Below average — CMS composite of the measures below.
A standard survey is most likely before around August 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Accura Healthcare Of Cascade Llc during CMS and state inspections, most recent first.
A resident with dementia and independent transfer status was physically forced by a CNA during an attempted transfer to supper after she said no. Witnesses reported the CNA grabbed both arms, pulled on the resident’s forearms, and tried to lift her into a wheelchair without a gait belt, while the resident resisted and later reported pain. The resident was found with two new bruises on the forearm, and multiple staff described the CNA as rough, rushed, and inappropriate with residents.
A resident with DM, anemia, CKD, arthritis, and an unstageable left heel pressure ulcer was observed receiving a dressing change during which an RN failed to follow required infection control practices. After initially performing hand hygiene and donning PPE, the RN removed the old dressing, cleansed and dried the wound, and applied a new nonstick pad and cling wrap using the same pair of gloves without performing hand hygiene or changing gloves between steps. The RN also reused scissors to cut tape for the new dressing without cleaning them after cutting off the old dressing. These actions did not follow the facility’s established dressing-change procedure, which required glove removal, hand hygiene at key points in the process, and cleaning of scissors before reuse.
The facility failed to train staff and implement effective procedures for selecting and using appropriately sized full body lift slings, resulting in staff using slings based on personal preference and without clear identification of correct sizing. Two residents dependent on mechanical lifts were affected, including one who experienced a fall during transfer due to improper sling use and lack of standardized protocols. Staff interviews and document reviews confirmed the absence of a system for sling sizing and identification.
Physical Abuse During Resident Transfer
Penalty
Summary
The facility failed to protect a resident from physical abuse by a staff member when a CNA physically forced the resident to transfer after the resident said she did not want to go to supper. Resident #14 had severely impaired cognitive skills for daily decision making, short- and long-term memory problems, and diagnoses including heart failure, hypertension, non-Alzheimer’s dementia, arthritis, and osteoporosis. The resident’s care plan described her as independent with transfers and ambulation, including use of a cane in her room and a front wheeled walker in the hallway. According to the investigation, a staff member reported witnessing CNA Staff E grab the resident by both arms and yank her out of a chair. Another staff member described the interaction as excessive and over the top, stating the resident said no when asked to go to supper and that Staff E pulled on the resident’s forearms without a gait belt. The same witness reported that Staff E physically tried to pick up the resident and force her into a wheelchair, while the resident twisted, turned, and attempted to get away. Staff E stated she performed a pivot transfer after the resident agreed to transfer, and denied reaching for the resident’s arms. The resident reported pain after the incident and later stated that pulling on her arms hurt. A head-to-toe assessment documented two new bruises on the left forearm, and wound documentation identified two in-house acquired bruises on the left outer forearm. Additional staff interviews described Staff E as rough with residents, quick, rushing them, and not understanding or having patience with dementia residents. Several staff members stated they had previously raised concerns about her tone, roughness, and interactions with residents, and one staff member wrote that many staff and residents had complained that she was rude and rough with residents.
Failure to Perform Hand Hygiene and Glove Changes During Wound Care
Penalty
Summary
The deficiency involves a failure to follow infection prevention and control practices, specifically hand hygiene and glove changes, during wound care for one resident. The resident had intact cognition and medical diagnoses including DM, anemia, CKD, and arthritis, and was admitted with an unstageable pressure ulcer on the left heel. The care plan and TAR directed daily dressing changes to the left heel using dry gauze, with saline to loosen the dressing if needed. During an observed dressing change, an RN performed initial hand hygiene, donned a gown and gloves, and set up a barrier and supplies on the tray table. The RN used scissors to cut off the old cling wrap dressing, placed the scissors on the tray table, and then, without performing hand hygiene or changing gloves, opened the NS, moistened gauze, and removed the stuck dressing from the wound. The RN continued the procedure using the same pair of gloves, including moistening additional gauze with NS to wash and dry the wound, replacing the NS lid and discarding it, and then opening a new nonstick pad and applying it to the wound, followed by wrapping the heel with cling. The RN then used the same uncleaned scissors to cut tape and secure the dressing before finally cleaning the scissors with a wipe at the end of the procedure. Hand hygiene and glove changes were not performed between removal of the soiled dressing, cleansing of the wound, and application of the new dressing, contrary to the facility’s own competency-based procedure for dressing changes, which required removal of gloves and hand hygiene after removing the soiled dressing, and again after cleaning the wound, before applying the new dressing. Interviews with facility leadership confirmed that staff were expected to follow these hand hygiene and glove-change steps and to clean scissors before reuse, and the RN had a documented competency for dressing change on file.
Failure to Train Staff and Implement Sling Sizing Guidelines for Mechanical Lifts
Penalty
Summary
The facility failed to provide adequate training and maintain effective procedures regarding the sizing and use of full body lift slings for residents requiring mechanical transfers. Observations and staff interviews revealed that staff members selected slings based on personal preference rather than resident-specific sizing guidelines. Sling tags were found to be illegible, and there was no system in place to distinguish or assign sling sizes to individual residents. The care plans for residents dependent on full body lifts did not specify the appropriate sling size, and staff were unaware of the correct sizing requirements. One resident with a history of stroke and Alzheimer's disease, who was dependent on two staff for all transfers using a full body lift, was transferred using a cloth blue full body sling without clear identification of the correct size. Staff involved in the transfer, including a new CNA and a business office manager acting as a CNA, used the sling without reference to any sizing protocol. The Assistant Director of Nursing confirmed the lack of a system for identifying sling sizes and acknowledged that staff were using slings according to their own preferences. Another resident with severe cognitive impairment and total dependence on staff experienced a fall from a Hoyer lift during a transfer. Both CNAs involved in the incident reported that the resident grabbed the Hoyer straps, causing the sling to shift and the resident to fall forward. Staff interviews indicated that slings were used interchangeably, with no consistent method for selecting the appropriate size or type. Concerns about the slipperiness of certain slings had been raised by staff, but there was no evidence of a standardized process for addressing these issues or ensuring proper sling selection for each resident.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Cascade
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Monticello Nursing & Rehab Center | 9.9 mi | ★★★★★ | 8 | 0 |
| Mercyone Dyersville Senior Care | 13.3 mi | ★★★★★ | 3 | 0 |
| Anamosa Care Center | 18.8 mi | ★★★★★ | 0 | 0 |
| Hawkeye Care Center Dubuque | 19 mi | ★★★★★ | 6 | 0 |
| Grand Meadows Senior Living & Health Care | 19.9 mi | ★★★★★ | 8 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.