Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.
based on 52 Google reviews

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These current public-data fields deserve follow-up with the facility and the official Medicare record. They are not a clinical risk score or a substitute for an in-person assessment.
This facility has areas of concern that warrant careful consideration. Registered Nurse hours are 65% of the EveryPlace reference benchmark; ask how RN coverage is allocated across shifts. The latest standard survey recorded 30 findings, above the MO average of 12.0. We recommend asking the administrator directly: "How are you addressing recent staffing shortfalls?" These are not reasons to panic, but they are reasons to ask tough questions and visit in person.
Reviews for Avenir at Mark Twain (formerly Mark Twain Manor) are highly polarized, with recent feedback highlighting a sharp divide between those who praise the therapy and activities staff and those who report severe neglect. Families frequently express that the quality of care is heavily dependent on having an advocate present daily to monitor hygiene, nutrition, and medical needs. While some recent reviewers note improvements under new management, others continue to report critical issues regarding call light response times and patient hygiene.
Quality Themes
Tap a score for detailsStrengths
Concerns
Rating Trends
Tap a year to see what changed
Distribution · 50 analyzed
Personalized based on this facility's data
Key Review Excerpts
“My Mom was here for 30 days and they took really good care of her. The staff was was very kind and attentive, but it also takes assertive efforts from the family to be involved with the care as well.”
“Ms. Celess at Mark Twain does an excellent job with activities and keeping family engaged. This was a pic from the family dinner they hosted for Valentine’s Day❤️ My mom stays active w her favorites like BINGO at least twice a week!!”
“If I could give them 0 stars, I would. They neglect their patients if family isn’t there daily. My mom went in for REHAB and almost died.”
Both RN and total nursing hours are below the EveryPlace reference benchmarks. Ask the facility how it staffs each shift for current resident needs.
Reference benchmarks (0.75 RN and 4.1 total nursing hours per resident/day) are comparison targets, not current federal minimum requirements.
Resident outcomes compared with national, state, and local averages · 17 measures
8
measures
8
measures
1
measures
Residents vaccinated for pneumonia
Residents with depression symptoms
Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.
Residents on antipsychotic medication
Residents whose walking got worse
Residents needing more daily help over time
Residents on anti-anxiety or sleep medication
Short-stay residents vaccinated for pneumonia
Short-stay residents vaccinated for the flu
Short-stay residents newly given antipsychotics
US average from Medicare published data
Detailed Medicare record · up to 3-year lookback
Families reported multiple concerns to authorities triggering 21 complaint investigations, focusing primarily on care quality standards, resident safety and accident prevention, and infection control practices. Issues with care planning and safety hazards appear repeatedly across surveys from 2019 to 2025, suggesting persistent challenges despite corrections. While all deficiencies show provider correction dates, the pattern of recurring problems in core care areas warrants careful consideration during your visit.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Emergency Preparedness Deficiencies
Develop and maintain an Emergency Preparedness Program (EP).
Emergency Preparedness Deficiencies
Conduct risk assessment and an All-Hazards approach.
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
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.
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.
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.
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
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.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Administration Deficiencies
Have a plan that describes the process for conducting QAPI and QAA activities.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Construction Deficiencies
Use approved construction type or materials.
Egress Deficiencies
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Smoke Deficiencies
Provide properly protected cooking facilities.
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Resident Rights Deficiencies
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Resident Rights Deficiencies
Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Quality of Life and Care Deficiencies
Provide appropriate foot care.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Administration Deficiencies
Provide timely, quality laboratory services/tests to meet the needs of residents.
Nutrition and Dietary Deficiencies
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.
Administration Deficiencies
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
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.
Environmental Deficiencies
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
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.
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care Deficiencies
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Federal Penalties
Payment Denial
Jan 21, 2025
14-day denial
Fine
Jan 21, 2025
$134,043
Fine
Jan 19, 2024
$26,687
Payment Denial
Jan 19, 2024
19-day denial
Fine
Sep 25, 2023
$4,587
Fine
Sep 18, 2023
$4,587
Fine
Sep 11, 2023
$4,587
Fine
Sep 5, 2023
$4,587
Fine
Aug 28, 2023
$4,587
Avenir at Mark Twain
for profit
Owners
Mark Twain Holdco LLC
Owner · Organization
Delta Edge Strategic Advisors
Owner (parent company) · Organization
Hhhh Ventures LLC
Owner (parent company) · Organization
Krpss Partners
Owner (parent company) · Organization
Felheim, Yitchok
Owner (parent company)
Jacobovitch, Yossi
Owner (parent company)
Lapciuc, Avraham
Owner (parent company)
Key personnel
Contact this facility directly and verify the details that matter most to your family.
Medicare Care Compare
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Google Reviews
52 reviews from families & visitors
Official Website
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Medicare data downloads
Original nursing home datasets
EveryPlace is a research directory. Facility information is compiled from public sources — Medicare.gov, state licensing portals, Google Places, and publicly available street-level imagery. Some summaries, interpretations, suggested questions, and pricing research are AI-generated or AI-assisted and may contain errors or omit important context. Listings do not constitute endorsement, recommendation, or advertisement, and we do not accept payment for placement. Families should verify all details directly with the facility and the original sources linked above before making any care decisions. See our Research Policy for our editorial standards, correction process, and image-removal policy.
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