Traditions Memory Care Of Newton

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

stated she slapped the other residents. She stated she was on 15 minute checks currently but she was able to get into other resident rooms without them knowing. On 10/28/25 at 9:20 a.m., Staff G CNA stated the facility did not have enough staff to keep an eye on Resident #1 at all times.On 10/28/25 at 9:27 a.m., the Director of Nursing(DON) stated Resident #1 had a 30 second switch and could go from saying she loved her to calling her vulgar names. She went into other resident's rooms and if they became agitated, she became agitated and would hit. She stated they carried out numerous medication changes and stated one

on one supervision may agitate her more. She stated if she was not on one on one supervision, there was no guarantee(she wouldn't physically lash out at staff again). She stated the sent out referrals to other smaller facilities which may suit her better. On 10/28/25 at 12:23 p.m., the MDS Coordinator, was queried as to if there were any interventions which kept the resident out of other resident rooms. She stated this would be staff watching her but stated one on one supervision was probably not an option staffing wise.

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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

10/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Traditions Memory Care of Newton

2130 West 18th Street South Newton, IA 50208

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

BIMS score as 13 out of 15, indicating intact cognition. Care Plan entries, dated 10/11/23, stated the resident had altered thought processes/cognition related to Alzheimer's dementia and directed staff to reassure the resident to decrease frustration. A 10/17/25 Health Status Note stated on 10/16/25 at 1:15 p.m. Resident #1 entered Resident #7's room and Resident #7 reported that Resident #1 hit her on the head. Staff then witnessed Resident #7 hit Resident #1. d. Resident #1 and Resident #2 The MDS assessment tool, dated 9/22/25, listed diagnoses for Resident #2 which included Alzheimer's disease, non-Alzheimer's dementia, and psychotic disorder. The MDS listed the resident's BIMS score as 4 out of 15, indicating severely impaired cognition. A 1/27/25 Care Plan entry directed staff to reassure the resident to decrease frustration. A 6/16/25 Care Plan entry stated the resident had altered thought processes/cognition related to Alzheimer's Dementia with behavioral disturbances, generalized anxiety disorder, delusional disorders, and major depressive disorder. A 10/16/25 Health Status Note stated the resident sat in the dining room and Resident #1 came up to him and hit him on the right shoulder area. A 10/16/25 Physical Aggression Initiated form stated a nurse gently placed her hand on the resident (Resident #1) for her to come and the resident immediately stood up, jerked away from the nurse, turned to face the other resident (Resident #2), and took her right hand and hit the other resident's right shoulder.

The nurse was unable to intervene in time as a dining room chair was between the resident and the nurse.

A 10/19/25 Health Status Note stated Resident #1 hit Resident #2 on the right shoulder. On 10/27/25 at 10:44 a.m., Staff A Hospice Social Worker walked in the hall with Resident #1. Staff A stated she visited 1-2 times per week and was worried about other residents so kept an eye on Resident #1. On 10/27/25 at 3:52 p.m. via phone, Staff B Registered Nurse (RN) stated Resident #1 went in and out of other resident rooms and she observed Resident #1 hit Resident #2. She stated they tried to keep her one on one with staff when they had staff to do this. On 10/27/25 at 4:01 p.m. via phone, Staff C Certified Nursing Assistant (CMA) stated she observed Resident #1 slap the back of Resident #2's shoulder. She stated Resident #1 was all over all of the time and hard to redirect. She stated they kept an eye out for her when she was up and awake but thought it was impossible for them to care for her and her behaviors. She stated she did not think it was possible to prevent her from physically lashing out. On 10/28/25 at 8:22 a.m., Staff D Licensed Practical Nurse (LPN) stated Resident #1 was constantly moving and didn't rest. She stated none of her medications were effective. She stated when they went towards her, she started swinging and hitting people. She stated there was not enough staff to watch her and when asked if she thought the other residents were safe from Resident #1, she said no. On 10/28/25 at 8:47 a.m., Staff E LPN stated the resident was not on one-on-one supervision and she roamed all over and they tried to keep an eye on her.

She stated it was not possible for them to prevent her from going in other rooms and stated she did not feel

this was the facility for her. On 10/28/25 at 9:10 a.m., Staff F CNA stated Resident #1 was very mean to other residents and sometimes aggressive. She stated she slapped the other residents. She stated she was

on 15-minute checks currently but she was able to get into other resident rooms without them knowing. On 10/28/25 at 9:20 a.m., Staff G CNA stated the facility did not have enough staff to keep an eye on Resident #1 at all times. On 10/28/25 at 9:27 a.m., the Director of Nursing (DON) stated Resident #1 had a 30 second switch and could go from saying she loved her to calling her vulgar names. She went into other resident's rooms and if they became agitated, she became agitated and would hit. She stated they carried out numerous medication changes and stated one on one supervision may agitate her more. She stated if

she was not on one-on-one supervision, there was no guarantee (she wouldn't physically lash out at staff again). She stated the sent-out referrals to other smaller facilities which may suit her better.

Event ID:

Facility ID:

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