Zearing Health Care, Llc

F-F609 for additional information. The facility reported a census of 35 residents.

Findings include:

Resident #1's Minimum Data Set (MDS) assessment dated [DATE REDACTED] identified a Brief Interview for Mental Status (BIMS) of 11, indicating moderate cognitive impairment. The MDS included a diagnosis of Huntington's disease (causes nerve cells in the brain to decay over time, affecting the person's movements, thinking ability, and mental health).

The Care Plan Focus revised 10/27/22 described Resident #1 as a smoker, who required supervision to smoke.

During an interview on 2/17/25 at 12:25 PM, Staff A, Certified Nurse Aide (CNA), reported she worked with Staff B, CNA, and Staff C, CNA, on 1/3/25. After she came in the building after she took residents out to smoke, Resident #1 came up to smoke late. Staff A reported as she assisted another resident take off her coat, Resident #1 grabbed a smoking protector. Staff D, Registered Nurse (RN), yelled at Resident #1 saying

it was too late to smoke. As Resident #1 tried to go out the door, Staff D pulled her arm and grabbed her away from the door. Resident #1 then walked down the hallway to her room. Staff A reported Staff B and her wrote written statements, then slid them under the Administrator's door but the statements never got to the Administrator.

During a follow-up interview on 2/17/25 at 12:51 PM, Staff A reported after she witnessed Staff E, Licensed Practical Nurse (LPN), grab Resident #1's other arm when she tried to go outside to smoke, she didn't separate the alleged abuser from the residents because her brain froze.

During an interview on 2/18/25 at 3:40 PM, the Administrator reported he first learned of the allegation of abuse against Resident #1 on 1/10/25 after Staff A's staffing agency, who employed her, contacted him via

the phone reporting Staff A reported the alleged abuse to the staffing agency. The Administrator added he expected the staff report allegations of abuse right away.

Review of Staff D's timecard punch detail reflected she worked the following dates and times, after the alleged incident prior to her suspension:

a. 1/3/25: 7:58 PM-6:20 AM

b. 1/4/25: 7:58 PM-6:37 AM

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 4 165320 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 165320 B. Wing 02/19/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Zearing Health Care, LLC 404 East Garfield St Zearing, IA 50278

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 0610 c. 1/5/25: 9:52 PM-6:26 AM

Level of Harm - Minimal harm or d. 1/7/25: 8:00 PM-6:23 AM potential for actual harm e. 1/8/25: 7:58 PM-6:39 AM Residents Affected - Few f. 1/9/25: 7:53 PM-6:26 AM

Review of facility policy titled, Nursing Facility Abuse Prevention, Identification, Investigation and Reporting Policy dated October 2022 indicated upon an allegation of resident abuse, the facility shall immediately implement measures to prevent further potential abuse of residents.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 4 of 4 165320