Harmony Waterloo

Inspectors wroteBased on observations, staff interviews, and record and policy reviews, the facility failed to ensure that staff securely stored all medications for 2 of 2 residents reviewed (R#2 and R#8). The facility also failed to maintain a safe environment because staff left the medication carts and treatment carts unlocked and unsupervised. The facility reported a resident population of 68.

Inspectors wroteBased on observations, and staff interview the facility failed to keep the daily nurse staff posting current for 2 of 4 days during the survey. In addition, the facility failed to post the number of hours nursing staff worked for 4 of 4 days during the survey. The facility reported a census of 71 residents.

Inspectors wroteBased on observation, staff interviews, and policy review the facility failed to have 2 of 2 cooks able to explain the puree process and procedure. The facility reported a census of 71 residents.

Inspectors wroteBased on observation, staff interviews, and policy review the facility failed to use an 8 ounce (oz.) scoop to serve mashed potatoes as the menu instructed and instead used a 6 oz. scoop resulting in an unknown amount of room trays and 13 of 13 residents in the dining room receiving less mashed potatoes than the menu instructed. The facility reported a census of 71 residents.

Inspectors wroteBased on observation, policy review, staff, and resident interviews, the facility failed to serve rooms trays at or above 135 degrees Fahrenheit ( F) for 3 of 3 test trays and 4 of 12 resident interviews (Resident #54, #34, #78, and #63). The facility reported a census of 71 residents.

Inspectors wroteBased on observation, record review, policy review, resident and staff interviews the facility failed to implement and maintain a restorative program for 2 of 2 residents reviewed (Resident #17 and # 26). The facility reported a census of 71 residents.

Inspectors wroteBased on observation, clinical record review, policy review, manufactures instructions for use, and staff interviews, the facility failed to properly prime an insulin pen before administering for 1 of 2 residents observed (Resident #22). The facility reported a census of 71.

Inspectors wroteBased on observations, record review, resident and staff interviews and policy review, the facility deprived a resident of care by failing to communicate in a respectful manner during bedtime care, abandoned the resident in a vulnerable state and failed to respond to the resident's requests for necessary care resulting in the resident's ongoing fear and anxiety. Resident #4 stated on 10/13/25 one of the two nursing staff was arguing with her about her preference of care. Both nursing staff knowingly left Resident #4 on her bed, soiled with urine, without a cover and no staff answered the light for approximately an hour. Resident #4 began crying and expressed fear as her phone was placed out of reach by staff and she had no way of getting assistance as staff would not come when she called out for help. [...]

Inspectors wroteBased on observation, clinical record review, document review, policy review, resident and staff interviews, the facility failed to keep resident's free from financial exploitation (abuse) when a staff member utilized a resident's credit card to pay their personal cell phone bill for 1 of 4 resident's sampled (Resident #7). The residents gave the staff money, credit, and/or debit cards to purchase pop for them from the vending machine. The staff reported they always did this, especially for residents who couldn't get out of bed to get the pop themselves. After 1 resident discharged from the facility, the resident received a phone call from her bank regarding an overdraft charge for a cellular phone bill, the resident contacted the police who started an investigation. [...]

Inspectors wroteBased on record review, resident and staff interviews, the facility failed to treat residents with dignity and respect ensuring the resident 's rights were met for 2 of 3 residents reviewed (Resident #65 and #8). The facility reported a census of 80 residents.

Inspectors wroteBased on observations, resident and staff interviews, the facility failed to keep the shower room at a comfortable temperature to meet within regulation of 71 to 81 degrees per resident request (Resident#38 and #65). The facility reported a census of 80 residents.

Inspectors wroteBased on clinical record review, staff interviews and the Resident Assessment Instrument (RAI) manual, the facility failed to accurately document and submit accurate resident Minimum Data Set (MDS) Assessment for 2 of 5 residents reviewed (Resident #36 and #65). The facility reported a census of 80 residents.

Inspectors wroteBased on record review and staff interview the facility failed to ensure 1 of 1 residents (Resident #72) Pre-admission Screening and Resident Review (PASRR) was submitted for review when she had new diagnoses documented in her medical record. The facility reported a census of 80 residents.

Inspectors wroteBased on clinical record review, facility policy and staff interview the facility failed to follow up on blood sugar levels that were out of physician defined parameters for 1 of 2 diabetic residents (Resident #9) reviewed. The facility reported a census of 80 residents.

Inspectors wroteBased on clinical record review, staff interviews, family interviews and policy review, the facility failed to complete a full assessment to include neurological assessments and failed to notify family and the provider timely for 1 of 4 residents reviewed (Resident #1). Resident #1 fell out of her wheelchair and landed on her face. The fall was witnessed by Staff A, Registered Nurse (RN). The facility reported a census of 79 residents.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to treats residents with dignity for 4 residents (Resident #2, #6, #7, and #8). Observations revealed the 4 residents left in the dining room for extended periods after meals. The facility reported a census of 84 residents.

Inspectors wroteBased on clinical record review, resident interview, staff interview and pharmacist interview, the facility failed to ensure anxiety medications administered for 1 of 3 residents reviewed (Resident #2). The facility reported a census of 84 .

Inspectors wroteBased on observation, staff interview and policy review, the facility failed to provide a comfortable, clean, homelike environment. Resident #21 had difficulty managing their urinal and frequently spilled his urinal. This resulted in his room and hallway outside of his room to smell like urine. Resident #51's room had dried fecal on his floor that remained there for over 24-hours. Resident #60's had a urinal present sitting on his floor and then moved to the hearing unit. The urinal contained urine and had a visible amount of urine on the floor/heating unit beneath the urinal. In addition, the facility failed to provide a homelike enviroment during meals by removing the trays used to carry the residents' food to the table. The facility reported a census of 71 residents.

Inspectors wroteBased on observation and resident interview the facility failed to maintain dignity for 2 of 2 residents reviewed (Residents #6 and #65). The facility failed to shave the facial hair of 1 female resident (Resident #6) and 1 male resident (Resident #65). The facility reported a census of 71 residents.

Inspectors wroteBased on observation, record review, resident and staff interviews, the facility failed to obtain a physician order for the use of oxygen therapy for 1 of 19 residents reviewed (Resident #19) for oxygen therapy. The facility reported a census of 71 residents.

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to store food in accordance with professional standards. The facility failed to seal, label, and date opened items. The facility reported a census of 71.

Inspectors wroteBased on observation and staff interview, the facility failed to provide housekeeping services in a manner to maintain a safe, clean, comfortable and homelike environment. The facility reported a census of 63 residents.