The Vistas At Bettendorf

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, facility policy review, family and staff interview, the facility failed to notify the family representative of the development of a diabetic foot ulcer for 1 of 3 residents (Resident #1) reviewed for notifications. The facility reported a census of 75 residents.Finding include:The Minimum Data Set (MDS) dated [DATE REDACTED] identified Resident #1 with a BIMS (Brief Interview for Mental Status) score of 9 out of 15, which indicated a moderate cognitive impairment. The MDS list of diagnoses included unspecified dementia, coronary artery disease and diabetes mellitus. The MDS indicated at the time of assessed Resident #1 did not have any wound or skin problems. Review of the electronic health record (EHR) revealed a [Name redacted} Wound Physician's Initial Wound Evaluation & Management Summary, dated 9/15/25, revealed a Diabetic Wound of the Left, Medial Heel Full Thickness. The summary indicated, in part: Etiology (type) Diabetic; Duration: less than 1 days.Estimated Time to Heal: 2-4 months.Wound Size (L x W x D): 3.0 x 6.0 x 0.1 cm (centimeter). During an interview on 10/22/25 at 10:32 AM, Resident #1 family representative sated the facility did not tell them of the development of the resident's diabetic foot ulcer.

They stated they were not aware of the wound, and learned of it when the Wound Care provider came to

the resident's room to provide care during their visit. During an interview on 10/23/25 at 10:24 AM, the MDS Coordinator reported the nurse who found the wound first is responsible for notifying the family that same day. During an interview on 10/23/25 at 12:02 PM, the ADON (Assistant Director of Nursing) stated she expected nursing staff to notify the family of any change of condition, new wounds, new medication orders, any new orders, any behavioral changes. She would also expect them to document the notification in the progress notes the same day.A review of the Facility Policy titled: Change in a Resident's Condition or Status, dated as last revised December 2016 and had the following documentation:1. Unless otherwise instructed by the resident, a nurse will notify the resident's representative when:a. The resident is involved

in any accident or incident that results in an injury including injuries of an unknown source;b. There is a significant change in the resident's physical, mental, or psychosocial status;c. There is a need to change

the resident's room assignment;d. A decision has been made to discharge the resident from the facility; and/ore. It is necessary to transfer the resident to a hospital/treatment center.2. Except in medical emergencies, notifications will be made within twenty-four (24) hours of a change occurring in the resident's medical/mental condition or status.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Vistas at Bettendorf

2500 Grant Street Bettendorf, IA 52722

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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

were not signed out would be if the resident refused and she would expect the nurse to document why with different numerical codes on the TAR. Review of the facility policy titled Physician Orders, Approval Signature of Administer dated 10/13/25, directed: a. The individual administering the medication must initial

the resident's MAR on the appropriate line after administering medications.b. Topical medications used in treatments must be recorded on the resident's treatment record.c. If a drug is withheld, refused, or given at

a time other than the scheduled time, the individual administering the medication shall note in the EMAR with the appropriate code and make a progress note as to why med was not given.

Event ID:

Facility ID:

If continuation sheet