Accura Healthcare Of Pomeroy, Llc

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

any falls, Resident #2 pointed to the matt on the floor and said that they put it next to his bed. He then said I do it on purpose. He explained that he would roll out of bed on purpose and put himself on the floor so the alarm would go off and it would get their attention. When asked if there were any staff that have treated him rough, he said that there was one who grabbed his arm, mostly the right arm and said it's almost healed now. she was trying to prevent him from getting into the bathroom. He said that sometimes he would bump his arms on the side rails when they rolled him over in bed. On 8/12/25 at 8:21 AM, Staff G, CNA said that since 7/5 when Resident #2 made allegations of abuse, they started taking pictures of all new bruises. She said that there were many times that he would get combative with the staff when they provided cares and when they would report it, they were told that he just didn't like them and to step away from him. She said that there was an incident when they were transferring him with the mechanical lift, he raised his fist and hit

the arm of the lift which bruised on his hand. On 8/12/25 at 9:02 AM, Staff C, CMA said that many times Resident #2 was combative and it wasn't documented. She displayed a bruise on her leg where he slammed his wheel chair into her. On 8/12/25 at 9:13 AM Staff I, CNA said that there were many incidences

in past, that Resident #2 was combative and he hit her. She reported to Nursing and the Administrator and

she was told to just get away from him. She did not see any new interventions or documentation completed.On 8/12/25 at 11:12 AM, Staff B, CNA said that Resident #2 often had bruising on his arms, he would get agitated when the staff tried to clean him. He would report to the nurses whenever it happened.On 8/12/25 at 1:11 PM the Director of Nursing said that Resident #2 often had bruises on his arms because he would bump them on the walls and side rails of the bed. She said that they hadn't been keeping track of the bruising before the incident on 7/5/25.On 8/12/25 at 2:30 PM, the Administrator said that Resident #2 often got caught up on the hall arm rests and in doorways which caused bruising. She said that if there were incidents between residents and staff such as hitting them or running his wheel chair into them, staff should step back and there should be a behavior note in the nursing documentation. They would do an incident report if/when the resident sustained new injury.According to a facility policy dated 5/6/23 titled: Skin Management Protocol to notify the DON and wound nurse of new skin alteration and complete incident report and a skin sheet.

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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

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Accura Healthcare of Pomeroy, LLC

303 East 7th Street Pomeroy, IA 50575

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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

her room and she took her meal trays in the room as well. She said there was an agency nurse that put her cup of pills in front of her one evening and then left the room. The tray was taken back to the kitchen with

the pills and another nurse found them and brought them back to her to take.On 8/12/25 at 2:15 PM, Staff J said that it was a Sunday night when agency staff set a cup of medications for Resident #3 and it was left

on the food tray without the resident's knowledge. The kitchen staff picked up the tray and found the medications, and gave them to Staff J, she then took the medications to the resident to take.On 8/13/25 at 10:30 AM the Administrator said that they do not have any residents that have been assessed to be able to administer their own medications unsupervised. She said we don't do that here She said that the nurses should know the 5 rights of medication administration and double check during medication pass.

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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

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Accura Healthcare of Pomeroy, LLC

303 East 7th Street Pomeroy, IA 50575

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 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview and record review the facility failed to ensure that staff were orientated and trained to care for residents. Temporary nurses and Certified Nurse Aides (CNA) were expected to perform the job duties without proper training. The facility reported a census of 36 residents.Findings include: On 8/12/25 at 1:00 PM, the Administrator and the Assistant Director of Nursing (ADON) stated they had orientation checklists for agency staff. In the absence of the Director of Nursing (DON) they would look for documentation that the following temporary staff had been oriented: Staff C, CNA, Staff E, CNA, and Staff D, Registered Nurse (RN). In an observation on 8/12/25 at 1:10 PM, Staff L, CNA was assisting residents with transfers too and from their rooms. Staff L said that she was with a staffing agency it was her second day at this facility. The last time she worked at this facility was 6 months previous. She said that she did not get an orientation, and she didn't remember any education checklists offered to her before she worked independently with the residents.On 8/12/25 at 10:05 AM, Staff E, CNA said that she worked the overnight shift on the previous Sunday, and it was a difficult night because she was the only aide on floor. She had worked several other shifts at this facility and she tried to transfer Resident #2 without the use of the mechanical lift because he told her that he could stand. When she found that he wasn't standing, she lowered him back down onto the bed. Staff E said that she did not get an orientation or education before

she worked independently with the residents. On 8/12/25 at 10:14 AM, Staff M, CNA said that she worked

the overnight shifts and she did not get any orientation or education. She said that she knew how to transfer residents and provide cares because she was a CNA for a long time.On 8/12/25 at 10:23 AM, Staff D, RN said that she usually worked the weekends at this facility. She said when she first started she was expected to come in an hour early and another nurse showed her around the building. She did not remember getting

a complete orientation or a signed checklist.On 8/12 at 9:45 AM, Resident #5 was in her wheel chair in the dayroom. She had bruising on her left arm and said it was from a recent hospitalization. She said that she was on dialysis and was feeling much better. The resident said that she was concerned about good staff that were leaving and the temporary aides don't know what they are doing. She said that on that morning,

she had to explain to the CNA how to help her with her catheter and toileting needs.On 8/13/25 at 11:00 AM, the Administration said that many orientation checklists were on the DON's desk except for the 3 staff that were requested.A form titled: Agency Staff Checklist indicated that the following items would be included in orientation:a. Facility layout with tourb. Shift routine/general duties. Resident care, mechanical lifts, documentation, narcotic count, medication deliveries, change in condition guidelines, 24 hour report, Pocket Care Plans, Medication administrationc. Communication; Door alarms, telephone use, walkie use,d.

Abuse Policy; what to report and whene. Resident Incident Reports; falls, skin protocol, medication errors, deathf. Emergencies; physician contacts, hospital contactsg. Emergency Procedures: fire, weather, elopement, leave of absence, emergency carth. DON notificationi. Concern [NAME] signing, staff acknowledged that they had received training for all of the above guidelines and information to perform the job. The orientation was not intended to cover every situation which may arise while on assignment but was

a general guideline.

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