Inspection Reports for Keystone Nursing Care Center
250 Fifth Street, IA, 522499521
Back to Facility ProfileDeficiencies per Year
4
3
2
1
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Inspection Report
Annual Inspection
Deficiencies: 0
Sep 11, 2025
Visit Reason
An annual recertification survey was conducted from September 8, 2025 through September 11, 2025.
Findings
The facility was found to be in substantial compliance.
Inspection Report
Complaint Investigation
Deficiencies: 0
May 8, 2025
Visit Reason
A complaint investigation for complaint #127169-C and facility reported incident #127120-I was conducted from May 7, 2025 to May 8, 2025.
Findings
The facility was found to be in substantial compliance at the time of the survey.
Complaint Details
Investigation was related to complaint #127169-C and facility reported incident #127120-I; the facility was found to be in substantial compliance.
Inspection Report
Re-Inspection
Deficiencies: 0
Feb 27, 2025
Visit Reason
A revisit of the survey ending February 6, 2025 was conducted on February 26, 2025 to February 27, 2025 to verify correction of previous deficiencies.
Findings
All deficiencies were corrected and the facility is in substantial compliance effective February 20, 2025.
Inspection Report
Complaint Investigation
Census: 39
Deficiencies: 1
Feb 6, 2025
Visit Reason
The inspection was conducted as an investigation of complaint #125885-A and facility reported incident #125864-M, which involved a resident fall and injury.
Findings
The facility failed to properly transfer a resident using a mechanical lift as required by the care plan, resulting in a fall with a fractured femur. Multiple progress notes and interviews documented the incident, the resident's injuries, and staff actions. The facility suspended the involved staff and initiated corrective actions.
Complaint Details
The visit was complaint-related, investigating complaint #125885-A and facility reported incident #125864-M. The complaint was substantiated as the facility failed to follow the care plan for resident transfers, leading to injury.
Severity Breakdown
SS=G: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to properly transfer a resident using a mechanical lift as directed in the care plan, resulting in a fall and fractured femur. | SS=G |
Report Facts
Resident census: 39
Complaint number: 125885
Incident number: 125864
Resident age: 97
BIMS score: 10
Vital signs: Temperature 97.9 F, pulse 102 bpm, respirations 20 per minute, blood pressure 148/84, oxygen saturation 94%
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tracy Bruys | RN BSN Admin | Signed the plan of correction letter dated 2/20/2025 |
| Staff A | Employee who transferred the resident improperly, causing the fall | |
| Staff B | LPN | Reported details of the fall and resident condition |
| Staff D | Assisted with resident transfer and involved in incident investigation | |
| Staff C | CNA | Witnessed and reported on resident transfer and fall incident |
| Director of Nursing | DON | Conducted internal investigation and interviewed staff |
| Licensed Nursing Home Administrator | LNHA | Interviewed regarding incident and staff actions |
Inspection Report
Annual Inspection
Deficiencies: 0
Sep 19, 2024
Visit Reason
An annual recertification survey and investigation of complaint #123510-C was conducted from 09/16/2024 to 09/19/2024.
Findings
The facility was found to be in substantial compliance.
Inspection Report
Complaint Investigation
Deficiencies: 0
Aug 2, 2024
Visit Reason
A complaint investigation was conducted for complaint #122484-C and a facility reported incident #116417-I.
Findings
The facility was found to be in substantial compliance with no deficiencies cited.
Complaint Details
Complaint #122484-C and facility reported incident #116417-I were investigated and found to be in substantial compliance.
Inspection Report
Plan of Correction
Deficiencies: 0
Jul 10, 2023
Visit Reason
The document is a statement of deficiencies and plan of correction related to the facility's compliance status following a survey.
Findings
The facility was certified in compliance based on acceptance of a credible allegation of compliance and plan of correction effective July 10, 2023. No specific deficiencies or severity levels are detailed in the report.
Inspection Report
Annual Inspection
Census: 48
Deficiencies: 2
Jun 22, 2023
Visit Reason
The inspection was conducted as part of the facility's Annual Recertification Survey and investigation of Complaint #113311-C.
Findings
The facility was found deficient in quality of care related to failure to notify the physician for elevated blood sugars for one resident and failure to document non-pharmacological interventions prior to administration of PRN anxiolytics for another resident. The complaint was substantiated.
Complaint Details
Complaint #113311-C was substantiated.
Deficiencies (2)
| Description |
|---|
| Facility failed to notify the Physician for elevated blood sugars for Resident #205. |
| Facility failed to document non-pharmacological interventions attempted prior to administration of PRN anxiolytics for Resident #26. |
Report Facts
Resident census: 48
Blood sugar readings: 500
Blood sugar readings: 50
MDS Brief Interview for Mental Status score: 14
MDS Brief Interview for Mental Status score: 7
PRN anxiolytic medication dose: 0.5
Medication administration times: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tracy Bruns | RN BSN Admin | Signed the plan of correction |
| Licensed Practical Nurse (LPN) Staff A | Interviewed regarding PRN anxiolytic interventions | |
| Licensed Practical Nurse (LPN) Staff B | Interviewed regarding blood sugar policy and physician notification | |
| Licensed Practical Nurse (LPN) Staff C | Interviewed regarding blood sugar policy and physician notification | |
| Director of Nursing (DON) | Interviewed regarding blood sugar policy and PRN anxiolytic administration |
Inspection Report
Plan of Correction
Deficiencies: 0
Apr 8, 2022
Visit Reason
The document is a plan of correction submitted following a survey to address deficiencies and certify compliance.
Findings
The facility was found to be in compliance based on acceptance of the credible allegation of compliance and plan of correction effective April 8, 2022.
Inspection Report
Annual Inspection
Census: 40
Deficiencies: 1
Apr 7, 2022
Visit Reason
The inspection was conducted as the facility's Annual Recertification Survey from April 4, 2022 to April 7, 2022.
Findings
The facility failed to ensure expired food items were properly labeled and dated to reduce the risk of contamination and food-borne illness. Multiple food items in the kitchen were found unlabeled or past their best-by dates.
Severity Breakdown
SS=E: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to ensure expired food items were served to residents and failed to label and date food items when opened to reduce contamination risk. | SS=E |
Report Facts
Census: 40
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dietary Supervisor | Interviewed during kitchen tour regarding food labeling and expiration | |
| Facility Dietician | Present during kitchen tour revealing food labeling issues |
Inspection Report
Annual Inspection
Deficiencies: 0
Jan 7, 2021
Visit Reason
The inspection was conducted as a recertification survey from January 4, 2021 to January 7, 2021, including investigation of complaint #91457.
Findings
The facility was found in substantial compliance at the time of the recertification survey. The complaint investigation was unsubstantiated.
Complaint Details
Complaint #91457 investigation was unsubstantiated.
Inspection Report
Abbreviated Survey
Census: 27
Deficiencies: 0
Dec 8, 2020
Visit Reason
A Focused COVID-19 Infection Control Survey was conducted on 12/7-8/2020 by the Department of Inspections and Appeals to assess the facility's compliance with CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Routine
Census: 39
Deficiencies: 0
Nov 18, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspection and Appeals on 11-17-20 and 11-18-20 to assess the facility's compliance with CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Abbreviated Survey
Census: 45
Deficiencies: 0
Jun 24, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspections and Appeals on 6/24/20 to assess the facility's compliance with CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices to prepare for COVID-19.
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