Inspection Reports for
Chautauqua Guest Home #2 (11th St.)
602 11th Street, Charles City, IA, 506163403
Back to Facility ProfileDeficiencies (last 6 years)
Deficiencies (over 6 years)
1.5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
66% better than Iowa average
Iowa average: 4.4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Occupancy
Latest occupancy rate
83% occupied
Based on a October 2025 inspection.
Occupancy rate over time
Inspection Report
Re-Inspection
Deficiencies: 0
Date: Oct 30, 2025
Visit Reason
A revisit of the survey ending September 18, 2025 and investigation of facility reported incidents #2619120-I was conducted on October 29-30, 2025.
Findings
All deficiencies were corrected and the facility is in substantial compliance effective October 15, 2025.
Inspection Report
Annual Inspection
Census: 38
Deficiencies: 2
Date: Oct 15, 2025
Visit Reason
The inspection was conducted as part of the facility's annual recertification survey and investigation of complaints #1775880-C and #2617171-C, including a facility reported incident #2619120-I from September 15-18, 2025.
Findings
The facility was found not in compliance with 42 CFR Part 483 requirements, specifically related to pain management and food safety. Deficiencies included failure to provide timely pain medication and proper notification of pain changes for a resident, and multiple food safety violations such as uncovered garbage, undated food items, and improper thermometer use in refrigerators.
Deficiencies (2)
Failure to provide or offer as needed pain medication in a timely manner and notify the resident's physician of new onset and increased pain for Resident #14 after a fall.
Food safety violations including uncovered and overflowing garbage cans, undated and improperly stored food items, lack of internal thermometers in refrigerators, dirty kitchen equipment, and failure to follow proper food handling and sanitation procedures.
Report Facts
Resident census: 38
Pain medication orders: 5
Blood sugar readings: 570
Blood sugar readings: 721
Morphine dosage: 6
Temperature reading: 58.6
Food storage duration: 3
Inspection Report
Complaint Investigation
Census: 38
Deficiencies: 1
Date: Sep 18, 2025
Visit Reason
The inspection was conducted due to a complaint investigation regarding the facility's failure to provide timely and appropriate pain management for a resident (Resident #14) after a fall.
Complaint Details
The investigation was triggered by a complaint related to inadequate pain management for Resident #14 after a fall. The complaint was substantiated as the facility failed to provide timely pain relief and physician notification, resulting in actual harm to the resident.
Findings
The facility failed to provide or offer as needed pain medication in a timely manner, non-medication pain relief, and/or notify the resident's physician of new onset and increased pain. Resident #14 suffered a left hip fracture that was not promptly addressed, resulting in actual harm.
Deficiencies (1)
F 0697: The facility failed to provide safe, appropriate pain management for Resident #14 who reported increased pain after a fall. The resident did not receive timely additional medication or physician notification despite ongoing pain and eventual diagnosis of a left hip fracture.
Report Facts
Residents Affected: 1
Census: 38
Pain level: 4
Pain level: 2
Blood sugar: 570
Blood sugar: 721
Morphine dosage: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff G | Licensed Practical Nurse (LPN) | Reported working with Resident #14 after fall and noted resident's pain and family reluctance to send resident out. |
| Staff E | Registered Nurse (RN) | Worked on 9/13/25 when Resident #14 fell, assessed resident, administered PRN acetaminophen, and reported pain and facial grimacing. |
| Staff D | Certified Nurse Aide (CNA) | Worked with Resident #14 on night of 9/13/25 and reported resident had a lot of pain and communicated this to nursing staff. |
| Director of Nursing | Director of Nursing (DON) | Stated not seeing Resident #14 from 9/13/25 to 9/16/25 but spoke with resident's doctor and daughter about pain and care plan. |
| Staff F | Registered Nurse (RN) | Cared for Resident #14 on 9/15/25 evening shift, noted high blood sugars, pain complaints, and sent resident to ER. |
Inspection Report
Complaint Investigation
Census: 38
Deficiencies: 2
Date: Sep 18, 2025
Visit Reason
The inspection was conducted following a complaint investigation related to inadequate pain management for a resident after a fall and concerns about food safety and sanitation in the facility's kitchen.
Complaint Details
The investigation was triggered by complaints regarding inadequate pain management for Resident #14 after a fall. The complaint was substantiated with findings of actual harm due to failure to provide timely pain relief and notify the physician. Additional concerns about food safety were also investigated.
Findings
The facility failed to provide timely and adequate pain management for Resident #14 after a fall resulting in a hip fracture, including failure to notify the physician promptly and provide appropriate pain relief. Additionally, the facility failed to maintain proper food safety standards in the kitchen, including improper glove use, uncovered garbage, undated and moldy food items, and serving milk above safe temperature.
Deficiencies (2)
F 0697: The facility failed to provide safe, appropriate pain management for Resident #14 after a fall, including delayed medication administration and failure to notify the physician of increased pain, resulting in actual harm.
F 0812: The facility failed to procure food from approved sources and maintain sanitary food preparation and storage, including uncovered garbage, moldy and undated food, improper glove use, and serving milk above 40 degrees Fahrenheit.
Report Facts
Residents census: 38
Pain level: 4
Pain level: 2
Milk temperature: 58.6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff E | Registered Nurse (RN) | Worked on 9/13/25 when Resident #14 fell and provided initial assessment and PRN acetaminophen |
| Staff F | Registered Nurse (RN) | Provided care for Resident #14 on 9/15/25 and sent resident to ER |
| Staff G | Licensed Practical Nurse (LPN) | Worked with Resident #14 after fall and reported resident's pain complaints |
| Staff D | Certified Nurse Aide (CNA) | Worked with Resident #14 on night of fall and reported pain complaints to nurse |
| Director of Nursing | Director of Nursing (DON) | Spoke with Resident #14's doctor and family regarding pain management |
| Staff B | Dietary Cook | Observed improperly handling bread with gloved hands during food preparation |
| Staff C | Dietary Aide | Observed preparing drinks and reported glove use and handwashing practices |
| Staff A | Dietary Aide | Reported hand hygiene and food handling practices in kitchen |
| Certified Dietary Manager | Certified Dietary Manager (CDM) | Interviewed regarding kitchen sanitation and food safety policies |
Inspection Report
Complaint Investigation
Census: 44
Deficiencies: 0
Date: Mar 27, 2025
Visit Reason
The inspection was conducted following a complaint investigation of Complaint #125737 from March 26, 2025 to March 27, 2025.
Complaint Details
Complaint #125737 was investigated and the facility was found in compliance.
Findings
The Chautauqua Guest Home #2 was found to be in compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities after the complaint investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Dec 9, 2024
Visit Reason
The inspection was conducted as a complaint investigation of Complaint #125277-C.
Complaint Details
Complaint #125277-C was substantiated without deficiency.
Findings
The complaint investigation was substantiated but no deficiencies were found; the facility was in compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities.
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Sep 19, 2024
Visit Reason
Annual inspection survey of the nursing home facility to assess compliance with health and safety regulations.
Findings
No health deficiencies were found during the inspection.
Inspection Report
Annual Inspection
Census: 43
Deficiencies: 0
Date: Sep 19, 2024
Visit Reason
The inspection was conducted as the annual recertification survey for the Chautauqua Guest Home #2 Nursing Home.
Findings
The facility was found to be in compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities following the annual recertification survey conducted from September 16 to September 19, 2024.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Apr 15, 2024
Visit Reason
A complaint investigation was conducted for facility reported incidents #115540-I.
Complaint Details
Complaint investigation for incidents #115540-I; facility found in substantial compliance.
Findings
The facility was found to be in substantial compliance.
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Jun 22, 2023
Visit Reason
Annual inspection survey of Chautauqua Guest Home #2 to assess compliance with health and safety regulations.
Findings
No health deficiencies were found during the inspection.
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Jun 22, 2023
Visit Reason
An annual recertification survey and investigation of complaints #111453-C and #111455-C were conducted from June 19, 2023 to June 22, 2023.
Complaint Details
Investigation of complaints #111453-C and #111455-C was conducted during the survey.
Findings
The facility was found to be in substantial compliance.
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Apr 11, 2022
Visit Reason
The document is a plan of correction submitted following a survey to address deficiencies and achieve compliance certification effective April 1, 2022.
Findings
The facility submitted a credible allegation of compliance and plan of correction, resulting in certification in compliance with 42 CFR Part 483, Subpart B-C.
Inspection Report
Annual Inspection
Census: 41
Deficiencies: 4
Date: Mar 14, 2022
Visit Reason
The annual health recertification survey was conducted from 3/14/22 to 3/17/22 to assess compliance with federal regulations and identify any deficiencies.
Findings
The survey identified multiple deficiencies including failure to respect resident rights during meal service, improper management of personal funds, lack of a surety bond for resident funds, and failure to meet professional standards in medication administration. Plans of correction were submitted with specified correction dates.
Deficiencies (4)
Failure to treat residents with respect and dignity during meal service, including inappropriate comments and behavior by staff.
Failure to properly manage residents' personal funds, including failure to maintain interest-bearing accounts for funds exceeding $100.
Failure to maintain a surety bond to assure security of all resident personal funds deposited with the facility.
Failure to meet professional standards of quality in medication administration, including improper supervision and documentation.
Report Facts
Deficiencies cited: 4
Resident census: 41
Resident accounts reviewed: 3
Resident accounts managed: 21
Resident trust funds total: 9327.09
Resident savings accounts total: 8052
Resident fund bond coverage: 3000
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary Shupe | Administrator | Signed initial comments and plan of correction |
| Staff D | Certified Nurses Aide (CNA) | Named in resident rights deficiency for inappropriate comments during meal service |
| Staff C | Certified Medication Aide (CMA) | Involved in medication administration deficiency |
| Staff F | Involved in medication administration deficiency | |
| Staff A | Registered Nurse (RN) | Involved in medication administration deficiency |
| Staff E | Interviewed regarding resident funds and surety bond | |
| Director of Nursing | Director of Nursing | Interviewed regarding resident rights and medication administration deficiencies |
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Jan 7, 2021
Visit Reason
The Department of Inspection and Appeals conducted the annual health survey at the facility from January 4-7, 2021.
Findings
The facility was found to be in substantial compliance with the Code of Federal Regulations (42CFR), Part 483, Subpart B-C.
Inspection Report
Abbreviated Survey
Deficiencies: 0
Date: Dec 22, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspection and Appeals on December 21-22, 2020 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: 39
Deficiencies: 0
Date: Dec 3, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspection and Appeals on December 2-3, 2020.
Findings
The facility was found to be in compliance with the Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) recommended practices of COVID-19.
Inspection Report
Routine
Census: 41
Deficiencies: 0
Date: Jul 16, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by representatives of the Department of Inspection and Appeals from 7/13/20 to 7/16/20 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: 43
Deficiencies: 0
Date: Jun 15, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspection and Appeals to assess the facility's 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.
Report Facts
Total residents: 43
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