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F0550
E

Failure to Ensure Resident Dignity Due to Unprofessional Staff Conduct

Marshalltown, Iowa Survey Completed on 04-24-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure residents' dignity and respect for five residents with intact cognition, as evidenced by multiple reports of unprofessional and disrespectful conduct by a staff member, specifically the previous Director of Nursing (DON), referred to as Staff A. Residents reported that Staff A argued with them, persisted in trying to convince them to perform activities such as showering against their wishes, and used a demanding and superior attitude, particularly during night shifts. Several residents described being talked down to, yelled at, or directed to go to their rooms in a manner they found disrespectful. One resident recounted Staff A making a blunt and upsetting comment about their eating habits in front of a family member, while another described Staff A as treating them like a child and being rude to their family member over the phone. Facility documentation and interviews with both residents and staff confirmed a pattern of inappropriate and unprofessional behavior by Staff A, including repeated complaints about her conduct. The facility's own investigation revealed that Staff A's actions did not align with the expectations of leadership and the facility's policy on employee standards and code of conduct, which requires staff to maintain a positive and respectful environment. The incidents involved residents who were cognitively intact, as indicated by their BIMS scores, and who were able to clearly articulate their experiences of being treated without dignity and respect.

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