Caring Acres Nursing and Rehab Center

Inspectors wroteBased on observations, staff interviews, family interviews, document review and policy review the facility failed to follow and prepare food according to the facility's menu, which was reviewed by the dietitian. The facility reported a census of 22 residents.

Inspectors wroteBased on the record review, resident family interview, staff interview and policy review the facility failed to provide ready access to personal funds managed by the facility. The facility provided a document with 14 of 22 residents with resident trust funds at the facility. The facility reported a census of 22 residents.

Inspectors wroteBased on the record review, resident family interview, staff interview and policy the facility failed to provide an individual financial record to the resident and/or power of attorney (POA) in the form of quarterly statements and upon request. The facility provided a document with 14 of 22 residents with resident trust funds at the facility. The facility reported a census of 22 residents.

Inspectors wroteBased on observations, staff interviews, resident interviews, resident family interviews, Electronic Record review (EHR), and policy review the facility failed to provide a clean and homelike environment when the floors in all areas of the buildings that had carpets had large stains. The facility also had an area of the wall in a resident's room that had black furry areas and flaking debris near a pipe with areas of the wall missing. The facility reported a census of 22 residents.

Inspectors wroteBased on observations, staff interviews, family interviews and Electronic Health Record review (EHR) the facility failed to ensure the safekeeping and confidentiality of sensitive resident records including the resident's Social Security card and Driver's License identification card for 2 of 2 residents (Resident #7 and #8). The facility reported a census of 22 residents.

Inspectors wroteBased on Electronic Health Record (EHR) review, observations, staff interviews, and policy review the facility failed to provide appropriate incontinence care when a resident was not taken to the toilet every 2 hours to prevent stool incontinence to 1 of 3 residents reviewed (Resident #3). The facility reported a census of 22 residents.

Inspectors wroteBased on observations, staff interviews, Electronic Health Record (EHR) review, and policy review, the facility failed to complete appropriate hand hygiene for 2 of 2 residents observed (Resident #3 and #4). The facility further failed to apply appropriate Personal Protective Equipment (PPE) when catheter care was completed on a resident (Resident #3) with Enhanced Barrier Precautions (EBP). The facility reported a census of 22 residents. Findings Include:1. The Minimum Data Set (MDS) dated [DATE] documented Resident #3 had a Brief Interview for Mental Status (BIMS) score of 3 indicating severe cognitive impairment. The MDS further documented Resident #3's dependent functional abilities for toileting hygiene and personal hygiene. The MDS documented Resident #3 required an indwelling catheter and had bowel/bladder incontinence and was dependent on staff for toilet care. [...]

Inspectors wroteBased on clinical record review, family interview, resident interview, staff interview, and policy review the facility failed to assist residents with their activities of daily living (ADLs) for 4 of 8 residents reviewed (Residents #1, #3, #21, and #30). The facility reported a census of 24 residents.

Inspectors wroteBased on observation, resident and staff interview, and policy review the facility failed to serve food at an appetizing temperature. The facility reported a census of 24 residents.

Inspectors wroteBased on resident interviews, staff interview, and policy review the facility failed to protect 3 of 12 residents' (Resident #1, #3, #15) personal property from loss or theft. The facility reported a census of 24 residents.

Inspectors wroteBased on record review, staff interview, and policy review the facility failed to develop a Comprehensive Person-Centered Care Plan that included specialized services or specialized rehabilitative services the nursing facility would provide as a result of Preadmission Screening and Record Review (PASARR) recommendations for 2 of 4 residents reviewed (Resident #12 and Resident #3). The facility reported a census of 24 residents.

Inspectors wroteBased on clinical record review, staff interview, and policy review the facility failed to revise and implement care plans for 2 of 3 residents reviewed (Residents #5 and #9). The facility reported a census of 24 residents.

Inspectors wroteBased on observations, staff interview, and policy review the facility failed to serve food under sanitary conditions to prevent foodborne illness during one of one meal observed. The facility reported a census of 24 residents.

Inspectors wroteBased on observation, clinical record review, staff interview, and policy review the facility failed to maintain infection control practices with catheter care and hand hygiene for 1 of 3 residents reviewed (Resident #2). The facility reported a census of 24 residents.

Inspectors wroteBased on previous Centers of Medicare and Medicaid Services (CMS) from 2567 review, staff interviews, and facility policy review the facility failed to ensure they provided a comprehensive, effective Quality Assessment and Performance Improvement (QAPI) program. The facility reported a census of 31 residents. Findings Include: A review of the Department of Inspections, Appeals and Licensing website revealed the facility had repeated deficient practices identified during complaint investigations from 8/3/2023 to 6/19/2025. The repeat deficiencies cited include:-8/3/2023 during a compliant investigation: 609 Failure to Report-6/24/2024 during a complaint investigation: 610 Failure to Investigate-8/2/2024 during a complaint investigation: 609 Failure to Report-6/19/2025 during a complaint investigation: [...]

Inspectors wroteBased on clinical record review, facility investigative file review, staff interviews and facility policy review the facility failed to timely report an allegation of abuse to the appropriate management staff member for 1 of 5 (Resident #1) residents reviewed. The facility reported a census of 31 residents.

Inspectors wroteBased on the facility investigative file review, resident and staff interviews and facility policy review the facility failed to complete a thorough investigation, for 1 of 5 residents reviewed (Resident #1), when a resident reported money was missing from her room. The facility reported a census of 31 residents.

Inspectors wroteBased on clinical record review, facility investigative file review, employee file review, staff interview and facility policy review the facility failed to provide proper assessments and interventions after 2 of 3 residents (Resident #1 and #4) had a change in condition. Resident #1 experienced a change in condition on May 18, 2025 during the day and on the evening shifts. The nurse that worked failed to assess the resident after staff reported concerns to him. The resident developed a fever at approximately 7:00 PM and staff applied a cold rag to his head. A PRN medication was not given to assist with lowering his fever nor was the physician notified until the resident's vital signs significantly changed at approximately 3:00 AM and was sent to the hospital. The resident was admitted to the hospital and expired 5 hours later. [...]

Inspectors wroteBased on observations, interviews, electronic health record (EHR) reviews, and facility policy review the facility failed to provide dignity to 3 of 7 residents (Resident #4, Resident #6, Resident #7). The facility failed to provide dignity to the residents as demonstrated by a staff telling a resident to sit down when the resident indicated the need to use the bathroom, a staff using discriminatory words towards a resident and in front of other residents, and a resident sitting exposed in a common area with other residents. The facility reported a census of 24 residents. Findings Include: 1. The Minimum Data Set (MDS) for Resident #4, dated 4/16/25 identified a Brief Interview for Mental Status (BIMS) score of 6/15 indicating severe cognitive impairment. [...]

Inspectors wroteBased on clinical record review, staff interviews, facility investigative file review, employee file review, and policy review the facility failed to ensure 1 of 5 residents reviewed (Resident #4) was free from verbal abuse. The facility reported a census of 24 residents.

Inspectors wroteBased on record review, facility investigative file review, employee file review, staff interviews, and facility policy review the facility failed to timely report an allegation of abuse to the appropriate management staff member. The facility reported a census of 24 residents.

Inspectors wroteBased on clinical record review, staff interviews and facility policy review the facility failed to sign out an as needed (PRN) medication when given and follow up to ensure the PRN was effective for 1 of 3 residents reviewed (Resident #1). The facility reported a census of 24 residents.

Inspectors wroteBased on clinical record review, staff interviews and facility policy review the facility failed to properly transfer Resident #1 from the floor to her bed after she sustained a fall with complaints of hip pain. The facility reported a census of 24 residents.

Inspectors wroteBased on facility document review and staff interview the facility failed to accurately submit the required Payroll Based Journal (PBJ) quarterly report. The facility reported a census of 25 residents.

Inspectors wroteBased on staff interview, and policy review the facility failed to properly establish and implement written policies and procedures for the Quality Assurance and Performance Improvement (QAPI) plan. The facility reported a census of 25 residents.

Inspectors wroteBased on policy review, document review, and staff interview the facility failed to maintain records of quality assurance meetings for 3 of 4 quarters reviewed. The facility reported a census of 25 residents.

Inspectors wroteBased on observations, staff interviews and clinical record review the facility failed to implement adequate infection control measures to prevent the spread of pathogens. Staff failed to use hand hygiene while assisting Residents #17, #1 and #10 with toileting. Laundry staff failed to cover personal items while transferring to rooms, and frequently left full garbage bags on the floor. The facility reported a census of 25 residents.

Inspectors wroteBased on Electronic Health Records (EHR) review, observations, resident interviews and staff interview the facility failed to provide the residents with a comfortable homelike environment by not providing warm water in the residents rooms. The facility reported a census of 25 residents.

Inspectors wroteBased on observations, resident interviews, staff interviews, clinical record review and policy review the facility failed to ensure that staff followed physicians' orders for 4 of 16 residents reviewed. Resident #18 had several pressure ulcers with treatment orders to be completed twice daily. Staff failed to complete the treatments as ordered. Staff failed to observe medication administration for Residents #14 and #20, and Staff J was alerted by a resident that she was about to give the medication for Resident #26 to the wrong person. The facility reported a census of 25 residents.

Inspectors wroteBased on observations, staff interviews clinical record review and policy review the facility failed to implement interventions to prevent accidents and hazards for 4 of 16 residents reviewed. Residents #10 and #25 were identified as elopement risk and had Wander Guard alarm bracelets. Staff failed to ensure that the alarms were working by conducting daily checks. Staff also failed to provide safe transfer techniques with Resident #1 and #17. The facility reported a census of 25 residents.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that competent and trained staff were providing resident care. The facility reported a census of 25 residents.

Inspectors wroteBased on facility document review, staff interviews, and facility job description review the facility failed to employ a staff with specialized training in infection prevention and control. The facility reported a census of 25 residents.

Inspectors wroteBased on Electronic Health Record (EHR) review, and staff interviews the facility failed to develop and implement policies and procedures, to ensure the resident's medical record included documentation that the resident did or did not receive pneumococcal immunizations for 4 of 5 residents reviewed (Resident #6, #13, #17, and #20). The facility reported a census of 25 residents.

Inspectors wroteBased on Electronic Health Record (EHR) review, policy review, and staff interviews the facility failed to develop and implement policies and procedures, to ensure the resident's medical record included documentation that the residents were offered the immunization and did or did not receive the COVID-19 immunizations for 4 of 5 residents reviewed (Resident #3, #6, #13, and #17). The facility reported a census of 25 residents.

Inspectors wroteBased on personnel file review, and staff interviews the facility failed to ensure that all Certified Nurse Aides (CNA's) had completed the required 12 hours of continuing education annually for 2 of 5 files reviewed. The facility reported a census of 25 residents.

Inspectors wroteBased on observations, interviews, clinical record review, and facility policy the facility failed to provide dignity to 3 out of 16 residents (Resident #2, #1, #10). The facility failed to provide dignity to residents as demonstrated by a resident waiting over 45 minutes for toileting, not providing privacy with incontinence, and personal embarrassment of a resident due to incontinence. The facility reported a census of 25 residents. Findings Include: 1. The Minimum Data Set (MDS) for Resident #2, dated 1/5/25 identified a Brief Interview for Mental Status (BIMS) score of 13/15 indicating normal cognitive functioning. The document revealed the resident had no behaviors. The resident had diagnoses of cerebrovascular accent (CVA) with hemiplegia or hemiparesis (stroke with an affected extremity(ies)), depression, and adjustment disorder, unspecified. [...]

Inspectors wroteBased on staff interviews, personnel record reviw and policy review the facility failed to ensure background checks were completed before hire for 1 of 5 staff reviewed. The facility reported a census of 25 residents.

Inspectors wroteBased on clinical record review, staff interviews, and policy review the facility failed to complete a Pre-admission Screening and Resident Review (PASARR) process for 2 of 2 residents (Resident #15, Resident #21) reviewed for PASARR. The facility failed to complete a new PASARR for a resident who was diagnosed with new mental disorder diagnoses since completion of the previous PASARR and failed to coordinate assessments with the PASARR program by incorporating the recommendations into a resident's assessment and Care Plan. The facility reported a census of 26 residents.

Inspectors wroteBased on clinical record reviews, staff interviews, and policy review, the facility failed to identify target behaviors for psychotropic medication use for 1 of 2 residents reviewed (Resident #15). The facility reported a census of 25 residents.

Inspectors wroteBased on facility document review and staff interview, the facility failed to submit 4 of 4 residents reviewed to the Iowa Department of Veteran Affairs (Resident #12, #18, #22, and #26). The facility reported a census of 25 residents.

Inspectors wroteBased on observations, staff and resident interviews, clinical record review and facility document review the facility failed to ensure that they provided adequate nurse staffing to meet the needs for 3 of 4 residents reviewed. Residents #1, #3 and #4 indicated that many times there were only 2 staff on duty and they waiting a long time to get a response to their call lights. When the facility didn't have anyone else to work, Staff D, Licensed Practical Nurse (LPN) worked 23 consecutive hours and 49 hours in a three-day period. The facility reported a census of 24 residents.

Inspectors wroteBased on facility document review, and staff interviews the facility failed to ensure that a Registered Nurse (RN) was at the facility for 8 consecutive hours every day. In a 30-day timeframe, 4 days with no RN coverage. The facility reported a census of 24 residents.

Inspectors wroteBased on observation, interview and record review the facility failed to develop a care plan for 1 of 4 residents reviewed. Resident #1 was admitted to the facility on [DATE], as of 11/26/24 the clinical record lacked a care plan. The facility reported a census 24 residents.

Inspectors wroteBased on observation, resident interview, staff interviews and clinical record review the facility failed to ensure they had the proper equipment and services to meet the needs of residents before admission for 1 of 1 residents reviewed. Resident #1 sustained a knee injury that required therapy services and the facility agreed to accept the resident before considering his bariatric equipment needs. The facility reported a census of 24 residents.

Inspectors wroteBased on clinical record review, facility record review, staff and resident interviews, and facility policy reviews the facility failed to ensure 1 of 3 residents (Resident #1) was free from abuse and psychological harm. Resident #1 reported to staff that Staff A CNA had provided peri-cares in a rough manner, had called her names and used curse words in front of her. The facility suspended Staff A while they completed their investigation and allowed her to come back to work as long as she did not provide cares to Resident #1. Staff reported when Staff A would come to work, Resident #1's demeanor would change: she would become guarded, shaky, stay by other staff member's side, tear up, was fearful for her safety. Resident #1 reported it made her mad because this is her home and she should not feel this way about a staff member in her home. The facility reported a census of 26 residents. [...]

Inspectors wroteBased on clinical record review, facility investigative file review, resident and staff interviews, and facility policy review the facility failed to report 1 of 3 resident's (Resident #1) allegation of abuse to the appropriate staff members to ensure timely reporting to the State Agency. On 7/23/24 at roughly 8:30 PM Staff A and Staff B had assisted Resident #1 with getting ready for bed. Resident #1 told staff she was upset and yelling that she had asked two hours prior to be put to bed. Staff explained to her they were assisting others with baths, passing the snack cart out and assisting others to bed. Resident #1 yelled I asked you two f***ing hours ago. Staff A replied with I am not putting up with your shit tonight. Resident #1 replied I am not dealing with your attitude either. [...]

Inspectors wroteBased on clinical record review, resident and staff interviews, and facility policy review the facility failed to protect 1 of 3 residents (Resident #1) from psychosocial harm during and after the investigation of an allegation of abuse. The facility reported a census of 26 residents.

Inspectors wroteBased on clinical document review, electronic health records (EHR), observation, staff interviews, and policy review the facility failed to follow physician orders (Resident #2), failed to direct the implementation of physician orders and failed to administer medications as ordered by not transcribing orders for 2 of 2 residents (Resident #2 and #4) reviewed. The facility reported a census of 28 residents.

Inspectors wroteBased on observations, vendor interviews, staff interviews, and facility document review the facility failed to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident by maintaining a status of non-payment with several local vendors. The facility reported a census of 28 residents.

Inspectors wroteBased on clinical record review, facility record review, policy review, and staff interviews the facility failed to notify the Long-Term Care Ombudsman of a transfer to a hospital for 2 of 3 residents (Resident #1, and #23) reviewed. The facility reported a census of 28 residents.

Inspectors wroteBased on clinical record review, staff interviews, and policy review the facility failed to obtain bed hold notifications for 2 of 3 residents (Residents #1, #23) reviewed. The facility reported a census of 28 residents.

Inspectors wroteBased on clinical record review, staff interview, and policy review, the facility failed to fully review and revise the comprehensive care plan for 1 of 1 resident reviewed (#18). The facility reported a census of 28.