7 Reports
Inspection Report — May 27, 2025
Renewal
Date: May 27, 2025
Visit Reason
Renewal inspection of the adult foster care family home license.
Findings
The home was found in non-compliance with 6 rules; a written corrective action plan was required before the license is renewed.
Deficiencies (5)
R 325.1932 Resident medications: Resident A’s medication administration record was blank on 5/5/2025 for the 8:00 pm dose of Guaifenesin with no documentation explaining why the medication was not given.
R 325.1975 Laundry and linen requirements: A used coffee maker, iron, and fabric starch spray were stored in the clean linen area, posing a risk for cross contamination.
R 325.1976 Kitchen and dietary: Dishwasher sanitization records for April and May 2025 were missing or blank, so it could not be determined if dishware and utensils were properly cleaned and sanitized.
R 325.1976 Kitchen and dietary: Multiple food items were found unlabeled without open dates in various facility kitchens and refrigerators, making it unclear if the food was safe for consumption.
R 325.1979 General maintenance and storage: A hazardous and toxic chemical was stored in an unlocked bathroom accessible to residents, presenting a potential risk of harm.
Report Facts
Corrective action plan due: 15
Inspection Report — May 27, 2025
Complaint Investigation
Date: May 27, 2025
Visit Reason
Investigation of a complaint received on 2025-05-23 about medication administration and care in accordance with service plans.
Complaint Details
Resident A and Resident B not provided care in accordance with service plans: not established. Resident A not administered medication in accordance with physician orders: established. Additional findings: no violation.
Findings
One violation was established related to medication administration. The facility was found in compliance with care according to service plans.
Deficiencies (1)
R 325.1932 Resident medications: facility staff did not follow physician orders for the Lidocaine 4% patch by leaving it on from the previous day instead of removing it after 12 hours as required.
Report Facts
Corrective action plan due: 15
Inspection Report — Jan 24, 2024
Complaint Investigation
Date: Jan 24, 2024
Visit Reason
Investigation of a complaint received on 2024-01-24 about Resident A's care including call light response times, shower provision, and medication administration.
Complaint Details
Increased call light response times: established. Resident A does not receive showers: established. Resident A received incorrect medication: not established. Additional findings: none.
Findings
Two rule violations were established related to call light response times and shower provision. The medication error allegation was not substantiated.
Deficiencies (2)
R 325.1921 Governing bodies, administrators, and supervisors: Resident A experienced call light response times averaging 10 minutes, exceeding the expected five minutes or less, resulting in lack of timely assistance with toileting and dressing.
R 325.1931 Employees; general provisions: The facility did not follow Resident A’s service plan by failing to offer showers on 01/21 due to staffing and not re-approaching Resident A after she initially refused a shower on 01/24.
Report Facts
Corrective action plan due: 15
Inspection Report — Nov 28, 2023
Complaint Investigation
Date: Nov 28, 2023
Visit Reason
Investigation of a complaint received on 2023-11-20 about mold in the walk-in cooler and unlabeled, uncovered, undated food.
Complaint Details
Mold in the walk-in cooler and food stored not labeled, dated, or covered: established.
Findings
One rule violation was established regarding food safety and cleanliness in the kitchen.
Deficiencies (1)
R 325.1976 Kitchen and dietary: food items were not properly covered or labeled when stored, mold was observed on a cooling rack in the walk-in refrigerator, and equipment used to store and transport food was not cleaned regularly.
Report Facts
Corrective action plan due: 15
Inspection Report — Jul 11, 2023
Complaint Investigation
Date: Jul 11, 2023
Visit Reason
Investigation of a complaint received on 2023-07-07 about Resident B not being included in a care conference and staff not providing Resident B with her pendant and checking on her throughout the night as outlined in her service plan.
Complaint Details
Resident B not included in care conference: established. Staff did not provide Resident B with her pendant and check on her throughout the night: not established.
Findings
One violation was established regarding Resident B not being included in a care conference scheduled to discuss her service plan. The allegation that staff did not provide Resident B with her pendant and check on her throughout the night was not established.
Deficiencies (1)
R 325.1922 Admission and retention of residents: Resident B did not participate in a meeting to discuss her service plan and was upset she was excluded from the discussion between Ms. Busch and Relative B1 by telephone.
Report Facts
Corrective action plan due: 15
Inspection Report — Jun 14, 2011
Date: Jun 14, 2011
Visit Reason
Increase capacity from 147 to 177 licensed beds due to a new addition to the facility.
Findings
The new addition to the facility was inspected and found compliant with applicable rules. The licensed bed capacity is recommended to be increased to 177.
Report Facts
Inspection Report — Jun 24, 2009
Original Licensing
Date: Jun 24, 2009
Visit Reason
Original license application for a home for the aged.
Findings
The applicant is found to be in compliance with the licensing act and applicable administrative rules.
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