Adel Acres

Inspectors wroteBased on clinical record review, observation, written staff statement, personnel file review, staff interviews and policy review, the facility failed to provide adequate nursing supervision for 1 of 3 residents reviewed (Resident #1), which resulted in a resident falling from the bed to the floor, causing the resident significant pain and injuries. The facility reported a census of 41 residents.

Inspectors wroteBased on clinical record review, facility document review, staff interviews, and policy review, the facility failed to ensure a significant medication error did not occur for 1 of 5 residents reviewed for medication administration. Resident #35 received one dose of 25 milligram (mg) Oxycodone HCl (an opioid narcotic used for pain management) and two doses of 45mg Oxycodone HCl when Physician Orders stated to administer 15mg. The facility reported a census of 40.

Inspectors wroteBased on facility record review, staff interview and facility policy review, the facility failed to staff a Registered Nurse (RN) for a minimum of eight consecutive hours per day for two of thirty (2 of 30) days reviewed. The facility reported a census of 40 residents.

Inspectors wroteBased on the Centers for Medicare & Medicaid Services (CMS) Payroll Based Journal (PBJ) Staffing Data Report (October 1 - December 31, 2025) review, facility record review, staff interview and facility policy review, the facility failed to submit accurate staffing records to CMS. The facility reported a census of 40 residents.

Inspectors wroteBased on observations, staff interviews, and policy review the facility failed to ensure appropriate kitchen sanitation practices were followed. The facility reported a census of 40.

Inspectors wroteBased on clinical record review, staff interview and policy review the facility failed to inform the resident in advance of the risks and benefits of psychotropic medications (medications that affect a person's mental state), the treatment alternatives or other options and was able to choose the option preferred for 1 of 5 residents reviewed for psychotropic medications (Resident #16). The facility reported a census of 40 residents.

Inspectors wroteBased on clinical record review, staff interview and policy review, the facility failed to attempt a gradual dose reduction for a resident prescribed psychotropic medication (medication that affect a person's mental state) for 1 of 5 residents reviewed for medications (Resident #10). The facility reported a census of 40 residents.

Inspectors wroteBased on clinical record review, staff interview and policy review, the facility failed to follow physician orders for 1 of 5 residents reviewed for unnecessary medications (Resident #10). The facility reported a census of 40 residents.

Inspectors wroteBased on observation, staff interview, and policy review the facility failed to provide appropriate incontinence care for one (Resident #7) of one resident reviewed. The facility reported a census of 40 residents.

Inspectors wroteBased on clinical record review, staff interviews, and facility policy review, the facility failed to document a medical rationale for adding additional psychotropic medications and increasing the dosage of a current psychotropic medication for 1 of 5 (Res #8) residents reviewed for unnecessary medications. The facility reported a census of 40 residents.

Inspectors wroteBased on observation, staff interviews and policy review, the facility failed to store drugs in a safe manner and in locked compartments. The facility reported a census of 41 residents.

Inspectors wroteBased on observation, staff interviews, and policy review, the facility failed to ensure appropriate puree portion sizes for two residents who received a puree diet. The facility reported a census of 40.

Inspectors wroteBased on review of the facility's Quality Assurance Performance Improvement (QAPI) plan, the facilities past 5 surveys, and staff interview, the facility failed to correct their own deficiencies for 2 of 2 areas of concern. The facility reported a census of 41 residents.

Inspectors wroteBased on observations, staff interviews, and policy review, the facility failed to follow Enhanced Barrier Protection (EBP) and appropriately discard soiled wound care dressings for 1 of 2 residents reviewed for wound care. The facility reported a census of 40.

Inspectors wroteBased on clinical record review, staff interviews, and policy review the facility failed to follow the physician's order to complete blood sugar (BS) checks and administer intravenous (IV) antibiotics for a resident with diabetes and an infection and failed to notify the physician when an IV antibiotic was not available/or able to be administered for 1 (Resident #1) of 3 residents reviewed. The resident was re-hospitalized for sepsis and had high blood sugars. The facility reported a census of 42 residents.

Inspectors wroteBased on electronic health record review, document review, family and staff interviews, and policy review, the facility failed to promptly identify and intervene for a change in a resident's condition after falls for 2 of 3 residents reviewed for assessment and intervention (Residents #3 and #4). The facility reported a census of 42.

Inspectors wroteBased on record review, staff interview, and policy review the facility failed to ensure the resident had a physician that would provide orders and respond promptly to notification of a resident's elevated blood sugars (BS), abnormal blood lab work, and intravenous (IV) medication for infection not able to be administered for 1 (Resident #1) of 3 residents reviewed. The facility reported a census of 42 residents.

Inspectors wroteBased on clinical record review, observations, family and staff interviews, and policy review, the facility failed to ensure nursing staff completed weekly assessments and provide timely intervention (resulting in worsening of skin impairment) when a resident exhibited a change in skin condition for 1 of 3 residents reviewed for skin concerns or had a change in condition (Resident #30), and failed to document if oxygen provided to a resident when the resident's oxygen saturations dropped below the physician's ordered parameters for 1 of 3 residents reviewed for oxygen (Resident #30). The facility reported a census of 44 residents.

Inspectors wroteBased on direct observation, staff interview, facility documentation, and facility policy review, the facility failed to implement measures to ensure safety for each resident identified at risk of injury to themselves. The facility reported a census of 44.

Inspectors wroteBased on observation, staff interview, and policy review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety. The facility reported a census of 44.

Inspectors wroteBased on clinical record review, observations, staff interviews, staff competency checklist and policy review, the facility failed to follow enhanced barrier precautions for 1 of 4 residents sampled and required enhanced barrier precautions and 1 of 1 residents observed for catheter care (Resident #26). The facility staff also failed to use a barrier when emptying the catheter. The facility staff also failed to follow infection control practices for 1 of 4 residents observed during cares (Resident #30). The facility reported a census of 44 residents.

Inspectors wroteBased on clinical record review, observations, resident and staff interviews, and policy review the facility failed to carry out therapy recommendations and provide restorative exercises for 1 of 3 residents reviewed for rehabilitation services and/or limited range of motion (Resident #17). The facility reported a census of 44 residents.

Inspectors wroteBased on clinical record review, observations, staff interview, manufacturer recommendations, and policy review the facility failed to ensure a medication error rate of less than 5%. During observations of medication administration, the facility had 2 errors out of 30 opportunities for error resulting in an error rate of 6.67 % (Residents #19 and #22). The facility identified a census of 44 residents.

Inspectors wroteBased on clinical record review, observation, staff interview, manufacturer's instructions, and policy review the facility failed to administer insulin according to the physician's orders for sliding scale insulin and per manufacturer instructions to ensure the proper amount of insulin administered for one of two residents observed who received insulin during medication pass (Resident #19). The facility failed to update sliding scale orders inside the plastic bin with blood sugar supplies for one of seven residents who took insulin. The facility reported a census of 44 residents.

Inspectors wroteBased on observation, menu review, record review, and staff interviews, the facility failed to serve the appropriate portions for two of two residents who received pureed diets (Resident #5 and #25). The facility reported a census of 44 residents.

Inspectors wroteBased on direct observation, clinical record review, staff interview, and facility policy review, the facility failed to protect the personally identifiable information of residents for 1 of 14 residents reviewed (Resident #96). The facility reported a census of 44.

Inspectors wroteBased on observations, staff interviews and policy review, the facility failed to secure prescribed medications from the possibility of unauthorized access. The facility reported a census of 42 residents.

Inspectors wroteBased on observations, staff interviews, and policy review, the facility failed to properly protect resident information from unauthorized access. The facility reported a census of 42 residents.

Inspectors wroteBased on direct observation, clinical record review, staff interview, and policy review, the facility failed to grant a resident the right to choose to wear personal clothing for 1 of 3 residents reviewed (Resident #5). The facility reported a census of 42.

Inspectors wroteBased on clinical record review, staff interviews, and policy review, the facility failed to implement the resident's Care Plan for 1 of 3 residents who fell (#3). The facility reported a census of 42 residents.

Inspectors wroteBased on clinical record review, staff interviews, and policy review, the facility failed to provide assessment and interventions for 1 of 3 residents who fell (#3). The facility reported a census of 42 residents.

Inspectors wroteBased on observations, staff interview, and policy review the facility failed to implement the infection control policy as staff failed to perform hand hygiene during medication administration for one (1) resident (#4) and between feeding two (2) residents (#10, #11). The facility staff also failed to clean a mechanical lift between two residents' use (#6, #9). The facility reported a census of 42 residents.

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

Inspectors wroteBased on the Center for Medicare and Medicaid Services (CMS) Payroll Based Journal (PBJ) Staffing Data Report (October 1 - December 31) review, facility staffing reports review, employee time cards review, and staff interviews, the facility failed to submit accurate staff reports for the PBJ Staffing Data Report. The facility reported a census of 40 residents.

Inspectors wroteBased on observations, staff interview, and policy review, the facility failed to ensure dietary staff practiced food safety procedures when preparing and serving resident meals to reduce the risk of cross contamination and foodborne illness. The facility reported a census of 40 residents.

Inspectors wroteBased on record review and staff interview the facility failed to assure resident's or their representatives completed the Skilled Nursing Facility (SNF) Advanced Beneficiary Notices (ABN)/clarified their wishes for 2 of 3 residents reviewed (Resident #10 and #37). The facility reported a census of 40 residents.

Inspectors wroteBased on personnel file reviews, staff interviews, and policy review the facility failed to complete the Iowa Criminal History, Iowa Sex Offender Registry, Iowa Central Abuse Registry and Professional License information prior to employment for 1 of 5 employees reviewed (Staff C). The facility census was 40. The personnel file for Staff C, Certified Nursing Assistant (CNA), reflected a rehire date of 3/11/24. The file lacked the background check. On 5/22/24 at 1:37 PM the Business Office Manager reviewed Staff C's personnel file and confirmed the only Iowa Criminal History, Iowa Sex Offender Registry, Iowa Central Abuse Registry and Professional License in the file was dated 10/24/23. The staff completed an online verification via the facility's The Single Contact Repository (SING) account for Staff C's background check. [...]

Inspectors wroteBased on record review and staff interview, the facility failed to submit a Level 2 Preadmission Screening and Resident Review (PASSR) evaluations for a change in diagnoses or treatment for 2 of 4 residents reviewed (Resident #40 and #18). The facility reported a census of 40.

Inspectors wroteBased on observation, record review, and staff interview, the facility failed to assure appropriate care of a catheter for 1 resident reviewed with a catheter (Resident #37). The facility reported a census of 40 residents.

Inspectors wroteBased on observation, record review, and staff interview the facility failed to assure residents received the recommended dietary interventions for a history of significant weight loss for 1 of 3 residents reviewed (Resident #37). The facility reported a census of 40 residents.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to offer and complete the Veterans Administrator form for 1 of 3 residents reviewed for VA (Resident #30). The facility failed to file the residents paperwork for eligibility for 1 of 3 residents reviewed for VA (Resident #22). The facility reported a census of 40 residents.

Inspectors wroteBased on observation, record review and staff interview, the facility failed to provide care in a manner to prevent infection for 2 of 13 residents reviewed (Resident #30 and #37). The facility reported a census of 40 residents.

Inspectors wroteBased on clinical record review, hospital clinical record review, hospital images, staff interviews, and policy review, the facility failed to identify a resident with pressure ulcers/wounds and to assure the resident received treatment and services, consistent with professional standards of practice, to promote healing of ulcers/wounds for 1 of 3 residents reviewed (Resident #1). The facility reported a census of 45 residents.

Inspectors wroteBased on the review of the Quality Assurance Performance Improvement (QAPI) sign in sheets, staff interview, and policy review, the facility failed to ensure all required members attended the quarterly Quality Assessment and Assurance (QAA) meetings. Specifically, the Director of Nursing (DON)/Infection Preventionist(IP) failed to be present for 2 of the 4 quarterly meetings reviewed. The facility reported a census of 45 residents.