Ramsey Village

F 0677

Provide care and assistance to perform activities of daily living for any resident who is unable.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, record review, staff interview, and policy review, the facility failed to provide repositioning and incontinence care for 1 of 3 residents (#6). The facility reported a census of 69 residents.Findings include:The Minimum Data Set (MDS) dated [DATE REDACTED] for Resident #6 revealed a Brief Interview for Mental Status (BIMS) score of 02 out of 15 which indicated severely impaired cognition. It included diagnoses of renal (kidney) disease, Alzheimer's Disease, non-Alzheimer's dementia, disorder of kidney and ureter, and need for assistance with personal care. The MDS documented that the resident required supervision with eating, maximal assistance with oral and personal hygiene, bathing, upper body dressing, and rolling left and right in bed, and was dependent with all other Activities of Daily Living (ADLs) and mobility. The MDS also indicated he was always incontinent of bowel and bladder.The Care Plan dated 12/15/22 and revised 8/28/24 documented the following; the resident had bladder incontinence and used disposable briefs. 2-4 times per shift and prn and directed staff to clean peri-area with each incontinence episode. It also indicated the resident had bowel incontinence and directed staff to check the resident per schedule and assist with toileting as needed, provide a bedpan/bedside commode, and provide pericare after each incontinent episode. A revision dated 10/01/25 indicated the resident was dependent with toilet use and required 2-person assistance and a mechanical lift for all transfers. Check resident per schedule and assist with toileting as needed.During a continuous observation on 10/23/25 that began at 8:46 AM, Staff I, Certified Medication Aide (CMA) brought Resident #6 in his wheelchair to the TV lobby area after breakfast.

The resident stayed in the location where he was placed and in the same position in his wheelchair until 11:00 AM at which time Staff J, Certified Nursing Aide (CNA) transported him back to the dining room to eat lunch.Between 11:12 AM and 11:27 AM, Staffs A, B, H, J, and K, CNAs, and Staffs L, M, and N, Licensed Practical Nurse (LPN) stated they had not assisted Resident #6 for repositioning or toileting after breakfast.The Electronic Health Record (EHR) indicated the resident received bladder elimination and personal hygiene assistance on 10/23/25 at 8:52 AM and toileting transfer and toileting hygiene at 8:53 AM.At 11:30 AM, Staff O, CNA, stated she provided Resident #6's incontinence care and repositioning at 9:40 AM. She also stated Staff J and Staff K assisted her. She further stated she documents resident hygiene care after she completes it and the times documented were from before breakfast.At 2:46 PM, the Director of Nursing (DON) stated staff should've taken the resident to his room after his breakfast and performed incontinence care and repositioning.A policy titled Repositioning revised May 2013 indicated residents who are in a chair should be on an every one hour (q1 hour) repositioning schedule.

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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ramsey Village

1611 27th Street Des Moines, IA 50310

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

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

and right, maximal assistance with sit-to-lying and lying-to-sitting, and was dependent with all other mobility.

It also indicated he was always incontinent of bowel and frequently incontinent of bladder and used a wheelchair for mobility.The Care Plan revised 1/10/25 indicated Resident #5 required assistance of 2 with a mechanical lift for transfers.On 10/22/25 at 2:56 PM, Staff A, CNA and Staff E, CNA took the mechanical lift into Resident #5's room to transfer him from his recliner to his bed for incontinence care. Staff E positioned

the total body mechanical lift in front of the resident. Staff A and Staff E connected the sling to the lift. Staff E locked the wheels of the mechanical lift and raised Resident #5 off the recliner. She repositioned the lift under the bed with the legs closed, left the wheels unlocked, and lowered the resident onto his bed.At 3:12 PM, Staff E stated the total body lift wheels should be locked when lifting and lower a resident and unlocked to move them in the lift. She stated she forgot to lock the wheels when lowering him onto his bed.The manufacturer's document titled User Manual revised 5/11 indicated the total body mechanical lift's legs must be in the maximum open position and the shifter handle locked in place for optimum stability and safety. If it is necessary to close the legs of the lift to maneuver the lift under a bed, close the legs of the lift only as long as it takes to position the lift over the patient and lift the patient off the surface of the bed.

When the legs of the lift are no longer under the bed, return the legs of the lift to the maximum open position and lock the shifter handle immediately. It also indicated the manufacturer does NOT recommend locking the rear casters of the patient lift when lifting an individual. Doing so could cause the lift to tip and endanger the patient and assistants. It further indicated to ensure the legs of the lift (with patient) are in the open position and the wheelchair wheels are locked before lowering the patient into the wheelchair for transport.On 10/23/25 at 2:46 PM, the Director of Nursing (DON) stated the wheelchair wheels should be locked during all transfers and he would have to refer to the sit-to-stand mechanical lift's owner's manual.

He also stated staff should not propel residents in wheelchairs without foot pedals. He further stated staff should've opened the mechanical lift's legs once under the resident's bed if space allowed and staff should've followed the manufacturer's recommendations which state to unlock the mechanical lift's wheels when raising or lowering a resident.

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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ramsey Village

1611 27th Street Des Moines, IA 50310

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

with both residents on EBP. At 7:36 AM, Staff H exited the room with the PPE gown on and walked to another unit to get a mechanical lift. At 7:40 AM, Staff H stated both residents were on EBP due to each one had an invasive device. He stated he didn't know he wasn't supposed to exit the room wearing PPE if

he hadn't touched anything but added he should've known better.A policy titled Personal Protective Equipment - Using Gowns revised [DATE REDACTED] directed staff that gowns must be discarded in the appropriate container located in the room.On 10/23/25 at 2:46 PM, the DON stated staff should've removed the PPE

before exiting the residents' room.

Event ID:

Facility ID:

If continuation sheet