Harmony Marshalltown

Inspectors wroteBased on observations, clinical record review, staff interviews and policy review, the facility failed to use Enhanced Barrier Precautions (EBP) during wound care for 2 of 2 residents observed (Resident #2 and Resident #3). The facility reported a census of 51 residents.

Inspectors wroteBased on observation, staff interview and manufacturer's recommendations, the facility failed to ensure the dishwasher temperature reached 120 degrees during the final rinse cycle. The facility reported a census of 40 residents.

Inspectors wroteBased on observation, facility records, facility policies, resident and staff interviews, the facility failed to provide bath/shower at least two times for week. The facility reported a census of 49 residents.

Inspectors wroteBased on observation, facility records and staff interviews the facility failed to post the daily nurse staffing data which included the facility name, total number and actual hours worked at the beginning of each shift. The facility reported a census of 49 residents.

Inspectors wroteBased on clinical record review, observation, staff interview, policy review, and guidance from the Centers for Disease Control and Prevention (CDC), the facility failed to follow Enhanced Barrier Precautions (EBP) practices during peri cares for 1 of 3 residents reviewed for bowel and bladder (Resident #6). In addition, the facility failed to perform hand hygiene for 1 of 1 resident reviewed for wound care (Resident #19) and failed to post Transmission Based Precautions (TBP) isolation signage for 1 of 6 residents reviewed for infection control (Resident #55).

Inspectors wroteBased on clinical record review, resident interview, and staff interviews, the facility failed to provide a safe discharge for 1 out of 1 resident reviewed (Resident #2). On 7/3/25 at approximately 6:15 PM, Resident #2 exited the building to go see his support animal without staff knowledge. On 7/4/25 around 3:00 AM, Resident #2 requested to return to the facility. Due to the frustration of not being able to get a ride back to the facility, Resident #2 used his electric wheelchair and transported himself to a convenience store at 3:00 AM. At 5:30 AM the police notified the Administrator they found Resident #2. On 7/4/25 at 5:50 AM, the Administrator went to the convenience store and had Resident #2 sign a form indicating he left the facility against medical advice (AMA). [...]

Inspectors wroteBased on observation, clinical record review, staff and resident interviews, and facility policy, the facility failed to ensure residents safely returned to the building from smoking for 3 of 5 residents reviewed (Residents #1, #2, and #5). On 7/7/25 around 8:00 PM Resident #1 went outside to smoke. After smoking, she couldn't get back into the to the building and remained outside on 7/7/25 at 8:00 PM until 7/8/25 at 6:00 AM. The staff failed to do visual checks on Resident #1 for 10 hours. During the time Resident #1 couldn't get back into the building, the weather had a forecast of heavy rain shower with thunder and lightning. The rain began at 5:00 AM to 6:00 AM, this resulted in a temperature drop from 90 degrees Fahrenheit (F) to 72 degrees F. At that Resident #1 began to panic, became fearful, scared, and crying. [...]

Inspectors wroteBased on staff interviews, clinical record review and policy review the facility failed to provide interventions to prevent a deep tissue injury (a type of pressure injury that occurs when underlying soft tissue is damaged due to prolonged pressure, often over bony prominence.) from performing for 1 of 2 residents reviewed (Resident #3). The facility identified a census of 51 residents.

Inspectors wroteBased on resident interview, staff interview, and the facility policy review, the facility failed to consistently answer call lights within a reasonable amount of time (defined as 15 minutes or less) for 4 of 4 residents reviewed (Residents #2, #5, #18 and #19). The residents and staff reported low staffing caused missed or delayed resident care. The facility reported a census of 51 residents.

Inspectors wroteBased on resident and staff interviews, facility policy, the facility failed to provide adequate smoking policies for residents in regards to smoking times, smoking areas, and smoking safety for 4 of 4 resident reviewed (Residents #1, #2, #17, and #18). The facility identified a census of 51 residents.

Inspectors wroteBased on facility policy review, resident, and staff interviews, the facility failed to treat a resident with respect and dignity in a manner that promotes maintenance or enhancement of his or her quality of life for 1 out of 4 resident reviewed (Resident #1). The facility identified a census of 51 residents.

Inspectors wroteBased on clinical record review, facility policy review, and staff interview, the facility failed to notify the facility's physician of a incident related to a resident left outside all night long for 1 of 3 residents reviewed (Resident #1). The facility identified a census of 51 residents.

Inspectors wroteBased on staff interview, clinical record review, facility document review, and policy review, the facility failed to maintain complete and accurate medical records for each resident. The facility failed to document an incident when a resident got left outside all night long in the electronic health record (EHR) for 1 of 3 residents reviewed (Resident #1). The facility reported a census of 51 residents.

Inspectors wroteBased on electronic health record review, staff interview, and state regulation review, the facility failed to initiate and complete resident assessments in a timely manner for 1 of 3 residents reviewed nursing for supervision (Resident #1). On 2/17/25, the facility staff observed a bruise to Resident #1's face. The facility failed to conduct neurological assessments following the injury to Resident #1's face, even after Resident #1 reported someone knocked her into the wall. Then on 4/7/25, after Resident #1 returned to the facility from exiting independently without staff knowledge, the facility failed to conduct a thorough assessment of her. The facility reported a census of 52.

Inspectors wroteBased on electronic health record review, facility document review, staff interviews, and policy review, the facility failed to provide adequate supervision resulting in a resident elopement for 1 of 1 resident reviewed (Resident #1). The facility reported a census of 52.

Inspectors wroteBased on electronic health record review, staff interview and policy review, the facility failed to ensure the nursing staff had the knowledge to initiate appropriate responses during resident care for 1 of 3 residents reviewed for nursing supervision (Resident #1). The facility reported a census of 52.

Inspectors wroteBased on electronic health record review, staff interviews, and policy review, the facility failed to ensure the resident's medical record contained sufficient and adequate medical information for 2 of 3 residents reviewed for nursing supervision (Residents #1 and #3). The facility reported a census of 52.

Inspectors wroteBased on observation, staff interview, and facility policy, the facility failed to protect food from contamination during meal service. The facility reported a census of 55 residents.

Inspectors wroteBased on resident, family and staff interviews and policy review, the facility failed to maintain the confidentiality of a resident's private personal and medical records for 1 of 1 resident reviewed (Resident #27). The facility reported a census of 55 residents.

Inspectors wroteBased on staff interview, clinical record review and Preadmission Screening and Resident Review (PASRR) evaluation, the facility failed to complete a PASRR screening for 1 out of 2 residents reviewed in the current sample who had mental health changes (Resident #40). The facility reported a census of 55 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 3 of 20 residents (Residents #1, #2 and #40) sampled for Care Plan review. The facility reported a census of 55 residents.

Inspectors wroteBased on clinical record review, observation, family interview, staff interview and facility policy the facility failed to adequately manage a resident's urinary catheter to minimize risk for infections for 1 of 2 residents reviewed for catheters (Resident #56). The facility reported a census of 55 residents.

Inspectors wroteBased on observations, clinical record review, staff interviews, resident interview and facility policy, the facility failed to follow physician orders and manage oxygen use for 1 of 1 resident sampled for respiratory care (Resident #5). The facility reported a census of 55 residents.

Inspectors wroteBased on daily staffing review and staff interview the facility failed to provide a Registered Nurse (RN) in the facility for eight (8) consecutive hours per day as required by Federal Regulations. The facility reported a census of 55 residents.

Inspectors wroteBased on record review, observation, staff interview, resident interview and provided Center of Disease Control (CDC) protocol, the facility failed to maintain infection control interventions for 1 of 1 resident on transmission based precautions (Resident #56). The facility reported a census of 55 residents.

Inspectors wroteBased on clinical record review, staff interview, Centers for Disease Control and Prevention (CDC) guidelines, and facility policy review, the facility failed to screen for eligibility, offer, provide education, and document vaccine consent or refusal for the pneumococcal immunizations for 2 of 5 resident reviewed (Residents #33 and #24) for immunizations. The facility reported a census of 55 residents.

Inspectors wroteBased on clinical record review, staff interviews, Centers for Disease Control and Prevention (CDC) guidelines, and facility policy review, the facility failed to screen for eligibility, offer, provide education and document vaccine consent or refusal for the COVID-19 (coronavirus disease) immunization for 2 of 5 resident reviewed (Residents #56 and #24). The facility reported a census of 55 residents.

Inspectors wroteBased on observation of equipment, staff interview, and Smart Stand Lift (a sit to stand machine used to help move a resident) Manual, the facility failed to have adequate equipment to ensure residents safety during transfers for 2 of 4 lifts observed. The facility reported a census of 59 residents.

Inspectors wroteBased on observations, environmental tour, resident, staff and laundry personnel interviews, the facility failed to provide clean, available linen soaker pads (pads used to protect furniture from incontinence) for resident care. The facility reported a census of 62 residents.

Inspectors wroteBased on clinical record review, facility policy and procedure, and staff and resident interviews, the facility failed to follow physicians' orders for 2 of 3 residents reviewed. (Residents #3 and #4). The facility reported a census of 62 residents.

Inspectors wroteBased on resident and staff interviews, along with the facility policy, the facility staff failed to answer resident call lights in a timely manner (not longer than 15 minutes) for 2 of 3 residents reviewed (Residents #2 and #4). The facility identified a census of 62 residents.

Inspectors wroteBased on observation, facility menu review, staff interview and policy review the facility failed to follow the dietician approved menu as written. The facility reported a census of 62 residents.

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to maintain hot food items at 135 degrees or greater to prevent potential for food borne illness and to keep the food palatable for resident's satisfaction. The facility reported a census of 62 residents.

Inspectors wroteBased on observation, staff interview and policy review, the facility failed to ensure they didn't serve expired food items. In addition, the facility failed to label open food items, date open food items, ensure a clean, sanitary kitchen and equipment to reduce the risk of contamination and food borne illness. The facility reported a census of 62 residents.

Inspectors wroteBased on observation, clinical record review, and staff interview the facility failed to maintain infection control practices, including failing to complete hand hygiene for 1 of 3 residents reviewed (Resident #4). The facility reported a census of 62 residents.

Inspectors wroteBased on observations, staff interview, and facility policy review, the facility failed to serve food within an appropriate temperature range and palatable manner. The facility reported a census of 56 residents.

Inspectors wroteBased on observations, staff interviews, and policy review, the facility failed to store and prepare food in accordance with professional standards for 56 residents. The facility reported a census of 56 residents. Findings Include: 1. On 1/29/24 from 10:00 AM -11:00 AM, a continuous observation during the initial Primary Kitchen Tour revealed the following: a. The upright stainless steel refrigerators and freezer units exterior door handles were covered with a sticky dark substance. b. A buildup of debris noted on the bottom of all units. c. Multiple shelves inside the units were covered with yellow colored sticky substance. d. All units had several items not labeled/dated: lettuce, carrots, diced tomatoes. e. The 2-compartment industrial oil deep fryer had a buildup of solid brown substance on the top and all sides. f. [...]

Inspectors wrote2. The MDS for Resident #14, dated 11/8/23, reflected a BIMS score of 13 out of 15, indicating intact cognition. The MDS further documented diagnoses to include medically complex conditions, heart failure and diabetes. The Care Plan for Resident #14, with a revision date of 5/22/23, reflected the resident dependent on staff for activities, cognitive stimulation and social interaction due to immobility and physical limitations. The Care Plan directed staff to please be kind and considerate with all interactions. On 1/29/24 at 1:05 PM, Resident #14 stated during an interview there is a staff person, Staff D, CNA, who made her feel degraded when the resident had an accident. The staff person will make comments such as that is not what I wanted to do today, pick up your bowel movement or clean up your urine. [...]

Inspectors wroteBased on review of employee files and staff interviews the facility failed to complete a criminal background check for 3 of 3 hired employees prior to the employee being allowed to work alone with residents in the facility (Staff D, Staff F and Staff G). The facility reported a census of 56 residents. Findings Include: 1. Review of the employee file for Staff D, Certified Nursing Assistant (CNA), revealed Staff D hired and employed by the facility on 4/16/2018 to 7/2/2018. A document dated 3/26/2018 revealed the results of a criminal background check showed Criminal History found. On 4/8/2018 a document titled Record Check Evaluation (RCE) received from the Iowa Department of Human Services (DHS) indicating DHS had completed RCE on the criminal history of the applicant and the results indicated applicant may work for the agency. [...]

Inspectors wrote2. The MDS assessment dated [DATE], indicated Resident #19 with diagnoses of malnutrition, Alzheimer's Disease, impaired cognition, and non-traumatic Brain Dysfunction. Resident able to eat independently without assistance, uses a wheelchair and are Substantial/maximal assistance for transfers and cares. The Care Plan dated 11/16/23, indicated having impaired physical mobility, Resident #19 is non-ambulatory, requiring transfers with EZ Stand (a mechanical lift) and assistance of two. Resident able to feed independently with setup, prompting and cueing. Resident eats at an over the bed table in the dining room, as Resident's wheelchair is too high for dining room tables. Also indicated in Care Plan, a revision dated 12/24/23, burn to right thigh with interventions to refer to Wound Clinic. [...]

Inspectors wroteBased on clinical record review, Electronic Health Records (EHR) review, staff interviews and facility policy review, the facility failed to provide Dialysis services consistent with professional standards by not completing a Dialysis Assessment to 1 of 1 residents reviewed (Resident #63). The facility reported a census of 56 residents. Findings Include: 1. The Minimum Data Set (MDS) dated [DATE] for Resident #63 documented an admission date of 1/19/24 and a diagnosis of end stage renal disease (ESRD). Review of the EHR for Resident #63 revealed Nursing Assessments Pre/Post Dialysis treatments were not completed. A weight gain since admission of +5 lbs was not addressed by the nurses nor reported to the Primary Care Physician (PCP). Review of Resident #63's Care Plan lacked documentation of Dialysis services, Nursing Assessments, monitoring, interventions or goals. [...]

Inspectors wroteBased on clinical record review, staff interviews and policy review, the facility failed to ensure the resident narcotics were counted between shifts for 1 of 1 residents reviewed (Resident #48). The facility reported a census of 56 residents. Findings Include: The Minimum Data Set (MDS) assessment dated [DATE] documented Resident #48 with diagnoses of hip fracture, cancer and had a mild (1) intensity of pain in the previous five (5) days. The Pharmacy delivered 30 tablets of Hydrocodone-Acetaminophen 5-325 milligram (MG) on 8/1/23. The Electronic Health Record (EHR) review revealed Resident #48 received Hydrocodone-Acetaminophen 5-325 milligram (MG) 1 tablet by mouth every 4 hours on as needed basis 18 times between 8/1/23 and 10/27/23. [...]

Inspectors wroteBased on observation, staff interviews and facility policy review, the facility's Dietary Staff failed to perform the proper functions of food and nutrition services for the pureed food process for 2 of 2 residents requiring a pureed diet. The facility reported a census of 54 residents. Findings Include: During an observation 1/31/24 at 9:00 AM, Staff E, Cook, began the process to puree the lunch meal for residents at the facility on a pureed diet. Staff E was unsure of the entire puree process, inquiring if water could be used for the liquid added while pureeing and if the food should be measured after it is pureed. Initially Staff E did not measure the amount of food pureed, but then did get a measuring bowl to measure the amount of food pureed. [...]

Inspectors wroteBased on staff interviews and employee record review, the facility failed to employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service by not having a qualified professional serve as the Dietary Manager. The facility reported a census of 56 residents. Findings Include: During an interview 1/29/24 at 10:32 AM with the facilities Dietary Manager, revealed she had been in the position for eight (8) months but did not have education and training completed to be a qualified professional to serve as the Dietary Manager at the facility. She further stated that the Administrator had talked with her about taking a Certified Dietary Manager (CDM) course but had not set up a date. She reported the facility Dietician made weekly onsite visits and was not employed on a full-time basis at the facility. [...]

Inspectors wroteBased on interviews, observations, and record review, the facility failed to provide appropriate nursing supervision to ensure safety for 1 of 3 residents sampled (Resident #1). Resident #1 required assist of 1 for transfers and ambulation. The facility failed to provide the assist of 1 resulting in Resident #1 falling in her room and fracturing her hip. The facility reported a census of 51 residents.

Inspectors wroteBased on interviews and clinical record review, the facility failed to offer and administer a 2nd dose of pneumococcol vaccine for 1 of 5 residents reviewed (Resident #3). Resident #3 received 1 of the 2 recommended doses. The facility reported a census of 51 residents.