Inspection Reports for Sibley Specialty Care
700 9th Avenue North, IA, 512491050
Back to Facility ProfileDeficiencies per Year
4
3
2
1
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Inspection Report
Complaint Investigation
Census: 40
Deficiencies: 1
Oct 22, 2025
Visit Reason
The inspection was conducted as a result of an investigation into a facility-reported incident where a resident exited the building unsupervised.
Findings
The facility failed to provide adequate nursing supervision to prevent a resident with severe memory impairment from leaving the facility unsupervised. The resident was found outside by local hospital staff and returned safely with no injuries. Staff training was conducted following the incident.
Complaint Details
The visit was triggered by a complaint/investigation of a facility-reported incident where Resident #1 exited the building unsupervised. The complaint was substantiated as the facility failed to prevent the incident.
Severity Breakdown
SS = D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide adequate nursing supervision to prevent a resident from exiting the building. | SS = D |
Report Facts
Resident census: 40
Residents reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Dietary Aide | Named in the finding for letting the resident out unsupervised. |
| Staff B | Registered Nurse | Interviewed regarding the incident and response. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Aug 5, 2025
Visit Reason
A complaint investigation for complaint #1701661-C was conducted from August 4, 2025 to August 5, 2025.
Findings
The facility was found to be in substantial compliance with no deficiencies cited.
Complaint Details
Complaint #1701661-C was investigated and found to be unsubstantiated as the facility was in substantial compliance.
Inspection Report
Plan of Correction
Deficiencies: 0
May 29, 2025
Visit Reason
The document is a Plan of Correction submitted following a survey, indicating acceptance of a credible allegation of substantial compliance and certification of the facility in compliance effective May 28, 2025.
Findings
The facility was found to be in substantial compliance based on the credible allegation and Plan of Correction accepted by the surveyors, resulting in certification of compliance.
Inspection Report
Annual Inspection
Census: 39
Deficiencies: 3
May 8, 2025
Visit Reason
The inspection was conducted as part of the facility's annual recertification survey and investigation of a reported incident #125957-1 from May 5 to May 8, 2025.
Findings
The facility was found deficient in food service portion control and sanitation practices, including failure to serve full meal portions and inadequate kitchen sanitation. Infection prevention and control deficiencies were also identified, including improper hand hygiene during wound care and food preparation.
Severity Breakdown
Level E: 2
Level D: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to serve full portions of food to residents as per the planned menu. | Level E |
| Failure to maintain proper sanitary conditions in the kitchen area, including buildup of debris on food containers and equipment. | Level E |
| Failure to ensure proper hand hygiene and glove use during food preparation and wound care. | Level D |
Report Facts
Census: 39
Incident number: 125957
Audit frequency: 3
Audit frequency: 4
Audit frequency: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Observed failing to serve full food portions, improper hand hygiene, and improper glove use during food preparation. | |
| Staff A | Registered Nurse | Observed performing wound care with improper hand hygiene and glove use. |
| Dietician | Interviewed regarding proper food portioning and hand hygiene expectations. | |
| Director of Nursing | DON | Interviewed regarding wound dressing procedures and glove use. |
| Infection Preventionist | Observed wound dressing changes and educated nurses on hand hygiene. |
Inspection Report
Plan of Correction
Deficiencies: 0
Jul 11, 2024
Visit Reason
The document serves as a Plan of Correction following a survey, indicating acceptance of a credible allegation of substantial compliance and certification of the facility in compliance effective July 11, 2024.
Findings
The facility was found to be in substantial compliance based on the credible allegation and Plan of Correction submitted, leading to certification of compliance effective July 11, 2024.
Inspection Report
Complaint Investigation
Census: 43
Deficiencies: 1
Jun 28, 2024
Visit Reason
The inspection was conducted due to a facility reported incident #121441-M involving allegations of physical abuse of a resident.
Findings
The investigation found that Staff E was verbally and physically aggressive towards Resident #1, including hitting the resident. The facility failed to implement appropriate interventions to protect the resident from abuse. Staff received additional training and corrective actions were planned.
Complaint Details
The complaint investigation was related to physical abuse of Resident #1. The facility reported incident #121441-M was reviewed, including statements from multiple staff and interviews with the resident. The complaint was substantiated by evidence of staff hitting and verbally abusing the resident.
Deficiencies (1)
| Description |
|---|
| Facility failed to protect Resident #1 from verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion as evidenced by staff hitting the resident and verbal aggression. |
Report Facts
Resident census: 43
BIMS score: 10
Date of incident: Jun 6, 2024
Date of survey completion: Jun 28, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff E | Nurse aide | Named in physical and verbal abuse of Resident #1 |
| Staff D | Certified Nursing Assistant | Witnessed and reported the abuse incident involving Staff E and Resident #1 |
| Staff F | Registered Nurse | Interviewed regarding the incident and assessment of Resident #1 |
| Staff G | Social Worker and Administrator | Interviewed Resident #1 and involved in investigation |
| Staff C | Assistant Director of Nursing | Interviewed and assessed Resident #1 after the incident |
| Staff H | Registered Nurse | Conducted assessment of Resident #1 post-incident |
Inspection Report
Plan of Correction
Deficiencies: 0
May 10, 2024
Visit Reason
The document reflects acceptance of a credible allegation of substantial compliance and approval of the facility's Plan of Correction.
Findings
The facility will be certified in compliance effective May 10, 2024, based on acceptance of the Plan of Correction and substantial compliance.
Inspection Report
Renewal
Census: 40
Deficiencies: 3
Apr 18, 2024
Visit Reason
The inspection was conducted as part of the facility's annual recertification survey from March 15, 2024 to March 18, 2024.
Findings
The facility failed to obtain required signatures for consent on Notice of Medicare Non-Coverage forms for sampled residents, failed to develop and implement adequate abuse/neglect policies including background checks for new hires, and failed to notify the Long Term Care Ombudsman of resident transfers as required.
Deficiencies (3)
| Description |
|---|
| Failed to obtain resident or representative signatures for consent on Notice of Medicare Non-Coverage (NOMNC) forms for sampled residents. |
| Failed to develop and implement written abuse/neglect policies and procedures including ensuring criminal background checks for new hires. |
| Failed to notify the Long Term Care Ombudsman for resident transfers to the hospital for 2 of 2 residents reviewed. |
Report Facts
Census: 40
Residents sampled for NOMNC consent: 3
Employees reviewed for background check: 5
Employees failed background check compliance: 1
Residents reviewed for Ombudsman notification: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Non-certified nursing assistant | Named in background check deficiency for lacking Iowa Criminal Background Check documentation |
Inspection Report
Complaint Investigation
Census: 38
Deficiencies: 0
Sep 11, 2023
Visit Reason
A COVID-19 Focused Infection Control Survey and a complaint investigation for facility reported incidents #112730-I and #113017-I were conducted from September 11, 2023 to September 14, 2023.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices for COVID-19 preparation and was in substantial compliance regarding the complaint investigation. Incidents #112730 and #113017 were not substantiated.
Complaint Details
Complaint investigation for incidents #112730-I and #113017-I was conducted and found the incidents were not substantiated.
Report Facts
Total Residents: 38
Inspection Report
Plan of Correction
Deficiencies: 0
Mar 31, 2023
Visit Reason
The document serves as a statement of deficiencies and plan of correction related to the facility's compliance status.
Findings
The facility was certified in compliance effective March 31, 2023, based on acceptance of a credible allegation of compliance and plan of correction.
Inspection Report
Annual Inspection
Census: 60
Deficiencies: 2
Mar 16, 2023
Visit Reason
The inspection was conducted as the facility's annual recertification survey from March 13, 2023 to March 16, 2023.
Findings
The facility failed to coordinate PASARR assessments properly, including failure to refer one resident for PASARR evaluation and failure to follow up on care plan side effects for antidepressant medication for another resident. The facility also lacked a care plan policy.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to refer 1 resident with a negative Level I PASARR result for appropriate Level II PASARR evaluation and determination. | SS=D |
| Failure to include side effects of antidepressant medication on a care plan for 1 of 5 residents reviewed. | SS=D |
Report Facts
Census: 60
Residents reviewed: 1
Residents reviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing | Interviewed regarding PASARR policy and care plan policy |
Inspection Report
Annual Inspection
Census: 38
Deficiencies: 3
Oct 14, 2021
Visit Reason
The inspection was conducted as part of the facility's annual recertification survey and investigation of complaint #97987-C and incidents #87682-I and #100274-I.
Findings
The facility was found deficient in maintaining privacy and dignity for a resident with an indwelling urinary catheter by failing to conceal the catheter bag properly. Additionally, deficiencies were found in food safety practices, including improper storage of kitchen utensils and lack of eye protection among dietary staff during food service.
Complaint Details
Complaint #97987-C was investigated and found not substantiated. Incidents #87682-I and #100274-I were also not substantiated.
Deficiencies (3)
| Description |
|---|
| Failure to assure a resident with an indwelling urinary catheter maintained dignity and privacy by not placing the catheter bag in a privacy bag or placing it in a ripped privacy bag that failed to conceal the catheter bag. |
| Failure to ensure the kitchen had dishwasher and utensils stored to prevent contamination and ensure kitchen staff had hygienic practices to prevent the spread of infection. |
| Dietary staff not wearing eye protection with source control not covering nose and mouth during food service. |
Report Facts
Census: 38
Date Survey Completed: Oct 14, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff C | Certified Nursing Assistant (CNA) | Assisted Resident #28 and provided information about the privacy bag. |
| Director of Nursing | Director of Nursing (DON) | Provided expectations regarding catheter bag concealment and privacy. |
| Staff A | Dietary Aide | Observed not wearing eye protection during food service. |
| Staff B | Dietary Aide | Observed not wearing eye protection during food service. |
| Dietary Manager | Dietary Manager (DM) | Reported on food storage practices, PPE use, and training. |
| Administrator | Administrator | Reported directives given to kitchen staff regarding PPE. |
Inspection Report
Routine
Census: 37
Deficiencies: 0
Jun 12, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspection 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.
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