Stonebridge Desoto
Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.
based on 55 Google reviews
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Quality Concerns Identified
Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.
- Low staffing rating (2/5 stars)
- High staff turnover (68%)
Above average in MO · Below recommended RN staffing · Above average staffing · $8,278 in fines
What this means for your family
While some families report positive experiences with the social work and activity teams, the recurring, serious allegations regarding hygiene and neglect are concerning. If you consider this facility, perform an unannounced visit to check the cleanliness of resident rooms and observe staff response times to call lights.
Google Reviews
Google Reviews
55 reviews on Google“Stonebridge DeSoto receives highly polarized reviews, with a significant divide between glowing praise from staff or family members and severe allegations of neglect from others. Critics consistently report issues with hygiene, including urine-stained bedding and odors, as well as understaffing that leads to delayed medication and missed meals. Conversely, supporters describe the facility as a warm, family-oriented environment with compassionate staff.”
Quality Themes
Tap a score for detailsStrengths
- Friendly and compassionate staff
- Family-oriented atmosphere
- Helpful social work and administrative support
- Active engagement programs
Concerns
- Poor hygiene and sanitation (urine-stained beds, odors, mold) (mentioned by 4 reviewers)
- Understaffing leading to neglect and delayed care (mentioned by 4 reviewers)
- Medication management errors or delays (mentioned by 2 reviewers)
- Missing personal belongings and clothing (mentioned by 2 reviewers)
Rating Trends
Tap a year to see what changed
Distribution · 60 analyzed
How They Respond to Reviews
This facility rarely responds to reviews.
Questions for Your Tour
- 1Given the current staffing levels, what specific protocols do you have in place to ensure residents receive timely assistance with daily needs like hygiene and bathroom calls?
- 2I noticed some concerns regarding facility cleanliness; could you walk me through your daily deep-cleaning schedule and how you monitor the sanitation of resident rooms and common areas?
- 3How does your nursing team manage the medication administration process to ensure accuracy and prevent delays for residents with complex health needs?
- 4What measures are in place to help residents keep track of their personal belongings and clothing to ensure nothing goes missing?
- 5I see that you have a very active engagement program; could you tell me more about how these activities are tailored to residents who might have different levels of mobility or cognitive ability?
- 6In the event of a medical emergency, what is your facility's protocol for notifying family members and coordinating care with local hospitals?
Personalized based on this facility's data
Key Review Excerpts
“The amount of black mold everywhere is disgusting, they leave people in urine stained beds for days they never serve water or drinks to residents.”
“My dad's clothes disappeared the first day. He came home this morning in someone else's pants. None of his pants made it home and only one shirt and his jacket made it home and no socks.”
“Candice the social worker in particular was a godsend in terms of navigating the incredibly complicated healthcare system.”
Quality Measures
Quality Measures
Resident outcomes compared with national, state, and local averages · 17 measures
3
measures
11
measures
3
measures
Residents with depression symptoms
Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.
Residents whose walking got worse
Residents needing more daily help over time
Residents on anti-anxiety or sleep medication
Residents on antipsychotic medication
Residents who lost too much weight
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
Inspection History
Medicare Inspection History
3-year lookback · Medicare 2026
Stonebridge DeSoto has a concerning pattern of recurring deficiencies across multiple care areas, with families filing complaints that triggered inspections. The facility repeatedly struggles with infection control, food safety, medication management, and care planning across surveys from 2022-2025. While the facility corrects issues when cited, the same problems resurface, suggesting ongoing systemic challenges with maintaining consistent standards of care and safety.
Jul 24, 2025Complaint1
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Mar 13, 2025Routine8
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
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.
Miscellaneous Deficiencies
Have restrictions on the use of portable space heaters.
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Resident Rights Deficiencies
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.
Feb 9, 2024Routine17
Smoke Deficiencies
Install an approved automatic sprinkler system.
Egress Deficiencies
Install proper backup exit lighting.
Smoke Deficiencies
Provide properly protected cooking facilities.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Resident Rights Deficiencies
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.
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
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.
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 appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
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.
Administration Deficiencies
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Infection Control Deficiencies
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Resident Rights Deficiencies
The resident has the right to receive notices in a format and a language he or she understands.
Sep 20, 2023Complaint1
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Aug 5, 2022Routine8
Miscellaneous Deficiencies
Have restrictions on the use of portable space heaters.
Gas, Vacuum, and Electrical Systems Deficiencies
Meet requirements for the installation and maintenance of electrical systems.
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
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.
Federal Penalties
Fine
Jul 24, 2025
$6,368
Ownership & Operations
Who Operates This Facility
Stonebridge Desoto
for profit
Chain Affiliation
Stonebridge Senior Living
12 facilities nationwide
Chain avg rating: 2.7/5 · Rank 5 of 12
Ownership & Management
Owners
Lierman, Mark
Owner
Key personnel
Contact
Get in Touch
Contact this facility directly and verify the details that matter most to your family.
References & Resources
Medicare Care Compare
Official Medicare quality ratings, inspections & staffing data
Google Maps
Photos, directions & neighborhood info
Google Reviews
55 reviews from families & visitors
Official Website
Visit stonebridgeseniorliving.com
Medicare data downloads
Original nursing home datasets
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Safer Alternatives Nearby
Based on current clinical data, we identified 2 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.