Iowa City Rehab: Wound Care Falsified on Records - IA
It was September 11, 2025. The nurse had already signed the Treatment Administration Record saying the dressing change was complete.
The resident was wearing a compression garment over his upper chest and back. Through the fabric, the drainage was visible. He told the inspector staff had not changed his dressing yet.
Thirty-four minutes later, at 11:37 a.m., an inspector found Staff D, a licensed practical nurse, in the resident's room preparing to do the wound care. The Hibiclens, a prescription-ordered wound cleanser, was sitting in a plastic basin on top of the dresser, a 12 to 14 ounce bottle, right there in the room. Staff D did not use it. She used Vashe Wound Wash Solution instead, a different cleanser, and told the inspector it looked like there were new wound care orders since the last time she had worked.
There were supplies on hand. The correct one was within arm's reach.
CMS classified the violation as minimal harm or potential for actual harm, affecting a small number of residents. The complaint inspection was completed October 8, 2025.
What the record showed and what the resident's shirt showed were two different things. The nurse had signed off on care she had not yet given, then returned to provide it using the wrong product, with the right one sitting three feet away.
The resident stood in a common room and pulled up his shirt to make the point himself.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Iowa City Rehab & Health Care from 2025-10-08 including all violations, facility responses, and corrective action plans.
Download the official CMS inspection PDF from Medicare.gov
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 23, 2026 · Our methodology
Iowa City Rehab & Health Care in Iowa City, IA was cited for violations during a health inspection on October 8, 2025.
The nurse had already signed the Treatment Administration Record saying the dressing change was complete.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.