Accura Healthcare of Marshalltown

Inspectors wroteBased on review of the nursing schedule, staff interviews, Payroll Based Journal Data Report, and facility policy review, the facility failed to provide a Registered Nurse (RN) in the facility for eight (8) consecutive hours per day for 19 days between December 1, 2025 - March 8, 2026. The facility reported a census of 59 residents.

Inspectors wroteBased on observations, interviews and record review, the facility failed to report a resident-to-resident altercation for 1 of 3 altercations reviewed (Resident #10 and Resident #43). The facility failed to report when Resident #43 yelled at Resident #10 that she better not go into his room again or Resident #43 would give Resident #10 something to cry about. The facility reported a census of 59 residents.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to actively assist and plan a discharge from the facility for 1 of 2 residents reviewed (Resident #43). Resident #43 admitted to the facility for skilled care after a stroke, he desired to discharge from the facility. The facility could not provide documentation regarding active discharge planning with Resident #43 from 12/19/25 to 3/10/26. The facility reported a census of 59 residents.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide ongoing restorative services for 1 of 1 resident reviewed (Resident #2). Resident #2 did not receive Passive Range of Motion (PROM) on a consistent basis, nor did he receive PROM per his plan of care directions. The facility reported a census of 59 residents.

Inspectors wroteBased on clinical record review, resident and staff interviews the facility failed to provide to the resident or their representative a summary of the baseline care plan for 1 out of 2 residents reviewed (Residents #2). The facility reported a census of 54 residents.

Inspectors wroteBased on clinical record review and staff interviews, the facility failed to provide care and services according to accepted standards of clinical practice for 1 of 3 resident reviewed (Resident #2) for Physician orders. The facility reported a census of 54 residents.

Inspectors wroteBased on clinical record review, staff interviews, hospital nurse interview and resident interview, the facility failed to administer oxygen per Physician orders for 1 of 1 resident reviewed (Resident #2) for respiratory services. The facility reported a census of 54 residents. Findings Include: Resident #2's Minimum Data Set (MDS) assessment dated [DATE] identified a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. The MDS included diagnoses of hypertension (high blood pressure), chronic kidney disease, type 2 diabetes mellitus, bacteremia (blood stream infection), chronic respiratory failure and chronic obstructive pulmonary disease (COPD). The Care Plan with a target date of 2/13/26 documented Resident #2 had a diagnosis of COPD and hypertension and required the use of oxygen at 2 liters per minute. [...]

Inspectors wroteBased on clinical record review, facility policy review, and staff interview, the facility failed to protect the resident's right to be free from physical abuse for 1 of 1 resident reviewed for abuse (Resident #1). As a Certified Nurse Aide (CNA) finished giving Resident #1 his bath, the CNA turned the water to cold and purposely sprayed him. Resident #1 became angry, grabbed the shower head and slapped it against the wall. The facility reported a census of 46 residents.

Inspectors wroteBased on clinical record review, policy review, and staff interview, the facility failed to report an allegation of abuse in a timely manner for 1 of 1 resident reviewed for abuse (Resident #1). The facility reported a census of 46 residents.

Inspectors wroteBased on clinical record review, policy review, and staff interview, the facility failed to investigate an allegation of abuse and separate an alleged perpetrator of abuse from residents in a timely manner for 1 of 1 resident reviewed for abuse (Resident #1). The facility reported a census of 46 residents.

Inspectors wroteBased on clinical record review, policy review, and staff interviews, the facility failed to store and/or handle controlled medications in accordance with professional standards to ensure medications were secure for 1 of 3 residents reviewed for the storage of controlled substances (Resident #2). The facility reported a census of 46 residents.

Inspectors wroteBased on review of the facility's Quality Assurance Performance Improvement (QAPI) plan, the facilities past surveys, and staff interview, the facility failed to correct their own deficiencies for 3 of 15 areas of concern. The facility reported a census of 56 residents.

Inspectors wroteBased on record review, resident interviews, staff interviews and policy review, the facility failed to be respectful and ensure residents' dignity for 5 of 21 residents reviewed (Residents #9, #13, #18, #22, and #28). The facility reported a census of 56 residents.

Inspectors wroteBased on clinical record review, Facility Assessment, Payroll Based Journal (PBJ) data, staff and resident interviews, the facility failed to provide enough staff to care for residents in a timely manner for 5 of 17 residents reviewed (Residents #13, #30, #34, #28, and #162). The facility reported a census of 56 residents.

Inspectors wroteBased on observations, staff interviews and policy review, the facility failed to label food and drinks with dates after opening, discard product after recommended date, ensure a male staff member wore a beard net, and failed to prepare and serve food under sanitary conditions to reduce the risk of contamination and food borne illness. The facility identified a census of 56 residents.

Inspectors wroteBased on clinical record review, staff interview and facility policy review the facility failed to supervise one out of two residents reviewed for elopement (Resident #161). The facility reported a census of 56 residents. Findings Included: Resident #161's Minimum Data Set (MDS) assessment dated [DATE], identified a Brief Interview for Mental Status (BIMS) score of 13, indicating intact cognition. Resident #161 walked independently with cane. The MDS included diagnoses of Alzheimer's dementia and heart failure. The Care Plan Focus dated 3/10/25, identified Resident #161's confusion related to Alzheimer's. The Interventions directed the following: a. Directed to monitor Resident #161's behavior, redirect him as needed (PRN). b. Remind him as needed as he forgets. [...]

Inspectors wroteBased on clinical record review, observations, staff interviews, and facility policy review the facility failed to maintain catheter tubing off the floor for 4 out of 4 days reviewed for one out of two residents reviewed (Resident #12). The facility reported a census of 56 residents.

Inspectors wroteBased on clinical record review, staff interview and facility policy review, the facility failed to complete a gradual dose reduction (GDR) for an antipsychotic medication for 1 out of 5 residents reviewed for unnecessary medications. (Residents #10). The facility reported a census of 56 residents.

Inspectors wroteBased on clinical record review and staff interviews, the facility failed to provide Occupational Therapy (OT) per Physician order and failed to start Physical Therapy (PT) in a timely manner for 1 of 1 resident reviewed (Resident #1) for therapy services. The facility reported a census of 56 residents.

Inspectors wroteBased on observation, staff interviews, the Centers for Disease Control and Prevention (CDC), and facility policy review, the facility staff failed to follow enhanced barrier precautions (EBP) while doing wound care by not wearing the required person protective equipment for 1 of 2 residents (Resident #15) observed for wound care. The facility reported a census of 56 residents.

Inspectors wroteBased on clinical record review, staff interview, Centers for Disease Control and Prevention (CDC) guidelines, and facility policy review, the facility failed to conduct eligibility screening, offer, and provide education related to the pneumococcal (pneumonia) immunization. In addition, the facility failed to document the vaccine consent or refusal for the pneumococcal immunization for 1 of 5 resident reviewed (Resident #47) for immunizations. The facility reported a census of 56 residents.

Inspectors wroteOn 1/9/25 at 10:11 AM, witnessed Resident #2 sitting in the sun room near the nurse's station in a power wheelchair. The power wheelchair had black electrical tape on the left arm rest by the cup holder. Resident #2 acknowledged they had the black electrical tape to hold the cup holder on the arm rest. Based on observation, facility policy review, resident, and staff interview, the facility failed to keep a resident's equipment clean and in good repair for 4 of 5 residents reviewed (Residents #13, #5, #15, and #2). The facility reported a census of 61 residents.

Inspectors wroteBased on clinical document review, facility policy review, resident, and staff interview, the facility failed to provide showers per the residents' request for 4 of 4 residents (Residents #6, #1, #14, and #7) reviewed. The facility identified a census was 61 residents.

Inspectors wroteBased on clinical record review, resident, and staff interview the facility failed to provide residents with limited mobility services, equipment, and assistance to maintain or improve their mobility with the maximum practicable independence for 4 of 4 residents (Residents #13, #6, #5 and #1) reviewed. The facility identified a census of 61 residents.

Inspectors wrote2. Resident #2's MDS assessment dated [DATE] listed an admission date of 9/3/24 from home. The MDS identified a BIMS score of 14, indicating intact cognition. The MDS included diagnoses of multiple sclerosis (an autoimmune disorder that affects the nervous system and causes inflammation with damage to the protective covering of the nerves), depression, and adjustment disorder (excessive reactions to stress that involve negative thoughts, strong emotions, and changes in behavior) with mixed disturbance of emotions and conduct. Staff J, Director of Nursing (DON), signed the MDS indicating completion on 12/10/24. The Educational Counseling Form signed 10/7/24 by Staff J and the Administrator reflected Staff J received educational counseling related to being kind and considerate toward residents and staff members. [...]

Inspectors wroteBased on record review and staff interview the facility failed to follow physician orders for 1 of 1 resident (Resident #3). The facility reported a census of 61 residents.

Inspectors wroteBased on resident and staff interviews the facility failed to operate the full-body mechanical lift (lift) by allowing workers under the age of 18 to operate the lifts without adult supervision. The facility reported a census of 61. Findings Include: Resident #6's Minimum Data Set (MDS) assessment dated [DATE], identified a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. Resident #6 required substantial/maximal to total assistance with activities of daily living (ADLs). Resident #6 had a functional limitation in range of motion to upper and lower extremity on one side. The MDS included diagnoses of stroke, peripheral vascular disease (impaired blood vessels in the extremities), hemiplegia (weakness on one side of the body), and renal insufficiency (impaired kidney function). [...]

Inspectors wroteBased on clinical record review, staff interviews and policy review, the facility failed to ensure staff certified in cardiopulmonary resuscitation (CPR) performed the procedure for 1 of 1 resident reviewed for initiation of CPR (Resident #2). The facility reported a census of 56 residents.

Inspectors wroteBased on observations, staff interviews, facility documents, and policy review, the dietary staff failed to label and store food items in order to maintain food quality and reduce the risk of contamination and food borne illness. The facility also failed to ensure resident dishes and kitchen equipment reached the appropriate sanitizing temperature when utilizing the dish machine to reduce the risk of bacteria growth and cross contamination. The facility reported a census of 53 residents.

Inspectors wroteBased on clinical record review, staff interviews, Centers for Disease Control and Prevention (CDC) guidelines and facility policy review, the facility failed to screen for eligibility, offer, provide education and document vaccine consent or refusal for the COVID 19 (coronavirus disease) immunization for 3 of 5 resident reviewed (Resident #23, #43, #22). The facility reported a census of 53 residents.

Inspectors wroteBased on clinical record review, observation, and staff interview, the facility failed to accurately assess residents for the need of safety smoking equipment for two of three residents reviewed for smoking (Residents #22 and #56). The facility reported a census of 53 residents.

Inspectors wroteBased on clinical record review, observation and staff interview, the facility failed to develop and implement a comprehensive person centered Care Plan for 1 of 16 residents reviewed (Residents #56), regarding the use and need of a wander guard due to history of exit seeking. The facility reported a census of 53 residents.

Inspectors wroteBased on direct observation, resident interviews, staff interviews, and document review the facility failed to provide and document restorative cares for 3 of 3 residents reviewed (Residents #7, #24, and #43). The facility reported a census of 53.

Inspectors wroteBased on clinical record review, staff interviews, observations, and policy review the facility failed to implement consistent supplement serving amounts for 1 of 3 residents reviewed (Resident #43) for nutrition and weight loss. The facility reported a census of 53 residents.

Inspectors wroteBased on observation, staff interview, the Centers for Disease Control and Prevention (CDC) and facility policy review, the facility staff failed to follow infection control practices in order to prevent and control the onset and spread of infection within the facility by not wearing the required personal protection equipment and rinsing resident equipment after use for one of one resident observed (Resident #52). The facility reported a census of 53 residents.

Inspectors wroteBased on observation and staff interviews, the facility failed to post the daily nurse staffing information. The facility reported a census of 53 residents.

Inspectors wroteBased on clinical record review, primary physician and staff interviews, the facility failed to ensure residents were given medications as prescribed by the physician, when a nurse administered the wrong medications to the wrong resident for 1 of 1 residents reviewed (Resident #52). The facility reported a census of 52 residents. Findings Include: The admission Minimum Data Set (MDS) for Resident #52 dated 10/18/23 documented a Brief Interview for Mental Status (BIMS) score of 15 out of 15 indicating intact cognition for decision making. The MDS revealed he had diagnoses of atrial fibrillation, gastroesophageal reflux disease (GERD), arthritis, compression fracture, and neoplasm of the prostate. The resident received an anticoagulant, diuretic and opioid during the 7-day observation period. [...]

Inspectors wroteBased on clinical record review, resident representative interview and staff interviews the facility failed to provide notification of changes for 1 of 3 residents reviewed (#24). The facility reported a census of 52 Residents. Findings Include: The Minimum Data Set (MDS) for Resident #24 dated 8/10/23 documented diagnoses included renal failure, dependence on renal dialysis, malignant neoplasm of colon and bipolar. The MDS relayed Resident #24 has serious mental illness. The Brief Interview of Mental Status (BIMS) score of 15 out of 15 indicated no cognitive impairment. The Electronic Profile Record updated 1/1/23 for Resident #24 revealed resident has an assigned Guardian as responsible party contact for financial and healthcare issues. The Care Plan, last review date 8/23/23 documented Resident #24 at risk for weight loss, goal to consume 50% of most meals. [...]

Inspectors wroteBased on observation, resident, family, and staff interviews, and facility admission Agreement review, the facility failed to ensure adequate provisions for housekeeping in a resident room (Resident #30) and failed to create homelike environment with clean carpets throughout the halls and common areas. The facility reported a census of 52 Findings Include: The Minimum Data Set (MDS) dated [DATE] for Resident #30 revealed the Brief Interview for Mental Status (BIMS) score of 15 out of 15, indicating the resident's cognition intact On 11/1/23 at 2:00 PM, Resident#30 reported their roommate went to the hospital on [DATE] and the dried urine still on the floor next to the bed. Resident #30 reported cleanliness is an issue they wanted addressed. [...]

Inspectors wroteBased on clinical record review, staff interviews and review of the Long-Term Care (LTC) Facility Resident Assessment Instrument (RAI) 3.0 Manual, the facility failed to complete a Comprehensive Assessment after a significant change for 1 of 3 residents reviewed for Hospice (Resident #20). The facility reported a census of 52 residents. Findings Include: The Admitting Minimum Data Set (MDS) dated [DATE] documented Resident #20's diagnoses included heart failure, diabetes, osteoporosis, and osteomyelitis. A Quarterly MDS with initiation date 11/25/23 for Resident #20, documented status in progress, there was not a Significant Change Assessment to address the change to Hospice Care. The MDS tracking in the Electronic Health Record (EHR) for Resident #20 lacked a Significant Change Assessment for the Hospice admission. [...]