Inspection Reports for Colonial Manor of Amana
3207 220th Trail, IA, 522030000
Back to Facility ProfileDeficiencies per Year
4
3
2
1
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Inspection Report
Complaint Investigation
Deficiencies: 0
Oct 7, 2025
Visit Reason
A complaint investigation was conducted for complaints #2587694-C and facility reported incidents #2585587-I on October 07, 2025.
Findings
The facility was found to be in substantial compliance with no deficiencies cited.
Complaint Details
Investigation related to complaints #2587694-C and facility reported incidents #2585587-I; facility found in substantial compliance.
Inspection Report
Annual Inspection
Deficiencies: 0
Jun 19, 2025
Visit Reason
An Annual Recertification Survey and investigation of Complaint #127876 were conducted from June 16, 2025 to June 19, 2025.
Findings
The facility was found to be in substantial compliance with the Health Survey.
Complaint Details
Investigation of Complaint #127876 was conducted during the survey.
Inspection Report
Annual Inspection
Deficiencies: 0
Aug 8, 2024
Visit Reason
An Annual Recertification survey was conducted from August 5, 2024 to August 8, 2024.
Findings
The facility was found to be in substantial compliance.
Inspection Report
Plan of Correction
Deficiencies: 0
May 1, 2024
Visit Reason
The document serves as a Plan of Correction following a survey to address deficiencies and certify the facility's compliance.
Findings
The facility was found to be in substantial compliance based on the credible allegation and Plan of Correction, resulting in certification effective May 1, 2024.
Inspection Report
Complaint Investigation
Census: 42
Deficiencies: 2
Apr 18, 2024
Visit Reason
The inspection was conducted as an investigation of Complaint #116386-C and Facility Reported Incident #120021-1 from April 16 to April 18, 2024.
Findings
The facility was found to have deficiencies in quality of care and free of accident hazards/supervision/devices. The facility failed to assess and intervene after a resident's mental status change and failed to ensure proper use of gait belts during resident transfers. Both complaints were substantiated.
Complaint Details
Complaint #116386-C was substantiated. Facility Reported Incident #120021-1 was substantiated.
Severity Breakdown
Level D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility failed to further assess and intervene after a change in mental status for 1 of 4 residents reviewed. | Level D |
| Facility failed to ensure staff utilized a gait belt in accordance with the care plan for 1 of 3 residents reviewed for transfers. | Level D |
Report Facts
Resident census: 42
Residents reviewed for mental status assessment: 4
Residents reviewed for transfers: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tanya Powell | Administrator | Signed the plan of correction |
| Staff A | Certified Nursing Assistant (CNA) | Provided information regarding Resident #1's transfer assistance needs |
| Staff B | Registered Nurse (RN) | Reported on Resident #1's fall and gait belt usage |
| Staff C | Doctor of Medicine (MD) | Stated expectations for notification of resident mental status changes |
Inspection Report
Plan of Correction
Deficiencies: 0
Oct 17, 2023
Visit Reason
The document serves as a plan of correction following a survey, indicating acceptance of credible allegation of substantial compliance and certification of the facility.
Findings
The facility was found to be in substantial compliance based on the credible allegation and plan of correction, resulting in certification effective October 17, 2023.
Inspection Report
Annual Inspection
Census: 37
Deficiencies: 1
Oct 5, 2023
Visit Reason
The inspection was conducted as part of the facility's Annual Recertification Survey and investigation of multiple complaints (#111646-C, #115105-C, #115424-C, and #115799-C) from October 2 to October 5, 2023.
Findings
The facility was found deficient in providing adequate ADL care for dependent residents, specifically failing to provide complete perineal care to prevent contamination following an incontinent episode for one resident. The complaint #115105-C was substantiated with detailed observations of improper incontinence care practices by staff.
Complaint Details
Complaint #115105-C was substantiated based on clinical record review, observations, staff interviews, and policy review indicating inadequate incontinence care.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide complete perineal care to prevent contamination following an incontinent episode for Resident #12. | SS=D |
Report Facts
Complaint numbers investigated: 4
Resident census: 37
BIMS score: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tanya Powell | Administrator | Signed the plan of correction |
| Director of Nursing | Referenced in findings and plan of correction but no full name provided | |
| Staff A, Certified Nursing Assistant (CNA) | Involved in resident care during deficient practice | |
| Staff B, Certified Nursing Assistant (CNA) | Involved in resident care during deficient practice |
Inspection Report
Annual Inspection
Deficiencies: 0
Sep 27, 2022
Visit Reason
The inspection was conducted as an annual certification survey to determine compliance with regulatory requirements.
Findings
Based on the onsite visit completed September 26-27, 2022, the facility was certified in compliance effective August 20, 2022. No deficiencies or plans of correction were effectuated.
Inspection Report
Complaint Investigation
Census: 36
Deficiencies: 1
Aug 19, 2022
Visit Reason
The inspection was conducted as a result of investigations into Complaints #105489-C, #105492-C, and a Facility Self-Reported Incident #105502-I from August 12 to August 19, 2022.
Findings
The facility failed to safely transfer one resident, resulting in injury including facial bone fractures and other injuries. The investigation substantiated the complaints and self-reported incident, revealing inadequate supervision and assistance during transfers.
Complaint Details
Complaints #105489-C and #105492-C were substantiated. Facility Self-Reported Incident #105502-I was substantiated.
Severity Breakdown
SS=G: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure the resident environment remains free of accident hazards and to provide adequate supervision and assistance devices to prevent accidents, resulting in injury to Resident #1 during transfer. | SS=G |
Report Facts
Resident census: 36
Dates of complaint investigation: August 12, 2022 to August 19, 2022
MDS Assessment date: 5/26/22
Care Plan date: 6/9/22, 7/13/22, 8/1/22
Incident Report date: 7/11/22
Hospital admission days: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tanya Powell | Administrator | Signed plan of correction and provided statements regarding corrective actions |
| Staff C | Licensed Practical Nurse (LPN) | Interviewed regarding incident and transfer safety |
| Staff A | Certified Nursing Assistant (CNA) | Interviewed regarding care and transfer of Resident #1 |
| Staff B | Certified Nursing Assistant (CNA) | Interviewed regarding assistance with transfer and incident |
| Staff D | Certified Nursing Assistant (CNA) | Interviewed regarding training and transfer procedures |
| Staff E | Certified Nursing Assistant (CNA), Restorative Director | Interviewed regarding training and documentation |
| Director of Nursing | Director of Nursing (DON) | Interviewed regarding incident and corrective actions |
Inspection Report
Plan of Correction
Deficiencies: 0
Jun 17, 2022
Visit Reason
The document is a plan of correction submitted following a deficiency statement, indicating the facility's acceptance of compliance and corrective actions.
Findings
The facility was certified in compliance based on acceptance of a credible allegation of compliance and plan of correction effective June 17, 2022.
Inspection Report
Renewal
Census: 38
Deficiencies: 1
May 26, 2022
Visit Reason
The inspection was conducted as part of the facility's Recertification Survey and investigation of Complaint #096135-C, which was unsubstantiated.
Findings
The facility failed to properly assess residents for risk of entrapment from bed rails prior to installation and did not use appropriate alternatives to bed rails for three of 31 residents reviewed. The facility also failed to ensure safety and proper use of side rails for residents.
Complaint Details
Complaint #096135-C was investigated and found to be unsubstantiated.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to assess residents for risk of entrapment from bed rails prior to installation and failure to use alternatives to bed rails for three residents. | SS=D |
Report Facts
Residents reviewed for bed rails: 31
Census: 38
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tanya Powell | Administrator | Named in plan of correction as responsible for implementing side rail assessment process |
Inspection Report
Annual Inspection
Census: 31
Deficiencies: 4
Jan 14, 2021
Visit Reason
The inspection was conducted as a recertification survey from January 11 to January 14, 2021, to assess compliance with federal regulations for the facility.
Findings
The facility failed to maintain cleanliness in the kitchen, with observations of cobwebs, dead insects, and black fuzz on vents and ceiling tiles. The cleaning schedule lacked direction for cleaning these areas, and staff interviews revealed inconsistent cleaning practices.
Severity Breakdown
SS=E: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Cobweb on the underside of the right front hood over the stove. | SS=E |
| Top of stove hood covered with fuzz and residue, including cobwebs and a dead fly. | SS=E |
| Dead moth hung from the gas line pipe where it met the ceiling tile. | SS=E |
| Heating/cooling vents and ceiling tiles contained 15-50% black fuzz. | SS=E |
Report Facts
Census: 31
Inspection dates: 4
Cobweb size: 5
Vent size: 18
Vent size: 12
Black fuzz coverage: 25
Inspection Report
Routine
Census: 42
Deficiencies: 0
Aug 13, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspections and Appeals on 8/12-13/20 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.
Inspection Report
Abbreviated Survey
Census: 45
Deficiencies: 0
Jun 25, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspection and Appeals on 6/25/20 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: 45
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