The Bridges at Ankeny

Inspectors wroteBased on observations, interviews and documentation review, the facility failed to provide grooming for 1 of 3 residents reviewed (Resident #7). Resident #7 was noted to have caked dried on food in his mustache and beard on 2 separate days. Refusals of care were not documented. The facility reported a census of 96.

Inspectors wroteBased on resident interview, staff interview and policy review, the facility failed to notify a qualified staff member of an intravenous (IV) pump that was not working properly resulting in a delay of the resident's continuous IV medication for 1 of 5 residents reviewed for medication administration (Resident #12). The facility reported a census of 96 residents. The facility corrected the noncompliance prior to the beginning of the survey on 6/9/26 by doing the following; a. The scheduler was immediately educated on the need to ensure a registered nurse (RN) or licensed practical nurse (LPN) with IV certification was on the schedule at all times while an IV is in the building. b. The master schedule was reviewed to identify and areas of concern that may not have IV staff. c. Staff education to LPN's who are not certified included the purpose as follows; [...]

Inspectors wroteBased on record review, policy review and staff interviews, the facility failed to ensure all residents received medication as ordered by a physician and failed to prevent potentially serious medication errors when staff administered the wrong medications or dosage for 3 of 3 residents reviewed (Residents #103, #105 and #102). Resident #103 received the wrong medications, transferred to the hospital where he was admitted to the hospital and had bradycardic episodes (temporary or sustained drop in heart rate below 60 beats per minute). The facility reported a census of 90 residents. The facility corrected the immediate concern prior to the survey on 3/9/26 when the facility staff implemented the following corrective actions: The facility conducted a root cause analysis of how and why the medication errors occurred. [...]

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed toEnsure sanitary and safe conditions in the three kitchenettes and six service areas in the facility maintained for food services. These failures posed the risk of food borne illness to the residents receiving food from the kitchenettes and service areas. Maintain best practices in accordance with professional standards of food service safety. The deficient practice has the potential to result in food borne illness among the residents that consumed food from the kitchen. The facility reported a resident census of 90.

Inspectors wroteBased on clinical record review, observation, staff interviews and policy review, the facility failed to implement Transmission Based Precautions (TBP) for 1 of 2 residents reviewed for TBP (Resident #5). The facility also failed to demonstrate proper mechanical lift sanitation practices and Personal Protective Equipment (PPE) use to prevent cross contamination for 3 of 6 units reviewed for infection control (Units #100, #500 and #600). The facility failed to provide filter changes/cleaning to a non-invasive device (BiPAP) machine for 1 of 1 residents reviewed for BiPAP use (Resident#1). The facility reported a census of 90.

Inspectors wroteBased on clinical record review, observation, staff interviews, and policy review, the facility failed to obtain orders and accurate settings for a Bilevel Positive Airway Pressure (BiPAP) to ensure safe and accurate delivery of respiratory therapy for 1 of 2 resident reviewed for respiratory care (Resident #1). The facility reported a census of 90 residents.

Inspectors wroteBased on observations, staff interviews, and facility policy review, the facility failed to ensure the daily nurse staffing information was posted for 18 days of the 31 days reviewed (February 10 to March 12, 2026). This failed practice had the potential to affect all residents residing in the facility and their representatives, visitors, and others who wanted to review the facility's current staffing levels. The facility reported a census of 90 residents.

Inspectors wroteBased on observation, record review and staff interview, the facility failed to administer medications according to the Physician's order and in a timely manner for 4 of 4 residents reviewed. (Res #1, #2, #4 and #8 ) The facility identified a census of 84 residents.

Inspectors wroteBased on observation, a call light audit report, resident, family and staff interview, Resident Council Notes and facility policy review, the facility failed to answer resident call lights in a timely manner (within 15 minutes) for 2 of 7 residents reviewed. (Resident #1, #6 ) The facility identified a census of 84 residents.

Inspectors wroteBased on observation, clinical record review, staff and resident interview and facility policy review, the facility staff failed to follow appropriate infection control practices during an outbreak status and when 1 of 3 residents (Resident #4, #5) presented on barrier precautions. The facility identified a census of 84 residents.

Inspectors wroteBased on clinical record review and staff interview the facility failed to maintain a complete and accurate Care Plan for 1 of 3 residents reviewed. (Res #1) The facility identified a census of 84 residents.

Inspectors wroteBased on observation, clinical record review, resident and staff interview and facility policy review, the facility failed to provide proper perineal care for 1 of 3 residents reviewed. (Res #4 ) The facility identified a census of 84 residents.

Inspectors wroteBased on observation, clinical record review, document review, resident, family, and staff interviews, the facility failed to provide sufficient staff to ensure call lights were answered within a reasonable amount of time (within 15 minutes) to provide needed care and supervision to residents. Family members and residents reported having to wait thirty to sixty minutes for the call light to be answered numerous times during the week. Observation of the call light system revealed the call lights were answered between one to sixty four minutes. The facility reported a census of 83 residents.

Inspectors wroteBased on record review, family and staff interview, the facility failed to involve the resident and/or resident's representative in care conferences and ensure care conferences held at least quarterly for one of three residents reviewed for care conferences (Resident #63). The facility reported a census of 83 residents.

Inspectors wroteBased on direct observation, clinical record review, staff interview, and facility policy review, the facility failed to follow accepted professional standards and practices regarding medication being left in the open. The facility reported a census of 83.

Inspectors wroteBased on record review, family interview and policy review the facility failed to provide oral hygiene cares as directed in the care plan for 3 of 3 residents reviewed for oral cares (Resident # 63 and #25). The facility reported a census of 83 residents.

Inspectors wroteBased on record review, observations, and family and staff interviews, and policy review the facility failed to carry out therapy recommendations and provide restorative exercises for 3 of 4 residents reviewed for restorative services and/or limited range of motion (Resident #36, #54 and #63). The facility reported a census of 83 residents.

Inspectors wroteBased on observations, record review, staff interview, and policy review the facility staff failed to ensure a resident's bed was placed in a low position to ensure the resident's safety for one of five residents reviewed for transfers (Resident #12). The facility reported a census of 83 residents.

Inspectors wroteBased on record review, observations, staff interview, and policy review the facility failed to provide complete incontinence care for one of four residents observed (Resident #27) for incontinence care. The facility reported a census of 83 residents.

Inspectors wroteBased on clinical record review, resident and staff interview, and facility document review, the facility records failed to maintain complete and accurate documentation for 1 of 22 residents reviewed (Resident # 23). The facility reported a census of 83. Findings Include: The Annual minimum data set (MDS) for Resident #23, dated 02/06/2025, documented her brief interview for mental status score (BIMS) as 14, indicating intact cognition. In an interview on 02/18/2025 at 01:51 PM with Resident #23, she reported that on 02/12/2025 she was ambulating independently in her room when she slipped and fell over her four wheeled walker. She reported she was assisted to her feet by the Certified Nurses' Assistants (CNAs) and assessed after her fall by one of the nurses. [...]

Inspectors wroteBased on record review, observations, staff interview, and policy review the facility failed to ensure staff utilized Enhanced Barrier Precautions (EBP's) when cares provided for one of six resident sampled on EBP's (Resident #27). The facility reported a census of 83 residents. The Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #27 had diagnoses of end stage renal disease, obstructive uropathy, and diabetes. The MDS indicated the resident had an indwelling catheter. The MDS revealed the resident had dependence on staff for toileting. The Care Plan revised 6/12/24 revealed the resident had a suprapubic catheter. The resident required EBP's related to presence of indwelling suprapubic catheter. The Care Plan directed staff to implement and adhere to EBP's during completion of high contact activities, and hand hygiene prior to and after cares. [...]

Inspectors wrote2. The Quarterly Minimum Data Sample (MDS) for Resident #10, dated 06/24/24, which documented relevant diagnoses of heart failure, hypertension, renal failure, and respiratory failure. It documented Resident #10 is fully dependent for transfers, requiring two-person assistance and a mechanical lift device. The Care plan for Resident #10, last revised on 07/18/24, documented the resident requires two-person assistance with use of a mechanical lift device for all transfers. A direct observation on 09/17/24 at 12:20 PM revealed Staff K, Certified Nurses Aide (CNA), and Staff L, CNA, performing a mechanical lift transfer for Resident #10. During the transfer, Staff L failed to engage the stability legs to ensure the safety of the resident during the transfer. Additionally, Staff K failed to notice the stability legs were not engaged during the transfer. [...]

Inspectors wroteBased on observations, call light event report, resident, family and staff interviews, and policy review, the facility failed to answer call lights in a timely manner within 15 minutes and adequately assess and ensure sufficient staff to meet the residents' needs for 6 of 6 nursing units. The facility reported a census of 87 resident.

Inspectors wroteBased on facility assessment review, and resident, family, and staff interviews, the facility failed to adequately evaluate their resident population and identify required resources and staffing levels needed to provide the necessary care and services needed for current residents. The facility reported a census of 87 residents.

Inspectors wroteBased on clinical record review, observations, staff interview, and policy review the facility failed to provide toileting assistance and care for a resident in an environment that maintained or enhanced dignity for one of ten residents sampled (Residents #7). The facility reported a census of 87 residents.

Inspectors wroteBased on direct observation and staff interview, the facility failed to maintain a safe, clean, and homelike environment due to food being left on the floor of the dining hall for multiple days without having been cleaned. The facility reported a census of 87.

Inspectors wroteBased on direct observation, family and staff interviews, and facility document review, the facility failed to follow Care Plans for 1 of 18 residents observed (Resident #3). The facility reported a census of 87.

Inspectors wroteBased on direct observation, clinical record review, and family and staff interviews, the facility failed to administer oxygen and other respiratory treatments in accordance with physician orders and resident Care Plans for 1 of 13 residents on oxygen or respiratory therapies (Resident#3). The facility reported a census of 87.

Inspectors wroteBased on direct observation, staff interview, and facility document review, the facility failed to serve each resident with a nourishing, well-balanced diet that takes into consideration the preferences of the resident for 1 of 18 residents assessed (Resident #6). The facility reported a census of 87.

Inspectors wroteBased on clinical record review, observation, staff interview, and policy review the facility staff failed to wear gloves and follow Enhanced Barrier Precautions (EBP) and infection control practices for 1 of 10 residents reviewed (Resident #7). The facility reported a census of 87 residents.

Inspectors wrote4. The Minimum Data Set (MDS) for Resident #9, dated 3/15/24, documents the resident is always incontinent of urine and frequently incontinent of bowel. The MDS further documents diagnoses to include debility, cardiorespiratory conditions, coronary artery disease, heart failure and renal insufficiency. The Care Plan for Resident #9, with an initiation date of 4/2/24, documents under the problem section the resident is incontinent of bowel and bladder and instructs staff under the interventions section to clean peri-area with each incontinence episode. During an observation 4/2/24 at 2:34 PM, Staff J, Certified Nursing Assistant (CNA), began to perform peri care to Resident #9 after an episode of bowel incontinence, with Staff K, Assistant Director of Nursing (ADON), present. [...]

Inspectors wroteBased on clinical record review, staff interview, and policy review, the facility failed to provide discharge and medical information to the receiving health care institution at the time of discharge for one of four residents reviewed who transferred to the hospital (Resident #76). The facility reported a census of 82 residents.

Inspectors wroteBased on record review, staff interview, and policy review the facility failed to notify the Long Term Care (LTC) Ombudsman of a resident transfer as required for 1 of 4 residents reviewed who were transferred from the facility (Residents #76). The facility reported a census of 82 residents.

Inspectors wroteBased on clinical record review, staff interview, and policy review, the facility failed to develop and update the comprehensive Care Plan with Preadmission Screening and Resident Review (PASRR) Level II service recommendations for one of one resident reviewed who had a PASRR Level II determination (Residents #19). The facility reported a census of 82 residents.

Inspectors wroteBased on observation, record review, family and staff interview and policy review, the facility failed to develop and implement a comprehensive person-centered care plan for 3 of 18 residents reviewed for care plans (Resident #48, #55 and #76). The facility reported a census of 82 residents.

Inspectors wroteBased on record review, staff interview and policy review, the facility failed to review and revise a resident's Care Plan (Resident #26) to meet the resident's needs for catheter care for 1 of 18 residents reviewed for comprehensive care plans. The facility reported a census of 82 residents.

Inspectors wroteBased on clinical record review, observation, staff interview, manufacturer instructions, and policy review, the facility failed to assure a medication error rate of less than 5%. During observation of medication administration, the facility had 2 errors out of 32 opportunities for error resulting in an error rate of 6.25% (Residents #11). The facility identified a census of 82 residents.

Inspectors wroteBased on clinical record review, observation, staff interview, manufacturer's instructions, and policy review, the facility failed to administer two of two insulin flexpens properly to ensure the proper amount of insulin administered during medication pass (Resident #11). The facility reported a census of 82 residents.

Inspectors wroteBased on clinical record review, staff interview, and policy review, the facility failed to accurately complete a Minimum Data Set (MDS) assessment for one of eighteen resident's reviewed in the sample (Residents #19). The facility reported a census of 82 residents.

Inspectors wroteBased on observations, staff interviews, provider interview, clinical record review, and facility policy review the facility failed to provide assessment and intervention to identify pressure ulcer development for 1 of 3 residents reviewed (Resident #4). Resident #4 developed a wound on her coccyx and the nurse who applied the treatment failed to assess the area and identify the pressure ulcer (PU). The facility failed to do a nursing assessment when applying the treatment to the area. The wound on Resident #4's coccyx (tailbone) was determined to be a Stage 2 Pressure Ulcer. The facility's nurses were not staging pressure ulcers and there was confusion regarding who was to identify the areas as pressure and then stage areas if they were pressure. The facility reported a census of 96 residents.

Inspectors wroteBased on staff interviews, observations, clinical record review, and facility policy review the facility failed to provide perineal (peri) care (groin and buttocks care) using accepted infection control practices for 1 out of 2 residents reviewed (Resident #4). An observation revealed that a Certified Nurse Aide provided peri care to Resident #4 without removing gloves between clean and dirty sites and used the same gloves to apply a cream to an open area on Resident #4's coccyx (tailbone). The facility reported a census of 96 residents.