Inspection Reports for Lakeside Village
2067 IA-4, Panora, IA 50216, United States, IA, 50216
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Inspection Report
Complaint Investigation
Census: 38
Deficiencies: 1
Sep 8, 2025
Visit Reason
The inspection was conducted as a complaint investigation following Incident #129917-I involving a tenant elopement and staff failure to respond properly to door alarms.
Findings
The program failed to implement and follow policies and procedures regarding staff response to door alarms, resulting in a tenant with severe cognitive impairment leaving the facility unsupervised. Staff did not hear or respond immediately to door alarms as required by policy and training.
Complaint Details
The complaint investigation was triggered by Incident #129917-I involving a tenant elopement. The investigation found the complaint substantiated as staff failed to respond immediately to door alarms, allowing a tenant with dementia to leave the facility unsupervised.
Deficiencies (1)
| Description |
|---|
| Failure to implement and follow policies and procedures regarding staff response to door alarms, leading to a tenant elopement. |
Report Facts
Tenants without cognitive impairment: 31
Tenants with cognitive impairment: 7
Total census: 38
Temperature: 87
Distance from facility: 0.1
Speed limit: 55
Inspection Report
Renewal
Census: 35
Deficiencies: 1
Oct 31, 2024
Visit Reason
The visit was conducted as a recertification visit to determine compliance with certification rules for an Assisted Living Program for People with Dementia.
Findings
The program failed to ensure the door alarm response policy was followed at all times, as evidenced by observations and interviews revealing issues with the ARIAL alarm system and staff response to door alarms.
Complaint Details
There were no regulatory insufficiencies cited during the investigation of Incidents 121601-I and 122624-I or Complaints 124371-C and 121275-C.
Deficiencies (1)
| Description |
|---|
| The program failed to ensure the door alarm response policy was followed at all times, including issues with the ARIAL alarm system and staff response to alarms. |
Report Facts
Number of tenants without cognitive impairment: 26
Number of tenants with cognitive impairment: 9
Total census: 35
Inspection Report
Complaint Investigation
Census: 52
Deficiencies: 1
Jan 3, 2024
Visit Reason
The inspection was conducted as a complaint investigation triggered by Complaint #117535-C to assess regulatory compliance related to building and grounds maintenance.
Findings
The program failed to consistently ensure the building and grounds were well-maintained, clean, safe, and sanitary, affecting all tenants (census 52). Specific deficiencies included missing siding, loose soffits, missing fascia board trim, water damage with mold appearance, rotted deck support posts, a non-functional industrial washer, and numerous missing dryer vent covers leading to bird infestations.
Complaint Details
The investigation of Complaint #117535-C resulted in the cited regulatory insufficiency related to structural requirements and maintenance.
Deficiencies (1)
| Description |
|---|
| Buildings and grounds were not well-maintained and safe, including missing siding, loose soffits, missing fascia board trim, water damage with mold appearance, rotted deck support posts, non-functional washer, and missing dryer vent covers. |
Report Facts
Number of tenants without cognitive impairment: 42
Number of tenants with cognitive impairment: 10
Total census: 52
Dryer vent covers missing - North side: 1
Dryer vent covers missing - South side: 5
Dryer vent covers missing - West side: 17
Duration dryer vent plugged: 7
Duration washer out of order: 24
Inspection Report
Complaint Investigation
Census: 67
Deficiencies: 1
Apr 5, 2023
Visit Reason
The inspection was conducted as an investigation of Complaint #105627-C regarding regulatory insufficiency related to service plans for tenants.
Findings
The program failed to ensure a nurse review was completed following a significant change in a tenant's chronic condition for 1 of 4 tenants reviewed, specifically Tenant C-1. The nurse review was not completed timely after emergency room visits and medication changes.
Complaint Details
Investigation of Complaint #105627-C found regulatory insufficiency related to service plans and nurse reviews for chronic conditions. The complaint was substantiated by findings on Tenant C-1.
Deficiencies (1)
| Description |
|---|
| Failure to ensure a nurse review was completed following a significant change in a tenant's chronic condition. |
Report Facts
Number of tenants without cognitive disorder in General Population Program: 53
Number of tenants with cognitive disorder in General Population Program: 0
Total Population of General Population Program: 53
Number of tenants without cognitive disorder in Dementia-Specific Program: 1
Number of tenants with cognitive disorder in Dementia-Specific Program: 13
Total Population of Dementia-Specific Program: 14
Total census of Assisted Living Program: 67
Resident age: 68
Medication dosage: 500
Medication frequency: 4
Medication duration: 7
Medication dosage: 60
Date of tenant admission: Aug 31, 2021
Date of nurse review: Jul 3, 2022
Date of tenant discharge: Nov 26, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mala Y Kammer | Director | Signed the report as Laboratory Director/Provider/Supplier Representative |
Inspection Report
Renewal
Census: 48
Deficiencies: 1
Jun 1, 2022
Visit Reason
The inspection was conducted as part of the recertification (renewal) of the Assisted Living Program at Lakeside Village.
Findings
The facility was found to have a regulatory insufficiency related to dementia-specific education for personnel. Specifically, 3 of 4 new hires did not complete the required minimum of eight hours of dementia-specific training within 30 days of employment.
Complaint Details
There were no regulatory insufficiencies cited during the investigation of Complaint #104663-C and/or Complaint #104850-C.
Deficiencies (1)
| Description |
|---|
| Failure to ensure all personnel employed by a dementia-specific program received the minimum of eight hours of dementia-specific education and training within 30 days of employment on 3 of 4 new hire files reviewed. |
Report Facts
Number of tenants without cognitive disorder in General Population Program: 36
Number of tenants with cognitive disorder in General Population Program: 0
Total Population of General Population Program: 36
Number of tenants without cognitive disorder in Dementia-Specific Program: 2
Number of tenants with cognitive disorder in Dementia-Specific Program: 12
Total Population of Dementia-Specific Program: 12
Total census of Assisted Living Program: 48
Dementia-specific training hours completed by Staff B within first 30 days: 6.6
Dementia-specific training hours completed by Staff D within first 30 days: 4.25
Dementia-specific training hours completed by Staff E within first 30 days: 4.5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Named in deficiency for incomplete dementia-specific training | |
| Staff D | Named in deficiency for incomplete dementia-specific training | |
| Staff E | Named in deficiency for incomplete dementia-specific training | |
| Staff A | Administrator | Confirmed findings of incomplete dementia-specific training |
Inspection Report
Complaint Investigation
Census: 51
Deficiencies: 0
Oct 14, 2021
Visit Reason
The inspection was conducted to investigate complaint #97236 and included an infection control review.
Findings
No regulatory insufficiencies were cited during the investigation of complaint #97236 or during the infection control review.
Complaint Details
Complaint #97236 was investigated and found to have no regulatory insufficiencies.
Report Facts
Number of tenants without cognitive disorders: 41
Number of tenants with cognitive disorders: 0
Number of tenants without cognitive disorders: 0
Number of tenants with cognitive disorders: 10
Total tenants: 51
Inspection Report
Plan of Correction
Census: 49
Deficiencies: 0
Jan 7, 2021
Visit Reason
The document is a plan of correction related to an onsite infection control survey and investigation of complaints at an assisted living program.
Findings
No regulatory insufficiencies were cited during the onsite infection control survey or during the investigation of complaints 91282-C, 91510-C, 95001-C, and 95068-C.
Report Facts
Number of tenants without cognitive disorder in General Population Program: 36
Number of tenants with cognitive disorder in General Population Program: 0
Total Population of General Population Program: 36
Number of tenants without cognitive disorder in Dementia-Specific Program: 2
Number of tenants with cognitive disorder in Dementia-Specific Program: 11
Total Population of Dementia-Specific Program: 13
TOTAL census of Assisted Living Program: 49
Inspection Report
Renewal
Census: 60
Deficiencies: 0
Dec 3, 2019
Visit Reason
Recertification conducted to determine compliance with certification for an Assisted Living Program for People with Dementia.
Findings
No regulatory insufficiencies were cited during the recertification inspection.
Report Facts
Number of tenants without cognitive disorder in General Population: 47
Number of tenants with cognitive disorder in General Population: 0
Number of tenants without cognitive disorder in Memory Care Unit: 6
Number of tenants with cognitive disorder in Memory Care Unit: 7
Total Census of Assisted Living Program for People with Dementia: 60
Inspection Report
Complaint Investigation
Census: 55
Deficiencies: 1
Feb 19, 2019
Visit Reason
The inspection was conducted as an investigation of Complaint #81220-C regarding tenant rights violations at Lakeside Village.
Findings
The program failed to ensure tenants were consistently treated with consideration, respect, and full recognition of personal dignity and autonomy. Multiple tenants and staff reported that Staff A was rude, used profanity, treated tenants poorly, and failed to report incidents to management.
Complaint Details
Complaint #81220-C was investigated and substantiated based on interviews with tenants and staff. Staff A was found to have used profanity, treated tenants rudely, and failed to report incidents to management despite multiple complaints.
Deficiencies (1)
| Description |
|---|
| Failure to ensure tenants were consistently treated with consideration, respect, and full recognition of personal dignity and autonomy, as evidenced by Staff A's behavior toward tenants. |
Report Facts
Number of tenants without cognitive disorder in general population: 39
Number of tenants with cognitive disorder in general population: 2
Number of tenants without cognitive disorder in memory care unit: 3
Number of tenants with cognitive disorder in memory care unit: 11
Total census of Assisted Living Program for People with Dementia: 55
Number of tenants interviewed regarding rights violation: 10
Number of tenants who felt their rights were violated by Staff A: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Named in findings related to rude behavior, use of profanity, and poor treatment of tenants |
Inspection Report
Complaint Investigation
Census: 54
Deficiencies: 0
Jan 2, 2019
Visit Reason
Investigation of Incident #80145 at the assisted living facility.
Findings
No regulatory insufficiencies were cited during the investigation of Incident #80145.
Complaint Details
Investigation of Incident #80145; no regulatory insufficiencies were found.
Report Facts
Number of tenants without cognitive disorder in General Population program: 40
Number of tenants with cognitive disorder in General Population program: 1
Total population of General Population program: 41
Number of tenants without cognitive disorder in Dementia-Specific program: 3
Number of tenants with cognitive disorder in Dementia-Specific program: 11
Total population of Dementia-Specific program: 14
Total census of Assisted Living Program: 54
Inspection Report
Complaint Investigation
Census: 50
Deficiencies: 0
Oct 23, 2018
Visit Reason
The inspection was conducted as an investigation of Incident #78521-I and Complaint #79225-C at the assisted living program for people with dementia.
Findings
No regulatory insufficiencies were cited during the investigation of the incident and complaint.
Complaint Details
Investigation of Incident #78521-I and Complaint #79225-C found no regulatory insufficiencies.
Report Facts
Census: 50
Number of tenants without cognitive disorder: 39
Number of tenants with cognitive disorder: 11
Inspection Report
Renewal
Census: 34
Deficiencies: 0
Nov 14, 2017
Visit Reason
The visit was a recertification inspection to determine compliance with certification of an Assisted Living Program for People with Dementia (ALP/D).
Findings
No regulatory insufficiencies were cited during the recertification visit, indicating compliance with the assisted living program requirements.
Report Facts
Number of tenants without cognitive disorder in General Population Program: 27
Number of tenants with cognitive disorder in General Population Program: 2
Total Population of General Population Program: 29
Number of tenants without cognitive disorder in Dementia-Specific Program: 0
Number of tenants with cognitive disorder in Dementia-Specific Program: 5
Total Population of Dementia-Specific Program: 5
Total census of Assisted Living Program: 34
Inspection Report
Complaint Investigation
Census: 37
Deficiencies: 2
Apr 6, 2017
Visit Reason
The inspection was conducted as a result of complaint investigation #66703-C and Incident 67011-I regarding tenant safety and care concerns at Lakeside Village.
Findings
The program failed to provide adequate care and supervision to Tenant #1, resulting in the tenant leaving the building unsupervised and the failure of the dementia-specific program's exit door alarm system. The incident affected 5 tenants in the dementia-specific program.
Complaint Details
Investigation #67011-I was substantiated as the program failed to provide adequate supervision and failed to maintain a functioning alarm system on the dementia-specific exit door, leading to an elopement incident involving Tenant #1.
Deficiencies (2)
| Description |
|---|
| Failure to provide care, treatment, and adequate/appropriate services as directed by service plans, affecting Tenant #1. |
| Failure to ensure each exit door in the dementia-specific setting had an operating alarm system, affecting 5 tenants. |
Report Facts
Number of tenants without cognitive disorder in General Population Program: 30
Number of tenants with cognitive disorder in General Population Program: 2
Total Population of General Population Program: 32
Number of tenants without cognitive disorder in Dementia-Specific Program: 0
Number of tenants with cognitive disorder in Dementia-Specific Program: 5
Total Population of Dementia-Specific Program: 5
Total census of Assisted Living Program: 37
Global Deterioration Scale (GDS) score for Tenant #1: 4
Temperature at Audubon airport: 50
Temperature at Perry airport: 56
Distance from North to South door: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jana Smith | Monitor | Monitor for Plan of Correction |
Inspection Report
Complaint Investigation
Census: 47
Deficiencies: 0
Dec 5, 2016
Visit Reason
Investigation of Complaint #63724-C regarding the Assisted Living Program at Lakeside Village.
Findings
No regulatory insufficiencies were cited during the investigation of the complaint. The census included 47 residents across general and dementia-specific programs.
Complaint Details
Complaint #63724-C was investigated and found to have no regulatory insufficiencies.
Report Facts
Number of tenants without cognitive disorder in General Population Program: 37
Number of tenants with cognitive disorder in General Population Program: 2
Total Population of General Population Program: 39
Number of tenants without cognitive disorder in Dementia-Specific Program: 1
Number of tenants with cognitive disorder in Dementia-Specific Program: 7
Total Population of Dementia-Specific Program: 8
TOTAL census of Assisted Living Program: 47
Inspection Report
Monitoring
Census: 36
Deficiencies: 0
Nov 5, 2015
Visit Reason
The visit was conducted as a Final Recertification Monitoring Evaluation to determine compliance with certification of an Assisted Living Program.
Findings
No regulatory insufficiencies were found during this evaluation. The review of recertification documents was completed and accepted, including approval of evacuation plans by the State Fire Marshal and Facility Engineer.
Report Facts
Number of tenants without cognitive disorder in General Population Program: 31
Number of tenants with cognitive disorder in General Population Program: 0
Total Population of General Population Program: 31
Number of tenants without cognitive disorder in Dementia-Specific Program: 0
Number of tenants with cognitive disorder in Dementia-Specific Program: 5
Total Population of Dementia-Specific Program: 5
Total census of Assisted Living Program: 36
Inspection Report
Complaint Investigation
Census: 30
Deficiencies: 0
May 14, 2015
Visit Reason
The inspection was conducted as a complaint/incident investigation following allegations related to service plans, nurse review, and staffing at Lakeside Village.
Findings
The investigation found all allegations to be unsubstantiated with no regulatory insufficiencies identified. Staff training and supervision were reviewed and found adequate, and the program agreed to retrain staff on medication administration.
Complaint Details
The complaint investigation addressed allegations regarding service plans, nurse review, and staffing. All findings were unsubstantiated based on tenant file reviews, staff interviews, and observations.
Report Facts
Census: 30
Number of tenants without cognitive disorder: 27
Number of tenants with cognitive disorder: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rose Boccella | Program Coordinator | Author of the report and contact person for questions |
Inspection Report
Follow-Up
Census: 31
Deficiencies: 2
Dec 30, 2013
Visit Reason
Final Revisit to Recertification Monitoring Evaluation and Complaint/Incident Investigation following a prior investigation by DIA on December 30 and 31, 2013.
Findings
The report notes regulatory insufficiencies in the areas of Structural Requirements and Nurse Review. The program had previously received regulatory insufficiencies related to Evaluation, Service Plans, Tenant Rights, Structural, Policy and Procedures, Tenant Documents, and Life Safety during the August 2013 recertification and complaint investigation. The revisit confirmed corrections in some areas but noted ongoing issues related to structural requirements and nurse review.
Complaint Details
The visit was complaint-related with Complaint/Incident Intake numbers 44976-AR1 and 46468-C. Allegations included failure to evaluate tenant eligibility, inappropriate sexual behavior, tenant injury requiring follow-up care, staff making fun of tenants, and call lights not being answered for over an hour. The complaint investigation found some substantiated issues but no regulatory insufficiencies in tenant rights or call light response times.
Deficiencies (2)
| Description |
|---|
| Regulatory insufficiency related to structural requirements, specifically the size of apartments not meeting specifications for a general population apartment. |
| Regulatory insufficiency related to nurse review, including requirements for nurse review when a tenant does not receive personal or health-related care or when there is an observed significant change in condition. |
Report Facts
Number of tenants without cognitive disorder: 31
Number of tenants with cognitive disorder: 0
Total census of Assisted Living Program: 31
Number of tenants interviewed at meeting: 19
Call light response time: 5
Call light response time: 10
Call light calls per day: 11
Square footage of apartment #256: 245
Square footage of apartment #257: 170
Minimum required square footage for single occupancy dwelling unit: 240
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kim Stodgel | Administrator | Administrator of Lakeside Village Assisted Living, named in report correspondence |
| Lori Miner | RN BSN | Monitor during the December 30 and 31, 2013 monitoring visit |
| Jim Berkley | RN BS, Program Coordinator | Monitor during the December 30 and 31, 2013 monitoring visit and author of cover letter |
Inspection Report
Complaint Investigation
Census: 33
Deficiencies: 7
Aug 22, 2013
Visit Reason
The inspection was conducted as a Final Recertification and Complaint/Incident Investigation following a complaint intake #44976-A, assessing regulatory insufficiencies in tenant care, service plans, tenant rights, structural requirements, policies, procedures, tenant documents, and life safety at Lakeside Village Assisted Living.
Findings
The report found multiple regulatory insufficiencies including failure to properly evaluate tenants, update service plans, maintain complete documentation, and ensure tenant safety. Specific issues included a Stage IV decubitus ulcer on Tenant #1, accessible chemicals in the dementia unit, and inadequate supervision of tenants exhibiting sexual behaviors. A $7,000 civil penalty was assessed.
Complaint Details
Complaint Intake #44976-A involved allegations of inadequate care for Tenant #1 with a Stage IV pressure ulcer and concerns about sexual behavior between Tenants #3 and #4. The complaint was substantiated with findings of regulatory insufficiencies in tenant care, evaluations, and safety.
Deficiencies (7)
| Description |
|---|
| Failure to properly perform evaluations, update service plans, and maintain complete documentation for Tenant #1 with a progressing Stage IV decubitus ulcer. |
| Chemicals accessible to tenants in the dementia unit. |
| Failure to perform appropriate evaluations and update service plans for Tenants #3 and #4 exhibiting physical and sexual type behaviors. |
| Unlocked medication room door and unsecured chemicals in the dementia unit. |
| Failure to maintain documentation related to medication administration and care for Tenant #1. |
| Failure to provide adequate supervision and safety measures related to tenant wandering and sexual behaviors. |
| Failure to maintain an operating alarm system connected to each exit door in the dementia-specific program. |
Report Facts
Civil penalty amount: 7000
Reduced civil penalty amount: 4550
Tenant census: 33
Tenants without cognitive disorder: 30
Tenants with cognitive disorder: 3
Dates of monitoring visit: 2013-08-22 to 2013-08-29
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jim Berkley | Program Coordinator | Named in relation to civil penalty payment and contact for questions. |
| Jim Friberg | Acting Bureau Chief, Adult Services Bureau | Signed the demand letter. |
| Hal L. Chase | RN BSN MPH | Monitor for the investigation. |
| Jim Berkley | RN BS | Monitor for the investigation. |
| HRN #1 | Hospital Registered Nurse | Interviewed regarding wound care for Tenant #1. |
| ARNP | Advanced Registered Nurse Practitioner | Interviewed and reported on Tenant #1's wound care and treatment. |
Inspection Report
Complaint Investigation
Census: 34
Deficiencies: 7
May 28, 2013
Visit Reason
The inspection was conducted as a final complaint/incident investigation regarding allegations that a tenant chronically eloped from the program without staff knowledge and that the program failed to report the elopement as required by regulation.
Findings
The investigation found no tenant elopements since January 2013, with the program's alarm system functioning appropriately to prevent elopements. Several tenants exhibited aggressive behaviors and exceeded the level of care allowable to remain in the program. Multiple regulatory insufficiencies were identified related to tenant admission, program reporting, structural requirements, service plans, and tenant documentation.
Complaint Details
The complaint alleged a tenant eloped from the program without staff knowledge and the program failed to report the elopement as required. The investigation found no elopements since January 2013 and that the program's alarm system functioned appropriately to prevent elopements. The exit seeking behavior did not require reporting to the Department of Inspections and Appeals.
Deficiencies (7)
| Description |
|---|
| A program shall not knowingly admit or retain a tenant who is bed-bound, requires routine two-person assistance, is dangerous to self or others, or displays behaviors placing others at risk. |
| The buildings and grounds shall be well-maintained, clean, safe and sanitary. |
| A program shall evaluate each tenant's functional, cognitive and health status within 30 days of occupancy and as needed thereafter. |
| A program shall evaluate each prospective tenant's health status prior to occupancy to determine eligibility and needed services. |
| A service plan shall be developed for each tenant based on evaluations and updated at least annually and when changes occur. |
| The service plan shall be individualized and indicate the tenant's identified needs and preferences for assistance. |
| Documentation for each tenant shall be maintained including medical information, incident reports, and nurses' notes. |
Report Facts
Total census: 34
General population tenants without cognitive disorder: 25
Dementia-specific program tenants without cognitive disorder: 5
Dementia-specific program tenants with cognitive disorder: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jim Berkley | Program Coordinator | Signed cover letter regarding the Final Complaint/Incident Investigation Report |
| Maribeth Freland | RN | Monitor who conducted the complaint/incident investigation |
Inspection Report
Monitoring
Census: 23
Deficiencies: 2
Sep 21, 2011
Visit Reason
An on-site monitoring evaluation was conducted at Lakeside Village to review the Assisted Living Program's compliance with regulatory requirements and the Plan of Correction.
Findings
The evaluation found regulatory insufficiencies related to individualized service plans and dementia-specific education for program personnel. The Plan of Correction was accepted by the Department of Inspections and Appeals.
Deficiencies (2)
| Description |
|---|
| The service plan was not individualized and did not indicate the tenant's identified needs and preferences for assistance, including planned and spontaneous activities for tenants with dementia. |
| Staff member files lacked documentation of dementia education as required by regulation. |
Report Facts
Total census: 23
Number of tenants without cognitive disorder: 21
Number of tenants with cognitive disorder: 2
Number of tenants in dementia-specific program: 4
Number of tenants in general population program: 19
Number of tenants attending satisfaction meeting: 8
Number of staff hired without dementia education documentation: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kim Stodgel | Executive Director | Named as Executive Director of The Lakeside Village |
| Lori Miner | RN BSN | Monitor conducting the evaluation |
| Jim Berkley | Program Coordinator | Signed letter regarding certification and Plan of Correction acceptance |
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