Caring Acres Nursing And Rehab Center

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

the issue within two hours to the State Agency.The facility provided a document titled Nursing Facility Abuse Prevention, Identification, Investigation, and Reporting Policy that was updated on 10/19/2025. The policy statement included: these procedures shall include the screening and training of employee, protection of residents and the prevention, identification, investigation, and timely reporting of abuse, neglect, mistreatment, and misappropriation of property without fear of recrimination or intimidation. All allegations of resident neglect, exploitation, mistreatment, injuries of unknown origin and misappropriation shall be reported to the Iowa Department of Inspections, Appeals and Licensing (DIAL) no later than two hours after the allegation is made.Persons Responsible for Reporting a Crime:Everyone having knowledge of the criminal act has an independent duty to report to law enforcement and DIAL.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/14/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Caring Acres Nursing and Rehab Center

1000 Hillcrest Drive Anita, IA 50020

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610

Respond appropriately to all alleged violations.

Level of Harm - Minimal harm or potential for actual harm

Based on the facility investigative file review, resident and staff interviews and facility policy review the facility failed to complete a thorough investigation, for 1 of 5 residents reviewed (Resident #1), when a resident reported money was missing from her room. The facility reported a census of 31 residents.Findings include:According to the admission Minimum Data Set (MDS) assessment with a reference date of 8/25/2025, Resident #1 had a Brief Interview of Mental Status (BIMS) score of 15. A BIMS score of 15 suggested no cognitive impairment. The following diagnoses were listed for Resident #1: cerebral palsy, anemia, neurogenic bladder, anxiety, depression, bipolar, post-traumatic stress disorder (PTSD), nephrotosis, and bactermia.On 10/10/2025 at 10:43 AM Resident #1 stated she would keep her money wrapped in two red socks in a zip lock bag located in her top right drawer of the dresser that was located to the left of her bed. When she noticed $90 was missing she notified staff and the facility replaced her money. Since then she puts her money in a lock box.Review of the facility's 5-day investigation revealed

the following:-Resident statement, timeline of incident and plan of action.The 5-day investigation lacked staff and other resident interviews.On 10/10/2025 at 1:03 PM the Director of Nursing (DON) stated she was not working when Resident #1 reported her money was missing. She indicated Staff A completed the investigation and would need to see if the Administrator had the investigative file for this self-report.On 10/10/2025 at 2:00 PM the Administrator indicated he was unable to find the paper file that contained the investigation in to Resident #1's missing money. During a follow-up interview on 10/14/2025 at 10:59 AM

the Administrator was asked to explain their investigative process: he stated they would separate the individuals, complete the initial investigation, 5-day report and education staff. He added all of this would be documented and sent to the State Agency. They would talk to all residents to ensure their safety and to report any concerns. They would also talk to all staff involved and other pertinent staff members. Once the investigation is completed the file would be placed in a binder or in a file on the computer. He prefers to have these files on the computer. He acknowledged they were unable to find the investigation that was completed by Staff A.On 10/14/2025 at 9:16 AM the State Agency's Intake Specialist indicated the facility submitted the following information for their self-report: Resident #1's care plan, facesheet and the facility's 5 day summary.The facility provided a document titled Nursing Facility Abuse Prevention, Identification, Investigation, and Reporting Policy that was updated on 10/19/2025. The policy statement included: these procedures shall include the screening and training of employee, protection of residents and the prevention, identification, investigation, and timely reporting of abuse, neglect, mistreatment, and misappropriation of property without fear of recrimination or intimidation. Should an incident or suspected incident of resident abuse be reported, observed, the Administrator or his/her designee will designate a member of management to investigate the alleged incident. The Administrator or designee will complete documentation of the allegation of resident abuse and collect any supporting documents relative to the alleged incident.A) Review documentation in the resident recordD)Attempt to obtain witness statements (oral and/or written) from all known witnessesFollowing investigation, the Administrator or designated agent will be responsible for forwarding the results of the investigation to the Department of Inspections, Appeals, and Licensing (DIAL). The written report shall be forwarded to DIAL. This written report shall be forwarded to the Department within five days of the initial report.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/14/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Caring Acres Nursing and Rehab Center

1000 Hillcrest Drive Anita, IA 50020

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0865

Have a plan that describes the process for conducting QAPI and QAA activities.

Level of Harm - Minimal harm or potential for actual harm

Based on previous Centers of Medicare and Medicaid Services (CMS) from 2567 review, staff interviews, and facility policy review the facility failed to ensure they provided a comprehensive, effective Quality Assessment and Performance Improvement (QAPI) program. The facility reported a census of 31 residents.Findings Include: A review of the Department of Inspections, Appeals and Licensing website revealed the facility had repeated deficient practices identified during complaint investigations from 8/3/2023 to 6/19/2025. The repeat deficiencies cited include:-8/3/2023 during a compliant investigation: 609 Failure to Report-6/24/2024 during a complaint investigation: 610 Failure to Investigate-8/2/2024 during a complaint investigation: 609 Failure to Report-6/19/2025 during a complaint investigation: 609 Failure to ReportOn 10/14/2025 at 12:11 PM the Administrator stated he came started at the facility a week ago on 10/6/2025. He stated to prevent repeat deficiencies they would hold monthly all staff meetings, as well as mandatory meetings. If staff are unable to attend they have a week to meet with their supervisors to review items from the meeting. When asked what would be done to ensure the education provided has been retained, he stated they would revisit the education during their QAPI and all staff meetings. He wants to start doing stand downs every day to provide more communication opportunities with staff members.The facility provided a document titled Quality Assurance and Performance Improvement Plan (QAPI)/Quality Assessment and Assurance (QAA) with a revision date of 5/23/2023. The purpose of this document is to ensure facilities develop a plan that describes the process for conducting QAPI/QAA activities, such as identifying and correcting quality deficiencies as well as opportunities for improvement, which will lead to improvement in the lives of nursing home residents, through continuous attention to quality of care, quality of life, and resident safety. Quality Assurance and Performance Improvement is a systematic approach for improving quality of life, quality of care, and services we provide to our residents. We take a proactive approach to continually improve the way engage and care for our residents, caregivers, and other partners so that we may realize our vision to provide a homelike environment to our residents and a pleasant work environment to our team members. To do this, all employees will participate in ongoing QAPI efforts which support our mission of partners in care, family for life.

Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet