Accura Healthcare of Pleasantville, LLC

Inspectors wroteBased on clinical record review, family, staff, and long term care ombudsman interviews, and facility policy review, the facility failed to complete a thorough and accurate discharge summary for one of two residents (Res #52) reviewed for discharge. The facility reported a census of 42 residents.

Inspectors wroteBased on record review, and resident and staff interviews, the facility failed to ensure staff responded and answered residents' call lights within 15 minutes, and met residents' needs in a timely manner for one of two units. The facility reported a census of 45 residents.

Inspectors wroteBased on facility abuse investigation, record review, staff interviews, and policy review, the facility failed to report allegations of abuse to the Iowa Department of Inspections, Appeals and Licensing (DIAL) within 24 hours for 3 of 3 residents reviewed for abuse (Resident #47, #9, and #30). The facility reported a census of 45 residents.

Inspectors wroteBased on record review, observations, resident and staff interviews, and policy review the facility failed to carry out therapy recommendations and provide restorative exercises for 4 of 6 residents reviewed for restorative services and/or limited range of motion (Resident #3, #18, #33, and #37). The facility reported a census of 45 residents.

Inspectors wroteBased on direct observation, facility record review, staff interviews, and policy review the facility failed to store and handle foods in a safe and hygienic manner, and failed to provide a clean and hygienic kitchen to cook and serve food. The facility reported a census of 45.

Inspectors wroteBased on review of CMS-2567 reports, staff interview and facility policy review, the facility failed to have an effective QAPI (Quality Assurance Performance Improvement) process to address previously identified quality deficiencies to assist in the provision of quality care for residents and attain substantial compliance with Federal regulations and State rules. The facility had several repeat deficiencies identified on the facility's current recertification and complaints survey. The facility reported a census of 45 residents.

Inspectors wroteBased on clinical record review, facility document review, staff and family interview, the facility failed to meet a resident's need for corrective lenses by failing to schedule an optometrist appointment for replacement eye wear in a reasonable time frame for 1 of 16 residents assessed (Resident #34). The facility reported a census of 45.

Inspectors wroteBased on record review, staff interview and policy review, the facility failed to provide the appropriate Center for Medicare Services (CMS) Notice of Medicare Non-Coverage (NOMNC) form to address service options and liability for payment for one of two residents reviewed for Advanced Beneficiary Notices (ABN) (Resident #99). The facility reported a census of 45 residents.

Inspectors wroteBased on observations, health record review, review of resident's trust statements, purchased items receipts, staff interviews, and policy review, the facility staff failed to properly handle resident's funds for 1 of 3 (Resident #30) residents reviewed. The facility reported a census of 45.

Inspectors wroteBased on interviews, review of the facility's abuse investigation, and policy review, the facility failed to take action to prevent further potential concerns by letting an employee with accusations of abuse continue to have contact with residents while the facility conducted an investigation for allegations of abuse. The facility reported a census of 45 residents.

Inspectors wroteBased on clinical record review, facility abuse investigation, staff interviews and policy review, the facility failed to provide a thorough investigation into 2 of 2 allegations of misappropriation of resident's (Resident #30 and Resident #9) funds. The facility reported a census of 45 residents.

Inspectors wroteBased on clinical record review, staff interview, and policy review, the facility failed to accurately complete a resident's Minimum Data Set (MDS) assessment by not coding Hospice services and diagnosis of Dementia for 1 of 19 Residents reviewed in the sample (Residents #26). The facility reported a census of 45 residents.

Inspectors wroteBased on record review, staff interview, and policy review the facility failed to develop a comprehensive care plan for 2 of 19 residents reviewed for care plans (Resident #26 and #37). The facility reported a census of 45 residents.

Inspectors wroteBased on record review, resident and staff interview, the facility failed to ensure care conferences held at least quarterly for one of one residents reviewed for care conferences (Resident #33) and failed to document follow up on the concerns addressed. The facility reported a census of 45 residents.

Inspectors wroteBased on observation, record review, policy review, resident and staff interviews, the facility failed to complete an assessment and provide an intervention for 3 of 3 residents (Resident #12, #26 and #37). Resident #12 acquired a puncture wound to his right lower calf from a broken wheelchair and the nurse failed to make an assessment 12 or more hours after a CNA reported the incident. The facility failed to monitor Resident #26 after obtaining a burn. The facility reported a census of 47 residents

Inspectors wroteBased on record review, observations, staff interviews, and policy review the facility staff failed to change gloves when performed cares and then touched other objects for one of four residents sampled for cares (Resident #18). The facility staff also failed to disinfect a mechanical lift after use for one of three residents observed for transfers. The facility reported a census of 45 residents.

Inspectors wroteBased on employee roster review, education transcript review and staff interviews, the facility staff failed to complete a minimum of 12 hours of regular in-service education for 3 of 4 Certified Nursing Assistants (CNAs) sampled who had worked at the facility greater than 1 year (Staff G, Staff M, and Staff N). The facility identified a census of 45.

Inspectors wroteBased on record review, staff interviews, observations, and policy review the facility failed to provide a safe environment to prevent the development and transmission of communicable diseases and infections by not appropriately wearing Personal Protective Equipment (PPE) and the facility not making PPE available to wear while caring for all Covid 19 residents at the facility leading to Resident #16 becoming positive for Covid 19. Resident #16 was transferred to the hospital related to shortness of breath with oxygen levels of 89 percent on 6 liters (L) of oxygen requesting to be sent to the ED. Resident #16 tested positive for Covid 19 on 9/6/24. Resident #16 had a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) as well as Congestive Heart Failure (CHF). Staff reported not having eye protection or gowns available until 9/23/24. [...]

Inspectors wroteBased on electronic health records (EHR), resident interview, staff interviews, and policy review the facility failed to provide nursing staff to assure residents safety by not completing visual observations, providing cares, or offering assistance to a resident that required assistance for 1 of 6 residents reviewed (Resident #9). The facility reported a census of 45 residents.

Inspectors wroteBased on observation and staff interview the facility staff failed to maintain a locked and secured treatment cart for one of two med carts reviewed. The facility identified a census of 45 residents.

Inspectors wroteBased on observation, resident interviews, and staff interviews the facility failed to be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The facility reported a census of 45 residents.

Inspectors wroteBased on observations, clinical record review, resident interviews, staff interviews, Resident [NAME] of Rights, and policy review the facility failed to provide personal care to a resident that was incontinent, provide medication when a resident requested, allow a resident to make his own decision, and properly serve residents on appropriate flatware. Concerns were found for 4 of 6 residents reviewed for dignity (Resident #4, 10, 20, and 22). The facility reported a census of 45 residents.

Inspectors wroteBased on observation, clinical record review, resident interview, staff interview and facility policy review the facility failed to bath 3 of 4 residents according to their individual schedules and bathing requests. (Resident #2, #4 and #5 ) The facility also failed to provide appropriate perineal cares for 1 of 3 residents reviewed. (Res #10)

Inspectors wroteBased on electronic health records (EHR) review, personnel file review, observations, resident interview, staff interview, and policy review the facility failed to provide complete and accurately documented electronic health records for 2 of 5 residents (Residents #10, and #20) reviewed. The facility reported a census of 45 residents.

Inspectors wroteBased on clinical record review, staff email and policy review the facility failed to represent an accurate picture of the resident's status during the observation period of the Minimum Data Set (MDS) by not completing an accurate assessment of resident behaviors for 1 of 3 residents reviewed. (Resident #1) The facility also failed to properly code their 802 Matrix related to restraints for 6 of 6 residents reviewed. The facility reported a census of 45 residents.

Inspectors wroteBased on clinical record review, staff interview and policy review the facility failed to implement Care Plans (CP) for 3 of 3 residents (Resident #2, #4 and #5) reviewed. The facility reported a census of 45 residents.

Inspectors wroteBased on observation, clinical record review and staff interview the facility staff failed to properly set up and administer medications in accordance with Professional Standards of Practice for 3 residents reviewed. (Resident #10, #1 and #21). The facility identified a census of 45 residents.

Inspectors wroteBased on observation, clinical record review, staff interview and facility policy review the facility failed to follow physician orders for 1 of 3 residents reviewed. (Resident #18) The facility identified a census of 45 residents.

Inspectors wroteBased on observation, clinical record review and staff interview the facility failed to provide restorative services to the residents as a means to maintain their highest level of functioning. (Resident #5) The facility identified a census of 45 residents.

Inspectors wroteBased on facility activity calendars, resident interview, staff interview and facility assessment the facility failed to employ a Activities Director (AD). The residents activity choices did not reflect a well round choice that catered to the residents interests for their physical, mental and psychosocial wellbeing. The facility reported a census of 41 residents.

Inspectors wroteBased on observations, resident interviews, staff interviews and facility policy the facility failed to provide dignity with dining for residents in the main dining room used by up to 20 residents at 3 of 3 meals observed. The facility reported a census of 41 residents.

Inspectors wroteBased on observations, resident interviews, staff interviews and facility policy the facility failed to offer a home like environment for resident dining experience in the common dining area where up to 20 residents have daily meals for three of three meal observations. The facility reported a census of 41.

Inspectors wroteBased on facility activity calendars, resident interview, staff interview and facility assessment the facility failed to provide a program to include resident activities catered for resident interests for resident's physical, mental and psychosocial wellbeing. The facility reported a census of 41.

Inspectors wroteBased on observation, dietary documents, staff interview, resident interview and policy review, the facility failed to prepare appropriate portions for six (6) residents who received pureed meals, and nine (9) residents who received mechanical soft diets. The facility failed to serve appropriate portions for multiple residents who received tater tots. The facility failed to post menus or offer residents alternative options. The facility reported a census of 41 residents.

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to provide food served by a method to maintain a safe and appetizing temperature. The facility reported a census of 41.

Inspectors wroteBased on observations, staff interviews, and facility policy review, the facility failed to maintain sanitary practices by failing to properly contain hair in the food preparation area and failing to prevent cross-contamination during food service. The facility reported a census of 41 residents.

Inspectors wroteBased on clinical record review, provider interview and staff interview, the facility failed to provide timely notification of resident evacuation from the facility for 1 of 3 residents reviewed (Resident#94). The facility reported a census of 41 residents.

Inspectors wroteBased on record review, responsible party interview and staff interviews the facility failed to ensure quarterly interdisciplinary team meeting with inclusion of the resident and/or resident representative to discuss resident changing goals, for care plan review and /or revisions for 1 of 2 (Resident #17) residents reviewed. The facility reported a census of 41 residents.

Inspectors wroteBased on interviews, observations and record review, the facility failed to follow professional standards during medication administration for 1 out of 4 residents (Resident #11) reviewed. The facility reported a census of 41.

Inspectors wroteBased on record review and staff interviews the facility failed to complete a discharge summary for 2 of 2 residents (#43, and #94 ) reviewed. The facility reported a census of 41 residents.

Inspectors wroteBased on clinical record review, observation, family interview, staff interview and facility policy the facility failed to provide appropriate intervention and catheter care to minimize or prevent complications from the occurrence of urinary tract infections for 1 of 3 residents reviewed (Residents #2). The facility reported a census of 41 residents.

Inspectors wroteBased on interviews, record review, facility policy review, and Centers for Disease Control information the facility failed to follow proper infection control practices to migate the risk for the spread of infectious disease. The facility reported a resident census of 24.

Inspectors wroteBased on record review and staff interviews, the facility failed to provide sufficient staffing to ensure residents receive care and services to maintain their optimal health and well being. Facility reported census was 24 residents.

Inspectors wroteBased on clinical record review and staff interviews, the facility failed to ensure residents are appropriately assessed and provided interventions to maintain their optimal health, and well being for 1 of 3 residents reviewed. (Resident #7) The facility reported census was 24.