Accura Healthcare Of Creston

F 0658

Ensure services provided by the nursing facility meet professional standards of quality.

Level of Harm - Minimal harm or potential for actual harm

Based on clinical record review, resident and staff interviews, and policy review, the facility failed to follow

the physician's orders for 1 of 3 residents (#1). The facility reported a census of 21 residents. Findings include:The Minimum Data Set (MDS) for Resident #1 dated 8/06/25 revealed a Brief Interview for Mental Status (BIMS) score of 11 out of 15 which indicated moderately impaired cognition. It included diagnoses of chronic obstructive pulmonary disease (COPD), anxiety, depression, cerebrovascular accident (stroke) with right side hemiplegia (paralysis), aphasia (inability to speak), and dysphagia (difficulty swallowing). It indicated the resident required setup assistance with eating, moderate assistance with oral hygiene, maximal assistance with toileting hygiene, upper body dressing, and personal hygiene and all mobility, and was dependent with bathing, lower body dressing, and footwear. It also indicated the resident had a feeding tube and more than 50% of his total caloric intake was provided by tube feeding but the resident did not experience coughing or choking when swallowing medications.The Electronic Health Record (EHR) included a physician's order dated 5/13/25 which indicated staff may crush medications and slurry/cocktail meds if appropriate and administer every shift for medication administration.The Care Plan revised 11/26/24 directed staff to administer the resident's medications as ordered.The October Medication Administration Record (MAR) confirmed the resident did not receive his scheduled evening medications on 10/24/25 and directed the reader to see Progress Notes.The Progress Notes dated 10/24/25 indicated seven (7) of the resident's scheduled evening medications were not done because the nurse could not access the G-tube (PEG tube <Percutaneous Endoscopic Gastrostomy> - a feeding tube surgically inserted directly into the stomach).On 10/30/25 at 5:35 am, Staff A, Registered Nurse (RN) stated he could not give Resident #1 his medications because he could not access Resident's #1's G-tube. He also stated

he charted against them because he did not feel Resident #1 would miss any nighttime medications that would be detrimental.On 10/30/25 at 9:00 am, Resident #1 indicated he didn't receive his nighttime medications on 10/24/25.On 10/30/25 at 11:18 am, the Director of Nursing (DON) stated staff should have contacted the on-call nurse and escalated the situation higher if needed.On 10/30/25 at 12:21 pm, the Administrator indicated the facility did not have a policy regarding following physician's orders.

Residents Affected - Few

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

10/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Accura Healthcare of Creston

1000 East Howard Creston, IA 50801

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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

also confirmed he notified Staff B of his pain when she began feeding him through his tube on 10/25/25.On 10/30/25 at 9:37 am, Staff B stated she continued feeding the resident after his complaints of pain because

she thought he had not eaten enough during previous shifts and his pain was potentially due to hunger.

She said she had no idea what his squirmy reaction was for but she knew patients were sometimes tender

after surgeries. She stated based on his reaction, she didn't know whether to stop or finish because she didn't know if it was pain or hunger.On 10/30/25 at 10:20 am, the DON stated the piston syringes would have fit the resident's feeding tube. An observation of the accessible piston syringes and the resident's feeding tube revealed the syringes would have functioned in administering the resident's medications.On 10/30/25 at 11:18 am, the DON stated Staff A should have called the on-call nurse regarding the inability to access the resident's feeding tube and escalated it as needed. She also stated Staff B should have stopped

the action and contacted the DON.An undated policy titled Care and Treatment of Feeding Tubes indicated

the facility policy is to utilize feeding tubes in accordance with current clinical standards of practice, with interventions to prevent complications to the extent possible.

Event ID:

Facility ID:

If continuation sheet