Inspection Reports for Calvin Community
4210 Hickman Rd, Des Moines, IA 50310, United States, IA, 50310
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Inspection Report
Plan of Correction
Deficiencies: 0
Jan 9, 2026
Visit Reason
The document serves as a statement of deficiencies and plan of correction following a survey completed on January 9, 2026, related to the facility's compliance with health requirements.
Findings
Based on acceptance of the credible allegation of substantial compliance and the Plan of Correction, the facility will be certified in compliance with health requirements effective January 9, 2026. No specific deficiencies are detailed in this document.
Inspection Report
Annual Inspection
Census: 55
Deficiencies: 8
Dec 18, 2025
Visit Reason
The inspection was conducted as an annual recertification survey of the facility to assess compliance with federal regulations.
Findings
The facility was found deficient in multiple areas including failure to complete and provide discharge summaries, incomplete comprehensive care plans for residents on psychotropic medications, failure to transcribe and initiate a physician order, unsafe wheelchair transport practices, unsecured medication cart, improper food safety practices, incomplete resident medical records documentation, and inadequate infection prevention and control practices.
Severity Breakdown
SS = D: 6
SS = E: 2
Deficiencies (8)
| Description | Severity |
|---|---|
| Failure to complete a discharge summary and provide it to resident/family for Resident #65. | SS = D |
| Failure to develop and implement comprehensive care plans that include targeted behaviors and non-pharmacological interventions for residents on psychotropic medications (Residents #3, #6, #2, #44). | SS = E |
| Failure to transcribe and initiate a physician order for Sertraline for Resident #44. | SS = D |
| Failure to provide adequate supervision and assistance devices by transporting Resident #48 in a wheelchair without foot pedals. | SS = D |
| Failure to store medications safely when medication cart was left unlocked and unattended. | SS = D |
| Failure to prepare food under sanitary conditions by not covering facial hair during food preparation. | SS = D |
| Failure to maintain complete and accurate resident records related to a urinary tract infection for Resident #10. | SS = D |
| Failure to use proper hand hygiene and infection control practices during medication administration and wound care, and failure to use full Enhanced Barrier Precautions during wound care for Resident #38. | SS = E |
Report Facts
Census: 55
Deficiencies cited: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Assistant Director of Nursing | Assistant Director of Nursing | Named in relation to failure to complete discharge summary and failure to transcribe physician order |
| Director of Nursing | Director of Nursing | Named in relation to expectations for care plans, hand hygiene, and medication cart security |
| Staff B | Registered Nurse | Named in relation to failure to use foot pedals on wheelchair, improper hand hygiene, and wound care practices |
| Staff C | Licensed Practical Nurse | Named in relation to locking medication cart |
| Staff A | Director of Social Services | Named in relation to limited input on care plans |
| Staff D | Cook | Named in relation to failure to cover facial hair during food preparation |
Inspection Report
Plan of Correction
Deficiencies: 0
Feb 14, 2025
Visit Reason
The document is a Plan of Correction submitted following an inspection, indicating acceptance of credible allegation of substantial compliance and certification of the facility in compliance with health requirements.
Findings
The facility was found to be in substantial compliance with health requirements as of February 14, 2025, based on acceptance of the Plan of Correction.
Inspection Report
Annual Inspection
Census: 52
Deficiencies: 3
Jan 23, 2025
Visit Reason
The inspection was conducted as an Annual Recertification Survey to assess compliance with federal regulations and facility standards.
Findings
The facility was found deficient in maintaining resident dignity for one resident, accuracy of Minimum Data Set (MDS) assessments for one resident, and timely revision of care plans for three residents. The facility failed to ensure appropriate covering of a resident while waiting for a shower, accurately code prescribed medications in the MDS, and update care plans to reflect current resident needs.
Severity Breakdown
SS=D: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to maintain dignity for Resident #2 by not appropriately covering the resident while waiting for a shower, leaving the groin exposed. | SS=D |
| Failure to accurately code the federally mandated Minimum Data Set (MDS) assessment for Resident #24 by omitting anticoagulant medication use. | SS=D |
| Failure to timely update care plans for Residents #20, #22, and #38 to reflect hospice services and wanderguard alarm status. | SS=D |
Report Facts
Residents reviewed: 17
Residents reviewed: 19
Census: 52
Inspection Report
Plan of Correction
Deficiencies: 0
Apr 18, 2024
Visit Reason
The document serves as a statement of deficiencies and plan of correction related to the facility's certification compliance.
Findings
The facility was found to be in substantial compliance based on the credible allegation and plan of correction, resulting in certification effective April 18, 2024.
Inspection Report
Annual Inspection
Census: 51
Deficiencies: 1
Mar 28, 2024
Visit Reason
The inspection was conducted as an annual recertification survey of Calvin Community to assess compliance with federal regulations.
Findings
The facility failed to refer Resident #17 for a Level II PASRR evaluation after a new diagnosis of bipolar disorder was added, indicating a deficiency in coordinating PASARR assessments. The facility acknowledged the deficiency and outlined corrective actions including policy review and improved communication.
Deficiencies (1)
| Description |
|---|
| Failure to refer Resident #17 for a Level II PASRR evaluation after new mental health diagnosis. |
Report Facts
Census: 51
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Social Services Director | Social Services Director | Reported on PASRR review process and confirmed last PASRR completed for Resident #17 |
| Administrator | Administrator | Acknowledged lack of PASRR policy and commitment to develop one |
Inspection Report
Complaint Investigation
Deficiencies: 0
Dec 12, 2023
Visit Reason
A complaint investigation for complaint #113988-C was conducted on December 12, 2023.
Findings
Complaint #113998-C was unsubstantiated. The facility was found to be in substantial compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities.
Complaint Details
Complaint #113998-C was unsubstantiated.
Inspection Report
Deficiencies: 0
May 2, 2023
Visit Reason
The inspection was conducted to assess compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities.
Findings
The Calvin Community Nursing Home was found to be in compliance as of April 6, 2023. A discretionary denial of payment for new admissions was in effect from March 28, 2023 to April 5, 2023.
Report Facts
Discretionary Denial of Payment Period: From March 28, 2023 to April 5, 2023
Inspection Report
Annual Inspection
Census: 52
Deficiencies: 1
Apr 4, 2023
Visit Reason
The inspection was conducted as part of the facility's annual recertification survey and a Federal Comparative survey.
Findings
The facility was found non-compliant with 42 CFR Part 483 requirements related to food and drink temperature control. Observations revealed that food served on the second floor was not maintained within the safe temperature range, and staff failed to take food temperatures prior to serving after a process change. The facility implemented corrective actions including revised food temperature policies and ongoing monitoring.
Severity Breakdown
E: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure food served was within the safe temperature range (41 to 135 degrees Fahrenheit) for residents on the second floor. | E |
Report Facts
Census: 52
Correction date: Apr 16, 2023
Food Handler Course deadline: Apr 30, 2023
Food Handler Course timeframe for new employees: 30
Monitoring period: 30
Audit period: 90
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff L | Food Service Worker | Observed delivering trays and taking food temperatures during inspection |
| Dietary Manager | Reported on changes to food serving process and temperature taking | |
| President/Chief Executive Officer | CEO | Explained need to reheat trays due to unacceptable food temperatures and documented resident count |
| Director of Food Services | Responsible for daily review and sign-off of food temperature logs during corrective action period | |
| Health Center Administrator | Conducts bi-weekly audits of food temperature logs during corrective action period |
Inspection Report
Routine
Census: 52
Deficiencies: 5
Mar 3, 2023
Visit Reason
A health comparative Federal Monitoring Survey (FMS) was conducted by the Centers for Medicare & Medicaid Services (CMS) on March 3rd, 2023 following an Iowa Department of Inspection and Appeals (IDIA) recertification survey on January 23rd, 2023. Complaint #IA00104759 and #IA00105043 were investigated and substantiated.
Findings
The facility failed to revise the comprehensive care plan for one resident (R44) after multiple falls, failed to provide services meeting professional standards for medication administration for one resident (R15), failed to prevent a fractured wrist for R15 due to inadequate supervision and repositioning, failed to document ongoing assessment and communication for one resident (R19) receiving dialysis, and failed to maintain an effective infection prevention and control program including hand hygiene and surveillance.
Severity Breakdown
SS=D: 3
SS=G: 1
SS=F: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to revise comprehensive care plan for resident R44 after multiple falls. | SS=D |
| Failed to provide services meeting professional standards when LPN prepared medications and failed to observe full medication pass for resident R15. | SS=D |
| Failed to prevent fractured wrist for resident R15 due to inadequate supervision and repositioning. | SS=G |
| Failed to document ongoing assessment and communication with dialysis center for resident R19. | SS=D |
| Failed to maintain infection prevention and control program including surveillance, tracking, hand hygiene, and proper infection control practices. | SS=F |
Report Facts
Residents sampled: 20
Census: 52
Antibiotics ordered: 5
Hand hygiene audits: 25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RN2 | Registered Nurse | Observed failing to perform hand hygiene before medication administration and tube feeding |
| LPN2 | Licensed Practical Nurse | Observed failing to place barrier when applying barrier cream to resident R15 |
| LPN4 | Licensed Practical Nurse | Observed preparing medications in liquid nutrition without observing full medication pass |
| NA1 | Nurse Aide | Observed feeding resident R15 with bare hands touching food |
| Director of Nursing | Director of Nursing | Provided interviews regarding fall prevention, dialysis communication, and infection control |
| Infection Preventionist | Infection Preventionist | Provided interview regarding infection control program and surveillance |
Inspection Report
Annual Inspection
Census: 52
Deficiencies: 2
Jan 23, 2023
Visit Reason
The inspection was an annual health recertification survey conducted from January 17, 2023 to January 23, 2023, which included a complaint investigation (#104759) that was not substantiated.
Findings
The facility failed to update the care plan for one resident following a change in condition and failed to ensure food temperatures were checked before serving, resulting in food being served at unsafe temperatures for 11 of 52 residents reviewed.
Complaint Details
Complaint #104759 was investigated during the survey and was not substantiated.
Severity Breakdown
SS=D: 1
SS=E: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to update the Care Plan for Resident #15 following a change in condition, including unaddressed pressure ulcers and a wrist fracture. | SS=D |
| Failed to assess and ensure hot food temperatures before serving meals to residents, with food served below safe temperature standards. | SS=E |
Report Facts
Census: 52
Pressure ulcer measurement: 1.3
Pressure ulcer measurement: 0.8
Pressure ulcer measurement: 0.1
Food temperature: 140
Food temperature: 147
Food temperature: 108
Food temperature: 98
Food temperature: 98
Food temperature: 98
Food temperature: 130
Food temperature: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff I | Certified Nurse Aide (CNA) | Observed providing proper peri care and repositioning Resident #15 |
| Staff J | Certified Nurse Aide (CNA) | Observed providing proper peri care and repositioning Resident #15 |
| Staff K | Licensed Practical Nurse (LPN) | Observed providing wound care to Resident #15 |
| Staff E | Licensed Practical Nurse (LPN) | Reported Resident #15 had a wrist fracture in May 2022 |
| Staff D | Licensed Practical Nurse (LPN) | Reported Resident #15's wrist fracture should have been added to Care Plan within a week |
| Staff H | Director of Food Services | Observed preparing pureed meals and acknowledged dietary staff lacked education on food temperature checks |
| Staff G | Dietary Aide | Prepared residents' plates without assessing meal temperatures and served food |
| Staff F | Dietary Cook | Acknowledged food should be temperature checked and retrieved thermometer |
Inspection Report
Complaint Investigation
Deficiencies: 0
Apr 7, 2022
Visit Reason
A complaint investigation was conducted for multiple complaints (#99983-C, #101443-C, #101526-C, #102743-C, #103084-C, #103737-C, #103777-C) from April 7-20, 2022.
Findings
The facility was found to be in substantial compliance and none of the complaints were substantiated.
Complaint Details
Complaints #99983-C, #101443-C, #101526-C, #102743-C, #103084-C, #103737-C, and #103777-C were all investigated and found not substantiated.
Inspection Report
Annual Inspection
Census: 48
Deficiencies: 4
Aug 5, 2021
Visit Reason
The inspection was conducted as an annual health survey of the facility from August 2 to August 5, 2021.
Findings
The facility was found deficient in several areas including failure to provide bed-hold notices for residents upon transfer, failure to ensure staff followed physician orders to prevent infection, insufficient nursing staff response times to call lights, and failure to hold required Quality Assurance Performance Improvement (QAPI) meetings. The facility reported a census of 48 residents at the time of the survey.
Severity Breakdown
Level B: 1
Level D: 2
Level E: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failure to provide bed-hold notice for 2 of 2 residents reviewed upon transfer to hospital. | Level D |
| Failure to ensure staff followed physician orders to prevent infection and subsequent hospitalization of Resident #6. | Level D |
| Failure to ensure sufficient nursing staff responded timely to call lights for seven residents. | Level E |
| Failure to ensure required Quality Assurance Performance Improvement (QAPI) committee meetings were held as required. | Level B |
Report Facts
Census: 48
Residents reviewed for bed-hold notice: 2
Residents with call light response issues: 7
QAPI meetings reviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff C, Registered Nurse | Interviewed regarding bed-hold notices and dialysis care | |
| Assistant Director of Nursing (DON) | Verified facility expectations for staff to follow physician orders and call light response times | |
| Director of Quality Assurance Performance Improvement (QAPI) | Interviewed regarding QAPI meetings and attendance | |
| Health Center Director of Nursing (DON) | Received resident concerns about call light response times |
Inspection Report
Routine
Census: 42
Deficiencies: 0
Sep 9, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspection and Appeals on 9/9/20 and 9/10/20 to assess compliance with CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Routine
Census: 54
Deficiencies: 0
Aug 20, 2020
Visit Reason
A COVID-19 Infection Control Survey was conducted by the Department of Inspections and Appeals from 08/18/2020 through 08/20/2020 to assess the facility's compliance with CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found in compliance with CMS and CDC recommended practices to prepare for COVID-19.
Report Facts
Total Residents: 54
Inspection Report
Routine
Census: 54
Deficiencies: 0
Jul 1, 2020
Visit Reason
A COVID-19 Infection Control Survey was conducted by the Department of Inspections and Appeals to assess the facility's compliance with CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found in compliance with CMS and CDC recommended practices to prepare for COVID-19.
Report Facts
Total Residents: 54
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