Algona Manor Care Center

Based on record review, staff interview and policy review the facility failed to complete a background check for 1 of 6 current employees reviewed (Staff A, Certified Nurse Aide) (CNA). The facility reported a census of 30 residents. Findings include: Review of Staff A, CNA 's employee file documented a hired date of 9/20/24. Further review of the employee file lacked documentation of a background check in the file. During an interview on 6/10/25 at 2:06 PM, the Administrator reported the background check for Staff A, CNA was not completed. She reported the office manager just started around time of hire for Staff A and missed it but it should have been done. The facility Nursing Abuse Prevention, Identification, Investigation and Reporting Policy date October 2022 documented the facility will conduct a criminal record check prior to hire, in the manner prescribed under 481 Iowa Administrative Code 58.11(3).

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and staff interview, the facility failed to complete a new Preadmission Screening and Resident Review (PASRR) for Level I on 2/27/25 for Resident #27. The facility reported a census of 30 residents. Findings included: The Minimum Data Set (MDS) assessment dated [DATE] for Resident #27 showed a Brief Interview for Mental Status (BIMS) score of 12 indicating moderate cognitive impairment. The MDS documented diagnosis of anxiety, psychotic disorder (other than schizophrenia), and malnutrition. Review of the PASRR Level 1 Screening Outcome dated 8/12/24 for Resident #27 revealed PASRR Level I Determination No Level II Required. Review of the clinical chart revealed this PASRR came with Resident #27 from the hospital when admitted to the facility. The facility failed to submit a new PASRR due to the new diagnosis given on 2/27/25. The Progress Notes dated 2/27/25 for Resident #26 revealed the facility received a new diagnosis of delusions. Interview on 6/10/25 at 2:58 p.m. with the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, clinical record review, staff interview and a nursing assistant checklist form the facility failed to provide appropriate perineal cares for 1 of 3 residents reviewed, (Res #1). The facility reported a census of 31 residents. Findings include: A Minimum Data Set (MDS) assessment form dated 9/24/24 indicated Resident #1 had diagnosis that included Non-Alzheimer's Dementia. The assessment indicated the resident had a Brief Interview for Mental Status (BIMS) score of 8 out of 15 (cognitively impaired), dependent on staff with toilet transfers and toileting and frequently incontinent of her bowels and bladder. A Care Plan indicated the resident had a Focus area of a requirement of assistance with activities of daily living (ADL's), revised 7/17/24. The Interventions/Tasks included the following as dated. a. Please assist me with toileting upon rising in the morning, before or after activities and at my hour of sleep (HS). Assist me with any incontinent cares as needed. I utilize adult incontinent pull ups.(revised 4.18.24) An observation on 10/8/24 at 12:55 p.m.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, staff interviews and policy review, the facility failed to store food items according to professional standards and ensure food items were labeled with dates after opening. The facility identified a census of 35 residents. Findings include: 1. An initial kitchen tour conducted on 8/5/24 at 10:05 AM, of the kitchen revealed the following items were stored/opened in the kitchen's refrigerator ready for service and not labeled with a date after opening: a. American cheese slices in zip lock bag b. Container of ham salad c. Slices of smoked ham in zip lock bag d. Individual packed slices of Swiss cheese e. 46 oz Tomato juice f. 16 oz butter blend spread block- not sealed appropriately g. Cookies Mild salsa h. 1 gallon worcestershire sauce i. Heinz tomato ketchup j. 1 gallon tartar sauce k. 30 oz Mayonnaise l. 24 oz Hershey syrup m. 12 oz Dijon Mustard n. 12 oz honey mustard o. 1 gallon chocolate milk p. Two 1 gallon 2% milk q. Pint Half & Half cream and milk r. Half gallon Almond breeze s. Heavy whipping cream t. 7 servings cucumber salad in individual bowls u.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, staff interviews, and policy review the facility failed to revise a Care Plan for 1 of 13 residents reviewed (Resident #21) for prophylactic antibiotic therapy. The facility reported a census of 35. Findings include: Resident #21 ' s Minimum Data Set (MDS) dated [DATE] assessment identified a Brief Interview for Mental Status (BIMS) score of 14, indicating intact cognition. Resident #21 ' s MDS included diagnoses of coronary artery disease, hypertension (high blood pressure), chronic obstructive pulmonary disease (COPD) and pulmonary embolism (blood clot in lungs) without acute cor pulmonale. The Care Plan with revised date of 7/24/24 identified Resident #21 required assistance with activity of daily living due to COPD. The Care Plan revealed Resident #21 had supplemental oxygen continuously. The Care Plan directed staff to update the Physician with any signs of respiratory distress such as a decreased oxygen saturation and complaints of new onset of shortness of breath. A…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and staff interviews, the facility failed to provide assessment and interventions necessary for the care and services, to maintain the residents' highest practical physical well- being for 1 of 3 resident reviewed (Resident #13) for antibiotic therapy. The facility failed to monitor and complete urinary assessments/interventions for a resident who was diagnosed with a urinary tract infection. The facility reported a census of 35 residents. Findings include: Resident #13 ' s Minimum Data Set (MDS) dated [DATE] assessment identified a Brief Interview for Mental Status (BIMS) score of 04, indicating severely impaired cognition. The MDS identified Resident #13 was dependent on staff for toilet transfers and toileting hygiene. The MDS documented Resident #13 was frequently incontinent of urine. Resident #13 ' s MDS included diagnoses of coronary artery disease, hypertension (high blood pressure), urinary tract infection (UTI) in the past 30 days, and non-alzheimer ' s disease. The…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, record review, staff interviews and facility policy the facility failed to properly prevent a stage 1 pressure ulcer consistent with professional standards of practice for 1 of 2 residents reviewed (Resident #26). The facility reported a census of 35 residents. Findings include: 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. Stage II is partial thickness loss of dermis presenting as a shallow open ulcer with a red or pink wound bed, without slough (dead tissue, usually cream or yellow in color). May also present as an intact or open/ruptured blister. Stage III Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Stage IV is full…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, clinical record review, staff interviews, and policy review, the facility failed to provide a safe and sanitary environment to help prevent the development and transmission of communicable diseases and infections. The facility failed to follow hand hygiene and gloving practices consistent with accepted standards of practice for 1 of 2 residents reviewed (Residents #1). The facility reported a census of 35 residents. Findings include: Resident #1 ' s Minimum Data Set (MDS) dated [DATE] assessment identified a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. The MDS identified Resident #1 required supervision or touching assistance with rolling in bed and was dependent on staff to sit up or lay down in bed. The MDS identified Resident #1 required a mechanical lift and was dependent on staff for transfers and toileting. Resident #1 ' s MDS included diagnoses of anemia, hypertension (high blood pressure), multidrug-resistant organism, diabetes mellitus,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on review of facility policy, staff interview and record review the facility failed to follow an antibiotic stewardship program that included antibiotic use protocols and a system to monitor antibiotic use for 1 resident (Resident #26). The facility reported a census of 35 residents. Findings include: The facility form named Nursing Home Physician Fax reported a new order for Resident #26 from the physician dated 1/11/23 for Methenamine 1 Gram, 1 tablet twice daily by prophylactic for urinary tract infection with no end date. The current Clinical Physician ' s Orders dated 8/8/24 for Resident #26 documented Resident #26 continued with the order for Methenamine 1 Gram, take 1 tablet by mouth twice daily related to urinary tract infections. The clinical record lacked documentation that the facility monitored the long term use of Resident #26 ' s antibiotic. An interview on 8/8/26 at 9:30 AM the Infection Preventionist (IP) stated they have a system in place to monitor long term use of antibiotics to assure they were still necessary. The IP revealed they generally review them…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, resident interview, staff interview, Resident Council Minutes and facility policy review the facility failed to answer resident call lights within the allotted professional standards of 15 minutes for 1 of 3 residents reviewed. (Resident #3) The facility identified a census of 32 residents. Findings include: During an interview on 4/5/24 at 1:30 p.m. Resident #3 verbalized a concern related to wait times for her call light. The resident used the clock on her wall and timed the call light on for 30 minutes and even longer at times which made her feel like no one was there for her. Additionally, when staff toileted her and left her in the bathroom for long periods of time it caused pain. During an interview on 4/9/24 at 11:41 a.m. Staff B, Certified Nursing Assistant (CNA) confirmed observations of call lights on longer than 15 minutes on 2nd shift. The staff member indicated some of the reasons had been because some of the residents eat and ran back to room and wanted to go to bed right away. At 6 p.m. staff took breaks, nurse's change of shift and dietary…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, policy review, and staff interview, the facility failed to develop and implement a comprehensive and person-centered care plan that included all of the resident ' s medical and psychosocial needs for 3 of 12 residents reviewed (Residents #16, #24, and #29) who had orders for lower leg edema management and hearing aids. The facility reported a census of 36 residents. Findings include: 1. Resident #16 ' s Minimum Data Set (MDS) assessment dated [DATE] identified a Brief Interview for Mental Status (BIMS) score of 08, indicating moderate cognitive impairment. The MDS indicated that Resident #16 required extensive assistance of one staff with bed mobility, transfers, ambulation, dressing, personal hygiene and toilet use. The MDS included diagnoses of non-traumatic brain dysfunction, coronary artery disease, non-Alzheimer ' s dementia, right side hemiplegia and hemiparesis (paralysis and weakness), and stroke. Review of resident ' s clinical Progress Notes from April 2020 revealed…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.