Inspection Reports for Senior Suites of Urbandale
4700 84th St, Urbandale, IA, 503227352
Back to Facility ProfileInspection Report Summary
The most recent inspection on October 28, 2025, found no deficiencies during the recertification visit for the Assisted Living Program. Earlier inspections showed a pattern of medication policy deficiencies related to narcotic counts in 2023 and 2021, while prior complaint investigations and renewal visits generally found no regulatory insufficiencies. The main issues cited involved failure to follow medication policies for controlled substances, with no fines or enforcement actions listed in the available reports. Complaint investigations were mostly unsubstantiated, except for a 2012 case involving falls and inadequate assessments that identified multiple deficiencies but no enforcement actions. The facility’s record suggests improvement over time, with recent inspections showing no deficiencies after earlier medication-related issues.
Deficiencies (last 14 years)
Deficiencies (over 14 years)
1.2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
73% better than Iowa average
Iowa average: 4.4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
17 residents
Based on a October 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Renewal
Census: 17
Deficiencies: 0
Date: Oct 28, 2025
Visit Reason
Recertification visit conducted to determine compliance with certification rules for an Assisted Living Program.
Findings
No regulatory insufficiencies were cited during the recertification visit for the Assisted Living Program.
Report Facts
Number of tenants without cognitive impairment: 16
Number of tenants with cognitive impairment: 1
Total census: 17
Inspection Report
Renewal
Census: 27
Deficiencies: 1
Date: Oct 9, 2023
Visit Reason
The visit was a recertification visit conducted to determine compliance with certification for an Assisted Living Program.
Findings
The program failed to follow its medication policy regarding narcotic counts on one medication cart reviewed. Specifically, narcotics were not properly counted at the start of a shift, and a narcotics count sheet was missing for controlled substances found on the medication cart.
Deficiencies (1)
Failed to follow medication policy regarding narcotic counts on one medication cart reviewed.
Report Facts
Number of tenants without cognitive impairment: 25
Number of tenants with cognitive impairment: 2
Total census: 27
Date of narcotics count: Oct 4, 2023
Date of corrective action: Oct 5, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff F | Documented narcotics count and confirmed missing narcotics count sheet | |
| Director of Nursing | Director of Nursing | Confirmed lack of written policy on narcotic destruction timeframe and inability to explain narcotic presence duration |
| Assistant Administrator | Confirmed missing narcotics count sheet and tenant absence |
Inspection Report
Complaint Investigation
Census: 28
Deficiencies: 0
Date: Aug 4, 2022
Visit Reason
The inspection was conducted to investigate incidents #103971-M and #103968-A at the assisted living program.
Complaint Details
Investigation of Incident #103971-M and #103968-A found no regulatory insufficiencies.
Findings
No regulatory insufficiencies were cited during the investigation of the incidents.
Report Facts
Number of tenants without cognitive disorder: 27
Number of tenants with cognitive disorder: 2
Total Population: 28
Inspection Report
Renewal
Census: 25
Deficiencies: 1
Date: Nov 18, 2021
Visit Reason
The inspection was conducted as a recertification to determine compliance with certification for an Assisted Living Program.
Findings
The program failed to follow its medication policy regarding narcotic counts for 1 of 1 tenants reviewed who received a schedule II narcotic. Specifically, staff did not complete the required narcotic count at the start of a shift as per facility policy.
Deficiencies (1)
Failed to follow medication policy regarding narcotic counts for 1 of 1 tenants reviewed who received a schedule II narcotic.
Report Facts
Number of tenants without cognitive disorder: 24
Number of tenants with cognitive disorder: 1
Total Population of Program: 25
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff D | Named in medication narcotic count deficiency | |
| Director of Nursing | Director of Nursing | Confirmed Staff D did not follow facility policy and responsible for auditing narcotic count log |
Inspection Report
Renewal
Census: 34
Deficiencies: 0
Date: Aug 1, 2019
Visit Reason
The inspection was conducted as a recertification visit to determine compliance with certification rules for an Assisted Living Program.
Findings
No regulatory insufficiencies were cited during the recertification visit for the Assisted Living Program.
Inspection Report
Complaint Investigation
Census: 44
Deficiencies: 0
Date: Feb 26, 2018
Visit Reason
Investigation of Complaint #73485-C at the assisted living program.
Complaint Details
Complaint #73485-C was investigated and found to have no regulatory insufficiencies.
Findings
No regulatory insufficiencies were cited during the investigation of the complaint.
Report Facts
Number of tenants without cognitive disorder: 40
Number of tenants with cognitive disorder: 4
Total census: 44
Inspection Report
Renewal
Census: 40
Deficiencies: 0
Date: Jul 26, 2017
Visit Reason
The visit was a recertification visit conducted to determine compliance with certification of an Assisted Living Program.
Findings
No regulatory insufficiencies were cited during the recertification visit.
Inspection Report
Monitoring
Census: 37
Deficiencies: 0
Date: Jul 13, 2015
Visit Reason
The visit was a Final Recertification Monitoring Evaluation to determine compliance with certification for an Assisted Living Program.
Findings
No regulatory insufficiencies were found during this evaluation. The review of recertification documents was completed and accepted, including the State Fire Marshal's inspection and Facility Engineer's approval of evacuation plans.
Report Facts
Number of tenants without cognitive disorder: 35
Number of tenants with cognitive disorder: 2
Total Population of Program at time of on-site: 37
Inspection Report
Complaint Investigation
Census: 35
Deficiencies: 7
Date: Oct 9, 2012
Visit Reason
The inspection was conducted as a complaint/incident investigation following allegations that the program failed to assess and intervene after a tenant fell twice, resulting in injury and death.
Complaint Details
The complaint involved a tenant who fell twice, sustained a head injury, and later died. The program was alleged to have failed to assess and intervene appropriately after these falls.
Findings
The investigation found multiple regulatory insufficiencies related to evaluation, policies and procedures, staffing, and nurse review, including failure to complete neurological checks, incomplete documentation, and inadequate staff delegation and training.
Deficiencies (7)
Failure to evaluate each tenant’s functional, cognitive, and health status within 30 days of occupancy and as needed thereafter.
Failure to follow written policies and procedures for witnessed and unwitnessed falls with potential for head injury.
Insufficient documentation of delegation of neurological assessment by RN to CNAs.
Insufficient number of trained staff to meet tenants’ identified needs.
Failure to document nurse assessment and intervention following tenant’s report of headache after fall.
Failure to assess and document health status of each tenant at least every 90 days and when changes occur.
Failure to provide written documentation of activities under the service plan including time, date, and signature.
Report Facts
Number of tenants without cognitive disorder: 33
Number of tenants with cognitive disorder: 2
Total census: 35
Tenant age: 93
Medication dosage: 650
Blood pressure readings: 132
Blood pressure readings: 88
Blood pressure readings: 128
Blood pressure readings: 50
Blood pressure readings: 155
Blood pressure readings: 52
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lori Miner | RN BSN | Monitor for complaint/incident investigation |
| Joyce Kix | RN | Monitor for complaint/incident investigation |
| Staff #1 | Registered Nurse (RN) | Completed neurological checks and assessments related to tenant fall |
| Staff #2 | Certified Medication Aide (CMA) | Assessed tenant after fall and documented observations |
| Staff #3 | RN | Evaluated tenant following fall and reported findings |
| Staff #4 | Certified Nurse Aide (CNA) | Assisted tenant to bathroom and activity room after fall |
Inspection Report
Monitoring
Census: 38
Deficiencies: 4
Date: Feb 8, 2011
Visit Reason
An on-site monitoring evaluation was conducted at Senior Suites of Urbandale on February 8 and 9, 2011, to review the facility's compliance with assisted living program regulations and the Plan of Correction submitted in response to prior regulatory insufficiencies.
Findings
The program did not receive any regulatory insufficiencies during this certification period. Tenant and family satisfaction was generally positive. Several regulatory insufficiencies were noted related to tenant evaluations, service plans, medication administration, and nurse reviews, including incomplete documentation and failure to update plans and assessments as required.
Deficiencies (4)
Failure to complete functional, cognitive, and health evaluations timely and consistently for tenants.
Service plans were not updated to reflect significant changes in tenant conditions or needs, and lacked documentation of preferences for nursing facility care.
Medication Administration Records (MAR) lacked documentation of administration times, effectiveness, and compliance with physician orders.
Nurse reviews lacked evaluations of tenant health status and failed to ensure medication orders were current.
Report Facts
Number of tenants without cognitive disorder: 36
Number of tenants with cognitive disorder: 2
Total population: 38
Tenant satisfaction meeting attendees: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lori Miner | RN BSN | Monitor conducting the evaluation |
Inspection Report
Complaint Investigation
Census: 44
Deficiencies: 0
Date: Mar 17, 2010
Visit Reason
The visit was conducted as a final incident investigation related to a complaint about medication tampering at Senior Suites Assisted Living, Urbandale, IA.
Complaint Details
The complaint involved suspicion that someone was tampering with a tenant's medications. The investigation substantiated that Staff #1 removed medication tablets from the tenant's bottles and subsequently admitted to taking and discarding some tablets. Staff #1 was suspended and later terminated. No regulatory insufficiencies were noted.
Findings
The investigation found that Staff #1 had opened and removed Hydrocodone tablets from a tenant's medication bottles without authorization. Video evidence confirmed the staff member's actions. No regulatory insufficiencies were identified.
Report Facts
Current number of tenants: 44
Hydrocodone tablets filled: 180
Hydrocodone tablets counted: 70
Hydrocodone tablets unaccounted: 20
Hydrocodone tablets remaining: 45
Hydrocodone tablets counted: 31
Hydrocodone tablets counted: 24
Hydrocodone tablets remaining: 50
Hydrocodone tablets missing: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Hal L. Chase | RN BSN MPH | Monitor conducting the incident investigation |
| Connie Schaffer | Certification Coordinator – Central Iowa | Signed cover letter for the report |
| Staff #1 | Certified Medication Aide | Named in medication tampering incident and investigation |
| Demaris Luttenegger | Administrator | Facility administrator named in report |
Inspection Report
Renewal
Census: 39
Deficiencies: 1
Date: Oct 8, 2008
Visit Reason
The visit was a recertification monitoring evaluation conducted to assess compliance with regulatory requirements and to review the program's corrective actions related to medications.
Findings
The program displayed prompt action to correct identified regulatory insufficiencies related to medication administration. The monitoring found some medication administration and documentation failures, but the Plan of Correction was accepted and no substantiated regulatory insufficiencies were found during this certification period.
Deficiencies (1)
Failure to give or document administration of medications to tenants as prescribed, including Caltrate, Glyburide, Namenda, Aricept, Seroquel, Cyclobenzaprine, Zocor, and Tramadol.
Report Facts
Current number of tenants without cognitive disorder: 38
Current number of tenants with cognitive disorder: 1
Total Population: 39
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lincoln Newsom | RN | Monitor conducting the evaluation |
| Connie Schaffer | Certification Coordinator | Named in letter regarding Plan of Correction acceptance |
Inspection Report
Complaint Investigation
Census: 43
Deficiencies: 0
Date: Jul 18, 2005
Visit Reason
A complaint investigation on-site visit was conducted at Senior Suites Assisted Living due to allegations of missing narcotic medications, improper medication administration records, and medication errors.
Complaint Details
The complaint was related to missing narcotic medications, improper medication administration records, and medication errors. No indiscretions were found upon staff interviews. Medication errors were substantiated but appropriately managed with error reports and staff counseling. No regulatory insufficiencies were identified.
Findings
The investigation found that medication records substantiated missed medications on one occasion and administration of medication after physician discontinuation on another. Medication error reports were completed timely, staff were counseled, and a medication in-service was initiated. No regulatory insufficiencies were noted.
Report Facts
Current number of tenants without cognitive disorder: 43
Current number of tenants with cognitive disorder: 0
Total Population: 43
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Hal L. Chase | RN BSN MPH | Monitor conducting the complaint investigation |
| Dee Luttenegger | Administrator | Administrator of Senior Suites Assisted Living |
Inspection Report
Monitoring
Census: 38
Deficiencies: 3
Date: Sep 2, 2004
Visit Reason
The on-site monitoring evaluation was conducted as a re-certification monitoring visit to assess compliance with Iowa Administrative Code regulations for assisted living programs.
Complaint Details
No complaints on file this certification period.
Findings
The evaluation identified regulatory insufficiencies including failure to complete tenant evaluations within required timeframes, incomplete documentation of physician orders by the registered nurse, and one employee providing transportation lacking a valid Class D chauffeur's license.
Deficiencies (3)
Tenant #1 had no preadmission scored cognitive evaluation; Tenants #1 and #2 did not have health status assessment within 30 days of admission.
Four of six records reviewed did not have the physician’s orders properly noted by the RN with time, date, and signature.
One of two employees who transported tenants did not have a Class D chauffeur’s license.
Report Facts
Current number of tenants without cognitive disorder: 29
Current number of tenants with cognitive disorder: 9
Total General Population: 38
Number of tenants interviewed: 18
Number of records reviewed: 6
Number of records with incomplete physician orders documentation: 4
Number of employees transporting tenants: 2
Number of employees without valid Class D chauffeur’s license: 1
Viewing
Loading inspection reports...
