Inspection Reports for
Holy Spirit Retirement Home
1701 W 25th St, Sioux City, IA, 511031705
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Inspection Report — Apr 21, 2026
Renewal
Date: Apr 21, 2026
Visit Reason
The visit was a recertification (renewal) visit to determine compliance with certification of an Assisted Living Program. The investigation also covered Incidents #130887-I, 130999-I, Complaint 130969-C, Complaint 131244-C, and Incident 131701-I.
Complaint Details
Investigation of Incidents #130887-I, 130999-I, Complaint 130969-C, Complaint 131244-C, and Incident 131701-I.
Findings
Regulatory insufficiencies were cited related to medication administration and staffing delegations. No insufficiencies were cited for Incidents #130887-I, 130999-I, and Complaint 130969-C. The facility failed to consistently administer medications as ordered and failed to ensure staff competency through proper nurse delegations.
Violations (2)
481-67.5(2)e(3) Medications: The program failed to consistently administer medications as ordered and according to the program's policy. Staff administered medications early, outside the allowed time frames without required physician notification.
481-67.9(4)b Staffing: The program's nurse failed to ensure staff competency by not completing nurse delegations prior to staff performing peri-care with a tenant. Staff E was suspended during investigation for concerns of possible sexual abuse and no documentation of delegation was completed.
Inspection Report — Jul 9, 2025
Complaint Investigation
Date: Jul 9, 2025
Visit Reason
The inspection was conducted as a complaint investigation for Complaint #129092-C and a recertification visit to determine compliance with certification of an Assisted Living Program for People with Dementia.
Complaint Details
Investigation of Complaint #129092-C revealed incomplete record keeping affecting current and former tenants, confirmed by the Assisted Living Manager.
Findings
The program failed to consistently retain tenant records for a minimum of three years after transfer or death, affecting 1 of 3 current tenants and 1 of 4 former tenants reviewed. Missing records included service plans and other documentation such as medication records and safety checks.
Violations (1)
Failure to consistently ensure tenant records were retained for three years as required.
Report Facts
Number of tenants without cognitive impairment: 3
Number of tenants with cognitive impairment: 10
Complaint number: 129092
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Assisted Living Manager | Interviewed and confirmed findings regarding incomplete record keeping |
Inspection Report — May 15, 2025
Complaint Investigation
Date: May 15, 2025
Visit Reason
Investigation of Complaints #128419-C and #128443-C at the assisted living facility.
Complaint Details
Complaints #128419-C and #128443-C were investigated and found to have no regulatory insufficiencies.
Findings
No regulatory insufficiencies were cited during the investigation of the complaints.
Report Facts
Number of tenants without cognitive impairment: 5
Number of tenants with cognitive impairment: 11
Inspection Report — Jan 15, 2025
Complaint Investigation
Date: Jan 15, 2025
Visit Reason
The inspection was conducted as an investigation of multiple complaints (#122237-C, 122877-C, 125779-C) and a revisit from a previous complaint (#121682-C).
Complaint Details
The visit was complaint-related, investigating complaints #122237-C, 122877-C, 125779-C and a revisit from complaint #121682-C dated 10/23/24.
Findings
The facility failed to include all required information in occupancy agreements, failed to include required statements in marketing materials, did not complete tenant evaluations prior to signing occupancy agreements, failed to maintain accurate documentation of personal and health-related care for tenants unable to advocate for themselves, and inconsistently developed service plans prior to occupancy agreements being signed.
Violations (5)
Occupancy Agreements failed to include the correct telephone number for the long-term care ombudsman, did not clearly state that Dependent Adult Abuse should be reported to DIAL, and lacked a statement that tenant landlord law applies to assisted living programs.
Marketing materials failed to include a statement informing the public that a copy of the occupancy agreement is available upon request.
Tenant evaluations were not completed prior to signing the occupancy agreement for one tenant.
The program failed to consistently maintain accurate documentation of personal and health-related care (task sheets) for tenants unable to advocate for themselves.
Service plans were not consistently developed prior to signing the occupancy agreement for one tenant.
Report Facts
Number of tenants without cognitive impairment: 25
Number of tenants with cognitive impairment: 14
Global Deterioration Scale (GDS) score: 5
Global Deterioration Scale (GDS) score: 4
Inspection Report — Oct 23, 2024
Complaint Investigation
Date: Oct 23, 2024
Visit Reason
The inspection was conducted as part of the investigation of Complaint #121682-C regarding regulatory insufficiencies at the assisted living program.
Complaint Details
The inspection was conducted following Complaint #121682-C which triggered the investigation of regulatory insufficiencies at the facility.
Findings
The facility was found deficient in multiple areas including incomplete and outdated occupancy agreements, failure to complete required tenant evaluations, inadequate notification for involuntary tenant transfers, missing legal documentation in tenant records, incomplete and unsigned service plans, failure to include other service providers in plans, lack of required staff training, and absence of operating door alarms on exit doors.
Violations (15)
Occupancy agreements failed to include required information such as correct telephone numbers for long-term care ombudsman and reporting dependent adult abuse, and tenant landlord law statement.
Occupancy agreements were not reviewed and updated to reflect changes in services or financial arrangements.
Tenant evaluations were not completed as required, specifically failure to use Global Deterioration Scale for moderate cognitive decline.
Failure to notify legal representative properly of involuntary tenant transfer including ombudsman contact information.
Tenant records lacked copies of durable power of attorney documentation.
Tenant records were not retained for the required minimum of three years after transfer or death.
Service plans were not consistently based on evaluations.
Service plans were not updated, signed, and dated within 30 days of tenant occupancy.
Service plans were not signed and dated at least annually.
Service plans failed to include other service providers such as hospice care in a timely manner.
Service plans failed to include person-centered planned and spontaneous activities for tenants with dementia.
Delegating nurse did not receive required training within six months of hire.
Staff failed to receive required eight hours of dementia-specific education within 30 days of employment.
Staff failed to receive required eight hours of dementia-specific continuing education annually.
Operating alarm system was not connected to each exit door in the dementia-specific program.
Report Facts
Number of tenants without cognitive impairment: 26
Number of tenants with cognitive impairment: 14
Room charge: 6120
Room charge: 6242
Room charge: 6492
Occupancy date: 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff C | Failed to complete eight hours of dementia-specific education within 30 days of employment | |
| Staff B | Failed to complete eight hours of dementia-specific continuing education annually | |
| Assisted Living Manager | ALM | Confirmed failures in tenant record documentation and evaluations |
Inspection Report — Mar 9, 2023
Renewal
Date: Mar 9, 2023
Visit Reason
The inspection was conducted as a recertification (renewal) of the Assisted Living Program to ensure compliance with regulatory requirements.
Findings
The program failed to ensure all staff responsible for food preparation or service received orientation and annual training on sanitation and safe food handling prior to handling food. This deficiency affected all 5 staff reviewed and potentially all 24 tenants.
Violations (1)
Failure to ensure all staff received orientation and annual training on sanitation and safe food handling prior to handling food.
Report Facts
Staff affected: 5
Tenants potentially affected: 24
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Resident Care Attendant | Did not receive orientation on sanitation and safe food handling prior to handling food |
| Staff D | Resident Care Attendant | Did not receive orientation on sanitation and safe food handling prior to handling food |
| Staff E | Resident Care Attendant | Did not receive orientation on sanitation and safe food handling prior to handling food |
| Staff F | Resident Care Attendant | Did not receive orientation on sanitation and safe food handling prior to handling food |
| Staff G | Resident Care Attendant | Did not receive orientation on sanitation and safe food handling prior to handling food |
Inspection Report — Nov 2, 2020
Renewal
Date: Nov 2, 2020
Visit Reason
Recertification visit conducted to determine compliance with certification of an Assisted Living Program, including an onsite infection control survey and investigation of a complaint.
Complaint Details
Complaint #93802-C was investigated and no regulatory insufficiencies were cited.
Findings
No regulatory insufficiencies were cited during the recertification visit, the infection control survey, or the complaint investigation.
Report Facts
Number of tenants without cognitive disorder in General Population Program: 16
Number of tenants with cognitive disorder in General Population Program: 3
Number of tenants without cognitive disorder in Memory Care Unit: 0
Number of tenants with cognitive disorder in Memory Care Unit: 9
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