Maple Manor Village
Inspection Findings
F-Tag F0602
F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
changed. Staff C left a note for the DON to notify her about missing narcotic/s and altered records. The Administrator and the DON completed follow-up interview with Staff A on 6/10/25. Administrator showed Staff A the Controlled Substance Medication Records and questioned if she could explain the entries that were crossed out or altered. Staff A pointed to the altered date on a line signed by another LPN and stated that she knows she shouldn't do this, but when she notices an error she has to correct it. The Administrator responded that line didn't appear to be an error until it was altered and that Staff A denied altering that line when first asked on 5/31/25. Staff A reviewed the other Controlled Substance Medication Records and was unable to explain the other errors and alterations. This Administrator then showed Staff A the camera footage from 5/30/25 (5/29/25) of Staff A dispensing several tablets from the narcotic drawer into one medication cup. Staff A stated that she doesn't know why she would have done this and that is not her normal practice. Staff A became tearful and stated that she has been having some health issues recently and has noticed memory loss. She reports that she has an appointment with her doctor for scans to test for
a brain tumor or early-onset Alzheimer's Disease. Administrator questioned why Staff A had not reported
this to a supervisor or HR previously and Staff A stated she didn't know and that she knows she should have. Due to the serious nature of the concerns identified, Staff A was notified that her position was terminated effective immediately.Review of available footage, revealed there was footage missing. The footage available was from 5/29/25 from 6:35 a.m. to 6:50 a.m. and from 9:45 a.m. to 10:00 a.m. The footage showed Staff A popping out several pills into one medication cup from different narcotic cards around 6:45 a.m. Staff A left the cart around 6:42 a.m. The footage also showed Staff A appearing to pop 1 pill into her hand from the narcotic drawer and then Staff A going into the nurses' station with that pill. A Controlled Medication Storage and Count Policy revised October 2023, directed the following:Purpose: To maintain safe storage and an accurate count of Scheduled II controlled medicationsProcedureNarcotics are stored under a double lock systemAfter removing the controlled medication from the bingo card or individual packet, the nurse will sign off the accompanying controlled medication sheet indicating the medication is takenAfter administration of the controlled medication, the nurse/medication aide will sign off
the eMAR (electronic Medication Administration Record)If the controlled medication needs to be wasted, a second nurse should witness the wasting of the controlled medication and both nurses will sign the medication sheet (a certified medication aide and licensed nurse can waste controlled medication) NOTE: 2 certified medication aides are NOT authorized to waste controlled medicationsAny narcotic count discrepancy will be immediately reported to the Director of NursingNarcotic counts are completed at the beginning and end of each shift or at the time when there is an exchange of medication cart keysRequires two nurses (or one nurse and one certified medication aide)Oncoming nurse validates medication count on
the medication card, off-going nurse validates medication count on the paper documentBoth nurses are required to sign off on the shift-to-shift count record
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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
11/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Maple Manor Village
345 Parriott Street Aplington, IA 50604
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-Tag F0658
F 0658 Level of Harm - Minimal harm or potential for actual harm
with state and federal guidelines. Medication and treatment orders will be entered in electronic medication administration record (eMAR) or electronic treatment administration record (eTAR) accordingly.Active orders should be followed and carried out as written/transcribed.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
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Facility ID:
If continuation sheet
Maple Manor Village in Aplington, IA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Aplington, IA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Maple Manor Village or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.