Inspection Reports for
Cobblestone Court Assisted Living
3187 140th Street, Sumner, IA, 50674
Back to Facility Profile7 Reports
Inspection Report — Mar 12, 2026
Renewal
Date: Mar 12, 2026
Visit Reason
Scheduled renewal visit to determine compliance with certification of an Assisted Living Program. Regulatory insufficiencies were cited during the investigation of Complaint #130764-C.
Complaint Details
Complaint #130764-C
Findings
The program failed to ensure medications were stored securely and administered only by qualified staff. A non-certified staff member administered medications to Tenant #1 without having completed the required medication manager course.
Violations (2)
231C.16A Medication setup: The program failed to ensure medications for Tenant #1 were stored in locked storage accessible only to authorized employees. A non-certified staff member handed medications to Tenant #1 after the administrator prepared and locked them in the tenant's cabinet.
481-67.5(2)f(1) Medications: The program failed to ensure only staff who completed a department-approved medication manager course administered medications. A non-certified staff member administered medications to Tenant #1 before becoming a medication manager.
Inspection Report — Oct 15, 2025
Renewal
Date: Oct 15, 2025
Visit Reason
The visit was a recertification inspection to determine compliance with certification rules for an Assisted Living Program.
Findings
No regulatory insufficiencies were cited during the recertification visit.
Inspection Report — Jun 11, 2024
Complaint Investigation
Date: Jun 11, 2024
Visit Reason
The inspection was conducted following a complaint investigation related to an allegation of an inappropriate relationship between Tenant #1 and Staff A at Cobblestone Court Assisted Living.
Complaint Details
The complaint was substantiated based on family reports, video footage, and staff interviews confirming inappropriate relationship and unauthorized visits by Staff A to Tenant #1's apartment.
Findings
The investigation found that Staff A repeatedly entered Tenant #1's apartment during night shifts without calls for assistance, violating program policies. Staff A was terminated due to substantiated allegations of inappropriate relationship and unauthorized visits.
Violations (1)
Program failed to ensure staff followed policy and procedure related to tenant interaction, specifically regarding inappropriate relationship and unauthorized apartment visits by Staff A.
Report Facts
Incident report date: Oct 30, 2023
Staff A hire date: Oct 20, 2021
Staff A termination date: Oct 31, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Named in finding related to inappropriate relationship and unauthorized apartment visits; terminated employment. | |
| Staff B | Registered Nurse | Provided statements and reviewed video footage related to the complaint. |
| Administrator | Interviewed regarding complaint and policy adherence; signed termination letter. |
Inspection Report — Aug 22, 2023
Renewal
Date: Aug 22, 2023
Visit Reason
The visit was conducted as a recertification to determine compliance with certification rules for an Assisted Living Program and included an investigation of Complaint #113850-C.
Complaint Details
Complaint #113850-C was investigated and no regulatory insufficiencies were found.
Findings
No regulatory insufficiencies were cited during the recertification visit or the complaint investigation.
Report Facts
Number of tenants without cognitive impairment: 35
Number of tenants with cognitive impairment: 0
Inspection Report — Dec 19, 2022
Complaint Investigation
Date: Dec 19, 2022
Visit Reason
The inspection was conducted as an investigation of Complaint #104838-C at the assisted living facility.
Complaint Details
Complaint #104838-C was investigated and found to have no regulatory insufficiencies.
Findings
No regulatory insufficiencies were cited during the complaint investigation at the facility.
Inspection Report — Jun 15, 2021
Renewal
Date: Jun 15, 2021
Visit Reason
The inspection was conducted as a recertification visit to determine compliance with certification for an Assisted Living Program.
Findings
No regulatory insufficiencies were cited during the infection control survey, but a deficiency was found related to failure to request child and dependent adult abuse record checks prior to employment for 6 of 6 staff reviewed.
Violations (1)
Failure to request the department of human services perform a child and dependent adult abuse record check prior to staffs' employment for 6 of 6 staff reviewed.
Report Facts
Number of tenants without cognitive disorder: 29
Number of tenants with cognitive disorder: 0
Staff reviewed for background check deficiency: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Andrew Boeckman | Administrator Assistant | Responsible for running SING background checks before finalizing hiring process |
| Ginny Boeckman | Administrator | Reviews new employee files to ensure SING background checks have been run |
Inspection Report — Jun 14, 2021
Renewal
Date: Jun 14, 2021
Visit Reason
Recertification visit to determine compliance with certification requirements.
Findings
The program failed to request child and dependent adult abuse record checks prior to employment for 6 of 6 staff reviewed. A civil penalty was assessed for this violation.
Violations (1)
481-67.19(3) Requirements for employer prior to employing an individual: The program failed to request the department of human services perform child and dependent adult abuse record checks prior to employment for six staff members.
Report Facts
Fine amount: 500
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