Laurens Care Center

F 0561 Level of Harm - Minimal harm or potential for actual harm

#4, and then she left suddenly. She assumed this was taken care of. She did not realize they still did not have VA meds. They still needed to get his meds through the VA. The Administrator admitted with the staff changes this had been missed. She planned to take the paperwork to the clinic.

Residents Affected - Few

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

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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

10/08/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Laurens Care Center

304 East Veterans Road Laurens, IA 50554

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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

meals and he liked to watch TV. She knew about incidents that had occurred.On 10/7/25 at 12:50 p.m. Staff B CNA stated Resident #1 was probably in his room or in the hallway prior to the incident occurring. She said she was not in the CNA room, she was outside holding the door open when she looked over and saw Resident #1 in the family room. She said he would have had to have slipped in through the first doors that are on his hall for her not to have seen him. Staff B said the doors were not closed. She said unless he opened the doors himself and got in, but she did not feel that he would be able to do that without slipping out of his wheelchair. She did not hear the doorbell. She said they were still doing the 15 minute checks, and they tried to watch him if he was out of his room, but they couldn't watch him 24/7.On 10/8/25 8:05 a.m.

Staff G CNA (last day of work 9/24/25) stated she did witness the incident in late May and she walked up

the 100 hall to the dining room and she saw Resident #1 with his hand in Resident #3's lap and the other hand under her shirt. She immediately moved the resident's apart. She said as soon as she got them apart

she notified nurse on duty about what had happened, and the nurse took over from there. She said the nurse called dispatch for the police and they had to talk to them about the situation. She said after they put Resident #1 on 15 minute checks, and if he was out of his room they tried to keep an eye on him to make sure he wasn't getting close to any female resident. She thought that was working fairly well.On 10/8/25 at 9:15 a.m. the Administrator stated if they had known Resident #1 had these kind of behaviors they would have considered carefully whether they would have taken him. And after the first incident and they got Interventions in place he had the second incident. They put the 15 minute checks in place. She said she wasn't for sure when the doorbell started. When she did the report to state and then the follow up she had written on the timeline that they hadn't had to start it yet. But they had set it up and she found out later that

it had been put in place. The doorbell was above his door frame so when they went in or out it sounded in

the nurses station. If there was nurse in there the door was usually open. It was unusual for them to have it shut if they were in there, except when they needed to discuss confidential information. She said they had done so much to try and prevent this from happening again, and then it happened the third time. She said

they couldn't make him stay in his room all the time, he still had rights also. She struggled with how they could prevent this with their current situation. They had increased some staffing. They have an afternoon activity person who comes in and is in the front area around the living area so if Resident #1 wanted to be out for activities, she's there to supervise, and also for some of the other residents that need some things to do. She had contacted the ombudsman and the healthcare association to see if they had any ideas that might help with their current situation.The facility Abuse Prevention, Identification, Investigation, and Reporting Policy revised 4/18/17 documented Residents must not be subjected to abuse by anyone, including, but not limited to, facility staff, other residents, consultants or volunteers, staff of other agencies serving the resident, family members or legal guardians, friends, or other individuals. Sexual abuse was non-consensual sexual contact of any type with a resident. Resident-to-resident sexual harassment, sexual coercion, or sexual assault is also considered abuse. The facility would presume that instances of abuse cause physical harm, or pain or mental anguish in residents with cognitive and/or physical impairments which may result in a resident unable to communicate physical harm, pain or mental anguish, in the absence of evidence to the contrary.

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