Accura Healthcare of Carroll

Inspectors wroteBased on clinical record review, facility document review, facility state self- report intake review, staff interviews, and policy review the facility failed to report to the state agency within the required time frame of 2 hours for an allegation of abuse for 1 of 2 residents reviewed. (Resident #2) The facility reported a census of 52 residents.

Inspectors wroteBased on observation, staff interviews, and policy review the facility failed to provide appropriate incontinence care for 1 of 3 residents reviewed (Resident #3). The facility reported a census of 52 residents.

Inspectors wroteBased on the Center for Medicare and Medicaid Services (CMS) Payroll Based Journal (PBJ) Staffing Data Report (October1 - December 31) review, facility staffing reports review, and staff interviews, the facility failed to submit accurate staff reports for the PBJ Staffing Data Report. The facility reported a census of 48 residents.

Inspectors wroteBased on document review, staff interviews, and facility policy review the facility failed to demonstrate good faith attempts to correct quality deficiencies based on issues that were identified with repeat deficiencies during the current survey process in 1 area and corrections that remained incomplete in a reasonable time frame. The facility reported a census of 48 residents.

Inspectors wroteBased on observations, cleaning schedule review, and staff and resident interviews, the facility failed to ensure residents had housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for 4 of 4 residents reviewed (Resident #21, #11, #25 and #24). The facility reported a census of 48 residents.

Inspectors wroteBased on document review, staff interview, and policy review the facility failed to implement the abuse and neglect policy by not completing background checks prior to staff employment. The facility reported a census of 48 residents.

Inspectors wroteBased on record review, staff and resident interview, the facility failed to administer medications in a timely manner for 11 of 20 residents reviewed (Resident # 21, #29, #27, #6, #25, #10, #2, #12, #16, #18 and #9). The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, document review, resident interviews, and staff interviews, the facility failed to provide nursing staff to assure residents safety by not responding to call lights in a timely manner for 4 of 6 residents reviewed (Resident #2, #45, #6, and #36). The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, facility investigative file review, observation, staff interviews, and facility policy review the facility failed to document on the Controlled Drug Use Record and the electronic Medication Administration Record (MAR) when lorazepam (Ativan) medication were administered for 3 of 3 resident reviewed for controlled substance use (Resident #22, #23 and #47). The facility also failed to consistently and accurately reconcile controlled medications and remove expired medications/treatments from the medication room. The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, resident interview, staff interview, and facility policy review the facility failed to ensure a resident's preference for med time for 1 of 2 resident's reviewed (Resident #21). The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, staff interview and guidance from the 2025 Resident Assessment Instrument (RAI) manual, the facility failed to complete and transmit a Minimum Data Set (MDS) assessment within federal guideline for 2 of 2 resident reviewed for MDS assessments (Resident #4 and #17). The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, staff interviews, and pharmacist interview, the facility failed to intervene and call the pharmacy and follow up with a physician when medication was unavailable for 1 of 6 residents reviewed (Resident #51). The facility reported a census of 48 residents.

Inspectors wroteBased on observations, clinical record review and policy review the facility failed to give medications according to manufacturer's instructions for 2 out of 5 residents observed during medication pass (Resident #24 and #14). The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, staff interviews, and Pharmacy interview, the facility failed to ensure residents were free of significant medication errors for 1 of 6 residents reviewed (Resident #51). The facility reported a census of 48 residents.

Inspectors wroteBased on observation, clinical record review, resident interviews, staff interview, and policy review the facility failed to provide food at an appetizing temperature to 3 of 15 residents (Residents #2, #5, and #45) reviewed. The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, observation, resident interview, staff interviews, and policy review the facility failed to use universal infection control measures (hand hygiene) during care of two separate wounds for 1 of 5 residents reviewed for infection control (Residents #2). The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, facility document review, staff interviews and resident interviews, the facility failed to answer call lights in a timely manner for 4 of 4 residents reviewed (Resident #3, #4, #5 and #6). The facility reported a census of 52 residents.

Inspectors wroteBased on clinical record review, resident interview, staff interview, and policy review the facility failed to provide nursing staff to assure residents safety by not responding to call lights in a timely manner. The facility reported a census of 47 residents.

Inspectors wroteBased on clinical record review, staff interview, and policy review the facility failed to revise and implement care plans for 1 of 3 residents (Resident #1) reviewed. The facility reported a census of 47 residents.

Inspectors wroteBased on staff interview, resident interviews, facility documentation and policy review, the facility failed to provide care for 6 out of 15 residents reviewed (Resident #1,#6, #9, #11, #12, #2) in a manner to promote dignity and respect. The facility reported a census of 47 residents.

Inspectors wroteBased on personnel file reviews, facility policy review and staff interviews, the facility failed to provide dependent adult abuse (DAA) recertification training within 3 years for 1 of 2 employees reviewed. The facility identified a census of 47 residents.

Inspectors wroteBased on clinical record review, staff interviews, and policy review, the facility failed to limit PRN (as needed) antipsychotic drugs to 14 days, failed to have a Physician evaluate for appropriateness of the medication and provide a clinical rationale prior to the antipsychotic medication usage being extended. In addition the facility failed to obtain a clinical rationale when an antianxiety medication usage was extended and also failed to complete behavioral documentation and offer/attempt nonpharmacological interventions prior to the administration of antianxiety medications for 1 out of 3 residents reviewed (Resident #2) for unnecessary medications. The facility reported a census of 47 residents.

Inspectors wroteBased on facility investigation review, staff interviews and policy review the facility failed to report an allegation of abuse within 2 hours to the Iowa Department of Inspections, Appeals and Licensing (DIAL) for 1 of 3 residents reviewed (Residents #1). The facility reported a census of 47 residents.

Inspectors wroteBased on staff interviews, facility investigation review, time card detail, and policy review the facility failed to separate a staff member from dependent residents accused of alleged abuse that occurred on 6/5/25 at 7:30 AM in a timely manner for 1 of 3 resident reviewed for abuse (Resident #1). The staff member continued to worked her shift and left the facility at 4:40 PM. The facility reported a census of 47 residents.

Inspectors wroteBased on clinic record review, staff interviews, family interview and policy review, the facility failed to administer medications per physician orders for 1 out of 3 residents reviewed (Resident #3) for significant medication errors. The facility reported a census of 47 residents.

Inspectors wroteBased on observation, clinical record review, staff interview and facility policy review, the facility failed to have interventions in place to prevent the development of a pressure ulcer for 1 of 4 residents reviewed (Resident #14). This resulted in harm to Resident #14 when she developed a Stage III pressure ulcer. The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, staff interviews and policy review the facility failed to conduct appropriate weight monitoring, nutritional assessments, interventions and timely Physician/family notifications for 1 of 2 residents reviewed (Resident #13) for weight loss resulting in severe unplanned weight loss. The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, staff interview, and guidance from the 2024 Resident Assessment Instrument (RAI) Manual, the facility failed to accurately reflect the status of 7 of 13 residents in the Minimum Data Set (MDS) Assessments (Resident #1, #5, #20, #30, #34, #35, #41). The facility reported a census of 48 residents.

Inspectors wroteBased on observation, staff interview, and review of facility menus, the facility failed to follow the posted menu and serve the appropriate portions for 2 of 2 residents who received pureed diets (Res #25 and Res #35), and failed to serve the ordered therapeutic menu for 6 of 6 residents (Res #1, #6, #18, #30, #38, #43) who were ordered to receive mechanical soft diets. The facility reported a census of 48 residents. Findings Include: Posted lunch menu for 3/10/25: 1 Maple Bacon Chicken Sandwich 4 oz French Fries 4 oz Hot Spiced Beets 1 sq Orange Poppyseed Cake 8 oz Milk The menu spreadsheet documented residents with mechanical soft diet orders should receive orange cake with no poppyseeds and residents with puree diet orders should receive pureed orange cake with no poppyseeds. On 3/10/25 at 12:05 pm, Resident #25 and Resident #38 were observed during noon meal service. [...]

Inspectors wroteBased on observation, staff interview, guidance from the 2022 Food & Drug Administration (FDA) Food Code and facility policy review, the facility failed to use proper sanitation and glove use during lunch service, and also failed to regularly clean and monitor the internal temperature of a refrigerator designated for resident food items. The facility reported a census of 48 residents. Findings Include: Initial kitchen walk through was initiated on 3/10/25 at 9:36 am. During the kitchen walk through, the Certified Dietary Manager (CDM) was asked about a policy regarding food brought to the facility by resident families/visitors. She stated there is a refrigerator in the employee break room and that is where those foods are stored. She stated the food gets thrown out if not eaten after three days. [...]

Inspectors wroteBased on staff interview, personnel record review and Facility Assessment review, the facility failed to ensure that Certified Nurse Aides (CNA) completed the required 12 hours of in-service training annually, for 3 of 3 personnel reviewed. The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, admission record review, family interview, staff interview and facility policy review the facility failed to provide complete information to residents regarding room rates for 4 of 4 residents (Resident #20, #22 #49 and #104) reviewed. The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review and staff interviews, the facility failed to complete family notification for 1 of 13 residents reviewed (Resident #35). The facility failed to notify Resident #35's family that an antiviral medication was started due to possible shingles infection. The facility reported a census of 48 residents.

Inspectors wroteBased on observations, family interview, staff interviews and Facility Assessment review, the facility failed to provide a clean, homelike environment for 2 of 3 residents (Resident #20 and #21) reviewed. The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, staff interview, guidance from the 2024 Resident Assessment Instrument (RAI) Manual, and facility policy review, the facility failed to complete and transmit a Minimum Data Set (MDS) Assessment within federal guidelines for 1 of 13 residents (Res. #45) reviewed for MDS Assessments. The facility reported a census of 48 residents.

Inspectors wroteBased on observation, clinical record review, staff interviews and policy review, the facility failed to complete and document appropriate assessments and interventions for the necessary care and services, to maintain the residents' highest practical physical well-being for 1 of 3 residents reviewed (Resident #22) with skin impairments. The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, staff interviews, and policy review the facility failed to provide adequate nursing supervision to prevent accidents and injuries for 1 of 1 resident reviewed (Resident #22) for falls. The facility failed to complete a root cause analysis (RCA), follow up fall assessments and implement a fall intervention after a fall occurred. The facility reported a census of 48 residents.

Inspectors wroteBased on observations, clinical record review, family interview and staff interview, the facility failed to accurately provide physician ordered respiratory services for 3 of 3 residents reviewed (Resident #20, #21, #34). The facility reported a census of 48 residents.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that staff used Enhanced Barrier Precautions (EBP) during resident cares for 1 of 3 residents reviewed. Staff K, Registered Nurse (RN) failed to use the recommended Personal Protective Equipment (PPE) while administering tube feedings to Resident #21. The facility reported a census of 48 residents.

Inspectors wroteBased on clinical record review, resident interviews, staff interviews and policy review the facility failed to establish a pest control program and failed to implement measures to eradicate and contain household pests for 2 of 3 residents reviewed. On 12/8/24 staff reported bugs in the room of Resident #1 and #2. The staff did not know what steps to take to mitigate the spread of what was later identified as bed bugs. The facility reported a census of 53 residents.

Inspectors wroteBased on observations, staff interviews, and policy reviews the facility failed to store, prepare, serve, and distribute food in accordance with professional standards. The facility reported a census of 50 residents.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to refer residents with an initial negative Level I result for the Pre-admission Screening and Resident Review (PASRR), with a newly evident or possible serious mental disorder, intellectual disability, or other related condition, to the appropriate state-designated authority for Level II PASRR evaluation and determination for 1 of 4 residents (Residents #14) reviewed. The facility reported a census of 50 residents.

Inspectors wroteBased on clinical record review, staff interviews, and policy review the facility failed to ensure as needed (PRN) orders for psychotropic medications did not exceed 14 days without physician review for 1 of 5 residents (Resident #52) reviewed. The facility reported a census of 50 residents.

Inspectors wroteBased on clinical record review, staff interview, and policy review the facility failed to obtain bed hold notifications for 4 of 4 residents (Residents #11, #15, #43, and #45) reviewed. The facility reported a census of 50 residents.

Inspectors wroteBased on facility record review, staff interviews, and policy review, the facility failed to implement a system to consistently and accurately reconcile controlled medications. The facility reported a census of 58 residents.

Inspectors wroteBased on observations, staff interviews and policy review, the facility staff failed to keep medication cart locked while unattended by staff in a resident common area. The facility reported a census of 58 residents.

Inspectors wroteBased on staff interview, resident interview, and facility documentation, the facility failed to provide care to promote dignity and respect for 1 of 8 residents reviewed (Resident #7). After Resident #7 turned on her call light to use the restroom, she waited so long she became incontinent of urine. Resident #7's felt terrible from becoming incontinent and not having assistance within 15 minutes to help her.

Inspectors wroteBased on clinical record review and staff interviews, the facility failed to notify the Physician and family when a resident had a change of condition for 1 of 6 residents reviewed (Resident #1).

Inspectors wroteBased on clinical record review, resident interviews, staff interview, and facility record reviews, the facility failed to provide sufficient staff to meet the needs of the residents who resided in the facility for 3 of 8 residents reviewed (Residents #6, #7, and #8).