Below average — CMS composite of the measures below.
A standard survey is most likely before around December 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 Thomas Rest Haven during CMS and state inspections, most recent first.
A resident with moderate cognitive impairment, morbid obesity, impaired balance, and a documented history of self-transferring and falls was care planned for specific fall interventions, including use of a gait belt during transfers, two-person assistance in some circumstances, a Hoyer lift for all transfers, and non-skid strips in the bathroom. Despite these directives and a high Morse Fall Scale score, staff did not consistently follow the care plan or standards of practice. After the resident was moved to a new room, anti-slip strips were not applied to the new bathroom floor, and on one occasion a CNA, unfamiliar with the care plan, assisted the resident into the bathroom without a gait belt; when the resident’s legs gave out while holding a grab bar, the CNA attempted to support her under the arms but could not prevent her from being lowered to the floor, resulting in fractures to the lower leg that were later classified as a major injury.
Failure to use hand hygiene and EBP during resident care. Staff did not consistently perform hand hygiene before feeding residents, during catheter care, or between glove changes, and hospice staff fed residents after touching hair and handling personal items without sanitizing hands. Staff also failed to wear gowns during high-contact wound care and catheter care for residents with an indwelling catheter, a suprapubic catheter, and pressure injuries.
A resident with severe cognitive impairment and multiple medical conditions experienced several falls and injuries, including bruising, swelling, and skin tears. Staff did not notify the physician or family after these incidents, and documentation of follow-up actions was lacking, despite facility policy requiring such notifications and assessments.
A resident with severe cognitive impairment and a history of falls experienced multiple incidents resulting in injuries, including abrasions, skin tears, and a swollen hand. Staff failed to complete and document required skin assessments, wound measurements, and timely notifications to the physician and family, despite facility policy and care plan requirements. Family concerns about the resident's untreated injuries were confirmed when fractures were discovered after transfer to another facility.
Missing Physician Signature on Advance Directive: A resident with moderately impaired cognition and multiple diagnoses, including seizure disorder, TBI, COPD, diabetes, and psychiatric conditions, had a DNR request documented on the care plan and Care Directive Determination form. The resident's wife signed the form, but the physician/NP signature was not present. Staff gave differing accounts of who was responsible for obtaining and faxing the signature, and the DON stated nurses were expected to ensure the advance directive was signed and returned within 24-48 hours.
A facility failed to ensure a current background check was completed for a rehired CNA. The staff file showed the last Single Contact License and background check was from 2020, and the file lacked a new check after the CNA was rehired. The Admin Asst acknowledged the omission, and the Administrator confirmed a second background check should have been completed before rehire.
The facility failed to notify the LTC Ombudsman of hospital transfers for two residents. One resident had intact cognition and reported being in the hospital, while another had severe cognitive impairment and EHR documentation confirmed a short-term hospital stay and return to the facility. Facility records for the relevant months did not include either resident on the Notice of Transfer Form, and the DON stated the expectation was for Ombudsman notification to be completed correctly each month.
Failure to provide timely catheter care for a resident with a suprapubic catheter and leg bag. The resident had BPH, renal insufficiency, obstructive uropathy, and a history of recurrent UTI treatment. The care plan directed staff to empty the leg bag every shift and PRN, but documentation showed catheter care only twice on multiple days, and staff observed the bag very full, half full, over half full, and full while the resident was in the hallway. Staff and the DON stated the bag should be emptied each shift or more often, and the LPN/IP said lack of documentation meant the task was not completed.
Failure to maintain and date oxygen equipment for residents requiring respiratory support. A resident with continuous O2 therapy, a resident with respiratory failure, and a resident with CHF/COPD had tubing, cannulas, and nebulizer equipment observed with outdated or missing dates despite physician orders and care plan directions for weekly changes and labeling. Staff interviews confirmed the expected weekly schedule, and the DON stated the facility had no policy on oxygen tubing change.
A resident with cognitive impairment and high fall risk, who required substantial assistance and was care planned to never be left unattended in the bathroom, was left alone on the toilet by a TNA who then went on break without notifying others. The resident attempted to get up unassisted, resulting in a fall with multiple abrasions and skin tears. Staff interviews confirmed the resident's supervision needs were documented and known, but were not followed, leading to the incident.
A facility failed to ensure staff documented the open date on a Vitamin B-12 bottle before administering it to a resident. An LPN administered the vitamin without an open date, later realizing the mistake after consulting with the Administrator. The resident had a BIMS score of 15 and a medical history including hypertension and Alzheimer's. The Administrator noted regular checks for open bottles but found no specific policy on open date documentation.
Two residents reported being instructed by staff to urinate in their briefs due to delayed assistance to the restroom, compromising their dignity. One resident, with moderate cognitive deficit, experienced stress and degradation, while another, with intact cognitive ability, was told he used his call light too often. The facility's administrator was unaware of these incidents, which violated the residents' rights to dignity and respect.
A resident with severe cognitive deficits and a history of attempting to get up on his own fell in the dining room due to inadequate supervision and the absence of a personal alarm on his chair. The fall resulted in a severe hip injury requiring surgery. Staff interviews revealed uncertainty about the alarm's presence and effectiveness, and observations showed ongoing challenges in managing the resident's fall risk.
A facility failed to complete and submit a resident's MDS assessment within the required timeframe. A resident was discharged, and the MDS was completed by the ADON but not submitted to CMS until much later. The DON acknowledged issues with the MDS process due to the former MDS coordinator's performance. The RAI Manual requires the MDS to be completed and submitted within specific timeframes.
Failure to Use Gait Belt and Implement Fall Precautions During High-Risk Transfer
Penalty
Summary
The deficiency involves the facility’s failure to ensure safe transfer techniques and fall prevention measures for a resident with a known history of frequent falls and self-transferring. The resident had moderate cognitive impairment (BIMS 11), required partial assistance with transfers and sit-to-stand, was always incontinent of urine, and had multiple comorbidities including hypertension, diabetes mellitus, COPD, and morbid obesity. Her care plan identified self-care deficits, impaired balance, poor safety awareness, and fall risk, and documented prior falls and the need for specific fall interventions, including non-skid strips in the bathroom, use of a Hoyer lift for all transfers as of 12/7/25, and staff education to use a gait belt when transferring. Nursing progress notes showed a pattern of self-transferring and fall-related events over several months, including documentation that the resident continued to self-transfer, had a witnessed fall during transfer to the toilet, and was being ambulated by staff when she reported her legs were giving out and was lowered to the floor. A Morse Fall Scale assessment scored her at 70, indicating high fall risk. Despite these documented risks and interventions, staff did not consistently follow the care plan and standards of practice. The resident’s care plan called for non-skid strips in the bathroom, but after she changed rooms on 12/3/25, the anti-slip strips were not implemented in the new bathroom. On the date of the major fall event, a CNA assisted the resident into the bathroom without applying a gait belt, despite having been educated on gait belt use and acknowledging she knew one should have been used. The CNA was behind the resident as the resident held onto a support bar; when the resident’s legs gave out, the CNA attempted to hold her by placing her arms under the resident’s armpits but was unable to keep her up and lowered her to the floor. Multiple staff confirmed that at the time of this fall the resident did not have a gait belt on, and that some staff typically used two-person assistance with a gait belt due to the resident’s size. The post-fall evaluation and emergency room X-ray documented fractures of the distal tibia and fibula, and a physician later determined the injury to be a major injury.
Failure to Use Hand Hygiene and EBP During Resident Care
Penalty
Summary
The facility failed to use universal infection control measures, including hand hygiene, and failed to use Enhanced Barrier Precautions (EBP) during catheter care and wound care for residents reviewed for infection control. During observation of catheter care for a resident with an indwelling catheter and diagnoses including progressive neurological conditions, Alzheimer’s disease, non-Alzheimer’s dementia, and obstructive uropathy, staff completed hand hygiene and donned gloves and gowns, but then raised the resident’s bed while wearing gloves, cleansed the thighs, penis, and catheter tubing, doffed gloves, donned new gloves without hand hygiene, and drained the catheter bag. The CNA later stated she should have changed her gloves after raising the bed. During lunch, hospice staff entered the dining room and went directly to the assisted feeding table. An RN sat next to one resident, touched the resident’s hair to put it into a ponytail, did not wash or sanitize her hands, and began feeding the resident. She then opened her backpack, placed a barrier on the floor, set the backpack on it, removed a laptop, typed on the keypad, and resumed feeding without using hand sanitizer. A hospice CNA fed another resident without washing hands or using hand sanitizer before feeding. The Administrator stated she would expect outside contracted staff to wash their hands or use hand sanitizer before feeding residents and after touching their hair. The facility’s policy required hand hygiene before direct resident contact and before preparing, serving, or eating food. The EBP policy stated gowns and gloves would be worn during high-contact care activities, and the catheter care policy required hand washing, gloves, and clean equipment. The report also documented wound care and catheter care observations where staff failed to consistently perform hand hygiene between glove changes and failed to wear gowns for EBP during wound care and catheter care. One resident with stage 3 pressure injuries and ear cancer had wound care performed without a gown during ear and buttock treatments, and another resident with a suprapubic catheter and leg bag had catheter emptying performed without a gown. The Interim DON stated staff should be utilizing EBP during catheter care, and staff stated EBP should be utilized during catheter care and all wound care.
Failure to Notify Physician and Family After Resident Falls and Injuries
Penalty
Summary
Staff failed to notify the physician and family when a resident experienced multiple falls and injuries, including a bruised and swollen hand, skin tears, and abrasions. Documentation in the clinical record showed that after each incident, such as falls and the discovery of new injuries, there was no evidence that the physician or family were informed, nor were follow-up orders or directions obtained from the physician. The facility's own Nursing Standards of Practice required staff to notify the physician of changes in condition and to document follow-up actions, but these steps were not followed. The resident involved had severe cognitive deficits, a history of wandering, and multiple medical diagnoses including cancer, anemia, DVT, BPH, and dementia. Despite being at risk for impaired skin integrity and having a care plan that called for close monitoring, staff did not document required notifications after incidents. Interviews with staff and the administrator confirmed that notifications were not made as required, and that documentation and follow-up were lacking after the resident's injuries and changes in condition.
Failure to Assess and Document Injuries After Multiple Falls
Penalty
Summary
The facility failed to provide timely and accurate assessment and interventions for a resident with a history of multiple falls and significant cognitive impairment. Despite documented care plans requiring weekly treatment documentation and detailed skin assessments, staff did not consistently complete or document skin assessments, measurements, or descriptions of injuries following several falls. There was also a lack of documentation regarding notification of the physician and family after incidents resulting in visible injuries, such as abrasions, swelling, and bruising. The resident, who was admitted for respite care and had diagnoses including cancer, anemia, deep venous thrombosis, benign prostatic hyperplasia, and dementia, experienced multiple falls during the stay. On several occasions, the resident was found on the floor with injuries such as abrasions, skin tears, and swelling, but the clinical record lacked comprehensive skin assessments, wound measurements, and timely documentation of these injuries. Additionally, there was insufficient evidence that the physician or family was notified after these incidents, despite the care plan and facility policy requiring such actions. Family interviews revealed concerns about the lack of communication regarding the resident's injuries, particularly a swollen and bruised hand that was later found to have fractures upon transfer to another facility. Staff interviews indicated that assessments and follow-up actions were not consistently performed or documented, and there was confusion among staff regarding the need for further medical evaluation. Facility policy required follow-up assessments and physician notification for changes in resident condition, but these procedures were not followed in this case.
Missing Physician Signature on Advance Directive
Penalty
Summary
The facility failed to acquire a physician's signature on an Advance Directive for Resident #29. Resident #29's MDS dated [DATE] identified a BIMS score of 10, indicating moderately impaired cognition, and documented diagnoses including seizure disorder or epilepsy, traumatic brain injury, malnutrition, anxiety disorder, depression, bipolar disorder, psychotic disorder, schizophrenia, PTSD, asthma, COPD or chronic lung disease, respiratory failure, type 2 diabetes, atherosclerosis of the aorta, rheumatoid arthritis, bilateral primary osteoarthritis of the hip, and muscle weakness. The care plan with a targeted completion date of [DATE] indicated that Resident #29 and/or the representative requested code status to reflect DNR. During record review, the Care Directive Determination form signed by the resident or representative at admission did not have a physician's signature. The form showed an X next to the option indicating that Resident #29 did not want CPR initiated, and the resident's wife signed the form on [DATE]. A fax dated [DATE] was sent to the Nurse Practitioner from the Social Services Director asking to review and sign. Staff K stated that the nurse completes the advance directive paperwork, obtains the resident or POA signature, and faxes it to the physician for signature, while the SSD stated that nurses are responsible for obtaining the advance directive signatures and faxing them to the doctors. The DON stated it was her expectation that nurses ensure the signatures are on the advance directives and that faxed forms should be returned within 24-48 hours.
Missing Background Check for Rehired CNA
Penalty
Summary
Develop and implement policies and procedures to prevent abuse, neglect, and theft was cited after the facility failed to ensure a current background check was completed for 1 of 4 staff reviewed. The file for a CNA showed the last Single Contact License and Background Check was completed on 12/3/20. Staff interviews revealed the CNA was first hired on 12/16/20, terminated on 11/15/23, and rehired on 3/1/24, but the file did not contain a background check for the rehire. The Administrative Assistant acknowledged the background check had not been done and began the process to run one, and the Administrator later acknowledged that a second background check should have been completed before the staff member was rehired. The facility policy stated that Iowa criminal record checks and dependent adult/child abuse registry checks would be completed on all prospective employees and other individuals engaged to provide services to residents prior to hire.
Failure to Notify Ombudsman of Hospital Transfers
Penalty
Summary
The facility failed to notify the Long-Term Care Ombudsman of transfers to a hospital for 2 of 3 residents reviewed, Residents #3 and #32. Resident #32 had a BIMS score of 14, indicating intact cognition, and her MDS showed she reentered the facility on 4/18/25 after a short-term general hospital stay. Resident #32 stated in interview that she had been in the hospital in April. However, the facility’s April 2025 Notice of Transfer Form to the Long Term Care Ombudsman did not include Resident #32. The Social Services Manager stated the residents should have been on the report and was unsure why they were not, and also stated residents who transferred out of the facility would be expected to be on the report. The Administrator/DON stated the expectation was for Ombudsman notification to be completed correctly each month when residents are transferred or discharged, and that the facility did not have a policy for the Ombudsman notification but followed the regulations. Resident #3’s MDS showed reentry to the facility from a short-term general hospital stay on 6/16/25, and the BIMS score was 4/15, indicating severe cognitive impairment. EHR progress notes showed Resident #3 was in the hospital from [DATE] through 6/16/25, and the Clinical Census page confirmed the resident was in the hospital during those dates. The facility’s June 2025 Notice of Transfer Form to the Long Term Care Ombudsman did not include Resident #3.
Failure to Provide Timely Catheter Care
Penalty
Summary
The facility failed to provide appropriate catheter care for one resident with an indwelling suprapubic catheter and leg bag. The resident had diagnoses including benign prostatic hyperplasia, renal insufficiency, and obstructive uropathy, and the care plan directed staff to assist with emptying the catheter leg bag every shift and as needed, with routine observation for proper positioning and urine flow. The resident also had a history of recurrent treatment for urinary tract infection, with multiple antibiotic orders documented across the record. The clinical record showed that catheter and suprapubic care were documented only twice on nine days during a 29-day review period. During observation, the resident was seen in a wheelchair with the catheter leg bag very full and expanded, and staff emptied it, producing 1100 ml of urine that was slightly cloudy and had a strong smell. Additional observations showed the leg bag at half full, over half full, and then full while the resident was independently propelling the wheelchair in the hallway and interacting with staff. Staff interviews indicated that catheter bags should be emptied each shift or more often as needed, and the Interim DON stated she would be concerned if a catheter bag was emptied only twice daily. The LPN/IP stated catheter drainage bags should be emptied at least once per shift and that if there was no documentation during a shift, the task was not completed. The Administrator also stated catheter bags should be emptied minimum every shift and as needed. The facility’s catheter care policy did not give guidance on emptying frequency, while the reference guide stated a leg bag should be emptied at least two or three times a day, or when it is one-third to one-half full.
Failure to Maintain and Date Oxygen Equipment
Penalty
Summary
The facility failed to provide respiratory care and services in accordance with professional standards of practice for residents requiring oxygen. Resident #10 had diagnoses including progressive neurological conditions, Alzheimer’s disease, non-Alzheimer’s dementia, and anxiety disorder, and the MDS documented continuous oxygen therapy. During observation, the oxygen tubing set ups in the resident’s room were dated 8/31 on both nasal cannulas, while the physician order required oxygen tubing, nasal cannula, and bag to be changed and dated weekly and as necessary. Staff interviews confirmed the tubing should be changed weekly and dated, and the DON stated the facility follows nursing standards of care, but also acknowledged the facility did not have a policy on oxygen tubing change. Resident #2 had a diagnosis of respiratory failure and required oxygen, with care plan and physician orders directing weekly change and dating of oxygen tubing and nasal cannula, as well as weekly replacement of the nebulizer mask. Although the MAR/TAR showed documentation that the oxygen tubing order had been completed on 9/7 and 9/14/25, observations on 9/15/25 and 9/16/25 showed the tubing and cannula dated 8/31. Resident #3 had diagnoses including heart failure, COPD, acute on chronic systolic and diastolic heart failure, and dyspnea, with orders to clean the nebulizer mask nightly and change the mask and tubing weekly, labeling and dating them. Observations on 9/15/25 and 9/16/25 showed the nebulizer mask and tubing without a label or date, and on 9/17/25 the CNA removed the nebulizer mask from the room and returned with a mask; later that morning the oxygen tubing for the nebulizer was dated 9/16/25. The facility did not have a policy related to oxygen tubing.
Resident Left Unattended in Bathroom Resulting in Fall and Injuries
Penalty
Summary
A resident with moderate cognitive impairment, non-Alzheimer's dementia, Parkinson's disease, anxiety disorder, and depression was identified as high risk for falls and required substantial to maximal assistance with transfers and toilet use. The resident's care plan specifically included an intervention to not leave the resident unattended in the bathroom due to impaired balance, poor safety awareness, and a history of falls. Despite these documented needs and interventions, the resident was left alone on the toilet in the bathroom by a Training Nurse Assistant (TNA), who then left the area to retrieve a brief and subsequently went on a meal break without notifying other staff that the resident was unattended. The incident occurred when the TNA, after placing the resident on the toilet, left to find a larger brief and was then called to dinner by an LPN. The TNA, feeling intimidated and distracted, went to dinner and forgot to inform anyone that the resident remained in the bathroom. During this time, no other staff were aware of the resident's location or that he was left unattended. The resident attempted to get up unassisted, resulting in a fall that caused multiple injuries, including abrasions and skin tears to the elbow, hip, buttock, and hand, as well as visible bleeding and bruising. Staff interviews confirmed that the resident was not to be left alone on the toilet and that this information was available in the care plan, Kardex, and communication book. The facility had a system in place to highlight residents who should not be left unattended, and staff were expected to be knowledgeable about each resident's care needs. Despite these protocols, the failure to follow the care plan and provide adequate supervision directly led to the resident's fall and subsequent injuries.
Failure to Document Open Date on Medication
Penalty
Summary
The facility failed to ensure that staff were aware of the date a stock supplement had been opened before administering it to a resident. During a medication administration observation, a Licensed Practical Nurse (LPN) prepared Vitamin B-12 for a resident without a documented open date on the bottle. The LPN acknowledged the absence of an open date and proceeded to administer the vitamin to the resident. After consulting with the Administrator, the LPN realized the mistake and noted that in the future, unmarked bottles should be destroyed, and a new bottle should be used with the open date documented. The resident involved had a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognitive function, and was independent in certain activities of daily living. The resident's medical history included hypertension, diabetes, Alzheimer's, anxiety, and depression. The Administrator mentioned that a nurse regularly checks the medication cart for open bottles without dates and that staff are instructed to document the open date when a bottle is first opened. However, the Administrator could not find a specific medication policy addressing open date documentation.
Failure to Maintain Resident Dignity in Incontinence Care
Penalty
Summary
The facility failed to ensure that residents were treated with dignity and respect, as evidenced by the experiences of two residents. Resident #238, who had a moderate cognitive deficit and required assistance with activities of daily living, reported that staff instructed him to urinate in his adult brief when they could not assist him to the restroom in a timely manner. This occurred primarily during the overnight shift, and he was not cleaned up until the next morning. The resident found this experience stressful and degrading, particularly when staff stood by and urged him to hurry while using a commode or urinal. Resident #1, who had intact cognitive ability and required assistance with toileting, also reported being told to urinate in his brief. He expressed discomfort discussing the details, but it was noted that a staff member had told him he was using his call light too often and should urinate in his brief. This led the resident to request a urinary catheter to avoid bothering the night staff. Staff B, a CNA, confirmed that she had told Resident #238 it was okay to urinate in his brief if staff could not assist him in time, and she denied telling Resident #1 to urinate in his brief, although she acknowledged his frequent requests for a catheter. The facility's administrator was unaware of these incidents and stated that such behavior was intolerable. The facility's policy on resident rights emphasizes the importance of treating residents with respect and dignity, including accommodating their needs. However, the actions of some staff members, particularly during the overnight shift, did not align with these principles, leading to the reported deficiencies in resident care and dignity.
Inadequate Supervision Leads to Resident Fall and Injury
Penalty
Summary
The facility failed to provide adequate nursing supervision to prevent falls for a resident with severe cognitive deficits. The resident, who was totally dependent on staff for hygiene and dressing and required partial assistance with transfers, had a history of attempting to get up on his own. Despite being at risk for falls due to impaired balance and increased anxiety, the resident's personal alarm was not on the chair at the time of the fall. This resulted in an unwitnessed fall in the dining room, leading to a severe left hip injury that required surgical intervention. Interviews with staff revealed that the resident was known to be easily agitated and often attempted to get up from his chair without assistance. On the evening of the fall, staff were present in the dining room but were occupied with other residents, and none witnessed the resident getting up. There was uncertainty among staff about whether the alarm was in place or functioning, and it was noted that the resident could stand up quickly, potentially rendering the alarm ineffective. Further observations indicated ongoing challenges in managing the resident's impulsiveness and fall risk. During a morning routine, a staff member failed to lock the wheels of the resident's wheelchair, which moved slightly when the resident sat down. The facility's administrator acknowledged the resident's challenges and mentioned recent medication changes that had improved his condition. However, the deficiency in supervision and adherence to care plan interventions, such as the use of motion alarms, contributed to the resident's fall and subsequent injury.
Failure to Timely Submit MDS Assessment
Penalty
Summary
The facility failed to complete and transmit a resident's Minimum Data Set (MDS) assessment upon discharge within the required timeframe for one of the fourteen residents reviewed. The MDS assessment for Resident #10, who was discharged on 07/24/24, was completed by the Assistant Director of Nursing (ADON) on 08/01/24 but was not submitted to CMS until 10/17/2024. The Director of Nursing acknowledged issues with the MDS process, attributing the delay to the former MDS coordinator not fitting well in the position. According to the Resident Assessment Instrument (RAI) Manual Version 3.0, the discharge return not anticipated MDS must be completed within 14 days after the discharge date and submitted within 14 days after the MDS completion date.
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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 Coon Rapids
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Regency Park Nursing & Rehab Center Of Carroll | 15.9 mi | ★★★★★ | 1 | 0 |
| St Anthony Senior Services | 16 mi | ★★★★★ | 6 | 0 |
| The New Homestead Care Center | 16.4 mi | ★★★★★ | 1 | 0 |
| Friendship Home Association | 16.9 mi | ★★★★★ | 2 | 0 |
| Accura Healthcare Of Carroll | 17.8 mi | ★★★★★ | 18 | 0 |
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