Inspection Reports for
Timberland Village
725 Timberland Drive, Story City, IA, 502488772
Back to Facility ProfileDeficiencies (last 10 years)
Deficiencies (over 10 years)
1.6 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
64% better than Iowa average
Iowa average: 4.4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
21 residents
Based on a September 2024 inspection.
This facility has shown a decline in demand based on occupancy rates.
Occupancy over time
Inspection Report
Renewal
Census: 21
Deficiencies: 0
Date: Sep 3, 2024
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.
Inspection Report
Renewal
Census: 15
Deficiencies: 0
Date: Jun 3, 2021
Visit Reason
A recertification visit was conducted to determine compliance with certification for an Assisted Living Program. An onsite infection control survey was also completed.
Findings
There were no regulatory insufficiencies cited during the recertification and infection control survey.
Inspection Report
Renewal
Census: 26
Deficiencies: 0
Date: May 15, 2019
Visit Reason
The inspection was conducted as a recertification to determine compliance with certification for an Assisted Living Program.
Findings
No regulatory insufficiencies were cited during the recertification inspection for the Assisted Living Program.
Inspection Report
Renewal
Census: 23
Deficiencies: 0
Date: May 8, 2017
Visit Reason
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
Complaint Investigation
Census: 22
Deficiencies: 0
Date: Apr 19, 2016
Visit Reason
The inspection was conducted as a complaint/incident investigation following allegations related to tenant elopement and level of care at Timberland Village.
Complaint Details
Two allegations were investigated: 1) Staffing - tenant eloped but no injury and no history of elopement; 2) Level of Care - tenant showed cognitive decline and was discharged to a higher level of care. Both findings were not substantiated.
Findings
No regulatory insufficiencies were identified. The tenant eloped during the day shift but was returned without injury, and the allegations regarding staffing and level of care were not substantiated.
Report Facts
Census: 22
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rose Boccella | Program Coordinator | Signed letter as contact for questions regarding the report |
Inspection Report
Renewal
Census: 24
Deficiencies: 2
Date: May 12, 2015
Visit Reason
The visit was a Final Recertification Monitoring Evaluation conducted by the Department of Inspections and Appeals (DIA) on May 11 and 12, 2015, to determine compliance with certification for an Assisted Living Program at Timberland Village.
Findings
The report identified regulatory insufficiencies related to the evaluation of tenants and service planning. Specifically, tenant evaluations were not completed with significant changes in condition, and service plans were not based on evaluations or updated to meet specific tenant needs.
Deficiencies (2)
Evaluation of tenants was not completed within 30 days of occupancy or with significant change, as required.
Service plans were not based on evaluations and did not meet the specific service needs of individual tenants.
Report Facts
Number of tenants without cognitive disorder: 22
Number of tenants with cognitive disorder: 2
Total population of program at time of on-site: 24
Total census of Assisted Living Program: 24
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kristi Eley | RN | Delegated QA chart reviews for compliance and service plan reviews |
| Cindi Martin | Program Administrator | Named as recipient of report and responsible for Plan of Correction |
Inspection Report
Monitoring
Census: 24
Deficiencies: 4
Date: Oct 17, 2012
Visit Reason
The visit was a Final Recertification Monitoring Evaluation conducted to review the Plan of Correction and ensure compliance with regulatory requirements for the Assisted Living Program at Timberland Village.
Findings
The program had no regulatory insufficiencies during this certification period. The monitoring evaluation included tenant assessments and food service observations, identifying some regulatory insufficiencies related to cognitive evaluations and food service training.
Deficiencies (4)
The program RN did not complete an evaluation of Tenant #1's cognitive status within 30 days of admission as required by regulation.
The program RN did not complete an evaluation of Tenant #2's health or cognitive status at least annually as required by regulation.
Staff #1's personnel file lacked documentation of annual in-service training related to safe food handling and food sanitation.
Staff #2's personnel file lacked documentation of annual in-service training related to safe food handling and food sanitation.
Report Facts
Number of tenants without cognitive disorder: 24
Number of tenants with cognitive disorder: 0
Total Population of Program at time of on-site: 24
Number of tenants attending community meeting: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Cindi Martin | Manager | Manager of Timberland Village, mentioned in report header |
| Maribeth Freland | RN | Monitor conducting the evaluation |
| Rose Boccella | Program Coordinator | Signed the certification letter |
Inspection Report
Monitoring
Census: 24
Deficiencies: 1
Date: Feb 15, 2011
Visit Reason
The visit was a Final Recertification Monitoring Evaluation conducted to review the Plan of Correction and ensure compliance with Iowa Code and Administrative Code for the assisted living program at Timberland Village.
Findings
The program did not receive any regulatory insufficiencies during the certification period except for one deficiency related to the service plan not being individualized and lacking certain required details. Tenant satisfaction was positive, and the Plan of Correction was accepted by the Department of Inspections and Appeals.
Deficiencies (1)
The service plan shall be individualized and shall indicate, at a minimum, the tenant’s identified needs and preferences for assistance, the service provider(s), if other than the program, including but not limited to providers of hospice care, home health care, occupational therapy, and physical therapy.
Report Facts
Current number of tenants without cognitive disorder: 23
Current number of tenants with cognitive disorder: 1
Total Population: 24
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Hal L. Chase | RN BSN MPH | Monitor conducting the evaluation |
| Rose Boccella | Program Coordinator | Signed letter regarding certification |
| Cindi Martin | Manager | Facility manager named in report |
Inspection Report
Monitoring
Census: 25
Deficiencies: 3
Date: Oct 7, 2008
Visit Reason
The visit was a final recertification monitoring evaluation conducted at Timberland Village Assisted Living to assess compliance with assisted living program regulations.
Findings
The evaluation found regulatory insufficiencies related to failure to update individualized service plans within required timeframes and medication administration documentation issues, including falsification of Medication Administration Records and interference with lawful enforcement activities.
Deficiencies (3)
Failure to update the service plan and acquire needed signatures within 30 days of occupancy for tenants requiring personal or health-related care.
Medication Administration Record (MAR) was not properly initialed; staff falsified initials on the MAR.
The program interfered with or attempted to impede authorized representatives of the Department of Inspections and Appeals in lawful enforcement activities.
Report Facts
Current number of tenants without cognitive disorder: 22
Current number of tenants with cognitive disorder: 3
Total Population: 25
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lincoln Newsom | RN | Monitor conducting the inspection |
| Cindi Martin | Administrator | Named as facility administrator |
| Staff #1 | Involved in medication administration record falsification |
Inspection Report
Monitoring
Census: 27
Deficiencies: 6
Date: Aug 26, 2004
Visit Reason
An on-site re-certification monitoring evaluation was conducted at Timberland Village to assess compliance with assisted living program regulations and evaluate tenant care and services.
Findings
The evaluation identified multiple regulatory insufficiencies including missing cognitive status in evaluations within 30 days of admission, lack of tenant signatures on service plan updates, improper medication supervision and storage, unrestricted tenant access to medications, inadequate staff training on medication administration, and incomplete physician order documentation.
Deficiencies (6)
The program did not include the cognitive status component in evaluations required within thirty days of admission.
The program did not obtain required tenant signatures and/or legal representative signatures on service plan updates as required.
The program did not supervise, store and administer the medications appropriately.
The program did not ensure access of medications were restricted to employees responsible for administration or storage of such medications.
The program did not ensure staff was trained to administer medications according to Nurse Delegation.
The program did not ensure physician signatures with name, date and time as required.
Report Facts
Tenants without cognitive disorder: 19
Tenants with cognitive disorder: 8
Total tenants: 27
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marsha Taylor | Administrator | Named as facility administrator |
| Charlotte Kemp | RN | Monitor conducting the evaluation |
| Jan O’Briant | LISW | Monitor conducting the evaluation |
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