 3.86 hours.
- Nursing staff turnover71.4%
- Missouri average56.0%
- Registered nurse turnover75.0%
- Missouri average47.8%
- Administrators who left2
Quality measures
CMS calculates these from residents' assessments and Medicare claims. They are shown as published, next to the Missouri and national averages. marks the measures CMS uses in its quality star rating; for those, the rating gives more points for a lower rate.
Long-stay residents
| Measure | This home | Missouri | U.S. |
|---|---|---|---|
| ★ Percentage of long-stay residents whose need for help with daily activities has increased | 22.8% | 18.1% | 13.9% |
| Percentage of long-stay residents who lose too much weight | 4.3% | 5.3% | 5.2% |
| ★ Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.7% | 1.1% | 0.8% |
| ★ Percentage of long-stay residents with a urinary tract infection | 0.8% | 2.3% | 1.6% |
| Percentage of long-stay residents who have depressive symptoms | 0.4% | 18.5% | 12.8% |
| Percentage of long-stay residents who were physically restrained | 0.0% | 0.0% | 0.1% |
| ★ Percentage of long-stay residents experiencing one or more falls with major injury | 2.6% | 4.1% | 3.2% |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 61.1% | 84.1% | 93.6% |
| ★ Percentage of long-stay residents whose ability to walk independently worsened | 23.9% | 17.4% | 14.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 17.4% | 25.6% | 19.5% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 93.2% | 90.9% | 95.5% |
| ★ Percentage of long-stay residents with pressure ulcers | 10.8% | 4.5% | 4.6% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 20.5% | 17.8% | 19.0% |
| ★ Percentage of long-stay residents who received an antipsychotic medication | 13.3% | 23.5% | 15.4% |
| ★ Number of hospitalizations per 1000 long-stay resident days | 2.04 | 2.11 | 1.90 |
| ★ Number of outpatient emergency department visits per 1000 long-stay resident days | 0.81 | 2.33 | 1.78 |
Short-stay residents
| Measure | This home | Missouri | U.S. |
|---|---|---|---|
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 14.7% | 65.7% | 82.0% |
| ★ Percentage of short-stay residents who newly received an antipsychotic medication | 3.6% | 2.2% | 1.6% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 56.7% | 63.5% | 79.8% |
| ★ Percentage of short-stay residents who were rehospitalized after a nursing home admission | Too few residents or stays to report | 26.0% | 23.8% |
| ★ Percentage of short-stay residents who had an outpatient emergency department visit | Too few residents or stays to report | 13.7% | 12.0% |
Measure periods: April 2025 to March 2026 for most measures; July 2024 to June 2025 for the flu vaccine measures; January to December 2025 for the hospital and emergency department measures, which CMS risk-adjusts. See the measures on Medicare.gov
Inspection history
Inspectors cited 63 health deficiencies in the three most recent inspection cycles. Of these, 3 were at the immediate jeopardy level; the rest were graded as no actual harm. 21 were cited in connection with a complaint investigation. The most recent citation at the harm level or above was on Jun 22, 2026: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
| Standard inspection | Health | Fire safety |
|---|---|---|
| Aug 20, 2025 | 30 | 11 |
| Jan 19, 2024 | 16 | 7 |
| Nov 8, 2019 | 17 | 3 |
Missouri homes averaged 11.4 health deficiencies in the latest cycle; the national average is 9.2. Each cycle's health count covers the standard inspection on that date plus the complaint and infection-control citations CMS assigns to that cycle.
Health citations, three most recent inspection cycles (63)
-
JImmediate jeopardy, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Jul 27, 2026)
-
DPotential for more than minimal harm, isolated
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Complaint investigation · Resident Rights · Deficient, Provider has date of correction (Jan 15, 2026)
-
DPotential for more than minimal harm, isolated
Ensure services provided by the nursing facility meet professional standards of quality.
Complaint investigation · Resident Assessment and Care Planning · Deficient, Provider has date of correction (Jan 15, 2026)
-
DPotential for more than minimal harm, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Jan 15, 2026)
-
DPotential for more than minimal harm, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Nov 14, 2025)
Show 25 more
-
EPotential for more than minimal harm, pattern
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Complaint investigation · Resident Rights · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
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.
Resident Rights · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
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.
Resident Rights · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
Ensure each resident receives an accurate assessment.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
Ensure services provided by the nursing facility meet professional standards of quality.
Complaint investigation · Resident Assessment and Care Planning · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
Provide safe and appropriate respiratory care for a resident when needed.
Quality of Life and Care · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
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.
Quality of Life and Care · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Complaint investigation · Nutrition and Dietary · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Complaint investigation · Nutrition and Dietary · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
Have a plan that describes the process for conducting QAPI and QAA activities.
Administration · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
Provide and implement an infection prevention and control program.
Infection Control · Deficient, Provider has date of correction (Oct 3, 2025)
-
EPotential for more than minimal harm, pattern
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Complaint investigation · Nursing and Physician Services · Deficient, Provider has date of correction (Oct 3, 2025)
-
DPotential for more than minimal harm, isolated
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Resident Rights · Deficient, Provider has date of correction (Oct 3, 2025)
-
DPotential for more than minimal harm, isolated
Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
Resident Rights · Deficient, Provider has date of correction (Oct 3, 2025)
-
DPotential for more than minimal harm, isolated
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Freedom from Abuse, Neglect, and Exploitation · Deficient, Provider has date of correction (Oct 3, 2025)
-
DPotential for more than minimal harm, isolated
Provide care and assistance to perform activities of daily living for any resident who is unable.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Oct 3, 2025)
-
DPotential for more than minimal harm, isolated
Provide appropriate foot care.
Quality of Life and Care · Deficient, Provider has date of correction (Oct 3, 2025)
-
DPotential for more than minimal harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care · Deficient, Provider has date of correction (Oct 3, 2025)
-
DPotential for more than minimal harm, isolated
Provide timely, quality laboratory services/tests to meet the needs of residents.
Administration · Deficient, Provider has date of correction (Oct 3, 2025)
-
DPotential for more than minimal harm, isolated
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
Nutrition and Dietary · Deficient, Provider has date of correction (Nov 19, 2025)
-
DPotential for more than minimal harm, isolated
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Administration · Deficient, Provider has date of correction (Oct 3, 2025)
-
DPotential for more than minimal harm, isolated
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Infection Control · Deficient, Provider has date of correction (Oct 3, 2025)
-
DPotential for more than minimal harm, isolated
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.
Infection Control · Deficient, Provider has date of correction (Oct 3, 2025)
-
DPotential for more than minimal harm, isolated
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Environmental · Deficient, Provider has date of correction (Oct 3, 2025)
Showing the 30 most recent of 63.
What severity letters A to L mean
Each sentence above is the requirement that was not met, in CMS's wording. For the inspection results as Medicare publishes them, open this home's page on Medicare.gov and look under "Health inspections".
Penalties, past three years
| Date | Type | Amount |
|---|---|---|
| Jun 22, 2026 | Fine | $65,396 |
| Jun 22, 2026 | Payment Denial | 4 days |
| Jan 21, 2025 | Fine | $134,043 |
| Jan 21, 2025 | Payment Denial | 14 days |
| Jan 19, 2024 | Fine | $26,687 |
| Jan 19, 2024 | Payment Denial | 19 days |
| Sep 25, 2023 | Fine | $4,587 |
| Sep 18, 2023 | Fine | $4,587 |
Missouri homes averaged 0.8 fines and $37,425 in fine amounts; the national averages are 0.9 and $30,972.
Cost
Not in the public data. CMS does not publish what a nursing home charges.
Ask the home for its daily private-pay rate and whether a bed is open for your coverage. See what Medicare covers and how Medicaid pays for a nursing home.
Compared within Missouri
Common questions
What is the CMS star rating for Avenir at Mark Twain?
Avenir at Mark Twain has an overall rating of 1 of 5 stars from CMS as of Sep 2026. Its health inspection rating is 1, staffing is 2 and quality measures is 3.
How many beds does Avenir at Mark Twain have?
Avenir at Mark Twain has 120 certified beds. It averages 77.1 residents per day, about 64.2% of its certified beds.
How much nursing care do residents get at Avenir at Mark Twain?
The home reports 3.47 hours of nurse staffing per resident per day, including 0.49 hours from registered nurses. The Missouri average is 3.43 hours and 0.46 hours from registered nurses.
Has Avenir at Mark Twain been fined?
Yes. CMS lists 5 fines totaling $235,300 in the past three years. It also lists 3 payment denials.
Does Avenir at Mark Twain accept Medicare or Medicaid?
CMS lists its participation as "Medicare and Medicaid". Ask the home whether a bed is open for your coverage.
Guides for families looking at this home
- Understanding the recordWhat to ask on a nursing home tourQuestions that turn a home's public record into a useful conversation when you tour, plus what to look for yourself.
- Understanding the recordInspection severity letters A to LHow inspectors grade each deficiency by harm and by how many residents were affected.
- Understanding the recordHow to read CMS star ratingsWhat the overall, health inspection, staffing and quality measure ratings cover, and what they leave out.
Nearest nursing homes
- 3 of 5 Ssm Health Depaul Hospital - Anna House 105beds 83.9%in use 4.62nurse hours a day
- 1 of 5 Parkwood Skilled Nursing and Rehabilitation Center 130beds 65.0%in use 3.18nurse hours a day
- 2 of 5 Stonebridge Maryland Heights 223beds 63.8%in use 3.50nurse hours a day
Sorted by straight-line distance. This is not a ranking or a recommendation. Compare all homes in St. Louis County
Who to call in Missouri
These offices serve residents of every nursing home in Missouri.
- Long-term care ombudsman Missouri Long-Term Care Ombudsman Program 800-309-3282 (Email: LTCOmbudsman@health.mo.gov) An advocate for residents and their families.
- File a complaint about a nursing home Adult Abuse and Neglect Hotline (long-term care facility complaints) 1-800-392-0210 (7 days a week, 7 a.m. to 8 p.m. Relay Missouri 1-800-735-2966. Reports can also be made online (moapss.health.mo.gov, linked from Health.Mo.Gov/abuse).) The state agency that inspects nursing homes.
Missouri staffing, bed-hold and Medicaid rules · Residents' rights in every state
Source: CMS Provider Data Catalog, nursing home datasets processed Sep 1, 2026. CMS Certification Number 265236. See this home's official record on Medicare.gov
See something shown incorrectly? Tell us. This site shows each record as CMS publishes it and cannot change the underlying record.