Halcyon House
Inspection Findings
F-Tag F0684
F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
or if something needs stat to community.c. All medications must have an ICD 10 (International Classification of Diseases, 10th Revision, a diagnostic and procedure coding system) code written next to the medication
in order for the pharmacy to enter those diagnosis. If not, we will be responsible to enter the diagnosis.d.
After medications have been put in by the pharmacy the NURSE must go under orders and confirm them to be correct from here we can change the time or ensure a stop date is in place. Nurse must ensure that the time has been changed from the default of - as directed by pharmacy. However, the pharmacy CANNOT see what we have changed and they also need us to put that information on the fax sheet and send it over to them so moving forward it all matches. e. Community will need to enter all house orders/standing orders.
Pharmacy will not do this.
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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
10/14/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Halcyon House
1015 South Iowa Avenue Washington, IA 52353
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 F0697
F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
pack. Staff D described the admission as messy, and the nurses were not ready to take Resident #1.
During an interview on 10/8/25 at 12:15 PM, the Medical Director stated Resident #1 was admitted for skilled nursing after a hospitalization for heart failure. The Medical Director stated he would expect the facility to call either the discharging hospital pharmacist and/or provider or his on-call group right away if a resident is experiencing pain so it can be treated. During an interview on 10/13/25 at 9:34 AM, the DON stated the expectation for Resident #1 was not met on the day of admission from the hospital on [DATE REDACTED].
Review of the facility policy, titled Pain Evaluation and Management, origination 7/2016, last revised 10/2025 revealed a Protocol statement, which declared: It is the policy of [company name redacted] that all residents have the right to appropriate pain assessment and pain management. All resident will be evaluated for indicators of a history of pain on admission, quarterly, with a significant change in status and with the new onset of potential pain or discomfort. Data will be collected through resident interview, staff interviews and observations. The Procedure section directed, in part:#8. If the resident has a diagnosis which could cause pain or discomfort, and they show no sign or symptoms of pain or discomfort, continue to reassess for indicators of pain and behavioral changes.#9. Notify PCP (primary care provider) of pain assessment findings if pain is indicated to start or change pain management program as necessary with on-going evaluation of effectiveness of medications prescribed.#10. Follow prescribed orders for pain management - documenting for PRN medications using provided pain scale of 0-10.
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Halcyon House in Washington, 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 Washington, 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 Halcyon House or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.