Adel Acres
Adel Acres in Adel, IA — inspection on October 16, 2025.
Found 3 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
someone out on Monday (7/21) to replace the PICC line.7/19/25 at 10 PM - IV placed in right
at 1:28 AM and 7/22/25 at 11:15 PM - IV antibiotic not administered due to no IV access, no
antibiotic due to resident pulling out PICC and IV line.
Order to discontinue IV antibiotic and new order for oral antibiotic medication.7/24/25 at 12:45 PM - Contacted provider due to drainage from insertion site of drain tube, pocket filled area above site, and resident in electrifying pain when palpating area.
Sent to hospital.Resident's MAR for 7/1-7/31/25 revealed the IV antibiotic was administered 1 of the 5 days ordered, 7/19/25.Resident's hospital Discharge summary dated [DATE], revealed sepsis and worsening of retroperitoneal abscess.Resident's Lab Report dated 8/18/25 revealed a glucose level of 328 (high) with normal range 70-99.Resident's Lab Report dated 9/2/25 revealed a hemoglobin A1C (a type of protein in the blood that measures the average blood sugar (glucose) level over the past 2-3 months) of 9.8 (high) with the goal of therapy of less than 7.0 and action suggested at more than 8.0.Resident's Nurses Notes revealed the following:9/7/25 at 3:48 PM - a new order for metformin 500 mg (milligrams) daily.9/15/25 at 7:50 PM - BS 554 (normal range 70-100).9/15/25 at 8:00 PM -new order for BS checks every 30 minutes for 2 hours, insulin order given, and recheck BS in 30 minutes. 9/15/25 at 8:40 PM - BS 600 and new order for sliding scale insulin AC and PRN (amount of insulin administered based on what BS is).9/15/25 at 10:42 PM- BS 579 at 9:15 PM.
Provider notified and order received to send to the hospital urgent for evaluation to rule out sepsis. 9/18/25 at 1:17 PM - New order to increase Metformin to 1000 mg daily.Resident's MAR dated 9/1-9/30/25 revealed an order starting on 9/18/25 for sliding scale insulin per BS at AC, HS, and PRN and notify provider if BS 401 and above.
The MAR documented BS above 401 and no documented notification of the provider on the following dates/times:9/20/25 at 11 AM - BS 513.9/21/25 at 2 AM - BS 407.9/21/25 at 11 AM - BS 429.9/21/25 at 5 PM - BS 432.9/30/25 at 11 AM - BS 406.The Facility Physician Orders policy, last reviewed 9/28/22, revealed to provide guidance and ensure physician orders are transcribed and implemented in accordance with professional standards.
Physician orders must be recorded in the medical record by the nurse and transcribed to the appropriate administration record (MAR).
Medications will be ordered from the pharmacy to ensure prompt delivery.The Facility Job Descriptions: Registered Nurse (RN) and Licensed Practical Nurse (LPN) revised 5/22, revealed essential functions: to accurately and promptly implements physicians' orders and assesses and documents the resident's condition and nursing needs.
Interview on 10/14/25 at 11:00 AM, Staff A, LPN stated if a resident was admitted to the facility with a diagnosis of diabetes with long-term current use of insulin and had been on sliding scale insulin in the hospital and the resident had no orders for insulin, she would call the provider to get orders for insulin and call the facility the resident transferred from to see about insulin orders.
Staff A stated she would also do an accu-check to see what the resident's BS was.
Interviews on 10/14/25 at 11:15 AM and 10/16/25 at 12:45 PM, Staff O, LPN stated if a resident was admitted to the facility with a diagnosis of diabetes with long- term current use of insulin, had been on sliding scale insulin in the hospital, and the resident had no orders for insulin stated she would call and ask the transferring facility if the resident had any insulin orders and clarify if the diagnosis was correct.
Staff O further stated if a medication was not available she would notify the pharmacy to see when it was going to be available and if unable to administer an IV antibiotic, she would notify the physician.Interview on 10/16/25 at 2:00 PM, Staff N, Primary Care Physician stated an admission order was given on 6/12/25 for a BS at AC and HS to monitor resident's diabetes.
Staff N stated she would have expected the facility to follow through with the order.
Staff N further stated if the BS had been monitored as ordered, would have been less likely for the BS to be so high, as would have provided earlier treatment if required and would have been better overall for the resident's health, as the resident was sent to the hospital with a BS that was not responding to treatment and possible infection.
165555 10/16/2025
Adel Acres 1919 Greene Street Adel, IA 50003
Resident #3 on 8/11/25.
Staff O stated she came to work about 7:00 AM and was talking with the
had 1 or 2 falls.
Staff O stated she assessed the resident with the DON later in the morning and noted
assessment, vital signs, check range of motion, look for rotation of legs, and document all.
Staff O stated then need to observe everything on the resident, do neuro checks per policy, complete and document a fall follow-up every shift for 72 hours and if the staff are reporting the resident is having pain and requiring increased assistance would do a full assessment, notify the physician for possible x-rays, and provide pain medication if available.
Interview on 10/14/25 at 3:45 PM, the DON stated she wasn't aware of Resident #3's falls and after she came in on 8/11/25 was the first she heard of the resident's pain and not bearing weight.
The DON stated she thought it was at the 9:30 AM morning meeting that she was notified by therapy and a CNA, therapy told her the resident was complaining of pain and the left hip, staff told her was the resident's right hip and he was not bearing weight on his right leg.
The DON stated noted a bruise on the resident's right hip and she called the physician who ordered an x-ray and the facility got the results of a hip fracture later that morning while the physician was in the building and the resident was then sent out via ambulance to the hospital. Resident #3's hospital Summary of Care dated with admission date of 8/11/25 revealed an x-ray report, dated 8/11/25, with a mildly displaced right intertrochanteric (hip) fracture in moderate varus (body part angles inward) malalignment and documented a right hip replacement surgery completed.
Facility's Healthcare Fall Management Program dated 10/14/24 revealed follow-up documentation should be completed every shift for at least 72 hours after the fall and should include: neuros (if applicable), vital signs, pain, and range of motion.
165555 10/16/2025
Adel Acres 1919 Greene Street Adel, IA 50003
Director. If she receives new labs with abnormal results, will call the provider, and if the provider
Further stated the provider will call the pharmacy and order medications, medications are delivered,
Also, sometimes the provider will order x-rays, and get the x-ray report and the facility doesn't, so the facility doesn't know the report is back and will have to call the provider to get the x-ray report.
Interview on 10/13/25 at 3:45 PM, the Director of Nursing (DON) stated the provider usually does all orders via email and fax.
The DON stated it varies with a response time for return calls from the provider.
Stated she has read different residents' progress notes that state the provider hadn't returned a call or several hours later before returned the call.
The DON stated if was an urgent call, she would expect a return call within 5 - 10 minutes, but return calls from the provider have not been very good.
The DON further stated she placed a call to the provider with a resident's BS of 600 and the connection was poor and not able to understand the conversation, and then the call ended and the provider did not call back.
The DON further stated there are problems with who is the point of contact for the provider and the facility set up a meeting with the provider to discuss things and the facility had to cancel the meeting so was going to set up another meeting with the provider.
Interview on 10/16/25 at 12:45 PM, Staff O, LPN/MDS Coordinator stated the provider is hard to work with, does not return calls.
Staff O stated she calls the transition nurse care manager during business hours when the provider does not return a call and after hours if the provider did not return a call, she would call back consistently if it was urgent till she gets the provider, or would call the Medical Director.Facility Physician Services policy, reviewed on 4/28/22, revealed the Physician and/or Nurse Practitioner will supervise the medical care of the resident by, but not limited to monitor changes in the resident's medical status, provide consultation/treatment based on the resident's condition, and a physician will be available 24 hours/day for the provision or the arrangement of emergency care.
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.