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The report includes initial comments describing census counts for general and dementia-specific programs and references regulatory insufficiencies tied to complaint investigation #82868-C. It cites failure to ensure a newly hired registered nurse completed required delegation reviews within 60 days for two long-term employees, with specific findings from interview and record review and the provider’s corrective-plan 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for both the general population program and the dementia-specific dedicated program at the time of the on-site.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},242082,1789185645,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":79,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":125,"read_time":79},16904993612988,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","# DEPARTMENT OF INSPECTIONS ANDAPPEALS\n\n\n| STATEMENT OF DEFICIENCIES  \u003Cbr>AND PLAN OF CORRECTION   |  | (X1)PROVIDER/SUPPLIER/CLIA  \u003Cbr>IDENTIFICATION NUMBER:  \u003Cbr>S0080   | (X2)MULTPLE CONSTRUCTION  \u003Cbr>A.BUILDING:_  \u003Cbr>B.WING   |  | (X3)DATE SURVEY  \u003Cbr>COMPLETED  \u003Cbr>C  \u003Cbr>06/27/2019   |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| STREETADDRESS,CITY,STATE,ZIP CODE  \u003Cbr>NAME OF PROVIDER OR SUPPLIER  \u003Cbr>209 W JEFFERSON  \u003Cbr>QHC MADISON SQUARELLC  \u003Cbr>WINTERSET,IA 50273   |  |  |  |  |  |  |\n| (X4)ID  \u003Cbr>PREFIX  \u003Cbr>TAG   | SUMMARY STATEMENT OF DEFICIENCIES  \u003Cbr>(EACH DEFICIENCYMUST BE PRECEDED BY FULL  \u003Cbr>REGULATORY OR LSCIDENTIFYING INFORMATION)   |  | ID  \u003Cbr>PREFIX  \u003Cbr>TAG   | PROVIDER'S PLAN OF CORRECTION  \u003Cbr>(EACH CORRECTIVEACTION SHOULD BE  \u003Cbr>CROSS-REFERENCED TO THEAPPROPRIATE  \u003Cbr>DEFICIENCY)   |  | (X5)  \u003Cbr>COMPLETE  \u003Cbr>DATE   |\n| A000  \u003Cbr>A058   |  Initial Comments  \u003Cbr>Assisted Living Programs are defined by the type  \u003Cbr>of population served.The census numbers were  \u003Cbr>provided by the Program at the time of the  \u003Cbr>on-site.  \u003Cbr>General Population Program  \u003Cbr>Number of tenants without cognitive disorder:26  \u003Cbr>Number of tenants with cognitive disorder:2  \u003Cbr>Total Population of Program at time of on-site:28  \u003Cbr>Dementia-Specific Program by Dedication  \u003Cbr>Number of tenants without cognitive disorder:2  \u003Cbr>Number of tenants with cognitive disorder:5  \u003Cbr>Total Population of Program at time of on-site:7  \u003Cbr>TOTAL census of Assisted Living Program:35  \u003Cbr>There following regulatory insufficiencies were  \u003Cbr>cited during the investigation of Complaint  \u003Cbr>\\#82868-C.  \u003Cbr>481-67.9(4)a Staffing  \u003Cbr>481-67.9(231B,231C,231D)Staffing.  \u003Cbr>67.9(4)Nurse delegation procedures.The  \u003Cbr>program's registered nurse shallensure certified  \u003Cbr>and noncertified staff are competent to meet the  \u003Cbr>individual needs of tenants.Nurse delegation  \u003Cbr>shall,at a minimum,include the following:  \u003Cbr>a.The program's newly hired registered  \u003Cbr>nurse shall within 60 days of beginning  \u003Cbr>employment as the program's registered nurse  \u003Cbr>document a review to ensure that staff are  \u003Cbr>sufficiently trained and competent in all tasks that  \u003Cbr>are assigned or delegated.   |  | A000  \u003Cbr>A058   | 08/14/  \u003Cbr>is8td  \u003Cbr>noxorec   |  | 19    |\n\nLABORATORYDIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE忆ng2 u g25ecmmarcap 890TSTATEFORM  \nDIVISION OF HEALTH FACILITIES-STATE OF IOWA  \n6899WEKR11If continuation sheet 1 of 8  \n# FORM APPROVED\n\nDFPARTMFNT OF INSPFCTIONS AND APPEALS  \n\n| STATEMENT OF DEFICIENCIES  \u003Cbr>AND PLAN OF CORRECTION   |  | PRoM门  R     PPiFRICID  \u003Cbr>(X1)  \u003Cbr>IDENTIFICATION NUMBER:  \u003Cbr>S0080   | (X2)MULTIPLECONSTRUCTION  \u003Cbr>A.BUILDING:_  \u003Cbr>B.WING_   |  | (X3)DATE SURVEY  \u003Cbr>COMPLETED  \u003Cbr>C  \u003Cbr>06/27/2019   |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| NAME OF PROVIDER OR SUPPLIER  \u003Cbr>STREETADDRESS.CITY.STATE.ZIP CODE  \u003Cbr>209 W JEFFERSON  \u003Cbr>HCMADISON SOUARELLC  \u003Cbr>WINTERSET,IA 50273   |  |  |  |  |  |  |\n| (X4)ID  \u003Cbr>PREFIX  \u003Cbr>TAG   | SUMMARY STATEMENT OF DEFICIENCIES  \u003Cbr>(EACH DEFICIENCY MUST BE PRECEDED BY FULL  \u003Cbr>REGULATORY ORLSC IDENTIFYING INFORMATION)   |  | ID  \u003Cbr>PREFIX  \u003Cbr>TAG   | PROMDERS PLAN OF CORRECTION  \u003Cbr>(EACH CORRECTIVEACTON SHOULD BE  \u003Cbr>CROSS-REFERENCED TO THE APPROPRIATE  \u003Cbr>DEFICIENCY)   |  | (X5)  \u003Cbr>COMPLETE  \u003Cbr>DATE   |\n| A058  \u003Cbr>A063   | Continued From page 1  \u003Cbr>This REQUIREMENT is not met as evidenced  \u003Cbr>by:  \u003Cbr>Based on interview and record review the  \u003Cbr>Program failed to ensure the newly hired  \u003Cbr>Reqistered Nurse(RN)conducted a review within  \u003Cbr>60 days of employment to ensure 2 of 2 long  \u003Cbr>term employees reviewed were sufficiently  \u003Cbr>trained and competent in tasks(Staff E and Staff  \u003Cbr>D).Findings include:  \u003Cbr>On 6/25/19 the Administrator reported the RN  \u003Cbr>began employment with the Program on 8/22/18.  \u003Cbr>On 6/25/19 record review revealed Staff E was  \u003Cbr>hired by the facility on 11/28/2016 as a Universal  \u003Cbr>W","cbCaioe96FwU5Lmk","https://ap.wps.com/l/cbCaioe96FwU5Lmk","pdf",534075,10,"English","# Statement of Deficiencies and Plan of Correction\n## Provider Identification and Survey Date\n## Summary Statement of Deficiencies","[{\"question\":\"What was the survey completion date for the provider’s report?\",\"answer\":\"The report lists the survey completed on 06/27/2019.\"},{\"question\":\"What regulatory issue is cited regarding nurse delegation?\",\"answer\":\"The report states the newly hired registered nurse did not complete delegation review requirements within 60 days to ensure certified and noncertified staff competence for assigned or delegated tasks.\"},{\"question\":\"How does the document describe the assisted living program census?\",\"answer\":\"It provides tenant counts for both the general population program and the dementia-specific dedicated program at the time of the on-site.\"}]","S0080 - 06/27/2019 - Assisted Living Program Statement of Deficiencies and Plan of Correction | PDF"]