Bethany Life
Inspection Findings
F-Tag F0550
F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
states she would never purposely cause discomfort for any of our residents. After interviewing the resident,
he states that he did not feel safe while the activity was being performed but stated it is her job and she did not do anything on purpose. Expectations, education and coaching provided to Staff C, to slow down, listen to the resident and ensure that things are at their pace the way they like it. Staff C verbalized understanding.Resident #1's clinical record lacked documentation of the incident.Interview on 10/27/25 at 4:45 PM, the facility Administrator verified the expectation of all staff are to treat the residents with dignity and respect at all times.The undated Resident Rights acknowledgement, described that the resident has
the right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility and also be free from verbal, sexual, physical and mental abuse and that the facility must ensure that all alleged violations involving mistreatment, neglect or abuse are reported immediately to the administrator of the facility.
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
11/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Bethany Life
212 Lafayette Street Story City, IA 50248
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 F0609
F 0609 Level of Harm - Minimal harm or potential for actual harm
within the 2-hour time frame. The Policy for Abuse, Neglect and Exploitation dated September 2025, the facility will have written procedures that include, reporting of all alleged violations to the Administrator or designee, state agency, within specified timeframes: Immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury.
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
11/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Bethany Life
212 Lafayette Street Story City, IA 50248
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 F0610
F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
was rough and slammed Resident #1 while doing peri-care. Staff A, spoke with Staff D, Licensed Practical Nurse (LPN), and told Staff D to keep Staff C away from Resident #1. Staff A indicated that it never crossed her mind that this was an allegation of abuse and that Staff C needed to be sent home. Staff A thought that keeping Staff C away from Resident #1 would take care of the incident.Interview on 10/27/25 at 3:35 PM, Staff C, CNA, stated that peri-cares were being completed on Resident #1 and dried stool was in-between
the buttocks. Staff C stated that she was using a wet wipe to cleanse the area. Resident #1 stated ow, that hurts. Staff C, stopped doing cares and proceeded to take a clean brief and place underneath the resident with assistance of Staff B. Staff C, indicated that this incident happened between 5:00 PM - 5:30 PM. Staff C stated that she answered call lights with other residents until 6:45 PM, when she was instructed to leave
the facility. Staff C stated Resident #1 had hemorrhoids and they were bleeding.Interview on 10/27/25 at 4:00 PM, Staff D, LPN, explained that Staff B came up to her and explained that Staff C was rough and slamming Resident #1 in bed while performing peri-cares. Staff D, told Staff B to call the on-call nurse to get direction on how to proceed. Staff D, stated that she got a phone call from Staff A, with direction to keep Staff C from doing cares with Resident #1. Staff D, stated that this was her first allegation of abuse and was not sure how to proceed. Staff D, spoke with Resident #1 after the incident and Resident #1 said that he did not feel safe after the incident. Interview on 10/27/25 at 4:15 PM, Staff B stated that peri-cares were being performed with Staff C and herself on Resident #1. Staff B stated that Staff C was rough and slammed Resident #1 around while performing cares and made Staff B uncomfortable. Staff B explained the incident to Staff D and Staff D told Staff B to call the on-call nurse manager. Staff B was not able to determine the time frame for the incident but stated that it was during the supper time meal. Interview on 10/27/25 at 4:45 PM, the facility Administrator verified Staff C needed sent home until an investigation was completed and that the expectation is not to take care of any other residents.The Abuse, Neglect and Exploitation Policy revised September 2025, that the facility will provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation and misappropriation of resident property and will make efforts to ensure all residents are protected from physical and psychosocial harm, as well as additional abuse, during and after the investigation.
Event ID:
Facility ID:
If continuation sheet
Bethany Life in Story City, 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 Story City, 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 Bethany Life or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.