Accura Healthcare Of Carroll

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

revealed that she radioed for help. Staff A revealed that a nurse came to the room and four staff members utilized a full body mechanical lift with a sling to transfer Resident #1 to a motorized wheelchair. Staff A revealed that Resident #1 was not complaining of any pain except for a little pain to a toe. Staff A revealed that Resident #1 did not complain of any pain in the ankle until later in the day. Interview 10/15/25 at 9:17 AM with Staff C CNA revealed that she was called to Resident #1's room for assistance after the incident.

Staff C revealed that when she entered the room Resident #1 was laying on the floor on her stomach. Staff C revealed that there were a couple of nurses and CNAs already present in the room when she arrived.

Staff C revealed that she obtained the full body mechanical lift and sling and helped reposition Resident #1 onto her back after the nurse completed an assessment. Staff C revealed that Resident #1 was complaining of toe pain at the time. Staff C revealed that Resident #1 was moving her feet around, and did have shoes

on at that time. Staff C then revealed that Resident #1 was an assist of one with a gait belt and four wheeled walker for transfers. Interview 10/15/25 at 9:27 AM with Staff D Licensed Practical Nurse (LPN) revealed that she was called to Resident #1's room after the incident by Staff A on the walkie system. Staff D revealed that Resident #1 was laying on the floor on her stomach when she entered the room. Staff D then revealed that she assessed Resident #1 while she was on the floor. Staff D then revealed that Resident #1 was complaining of ankle and toe pain, but was not complaining of hip or leg pain. Staff D revealed that Resident #1 stated she slipped out of bed first, and then stated that she had a jerky moment and fell. Staff D revealed that staff helped assist Resident #1 to her back, and then Staff D assessed more.

Staff D revealed that Resident #1 did not complain of pain once staff rolled her to her back. Staff D then revealed that the staff in the room then utilized a full body mechanical lift with a sling to transfer Resident #1 to her mechanical wheelchair per Resident #1 not wanting to go back to bed. Staff D then revealed that Resident #1 was complaining about pain to the right ankle. Staff D then revealed that Resident #1 did have

a normal range of motion with no facial grimacing or pain noted. Staff D revealed that Resident #1 is obese and has lymphedema so there was no swelling or bruising that Staff D could tell. Staff D revealed that Resident #1 stated she was okay until later in the afternoon, and this is when Resident #1 was complaining of pain more. Staff D then revealed that she had Resident #1 sent to the hospital at this time for an x-ray.

Interview 10/15/25 at 9:47 AM with Staff B revealed that she was called into the room after Resident #1 fell.

Staff B revealed that when she arrived Resident #1 was laying face down on the floor. Staff B then revealed that Resident #1 always has her shoes on before a transfer. Staff B then revealed that all staff in the room assisted Resident #1 with a full body mechanical lift and sling to Resident #1's wheelchair after the nurse assessed Resident #1. Staff B revealed that Resident #1 did not complain of any pain until after she was transferred to the wheelchair. Staff B then revealed that Resident #1 was a transfer assist with one staff with

a gait belt and four wheeled walker. Staff B further revealed that Resident #1 was to have two staff in the room at all times for cares related to false allegations. Review of a facility provided document titled, Comprehensive Care Plans dated April 2025 documented:a. The comprehensive care plan will be reviewed and revised by the interdisciplinary team after each comprehensive and quarterly MDS assessment.

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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

10/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Accura Healthcare of Carroll

2241 North West Street Carroll, IA 51401

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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, resident interview, staff interview, and policy review the facility failed to provide nursing staff to assure residents safety by not responding to call lights in a timely manner. The facility reported a census of 47 residents.Findings include: 1. Review of Resident #1's Minimum Data Set (MDS) dated [DATE REDACTED] revealed a Brief Interview for Mental Status (BIMS) score of 15 indicating intact cognition. The MDS further revealed diagnoses of heart failure, renal insufficiency, diabetes mellitus, hyperlipidemia, and morbid obesity. Interview 10/14/25 at 10:30 AM with Resident #1 revealed that call lights take longer than 15 minutes often, especially on the evenings and weekends. 2. Review of Resident #2's MDS dated [DATE REDACTED] revealed a BIMS score of 15 indicating intact cognition. The MDS further revealed diagnoses of diabetes mellitus, hyperlipidemia, anxiety disorder, respiratory failure, post polio syndrome, and morbid obesity.

Interview 10/14/25 at 2:05 PM with Resident #5 revealed call lights take over 15 minutes in the mornings, and the weekends often. 3. Review of Resident #4's MDS dated [DATE REDACTED] revealed a BIMS score of 14 indicating intact cognition. The MDS further revealed diagnoses of hyperlipidemia, arthritis, hip fracture, osteoporosis, and need for assistance with personal care. Interview 10/14/25 at 1:49 PM with Resident #4 revealed call lights often take over 15 minutes, and it always feels like the facility is short staffed. 4. Review of Resident #5's MDS dated [DATE REDACTED] revealed a BIMS score of 12 indicating moderate cognitive impairment.

The MDS further revealed diagnosis of cirrhosis, diabetes mellitus, anxiety disorder, and bipolar disorder.

Interview 10/14/25 at 1:55 PM with Resident #5 revealed that he feels that there is not enough staff on the pm shift or on the weekends, and call lights can take longer than 15 minutes at a time.Interview 10/15/25 at 8:20 AM with the Director of Nursing (DON) revealed that call lights are an issue, and the facility is working

on getting them better. The DON provided the call light log with response times up to 39 minutes. The DON then revealed that her expectation is for call lights to be answered in 15 minutes or less.Review of a facility provided document titled, Building Escalation Hourly Summary Report, dated 10/9/25 through 10/15/25 revealed call light response times ranging from 16 minutes in length to 39 minutes on multiple occasions.

Follow up interview 10/15/25 at 9:40 AM with the DON revealed that the facility does not have a call light policy, and that the facility just follows the standards of care.

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