Inspection Report Summary
The most recent inspection on October 3, 2024, found no deficiencies during the recertification visit. Earlier inspections showed a pattern of deficiencies related mainly to tenant care, including failure to provide adequate care, incomplete evaluations, and documentation issues, as well as some safety concerns like unsecured exit doors and missing door alarms. Several complaint investigations substantiated issues with care and compliance, particularly involving tenant evaluations, service plan updates, and incident reporting. Enforcement actions such as fines or license suspensions were not listed in the available reports. The facility’s most recent clean inspection suggests improvement following a history of mixed findings.
Deficiencies (last 11 years)
Deficiencies (over 11 years)
2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
55% better than Iowa average
Iowa average: 4.4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
14 residents
Based on a October 2024 inspection.
Census over time
Inspection Report
Renewal
Census: 14
Deficiencies: 0
Date: Oct 3, 2024
Visit Reason
The visit was a recertification inspection to determine compliance with certification rules for an Assisted Living Program for People with Dementia.
Findings
No regulatory insufficiencies were cited during the recertification visit.
Report Facts
Number of tenants without cognitive impairment: 1
Number of tenants with cognitive impairment: 13
Total census: 14
Inspection Report
Complaint Investigation
Census: 15
Deficiencies: 7
Date: Sep 27, 2023
Visit Reason
The inspection was conducted as part of the investigation of Complaint #109278-C regarding regulatory insufficiencies at the assisted living program.
Complaint Details
The visit was triggered by Complaint #109278-C. The complaint involved concerns about falls, bruising, skin breakdown, and inadequate care for Tenant #1. The complaint was substantiated as deficiencies were found.
Findings
The program failed to follow established policies and procedures related to incident reports and head injuries, failed to provide adequate and appropriate care, did not evaluate tenant eligibility prior to occupancy or with significant changes, failed to document nurse's notes by exception, did not update service plans based on evaluations, and failed to conduct nurse reviews at least every 90 days for tenants receiving personal or health-related care. These deficiencies pertained to Tenant #1 among three tenants reviewed.
Deficiencies (7)
Failed to follow established policies and procedures for incident reports and head injuries.
Failed to provide adequate and appropriate care to tenants.
Failed to evaluate functional, cognitive, and health status prior to occupancy to determine eligibility.
Failed to evaluate functional, cognitive, and health status annually and with significant change.
Failed to document nurse's notes by exception.
Failed to update service plans based on required evaluations.
Failed to assess and document health status of tenants receiving personal or health-related care at least every 90 days.
Report Facts
Number of tenants with cognitive impairment: 15
Total census: 15
Weight loss: 36
Date of inspection: Sep 27, 2023
Inspection Report
Complaint Investigation
Census: 13
Deficiencies: 7
Date: Apr 11, 2023
Visit Reason
The inspection was conducted as a complaint investigation related to Incident #111812-I and Complaint 111084-C at Independence Village of Waukee MC.
Complaint Details
The visit was complaint-related, investigating Incident #111812-I and Complaint 111084-C. No regulatory insufficiencies were cited during the investigation of Incident #111812-I, but deficiencies were cited during the investigation of Complaint 111084-C.
Findings
The investigation found multiple regulatory deficiencies including failure to consistently follow incident reporting policy, incomplete staff training and nurse delegation within required timeframes, failure to ensure dependent adult abuse training compliance, incomplete criminal history evaluations prior to employment, failure to use the required Global Deterioration Scale for cognitive evaluation, inadequate documentation of routine personal and health-related care, and failure to implement/document emergency response procedures for tenants with cognitive disorders.
Deficiencies (7)
Failure to consistently follow incident reporting policy for Tenant #3's fall incident.
Delegating nurse failed to ensure staff training within required timeframes for 5 tenants.
Program failed to ensure staff received required Dependent Adult Abuse training.
Failure to perform criminal history evaluations prior to employment for Staff A.
Failure to utilize the Global Deterioration Scale for tenants with moderate cognitive decline.
Failure to maintain accurate documentation on task sheets for routine personal and health-related care for 5 tenants.
Failure to implement and document staff procedures addressing emergency needs of tenants with cognitive disorders.
Report Facts
Number of tenants without cognitive impairment: 1
Number of tenants with cognitive impairment: 12
Total census: 13
Number of tenants affected by staff training deficiency: 5
Number of tenants potentially affected by staff training deficiency: 8
Number of tenants potentially affected by dependent adult abuse training deficiency: 13
Number of tenants reviewed for cognitive evaluation deficiency: 5
Number of tenants reviewed for documentation deficiency: 5
Number of tenants reviewed for emergency procedure deficiency: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Hired 1/3/23; criminal history evaluation completed after employment start date | |
| Staff B | Hired 7/21/21; nurse aide checklist completed 11/30/22 | |
| Staff C | Hired 11/1/19; nurse aide checklist completed 11/30/22; last Dependent Adult Abuse training completed 3/11/16 | |
| Wellness Coordinator | Delegating Nurse | Hired 6/20/22; failed to ensure timely staff training and incident report documentation |
| Regional Wellness Director | Confirmed failure to ensure criminal history evaluation prior to employment | |
| Wellness Director | Confirmed use of BCRS instead of required Global Deterioration Scale |
Inspection Report
Renewal
Census: 12
Deficiencies: 3
Date: Jun 16, 2022
Visit Reason
A recertification visit was conducted to determine compliance with certification for an Assisted Living Program for People with Dementia. During the recertification visit, investigations 104577-C & 97810-C were also completed.
Findings
The Program failed to ensure tenants received adequate and appropriate care, specifically Tenant #1 did not receive prescribed pain medication due to unavailability. The Program also failed to consistently perform required criminal history and abuse record checks prior to employment and failed to consistently evaluate tenants' functional status annually or with significant change.
Deficiencies (3)
Failed to ensure Tenant #1 received prescribed pain medication (Tramadol) as it was unavailable, resulting in missed doses.
Failed to consistently perform criminal history and child/dependent adult abuse record checks prior to employment for Staff A.
Failed to consistently evaluate tenants' functional status annually or with significant change, specifically Tenant #1 had no current cognitive evaluation.
Report Facts
Number of tenants with cognitive disorder: 12
Missed medication doses: 16
Staff reviewed: 4
Tenants reviewed: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Failed to receive criminal history and abuse record checks prior to employment; unable to administer pain medication due to unavailability | |
| Registered Nurse | RN | Interviewed regarding medication unavailability and follow-up with supplier; confirmed lack of cognitive evaluation for Tenant #1; stated insufficient nursing staff |
Inspection Report
Complaint Investigation
Census: 16
Deficiencies: 0
Date: Feb 20, 2020
Visit Reason
Investigation of Incident #88159-I at the Assisted Living Program for People with Dementia.
Complaint Details
Investigation of Incident #88159-I found no regulatory insufficiencies.
Findings
No regulatory insufficiencies were cited during the investigation.
Report Facts
Number of tenants without cognitive disorder: 1
Number of tenants with cognitive disorder: 15
Total Census: 16
Inspection Report
Renewal
Census: 17
Deficiencies: 1
Date: Aug 26, 2019
Visit Reason
The inspection was conducted as a re-certification survey and investigation of the Assisted Living Program for People with Dementia at Waukee Memory Care LLC.
Findings
The facility failed to meet life safety requirements related to the installation of door alarms on all exit doors in the dementia-specific program. One client eloped through an unalarmed door, prompting the deficiency. The provider planned corrective actions including installation of alarms and routine maintenance checks.
Deficiencies (1)
Failure to ensure door alarms were installed on all exit doors in the dementia-specific program, resulting in an elopement incident.
Report Facts
Number of tenants with cognitive disorder: 16
Number of tenants without cognitive disorder: 1
Total Census of Assisted Living Program for People with Dementia: 17
Date of incident report: Jun 21, 2019
Inspection Report
Renewal
Census: 14
Deficiencies: 0
Date: Aug 10, 2017
Visit Reason
Recertification visit conducted to determine compliance with certification for an Assisted Living Program with Dementia-Specific Program by Dedication.
Findings
No regulatory insufficiencies were cited during the recertification visit for the ALP/D Program.
Report Facts
Number of tenants with cognitive disorder: 14
Number of tenants without cognitive disorder: 0
Total Population of Program at time of on-site: 14
Inspection Report
Complaint Investigation
Census: 16
Deficiencies: 4
Date: Jan 6, 2016
Visit Reason
The inspection was conducted following a complaint/incident investigation regarding regulatory insufficiencies in evaluation of tenant, service plans, nurse review, and structural requirements at Waukee Memory Care, LLC.
Complaint Details
Complaint investigation report issued for Incident #56804-I involving tenant elopement due to malfunctioning door and failure to complete required evaluations and service plans. The complaint was substantiated with regulatory insufficiencies found.
Findings
The investigation found multiple regulatory insufficiencies including failure to complete evaluations of tenants with significant changes, incomplete service plans, inadequate nurse reviews, and structural deficiencies such as unsecured exit doors. Tenant #1 eloped due to a malfunctioning door alarm.
Deficiencies (4)
Evaluation of tenant not completed within 30 days of occupancy or significant change.
Service plans were not based on evaluations and were not updated with changes of condition to meet specific service needs.
Nurse reviews were not completed with a change of condition to assess and document health status and monitor progress.
Structural requirements not met: exit door to dementia program did not always secure upon closure and alarm system did not function.
Report Facts
Number of tenants with cognitive disorder: 16
Total population at time of on-site: 16
Civil penalty amount: 1000
Reduced civil penalty amount: 650
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rose Boccella | Program Coordinator | Contact for appeal and plan of correction |
| Jim Friberg | Bureau Chief, Adult Services Bureau | Signed demand letter |
Inspection Report
Monitoring
Census: 17
Deficiencies: 0
Date: Aug 31, 2015
Visit Reason
The visit was a Final Recertification Monitoring Evaluation to assess compliance with Iowa Administrative Code chapters 481-67 and 481-69 for the Assisted Living Program at Waukee Memory Care, LLC.
Findings
No regulatory insufficiencies were found during this evaluation. The review of recertification documents was completed and accepted, and the State Fire Marshal's inspection report and Facility Engineer's approval of evacuation plans were received.
Report Facts
Number of tenants with cognitive disorder: 17
Number of tenants without cognitive disorder: 0
Total Population of Program at time of on-site: 17
Total census of Assisted Living Program: 17
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rose Boccella | Program Coordinator | Signed letter regarding the Final Recertification Monitoring Evaluation Report |
Inspection Report
Complaint Investigation
Census: 15
Deficiencies: 0
Date: Dec 10, 2014
Visit Reason
The inspection was conducted as a complaint/incident investigation following an on-site monitoring visit on December 10, 2014, related to concerns about staffing, structure/life safety, and level of care at Waukee Memory Care, LLC.
Complaint Details
Concerns investigated included staffing adequacy, safety of the environment related to door alarms and elopement risk, and appropriateness of care for dementia-specific needs. All findings were not substantiated.
Findings
No regulatory insufficiencies were identified. All concerns regarding staffing, structure/life safety, and level of care were found to be not substantiated based on staff interviews, file reviews, and observations.
Report Facts
Number of tenants without cognitive disorder: 0
Number of tenants with cognitive disorder: 15
Total population of Program at time of on-site: 15
Total census of Assisted Living Program: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rose Boccella | Program Coordinator | Author of the report and contact person |
Inspection Report
Monitoring
Census: 13
Deficiencies: 0
Date: Mar 27, 2013
Visit Reason
The visit was conducted as a Final Recertification Monitoring Evaluation to assess compliance with Iowa Administrative Code chapters 481—67 and 481—69 for the Assisted Living Program.
Findings
No regulatory insufficiencies were found during this evaluation or the monitoring visit. The review of recertification documents and the State Fire Marshal's inspection report were accepted.
Report Facts
Number of tenants without cognitive disorder: 1
Number of tenants with cognitive disorder: 12
Total Population of Program at time of on-site: 13
TOTAL census of Assisted Living Program: 13
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Joyce Kix | RN | Monitor conducting the evaluation |
Inspection Report
Original Licensing
Census: 10
Deficiencies: 0
Date: Oct 11, 2011
Visit Reason
The visit was conducted as a Final Initial Certification Monitoring Evaluation for Waukee Memory Care, LLC to assess regulatory compliance for assisted living program certification.
Findings
The on-site evaluation found no regulatory insufficiencies, demonstrating compliance with Iowa Code and Administrative Code requirements for assisted living programs.
Report Facts
Number of tenants without cognitive disorder: 2
Number of tenants with cognitive disorder: 8
Total Population of Program at time of on-site: 10
TOTAL census of Assisted Living Program: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Joyce Kix | RN | Monitor conducting the evaluation |
| Ann Martin | RN | Monitor conducting the evaluation |
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