Accura Healthcare of Spirit Lake

Inspectors wroteBased on observation, and staff interview, the facility failed to ensure a safe, clean, comfortable, and homelike environment for 8 residents (Resident #2, #4, #10, #12, #13, #14, #15, and #16). The facility reported a census of 72 residents. Environmental observations:On 4/14/26 at 2:12 p.m. Resident #4 upset her bedside table was sticky. Verified it felt sticky. Resident #4 unsure how long it had been that way. On 4/15/26 at 9:03 a.m. Resident #4 again complained of her table being sticky. The center of the table felt sticky. The toilet seat in the resident's bathroom had large areas discolored brown. On 4/20/26 at 8:56 a.m. Staff A Certified Nursing Assistant (CNA) and Staff B CNA assisted Resident #4 with cares. Staff B thought the toilet seat was stained due to loose stools. Staff A didn't know what caused it. On 4/14/26 at 2:15 p.m. [...]

Inspectors wroteBased on observation, record review, and staff interview, the facility failed to ensure residents with a catheter received appropriate treatment and services to prevent infection for 3 of 3 residents reviewed (Resident #1, #7, and #8). The facility reported a census of 72 residents.1) According to the Minimum Data Set (MDS) assessment dated [DATE], Resident #1 scored 15 on the Brief Interview for Mental Status (BIMS) indicating no cognitive impairment. The resident had an indwelling urinary catheter. Diagnoses included neurogenic bladder. The Care Plan initiated 3/10/25 identified Resident #1 had a suprapubic (inserted through the abdomen to the bladder) catheter related to a bladder dysfunction. Resident #1 had the potential for urinary tract infections. [...]

Inspectors wroteBased on observations, staff interviews and policy review the facility failed to ensure proper temperatures for foods served to residents. The facility reported a census of 66 residents. Finding Include: During observation on 10/1/2025 at 11:19 a.m., Staff D, [NAME] checked the temperature of the food in the steam table. Staff D checked the temperature of the mashed potatoes which tempted at 131.9 degrees fahrenheit (F). Staff D proceeded with meal service and served the residents the mashed potatoes out of the steam table and did not reheat the potatoes to an appropriate safe temperature. Review of facility provided policy titled Food Temperatures dated 2013 revealed the following information:All hot foods items must be cooked to appropriate internal temperatures, held and served at a temperature of at least 135 degrees F. [...]

Inspectors wroteBased on observations, staff interviews, and facility policy reviews the facility failed to ensure food was stored and prepared under sanitary conditions. The facility identified a census of 66 residents.

Inspectors wroteBased on clinical record review and staff interview the facility failed to notify the Long Term Care Ombudsman(LTCO) for 1 of 1 residents reviewed who transferred to the hospital (Resident #10). The facility reported a census of 66 residents.

Inspectors wroteBased on observation, staff interview and facility policy, the facility failed to provide complete and appropriate incontinence care in a manner to prevent urinary tract infections for 2 of 3 residents observed (Resident #10 and #51). The facility reported a census of 66 residents.

Inspectors wroteBased on observation, staff interviews and facility policy review the facility failed to ensure residents received the proper diet texture to meet the residents needs. The facility reported a census of 66 residents. Findings Include: During an observation on 10/1/2025 at 11:37 a.m., during meal service Staff D, cook dished up a puree meal for Resident #17. Staff D placed mashed potatoes on the plate and placed serving of puree beef tips with gravy over the potatoes. Observation of the puree beef tips revealed chunks of beef on the plate. Asked Staff D if that was a puree meal and was she serving that portion to Resident #17, Staff D replied yes. Asked the Dietary Manager (DM) if the plate can be served to Resident #17 and the DM replied no not with the chunks of beef like that. [...]

Inspectors wroteBased on clinical record review, staff interviews, and facility investigation record review, the facility failed to protect residents from further potential abuse after receiving an allegation of abuse alleging a CNA treated Resident #71 roughly and threw her into her wheelchair. Staff reported Resident #71 had feared the staff member would answer her call light on 5/3/24. The resident reported the concern to a staff member who reported it to the charge nurse who reported it to the Assistant Director of Nursing (ADON). The ADON denied being aware of the situation. The situation occurred before breakfast and the facility didn ' t start to investigate until after 3:00 PM. This failure resulted in residents living at the facility to be exposed to the potential of abuse therefore causing an Immediate Jeopardy to the health, safety, and security of the resident. [...]

Inspectors wroteBased on temperature log review, observations, policy review, and staff interview, the facility failed to ensure food is stored, prepared, and served in a sanitary manner as well ensuring dishes and utensils cleaned in a sanitary manner to prevent foodborne illness. The facility reported a census of 67.

Inspectors wroteBased on observations, staff interview, and policy review, the facility failed to provide food that is nourishing and palatable. The facility reported a census of 67.

Inspectors wroteBased on observation and staff interview, the facility failed to provide infection control practices with the lack of enhanced barrier protection used during wound care treatment for 1 of 1 resident observed (Resident #53) and lack of hand hygiene when assisting residents to eat. The facility reported a census of 67.

Inspectors wroteBased on record review, staff and resident interview, the facility failed to notify the family of a change in condition for 1 of 3 residents reviewed (Resident #70). The facility reported a census of 70 residents.

Inspectors wroteBased on clinical record review, facility record review, staff interviews and facility policy the facility failed to appropriately implement interventions to protect 1 out of 3 residents reviewed from physical abuse, (Resident #71). The facility reported a census of 67 residents.

Inspectors wroteBased on clinical record review, facility record review, staff interviews and facility policy review the facility failed to report an allegation of abuse to the Iowa Department of Inspections & Appeals and Licensing (DIAL) within 2 hours of an allegation of abuse for 1 of 1 residents reviewed for abuse (Resident #71). The facility reported a census of 67 residents.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to refer 1 resident with a negative Level I result for the Preadmission Screening and Resident Review (PASRR), who was later identified with 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 out of 1 resident reviewed for PASRR requirements, (Resident #57). The facility reported a census of 67 residents.

Inspectors wroteBased on record review, staff and family interview, the facility failed to provide adequate assessment and timely intervention for 1 of 3 resident's reviewed with a change of condition (Resident #70). The facility reported a census of 67 residents.

Inspectors wroteBased on observations and staff interviews, the facility failed to provide food prepared by methods that conserve nutritive value and flavor. The facility reported a census of 67.

Inspectors wroteBased on clinical chart review, observations, staff interviews, and policy review, the facility failed to accurately care plan the use of Paid Nutritional Aides (PNAs), assess the appropriateness of PNA, and used a PNA for feeding assistance on a resident with swallowing difficulties for 1 of 2 residents who utilize a PNA at meals (Resident #27). The facility reported a census of 67.

Inspectors wroteBased on record review, staff interviews and facility policy review the facility failed to provide accurate resident records for 1 of 19 residents (Residents #71). The facility reported a census of 67 residents.

Inspectors wroteBased on observation, staff interview and record review, the facility failed to update the resident's care plan to accurately reflect the resident for 1 of 17 reviewed (Residents #14). The facility reported a census of 57 residents.

Inspectors wroteBased on clinical record review, family interview and staff interview the facility failed to provide bathing assistance twice weekly for 2 of 17 residents reviewed for bathing (Resident #32 and #45). The facility reported a census of 57 residents.

Inspectors wroteBased on clinical record review, staff interviews, and policy review the facility failed to complete weekly skin impairment assessments for a resident with a heel blister for 1 out of 17 residents reviewed (Resident #20). The facility reported a census of 57 residents.

Inspectors wroteBased on clinical record review, staff interviews, facility record review and facility policy review, the the facility failed to ensure residents were safe to smoke for 1 of 1 residents reviewed (Resident # 50). The facility reported a total census of 57 residents.