Average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of October 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.
Missing Discharge Summaries: The facility failed to ensure required discharge documentation, including the recapitulation of stay, was completed for 3 discharged residents. Records contained transfer/discharge reports and/or signed discharge instruction forms, but no recapitulation of stay was located. The Administrator stated the EHR was not configured to generate the document, and the DON confirmed there was no policy for discharge documentation.
MDS assessments for 5 of 5 sampled residents incorrectly coded bed rails as physical restraints in Section P. Care plans either did not mention restraints or identified turn rails for bed mobility and transfers, while the MDS Coordinator stated she marked yes whenever side rails were present and that about 15 residents had been coded this way. The DON stated the facility had no residents using restraints or alarms and did not have a policy for MDS accuracy.
A resident with a history of falls and impaired mobility fell in the bathroom, hit his head, and was later diagnosed with a brain bleed. The facility’s investigation was incomplete: the incident report lacked key details such as staff statements, footwear, last visualized time, and incontinence status, and the DON did not document all interviews or speak with the CNA who cared for the resident on the prior shift. The resident’s care plan also did not identify a toileting schedule before the fall-related intervention was added.
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.
Missing Discharge Summaries
Penalty
Summary
The facility failed to ensure completion and maintenance of comprehensive discharge summaries, specifically the recapitulation of stay, for 3 of 3 discharged residents sampled. For Resident #43, the MDS documented a discharge with no return anticipated, and although a transfer/discharge report was provided, the clinical record did not contain the required recapitulation of stay. For Resident #44, the MDS documented discharge with no return anticipated, and the EHR contained a signed Discharge Instruction Form and a transfer/discharge report, but no recapitulation of stay was located in the record. For Resident #45, the MDS documented discharge with no return anticipated, and the facility produced only a signed Discharge Instruction Form; no recapitulation of stay was found in the record. On interview, the Administrator stated the EHR software was not configured to generate a recapitulation of stay and that the document was not available in the current system configuration. The DON confirmed the vendor was correcting the issue and stated the facility did not have a policy regarding discharge documentation or recapitulation of stay.
MDS Miscode of Bed Rails as Physical Restraints
Penalty
Summary
The facility failed to accurately complete Section P (Restraints and Alarms) of the MDS for 5 of 5 sampled residents by coding bed rails as physical restraints. The clinical record review, staff interviews, and guidance from the 2025 LTC Facility RAI 3.0 User’s Manual showed that the MDS assessments for five residents documented daily use of a bed rail as a restraint, while the care plans did not document restraints for any of those residents. For two residents, the care plans identified turn rails to assist with bed mobility, and for one resident the care plan identified turn rails bilaterally to aid in bed mobility and transfers. The MDS Coordinator stated that if there are side rails on the bed, she documents yes on the MDS, and said that approximately 15 residents in the facility had been documented this way on their MDS assessments. She also stated the facility does not use restraints or alarms and would adjust the assessments accordingly. The DON stated the facility had no residents who use restraints, that the MDS coding would be addressed, and that residents with side rails had yearly assessments and used them only per resident request. The DON also stated the facility did not have a policy for the accuracy of the MDS assessments.
Incomplete fall investigation after resident head injury
Penalty
Summary
The facility failed to conduct a thorough investigation after a resident with a history of falls and impaired mobility fell in the bathroom and struck his head on the wall, resulting in a hospital transfer and a diagnosis of a brain bleed. The resident’s care plan identified a fall history and included an intervention to assist him back to his room after meals, toilet him, and then place him in a chair or bed, but it did not identify any toileting schedule or routine before that intervention was added for the fall. The incident summary stated the fall was unwitnessed, staff responded after hearing the fall, and the bathroom floor was dry and free of clutter with no equipment malfunction or environmental issue identified. The facility’s Accident Investigation Report listed general contributing factors such as the resident’s fall risk, an unwitnessed transfer or ambulation in the bathroom, and no environmental hazards, but the opened Risk Management Report was incomplete. It did not document critical investigative details including staff statements, the resident’s footwear, the time the resident was last visualized, or incontinence status. The resident later could not recall how the fall happened, and the Administrator stated the only witness to hearing the fall was the nurse who wrote the progress note and opened the report. Interviews showed that the DON reviewed the progress note and spoke with one CNA, but did not document that conversation and did not interview the CNA who had cared for the resident on the prior shift. That CNA described the resident’s usual routine, including toileting before or after meals, but could not provide details about the fall itself. The LPN who heard the thud stated the resident was in the bathroom without his walker and thought he may have been barefoot, but he was unable to state with certainty whether the resident had been toileted or was incontinent at the time of the fall. The facility policy required documentation of the event details, assessment for cause, personal care issues such as last toileted and shoes on, and potential causes for the fall, but those elements were not fully captured in the investigation.
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.
What surveyors are citing around you — mapped
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Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 71 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
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 | ★★★★★ | 9 | 0 |
| Thomas Rest Haven | 16.9 mi | ★★★★★ | 1 | 0 |
| Caring Acres Nursing And Rehab Center | 21.1 mi | ★★★★★ | 24 | 0 |
| Elm Crest Retirement Community | 21.1 mi | ★★★★★ | 9 | 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 October 2026) and official state health department websites.