Chautauqua Guest Home #2
Inspection Findings
F-Tag F0697
F 0697 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
facility's follow-up request to the physician for pain control determined Staff E cared for Resident #14 on the evening shift of 9/15/25, she charted Resident #14 had pain and facial grimacing. She reported she didn't contact the provider because after they assisted Resident #14 to bed and repositioned her for comfort, she was comfortable and slept until the end of her shift (10:00 PM). In addition, Staff F sent Resident #14 to the ER. Staff F reported she didn't contact the provider at the beginning of her shift because she slept comfortably until about 2:30 AM. At that time her alarm went off because a pillow fell and triggered the alarm. Staff F explained she noted congestion and began an assessment for respiratory status. Her full assessment triggered her to contact the provider and Resident #14 agreed to go to the ER for evaluation.During an interview on 9/18/25 at 1:02 PM the Administrator explained if a resident complained of pain, typically the nurse would try PRN pain medicine and alternative interventions such as massage, a change in environment, and change in position. If none of the interventions worked, then the facility should notify the doctor.The undated Incident Reports policy instructed the following:a. When an incident occurred,
the staff would notify the charge nurse, complete an appropriate assessment of the resident and document their findings. The nurse would then notify the attending physician and family. Notification can be in person, by telephone, through fax, and/or envelope delivery. The Charge Nurse would initiate the incident report and complete it as described on the form. When the nurse completed the form, they must turn it in to the nurse manager.b. At any time, professional nurses may analyze and initiate nursing interventions that could prevent a recurrence of the incident. The nurse manager will formally complete this analysis and document any necessary actions prior to turning the completed form into administration. This includes the provision of first aid and documenting actions completed.The undated Pain Protocol Policy directed the facility to ensure any residents with pain receive proactive care to alleviate or minimize pain through the collaborative efforts of the interdisciplinary health care team including the attending physician. The policy listed the following:a.
Pain indicators i. Verbalization of pain ii. Increase in agitation iii. Thrashing type behaviors/restlessness iv.
Combativeness v. Change in level of consciousness/lethargyb. Non-medicinal methods of relieving pain i.
Application of hot/cold ii. Massage therapy iii. Relaxation exercises, guided breathing iv. Social services counseling v. Isolation/stimulation vi. Light/Dark vii. Oxygen therapy viii. Reposition, body supports, immobilizations ix. Physical Therapy interventions
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If continuation sheet
F-Tag F0812
Federal health inspectors cited Chautauqua Guest Home #2 in Charles City, IA for a deficiency under regulatory tag F-F0812 during a standard health inspection conducted on 2025-09-18.
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 2 deficiencies cited during this inspection of Chautauqua Guest Home #2.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-15.
Chautauqua Guest Home #2 in Charles City, 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 Charles City, 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 Chautauqua Guest Home #2 or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.