Inspection Reports for Maple Heights
5300 Stone Ave, Sioux City, IA 51106, IA, 51106
Back to Facility ProfileDeficiencies per Year
8
6
4
2
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Inspection Report
Annual Inspection
Census: 46
Deficiencies: 5
Dec 18, 2025
Visit Reason
The inspection was an annual recertification survey conducted from December 15, 2025 to December 18, 2025 to assess compliance with federal regulations and quality of care standards at the facility.
Findings
The facility was found to have multiple deficiencies including failure to provide adequate monitoring and assessment of residents on psychotropic medications, failure to ensure a safe environment free of accident hazards, improper storage and labeling of drugs and biologics, and inadequate infection prevention and control practices.
Severity Breakdown
SS = D: 2
SS = E: 3
Deficiencies (5)
| Description | Severity |
|---|---|
| Failure to provide increased monitoring and assessment with medication changes for a resident on psychotropic medications. | SS = D |
| Failure to assess residents for safety while smoking, leading to accident hazards. | SS = D |
| Failure to ensure staff safely stored controlled substances under double lock for 4 of 46 residents. | SS = E |
| Failure to maintain narcotic sheets to monitor daily count of controlled drugs. | SS = E |
| Failure to establish and maintain an infection prevention and control program including hand hygiene and use of enhanced barrier precautions. | SS = E |
Report Facts
Census: 46
Deficiencies cited: 5
Inspection Report
Plan of Correction
Deficiencies: 0
Mar 4, 2025
Visit Reason
The document is a Plan of Correction submitted following a prior inspection, indicating acceptance of credible allegation of substantial compliance.
Findings
The facility was found to be in substantial compliance based on the accepted Plan of Correction and will be certified in compliance effective March 4, 2025.
Inspection Report
Annual Inspection
Census: 49
Deficiencies: 3
Feb 13, 2025
Visit Reason
The inspection was conducted as part of the facility's annual recertification survey and included investigation of complaints #121307-C and #123625-C.
Findings
The facility was found deficient in developing and implementing comprehensive care plans, labeling and storing drugs and biologicals properly, and infection prevention and control practices, including failure to implement Enhanced Barrier Precautions for certain residents. The facility reported a census of 49 residents during the survey.
Complaint Details
Complaint #121307-C was not substantiated. Complaint #123625-C was substantiated.
Severity Breakdown
Level D: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to develop a comprehensive care plan that included problems, goals, or approaches for Enhanced Barrier Precautions for 1 of 3 residents reviewed (Resident #26). | Level D |
| Failure to properly label and store drugs and biologicals, including leaving a medication cart unlocked and unattended. | Level D |
| Failure to establish and maintain an infection prevention and control program, including failure to implement Enhanced Barrier Precautions for 3 residents and staff not wearing required Personal Protective Equipment. | Level D |
Report Facts
Residents reviewed: 3
Census: 49
Medication cart unattended time: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tom Swanson | Administrator | Signed the report on 3-4-2025. |
| Staff E | Registered Nurse (RN) | Observed locking medication cart and interviewed regarding medication cart policy. |
| Staff A | Licensed Practical Nurse (LPN) | Observed providing medication administration and enteral feeding. |
| Staff F | Certified Nurses Aide (CNA) | Observed completing hand hygiene and donning gloves. |
| Director of Nursing (DON) | Interviewed regarding care plan policies, medication cart policies, and Enhanced Barrier Precautions. |
Inspection Report
Plan of Correction
Deficiencies: 0
Jun 18, 2024
Visit Reason
The document reflects acceptance of a credible allegation of substantial compliance and the facility's Plan of Correction, leading to certification in compliance effective June 5, 2024.
Findings
The facility was found to be in substantial compliance based on the credible allegation and Plan of Correction submitted, resulting in certification of compliance.
Report Facts
Certification effective date: Compliance effective June 5, 2024
Inspection Report
Annual Inspection
Census: 37
Deficiencies: 4
May 9, 2024
Visit Reason
The inspection was conducted as the facility's annual recertification survey from May 6, 2024 to May 9, 2024.
Findings
The facility was found deficient in developing and implementing comprehensive care plans, care plan timing and revision, food procurement and safety, and infection prevention and control. Specific issues included lack of measurable goals and interventions in care plans, failure to update care plans after condition changes, expired food products, and inadequate infection control practices.
Severity Breakdown
SS=D: 3
SS=E: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failure to develop and implement a comprehensive person-centered care plan with measurable objectives and timeframes. | SS=D |
| Care plan timing and revision deficiencies including lack of policy and failure to update care plans after condition changes. | SS=D |
| Food procurement, storage, preparation, and serving sanitary deficiencies including expired food items and failure to replace food before recommended shelf life. | SS=E |
| Infection prevention and control program deficiencies including failure to provide appropriate infection prevention practices and annual review. | SS=D |
Report Facts
Census: 37
Deficiency count: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing (DON) | Provided statements regarding care plan expectations, policies, and infection control practices |
| Certified Dietary Manager | Certified Dietary Manager (CDM) | Provided information about food product dates and kitchen observations |
| Staff A | Certified Nursing Assistant (CNA) | Provided statement regarding catheter bag dignity cover |
Inspection Report
Deficiencies: 0
Mar 30, 2023
Visit Reason
The inspection was conducted to assess compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities.
Findings
The Maple Heights Nursing Home was found to be in compliance with the regulatory requirements as of 3/16/23.
Inspection Report
Annual Inspection
Census: 36
Deficiencies: 6
Feb 23, 2023
Visit Reason
The inspection was conducted as part of the facility's annual recertification survey and investigation of complaint #110203-C, which was substantiated.
Findings
The facility was found deficient in developing and implementing comprehensive care plans addressing psychotropic medication usage, pain management, elopement risk, and dementia for several residents. Deficiencies were also found in accident hazard prevention during transfers, psychotropic medication PRN use without proper time limits, infection prevention and control practices related to COVID-19, and documentation of influenza, pneumococcal, and COVID-19 immunizations or refusals.
Complaint Details
Complaint #110203-C was substantiated.
Severity Breakdown
SS=D: 6
Deficiencies (6)
| Description | Severity |
|---|---|
| Failed to develop comprehensive care plans addressing psychotropic medication usage, opioid medication, pain management, elopement risk, and dementia for 4 of 14 residents reviewed. | SS=D |
| Failed to implement safe transfer practices using mechanical lifts for 1 of 3 residents reviewed. | SS=D |
| Failed to limit PRN psychotropic medication orders to 14 days or document physician rationale for longer use for 1 of 5 residents reviewed. | SS=D |
| Failed to implement adequate infection prevention and control measures, including proper PPE use and social distancing for residents positive for COVID-19. | SS=D |
| Failed to ensure resident medical records included documentation of influenza and pneumococcal immunization refusals for 1 of 5 residents reviewed. | SS=D |
| Failed to ensure resident medical records included documentation of COVID-19 immunization refusals for 2 of 5 residents reviewed. | SS=D |
Report Facts
Residents reviewed for care plan deficiencies: 14
Facility census: 36
Residents reviewed for transfer safety: 3
Residents reviewed for psychotropic medication use: 5
Residents reviewed for immunization documentation: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff D | Licensed Practical Nurse (LPN) | Observed not wearing gown or gloves while caring for COVID-19 positive resident |
| Staff K | Certified Nursing Assistant (CNA) | Reported observations of Resident #30 wandering |
| Staff A | Certified Nursing Assistant (CNA) | Observed transferring Resident #7 with mechanical lift without proper leg strap use |
| Staff J | Physical Therapist (PT) | Reported knowledge of Resident #7's mobility status and lift use |
| Staff C | Certified Nursing Assistant (CNA) | Reported on Resident #7's weight bearing and transfer needs |
| Director of Nursing | Director of Nursing (DON) | Provided multiple interviews regarding care plan expectations, medication orders, and infection control |
| Staff F | Licensed Practical Nurse (LPN) | Reported vaccine offering and documentation practices |
| Staff H | Director of Nursing (DON) | Verified lack of declination documentation for immunizations |
Inspection Report
Renewal
Census: 39
Deficiencies: 1
Oct 7, 2021
Visit Reason
A recertification health survey was completed from 10/4/21 to 7/21 and resulted in deficiencies related to comprehensive care plans.
Findings
The facility failed to develop care plans addressing respiratory deficits, goals, and interventions for 2 of 5 residents reviewed. The care plans lacked documentation addressing chronic respiratory diseases or breathing deficits, and the facility did not have an oxygen policy.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to develop and implement comprehensive care plans addressing respiratory deficits for residents. | SS=D |
Report Facts
Residents reviewed for comprehensive care plans: 5
Resident census: 39
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Thomas Lawrence | Administrator | Signed the report and involved in review of care plans |
Inspection Report
Abbreviated Survey
Census: 40
Deficiencies: 0
Sep 30, 2020
Visit Reason
A focused COVID-19 infection survey was completed 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: 41
Deficiencies: 0
Jun 16, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspection and Appeals to assess 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
Complaint Investigation
Census: 43
Deficiencies: 6
Feb 20, 2020
Visit Reason
The inspection was conducted as a recertification survey and investigation of a self-report related to falls and infection control issues at the facility.
Findings
The facility was found deficient in multiple areas including failure to ensure adequate supervision to prevent falls resulting in injuries, improper catheter care leading to infections, failure to discard expired medications and secure controlled substances, inadequate portion control for mechanical soft diets, improper food safety practices including dishwasher temperature and hand hygiene, and failure to maintain sanitary medication administration practices.
Complaint Details
The visit was complaint-related based on a self-report and investigation of falls and infection control concerns. The self-report was substantiated.
Deficiencies (6)
| Description |
|---|
| Facility failed to assure adequate supervision to prevent falls resulting in injury to Resident #13 due to malfunctioning motion alarms. |
| Facility failed to assure appropriate catheter care and infection prevention for Residents #7, #9, and #13. |
| Facility failed to discard outdated medications and failed to securely store controlled drugs subject to abuse for multiple residents. |
| Facility failed to assure residents on mechanical soft diets received appropriate portions of meat. |
| Facility failed to prepare and serve food in accordance with professional food safety standards including dishwasher temperature and hand hygiene. |
| Facility failed to maintain sanitary environment during medication administration when a tablet fell on the medication cart surface and was given to the resident. |
Report Facts
Residents with catheter care deficiencies: 2
Residents with incontinent care deficiencies: 1
Residents on mechanical soft diet: 9
Dishwasher rinse temperatures below 120 degrees: 29
Expired medications found: 3
Residents with unsecured controlled drugs: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff M | Certified Nursing Assistant | Mentioned in fall incident report and interview regarding alarm not sounding |
| Staff A | Registered Nurse | Interviewed about fall incident and alarm issues |
| Staff B | Licensed Practical Nurse | Observed performing catheter care with improper hand hygiene |
| Staff C | Licensed Practical Nurse | Interviewed about fall incident and alarm issues |
| Staff D | Certified Nursing Assistant | Interviewed about fall incident and alarm issues |
| Staff G | Certified Nursing Assistant | Observed improper catheter tubing placement and alarm handling |
| Staff H | Cook | Observed preparing and serving incorrect portions of mechanical soft diet |
| Staff J | Registered Nurse | Observed administering medications and interviewed about expired meds |
| Staff K | Registered Nurse | Reviewed medication orders and identified expired PRN medications |
| Director of Nursing | Director of Nursing | Interviewed about alarm issues, medication storage, and medication administration practices |
| Assistant Director of Nursing | Assistant Director of Nursing | Interviewed about alarm system and medication storage |
| Staff L | Registered Nurse | Observed administering medications including expired nasal spray |
| Staff I | Dietary Aide | Observed hand hygiene practices during meal service |
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