Dunlap Specialty Care

Inspectors wroteBased on Electronic Health Records (EHR) review, observations, resident interview, family interview, staff interviews, and policy review the facility failed to provide the residents with a comfortable/clean homelike environment by not cleaning resident rooms or common space in a timely manner. The facility reported a census of 33 residents.

Inspectors wroteBased on observations, staff interview, and policy review the facility failed to store food in accordance with professional standards by not dating open food items or disposing of expired food items. The facility reported a census of 33 residents.

Inspectors wroteBased on observation, Electronic Health Record (EHR) review, resident interview, family interview, staff interviews, and policy review the facility failed to follow physician orders for a resident with an ordered breathing treatment and a resident with oral medication for 2 of 4 residents (Resident #6 and #7). The facility reported a census of 33 residents.

Inspectors wroteBased on observations, interviews and record review the facility failed to ensure a resident does not develop pressure ulcers unless unavoidable and failed to ensure interventions in place for a resident with pressure ulcers for 1 of 3 residents reviewed. On 5/13/25, the Primary Care Provider discovered that Resident #15 had a pressure injury on his heel. Staff documented no new skin issues on the same day. In an observation on 5/22/25, staff failed to have interventions in place. The facility reported a census of 33 residents. The MDS (Minimum Data Set) assessment identifies the definition of pressure ulcers: Stage I is an intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have a visible blanching; in dark skin tones only it may appear with persistent blue or purple hues. [...]

Inspectors wroteBased on observation, interview, clinical record review and policy review the facility failed to ensure that medications were given in a timely manner for 1 of 4 residents. On 5/11/25, the morning medication, administered via Percutaneous Endoscopic Gastrostomy (PEG) tube, for Resident #3 were not administered until afternoon. The facility reported a census of 33 residents.

Inspectors wroteBased on observation, staff interviews and record review the facility failed to complete accurate resident records for 3 of 13 residents reviewed (Residents #3, #24 and #30.) Documentation on dialysis residents #30 and #24 had been completed up to 12 days after the date of the assessment. Staff entered a late nursing note for Resident #3 that indicated catheter care had been completed the previous evening when it had not been done. The facility reported a census of 33 residents.

Inspectors wroteBased on observations, Electronic Heath Record (EHR) review, policy review, and staff interviews the facility failed to provide appropriate infection prevention practices when providing care to a resident with an enteral feeding tube and stage 2 wound with one that had a care plan for Enhanced Barrier Precautions (EBP) for 2 of 3 reviewed (Resident #3 and #6). The facility reported a census of 33 residents.

Inspectors wroteBased on observations, record review, resident, staff and family interview the facility failed to ensure 1 of 2 residents (Resident #2) had orders to change his catheter. The facility reported a census of 34 residents.

Inspectors wroteBased on interview with staff and residents, record review, and policy review the facility failed to treat all residents with dignity and respect for 4 of 18 reviewed. Staff reported that Staff G, Licensed Practical Nurse (LPN) made disrespectful remarks to Residents #12, #25, and #29. Resident #81 reported that Staff J, Registered Nurse (RN) was disrespectful to her during cares. The facility reported a census of 26 residents.

Inspectors wroteBased on observations, staff interviews, and facility policy review the facility failed to ensure sanitary conditions where staff prepared food, and failed to perform hand hygiene during meal service. The facility identified a census of 26 residents.

Inspectors wroteBased on observations, record review, staff interviews, and policy reviews the facility failed to change and label oxygen tubing for 1 of 1 residents reviewed (Resident #15). The facility reported a census of 26 residents.

Inspectors wroteBased on observations, record review, staff interviews and policy reviews, the facility failed to accurately document the changing of oxygen tubing for 1 of 1 residents reviewed (Resident #15). The facility reported a census of 26 residents.

Inspectors wroteBased on clinical record review, observation, staff interview, and infection control policy the facility failed to use universal infection control measures and Enhanced Barrier Precautions (EBP) during catheter care for 1 of 1 residents reviewed for infection control (Resident #12). The facility reported a census of 26 residents.

Inspectors wroteBased on resident and staff interviews, and policy review, the facility failed to have ready and reasonable access to personal funds upon request for 1 of 18 residents reviewed (Resident #8). The facility reported a census of 26 residents. Findings Included: In an interview on 7/1/24 at 12:51 PM, Resident #8 stated, We rely on the business office person if we want money. We can only get money when she is here. In an interview on 7/2/24 at 3:10 PM, Staff C, Registered Nurse (RN) reported no personal funds are available to residents after normal business hours. In an interview on 7/2/24 at 3:13 PM, the Business Office Manager (BOM) stated, I ask residents if they need money before I leave. When asked if personal funds are available to residents after business hours, without giving her prior notice, the BOM replied, no. [...]

Inspectors wroteBased on clinical record review, staff interviews, and policy review, the facility failed to provide assessment and intervention timely for the necessary care and services after a resident fall for 1 of 6 residents reviewed (Resident #1). The facility reported a census of 29 residents.

Inspectors wroteBased on clinical record review, staff interview, and policy review the facility failed to provide timely notification to the physician for 1 of 1 residents admitted to hospice services (Resident #1). The facility reported a census of 29 residents.

Inspectors wroteBased on observation, clinical record review, staff interview, and policy review the facility failed to implement a comprehensive care plan for 1 of 4 residents reviewed ( Resident #5). The facility reported a census of 29 residents.

Inspectors wroteBased on observations, clinical record review, staff interviews, and policy review the facility failed to update the comprehensive care plan with a change in transfer assistance needed for 2 of 3 residents reviewed (#5 and #7). The facility reported a census of 29 residents.

Inspectors wroteBased on observations, clinical record review, staff interviews, and policy review the facility failed to ensure safe transfer techniques used by not using a gait belt for assisted transfers for 2 of 3 residents (Resident # 5 and Resident #7) reviewed. The facility reported a census of 29 residents.

Inspectors wroteBased on clinical record review, hospital document review, staff interviews, family interviews, hospice documents, hospice agreement and facility policy review the facility failed to notify in a timely manner 1 of 3 resident's hospice provider when she had a fall with injury (Resident #1). On [DATE] at 8:30 AM the nurse was called to the resident's room by another staff member. Resident #1 was lying on the floor on her left side. The resident reported she was getting up to go to the bathroom and fell. An assessment was completed and found skin tears to her left arm and next to her left eye. Bruising was noted to start over her left eye. At 10:07 AM the hospice nurse was notified that the resident had a fall and sustained an injury. When the hospice nurse arrived to the facility at 11:38 AM she noted a large hematoma to her left eye and it was swollen shut. [...]

Inspectors wroteBased on resident, family, and staff interviews, daily staffing review, facility assessment review, resident council notes review, resident group meeting, and facility policy review the facility failed to provide sufficient staff to ensure resident's needs were met and to answer call lights in a timely manner. The facility reported a census of 32 residents.

Inspectors wroteBased on clinical record view, investigative file review, staff interviews, and facility policy review the facility failed to report an allegation of abuse within 2 hours for 1 of 4 residents reviewed (Resident #2) for reportable incidences. The facility reported a census of 32 residents.

Inspectors wroteBased on clinical record review, facility investigative file review, staff interviews and facility policy review the facility failed to complete a thorough investigation of a reportable event for 1 of 4 residents (Resident #2) reviewed for reportable events. The facility also allowed an alleged perpetrator to return to work without completing a thorough investigation after Resident #2 made an abuse allegation against Staff G. The facility reported a census of 32 residents.

Inspectors wroteBased on clinical record review, staff interviews and facility policy review the facility failed to accurately document 1 of 3 resident's (Resident #1) received hospice services, on their Minimum Data Set (MDS) assessment. The facility reported a census of 32 residents.

Inspectors wroteBased on clinical record review, staff interview and facility policy review the facility failed to update 2 of 9 resident's care plans (Resident #1 and Resident #8). Resident #1's care plan did not include interventions while she received an anticoagulant medication. Resident #8's care plan did not include her current deep tissue injury and interventions for staff to follow. The facility reported a census of 32 residents.

Inspectors wroteBased on observations; resident, staff and family interviews; clinical record review, review of resident council notes; resident group meeting; and facility policy review the facility failed to provide baths on scheduled days or offer a bath on the non-scheduled days for 3 of 3 residents (Resident #1, #5, and #9) reviewed. The facility reported a census of 32 residents.

Inspectors wroteBased on record review, staff interviews and policy review the facility failed to ensure Resident #1's medical record was completed and accurate following a fall with major injury. The facility reported a census of 32 residents.

Inspectors wroteBased on record review, observation, resident and staff interviews and facility policy review the facility failed to keep a resident (Resident #27) from physically abusing other residents while living at the facility. Review of Resident #27 record revealed documentation in the past she has open handed slapped another resident in the face, hit a resident in the back of the head, and threw water at a resident. During the survey Resident #27 threw a full pop can at a resident causing mental anguish and pain. The facility was unable to produce documentation of nursing risk management incident report investigations potentially placing all residents at risk for resident to resident abuse due to failure to review incidents. [...]

Inspectors wroteBased on record review, resident and staff interviews, and facility policy review the facility failed to report continued resident to resident altercations for 1 of 3 residents reviewed to the State Agency (Iowa Department of Inspections and Appeals (DIA)), (Resident #27). The facility reported Resident #27 initial resident to resident physical altercation for an incident that occurred on 12/14/2022, however the facility failed to report subsequent resident to resident physical altercations by Resident #27 that occurred on 12/23/22 and 3/5/2023. During the facilities annual survey Resident #27 had an additional resident to resident physical incident that could of potentially been avoided if the State Agency would have been aware of Resident #27 continued aggression towards other residents. [...]

Inspectors wroteBased on record review, resident and staff interviews, and facility policy review the facility failed to implement safety measures and interventions for Resident #27 to protect residents from her physical resident to resident altercations for 2 of 3 residents reviewed (Residents #11 and #24). The facility failed to identify the root cause and implement interventions for Resident #27 aggression towards other residents potentially placing all residents at risk. The Iowa Department of Inspections and Appeals (DIA) informed the facility of the Immediate Jeopardy (IJ) that began as of December 14, 2022 on April 27, 2023 at 11:45 AM the Facility Staff removed the Immediate Jeopardy on April 27, 2023 through the following actions: a. Resident # 27 was placed on one to one supervision with staff for 24 hours a day, until further assessment and safety plan can be implemented. b. [...]

Inspectors wroteBased on record review, resident and staff interviews, and policy review the facility failed to provide residents with routine bathing at least twice a week and/or have documentation to support resident refusals for 5 of 5 residents reviewed for bathing (Residents #14, #284, #18, #19, and #21). Residents reported going multiple weeks without getting a bath. The facility reported a census of 37 residents.

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 37 residents.

Inspectors wroteBased on record review, staff interview, and policy review the facility failed to revise Care Plans after continued resident to resident physical altercations for 1 of 4 residents reviewed (Resident #27). The facility reported a census of 37 residents.

Inspectors wroteBased on record review, staff interview, and policy review the facility failed to provide needed services in accordance with professional standards by not completing treatments as ordered by the physician and pushing medications into a Gastrostomy tube (G-tube) not allowing medications to flow by gravity for 2 of 2 residents (Resident #14 and #285). The facility reported a census of 37 residents.

Inspectors wroteBased on record review, staff interview, and policy review the facility failed to implement policies and procedures regarding the technical aspect of feeding tubes by not applying initials to formula bottles and not verifying G-tube proper placement and functioning before beginning a feeding and before administering medications for 1 of 1 residents (Resident #14). The facility reported a census of 37 residents.

Inspectors wroteBased on observation, clinical record review, resident interview, and policy review, the facility failed to consistently offer as needed pain medication for acute breakthrough pain for 1 of 1 residents reviewed (Resident #27).

Inspectors wroteBased on clinical record review, policy review, document review, and staff interview, the facility failed to secure medications in a method in which a missing dose is easily detected with 16 missing doses for 2 of 2 residents reviewed (Residents #7 and #134). The facility reported a census of 37 residents.

Inspectors wroteBased on record review and staff interview the facility failed to document 3 of 3 residents or their representatives were provided education regarding the benefits and potential side effects of influenza immunization; and the residents either received or refused for the 2022 influenza season (#1, #25, and #28). The facility also failed to document for 2 of 2 residents or their representatives were provided education regarding the benefits of and potential side effects of the pneumococcal immunization; and if the residents either received or refused the vaccination (#25, and #28). The facility reported a census of 37 residents.

Inspectors wroteBased on record review, staff interview, and the Centers for Medicare and Medicaid Services (CMS) QSO-21-19-NH memo the facility failed to document in the residents record education of the COVID-19 vaccination was provided to them to make an informed decision for 5 of 5 residents reviewed that refused the COVID-19 vaccine (Resident #1, #8, #15, #25, and #28). The facility reported a census of 37 residents.

Inspectors wroteBased on record review, staff interviews, and policy review the facility failed to ensure for the calendar year of 2022 the Director of Nursing (DON), Medical Director or his/her designee, and the Infection Preventionist attend every quarterly meeting. The facility reported a census of 37 residents.

Inspectors wroteBased on record review and staff interviews the facility failed to employee a qualified Infection Preventionist during the facilities annual survey. The facility reported a census of 37 residents.