State Center Specialty Care
Inspection Findings
F-Tag F0580
F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, resident interview, staff interview and policy review, the facility failed to contact a resident's representative after she had voiced, she had suicidal thoughts and a plan in place for 1 of 3 residents reviewed (Resident #1). The facility reported a census of 33 residents. Findings include: The Minimum Data Set (MDS) dated [DATE REDACTED] for Resident #1 documented a Brief Interview for Mental Status score of 15 indicating intact cognition. The MDS further revealed the resident had diagnoses including anxiety disorder and encephalopathy (viral infection of the brain).The Care Plan initiated 3/20/25 revealed Resident #1 had a history of making comments about being dead with a goal to resolve thoughts of being better off dead or harming herself. Review of the Progress Notes dated 3/20/25 at 4:01 PM revealed Resident #1 had voiced comments of having suicidal thoughts and a plan. The resident stated she would put Visine on her food because she had seen that if ingested a person would have a heart attack within 15 minutes and it could not be traced. One-to-one (1:1) was initiated. The Progress Notes lacked documentation that the resident's representative was notified. During an interview on 10/9/25 at 9:20 AM,
the Director of Nursing (DON) revealed the resident representative would be contacted if there was a change in a resident's condition and that generally they offer to reach out to others. The DON further acknowledged the Progress Notes for Resident #1 lacked documentation that she had offered to contact
the resident's representative. During an interview on 10/9/25 at 10:00 AM, Resident #1 revealed that staff did not ask her if she wanted her representative contacted when she had suicidal thoughts and a plan when
the 1:1 was initiated but preferred they would have done so. Facility policy titled, Change in a Resident's Condition or Status, revised February 2021 directed the facility to promptly notify the resident representative of changes in the resident's medical/mental condition and/or status. The policy further documented that unless otherwise instructed by the resident, a nurse will notify the resident's representative when there is a significant change in the resident's physical, mental or psychosocial status.
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:
State Center Specialty Care in State Center, 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 State Center, 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 State Center Specialty Care or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.