The most recent inspection on April 17, 2025 found the facility to be in substantial compliance with no deficiencies noted. Earlier inspections showed a mixed record, with some deficiencies related primarily to resident care, including fall prevention and pressure ulcer interventions. A substantiated incident in July 2023 involved failure to implement care plan interventions to prevent a fall resulting in major injury. Complaint investigations were generally unsubstantiated or found the facility in substantial compliance, with no fines or enforcement actions listed in the available reports. The inspection history suggests improvement over time, with recent surveys showing compliance after earlier issues.
Deficiencies (last 5 years)
Deficiencies (over 5 years)0.6 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
86% better than Iowa average
Iowa average: 4.4 deficiencies/year
Deficiencies per year
43210
2020
2021
2023
2024
2025
Census
Latest occupancy rate54 residents
Based on a July 2023 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
The inspection was conducted as an annual recertification survey and included an investigation of a facility reported incident #121097-I.
Findings
The facility was found to be in substantial compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities. The reported incident #121097-I was not substantiated.
Complaint Details
Facility reported incident #121097-I was investigated and found not substantiated.
An investigation of Complaints #114900-C, #117622-C, #117624-C and Facility Self-Reported Incidents #114899-I and #114963-I was conducted from January 25, 2024 to January 31, 2024.
Findings
The facility was found in substantial compliance at the time of the investigations.
Complaint Details
Investigation involved multiple complaints and self-reported incidents; facility found in substantial compliance.
Inspection Report Plan of CorrectionDeficiencies: 0Sep 2, 2023
Visit Reason
The document serves as a statement of deficiencies and plan of correction for the facility, indicating acceptance of a credible allegation of compliance and plan of correction.
Findings
The facility was found to be in compliance based on acceptance of the credible allegation of compliance and plan of correction, with certification effective August 13, 2023.
The inspection was conducted as a Recertification Survey and investigation of a Facility Self-Reported Incident #113329-I from July 10 to July 13, 2023.
Findings
The facility failed to implement care plan interventions to prevent falls for a resident at risk, resulting in a substantiated incident involving a fall with major injury. The facility did not adequately monitor and intervene to prevent falls, violating federal regulations.
Complaint Details
Facility Self-Reported Incident #113329-I was substantiated.
Severity Breakdown
Level D: 1
Deficiencies (1)
Description
Severity
Failure to implement care plan interventions based on root cause analysis to prevent falls for a resident at risk, resulting in a fall with major injury.
Level D
Report Facts
Resident census: 54Incident dates: Incident investigation period from July 10, 2023 to July 13, 2023
Employees Mentioned
Name
Title
Context
Morgan Vander Molen
Human Resources Specialist
Signed the statement of deficiencies and plan of correction
Staff C
Registered Nurse (RN)
Observed resident after fall and reported findings
Staff E
Certified Medication Aide (CMA)
Discovered resident on floor after fall
Staff F
Certified Medication Aide (CMA)
Discovered resident on floor after fall
Staff D
Licensed Practical Nurse (LPN)
Reported on resident behavior prior to fall
Staff G
Care Plan Coordinator
Discussed fall assessment and interventions
Director of Nursing (DON)
Evaluated resident and commented on fall circumstances
A COVID-19 Focused Infection Control Survey and an investigation of Complaint #102077-C and a Facility Self-Reported Incident #109389-I were conducted by the Department of Inspections and Appeals from April 11, 2023 to April 13, 2023.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices to prepare for COVID-19 and was also found to be in overall substantial compliance.
Complaint Details
Investigation of Complaint #102077-C and Facility Self-Reported Incident #109389-I was conducted; facility found in substantial compliance.
The inspection was conducted as the facility's annual health survey to assess compliance with federal and state regulations.
Findings
The facility was found deficient in providing a bed hold notice upon hospital transfer for 1 of 2 residents reviewed, and failed to implement interventions to prevent pressure ulcers for 1 of 3 residents reviewed. The complaint #95259-C was not substantiated.
Complaint Details
Complaint #95259-C was investigated and found not substantiated.
Deficiencies (2)
Description
Failure to provide a bed hold notice upon hospital transfer for 1 of 2 residents.
Failure to implement interventions to prevent pressure ulcers for 1 of 3 residents reviewed.
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspections 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.
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