The incident occurred when three staff members were assisting the resident with his shower. Staff A directed cold water at the man's back for 10 to 15 seconds while he yelled and told her to stop, according to witness accounts gathered during the October inspection.
Two other staff members in the shower room told Staff A to stop because her actions were rude, but she continued spraying the resident anyway.
Staff C, who witnessed the incident, later told inspectors she heard the resident yelling and turned around to see Staff A spray him with cold water. The resident "yelled, screamed, and told her to stop, as Staff A laughed," according to the inspection report.
The witness said she knew it was wrong but initially didn't think about it being abuse.
Staff B, who was training at the time, corroborated the account. Staff B told inspectors that after the cold water incident, the resident said he didn't want his shower because it was cold.
The facility's Director of Nursing acknowledged that this resident didn't like showering and could be difficult to assist. She emphasized that staff should treat residents with respect and dignity and carry out care correctly.
She told inspectors that if staff witnessed potential abuse, she wanted them to report it immediately. That didn't happen in this situation.
The Director of Nursing learned about the incident only when she was completing competencies with Staff B, the new nursing assistant who had witnessed it. Staff B initially hesitated to report what happened but eventually told her about Staff A's actions toward the resident.
The Assistant Director of Nursing described the resident as "not easy to assist with showers" and said he only liked certain staff members helping him. She had never had problems with Staff A before the alleged incident.
She noted it was probably difficult for Staff C to report what happened because Staff C and Staff A were cousins.
The facility's Administrator said he expected staff to treat residents with dignity and respect. Staff should report suspected abuse immediately, he told inspectors.
When abuse is reported, the Administrator explained, he would suspend the alleged abuser, conduct a formal investigation, and report to the State Agency within two hours. He reported this situation to the State Agency when he found out about it.
The Administrator said the witnesses didn't realize it was abuse, but added there should have been no question that it was wrong.
When confronted by inspectors, Staff A denied intentionally spraying the resident with cold water. She described the resident as not combative that day, though he could be difficult on other occasions.
Staff A claimed she could have accidentally sprayed him while turning off the water. She said she placed the shower head on the hook, and when she turned off the water, the dial would have gone to the cold side before shutting off completely.
Water could have sprayed him at that point, she suggested.
Staff A maintained that Staff B was present for training purposes to observe the resident's shower. She insisted she would never intentionally spray a resident with cold water.
However, her explanation contradicted the detailed witness accounts. Staff C specifically described seeing Staff A spray the resident on his back while he screamed, and both witnesses said they told her to stop because it was rude.
The witnesses also reported that Staff A continued the behavior for 10 to 15 seconds despite the resident's pleas and their warnings.
The incident represents a violation of federal regulations requiring nursing homes to ensure residents are free from abuse. The Centers for Medicare and Medicaid Services classified this as causing actual harm to residents.
Federal inspectors determined the facility failed to protect the resident from abuse and failed to ensure immediate reporting of the incident by witnesses.
The resident's reaction after the incident - telling staff he didn't want his shower because it was cold - suggested the cold water spray affected his willingness to accept necessary personal care.
Staff C's admission that she knew the behavior was wrong but didn't initially recognize it as abuse highlights training gaps in recognizing and reporting resident mistreatment.
The family relationship between Staff A and Staff C, noted by the Assistant Director of Nursing, may have complicated the reporting process and delayed the facility's response to the incident.
The Administrator's acknowledgment that witnesses should have recognized the behavior as abuse indicates the facility's own leadership understood the seriousness of what occurred.
The delayed reporting meant the facility could not immediately investigate and address the situation, potentially leaving the resident vulnerable to further mistreatment.
Federal regulations require nursing homes to investigate allegations of abuse within 24 hours and report them to administrators immediately. The failure of witnesses to promptly report this incident violated those protections.
The resident's documented difficulty with showering made him particularly vulnerable to staff frustration and potential mistreatment during personal care activities.
Staff A's laughter during the incident, as described by witnesses, suggested deliberate cruelty rather than an accident or momentary lapse in judgment.
The facility's response only occurred after Staff B, the trainee, eventually decided to report what she had witnessed during her competency evaluation with the Director of Nursing.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Accura Healthcare of Marshalltown from 2025-10-09 including all violations, facility responses, and corrective action plans.
Additional Resources
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