Westwood Specialty Care

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Based on observations, facility policy review and staff interview the facility failed to cover exposed catheter bags for 3 of 3 residents reviewed (Resident #1, #5 and #6). The facility reported a census of 77 residents Findings include: 1. Observation on 12/16/25 at 2:24 p.m., revealed Resident #1 laying in bed with a catheter bag hanging on the side of the bed with no privacy cover, urine visible in the bag from the hallway.

1. 2. Observation on 12/16/25 at 9:59 a.m., revealed Resident #1 laying in bed with a catheter bag hanging on

the side of the bed with no privacy cover, urine visible from the door in the hallway. 3. Observation on 12/16/25 at 2:25 p.m., revealed Resident #6 in bed with a catheter bag hanging on the side of the bed with no privacy cover and urine visible from the door in the hallway. 4. Observation on 12/16/25 at 10:04 p.m., revealed Resident #5 laying in bed with catheter bag hanging on the side of the bed with no privacy cover, urine visible from the door in the hallway Review of the facility provided policy titled Dignity with a revised date of February 2021 revealed Demeaning practices and standards of care that compromise dignity are prohibited. Staff are expected to promote dignity and assist residents, for example, helping the resident to keep urinary catheter bags covered. Interview on 12/22/25 at 3:43 p.m., with Regional Nurse Consultant, revealed all catheter bags should have a cover as that is a dignity concern.

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

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Westwood Specialty Care

4201 Fieldcrest Drive Sioux City, IA 51104

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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

indicated that Resident #6 scheduled to receive baths on Mondays and Thursdays. Documentation showed that the resident failed to receive a bath on or around the following dates:a. 12/8/25b. 12/11/25c. 12/15/25d. 12/22/25e. 12/25/25f. 12/29/25In an interview on 12/29/25 at 12:55 PM, Staff E, Certified Nursing Assistant (CNA) reported several CNAs have recently resigned after being held accountable for not completing assigned duties. Staff E revealed the facility previously used bath aides, and residents were not consistently receiving scheduled baths. As a result, a new plan was implemented in which some resident baths are assigned to day shift and others to night shift. Staff E reported that none of the residents in her hall who are scheduled for night-shift baths have received them. Staff E is now expected to complete those missed baths

during the day in addition to her regularly scheduled assignments and baths often don't get done. The Bath, Shower/Tub policy last revised February 2018 identified for documentation the date and time the shower/tub bath was performed. The name and title of the individual(s) who assisted the resident with the shower/tub bath. All assessment data (e.g., any reddened areas, sores, etc., on the resident's skin) obtained during the shower/tub bath. How the resident tolerated the shower/tub bath. If the resident refused

the shower/tub bath, the reason(s) why and the intervention taken. The signature and title of the person recording the data. For reporting, notify the supervisor if the resident refuses the shower/tub bath. Notify the physician of any skin areas that may need to be treated. Report other information in accordance with facility policy and professional standards of practice.In an interview on 12/31/25 at 8:12 AM, the Administrator reported that he expected shower schedules to be followed as planned. He explained that, in an effort to improve shower completion, the process had been changed to provide some residents with evening showers. The Administrator indicated no knowledge of issues with evening showers not completed.

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

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Westwood Specialty Care

4201 Fieldcrest Drive Sioux City, IA 51104

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 0684

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or potential for actual harm

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

record review, resident and staff interviews and facility policy review the facility failed to provide physician ordered daily weights 1 of 1 residents reviewed (Resident #2). The facility reported a census of 77 residents.Findings include: The Minimum Data Set (MDS) assessment dated [DATE REDACTED] for Resident #2 documented heart failure, hypertension and coronary artery disease. The MDS showed the Brief Interview for Mental Status (BIMS) score of 14, indicating no cognitive impairment. Review of the physician order dated 7/17/25 at 3:21 p.m., revealed an order for daily weights if weight gain of greater than 3 pounds in one day or greater than 5 pounds in one week fax weights weekly. Review of daily weight records lacked daily weights on the following days:October 11, 17 and 31November 8, 9, 20, 21, 22, 28 and 30December 5 and 12 Review of the clinical record lacked any documentation the physician had been notified daily weights were not being completed and monitored as ordered. Review of the facility provided policy titled Physician Services with a revised date of February 2021 revealed supervising the medical care of residents includes monitoring changes in resident's medical status, providing consultation or treatment when called by the facility and overseeing a relevant plan of care for the resident. Interview on 12/30/25 at 2:01 p.m., with Regional Nurse Consultant revealed the facility should be doing daily weights if they are ordered and

they should notify the physician if they are not being completed or per the order with weight gains.

Residents Affected - Few

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

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

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Westwood Specialty Care

4201 Fieldcrest Drive Sioux City, IA 51104

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

In an interview on 12/29/25 at 12:55 PM, the Administrator reported staff should follow the operators manual when using the mechanical stand lift.

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

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

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

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Westwood Specialty Care

4201 Fieldcrest Drive Sioux City, IA 51104

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Based on observations and staff interview, the facility failed to provide complete and appropriate incontinence care in a manner to prevent urinary tract infections for 2 of 3 residents observed (Resident #1 and #4). The facility reported a census of 77 residents. Findings include: 1. Observation on 12/23/25 at 12:14 p.m., of Staff C, Certified Nursing Assistant (CNA) empty Resident #1's catheter bag. Staff C cleaned

the catheter end prior to emptying the urine from the bag. Staff C emptied the urine into the graduate, after

the bag was empty she closed the end and without cleaning the end placed back into the bag and cleaned up her supplies for the resident. When completed, she removed gown and gloves and performed hand hygiene. 2. Observation on 12/29/25 at 1:41 p.m., of Staff D, CNA assisting Resident #4 to the bathroom.

When resident #4 was completed in the bathroom, Staff D assisted her to a standing position and then took

a disposable wipe and wiped from front to back with the first wipe, used the same side and wiped the rectum 3 times and disposed of it into the trash. Took another wipe and wiped from front to the back and with the same side of the wipe on the rectum 2 times and disposed of it into the trash. Took another clean wipe and wiped from the front to the back and with the soiled side wiped the residents rectum 3 times and disposed of it into the trash. Staff with soiled gloves on pulled up the residents brief, and with the soiled gloves on pulled up the residents pants and adjusted her sweater and pulled the wheelchair closer to the resident. After the resident was in the chair, removed gloves and performed hand hygiene. Interview on 12/29/25 at 2:26 p.m., with Regional Nurse Consultant revealed she expected staff to perform peri care properly and to use a clean part of the wipe when doing care. She further revealed staff should be using an alcohol swab after emptying the catheter tubing.

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

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Westwood Specialty Care

4201 Fieldcrest Drive Sioux City, IA 51104

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

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review and staff interviews the facility failed to provide and maintain accurate resident records to reflect an incident occurring in the facility for 1 of 3 residents (Residents #4). The facility reported a census of 77 residents.Findings include: The MDS assessment dated [DATE REDACTED] for Resident #4 documented diagnoses of muscle wasting, dependence on a wheelchair and nerve damage. The MDS showed moderate cognitive impairment for daily decision making. The Clinical Physician Orders for Resident #4 dated 7/18/23 showed tramadol 50 milligram (MG) three times a day ordered for pain. The Controlled Drug Count Record dated 9/16/25 for Resident #4 showed Staff F, Certified Medication Assistant (CMA) failed to sign the count record at 6 AM. The Individual Narcotic Record for Resident #4 showed that on 9/16/25 PM shift the tramadol tablet count to be 30 tablets. The 9/17/25 AM tramadol showed the count to be 28 tablets.

The September Medication Reconciliation for 2025 showed Staff F, CMA administered Tramadol 50 mg at bedtime to Resident #4. In an interview on 12/30/25 at 12:00 PM, Staff G, a Licensed Practical Nurse (LPN), reported that on 9/16/25, after bedtime medications were administered, Staff G assumed responsibility for Staff F's assigned medication cart and residents. Staff G reported that at the end of their shift, during the AM narcotic count with Staff F, they discovered two tramadol tablets missing. Staff G could not specifically recall the number of tablets. When asked what happened next, Staff G reported that Staff F refused to sign the Drug Count Record and immediately left the building. When asked whether they had previously encountered issues with incorrect narcotic counts involving Staff F, Staff G reported that she and Staff F were new and that Staff F no longer worked at the facility after the tramadol went missing. When asked if she reported the missing medication, Staff G stated that she immediately contacted the Regional Nurse Consultant. The Storage of Medications policy last revised April 2020 identified Schedule II-V controlled medications are stored in separately locked, permanently affixed compartments. Access to controlled medication is separate from access to non-controlled medications. Controlled medications that are part of a single unit dose distribution system may be stored with non-controlled medications when the supply is minimal and shortages are readily detectable. The policy failed to address directions specific to narcotic counting, destruction of narcotics or action to be taken in the case of missing medication. In an

interview on 12/29/25 at 12:55 PM, the Regional Nurse Consultant reported she received notification of missing tramadol the morning of 9/17/25 and arrived at the building shortly after. The Regional Nurse Consultant confirmed two tramadol 50 mg tablets went missing. She reported the facility is unable to determine the cause of the missing tramadol. The Regional Nurse Consultant reported the investigation concluded when Staff F did not come back to the facility or answer their calls.

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

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Westwood Specialty Care

4201 Fieldcrest Drive Sioux City, IA 51104

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 0760 Level of Harm - Minimal harm or potential for actual harm

on 12/29/25 at 12:55 PM, the Regional Nurse Consultant reported staff should follow policy when administering medications. When asked if she would have expected staff to respond differently when Resident #1 received the jardiance and gabapentin, the Regional Nurse Consultant reported the staff notified the provider and followed physician orders.

Residents Affected - Few

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

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

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Westwood Specialty Care

4201 Fieldcrest Drive Sioux City, IA 51104

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 0842 Level of Harm - Minimal harm or potential for actual harm

procedure/treatment; d. How the resident tolerated the procedure/treatment; e. Whether the resident refused the procedure/treatment; f. Notification of family, physician or other staff, if indicated; and g. The signature and title of the individual documenting. In an interview on 12/29/25 at 12:55 PM, when asked whether the missing money and mediation should have been documented in the resident's records, the Regional Nurse Consultant stated something should have been documented.

Residents Affected - Few

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

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

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Westwood Specialty Care

4201 Fieldcrest Drive Sioux City, IA 51104

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

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, infection control policy and staff interview, the facility failed perform proper hand hygiene and adhere to infection control guidelines during medication pass for 4 of 4 residents observed (Resident #1, #4, #7 and #8) The facility reported a total census of 77 residents. Findings include: 1.

Observation on 12/23/24 at 9:01 a.m., revealed Staff A, Licensed Practical Nurse (LPN) did not perform hand hygiene prior to applying gloves. Once the gloves were applied the nurse cleaned off the top of the insulin bottle with an alcohol swab and drew up the insulin into the syringe, with gloves still on, placed the bottle back into the box and placed into the medication drawer. Staff took the gloved hand and locked the computer screen, with the soiled gloves on, entered the residents room with the insulin syringe and with another alcohol swab cleaned the area and administered the insulin to the resident. When completed, removed gloves and performed hand hygiene. 2. Observation on 12/23/24 at 9:11 a.m., revealed Staff A, LPN preparing medications for Resident #4. The nurse pushed pantoprazole (medication to decrease stomach acid) out of the pill card and the medication dropped onto the top of the medication cart. Staff A without performing hand hygiene applied a glove, picked up the medication and placed it into the medication cup with the other medication. Staff A removed the glove and performed hand hygiene and administered the medications to Resident #4. 3. Observation on 12/23/25 at 9:27 a.m., of Staff B, Registered Nurse (RN) preparing Resident #1's medication. Staff B took out a pill cutter out of the medication cart to cut the Guaifenesin tablet (medication to relieve chest congestion) tablet. The pill cutter was observed to have a white power substance on the top and bottom of the pill cutter. Staff B did not clean

the pill cutter and poured the tablet out of the bottle onto the pill cutter and without doing hand hygiene applied gloves. Staff B with a gloved hand placed the tablet in the correct spot to cut the tablet. Staff B cut

the tablet and placed half into the medication cup and the other half into the sharps container, removed her glove and did not perform hand hygiene. Staff B placed the pill cutter back into the medication cart and finished preparing the medications. Staff B administered Resident #1's medications and returned to the medication cart and proceeded to the next resident. 4. Observation on 12/23/25 at 9:40 a.m., with Staff B, RN with Resident #7's medication pass. Staff B brought in residents Fluticasone-Salmeterol (an inhaler to reduce lung inflammation) inhaler into his room and laid it directly on the bedside table with no barrier. Staff administered medications and inhaler and when completed exited the room with the inhaler and without wiping down the inhaler placed the inhaler back into the box and placed into the medication cart. Review of facility provided policy titled Administering Medications with a revised date of April 2019 revealed staff follows established facility infection control procedures for the administration of medications as applicable.

Review of the facility provided policy titled Handwashing and Hand Hygiene revised August 2019 revealed

the use of an alcohol-based hand rub or soap and water for the following before and after handling medications and before applying gloves and after removing gloves. Interview on 12/23/25 at 10:10 a.m., with the Regional Nurse Consultant revealed staff should be following infection control measures at all times.

Residents Affected - Some

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

Event ID:

Facility ID:

If continuation sheet