Average — CMS composite of the measures below.
The next survey window likely opens around June 2027
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 Nora Springs Care Center during CMS and state inspections, most recent first.
Dishwasher and clean dishes had a persistent white residue buildup. Surveyors observed residue on the dishwasher and on clean dishes during kitchen checks, and staff reported weekly descaling had been attempted but the buildup remained. The DM said the facility knew about the issue and was waiting on a water softener order, while the Administrator acknowledged awareness of the residue and said contact with the city about water usage had not yet produced a response.
A resident with moderately impaired cognition and DNR status did not have a completed and signed IPOST from a physician when reviewed for advance directives. The SW documented contacting the resident’s representative to sign the IPOST and noted the facility did not have the original form. Staff later acknowledged the physician had not signed the IPOST, and the record showed the NP eventually signed it.
Failure to provide resident-centered activities for a resident with intact cognition and diagnoses of anxiety and depression. The resident said favorite activities, religious practices, news, music, and reading were important, but staff did not visit or engage the resident, and the chart showed only verbal encouragement to attend group activities with no documentation of one-to-one or in-room activities. The ADON/Activity Director said there was not always time for one-on-one activities and had not provided any to the resident, while the Administrator stated staff need to offer one-on-one activities when a resident does not leave the room for group activities.
An RN and an LPN failed to verify the physical narcotic count against the count sheet during a shift change count for a resident receiving hospice care and liquid morphine for pain. Staff later identified a discrepancy in the morphine count, but the issue was not immediately reported when first noticed, and the facility could not determine the location of the missing medication. The resident had intact cognition, bladder cancer, and hospice services.
Staff failed to administer insulin as ordered for two residents and repeatedly held or reduced insulin doses without notifying the physician. One resident with severe cognitive impairment had multiple Lantus and Novolog doses held, while another resident with diabetes and intact cognition had repeated insulin Aspart doses held or cut in half per nursing judgment. Interviews showed staff were given inconsistent direction about whether insulin could be held without contacting the MD, despite the facility policy requiring medications to be given according to physician orders.
A resident with intact cognition and diagnoses of adult failure to thrive, diabetes, and cancer had an order for zinc sulfate on the MAR, but the medication was documented as unavailable over several days and was not administered. There was no documentation in the progress notes that the provider was notified of the omitted zinc sulfate, and the Administrator confirmed that such documentation could not be found. Review of the facility’s Medication Administration-Medication Pass policy showed it did not include a process for what staff should do when a medication is not available.
Two residents did not receive ordered medications as prescribed. One resident with severe cognitive impairment and multiple comorbidities had an admission order for daily furosemide, but the drug was omitted from the MAR and never administered after the facility returned the delivered medication to the pharmacy, with no evidence of discontinuation. Another resident with intact cognition and serious medical conditions had an order for daily zinc sulfate, which was documented as unavailable for several days due to a backorder, and there was no documentation that staff notified the pharmacy to obtain the medication from an alternative source. The facility’s medication administration policy lacked a defined process to verify accurate transcription of new admission orders.
A resident with intact cognition, multiple comorbidities, an open right knee wound, and care‑planned dependence for transfers was ordered by a physician and therapy to use a right knee immobilizer during all weight‑bearing activities. The care plan required the immobilizer for transfers and ambulation and called for education about risks of refusing recommendations, but did not specify which staff were competent to provide this education. A CNA, aware the immobilizer was required yet unsure when it had to be worn, assisted the resident in a chair‑to‑bed transfer without the immobilizer after the resident refused it, and did not notify an RN before proceeding. During the transfer the resident fell, sustaining bilateral leg injuries later described as bilateral closed fractures of the tibial plateau condyles and fibulae, with severe pain and an opened knee wound. Documentation lacked evidence of resident refusal of the immobilizer or of risk‑based education, and staff competency records and the transfer policy did not address immobilizer/appliance refusal or clarify responsibility for resident education.
Failure to timely report an alleged abuse incident. A resident with HF, HTN, DM, weakness, and moderate memory impairment was being showered when one CNA was observed by another CNA in the shower room with a cell phone appearing to record on Snapchat. The resident was in a shower chair with clothing partially on, and the second CNA immediately reported the event to the nurse, but the Administrator confirmed the allegation was not reported to DIAL within the required 2 hours.
The facility failed to label and date opened food items, including broccoli salad, shredded lettuce, and various pasta and dessert ingredients, during a kitchen inspection. The Dietary Supervisor expected staff to mark and date food items, but the facility lacked a specific policy, relying instead on the most recent food code and regulations.
Dishwasher and Clean Dishes Had White Residue Buildup
Penalty
Summary
The facility failed to maintain kitchen equipment and clean dishes in a sanitary condition because of a white residue buildup on the dishwasher and on clean dishes. During an initial kitchen walkthrough, surveyors observed white residue on the dishwasher and clean dishes, and a later observation showed the residue was still present on both the dishes and inside the dishwasher. Staff reported that weekly descaling had been attempted, but the dishes continued to retain the buildup. The Dietary Manager stated the facility was aware of the dishwasher issue and that an ordered water softener was still on backorder. The Administrator reported contacting the city in June about water usage to determine the needed softener size but had received no response, and also acknowledged awareness of the residue on the dishes and in the dishwasher. A Dietary Aide reported the white residue had persisted for a long time and that the issue had remained unresolved.
Incomplete IPOST for Resident with DNR Status
Penalty
Summary
The facility failed to ensure staff obtained a completed and signed Iowa Physician Orders for Scope of Treatment (IPOST) from a physician for one resident reviewed for advance directives. Resident #4 had a documented DNR code status and MDS assessments showing moderately impaired cognition, with BIMS scores of 8 and 12. The resident’s care plan directed staff to follow the advance directive for DNR status, and the resident’s profile also documented a DNR code status. A progress note documented that the Social Worker left a message with the resident’s representative asking them to call to sign the resident’s IPOST, and the note stated the facility did not have the original IPOST. Another note documented the Social Worker reviewed the care plan and code status with the resident, and the resident stated she was DNR. Staff acknowledged that the physician had not signed the IPOST and expected the physician to sign it. Later documentation stated the Nurse Practitioner signed the IPOST, and the record was observed to reflect that signature.
Failure to Provide Resident-Centered Activities
Penalty
Summary
The facility failed to provide resident-centered activities that incorporated Resident #29’s interests and hobbies. Resident #29’s MDS documented a BIMS score of 14, indicating intact cognition, and noted diagnoses including anxiety and depression. The resident reported that favorite activities, religious practices, keeping up with news, listening to music, and reading books, newspapers, and magazines were highly important. During interview, Resident #29 stated uncertainty about whether the facility offered activities, requested someone to read aloud and help with a computer tablet to watch movies, and said staff members did not visit or engage in activities. The resident also reported lying in bed all day and not getting out of bed for some time, which prevented participation in activities. Record review showed only verbal encouragement to attend group activities and no documentation of one-to-one or in-room activities offered. The Activity Director stated there was not always time to conduct one-on-one activities with residents remaining in rooms and reported not conducting any one-on-one activities with Resident #29. The Administrator stated staff members need to offer one-on-one activities if a resident does not leave the room for group activities.
Narcotic Count Discrepancy and Failure to Verify Controlled Medication Counts
Penalty
Summary
The facility failed to follow professional standards for reconciling controlled medications for one resident who had a BIMS score of 15, indicating intact cognition, and diagnoses including bladder cancer and hospice care. During a shift change narcotic count, an RN and an LPN counted the narcotics by reading the count book aloud, but neither staff member compared the physical controlled medication count to the count sheet to verify accuracy. The Administrator stated that staff are expected to verify the physical narcotic count against the narcotic count sheet whenever keys transfer. The facility also failed to immediately report a narcotic count discrepancy involving the resident’s liquid morphine sulfate. A facility incident summary documented that the count sheet showed 29.25 ml, while staff measured 24 ml, and the investigation later documented 29 ml should have remained when 24 ml was measured. Staff interviews showed that one CMA noticed a discrepancy but did not report it beyond the nurse at the time, another nurse did not recognize the discrepancy during a count, and the missing morphine was not identified until the next morning when another staff member counted the medication and notified the DON. The facility could not determine the location of the missing morphine, and the Controlled Medication Storage and Count Policy required immediate reporting of any narcotic count discrepancy to the DON.
Insulin Doses Held or Altered Without Physician Notification
Penalty
Summary
The facility failed to ensure residents were free from significant medication errors when staff administered insulin contrary to physician orders and did not notify the physician when insulin doses were held or altered for two residents. The facility’s Medication Administration-Medication Pass policy revised May 2023 directed staff to administer medications according to physician orders. Staff interviews showed inconsistent understanding of insulin administration, with some reporting they could hold insulin per nursing judgment and others stating the physician should be contacted when insulin needed to be held or changed. One resident had severe cognitive impairment with a BIMS score of 2 and a diagnosis of diabetes. The resident’s insulin orders included Lantus 35 units in the morning and Novolog 10 units at lunch and 8 units at supper, later with an additional Novolog 8-unit morning order. Progress notes documented multiple occasions when nurses held ordered insulin doses, including Lantus and Novolog, without physician notification or orders. Staff reported that nurses did not always verify with the doctor at the time and that they were instructed they could hold insulin per nursing judgment, while the DON stated nurses must call the physician if insulin needed to be held or adjusted. A second resident had intact cognition with a BIMS score of 14 and diagnoses of diabetes and adult failure to thrive. Physician transfer orders directed Basaglar 8 units daily in the morning and insulin Aspart 8 units three times daily before meals. Progress notes documented repeated instances of insulin Aspart being held or reduced to 4 units per nursing judgment without notifying the physician. The resident’s care plan directed staff to administer medication as ordered and monitor blood sugars, but staff interviews confirmed they were holding insulin based on blood sugar readings and food intake without contacting the physician.
Failure to Notify Physician of Omitted Medication and Lack of Process for Unavailable Drugs
Penalty
Summary
The deficiency involves the facility’s failure to notify a physician when a resident did not receive an ordered medication and the lack of a policy process for handling unavailable medications. A resident with intact cognition, as evidenced by a BIMS score of 14, and diagnoses including adult failure to thrive, diabetes, and cancer had an order for zinc sulfate listed on the October 2025 MAR, with documentation directing review of progress notes from 10/4/25 to 10/9/25. During that period, the Orders-Administration Note documented zinc sulfate as unavailable, and the progress notes contained no evidence that the provider was notified that the resident did not receive the ordered zinc sulfate. The Administrator confirmed there was no documentation of physician notification regarding the omitted zinc, and the facility’s Medication Administration-Medication Pass policy, revised May 2023, did not include a process for what to do if a medication is not available. This failure occurred for 1 of 3 residents reviewed, in the context of a reported facility census of 47 residents.
Failure to Administer Ordered Medications and Obtain Unavailable Drug
Penalty
Summary
The deficiency involves the facility’s failure to ensure residents were free from significant medication errors by not administering medications as ordered by physicians for two residents. For one resident with severe cognitive impairment, cancer, heart failure, and dementia, admission orders dated 11/20/25 included furosemide 20 mg daily. The resident’s EHR showed an admission date of 11/20/25 and discharge on 12/1/25, but the November 2025 MAR did not contain the furosemide order or any documentation of its administration from November 21 through the end of the month. The contracted pharmacy reported that when they delivered the furosemide on admission, the facility sent it back and never administered the medication. The Administrator later confirmed that the admission orders for furosemide were present and not discontinued, indicating the medication should have been given. The facility’s medication administration policy did not include a process to verify that new admission medications were correctly transcribed. For another resident with intact cognition and diagnoses including adult failure to thrive, diabetes, and cancer, admission orders dated 10/3/25 included zinc sulfate 220 mg daily starting 10/4/25. The October 2025 MAR listed the zinc order, but from 10/4/25 to 10/9/25 the Orders-Administration Note documented zinc sulfate as unavailable, and the MAR directed staff to see progress notes for that period. The Administrator reported that the staff member responsible for ordering stock medications did not obtain the zinc immediately because it was on backorder and was uncertain whether the pharmacy had been informed of the shortage. The Administrator also could not find documentation that the facility notified the pharmacy that zinc needed to be obtained from them after the regular supplier had it on backorder.
Failure to Ensure Competent Staff Response to Refusal of Physician‑Ordered Knee Immobilizer During Transfer
Penalty
Summary
The deficiency involves the facility’s failure to ensure that nursing staff had and used appropriate competencies to explain the risks of not wearing a physician‑ordered knee immobilizer before transferring a resident, and to follow care plan and therapy directives regarding that immobilizer. The resident involved had intact cognition with a BIMS score of 15 and was care planned as dependent for transfers and ambulation, requiring assistance of two staff. The MDS and care plan documented multiple active diagnoses including fractures, osteoporosis, diabetes mellitus, morbid obesity, renal failure requiring dialysis, and an open surgical wound to the right knee. The care plan specified that a right knee immobilizer was to be on during transfers and ambulation, and that the resident was at risk for falls related to altered gait and balance, osteoporosis, prior fracture, obesity, renal failure, and an open wound with delayed healing. The care plan also identified a history of noncompliance with therapy recommendations and directed staff to educate the resident regarding potential risks and adverse effects of refusing recommendations, but it did not specify which staff were competent or responsible to provide that education. Physician and therapy documentation directed that the resident should continue with a protective knee immobilizer at all times while weight‑bearing and that transfers and ambulation with two‑person assist and a walker required the immobilizer to be on. On the date of the incident, a CNA assisted the resident to transfer from a chair to a bed without the right knee immobilizer in place. The CNA acknowledged knowing that the resident needed the immobilizer for transfers and reported that the resident had refused to wear it. The CNA stated she offered limited education, telling the resident the immobilizer could be cleaned and would probably be better to have it on, but she did not notify the nurse of the refusal before proceeding with the transfer and verbalized she did not know when the immobilizer was required to be on. The RN on duty reported that she was only called to the room after the transfer attempt, not beforehand, and found the resident on the floor with legs bent backwards and without the knee immobilizer. Following the transfer attempt without the immobilizer, the nurse’s assessment documented that the resident’s legs were bent backwards in a “W” position, the right knee wound was split open and actively bleeding, and the resident reported severe pain rated 10/10, was nearly hyperventilating, and could not move her legs or wiggle her toes. The incident report and subsequent documentation identified suspected bilateral broken legs, later described as bilateral closed fractures of the condyles of the tibial plateau and fibulae. Progress notes lacked documentation that the resident had refused the immobilizer or that staff had provided education on the potential risks and adverse effects of refusing it. Review of the CNA’s personnel file showed orientation and skills checklists for general tasks such as ambulation, transfers, use of gait belts, and splints/braces, but the skills evaluation lacked competency elements for alerting the nurse regarding refusal of immobilizers or appliances and lacked a facilitator signature. The facility’s transfer policy directed staff to transfer residents according to the care plan and to notify the nurse and document changes in condition, but it did not address immobilizers/appliances or specify who was responsible for education when such devices were refused. The facility also lacked a policy for training or competency of staff specific to immobilizers and appliances.
Failure to Timely Report Alleged Abuse Incident
Penalty
Summary
The facility failed to report an alleged violation involving mistreatment, neglect, or abuse of a resident to the Department of Inspection and Appeals and Licensing within 2 hours. Resident #1 had diagnoses including heart failure, hypertension, diabetes mellitus, weakness, and needed assistance with personal hygiene. The resident’s MDS documented a BIMS score of 9, indicating moderate memory impairment, and the care plan noted impaired cognitive function, the need for time to respond and process tasks, and the need for cues, direction, redirection, and a consistent routine and environment. According to the facility investigation, a CNA was assigned to shower the resident during the evening shift, and another CNA entered the shower room to retrieve a wheelchair from storage behind the shower area. The second CNA reported seeing a cell phone propped against the wall and recording on Snapchat, and observed the first CNA quickly change position when startled. The resident was sitting in a shower chair with a shirt and brief on, with pants not fully on, when the incident occurred. The second CNA immediately reported the event to the nurse on duty, and facility leadership was notified, but the Administrator later confirmed the facility did not notify DIAL within the required 2-hour timeframe.
Failure to Label and Date Opened Food Items
Penalty
Summary
The facility failed to label and date food items when opened, which is necessary to reduce the risk of contamination and food-borne illness. During an initial tour of the facility kitchen, it was observed that two large bowls of broccoli salad, an opened bag of shredded lettuce, two opened bags of spaghetti noodles, an opened bag of penne pasta, an opened bag of egg noodles, an opened bag of pudding pie filling, and an opened bag of plain gelatin were not labeled or dated. The Dietary Supervisor stated that staff were expected to mark and date food items when opened, but the facility did not have a specific policy for labeling and dating food, as they followed the most recent food code, rules, and regulations.
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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 Nora Springs
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Heritage Care And Rehabilitation Center | 8.3 mi | ★★★★★ | 0 | 0 |
| Good Shepherd Health Center | 9 mi | ★★★★★ | 7 | 0 |
| I O O F Home And Community Therapy Center | 10.1 mi | ★★★★★ | 3 | 0 |
| Mercyone North Iowa Medical Services | 12.4 mi | — | 0 | 0 |
| Manly Specialty Care | 13.2 mi | ★★★★★ | 7 | 0 |
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