Shell Rock Senior Living
Inspection Findings
F-Tag F0637
Federal health inspectors cited Shell Rock Senior Living in Shell Rock, IA for a deficiency under regulatory tag F-F0637 during a standard health inspection conducted on 2025-09-04.
Category: Resident Assessment and Care Planning Deficiencies
The facility was found deficient in the following area: Assess the resident when there is a significant change in condition
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of Shell Rock Senior Living.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-22.
F-Tag F0692
Federal health inspectors cited Shell Rock Senior Living in Shell Rock, IA for a deficiency under regulatory tag F-F0692 during a standard health inspection conducted on 2025-09-04.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Provide enough food/fluids to maintain a resident's health.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of Shell Rock Senior Living.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-22.
F-Tag F0732
Federal health inspectors cited Shell Rock Senior Living in Shell Rock, IA for a deficiency under regulatory tag F-F0732 during a standard health inspection conducted on 2025-09-04.
Category: Nursing and Physician Services Deficiencies
The facility was found deficient in the following area: Post nurse staffing information every day.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of Shell Rock Senior Living.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-22.
F-Tag F0803
F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Based on record review, observation, staff interview, and policy review the facility failed to provide the correct portion size of 8 ounce (oz.) of chicken and pasta alfredo for 32 of 34 residents during a meal
observation on 9/3/25 at the noon meal service. The facility reported a census of 34 residents. Findings include:The facility's menu for the noon meal on 9/3/25 titled, Week 2 Wednesday, dated 5/14/25 instructed to provide 8 oz. of chicken and pasta alfredo. During an observation of the noon meal service on 9/3/25 from 11:55 AM to 12:55 AM, Staff D, Cook, used a 6 oz. scoop instead of an 8 oz. scoop as the menu directed for serving 32 servings of chicken and pasta alfredo. During an interview on 9/3/25 at 12:53 PM
the Dietary Manager reported they provided a heaping 6 oz. scoop of the chicken and pasta alfredo to all residents instead of using an 8 oz. scoop as they didn't have 8 oz scoops in the facility and needed to order more. She explained she told Staff D he should use 2, four (4) oz. scoops, but he didn't. During an interview
on 9/3/25 at 12:55 PM Staff D said he used a 6 oz. scoop of chicken and pasta alfredo instead of the 8 oz. scoop as the facility didn't have any 8 oz. scoops. During an interview on 9/4/25 at 10:47 AM the Director of Nursing (DON) stated she expected all residents get the intended scoop size of the chicken and pasta alfredo. She added if the facility didn't have an 8 oz. scoop, they should have placed an order to get new ones. During an interview on 9/4/25 at 10:37 AM the Administrator reported she expected the staff to follow
the menu and use the scoop size as directed. The facility's undated Select Menu policy lacked direction to use the proper scoop sizes.
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
09/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Shell Rock Senior Living
920 North Cherry Street Shell Rock, IA 50670
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-Tag F0812
F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many
FORM CMS-2567 (02/99) Previous Versions Obsolete
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Based on observation, staff interviews, and policy review the facility failed to clean the kitchen convection oven and handwashing sink. In addition, the facility failed to ensure staff wore hairnets and didn't touch food with their contaminated gloved hands. The facility reported a census of 34 residents. Findings include:
During an initial kitchen walk through on 9/2/25 at 9:18 AM observed the white hand washing sink had a dark brown discoloration around the drain measuring approximately 6 inches by 6 inches. In addition, the convection oven had a brown-like sticky discoloration on the inside and the outside of the doors, throughout
the inside of the oven and on the metal racks. An observation of the Dietary Manager wearing a baseball cap without a hair net, and the hair appeared over one inch in length protruding out below the baseball cap.
During a follow-up walk through observation on 9/3/25 at 11:56 AM the hand washing sink continued to have a dark brown discoloration around the drain measuring approximately 6 inches by 6 inches. The convection oven also continued to have a brown sticky-like discoloration on the inside and outside of the doors and throughout the inside of the oven and on the metal racks. During an observation on 9/3/25 at 11:59 AM the Dietary Manager held a cool whip container with a gloved hand and a spatula with another gloved hand. As she scooped out the cool whip onto the dessert to serve, she took the gloved hand holding
the cool whip container and used her index finger to scrape off the spatula to get the whip cream to cover dessert. During the observation, she continued to wear a baseball cap without a hairnet. During an
observation of the noon meal service on 9/3/25 from 11:55 AM to 12:55 AM while wearing gloves, Staff D, Cook, touched the diet name cards, serving utensils, plates, and transportation carts. Staff D proceeded to grab the garlic bread and place one on each residents' plate with the same gloved hands. Staff D served approximately 32 servings of garlic bread with contaminated gloves During an interview on 9/3/25 at 12:55 PM Staff D revealed he didn't use tongs during meal service and instead grabbed each piece of garlic bread and set them on the plates with his gloved hands. He explained as long as he had gloves on, he didn't need to use a tongs to touch the bread. During an interview on 9/3/25 at 2:45 PM the Infection Preventionist said she hadn't completed audits on the kitchen practices.During an interview on 9/4/25 at 10:47 AM the Director of Nursing (DON) reported she didn't know why Staff D wore gloves during 9/3/25 noon meal service, as that isn't their normal routine. She expected them to use tongs to place the bread on
the plates. During an interview on 9/4/25 at 10:37 AM the Administrator revealed she would expect the Dietary Manager to wear a hairnet and not just a baseball cap. She also informed Staff D during the 9/3/25 noon meal service does not normally wear gloves as that is not their normal routine and practice and believe it was due to being nervous, and food should not be touched with contaminated gloves. The facility's undated General Food Preparation and Handling policy directed the following: a. Clean and sanitize the kitchen surfaces and equipment as appropriate. b. Disposable gloves are single use item and should be discarded after each use. Employees should wash hands prior to putting gloves on and after removing gloves. c. Food should be prepared and served with clean tongs, scoops, forks, spoons, spatulas or other suitable implements to avoid manual contact with prepared foods. d. Use tongs or other servings utensils to serve breads or other items to avoid bare hand contact with food
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
09/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Shell Rock Senior Living
920 North Cherry Street Shell Rock, IA 50670
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-Tag F0880
Federal health inspectors cited Shell Rock Senior Living in Shell Rock, IA for a deficiency under regulatory tag F-F0880 during a standard health inspection conducted on 2025-09-04.
Category: Infection Control Deficiencies
The facility was found deficient in the following area: Provide and implement an infection prevention and control program.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of Shell Rock Senior Living.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-22.
F-Tag F0925
F 0925
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Level of Harm - Minimal harm or potential for actual harm
Based on observation, staff interviews, and policy review the facility failed to keep flies off the food prior to serving. The facility reported a census of 34 residents. Findings include: During an observation on 9/3/25 at 12:08 PM a fly landed on two (2) bowls of crushed pineapple, then flew over, and landed on pureed peas.
The kitchen had (4) flies present during the observation in the kitchen and one (1) dead fly noted on a cupboard door from 11:55 AM to 12:55 AM. During an interview on 9/3/25 at 2:45 PM the Infection Preventionist reported she hadn't completed audits on practices in the kitchen.During an interview on 9/4/25 at 10:37 AM with the Administrator explained the facility had bug traps but didn't know when pest control last came to the facility. She reported flies shouldn't land on the food during food service. Review of
the facility's undated General Food Preparation and Handling policy instructed to prepare food items to conserve maximum nutritive value, develop, enhance flavor, and keep free of harmful organisms and substances. Review of the facility's undated policy Pest Control Program directed the facility to use a variety of methods to control certain seasonal pests, i.e. (example) flies. The program would involve indoor and outdoor methods deemed appropriate by the outside pest service, state and Federal regulations.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Shell Rock Senior Living in Shell Rock, IA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Shell Rock, IA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Shell Rock Senior Living or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.