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 Oakview Nursing Home during CMS and state inspections, most recent first.
The facility failed to offer the COVID-19 vaccine to 5 reviewed residents, including residents with BIMS scores ranging from severe to intact cognition. Their MDS assessments showed they had not received an updated COVID-19 vaccine, and their EHRs lacked documentation of either vaccine receipt or a vaccine offer. The DON stated the facility should offer the vaccine at least annually but could not prove it had been offered, despite the facility policy directing COVID-19 vaccination offers per CDC or state guidance.
Missed Quarterly MDS Assessment: The facility failed to complete a resident’s quarterly MDS within the required timeframe. The MDS Coordinator said the EHR tracking system did not exist, and the DON/Administrator reported there was no facility policy for MDS assessments, with staff relying on the RAI Manual, which requires the quarterly MDS every 3 months.
A resident with HF, renal failure, and fatigue experienced a significant weight loss along with repeated poor meal intake, but the care plan lacked interventions for the low intake. Progress notes did not document assessment or communication with the MD, RD, or family about the weight loss, and the order summary did not include oral nutrition supplements or fortified foods. The MDS Coordinator found no related progress note entries, and the DON stated nurses should assess and notify the MD and family immediately when residents have significant weight loss.
Cross-contamination occurred during perineal care when two CNAs used the same wipes multiple times and did not change gloves between dirty and clean tasks while caring for a resident with dementia, stroke, and total dependence for toileting hygiene and dressing. The CNAs touched the resident and multiple surfaces with dirty gloves, placed a clean brief on a bed pad where dirty wipes had been set, and later acknowledged the improper glove use; the DON and NC stated gloves must be changed between dirty and clean tasks and wipes used only once.
A resident with moderate cognitive impairment, muscle weakness, and difficulty walking was care-planned and documented on the Kardex to require a full-body mechanical lift with two staff for all transfers. Despite this, CNAs at times performed manual two-person transfers, including a difficult and awkward transfer from a commode to a recliner during which staff and the resident’s legs became tangled. The resident later reported her feet got tangled during the transfer, then complained of severe right ankle pain, swelling, and inability to bear weight, and imaging showed an ankle fracture that the physician documented as having occurred during a transfer. The facility’s investigation and staff interviews confirmed multiple instances of manual transfers being used instead of the required mechanical lift, in violation of the resident’s plan of care and the facility’s safe handling policy.
Failure to Offer and Document COVID-19 Vaccination
Penalty
Summary
The facility failed to offer the COVID-19 vaccine for 5 of 5 residents reviewed, including residents with varying cognitive status documented on their MDS assessments. Resident #3 had a BIMS score of 8, Resident #21 had a BIMS score of 12, Resident #29 had a BIMS score of 15, Resident #39 had a BIMS score of 3, and Resident #45 had a BIMS score of 13. For each of these residents, the MDS indicated they had not received an updated COVID-19 vaccine and did not have up-to-date vaccination status. Record review showed each of the five residents' EHRs lacked documentation of either vaccine receipt or a vaccine offer. During interview, the DON stated the facility should offer the vaccine at least annually and reported she could not prove the facility offered it. The facility policy titled Influenza, COVID-19 and Pneumococcal Vaccination instructed the facility to offer the COVID-19 vaccination as recommended by the CDC or the Iowa Department of Public Health, and the report noted CDC guidance for updated COVID-19 vaccination.
Missed Quarterly MDS Assessment
Penalty
Summary
The facility failed to complete the quarterly Minimum Data Set (MDS) assessment within the required timeframe for 1 of 1 residents reviewed, Resident #34. The resident’s MDS report in the EHR showed the last MDS assessment was completed on 3/4/26, and the current quarterly MDS had not been completed. During record review and staff interviews, the MDS Coordinator stated on 7/13/26 that the tracking system in the EHR did not exist, which caused the facility to miss the quarterly MDS. The Administrator stated on 7/13/26 that staff should complete the MDS within the required timeframe and reported the facility did not have a policy for MDS assessments, instead following the RAI Manual. The RAI Manual dated October 2025 instructed that the quarterly MDS be completed every 3 months.
Failure to Address Significant Weight Loss and Poor Intake
Penalty
Summary
The facility failed to identify and respond to a significant weight loss for Resident #11, who had diagnoses of heart failure, renal failure, and fatigue and was cognitively intact with a BIMS score of 15. The resident’s care plan identified a nutritional problem related to a new environment, advancing age, and comorbidities, with interventions to provide the ordered diet, monitor and record meal intake, have the RD evaluate and recommend diet changes as needed, and weigh the resident per facility policy. However, the care plan lacked interventions related to the low food intake documented during the current stay. The resident’s weight trend showed a drop from 174 pounds on 6/5/26 to 161 pounds on 7/8/26 and 160.5 pounds on 7/10/26. Progress notes lacked an assessment or communication with the physician, dietitian, or family regarding the July weight loss. Meal intake records from 6/16/26 through 7/15/26 documented repeated poor intake, including 0-25% for 26 meals, 26-50% for 11 meals, refusal of 8 meals, and missing documentation for 4 meals out of 88 total meals. The order summary did not list oral nutrition supplements or fortified foods. The MDS Coordinator reported no progress note entries for assessment or physician notification, and the DON stated nurses should assess and notify the physician and family immediately when residents experience significant weight loss.
Cross-Contamination During Perineal Care
Penalty
Summary
The facility failed to prevent cross-contamination during perineal care for one resident who had a BIMS score of 15, indicating intact cognition, and who was documented as having impairment to both sides of the upper and lower extremities with total dependence on staff for toileting hygiene and dressing. The resident also had diagnoses of dementia and stroke. On 7/14/26 at 12:55 PM, two CNAs performed perineal care and both completed hand hygiene and applied gowns and gloves before beginning care. During the care, Staff B and Staff C used the same wipe multiple times while cleaning the resident, including wiping from front to back and reusing wipes after setting them down on the bed pad. Staff B touched the resident's right hand with dirty gloves while adjusting the hand, and Staff C also reused the same dirty gloves while placing a clean brief under the resident on top of the bed pad where dirty wipes had been placed. The staff continued the care with the same dirty gloves, including pulling up the brief and pants, touching the resident's left hand, touching the bedsheet, grabbing the blanket, and covering the resident before removing gloves and completing hand hygiene. Both CNAs later acknowledged they did not change gloves between clean and dirty tasks and confirmed touching multiple surfaces and the resident with dirty gloves. The DON stated staff must change gloves between clean and dirty tasks, and the NC stated staff must use wipes only one time. The facility's Incontinent Care policy instructed staff to remove gloves after providing perineal care but did not direct staff to use a wipe only once or change gloves between dirty and clean tasks.
Failure to Follow Care-Planned Mechanical Lift Transfers Resulting in Ankle Fracture
Penalty
Summary
The deficiency involves the facility’s failure to follow the care-planned transfer method requiring the use of a full-body mechanical lift with two staff for a resident, resulting in an ankle fracture. The resident had a BIMS score of 11, indicating moderate cognitive impairment, and diagnoses including heart failure, chronic kidney disease, muscle weakness, and difficulty walking. The MDS, Care Plan Task, and Kardex all documented that this resident required a full-body mechanical lift with assistance of two staff for all transfers. Despite this, staff interviews and the facility’s own investigation revealed that CNAs at times performed manual two-person transfers instead of using the mechanical lift, including transfers to and from the commode and recliner. On one occasion, two CNAs attempted to place the mechanical lift sling under the resident while she was on the commode but were unable to do so and proceeded with a manual transfer to a recliner, which one CNA described as very hard, awkward, and a struggle, during which they became tangled with the resident’s legs. The resident later reported that her feet got tangled when she went to her chair the previous night and subsequently complained of severe right ankle pain, swelling, and inability to bear weight or move the ankle freely. The physician was notified, an x-ray was obtained showing a questionable right ankle fracture, and a physician progress note documented that the resident sustained an ankle fracture during a transfer. The facility’s investigation, including staffing review and staff statements, confirmed multiple instances where CNAs assisted this resident with two-person manual transfers instead of using the required mechanical lift, contrary to the facility’s Safe Resident Handling/Transfers Policy and the resident’s plan of care.
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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 Conrad
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Westbrook Acres | 8 mi | ★★★★★ | 9 | 0 |
| Grundy Care Center | 10.7 mi | ★★★★★ | 15 | 0 |
| Creekside | 10.8 mi | ★★★★★ | 7 | 0 |
| Iowa Veterans Home | 12.4 mi | ★★★★★ | 6 | 0 |
| Harmony Marshalltown | 13.6 mi | ★★★★★ | 18 | 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.