Inspection Reports for The Summit of Bettendorf MC
4699 53rd Ave., Bettendorf, IA, 52722
Back to Facility ProfileInspection Report Summary
The most recent inspection on March 5, 2025, found deficiencies related to incomplete tenant evaluations and service plans that were not properly based on assessments or updated after significant changes. Earlier inspections showed a pattern of issues primarily involving service plan updates, medication administration, staff training, and safety measures such as elopement prevention. Complaint investigations were mostly substantiated, including cases of inadequate service plan updates and failure to secure the facility against elopement, but enforcement actions such as fines or license suspensions were not listed in the available reports. Most complaints were substantiated, with no regulatory insufficiencies found in some investigations. The facility’s inspection history indicates ongoing challenges with documentation and care planning, with no clear trend of improvement or worsening over time.
Deficiencies (last 4 years)
Deficiencies (over 4 years)
3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
32% better than Iowa average
Iowa average: 4.4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
17 residents
Based on a March 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Census: 17
Deficiencies: 3
Date: Mar 5, 2025
Visit Reason
The inspection was conducted as an investigation into complaints #124583-C and #124221-C regarding regulatory insufficiencies at The Summit of Bettendorf MC assisted living program.
Complaint Details
The visit was complaint-related, investigating complaints #124583-C and #124221-C. No regulatory insufficiencies were cited during the investigation into Incident #124675-I, but insufficiencies were found related to the complaints.
Findings
The investigation found that the program failed to complete required tenant evaluations prior to admission, did not ensure service plans were based on health, functional, and cognitive assessments, and failed to update service plans following significant changes for reviewed tenants.
Deficiencies (3)
Failure to complete evaluations prior to admission for Tenant C1.
Failure to ensure service plans were based on assessments for Tenant C1.
Failure to update service plans following significant changes for Tenants C1 and C2.
Report Facts
Number of tenants without cognitive impairment: 4
Number of tenants with cognitive impairment: 13
Total census: 17
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Monica Reyes | RN-AL Director | Signed the inspection report and plan of correction |
Inspection Report
Renewal
Census: 14
Deficiencies: 0
Date: Oct 3, 2024
Visit Reason
Recertification visit conducted to determine compliance with certification rules for an Assisted Living Program for People with Dementia.
Findings
No regulatory insufficiencies were cited during the recertification visit for the Assisted Living Program for People with Dementia.
Inspection Report
Plan of Correction
Census: 14
Deficiencies: 1
Date: Apr 22, 2024
Visit Reason
The inspection was conducted to investigate a complaint (#117407-C) and a mandatory report (#114628-M) related to regulatory insufficiencies in service plans for tenants with cognitive impairment at The Summit of Bettendorf MC.
Complaint Details
The investigation was complaint-related, triggered by Complaint #117407-C and Mandatory Report #114628-M. No regulatory insufficiencies were cited during the investigation into Incident #113462-I. The complaint was substantiated as the service plan was not updated appropriately.
Findings
The facility failed to update the service plan of one discharged tenant (Tenant C1) following a change in her health condition. Tenant C1 had multiple health issues including dementia, urinary tract infections, and experienced several falls before passing away. The service plan did not reflect significant condition changes or interventions in a timely manner.
Deficiencies (1)
Failure to update the service plan of Tenant C1 to reflect changes in health condition and needs.
Report Facts
Number of tenants without cognitive impairment: 3
Number of tenants with cognitive impairment: 11
Total census: 14
Weight loss: 29
Dates of falls and incidents: 12
Inspection Report
Complaint Investigation
Census: 15
Deficiencies: 3
Date: Feb 7, 2023
Visit Reason
The inspection was conducted to investigate multiple complaints including Complaint #109302-C and Complaint #110644-C, as well as incidents and other complaints where no regulatory insufficiencies were found.
Complaint Details
The investigation was complaint-driven, specifically for Complaint #109302-C and Complaint #110644-C. No regulatory insufficiencies were found for other complaints and incidents mentioned.
Findings
The program failed to follow 3 out of 5 policies and procedures related to medication administration, narcotics reconciliation, and staff accepting gifts. Specific issues included improper medication administration observation, gaps in narcotic counts, and acceptance of gifts by staff.
Deficiencies (3)
Failure to follow medication administration policy including not observing tenant ingest medication and improper documentation.
Gaps in narcotic reconciliation records for January with missing counts on multiple days.
Staff accepted gifts from a tenant's family member contrary to program policy.
Report Facts
Number of tenants without cognitive impairment: 2
Number of tenants with cognitive impairment: 13
Total census: 15
Cost of gift accepted by staff: 20
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Named in medication administration deficiency for not observing medication ingestion and improper documentation | |
| Staff C | Named in gift acceptance deficiency for accepting a gift from a tenant's family member |
Inspection Report
Complaint Investigation
Census: 13
Deficiencies: 1
Date: Nov 2, 2022
Visit Reason
The inspection was conducted as an investigation into Incident #108695-I involving a tenant elopement at the assisted living facility.
Complaint Details
The complaint investigation was substantiated as the tenant eloped from the Memory Care unit on 10/28/22. Staff failed to secure the exit door and did not recognize the tenant's flight risk prior to the incident.
Findings
The program failed to provide adequate treatment and services for one tenant who eloped from the Memory Care unit. The tenant exited through an unsecured door and was found outside the facility. The facility lacked proper controls to prevent elopement and failed to ensure tenant safety.
Deficiencies (1)
Failure to provide adequate treatment and services to prevent tenant elopement.
Report Facts
Total census: 13
Number of tenants without cognitive disorder: 0
Number of tenants with cognitive disorder: 13
Global Deterioration Scale score: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Assisted Living Registered Nurse (ALRN) | Observed exiting Memory Care unit and involved in incident | |
| Staff A | Observed exiting Memory Care unit and involved in incident | |
| Staff B | Observed exiting Memory Care unit and involved in incident | |
| Executive Director | Confirmed staff should have checked area to prevent elopement | |
| Clinical Quality Specialist | Stated staff expectations for rounds on tenants in locked memory care area |
Inspection Report
Complaint Investigation
Census: 6
Deficiencies: 4
Date: Jun 22, 2022
Visit Reason
The inspection was conducted to investigate Incident #104979-I and to determine compliance with certification for a Dementia Specific Assisted Living Program.
Complaint Details
The visit was complaint-related, investigating an incident of elopement by Tenant #1. The incident report was found incomplete and not timely. The complaint was substantiated based on findings.
Findings
The facility was found deficient in multiple areas including failure to complete incident reports timely and in detail, failure to complete nurse delegated training and dementia-specific education within 30 days of employment for some staff, and failure to update service plans as needed for tenants reflecting their behaviors and needs.
Deficiencies (4)
Failure to complete incident reports timely and in detail related to Tenant #1's elopement.
Failure to complete nurse delegated training within 30 days of employment for 3 of 4 staff reviewed (Staff B, C, and D).
Failure to update service plans as needed for 2 of 2 tenants reviewed (Tenants #1 and #2) to reflect behaviors, refusals, allergies, and interventions.
Failure to ensure eight hours of dementia-specific education was completed within 30 days of employment by 2 of 4 staff reviewed (Staff B and C).
Report Facts
Number of tenants without cognitive disorder: 1
Number of tenants with cognitive disorder: 5
Total census: 6
Staff reviewed for nurse delegated training: 4
Staff failed nurse delegated training within 30 days: 3
Staff reviewed for dementia-specific education: 4
Staff failed dementia-specific education within 30 days: 2
Tenants reviewed for service plan updates: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Failed to complete nurse delegated training and dementia-specific education within 30 days of employment | |
| Staff C | Failed to complete nurse delegated training and dementia-specific education within 30 days of employment | |
| Staff D | Failed to complete nurse delegated training within 30 days of employment | |
| Director of Nursing | Director of Nursing (DON) | Completed incident report related to Tenant #1's elopement |
| Staff A | Observed Tenant #1 and provided information about tenant's behavior | |
| Executive Director | Executive Director | Confirmed training and education completion and provided interview information |
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