Northbrook Healthcare And Rehabilitation Center

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

On 8/12/2025 at 8:05 AM, during an interview, Resident #58 reported he did not like the signs posted in his room and walker to use the call light and ask for help. Resident #58 reported the signs were irritating and insulting to his intelligence. Resident #58 explained he had a couple falls back to back last week, one at night and one in the morning. After the falls, Resident #58 described staff as giving him heck and then putting the signs in his room without asking if it was okay. Resident #58 reported he had to go to the bathroom and used his call light prior to each of the falls. Resident #58 explained staff did not respond for about one hour, he got tired of waiting, got up and fell.

Review of Progress Notes, titled Nurses Note Narrative, dated 8/5/25 at 5:58 AM and 8/5/25 at 4:05 PM, Resident #58 had falls in relation to trying to use the bathroom in his room. A Nurses Note Narrative, dated 8/9/25, included documentation the resident was found sitting on the floor in front of the toilet in his room.

Resident #58 was noted to be continent and reported he lost his footing while entering the bathroom. The Progress Notes lacked documentation facility staff discussed changes to the care plan with either the resident or resident's representative to include the interventions of signs.

On 8/13/2025 at 11:13 AM, Staff N, Certified Nurses Aide (CNA), reported Resident #58 did not like to wait when he needed to use the bathroom. When asked by the surveyor if Resident #58 had complained about

the signs in his room, Staff N reported Resident #58 did say something the other day after falling about the signs. Staff N reported Resident #58 said that if he had to go, he was going to get up and go no matter what the signs told him.

Facility staff failed to consider the dignity and response of the resident when posting signs in the resident room.

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

08/14/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northbrook Healthcare and Rehabilitation Center

6420 Council Street NE Cedar Rapids, IA 52402

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)

Federal health inspectors cited Northbrook Healthcare and Rehabilitation Center in Cedar Rapids, IA for a deficiency under regulatory tag F-F0640 during a standard health inspection conducted on 2025-08-14.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 13 deficiencies cited during this inspection of Northbrook Healthcare and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-10.

Federal health inspectors cited Northbrook Healthcare and Rehabilitation Center in Cedar Rapids, IA for a deficiency under regulatory tag F-F0658 during a standard health inspection conducted on 2025-08-14.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Ensure services provided by the nursing facility meet professional standards of quality.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 13 deficiencies cited during this inspection of Northbrook Healthcare and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-10.

Federal health inspectors cited Northbrook Healthcare and Rehabilitation Center in Cedar Rapids, IA for a deficiency under regulatory tag F-F0679 during a standard health inspection conducted on 2025-08-14.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide activities to meet all resident's needs.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 13 deficiencies cited during this inspection of Northbrook Healthcare and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-10.

F 0684

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or potential for actual harm

Based on clincal record review, staff interview and policy review the facility failed to complete an assessment for 1 of 4 residents (Resident #96) reviewed for hospitalizations. The facility reported a census of 85 residents. Findings include: Progress Notes written on 6/3/25 at 4:28 PM document Resident #96 readmitted to the facility following cholecystitis (inflammation of the gallbladder), sepsis (sepsis happens when an infection you already have triggers a chain reaction throughout the body. It is a life threatening, medical emergency per the Center for Disease Control (CDC)), and septic shock (a severe form of sepsis characterized by dangerously low blood pressure and abnormalities in cellular and metabolic function). The clinical record lacked a physical assessment or vital signs on 6/3 and 6/4. The pre-dialysis assessment completed on 6/5 included vitals of Temperature 97.2 Fahrenheit (F), Pulse 88, Respirations 16, Blood Pressure (BP) 96/56 and oxygen saturation (O2 Sat) of 88%. The post-dialysis assessment completed on 6/5 included vitals of Temperature 98.7 F, Pulse 80, Respirations 18, BP 124/80 and O2 Sat of 98%. The clinical record lacked a physical assessment on 6/5. The clinical record lacked a physical assessment or vital signs on 6/6. The pre and post dialysis assessments on 6/7 lacked vital signs. The clinical record did include a temperature of 97.7 F. The clinical record lacked vital signs on 6/8 and 6/9. The clinical record lacked a physical assessment on 6/7 and 6/8. Progress Note written on 6/8/25 at 1:30 PM documented the resident had picked a scab and staff were unable to stop the bleeding. The nurse completed the dressing change to the resident's legs that started bleeding and running down her leg. The resident was sent to the Emergency Department (ED). The clinical record lacked documentation of the resident returning from the ED, vitals or physical assessment upon return. Progress Note written on 6/9/25 at 11:36 AM documented

the resident had copious amounts of drainage from bilateral leg wounds. She had poor circulation to all extremities, fingers and toes purple and cold and difficulty in getting an O2 sat reading. Progress Note written on 6/9/25 at 3:39 PM documented the resident was to be admitted to the hospital per her cardiologist. There were no vital signs documented on 6/9. Progress Note written on 6/10/25 at 12:20 AM documented the resident was admitted to the hospital with diagnosis including sepsis. During an interview

on 8/13/2025 at 12:54 PM, the Director of Nursing (DON) explained the resident went out and came back in less than 24 hours so didn't require a full admission assessment on 8/13/25. The DON was unable to locate vital signs or an assessment. At 1:00 PM, the DON reported she would have to ask the Assistant Director of Nursing (ADON) as she was able to locate information in the electronic health record better than I can.

On 8/14/25 at 9:57 AM the DON and ADON were unable to provide and additional documentation of vital signs or physical assessments. The undated facility policy titled Change in Condition Protocol directs staff to evaluate the resident's condition when a change from baseline is observed, complete a full assessment and document in Point Click Care (PCC), and every shift is required to perform and document vitals and a focused assessment. The policy further directs staff that there are no exceptions to this requirement.

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

08/14/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northbrook Healthcare and Rehabilitation Center

6420 Council Street NE Cedar Rapids, IA 52402

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 0689

missing foot pedals and she thought residents needed bags for them on the back of their chairs.

Level of Harm - Minimal harm or potential for actual harm

1. 3. The MDS for Resident #101 dated 5/27/25 (3 days after his fall) revealed diagnoses of cancer, hip

fracture and other fracture (rib), and malnutrition. The BIMS documented a score of 15/15 which indicated intact cognition. Section GG indicated the resident experienced functional limitation in range of motion in one lower extremity and used a walker with supervision or touch assistance.

Residents Affected - Few

The baseline Care Plan (CP) for the resident dated 5/20/25 indicated the resident needed physical, occupational, and speech therapies. It documented a history of falls and fall related injuries of right femur fracture and rib fractures. It listed the resident used a walker and wheelchair.

A document titled Physical Therapy Treatment Encounter Notes, date of service 5/26/25, documented Resident #101 was weight bearing as tolerated and contact guard staff assist with a four wheel walker for toilet transfers during the session.

A Progress Note titled admission Follow-up Note dated 5/25/25 at 12:14 AM documented the resident was found on the floor next to his bed with his back against the bed and his legs out in front of him. He stated he was going from the chair to the bed when his walker collapsed and he fell. The resident told staff he had permission from therapy to transfer in his room. The note further documented staff obtained a different walker for the resident as he was correct in stating the walker collapsed. The writer noted the walker was in poor condition and had screws missing that would keep the walker working properly. The Assistant Director of Nursing (ADON) was notified.

On 8/14/2025 at 8:36 AM the Director of Nursing (DON) reported the Assistant Director of Nursing (ADON) was responsible for monitoring cleaning of equipment and ensuring staff monitored it for safety.

During an interview with the ADON on 8/14/2025 at 9:54 AM she reported when she thought about the walker, she recalled one of the sides didn't have something right about it and it was discussed in a morning meeting. She stated the restorative aide would have been responsible for checking the walker and it should have been repaired or out of service if not safe. She said she would need to continue to work with the new restorative aide to monitor things like that.

On 8/14/2025 at 10:21 AM the Administrator stated she thought the documentation had been over-exaggerated. She recalled the walker was disposed of and discussed that morning in a quality assurance meeting. The restorative aide participated and staff were told to double and triple check equipment for safety after the incident. She also asked maintenance and therapy to look into it.

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

08/14/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northbrook Healthcare and Rehabilitation Center

6420 Council Street NE Cedar Rapids, IA 52402

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)

Federal health inspectors cited Northbrook Healthcare and Rehabilitation Center in Cedar Rapids, IA for a deficiency under regulatory tag F-F0690 during a standard health inspection conducted on 2025-08-14.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 13 deficiencies cited during this inspection of Northbrook Healthcare and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-10.

Federal health inspectors cited Northbrook Healthcare and Rehabilitation Center in Cedar Rapids, IA for a deficiency under regulatory tag F-F0693 during a standard health inspection conducted on 2025-08-14.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 13 deficiencies cited during this inspection of Northbrook Healthcare and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-10.

F 0725

bathroom but because she had to wait an hour, she just went by herself.

Level of Harm - Minimal harm or potential for actual harm

On 8/13/25 at 4:38 p.m., the Director of Nursing (DON) stated she expected staff to answer call lights within 10 minutes or at least enter the room to touch base with the resident and tell them they would be back. She stated they had a lot of residents which required the assistance of two staff so it could take a minute.

Residents Affected - Some

On 8/13/25 at 5:05 p.m., the Administrator stated staff should answer call lights in a timely manner and they added more staff.

1. 6. The MDS assessment for Resident #58, dated 7/11/25, identified the resident had diagnoses of heart

failure, repeated falls and difficulty in walking. The MDS assessment revealed a BIMS score of 5 (indicative of severe cognitive impairment) and assessed the resident was dependent on staff for toileting, lower body dressing, mobility and transfers.

The Care Plan, last revised 8/12/25, revealed Resident #58 required assistance by staff with a walker for toileting, ambulation, and transfers. The resident required assistance of staff for dressing and personal hygiene.

On 8/12/2025 at 8:05 AM, during an interview, Resident #58 reported he had to wait to get up for up to hour

in the mornings, because he was waiting on help from staff. Resident #58 reported it (waiting to get up in

the morning) happened frequently; he explained waiting to get up happened a couple times a week.

Resident #58 reported going to the bathroom was the main issue. The resident reported he had a couple falls back to back last week, one at night and one in the morning. Resident #58 reported he had to go to the bathroom and used his call light prior to each of the falls. Resident #58 explained staff did not respond for about one hour, he got tired of waiting, got up and fell.

Review of Progress Notes, titled Nurses Note Narrative, dated 8/5/25 at 5:58 AM and 8/5/25 at 4:05 PM, Resident #58 had falls in relation to trying to use the bathroom in his room. A Nurses Note Narrative, dated 8/9/25, included documentation the resident was found sitting on the floor in front of the toilet in his room.

Resident #58 was noted to be continent and reported he lost his footing while entering the bathroom.

On 8/13/25 at 11:05 AM, Staff B, CNA, explained the morning time was the busiest time at the nursing home. Staff B reported she had one other CNA working the hall she was on. Staff B reported there were a few times residents had to wait longer than 30 minutes for their call light to be answered.

On 8/13/2025 at 11:13 AM, Staff N, CNA, reported Resident #58 did not like to wait when he needed to use

the bathroom. Staff N reported the residents usually did not have to wait longer than minutes. Staff N reported the morning time was busiest with trying to get resident's up for the day.

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

08/14/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northbrook Healthcare and Rehabilitation Center

6420 Council Street NE Cedar Rapids, IA 52402

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)

Federal health inspectors cited Northbrook Healthcare and Rehabilitation Center in Cedar Rapids, IA for a deficiency under regulatory tag F-F0812 during a standard health inspection conducted on 2025-08-14.

Category: Nutrition and Dietary Deficiencies

The facility was found deficient in the following area: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 13 deficiencies cited during this inspection of Northbrook Healthcare and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-10.

Federal health inspectors cited Northbrook Healthcare and Rehabilitation Center in Cedar Rapids, IA for a deficiency under regulatory tag F-F0847 during a standard health inspection conducted on 2025-08-14.

Category: Administration Deficiencies

The facility was found deficient in the following area: Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 13 deficiencies cited during this inspection of Northbrook Healthcare and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-10.

Federal health inspectors cited Northbrook Healthcare and Rehabilitation Center in Cedar Rapids, IA for a deficiency under regulatory tag F-F0880 during a standard health inspection conducted on 2025-08-14.

Category: Infection Control Deficiencies

The facility was found deficient in the following area: Provide and implement an infection prevention and control program.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 13 deficiencies cited during this inspection of Northbrook Healthcare and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-10.

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

cleaned by a certain time in the morning, but it might be afternoon before she got to them. Staff Q reported

she had heard residents complain of not getting their bathrooms cleaned. Staff Q reported being off this last weekend and had not received a complaint about the bathroom from Resident #7. Staff Q reported facility staff had been in the process of cleaning and replacing screens for months. Staff Q was aware there were missing and bent window screens. Staff Q reported Resident #17 was correct that housekeeping staff were cleaning the screens and her window screen got bent by housekeeping.

On 8/14/2025 at 8:12 AM, Staff R, housekeeping, reported she had heard complaints from residents about their toilets not getting cleaned. Staff R reported she cleaned Resident #7's toilet on Monday and the resident did not complain to her about staff not cleaning it for three days.

On 8/14/25 at approximately 9:00 AM, the Housekeeping Manager provided an audit of window screens and window cleaning and replacement. Housekeeping staff documented they last cleaned Resident #17's windows and screens on 6/23/25.

On 8/14/25 at 11:00 AM, during an interview, the Administrator reported they had been working on a facility wide project to replace window screens for the last several months. The Administrator reported being unaware of outlet issue in Resident #7's room. The Administrator contacted maintenance to repair the outlets immediately.

Review of the undated facility policy, titled Housekeeping Daily Tasks, revealed directions to housekeeping staff to clean residents toilets daily.

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

Event ID:

Facility ID:

If continuation sheet