Accura Healthcare Of Aurelia, Llc

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

and would say; please don't drop me. Staff F seemed annoyed by the resident. When transferring the resident with the mechanical lift into the wheel chair, the bars of the lift often came close to hitting the resident on the head. Staff A said that Staff F would pull back on the sling abruptly when the resident was being lowered down into the wheel chair said; I hope you hit your head on the bar of the lift. A written statement, dated 5/1/25 at 7:34 PM, from Staff H, CNA showed that Staff F was more mean to Resident #2 compared to other residents, more verbally aggressive. Staff H couldn't remember the date it had happened. On 10/21/25 at 12:24 PM, Staff F denied having ever told a resident to shut up and she only suggested that maybe the resident should be on Hospice because it would be a good thing to help her with her anxiety. Staff F said that she had known Resident #2 for over 19 years, worked with her when she was

in a group home for intellectual disabilities so she was familiar with how to interact with her. Staff F acknowledged that Resident #2 was afraid of falling when they rolled her in bed, mostly when her head would be down and looking at the floor. Staff F said she just tried to reassure her that we're not going to let you fall. Staff F said that after the allegations in May, she thought it would be best not to care for Resident #2 so there wouldn't be any more false allegations An Employee Corrective Action Form, Written Warning, dated 5/6/25, showed that there were allegations of abuse against Staff F. The expectations were that staff would speak to residents with dignity, respect and to provide great customer services. Staff F was re-educated on the facility abuse policy and she was assigned education on abuse prevention to be completed before returning to work. The written report showed that Staff F had been confronted about her treatment of Resident #2. Staff F responded that she had known the resident for a long time and I just know how she is. Management counseled her to consider her tone and how it may be perceived by other staff and visitors. Staff F and Management agreed that she would not to work with Resident #2 for the time being. On 10/21/25 at 8:30 AM, the ED and the Director of Nursing (DON) stated that they were first informed of the concerns with Staff F on 5/1/25 but did not have dates that the incidents had occurred. The ED said that a family member for Resident #2 reported that when the resident was in the group home, they had to treat her as if she was a 4-year-old. The ED responded that this was not acceptable in the nursing home environment. A facility policy titled: Freedom From Abuse Notice to Employees Resident/Patient Abuse, Neglect and Mistreatment of Belongings. Among the rights specified in the federal and state laws, each resident and patients had the right to a dignified existence and to be free form verbal, sexual, physical or mental abuse; Abuse included but not limited to: verbal abuse, oral, written, gestures language, including sarcastic remarks and derogatory statements, directed to residents' family members or significant others.

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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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Accura Healthcare of Aurelia, LLC

401 West Fifth Street Aurelia, IA 51005

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

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

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and policy review the facility failed to report allegations of abuse in a timely manner for 1 of 1 residents reviewed. On 5/1/25, several staff members reported that Staff F was rude and verbally abusive to Resident #2. They did not have dates and times as to when these incidences occurred. The facility reported

a census of 34 residents. Findings include: According to the Minimum Data Set (MDS) dated [DATE REDACTED], Resident #2 had a Brief Interview for Mental Status (BIMS) score of 3 (severe cognitive deficits.) The resident was totally dependent on staff for toileting, dressing, rolling and transfers. She was always incontinent of urine and bowel, and was impaired on both sides of her upper and lower extremities.

Diagnoses for Resident #2 included: heart failure, renal insufficiency and quadriplegia.The Care Plan for Resident #2 dated 4/15/25, showed that she was dependent on staff for activities of daily living related to unspecified intellectual disabilities. Staff were to converse while providing care. Resident #2 previously lived

in a home for people with intellectual disabilities, unable to care of herself. She required the assistance of two staff with the Hoyer (mechanical lift) for all transfers. Resident #2 could be verbally aggressive, staff were to monitor behaviors when resident became agitated, intervene before agitation escalated. A facility self-report to the Department of Inspections and Appeals and Licensing (DIAL) showed that on 5/1/25, the Executive Director (ED) had been notified that Resident #2 was being verbally abused by Certified Nurse Aide (CNA) Staff F. Staff A, CNA reported that while she and Staff F were transferring Resident #2 with the Hoyer mechanical lift, Staff F said: I hope this hits you in the head and we're not friends, don't call me Buddy. The self-report lacked potential dates that the alleged incident occurred. On 10/20/25 at 2:04 PM Staff B said that Staff F was disrespectful and rough with Resident #2. She did not know the dates that this had occurred and said she knew she should have come forward sooner but she was afraid of retaliation. A written statement dated 5/1/25 at 7:34 PM from Staff H, CNA showed that Staff F was more mean to Resident #2 compared to other residents, more aggressive verbally. Staff H couldn't remember when it happened. On 10/21/25 at 11:00 AM, the Director of Nursing (DON) said that they were made aware of the concerns with Staff F, on 5/1/25 but they did not know the date or dates when the incidents occurred. She said the staff that had concerns were educated about the importance of reporting allegations of abuse immediately. 10/21/25 1:10 PM the administrator said that the staff had all been educated on the facility abuse prevention policy and the importance of reporting concerns immediately. A facility policy titled: Nursing Facility Abuse Prevention, Identification, Investigation and Reporting Policy; Mental abuse was defined as use of verbal or nonverbal conduct which caused or potential to cause the resident to experience humiliation, intimidation fear shame agitation or degradation. All allegations of resident abuse, neglect exploitation mistreatment injuries of unknown origin and misappropriations would be reported immediately to the charge nurse. The charge nurse would be responsible for immediately reporting the allegations of abuse to the Administrator, or designated representative. All allegation of resident abuse would be reported to Iowa Department of Inspections and Appeals no later than two hours after the allegations was made.

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