Inspection Report Summary
The most recent inspection on January 27, 2025, identified multiple deficiencies related to incident reporting, tenant evaluations, service plans, nurse reviews, and life safety emergency policies. Earlier inspections showed a consistent pattern of issues involving medication administration, tenant care, staffing adequacy, documentation, and safety measures, with several substantiated complaints over the years. Notable deficiencies frequently involved failure to complete or update service plans, incomplete or inaccurate incident reports, insufficient staffing or training, and problems with door alarms and tenant supervision. Several investigations substantiated complaints about tenant safety, medication errors, and inadequate care, though enforcement actions included fines primarily in earlier years, with the most recent reports not listing fines or license suspensions. The facility’s inspection history shows ongoing challenges with regulatory compliance, with no clear long-term improvement trend evident.
Deficiencies (last 17 years)
Deficiencies (over 17 years)
7.9 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
80% worse than Iowa average
Iowa average: 4.4 deficiencies/yearDeficiencies per year
16
12
8
4
0
Census
Latest occupancy rate
22 residents
Based on a January 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Annual Inspection
Census: 22
Deficiencies: 9
Jan 27, 2025
Visit Reason
The inspection was conducted as an annual recertification survey to determine compliance with certification for a Dedicated Dementia-Specific Assisted Living Program, including investigation of complaints #125899-C and #126002-C.
Findings
The facility was found to have multiple regulatory insufficiencies related to incident reporting, evaluation of tenants, service plans, nurse reviews, and life safety emergency policies. Deficiencies included failure to complete detailed incident reports, failure to include witness statements, failure to complete evaluations prior to occupancy, failure to update service plans timely, failure to conduct nurse reviews every 90 days, and failure to have operating door alarms connected to each exit door.
Complaint Details
The inspection included investigation of complaints #125899-C and #126002-C. The complaints involved aggressive behavior by Tenant #1, including hitting staff and other tenants, and failure of staff to complete detailed incident reports. The tenant was hospitalized after an altercation. The complaint was substantiated as evidenced by multiple findings related to incident reporting and tenant evaluations.
Deficiencies (9)
| Description |
|---|
| Program failed to complete incident reports that were detailed. |
| Program failed to include statements from all staff who witnessed the incident as part of the incident report. |
| Program failed to develop a policy and procedure related to incident reports that include the timeframe incident reports are required to be retained. |
| Program failed to follow its policy and procedure related to incident reports. |
| Program failed to complete evaluations prior to taking occupancy for tenants. |
| Program failed to document nurse's notes by exception. |
| Program failed to update service plans within 30 days and as needed. |
| Program failed to complete nurse reviews every 90 days. |
| Program failed to have an operating door alarm connected to each exit door. |
Report Facts
Total census: 22
Incident report review: 1
Tenants reviewed: 4
Completion date: Mar 14, 2025
Inspection Report
Complaint Investigation
Census: 18
Deficiencies: 3
Jul 30, 2024
Visit Reason
The inspection was conducted as an investigation into Complaint #114635-C regarding regulatory insufficiencies at Country Manor Memory Care.
Findings
The investigation found deficiencies related to medication administration, evaluation of tenants, and service plans. Specific issues included failure to administer medications as ordered, incomplete evaluations after significant changes in tenant condition, and failure to update service plans to reflect tenant needs.
Complaint Details
The visit was triggered by Complaint #114635-C. The complaint involved medication administration and tenant care issues. The hospice nurse provided wound care orders that were not implemented or discontinued as required. The Executive Director confirmed not receiving wound orders from the hospice nurse. The cardiologist recommended amputation of a tenant's toe due to wound complications.
Deficiencies (3)
| Description |
|---|
| Failure to administer medications and treatments as prescribed by the tenant's physician or nurse practitioner. |
| Failure to ensure evaluations were completed with change of condition for discharged and current tenants. |
| Failure to ensure service plans were updated as needs changed for discharged and current tenants. |
Report Facts
Number of tenants without cognitive impairment: 1
Number of tenants with cognitive impairment: 17
Total census: 18
Date survey completed: Jul 30, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karecia Mahieu | Executive Director | Named in relation to findings about not receiving wound orders from hospice nurse and confirming findings on 7/31/24 |
| Danielle Brown | Director of Wellness | Named in Plan of Correction and interview confirming findings on 7/30/24 |
Inspection Report
Complaint Investigation
Census: 13
Deficiencies: 3
Oct 19, 2023
Visit Reason
The inspection was conducted as a complaint investigation into incidents #111401-1 and complaints #11298-C, #114550-C, and #114551-C regarding care and medication administration at the assisted living program.
Findings
The program failed to provide appropriate care to 1 of 5 discharged tenants, specifically Tenant C5, who was diagnosed with Alzheimer's and had medication and documentation deficiencies. The program also failed to administer medication properly to Tenant C5 and did not document health care visits and medication administration as required.
Complaint Details
No regulatory insufficiencies were cited during the investigation into Incident #111401-1, but regulatory insufficiencies were cited during the investigations into Complaints #114550-C and #114551-C.
Deficiencies (3)
| Description |
|---|
| Failure to provide appropriate care to Tenant C5 with Alzheimer's disease. |
| Failure to administer medication as prescribed to Tenant C5. |
| Failure to maintain proper documentation of health care visits and medication administration for Tenant C5. |
Report Facts
Number of tenants without cognitive disorder: 1
Number of tenants with cognitive disorder: 12
Total census: 13
Discharged tenants reviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Marie | Director | Confirmed findings on 10/18/23 at 10:15 PM and 10:15 AM |
Inspection Report
Plan of Correction
Census: 20
Deficiencies: 6
Feb 15, 2023
Visit Reason
The inspection was conducted as a recertification visit for an Assisted Living Program for People with Dementia and included investigations into multiple complaints and incidents.
Findings
The program failed to follow its policies and procedures regarding tenant care, including sexual behavior management, emergency transfers, tenant rights, staffing adequacy, staff training, background checks, and individualized service plans. Several tenants' needs were not properly identified or addressed, and supervision was insufficient.
Complaint Details
The report includes investigations into multiple complaints (#109854-C, #110767-C, #107888-C, #107954-C, #109955-C, #110978-C) and an incident (#110283-I). No regulatory insufficiencies were cited during the investigation of Complaint #109854-C, Complaint #110767-C, and Incident #110283-I. Deficiencies were cited during investigations of other complaints.
Deficiencies (6)
| Description |
|---|
| Failed to follow program policies for 2 of 7 current tenants and 1 of 4 discharged tenants regarding sexual behavior and emergency transfers. |
| Failed to provide proper care to 1 of 4 discharged tenants, including inadequate management of urinary tract infection and aggressive behaviors. |
| Insufficient number of trained staff to fully meet tenants' needs, resulting in missed visual checks and supervision failures. |
| Failed to train 5 of 6 employees within 30 days of hire as required by nurse delegation procedures. |
| Failed to complete background checks prior to date of hire for 3 of 7 employees reviewed. |
| Failed to identify and address the needs of 1 of 7 current tenants and 1 of 4 discharged tenants in service plans. |
Report Facts
Census: 20
Visual checks missed: 3
Visual checks missed: 10
Visual checks missed: 11
Antibiotic doses taken: 4
Antibiotic doses refused: 6
Staff not trained within 30 days: 5
Employees with late or missing background checks: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Witnessed sexual behavior between tenants #6 and #7 and reported to Director | |
| Staff J | Observed sexual acts between tenants #6 and #7 and reported to Director | |
| Staff A | Reported tenants #6 and #7 touched each other's genitals daily and provided frequent redirection | |
| Director of Resident Engagement | Confirmed insufficient supervision and lack of awareness of tenant sexual relationships | |
| Clinical Risk and Compliance Manager | Confirmed program failures in policy adherence, supervision, training, and background checks | |
| Tenant #6's son and designated power of attorney | Reported surprise at tenant's sexual relationships and approved one tenant's relationships |
Inspection Report
Complaint Investigation
Census: 20
Deficiencies: 2
Aug 11, 2022
Visit Reason
The inspection was conducted as a complaint investigation involving multiple complaints and incidents related to the assisted living program for people with dementia at Country Manor Memory Care.
Findings
No regulatory insufficiencies were found for some complaints, but deficiencies were cited related to failure to follow established program policies and procedures for two tenants, and failure to follow narcotic protocols for one tenant, including missing narcotics and inconsistent narcotic counts.
Complaint Details
The investigation involved complaints #100368-C, #100369-C, #100403-C, #102661-C, #106548-C and incidents #103873-I, #102385-I, #102453-I. No regulatory insufficiencies were cited for complaints #100368-C, #100369-C, #100403-C, #102661-C. Deficiencies were cited during investigation of complaint #106548-C and incidents #102385-I and #102453-I.
Deficiencies (2)
| Description |
|---|
| Failure to follow all established policies for 2 out of 7 tenants reviewed, including emergency transfer procedures and documentation of DNR wishes. |
| Failure to follow established narcotic protocols for 1 of 7 tenants reviewed, including missing Hydrocodone tablets and inconsistent narcotic counts. |
Report Facts
Number of tenants with cognitive disorder: 19
Number of tenants without cognitive disorder: 1
Total census: 20
Missing Hydrocodone tablets: 29
Missing Hydrocodone tablets: 8
Missing Hydrocodone tablets: 9
Missing Hydrocodone tablets: 16
Missing Hydrocodone tablets: 18
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff F | Program registered nurse | Involved in narcotic count and investigation of missing medications |
| Staff H | Counted narcotics, discovered missing tablets, terminated for not reporting missing narcotics | |
| Staff J | Counted narcotics, noticed missing tablets, terminated for not reporting missing medications | |
| Staff C | Staff involved in emergency response for Tenant #2 | |
| Staff A | Staff involved in emergency response for Tenant #2 |
Inspection Report
Complaint Investigation
Census: 23
Deficiencies: 0
Aug 10, 2021
Visit Reason
The inspection was conducted as an investigation into multiple incidents and complaints, specifically Incident #97334-I, Incident #98432-I, Complaint #97302-C, and Complaint #97536-C.
Findings
No regulatory insufficiencies were cited during the investigation of the incidents and complaints.
Complaint Details
Investigation into Incident #97334-I, Incident #98432-I, Complaint #97302-C, and Complaint #97536-C found no regulatory insufficiencies.
Report Facts
Number of tenants without cognitive disorder: 3
Number of tenants with cognitive disorder: 20
Total Census: 23
Inspection Report
Complaint Investigation
Census: 23
Deficiencies: 4
Apr 27, 2021
Visit Reason
The investigation of Incident #96229-I and Complaints #96943-C and #96955-C was completed to assess regulatory compliance related to tenant interactions and medication administration.
Findings
The program failed to follow policies regarding sexuality in dementia care, including inadequate communication with legal representatives about tenant intimacy. Medication administration errors occurred, including an extra dose of Melatonin given to a tenant and discrepancies in medication counts. Evaluations and service plans were not completed or updated timely in response to significant changes in tenant behavior.
Complaint Details
The visit was complaint-related involving Incident #96229-I and Complaints #96943-C and #96955-C. The complaints involved inappropriate sexual behavior between tenants with dementia and medication administration errors. The sexual relationship between tenants was not fully disclosed to legal representatives, and medication errors included extra doses and missing medications.
Deficiencies (4)
| Description |
|---|
| Failure to follow policies and procedures regarding sexuality in dementia care, including communication with legal representatives. |
| Failure to administer medications as prescribed, including extra doses of Melatonin and missing medication documentation. |
| Failure to complete tenant evaluations as needed with significant change in a timely manner. |
| Failure to update service plans based on evaluations and to reflect identified tenant needs and changes. |
Report Facts
Census of tenants with cognitive disorder: 18
Census of tenants without cognitive disorder: 5
Total census: 23
Medication discrepancy: 5
Number of tenants reviewed for deficiencies: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Admitted to giving an extra dose of Melatonin to Tenant #2 and was terminated for policy violation | |
| Staff C | Named in medication misuse investigation and suspended pending investigation | |
| Miranda Lewis | Manager | Signed the Plan of Correction letter |
Inspection Report
Complaint Investigation
Census: 25
Deficiencies: 13
Mar 15, 2021
Visit Reason
The investigation of Complaints #93240-C, #93988-C and #94640-C was completed. An onsite infection control survey and the recertification visit conducted to determine compliance with certification for a Dedicated Dementia Specific Assisted Living Program was also completed from 12/1/20 to 3/15/21.
Findings
Multiple regulatory insufficiencies were identified including failure to follow established policies and procedures related to infection control, incident reporting, and resident care. Specific findings included improper nebulizer use with a COVID-19 positive tenant, failure to include witness statements in incident reports, inadequate care leading to severe injury and hospitalization of a tenant, insufficient staffing to prevent elopement, incomplete nurse delegations, incomplete background checks, failure to document nurses' notes by exception, incomplete service plans, failure to complete nurse reviews for COVID-19 positive tenants, failure to note physician orders with time, date and signature, failure to complete required visual checks, and structural issues including a damaged fence and a malfunctioning exit door.
Complaint Details
The visit was complaint-related involving Complaints #93240-C, #93988-C and #94640-C.
Deficiencies (13)
| Description |
|---|
| Failure to follow established policy and procedures related to nebulizer treatments and hand hygiene during COVID-19 outbreak. |
| Incident reports failed to include witness statements from individuals who witnessed incidents involving three tenants. |
| Failure to provide adequate care resulting in severe injury, hospitalization, and death of Tenant #1 who was found on the floor for an extended period. |
| Insufficient staffing to meet tenant's identified needs, resulting in elopement of Tenant #2 through damaged fence. |
| Failure to ensure staff received training on all service plan tasks including continuous glucose monitoring and INR checks. |
| Failure to complete required criminal background checks prior to employment for some staff. |
| Failure to request Department of Human Services evaluation for employment prohibition when criminal record found. |
| Failure to document nurses' notes by exception for tenants receiving personal or health-related care. |
| Failure to develop service plans reflecting tenants' identified needs and preferences. |
| Failure to complete nurse reviews for tenants who were COVID-19 positive. |
| Failure to note physician orders with time, date and signature. |
| Failure to document completion of visual checks as indicated in tenants' service plans. |
| Failure to ensure the building was well-maintained including damaged fence and malfunctioning exit door. |
Report Facts
Census: 25
COVID-19 positive tenants: 24
COVID-19 positive staff: 8
Elopement duration: 10
Fence damage length: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Named in findings related to failure to notify nurse of incident, failure to complete rounds, and incomplete background check | |
| Staff C | Named in findings related to incomplete background check and nurse delegation training | |
| Staff D | Named in findings related to failure to complete rounds, incomplete background check, and failure to notify nurse of incident | |
| Staff E | Named in findings related to failure to complete nurse delegation training and incident response | |
| Staff F | Named in findings related to failure to complete nurse delegation training and incident response | |
| Staff H | Named in findings related to failure to complete nurse delegation training | |
| Staff K | Named in elopement incident of Tenant #2 | |
| Staff L | Named in incident report findings related to Tenant #3 fall | |
| Nurse #1 | On-call nurse | Named in interview regarding notification and incident response |
| Former Healthcare Coordinator | Named in incident response and infection control findings | |
| Director | Program Director | Named in multiple interviews and findings related to incident response, staffing, and policy compliance |
| Clinical Care Specialist | Named in interview regarding nurse reviews and incident response | |
| Maintenance Coordinator | Named in interview regarding fence repair and door maintenance |
Inspection Report
Complaint Investigation
Census: 30
Deficiencies: 2
Jul 14, 2020
Visit Reason
The inspection visit was conducted to investigate Complaint #91827-C related to tenant rights and staffing at Country Manor Memory Care.
Findings
The investigation found regulatory insufficiencies in tenant rights and staffing. Specifically, the program failed to ensure adequate care and treatment for a tenant with diabetes, including medication administration errors and insufficient staff training on insulin administration and blood sugar monitoring.
Complaint Details
Complaint #91827-C was investigated. The complaint was substantiated based on findings of medication errors and inadequate staff training related to diabetes care for Tenant #1.
Deficiencies (2)
| Description |
|---|
| Failure to ensure care, treatment, and services were adequate and appropriate for Tenant #1, including medication errors and inadequate response to low blood sugar. |
| Failure to ensure uncertified staff were trained to meet the needs of tenants, specifically regarding nurse delegation procedures for diabetes care. |
Report Facts
Census: 30
Tenants without cognitive disorder: 5
Tenants with cognitive disorder: 25
Medication units administered: 12
Medication units administered: 8
Blood sugar readings: 63
Blood sugar readings: 40
Blood sugar readings: 39
Blood sugar readings: 29
Blood sugar readings: 21
Blood sugar readings: 167
Dates of staff inservice: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Registered Nurse A | Registered Nurse (RN) | Responded to staff report, assessed Tenant #1, instructed staff, and confirmed service plan. |
| Miranda Lewis | Manager | Signed plan of correction letter dated 10/29/20. |
Inspection Report
Complaint Investigation
Census: 26
Deficiencies: 2
Nov 19, 2019
Visit Reason
The inspection was conducted as a complaint investigation into Incident #86493-I involving tenant safety and care concerns at Country Manor Assisted Living Program for People with Dementia.
Findings
The program failed to consistently provide adequate services to meet tenant needs, resulting in an elopement incident where Tenant #1 was found outside the facility with injuries. The service plan did not include the tenant's exit-seeking behavior, and the courtyard door was found propped open multiple times, allowing unauthorized exit.
Complaint Details
Complaint visit conducted 11/18/19 - 11/19/19 regarding Incident #86493-I involving Tenant #1 eloping from the facility and sustaining injuries. The complaint was substantiated based on interviews, record reviews, and observations.
Deficiencies (2)
| Description |
|---|
| Failure to provide adequate care and services to meet tenant needs, resulting in elopement and injury to Tenant #1. |
| Service plan failed to include Tenant #1's identified needs, including exit-seeking behavior. |
Report Facts
Number of tenants without cognitive disorder: 4
Number of tenants with cognitive disorder: 22
Total census: 26
Date of incident: Jul 31, 2019
Temperature on incident date: 82
Speed limit of road where tenant was found: 45
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Miranda Lewis | Manager | Signed plan of correction letter |
Inspection Report
Complaint Investigation
Census: 23
Deficiencies: 8
Jun 19, 2019
Visit Reason
The inspection was conducted as a complaint investigation related to Complaints #83177-C, #83178-C, #83183-C, #83192-C, and #83926-C at Country Manor, an assisted living program for people with dementia.
Findings
The investigation found multiple regulatory insufficiencies including failure to follow medication policies, inadequate incident reporting, failure to provide adequate and appropriate services to tenants, incomplete nurse delegation training, failure to update service plans, and failure to maintain the building in a clean and safe condition.
Complaint Details
Complaint investigation related to Complaints #83177-C, #83178-C, #83183-C, #83192-C, and #83926-C.
Deficiencies (8)
| Description |
|---|
| Program failed to follow medication policy for 5 of 6 tenants reviewed, including medication errors and unsecured medication carts. |
| Program failed to ensure incident reports were followed for 3 of 6 tenants reviewed. |
| Program failed to provide adequate and appropriate services to 5 of 6 current tenants and 3 of 3 discharged tenants reviewed. |
| Program failed to ensure nurse delegation training was completed within 60 days for 2 of 6 staff reviewed. |
| Program failed to administer medications as ordered for 4 of 5 tenants reviewed. |
| Program failed to complete evaluations with significant changes for 2 of 6 tenants reviewed. |
| Program failed to update service plans when changes were needed for 5 of 6 tenants reviewed. |
| Program failed to maintain building and grounds in a well-maintained, clean, safe and sanitary condition. |
Report Facts
Number of tenants without cognitive disorder: 4
Number of tenants with cognitive disorder: 19
Total census: 23
Tenants reviewed for medication policy: 6
Tenants reviewed for incident reports: 6
Staff reviewed for nurse delegation training: 6
Tenants reviewed for service plans: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Miranda Kinsey | Manager | Named as the manager in the plan of correction letter |
| Nurse Clinician #1 | Mentioned in relation to medication cart locking and nurse delegation documentation | |
| Staff F | Observed administering medications and involved in medication errors | |
| Staff D | Observed during tenant transfer and fall incident | |
| Hospice Nurse #1 | Provided hospice services and observations related to tenants | |
| Hospice Nurse #2 | Provided hospice services and observations related to tenants |
Inspection Report
Complaint Investigation
Census: 26
Deficiencies: 0
Apr 3, 2019
Visit Reason
Investigation of Incident #82234-I at the Assisted Living Program for People with Dementia.
Findings
No regulatory insufficiencies were cited during the investigation.
Complaint Details
Investigation of Incident #82234-I; no deficiencies found.
Report Facts
Number of tenants without cognitive disorder: 4
Number of tenants with cognitive disorder: 22
Inspection Report
Complaint Investigation
Census: 24
Deficiencies: 3
Sep 6, 2018
Visit Reason
The revisit of the recertification visit, complaints #75208-C, #75209-C, #75823-C and Incident #75340-I resulted in regulatory insufficiencies. During the course of the revisit, the investigation of Incident #77948-I was also conducted.
Findings
The program failed to provide adequate care, treatment, and services to a tenant who fell and sustained a fracture. The investigation revealed multiple failures in incident reporting, communication, and implementation of the plan of correction. The program also failed to develop and follow individualized service plans for tenants.
Complaint Details
Complaint investigation included complaints #75208-C, #75209-C, #75823-C and Incident #75340-I, and investigation #77948-I. The investigation found regulatory insufficiencies related to tenant care and service plans.
Deficiencies (3)
| Description |
|---|
| Failure to provide care, treatment and services adequate and appropriate to a tenant after a fall resulting in fracture. |
| Failure to implement the Plan of Correction effective 5-30-18 related to tenant rights. |
| Failure to develop service plans reflecting identified service needs for tenants #2, #3, and #4. |
Report Facts
Number of tenants with cognitive disorder: 20
Number of tenants without cognitive disorder: 4
Total census: 24
Date survey completed: Sep 6, 2018
Inspection Report
Complaint Investigation
Census: 24
Deficiencies: 11
May 3, 2018
Visit Reason
The recertification visit was conducted to determine compliance with certification for a Dedicated Dementia Specific Assisted Living Program. The investigation of Complaints #75208-C, #75209-C, 75823-C, and Incident #75340-I resulted in regulatory insufficiencies.
Findings
The program failed to ensure completion of incident reports for all incidents, failed to ensure tenants received adequate and appropriate care including appropriate supports and supervision, failed to ensure appropriate medical follow-up after alleged sexual assault, failed to ensure staff were sufficiently trained and competent, and failed to provide required training on dependent adult abuse and dementia-specific education. Multiple incidents involving tenant interactions and staff responses were documented.
Complaint Details
The visit was complaint-related involving multiple complaints and an incident (#75208-C, #75209-C, 75823-C, and #75340-I). The investigation found regulatory insufficiencies related to incident reporting, tenant rights, staffing, training, and care provision.
Deficiencies (11)
| Description |
|---|
| Program failed to ensure completion of incident reports for all incidents as required by program policy. |
| Program failed to ensure tenants received adequate and appropriate care, including supports and supervision to ensure safety and medical follow-up after alleged sexual assault. |
| Program failed to ensure newly hired registered nurse conducted a review within 60 days of employment to ensure staff were sufficiently trained and competent. |
| Program failed to ensure staff received required dependent adult abuse training. |
| Program failed to complete evaluations as needed with significant change for tenants. |
| Program failed to develop and update service plans reflecting specific care needs and changes. |
| Program failed to provide orientation and annual in-service training on safe food handling to staff. |
| Program failed to provide dementia-specific education and continuing education to staff. |
| Program failed to ensure respite care services met length of stay requirements and proper documentation. |
| Program failed to document nurses' notes by exception for permanent tenants. |
| Program failed to ensure 24-hour reports were implemented and reviewed daily. |
Report Facts
Number of tenants with cognitive disorder: 19
Number of tenants without cognitive disorder: 5
Total census: 24
Number of tenants reviewed for incident reports: 3
Number of tenants affected by sexual assault follow-up failure: 2
Number of staff reviewed for dependent adult abuse training: 8
Number of permanent tenants reviewed for evaluations: 4
Number of tenants reviewed for service plans: 4
Number of tenants reviewed for respite care length of stay: 3
Number of staff hired since September 2017 reviewed for food service training: 3
Number of newly hired staff reviewed for dementia-specific education: 6
Inspection Report
Plan of Correction
Census: 27
Deficiencies: 0
Dec 11, 2017
Visit Reason
The visit included investigation of Incident #70760-I and Incident #70763-I, and a revisit of Incident #70048-I and Complaint #70170-C to verify correction of previously cited regulatory insufficiencies.
Findings
No regulatory insufficiencies were cited from the investigations of Incident #70760-I and Incident #70763-I. Previously cited regulatory insufficiencies from Incident #70048-I and Complaint #70170-C were corrected.
Report Facts
Number of tenants without cognitive disorder: 5
Number of tenants with cognitive disorder: 22
Total Population of Program at time of on-site: 27
TOTAL census of Assisted Living Program: 27
Inspection Report
Complaint Investigation
Census: 27
Deficiencies: 6
Sep 12, 2017
Visit Reason
The inspection was a second revisit of investigation #64658-I and investigations of incidents #68237-I, 70048-I, and complaint #70171-C, focusing on regulatory insufficiencies related to incident reports, tenant rights, criteria for admission/retention, service plans, nurse review, and failure to implement previous plans of correction.
Findings
The investigation found multiple regulatory insufficiencies including failure to complete incident reports, inadequate care and treatment, failure to comply with admission and retention criteria, incomplete service plans, and failure to conduct nurse reviews as required. Several tenants exhibited severe cognitive decline and incidents of sexual and physical aggression were documented. A fall resulting in a fractured femur was not properly managed in a timely manner.
Complaint Details
The visit was complaint-related involving allegations of sexual and physical abuse by Tenant #7 and inadequate care following a fall of Tenant #5. The complaint was substantiated with regulatory insufficiencies cited.
Deficiencies (6)
| Description |
|---|
| Program failed to ensure completion of incident reports for all incidents as required, including sexual and combative behaviors of Tenant #7. |
| Program failed to provide adequate and appropriate care, treatment, and services to tenants, including failure to properly manage a fall resulting in a fractured femur for Tenant #5. |
| Program failed to comply with criteria for admission and retention of tenants, including retention of a chronically sexually aggressive tenant (#7). |
| Program failed to develop individualized service plans reflecting identified needs for tenants (#6 and #7). |
| Program failed to complete nurse reviews as warranted by significant changes in tenants' health status. |
| Failure to implement the plan of correction effective 6-1-17 as required. |
Report Facts
Total census: 27
Tenants without cognitive disorder: 4
Tenants with cognitive disorder: 23
Number of tenants reviewed: 6
Number of tenants reviewed for admission/retention: 5
Number of tenants reviewed for service plans: 5
Number of tenants reviewed for nurse review: 5
Fall incident date: 2017
Plan of correction effective date: 2017
Inspection Report
Complaint Investigation
Census: 34
Deficiencies: 3
Mar 30, 2017
Visit Reason
A revisit of the investigation of Incident #64658-I was completed to investigate regulatory insufficiencies related to incident reports and service plans at Country Manor Assisted Living Program.
Findings
The program failed to ensure incident reports were completed for all incidents and did not include statements from witnesses. The program also failed to develop individualized service plans reflecting tenants' identified needs and preferences, particularly for tenants #2 and #3. The plan of correction was not implemented as of the effective date.
Complaint Details
Complaint/Incident Intake #64658-I investigated allegations related to incident reports and service plans. The complaint was substantiated as regulatory insufficiencies were identified.
Deficiencies (3)
| Description |
|---|
| Program failed to ensure incident reports completed for all incidents and failed to include statements from witnesses. |
| Program failed to implement the Plan of Correction effective 3-1-17 in the area of service plans. |
| Program failed to develop individualized service plans reflecting identified needs and preferences for tenants #2 and #3. |
Report Facts
Number of tenants without cognitive disorder: 3
Number of tenants with cognitive disorder: 31
Total population at time of on-site: 34
Date survey completed: Mar 30, 2017
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nichole Will | Executive Director | Signed the Plan of Correction letter |
Inspection Report
Complaint Investigation
Census: 34
Deficiencies: 1
Dec 14, 2016
Visit Reason
The inspection was conducted as a complaint/incident investigation related to regulatory insufficiency concerning service plans at Country Manor, an assisted living facility with a dementia-specific program.
Findings
The investigation found that the program failed to develop individualized service plans reflecting identified tenant needs, specifically interventions to address elopement for two tenants. The facility had a total census of 34 tenants at the time of the visit, with 31 having cognitive disorders. The report detailed incidents of elopement and inadequate service plan interventions for two tenants with dementia.
Complaint Details
The complaint/incident investigation was triggered by Incident #64658-I. The investigation substantiated regulatory insufficiency related to service plans for tenants with dementia and elopement risk.
Deficiencies (1)
| Description |
|---|
| Failure to develop service plans reflecting identified needs of tenants, specifically interventions to address elopement for two tenants. |
Report Facts
Number of tenants without cognitive disorder: 3
Number of tenants with cognitive disorder: 31
Total population of program at time of on-site: 34
Distance traveled by tenant during elopement: 331
Number of sutures required for tenant injury: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nichole Will | Executive Director | Signed plan of correction letter |
Inspection Report
Complaint Investigation
Census: 29
Deficiencies: 3
Jun 14, 2016
Visit Reason
The inspection was conducted as a Final Recertification & Complaint/Incident Investigation following a complaint intake #60565-I, focusing on tenant rights, staffing, and record checks at Country Manor, Davenport, IA.
Findings
The report identified regulatory insufficiencies related to tenant rights, staffing, and record checks. Tenant #1 eloped from a locked dementia unit and sustained injuries, and the program lacked sufficient trained staff and complete record checks for employment.
Complaint Details
Complaint investigation related to Tenant #1 eloping from a locked dementia unit on 6-8-16, resulting in injuries. The complaint was substantiated with findings of inadequate care, staffing, and record checks.
Deficiencies (3)
| Description |
|---|
| Tenant rights were not met as Tenant #1 eloped and did not receive adequate care and services; staff did not hear or respond to a door alarm. |
| Staffing requirements were not met; insufficient trained staff were available to meet Tenant #1's needs during the elopement incident. |
| Record checks were incomplete; Staff E did not have an evaluation to determine if criminal history warranted prohibition of employment. |
Report Facts
Civil penalty amount: 4000
Reduced civil penalty amount: 2600
Census: 29
Number of tenants without cognitive disorder: 2
Number of tenants with cognitive disorder: 27
Date of survey completion: Jun 14, 2016
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Interviewed regarding rounds and elopement incident; did not hear door alarm. | |
| Staff B | Interviewed regarding elopement incident; could not lock door properly. | |
| Staff C | Interviewed regarding elopement incident; found Tenant #1 outside and assisted. | |
| Staff D | Interviewed regarding staffing needs; stated third shift needed more staff. | |
| Staff E | Staff member with incomplete record check evaluation. | |
| Linda Kellen | Bureau Chief | Signed demand letter and contact for report. |
| Rose Boccella | Program Coordinator | Contact for informal conference and civil penalty payment. |
| Nichole Will | Executive Director | Author of plan of correction letter. |
Inspection Report
Complaint Investigation
Census: 29
Deficiencies: 3
Jun 14, 2016
Visit Reason
The inspection was conducted as a recertification and investigation of Incident #60565-I involving tenant elopement and related regulatory insufficiencies at Country Manor Assisted Living Program.
Findings
The inspection found multiple regulatory deficiencies including failure to provide adequate care and treatment to a tenant who eloped, insufficient staffing to meet tenant needs, and incomplete criminal background record checks for staff.
Complaint Details
The complaint investigation was triggered by an incident where Tenant #1, a 79-year-old with severe cognitive decline, eloped from the facility on 6-8-16 and was found injured outside. The investigation included interviews with staff and review of incident reports and door alarm functionality.
Deficiencies (3)
| Description |
|---|
| Tenant rights not met as Tenant #1 eloped and failed to receive adequate care and treatment; staff did not hear or respond to door alarm. |
| Staffing deficiency: insufficient number of trained staff available to meet Tenant #1's needs during the incident. |
| Record checks deficiency: Staff E did not have a completed evaluation to determine if criminal history warranted prohibition of employment. |
Report Facts
Total census: 29
Tenant age: 79
Incident date: Jun 8, 2016
Staffing count: 3
Staffing count: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Interviewed regarding rounds and incident response; involved in assisting Tenant #1 | |
| Staff B | Interviewed regarding incident and securing door; witnessed Tenant #1 outside | |
| Staff C | Interviewed and found Tenant #1 lying outside; involved in emergency response | |
| Staff D | Interviewed regarding staffing levels and needs | |
| Staff E | Staff member with incomplete criminal background evaluation | |
| Nichole Will | Executive Director | Signed plan of correction letter; involved in interviews and corrective actions |
Inspection Report
Complaint Investigation
Census: 27
Deficiencies: 1
Nov 16, 2015
Visit Reason
The inspection was conducted following a complaint/incident investigation by the Department of Inspections and Appeals (DIA) on November 16, 2015, related to tenant care and rights at Country Manor, Davenport, Iowa.
Findings
No tenants exceeded the level of care and no concerns with Admission/Discharge or Tenant Rights were identified. However, a regulatory insufficiency was found in the area of Nurse Review, specifically that 90 day nurse reviews were not completed as required for some tenants.
Complaint Details
The complaint investigation included allegations regarding Admission/Discharge and Tenant Rights, both found not substantiated. The regulatory insufficiency was related to Nurse Review requirements not being met.
Deficiencies (1)
| Description |
|---|
| Failure to complete 90 day nurse reviews for tenants receiving program administered prescription medications as required by regulation. |
Report Facts
Number of tenants without cognitive disorder: 4
Number of tenants with cognitive disorder: 23
Total population at time of on-site: 27
Total census of Assisted Living Program: 27
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rose Boccella | Program Coordinator | Author of the complaint investigation report and contact for regulatory insufficiency |
| Nichole Will | Executive Director | Named in plan of correction response regarding nurse review deficiency |
Inspection Report
Monitoring
Census: 21
Deficiencies: 0
Sep 15, 2014
Visit Reason
The visit was a final recertification monitoring evaluation conducted to assess compliance with Iowa Code and Administrative Code chapters for the assisted living program at Country Manor Memory Care.
Findings
No regulatory insufficiencies were found during the evaluation. The facility was observed to be safe, clean, and sanitary, with tenants and family expressing satisfaction with the program and services.
Report Facts
Number of tenants without cognitive disorder: 3
Number of tenants with cognitive disorder: 18
Total census of Assisted Living Program: 21
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Margaret Kaltefleiter | RN MS | Monitor conducting the evaluation |
Inspection Report
Complaint Investigation
Census: 26
Deficiencies: 8
Aug 22, 2012
Visit Reason
The inspection was conducted as a final complaint/incident investigation of Country Manor Assisted Living Program following a complaint intake #40045-I. The investigation focused on regulatory insufficiencies related to evaluation, criteria for admission and retention, service plans, policies and procedures, staffing, compliance with plan of correction, and structural requirements.
Findings
The investigation found multiple regulatory insufficiencies including failure to comply with policies and procedures, staffing issues, inadequate service plans, and structural concerns such as unsecured courtyard doors. The program was assessed a $1,000 civil penalty and the plan of correction submitted was reviewed but requests for reconsideration on several issues were denied.
Complaint Details
Complaint/Incident Intake #40045-I involved multiple elopements by Tenant #1 and other concerns related to tenant safety, wandering, and program compliance. The complaint was substantiated with findings of regulatory insufficiencies.
Deficiencies (8)
| Description |
|---|
| Failure to follow policies and procedures related to elopement risk and wandering tenants. |
| Failure to complete functional, cognitive, and health evaluations within required timeframes. |
| Service plans did not identify or support interventions related to elopement risk, wandering, or other tenant needs. |
| Policies and procedures for alarmed exit doors did not meet minimum standards; courtyard doors were not alarmed exit doors. |
| Staff did not respond consistently to alarms on courtyard doors; tenants were left unattended in the courtyard. |
| Insufficient number of trained staff to meet tenants' identified needs at all times. |
| Failure to comply with plan of correction related to alarmed exit door signaling. |
| Structural deficiency: courtyard gates secured with padlocks but only one staff member had key; means to disable or remove locks on entrance doors for safety were inadequate. |
Report Facts
Civil penalty amount: 1000
Reduced civil penalty amount: 650
Number of tenants at time of on-site: 26
Number of tenants with cognitive disorder: 25
Number of tenants without cognitive disorder: 1
Dates of complaint investigation: August 22 and 23, 2012
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Hal Chase | RN BSN MPH | Monitor during complaint/incident investigation. |
| Lori Miner | RN BSN | Monitor during complaint/incident investigation. |
| Jim Berkley | Program Coordinator | Contact person for questions regarding the report and appeals. |
| Ann Martin | Bureau Chief, Adult Services Bureau | Signed the demand letter and report. |
Inspection Report
Complaint Investigation
Census: 22
Deficiencies: 2
Apr 25, 2012
Visit Reason
The inspection was conducted as a complaint/incident investigation regarding allegations that the assisted living program did not have a policy on pets and that a pet living at the program was not cared for by the tenant or staff.
Findings
The investigation found that the program had a pet policy and occupancy agreement with pet deposit requirements, and that Tenant #1 had cared for the dog appropriately. Multiple staff and family statements confirmed proper care and supervision. Several incidents involving tenant falls were reviewed, with no regulatory insufficiencies noted related to these incidents.
Complaint Details
The complaint alleged the program lacked a pet policy and that a pet was not cared for by the tenant or staff. The investigation found the program had a pet policy, and the tenant cared for the dog properly. No regulatory insufficiencies were substantiated.
Deficiencies (2)
| Description |
|---|
| No regulatory insufficiencies were noted related to the pet policy or tenant care. |
| No regulatory insufficiencies were noted related to tenant falls and incident reporting. |
Report Facts
Total census: 22
Number of tenants with cognitive disorder: 20
Number of tenants without cognitive disorder: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Cummins | MA | Monitor for complaint/incident investigation |
| Margaret Kaltefleiter | RN MS | Monitor for complaint/incident investigation |
Inspection Report
Monitoring
Census: 23
Deficiencies: 5
Mar 6, 2012
Visit Reason
The visit was conducted as a Final Recertification Monitoring Evaluation to review the facility's Plan of Correction and Request for Reconsideration related to regulatory insufficiencies in the Assisted Living Program.
Findings
The program failed to follow policies and procedures related to alarmed exit doors, medication administration, food service menu planning, life safety alarms, and transportation safety equipment. The Department of Inspections and Appeals accepted the Plan of Correction and Request for Reconsideration.
Deficiencies (5)
| Description |
|---|
| Failure to respond immediately to exit door alarms indicating tenant exit. |
| Medication errors including medications signed as given but not administered, incorrect dosages, and expired medications present. |
| Menus did not provide adequate daily recommended dietary allowances due to unapproved changes. |
| Failure to maintain all alarms in working condition; alarm system was turned off and door led to unsecured parking area. |
| Transportation vehicles lacked required fire extinguishers and safety triangles. |
Report Facts
Number of tenants with cognitive disorder: 22
Total population of program at time of on-site: 23
Number of tenants without cognitive disorder: 1
Expiration date: 2011
Expiration date: 2012
Expiration date: 2010
Medication dosage deviation: 325
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maribeth Freland | RN | Monitor conducting the evaluation |
| Joyce Kix | RN | Monitor conducting the evaluation |
| Jim Berkley | Program Coordinator | Signed letter regarding certification |
| Staff #1 | Certified Nurse Aide (CNA) | Responsible for ordering food and menu adjustments |
| Staff #2 | Served breakfast and reported no shell eggs were given |
Inspection Report
Complaint Investigation
Census: 24
Deficiencies: 4
Mar 8, 2011
Visit Reason
A complaint investigation on-site visit was conducted at Country Manor on March 8, 2011, to investigate allegations related to nursing follow-up and care.
Findings
The investigation found regulatory insufficiencies related to nurse review and delegation, including failure to conduct appropriate nurse follow-up after an incident and lack of nurse delegation training for medication administration. Several tenant incidents involving falls and injuries were documented, with some medication administration inconsistencies noted.
Complaint Details
Complaint Intake #32900-C involved allegations of inappropriate nurse follow-up related to an incident where a tenant fell and sustained injuries. The complaint was investigated with multiple staff interviews and tenant file reviews. The complaint was substantiated with findings of regulatory insufficiencies.
Deficiencies (4)
| Description |
|---|
| Failure to conduct nurse review when a tenant did not receive personal or health-related care or when a significant change in condition occurred. |
| Lack of appropriate nurse delegation training for staff responsible for medication administration. |
| Insufficient number of trained staff available at all times to meet tenants' identified needs. |
| Nursing services not provided in accordance with Iowa Code chapter 152 and 655-Chapter 6. |
Report Facts
Tenant population: 24
Date of investigation: Mar 8, 2011
Number of tenant files reviewed: 8
Number of staff files reviewed: 4
Date of report: Apr 8, 2011
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Cummins | Monitor | Named as monitor conducting the investigation |
| Margaret Kaltefleiter | RN Monitor | Named as monitor conducting the investigation |
| Jim Berkley | Program Coordinator | Signed cover letter accepting Plan of Correction |
Inspection Report
Complaint Investigation
Census: 14
Deficiencies: 0
Dec 21, 2009
Visit Reason
An on-site visit was conducted to investigate an incident involving a tenant eloping from the assisted living program. The investigation was triggered by an incident report and complaint regarding the tenant's elopement and door alarm failures.
Findings
The investigation found that the tenant eloped but was safely returned without injury. Door alarms did not sound during the elopement, and staff responded by implementing new policies including door code changes and increased monitoring. No regulatory insufficiencies were identified in this investigation.
Complaint Details
The investigation was complaint-related, focusing on an incident where a tenant eloped and door alarms failed to sound. The complaint was substantiated in that the alarms did not sound, but no injuries occurred and corrective actions were taken.
Report Facts
Current number of tenants in Dementia Specific Program: 14
Current number of tenants without cognitive disorder: 0
Total Population: 14
Civil penalty: 2500
Civil penalty: 4000
Civil penalty: 1500
Civil penalty: 500
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Cummins | Monitor | Named as monitor for the incident investigation |
| Chris Nothaft | Certification Coordinator – Eastern Iowa | Signed cover letter for the final incident investigation report |
Inspection Report
Complaint Investigation
Census: 27
Deficiencies: 3
Jan 13, 2009
Visit Reason
A complaint investigation on-site visit was conducted at Country House Residences on January 13, 2009 and February 18, 2009 to investigate regulatory insufficiencies related to medications, staffing, and other tenant safety concerns.
Findings
The program had regulatory insufficiencies in medications administration, staffing, and other areas including failure to consistently provide trained staff to meet tenant needs and missing medications. The program was under a Conditional Certificate with sanctions and a $2,500 civil penalty was assessed.
Complaint Details
The complaint investigation was substantiated with findings of missing medications (30 missing Risperdal pills), insufficient trained staff, and failure to fully implement the Plan of Correction from a prior complaint. The tenant was found with dried food on clothing and wearing a soiled adult incontinence product. Sexual inappropriate behavior by a tenant's spouse was reported but not fully addressed by staff.
Deficiencies (3)
| Description |
|---|
| The program did not consistently provide the administration of medications by an Iowa-licensed registered nurse or authorized agent. |
| The program did not consistently have sufficient trained staff available at all times to fully meet tenants' identified needs. |
| The program did not provide provisions to ensure the health, safety, and well-being of tenants. |
Report Facts
Missing medications: 30
Civil penalty amount: 2500
Tenants in Dementia Specific Program: 26
Tenants without cognitive disorder: 1
Total tenants: 27
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ann Martin | Bureau Chief, Adult Services Bureau | Signed the final report letter |
| Hal Chase | RN BSN MPH | Monitor for the complaint investigation |
| Stephanie Cummins | MA | Monitor for the complaint investigation |
| Lincoln Newsom | RN | Monitor for the complaint investigation |
Inspection Report
Complaint Investigation
Census: 28
Deficiencies: 6
Dec 31, 2008
Visit Reason
A complaint investigation on-site visit was conducted at Country House Assisted Living on December 31, 2008, to investigate regulatory insufficiencies related to medications, life safety, structural requirements, and other areas.
Findings
The investigation found multiple regulatory insufficiencies including medication administration errors, failure to provide an operating alarm system on exit doors in the dementia-specific program, unsecured kitchen cabinets and knives, and unmaintained building and grounds. The program did not implement the previously submitted plan of correction for medications. A civil penalty of $4,000 was assessed and the program's plan of correction was accepted.
Complaint Details
The complaint investigation was substantiated with findings of regulatory insufficiencies in medications, life safety, structural requirements, and other areas. A tenant was reported to have eloped but was found unharmed. The program was fined $4,000 and accepted the plan of correction.
Deficiencies (6)
| Description |
|---|
| Medications were either not given or not documented as given for multiple tenants. |
| The program did not administer medications as required by Iowa-licensed nurse or authorized agent. |
| The program did not consistently provide an operating alarm system connected to each exit door in the dementia-specific program. |
| Unsecured sharp kitchen knives and unlocked kitchen cabinets were found in all four pods. |
| The program did not consistently maintain a clean, safe, and sanitary building and grounds. |
| The program did not implement the previously submitted plan of correction related to medications. |
Report Facts
Civil penalty amount: 4000
Census: 28
Complaint investigation date: Dec 31, 2008
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lincoln Newsom | RN | Monitor conducting the complaint investigation |
| Ann Martin | Bureau Chief, Adult Services Bureau | Signed conclusion letter regarding the complaint investigation and civil penalty |
Inspection Report
Complaint Investigation
Census: 29
Deficiencies: 8
Sep 2, 2008
Visit Reason
The inspection was conducted as a Final Complaint Investigation, Complaint Revisit, and Recertification Monitoring Evaluation at Country House Residences, triggered by complaint intake #18835 and revisit #17623R1.
Findings
The report found substantiated regulatory insufficiencies in areas including Evaluation of Tenant, Service Plan, Nurse Review, Medications, Staffing, Record Checks, and Food Service. The program's Plan of Correction was accepted, and a civil penalty of $1,500 was assessed.
Complaint Details
The complaint investigation was substantiated, noting regulatory insufficiencies related to tenant evaluation, service plans, nurse review, medications, staffing, and other areas. The program was required to pay a civil penalty and submit a Plan of Correction.
Deficiencies (8)
| Description |
|---|
| The program did not consistently evaluate each tenant's functional, cognitive, and health status as needed. |
| Service plans were not consistently updated, signed, or reflective of tenants' needs and activities. |
| Medications and treatments were not consistently provided or documented as given. |
| Nurse reviews were incomplete or not conducted as needed to assess tenants' health status changes. |
| Staff did not consistently ensure health care orders were current or properly documented. |
| Food service staff lacked annual in-service training on food protection and sanitation. |
| Staffing was insufficient at times to meet tenants' identified needs, and some staff lacked training. |
| The program did not fully implement the Plan of Correction related to Nurse Review. |
Report Facts
Civil penalty amount: 1500
Civil penalty amount: 500
Census: 29
Dementia Specific Program tenants: 26
Tenants without cognitive disorder: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ann Martin | Bureau Chief, Adult Services Bureau | Signed the final report letter regarding the complaint and penalty. |
| Nichole Will | Director | Facility director named in the report and family satisfaction comments. |
| Stephanie Cummins | SW MA | Monitor for the investigation. |
| Lincoln Newsom | RN | Monitor for the investigation. |
Inspection Report
Complaint Investigation
Census: 28
Deficiencies: 6
Jun 25, 2008
Visit Reason
An on-site visit was conducted at Country House on June 25, 2008, to investigate a self-reported incident alleging abuse involving multiple tenants and staff.
Findings
The investigation found multiple regulatory insufficiencies including inconsistent evaluation of tenants' functional and cognitive status, inadequate service plans, incomplete nurse reviews, insufficient staffing and training, and failure to complete required employee background checks. Staff were observed and reported to have engaged in inappropriate and potentially abusive behaviors toward tenants.
Complaint Details
The complaint involved allegations that Staff #1 called tenants names, threatened them, forcefully yanked items away, and physically manhandled tenants. Staff #2 witnessed multiple incidents and reported them. Staff #1 was suspended pending investigation. No evidence of abuse was found, but regulatory insufficiencies were identified.
Deficiencies (6)
| Description |
|---|
| The program did not consistently evaluate each tenant’s functional, cognitive and health status as needed. |
| The program did not consistently develop service plans for tenants as needed, including plans that meet identified needs. |
| The program did not consistently assess and document the health status of each tenant and make recommendations at least every 90 days or with changes in health status. |
| The program did not provide sufficient trained staff available at all times to fully meet tenants’ identified needs. |
| The program did not consistently complete required background checks prior to hire. |
| The program did not establish and maintain a safe and homelike environment for individuals requiring assistance but not continuous health-related care. |
Report Facts
Census - Dementia Specific Program tenants: 26
Census - Tenants without cognitive disorder: 2
Total Population: 28
Civil penalty amount: 500
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ann Martin | Bureau Chief, Adult Services Bureau | Signed letter regarding final incident investigation report and civil penalty |
| Stephanie Cummins | SW MA Monitor | Conducted the incident investigation |
Inspection Report
Complaint Investigation
Census: 28
Deficiencies: 2
Apr 28, 2008
Visit Reason
A complaint investigation was conducted at Country House, Davenport, IA, triggered by allegations of bruising on a tenant and concerns about staff response and documentation.
Findings
The investigation found regulatory insufficiencies related to nurse review and staffing, including failure to assess and document tenant health status changes and insufficient trained staff availability. The alleged abuse incident was not substantiated by the Department of Human Services.
Complaint Details
The complaint alleged Tenant #1 had bruising on his/her arms from an unidentified staff member and a lapse of 34 hours between the incident and nurse assessment. The DHS investigation found the alleged incident was not founded.
Deficiencies (2)
| Description |
|---|
| The program did not assess and document the health status of a tenant, as needed, with a change in condition. |
| The program did not consistently provide sufficient trained staff available at all times to fully meet the tenants' identified needs. |
Report Facts
Current number of tenants in Dementia Specific Program providing specialized care: 27
Current number of tenants without cognitive disorder: 1
Total Population: 28
Complaint Intake Number: 17623
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Christenson | RN, MNHP, Director | Named as Director of Country House, recipient of complaint investigation report |
| Chris Nothaft | Certification Coordinator – Eastern Iowa | Signed letter accepting Plan of Correction |
Inspection Report
Complaint Investigation
Census: 31
Deficiencies: 7
Mar 25, 2008
Visit Reason
A complaint investigation on-site visit was conducted at Country House on March 25, 2008, in response to complaint intake #16615 regarding various allegations including medication management, tenant falls, and safety concerns.
Findings
The investigation found multiple regulatory insufficiencies related to tenant evaluations, service plans, medication administration, nursing services, staffing, and safety protocols. Some allegations were substantiated while others were not, and the program was required to submit a Plan of Correction.
Complaint Details
Complaint investigation involved allegations of unlocked narcotics, missing medications, failure to administer PRN medications, delayed reporting of tenant falls and injuries, insufficient staff response to falls, tenants attempting to elope, staff access to medications without certification, and inadequate sanitation practices. Some allegations were substantiated with observations and documentation; others were not.
Deficiencies (7)
| Description |
|---|
| The program did not consistently evaluate each tenant’s functional, cognitive, and health status within 30 days of occupancy and as needed. |
| The program did not consistently update a tenant’s service plan when needed by a multidisciplinary team. |
| The program did not consistently develop service plans that identified tenant needs and requests. |
| The program did not consistently develop service plans based on evaluations and designed to meet individual tenant needs. |
| The administration of medications was not always provided by an Iowa-licensed registered nurse or authorized agent in accordance with applicable rules. |
| The program did not consistently provide nursing services in accordance with Iowa Code and regulations. |
| The program did not consistently provide sufficient trained staff at all times to meet tenants’ identified needs. |
Report Facts
Current number of tenants in Dementia Specific Program: 30
Current number of tenants without cognitive disorder: 1
Total Population: 31
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Christenson | RN, MNHP, Director | Named as facility director and involved in medication and service plan findings |
| Chris Nothaft | Certification Coordinator – Eastern Iowa | Signed letter accepting Plan of Correction |
| Stephanie Cummins | SW MA | Monitor conducting the complaint investigation |
Inspection Report
Complaint Investigation
Census: 29
Deficiencies: 0
Nov 4, 2004
Visit Reason
A complaint investigation on-site visit was conducted at Country House to investigate allegations that tenants' needs were not being met due to various responsibilities of the direct care staff.
Findings
The investigation found that staffing levels and practices were appropriate, with direct care staff adequately meeting tenant needs. Interviews with staff and family members indicated satisfaction with care and activities provided. No regulatory insufficiencies were noted.
Complaint Details
The complaint was substantiated relating to staffing and occupancy and transfer criteria. The specific allegation was that tenants' needs were not being met due to various responsibilities of the direct care staff. The investigation found no regulatory insufficiencies in staffing.
Report Facts
Current number of tenants in Dementia Specific Program: 29
Current number of tenants without cognitive disorder: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tammy Humphreys | RN, BSN | Named as the Assisted Living Program contact |
| Stephanie Cummins | SW | Monitor conducting the complaint investigation |
Inspection Report
Monitoring
Census: 15
Deficiencies: 0
Oct 5, 2004
Visit Reason
An on-site monitoring evaluation was conducted to assess compliance with assisted living program regulations as part of the initial certification monitoring evaluation.
Findings
The on-site monitor found no regulatory insufficiencies during the evaluation. Tenant and family satisfaction was generally positive, with tenants feeling safe, satisfied with staff, activities, and food, and the facility being well maintained.
Report Facts
Current number of tenants without cognitive disorder: 13
Current number of tenants with cognitive disorder: 1
Current number of tenants in Dementia Specific Program: 1
Total census: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Cummins | SW | Monitor conducting the on-site evaluation |
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