(Des Moines) The Iowa Department of Inspections, Appeals, and Licensing took over responsibility for many of Iowa’s licensing boards in July 2023.
A Cass County assisted living center is one of several care facilities recently fined by the state in the wake of medication errors, injuries, and a death.
State records indicate that on July 8, a male resident of Allen Place, an assisted living center in Atlantic, was left unattended in the shower where he slipped and fell, suffering a head injury. He was taken by ambulance to a hospital, where he died a short time later.
According to the state inspectors, a non-skid bathmat was not in place in the shower at the time of the incident, and the worker tasked with showering the man was not properly trained and wasn’t assisting the man in the shower.
The worker in question had been on the staff for roughly one month. In a written statement referenced by inspectors in their report, the worker indicated he didn’t understand that the resident needed physical assistance standing and showering. So he sat a few feet away from the bathroom while the resident showered. Within a minute of the resident entering the shower, the worker reportedly wrote that the man fell.
“I lacked the proper training on the proper stand-by procedure,” the worker allegedly wrote in his statement. “Due to this lack of training, I thought the shower mat that’s normally down — but was up that day—should remain up.” … and “once [Tenant C1’s] in the bathroom, I leave the bathroom as to what I was taught before and leave the door half open while I sit in a nearby chair … Around a minute into the shower, he falls.”
The Iowa Department of Inspections, Appeals, and Licensing fined Allen Place $10,000.
Other Iowa care facilities recently fined by the DIAL include:
— Hallmar Village, a Cedar Rapids nursing home where a resident sustained two broken legs while being transferred to bed in a mechanical lift, was fined $20,500 by the state. The resident was facing amputation of one leg before being assigned to hospice care a few days later, according to state records.
Inspectors reported that one employee of the home, a certified nursing assistant, indicated the staff at the house had been using a modified method of using the mechanical lift with the resident that involved the use of a pillow and avoided the use of leg straps intended for safe transfers. The CNA reportedly told inspectors she felt the modifications by the staff posed a risk to the resident and said she relayed her concerns to a nurse.
The CNA also told inspectors that because the transfer process looked unsafe, she asked to work on a different floor at the home. A state review of training records indicated the nurse and two CNAs at the house “did not have training on the use of a mechanical lift,” according to inspectors.
— Bickford Cottage I, a Sioux City assisted living center, was fined $7,000 after a resident wandered from the facility on July 5 and wasn’t found for several hours. The resident was admitted to a local hospital due to acute kidney injury, dehydration, and elevated creatinine levels.
— Windsor Manor, a Grinnell assisted living center, was fined $5,000 after a male resident of the home was given seven separate medications intended for someone else. The resident who was mistakenly given the drugs became unresponsive and was admitted for a short time to a local hospital.
— Azria Health-Longview, a Missouri Valley nursing home, was fined $7,000 after a resident fell on June 30 and sustained a serious head injury. Inspectors noted that the facility was to have placed non-skid strips near the resident’s bed; however, the work order calling for that to be done included the wrong bed number. The resident suffered multiple facial fractures and had to be hospitalized. As of July 16, the resident was still hospitalized.
— Bickford Cottage, an Iowa City assisted living center, was fined $5,000 after a female resident wandered from the facility about 8 p.m. on June 1. About one hour later, an off-duty paramedic found the woman 1.3 miles from the facility.
