The most recent inspection on June 12, 2025, found no deficiencies during the recertification and complaint investigation. Earlier inspections showed a mix of findings, including issues with staff training, service plan accuracy, and timely nurse reviews. Deficiencies often involved incomplete or outdated service plans, insufficient staff training on dependent adult abuse and medication administration, and delays in required tenant evaluations. Complaint investigations were mostly unsubstantiated except for one in January 2024, which confirmed that a tenant’s service plan did not adequately address her care needs. The facility appears to have improved over time, with the latest inspection showing compliance after previous citations.
Deficiencies (last 5 years)
Deficiencies (over 5 years)2.4 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
45% better than Iowa average
Iowa average: 4.4 deficiencies/year
Deficiencies per year
86420
2017
2021
2023
2024
2025
Census
Latest occupancy rate32 residents
Based on a June 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
The visit was conducted as a recertification to determine compliance with certification for an Assisted Living Program and to investigate Complaint #125030-C.
Findings
No regulatory insufficiencies were cited during the recertification or the complaint investigation.
Complaint Details
Complaint #125030-C was investigated and no regulatory insufficiencies were found.
Report Facts
Number of tenants without cognitive impairment: 24Number of tenants with cognitive impairment: 8Total census: 32
The inspection was conducted as an investigation into Incident #114254-M concerning the care and service plan adequacy for tenants at the assisted living program.
Findings
The program failed to address the identified needs and preferences of Tenant #2 in her service plan, specifically regarding assistance with bathing, dressing, use of a splint for finger fractures, and other care requirements. Staff interviews and tenant statements confirmed these deficiencies.
Complaint Details
The visit was complaint-related, investigating Incident #114254-M. The complaint was substantiated by findings that Tenant #2's service plan did not reflect her medical and care needs, leading to inadequate assistance and potential harm.
Deficiencies (1)
Description
Failure to address Tenant #2's identified needs and preferences on the service plan, including assistance with bathing, dressing, and care related to finger fractures and splint use.
Report Facts
Number of tenants without cognitive disorder: 33Number of tenants with cognitive disorder: 2Total census: 35
The inspection was conducted as a recertification visit to determine compliance with certification rules for an Assisted Living Program.
Findings
The inspection found multiple regulatory insufficiencies including failure to provide dependent adult abuse training within 6 months of employment for 3 of 7 staff, failure to complete required criminal and abuse background checks prior to employment for 1 of 7 staff, failure to evaluate tenants' functional, cognitive, and health status within 30 days of occupancy for 3 tenants, and failure to provide food safety and sanitation training prior to handling food for 5 staff.
Complaint Details
No regulatory insufficiencies were cited during the investigation of Complaint #109146-C.
Deficiencies (4)
Description
Failed to provide 2 hours of dependent adult abuse training within 6 months of employment for 3 of 7 staff reviewed (Staff A, Staff B, Staff C).
Failed to complete a criminal, child, and dependent adult abuse background check prior to employment for 1 of 7 staff reviewed (Staff A).
Failed to evaluate tenant's functional, cognitive, and health status within 30 days of occupancy for 3 of 3 tenants reviewed (Tenant #1, Tenant #2, Tenant #3).
Failed to provide training on food safety and sanitation prior to handling food for 5 of 5 staff reviewed who prepared or served food (Staff A, Staff B, Staff C, Staff D, Staff E).
Report Facts
Number of tenants without cognitive disorder: 36Number of tenants with cognitive disorder: 1Total Population: 37Staff reviewed for dependent adult abuse training: 7Staff failed dependent adult abuse training: 3Staff reviewed for background checks: 7Staff failed background check prior to employment: 1Tenants reviewed for evaluation: 3Tenants failed evaluation within 30 days: 3Staff reviewed for food safety training: 5Staff failed food safety training: 5
Employees Mentioned
Name
Title
Context
Staff A
Named in findings for dependent adult abuse training, background check, and food safety training deficiencies
Staff B
Named in findings for dependent adult abuse training and food safety training deficiencies
Staff C
Named in findings for dependent adult abuse training and food safety training deficiencies
Staff D
Named in findings for food safety training deficiency
Staff E
Named in findings for food safety training deficiency
The inspection was a recertification visit conducted to determine compliance with certification rules for an Assisted Living Program.
Findings
No regulatory insufficiencies were cited regarding the onsite infection control survey. Several regulatory insufficiencies were cited related to medication administration, staffing training and delegation, dependent adult abuse training, service plan updates, and nurse reviews.
Deficiencies (6)
Description
Failure to ensure 2 of 7 staff reviewed were properly trained before administering medication to tenants.
Newly hired registered nurse failed to ensure 4 of 7 universal workers reviewed were sufficiently trained to carry out assigned tasks within 60 days of hire.
Failure to ensure 5 of 7 staff reviewed were trained by the registered nurse within 30 days of employment.
Failure to ensure 4 of 7 staff reviewed received dependent adult abuse training within six months of hire and every three years thereafter.
Failure to update service plans with significant changes for 1 of 3 tenants reviewed who received personal care services.
Failure to conduct nurse reviews every 90 days for 3 of 3 tenants reviewed who received health-related care.
Report Facts
Number of tenants without cognitive disorder: 27Number of tenants with cognitive disorder: 0Total census of Assisted Living Program: 27Staff reviewed for medication training: 7Staff not properly trained for medication administration: 2Universal workers reviewed for training within 60 days: 7Universal workers not sufficiently trained within 60 days: 4Staff reviewed for training within 30 days: 7Staff not trained within 30 days: 5Staff reviewed for dependent adult abuse training: 7Staff not trained for dependent adult abuse within 6 months: 4Tenants reviewed for service plan updates: 3Tenants with service plans not updated with significant change: 1Tenants reviewed for nurse reviews every 90 days: 3Tenants without nurse reviews every 90 days: 3
Investigation of Complaint #69719-C at the assisted living program.
Findings
No regulatory insufficiencies were cited during the investigation of the complaint.
Complaint Details
Complaint #69719-C was investigated and found to have no regulatory insufficiencies.
Report Facts
Number of tenants without cognitive disorder: 14Number of tenants with cognitive disorder: 1Total Population of Program at time of on-site: 15TOTAL census of Assisted Living Program: 15
The inspection was conducted as an initial visit to determine compliance with certification of an Assisted Living Program.
Findings
The facility was cited for failing to complete required 90 day nurse reviews for tenants receiving program-administered prescription medications. The facility has updated tenant review forms and set agreements for pharmacy reviews to ensure compliance.
Deficiencies (1)
Description
Program failed to complete 90 day nurse reviews as required for 2 of 2 tenants receiving program-administered prescription medications.
Report Facts
Number of tenants without cognitive disorder: 9Number of tenants with cognitive disorder: 2Total Population of Program at time of on-site: 11Total census of Assisted Living Program: 11Tenants reviewed for 90 day nurse reviews: 2
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