Above average — CMS composite of the measures below.
A standard survey is most likely before around September 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 Friendship Home Association during CMS and state inspections, most recent first.
The facility did not notify the representatives or POA for two residents with cognitive impairments when new physician orders were implemented and wander guard devices were placed. Both residents had significant mental health diagnoses and elopement risks. Documentation and staff interviews confirmed that notifications were not made, and the facility lacked a policy for informing family or POA of such changes.
A resident with severe cognitive impairment and a history of wandering exited a secured dementia unit undetected due to a deactivated magnetic lock and delayed staff response to alarms. Staff did not immediately respond to the alarm, which was faint or unheard by some, and the resident was found outside on a neighboring property after a fall was reported. The incident revealed lapses in supervision, delayed alarm response, and malfunctioning security systems.
The facility did not adhere to its policy of completing background checks before staff employment, as evidenced by Staff E's background check being conducted after rehire. The Administrator admitted the oversight, which contradicts the facility's policy requiring background checks for all new hires.
A facility failed to serve food as listed on the menu and did not accurately measure pureed food items for three residents. A Dietary Aide/Cook did not include bread and margarine in pureed meals and used water instead of nutritional thinning fluids. The Dietary Manager confirmed that staff were instructed to measure pureed food volumes and follow the menu, which was not done.
The facility was found deficient in food storage and hand hygiene practices. Opened food items in the refrigerator and freezer were undated, with some showing mold. During meal service, a dietary aide failed to wash hands and improperly used gloves, touching various surfaces and food items without proper hygiene. Facility policies on glove use and hand hygiene were not followed.
A facility failed to accurately document a resident's advanced directives, leading to inconsistencies between the IPOST, EHR, and care plan. The resident's IPOST indicated CPR, while the EHR listed Full Code status, conflicting with the family's request for DNR. Staff interviews revealed a lack of proper indicators in the resident's room, and the DON expected matching documentation. Facility policy required reviewing directives for inconsistencies.
Failure to Notify POA of Wander Guard Placement and New Orders
Penalty
Summary
The facility failed to notify the representatives or Power of Attorney (POA) for two residents when a new physician's order was implemented and a wander guard device was placed on each resident. For one resident with severe cognitive impairment and diagnoses including dementia and Alzheimer's disease, a wander guard was ordered and applied due to elopement risk, but there was no documentation of notification to the resident's POA. The POA later confirmed he was unaware of the device placement and had not been notified by the facility. For another resident with moderate cognitive impairment and diagnoses of mild intellectual disabilities, major depressive disorder, and generalized anxiety, a wander guard was also ordered and applied after an incident of attempted elopement. The resident's POA only learned of the device from the resident, not from facility staff, and there was no documentation of notification in the records. Staff interviews confirmed that the responsible LPN did not notify the residents' representatives or POAs about the new orders or the application of the wander guards. The DON and Administrator both acknowledged that there was no documentation of such notifications and that the facility did not have a policy in place for notifying family or POA of changes in condition, new orders, or the application of a wander guard. The facility census at the time was 42 residents, and the deficiency was identified through EHR review, observation, document review, and interviews with staff and family.
Failure to Provide Adequate Supervision and Prevent Elopement from Dementia Unit
Penalty
Summary
A resident with severe cognitive impairment and a history of wandering, as documented by a BIMS score of 3 and use of a wander guard, was able to leave the secured dementia care unit without staff knowledge. The resident exited through double doors, which were later found to have an inactive magnetic lock, and was discovered outside on a neighboring property by staff after an alarm had sounded for several minutes. Staff interviews revealed that the alarm was either faint or not heard by those on the unit, and that there was a delay in response as staff were engaged in other duties, such as medication administration and resident care. Multiple staff members, including LPNs, RNs, and CNAs, reported confusion regarding the source and urgency of the alarm. Some staff did not hear the alarm at all, while others heard it faintly but did not immediately act or communicate the situation to others. The alarm system's effectiveness was compromised by its location and volume, and the magnetic lock on the exit doors was found to be deactivated, possibly due to accidental contact with a switch by a medication cart. Staff were not immediately aware that the resident had left the unit, and a head count was only initiated after the alarm had been sounding for several minutes. The resident was found outside by a staff member and a member of the dietary team, with evidence of a fall reported by a neighbor. Upon return, the resident was assessed and found to have no injuries. The incident highlighted lapses in supervision, delayed response to alarms, and issues with the physical security systems intended to prevent elopement from the dementia care unit. Staff interviews confirmed that the required immediate response to alarms did not occur, and that the alarm and door locking systems were not functioning as intended at the time of the incident.
Failure to Complete Background Checks Prior to Employment
Penalty
Summary
The facility failed to implement its abuse and neglect policy by not completing background checks prior to staff employment. Specifically, the background check for Staff E was completed on February 13, 2024, despite the staff member being rehired on November 30, 2023. During an interview, the Administrator acknowledged that Staff E had worked at the facility before being rehired and admitted that the background check was missed upon rehire. The facility's policy, dated January 29, 2021, mandates that background checks be completed on all new hires per state regulation. The facility reported a census of 40 residents at the time of the survey.
Failure to Follow Menu and Measure Pureed Foods
Penalty
Summary
The facility failed to ensure that residents were served food as listed on the menu and did not accurately measure pureed food items for three residents. On the specified date, the lunch menu included ham loaf with pineapple sauce, potato, broccoli, bread/margarine, ice cream, and milk. However, the pureed meal was supposed to include pureed bread with margarine, which was not provided. Staff A, a Dietary Aide/Cook, prepared the broccoli for three residents requiring pureed foods using a small hand-held mixer and added water to aid in the pureeing process. She did not measure the volume of the pureed meat and used a 4-ounce scoop for both vegetables and meats without consulting the chart to determine the appropriate scoop size. Additionally, Staff A failed to include bread and margarine on the plates for residents in the Chronic Confusion or Dementing Illness (CCDI) unit, which included 13 residents. The Dietary Manager (DM) confirmed that staff were taught to prepare one more serving than needed when making pureed foods and to measure the volume after pureeing to determine the serving size. The DM also stated that Staff A was instructed to use thinning fluids with nutritional value rather than water and to follow the menus, including serving bread when it was listed. The facility's puree process, posted in the kitchen, outlined steps for preparing pureed foods, including measuring the total volume after pureeing and dividing it by the original number of portions. The facility's policy emphasized providing nourishing, palatable, and attractive meals that meet residents' daily nutritional needs and preferences, which was not adhered to in this instance.
Deficiencies in Food Storage and Hand Hygiene Practices
Penalty
Summary
The facility failed to ensure proper food storage and handling practices, as observed during a survey. In the walk-in refrigerator, several opened bags of shredded cheese, shredded lettuce, and cubed cheese were found without dates indicating when they were opened. Some of the cheese cubes were moldy. Additionally, an open bag of cubed turkey and several bags of frozen vegetables in the freezer were also undated. The Dietary Manager acknowledged these issues and disposed of the undated items. Furthermore, individual cups of pudding were found uncovered and undated on a tray cart. During meal preparation and service, staff failed to adhere to safe hand hygiene practices. A dietary aide was observed handling food without washing hands and using bare hands to remove cooked meat from parchment paper. The same staff member used a single glove on one hand to handle bread and cheese, touching various surfaces and wiping hands on her scrub top without conducting hand hygiene throughout the meal service. The facility's policy on glove use and hand hygiene was not followed, as gloves were used improperly, and handwashing was neglected before and after glove use.
Inconsistent Documentation of Resident's Advanced Directives
Penalty
Summary
The facility failed to maintain accurate documentation of a resident's choice regarding advanced directives, specifically for one resident out of five reviewed. The Minimum Data Set (MDS) indicated that the resident was admitted to the facility on a specific date. An Iowa Physician Orders for Scope of Treatment (IPOST) document, signed by the physician and the resident's representative, indicated a selection for Cardiopulmonary Resuscitation (CPR). However, the Electronic Health Records (EHR) contained a Clinical Physician Orders document that listed the resident as Full Code status, which conflicted with the resident's care plan that noted a request for Do Not Resuscitate (DNR) status by the resident's family. During staff interviews, it was revealed that the resident's room did not have a heart sticker above the bed, which would indicate a full code status. The Director of Nursing (DON) stated that the expectation was for the IPOST and physician orders to match regarding code status. The facility's policy on advanced directives required a review of all directives to identify and resolve any omissions or inconsistencies.
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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 Audubon
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Exira Care Center | 9.3 mi | ★★★★★ | 7 | 0 |
| Salem Lutheran Home | 10.8 mi | ★★★★★ | 10 | 0 |
| Thomas Rest Haven | 16.9 mi | ★★★★★ | 9 | 0 |
| Caring Acres Nursing And Rehab Center | 21.1 mi | ★★★★★ | 20 | 0 |
| Elm Crest Retirement Community | 21.1 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.