Inspection Reports for Bickford of Marion

The inspection was a recertification visit conducted to determine compliance with certification rules for a Dedicated Dementia-Specific Assisted Living Program.

The program failed to administer medications and treatments as prescribed, failed to complete evaluations with significant change, failed to document routine cares on individualized task sheets, failed to update service plans as needed, and failed to have a licensed dietitian review procedures for therapeutic diets and to provide food at required temperatures.

Complaint #116237-C was investigated regarding regulatory insufficiencies related to incident reporting, tenant rights, evaluations, retention criteria, service plans, and building maintenance at Bickford Cottage Marion.

The investigation identified multiple deficiencies including incomplete incident report policies and procedures, failure to follow incident report policies, failure to treat a tenant with dignity and autonomy, incomplete tenant evaluations, failure to discharge a tenant exceeding retention criteria, outdated service plans, and poor building maintenance with stained and frayed carpeting posing safety risks.

Complaint #116237-C was investigated and multiple regulatory insufficiencies were identified related to incident reporting, tenant rights, evaluations, retention criteria, service plans, and building maintenance.

The inspection was conducted as a recertification visit to determine compliance with certification for a Dedicated Dementia Specific Assisted Living Program and to investigate Complaint #101953-C.

The inspection identified multiple regulatory deficiencies including failure to follow incident reporting policies, failure to treat a tenant with dignity related to hospital discharge and return, failure to provide nurse delegation training within 30 days for some staff, failure to document nurse's notes by exception, failure to update tenant service plans as needed, and failure to ensure exit doors were alarmed at all times.

The inspection included investigation of Complaint #101953-C related to tenant care and incident reporting.

The inspection was conducted to investigate complaints #98918-C, #98977-I, and #99404-C, and included an onsite infection control survey.

No regulatory insufficiencies were found for complaints #98918-C and #98977-I. However, during the investigation of complaint #99404-C and the infection control survey, the program failed to follow its communicable and contagious disease preparedness plan, specifically failing to consistently document daily temperature and symptom monitoring for tenants as required by policy.

The investigation of Complaint #99404-C revealed regulatory insufficiencies related to infection control and communicable disease preparedness. Complaints #98918-C and #98977-I were investigated with no regulatory insufficiencies cited.

The inspection was conducted as an onsite infection control survey and investigation of Complaint #92042-C regarding regulatory insufficiencies in program policies and procedures, tenant evaluations, and service plans.

The program failed to establish an accident and emergency response policy that included provisions for head injuries, failed to complete tenant evaluations as needed with significant change, and failed to update service plans accordingly. Specific deficiencies were identified for four tenants, including inadequate response to falls and head injuries, incomplete evaluations after significant health changes, and outdated service plans.

The investigation was triggered by Complaint #92042-C. The complaint was substantiated with findings related to inadequate policies for head injuries, incomplete evaluations, and outdated service plans for tenants.

The inspection was conducted to investigate Complaint #87457-C, Incident #88018-I, and to perform a recertification visit to determine compliance with certification for a Dedicated Dementia Specific Assisted Living Program.

The program failed to ensure tenants were treated with consideration, respect, and full recognition of personal dignity and autonomy, failed to discharge a tenant requiring routine two-person assistance with transfers, failed to update service plans to reflect tenant needs, failed to ensure staff serving food had proper training, failed to ensure dementia-specific education for staff within 30 days of employment, and failed to administer medications as prescribed by the tenant's physician.

The visit was triggered by Complaint #87457-C and Incident #88018-I. The complaint involved allegations of tenant mistreatment and failure to provide adequate care. The investigation included interviews, record reviews, and observations. Staff M and Staff N were suspended and Staff N was terminated due to tenant rights violations.

The inspection was conducted as part of an investigation into Complaint #79520-C and self-reported incidents #80141-I and #80586-I at Bickford Cottage Marion.

The facility was found to have multiple regulatory insufficiencies including failure to follow incident reporting policies, insufficient staffing to meet tenant needs, failure to maintain written communication logs, failure to update service plans following significant changes, and failure to ensure a well-maintained building with a functioning secondary alarm system to monitor wandering activity.

The investigation was triggered by Complaint #79520-C and self-reported incidents #80141-I and #80586-I. The complaint involved incidents of tenant injuries, inadequate incident reporting, and safety concerns related to tenant wandering and staffing.

The inspection was a recertification visit to determine compliance with certification for a Dementia Specific Assisted Living Program.

The program failed to ensure training for non-certified staff regarding activities of daily living, failed to hire staff within 30 calendar days of background check results, failed to develop service plans reflecting tenant needs, and failed to ensure staff completion of orientation on sanitation and safe food handling as well as annual in-service training on food protection.

Investigation of Complaint #68793-C and Incident #69209-I at Bickford Cottage Marion Assisted Living Program.

No regulatory insufficiencies were cited during the complaint investigation. The census included 36 residents across dementia-specific and general assisted living programs.

Complaint #68793-C and Incident #69209-I were investigated with no regulatory insufficiencies found.

The inspection was conducted as an investigation of complaints #66186-C and 66188-I at the assisted living program.

No regulatory insufficiencies were cited during the investigation.

Investigation of complaints #66186-C and 66188-I resulted in no regulatory insufficiencies.

The inspection was conducted as part of investigations of Complaints #62035-C and #62036-C at the assisted living facility.

No regulatory insufficiencies were cited during the complaint investigations.

Investigations of Complaints #62035-C and #62036-C were conducted with no regulatory insufficiencies cited.

The inspection was conducted as a Final Complaint Investigation and Recertification Monitoring Evaluation following a complaint intake #56442-C, to determine compliance with certification for an Assisted Living Program.

No regulatory insufficiencies were cited during the complaint investigation. However, regulatory insufficiencies were found related to Dependent Adult Abuse Training, Food Service, and Dementia Specific Education for Personnel, requiring a Plan of Correction.

Allegation: Service Plans. Findings: Not substantiated. Review of tenant files and policies indicated individualized tenant plans were appropriate and no concerns with service plans were identified.

The inspection was conducted as a complaint/incident investigation following a tenant leaving the program after removing an electronic wandering bracelet.

No regulatory insufficiencies were identified during the investigation. Interventions were put in place to assist the tenant, and signs were posted to alert staff if someone wanted to leave the building or did not know the door code.

The tenant had not demonstrated any previous elopement tendencies and was assisted out by a visitor who did not realize the tenant resided at the program. No regulatory insufficiencies were cited during the investigation #51705-I.

The inspection was conducted as a complaint/incident investigation based on allegations regarding staffing, care, documentation, and tenant safety at Bickford Cottage Marion.

The investigation found no regulatory insufficiencies related to the complaints. Staffing, tenant care, documentation, and safety concerns were reviewed and no violations were identified.

The complaint investigation addressed allegations including staff not using gait belts, insufficient staff in the dementia unit, tenants exceeding level of care, tenant aggression, lack of documentation by direct care staff, pet odors, and frequent tenant falls. All allegations were found to have no regulatory insufficiencies.

The inspection was conducted as a complaint/incident investigation and recertification monitoring evaluation for Bickford Cottage Marion, triggered by complaints and regulatory concerns regarding policies, procedures, tenant incidents, service plans, food service, dementia-specific education, and record checks.

The report found multiple regulatory insufficiencies including failure to comply with policies and procedures, incomplete evaluations and service plans, inadequate staff training, failure to follow incident reporting policies, and deficiencies in food service and dementia-specific education. Several tenant incidents were documented with incomplete follow-up and documentation.

The complaint involved allegations that a tenant wandered into other tenant apartments and urinated and defecated in inappropriate places. The investigation confirmed these behaviors and identified multiple regulatory insufficiencies related to monitoring, service plans, and incident documentation.

The inspection was conducted following a complaint alleging that a tenant exceeded the level of care criteria for assisted living at Bickford Cottage Marion.

The program was found to have repeated regulatory insufficiencies in the area of Criteria for Admission and Retention, including retaining a tenant who exceeded the level of care criteria, was physically aggressive, and had unmanageable incontinence. A $1,000 civil penalty was assessed.

The complaint was substantiated. Tenant #2 was found to exceed level of care criteria for unmanageable incontinence, was a danger to self and others, and displayed unmanageable aggression and behaviors placing other tenants at risk.

The inspection was conducted as a complaint/incident investigation following a report that Tenant #1 fell in an unlocked laundry room and suffered a fractured hip.

The investigation found no regulatory insufficiencies. Tenant #1 had a fall resulting in a fractured hip, and the program completed an incident report and reviewed relevant files and policies.

The complaint involved Tenant #1 falling in an unlocked laundry room, sustaining a lump on the right leg and a fractured hip. The investigation included staff interviews, incident reports, and review of policies. No regulatory insufficiencies were identified.

The inspection was conducted as a complaint/incident investigation regarding allegations that a tenant exceeded the level of care and concerns about odors in the building.

The investigation found that Tenant #2 exceeded the level of care due to unmanageable behaviors and incontinence despite interventions. Service plans for tenants did not reflect identified needs. No regulatory insufficiency was noted related to odors in the building.

The complaint investigation was substantiated as Tenant #2 exceeded the level of care due to unmanageable behaviors and incontinence. The investigation included review of tenant files, staff interviews, and observations. No odor-related regulatory insufficiency was found.

The inspection was conducted as a complaint/incident investigation following a report of a tenant exhibiting dementia wandering away while unsupervised during an off-site activity.

The investigation found regulatory insufficiencies related to staffing and medications, including incidents of tenants eloping without staff knowledge and lack of documentation for head counts after elopements. The program failed to maintain adequate supervision and policies to prevent elopement and ensure tenant safety.

The complaint investigation was substantiated, noting multiple incidents of tenants eloping without staff knowledge, inadequate supervision during off-site activities, and failure to maintain required documentation of head counts following elopements.

The inspection was conducted as a complaint/incident investigation regarding allegations about tenant care and pet-related issues at Bickford Cottage Marion Assisted Living Program.

The investigation found a regulatory insufficiency related to medication administration and nursing services. Pet-related complaints were investigated and found to be unsubstantiated with no regulatory insufficiencies noted in that area.

Complaint/Incident Intake #37713-C involved allegations that a tenant was no longer able to care for his/her pet, a tenant's pet was aggressive, and a tenant's apartment had a bad odor. The investigation included tenant interviews, staff interviews, and review of incident reports and tenant council minutes. The pet-related complaints were found to be unsubstantiated with no regulatory insufficiencies noted.

The visit was a Final Recertification Monitoring Evaluation conducted to review the Plan of Correction and ensure compliance with regulatory requirements for the Assisted Living Program at Bickford Cottage of Marion.

The program did not receive any regulatory insufficiencies during the certification period. Staffing observations noted incomplete nurse delegations for some staff, but medication administration protocols were followed without adverse outcomes. Overall, tenants expressed satisfaction with services and staff.

A complaint investigation on-site visit was conducted at Bickford Cottage on June 14, 2011, to assess regulatory insufficiencies in Evaluation of Tenant, Service Plan, and Nurse Review.

The investigation found regulatory insufficiencies related to tenant evaluations, service plans, and nurse reviews, but no substantiated complaints of tenant mistreatment by staff. The facility was assessed a $1,000 civil penalty and submitted a Plan of Correction.

The complaint alleged tenant mistreatment by an administrative staff member and that the staff member did not listen to tenants. Interviews with tenants and staff found no mistreatment and tenants reported being treated with respect. Some tenants reported concerns about communication and maintenance issues, but no regulatory insufficiencies were noted in these areas.

A complaint investigation on-site visit was conducted at Bickford Cottage of Marion on February 14, 2011, to investigate multiple complaint allegations regarding tenant care, staffing, medication administration, activities, and structural issues.

The investigation identified several regulatory insufficiencies related to tenant evaluations, nurse reviews, staffing, and structural maintenance. Some complaints were substantiated with observations of missing documentation and medication discrepancies, while others found no regulatory insufficiencies.

Complaint allegations included tenant inability to stand and need for two-person transfers, morphine count discrepancies, lack of nurse coverage, activity director pressuring tenants to attend activities, and non-operational heat/air conditioning units. Some allegations were substantiated with monitoring observations; others had no regulatory insufficiencies noted.

The inspection was conducted as a final incident investigation following a report that a tenant was found on the floor, later complained of a headache, and became unresponsive, requiring transport to the Emergency Room.

The investigation found no regulatory insufficiencies. The tenant had multiple falls documented, with the most recent incident resulting in a subdural hematoma and subsequent death. Staff responded appropriately, and the program reported the incident to the Department as required.

The complaint involved a tenant who fell and became unresponsive with a subdural hematoma. The tenant had a history of falls and cognitive decline. The investigation concluded no regulatory insufficiencies were noted.

The visit was conducted as an incident investigation and recertification monitoring evaluation following a complaint alleging possible sexual assault of a tenant at Bickford Cottage, Marion, IA.

No regulatory insufficiencies were identified during the investigation. The tenant's file, staff interviews, and time log records did not confirm the alleged sexual assault or identify any perpetrator. Tenants and family members reported no mistreatment and expressed satisfaction with the program.

The complaint alleged that a tenant might have been sexually assaulted and that the program pushed for additional medications and relocation to discredit the tenant. The investigation found no substantiation of the allegations.

The inspection was conducted as a complaint investigation at Bickford Cottage, Marion, IA, regarding allegations of medication administration without physician's order, staffing issues related to tenant falls, and intimidation of staff.

No regulatory insufficiencies were identified during the investigation. Multiple allegations were reviewed including medication administration errors, staffing adequacy, tenant falls, intimidation and harassment of staff, and alleged illegal drug activity. Staff and tenant interviews and record reviews found no substantiated regulatory violations.

The complaint investigation addressed allegations including medication administered without physician's order, insufficient staffing leading to tenant falls, delayed medical attention for injured tenant, intimidation and harassment of staff by administrative personnel, illegal drug activity allegations, and alteration of nurses' notes. None of these allegations resulted in regulatory insufficiencies.

The visit was conducted as a complaint investigation at Bickford Cottage of Marion on June 29 and 30, 2009, in response to complaints regarding service plans, level of care appropriateness, staffing, medication management, and other care concerns.

The investigation found no regulatory insufficiencies or violations. All service plans were appropriately developed and signed, staffing and nurse coverage were adequate, medication policies were followed, and no substantiated deficiencies were identified related to the complaints.

The complaint investigation addressed multiple allegations including inappropriate service plans for tenants #1, #2, #4, and #8; inappropriate level of care for tenants #1, #2, #3, #4, and #8; lack of RN coverage in certain periods; failure to call the fire department after tenant falls; unfamiliarity with hip brace and pivot disc for tenant #3; absence of protocol for tenant #7's fainting spells; and inability of tenants #1 and #5 to self-inject insulin. All allegations were reviewed and monitoring observations found no regulatory insufficiencies.

The visit was a Final 3rd Recertification Revisit and Complaint Investigation conducted at Bickford Cottage Assisted Living to investigate complaints and verify compliance with Iowa Code and Administrative Code regulations for assisted living programs.

The program was found to be in full compliance with no regulatory insufficiencies noted during the complaint investigation. Previous sanctions were discontinued and the program was allowed to admit new tenants.

The complaint investigation included allegations of staff involvement in illegal drug activities and staff discussing confidential tenant information in public settings. Monitoring observations found no evidence of illegal drug use or inappropriate staff behavior, and no staff discussed tenant health information publicly. All related regulatory insufficiencies were noted as none.

The visit was a Final Recertification Monitoring Evaluation 2nd Revisit conducted to assess regulatory insufficiencies and compliance with Iowa Code and Administrative Code for assisted living programs, including evaluation of tenants, service plans, medications, and nurse review.

The program failed to comprehensively follow regulations, resulting in regulatory insufficiencies related to tenant evaluations, service plans, medication administration, and nurse review. The program was under a Conditional Certificate and assessed civil penalties, with some corrective measures accepted but not fully implemented.

The visit was a follow-up to a complaint investigation and recertification monitoring. The program was found noncompliant with regulatory requirements, resulting in a conditional certificate and civil penalties. The Request for Reconsideration was denied, and the Plan of Correction was accepted but not fully implemented.

A complaint investigation on-site and recertification revisit was conducted at Bickford Cottage Assisted Living on April 8, 2008, to evaluate regulatory insufficiencies and compliance with assisted living program regulations.

The program had multiple regulatory insufficiencies related to evaluation of tenants, service plans, medications, and staffing. The program was under a conditional certificate with sanctions including a $4,000 civil penalty and requirements for training and documentation submission. The Plan of Correction was accepted but not fully implemented at the time of revisit.

The complaint investigation was based on allegations from December 2007 that five employees were tested on nurse delegated training tasks, with concerns about staff feeling intimidated and lack of education on some tasks. The complaint was substantiated with findings of regulatory insufficiencies.

A complaint investigation on-site visit was conducted at Bickford Cottage on April 22, 2005, to investigate allegations that the program retained tenants requiring a higher level of care.

The program did not consistently evaluate each tenant's functional and cognitive abilities within 30 days of occupancy and as needed with condition changes. The program retained tenants requiring a higher level of care and had regulatory insufficiencies related to tenant documents and service plans not being appropriately signed or developed prior to occupancy.

There were substantiated complaints in the areas of criteria for exclusion of tenants and service plans during this certification period.

A complaint investigation was conducted at Bickford Cottage on September 14, 2004, triggered by allegations that the program retained tenants beyond the appropriate level of care and did not provide appropriate documentation on service plans.

The investigation found that the program retained tenants who met the criteria for exclusion due to requiring a higher level of care. Additionally, the program failed to provide documentation of tenant or legal representative signatures and did not document involvement of three staff members, including a health professional, on service plans.

The complaint alleged that the program retained tenants beyond the appropriate level of care and failed to provide appropriate documentation on service plans. The complaint was substantiated by observations including tenant chart reviews and service plan documentation deficiencies.