Below average — CMS composite of the measures below.
The next survey window likely opens 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 Continental Springs, Llc during CMS and state inspections, most recent first.
Failure to Obtain Consent Before Psychoactive Medications: The facility did not document that residents and/or their representatives were informed of the risks and benefits and gave consent before psychoactive meds were started or increased for 3 residents. One resident with anxiety and insomnia received Buspirone and Zolpidem without documented consent, another resident with bipolar disorder and PTSD received Vraylar and Amitriptyline increases without prior consent documentation, and a third resident with schizophrenia-related diagnoses received Fluvoxamine without documented consent. The DON confirmed the missing consent documentation.
Failure to Notify Ombudsman of Resident Discharges: The facility did not notify the State LTC Ombudsman of hospital discharges for three residents reviewed. One resident with multiple chronic conditions, including dementia, schizophrenia, diabetes, bipolar disorder, and COPD, was sent to the ER several times for acute changes such as coffee ground emesis, fever, weakness, leg pain, lethargy, and tachycardia, but there was no evidence the Ombudsman was notified of the hospital discharges. Another resident discharged from the facility had no evidence of Ombudsman notification or discharge reporting, and a third resident's hospital discharge also lacked Ombudsman notification.
Medication labeling and storage failures were identified when multiple opened insulin pens and a vial were found without opened dates, staff were unsure how long insulin could be used after opening, and undated insulin had been administered. Two medication refrigerators lacked evidence of daily temperature checks, and expired stock medications were left available in the medication room. In addition, a resident with emphysema had an albuterol inhaler left on a dresser instead of secured, and another resident with quadriplegia had Enemeez enemas left on a vanity despite no documented self-medication evaluation.
Improper Hand Hygiene and Glove Use During Food Prep and Meal Service: A dietary cook was observed preparing puree food and serving lunch while wearing the same gloves across multiple tasks, including handling food, equipment, microwave controls, bread, deli items, and soup containers. No hand hygiene was observed after glove removal or between tasks, and the cook confirmed the lapse. The CDM confirmed handwashing should occur after removing gloves and gloves should be changed when moving from non-food items to food items.
A facility failed to follow EBP and infection control practices during resident care. Staff wore gloves but no gowns for high-contact care for two residents on EBP, did not change gloves or perform hand hygiene appropriately during toileting and personal care for another resident, and did not clean reusable transfer equipment or a gait belt between uses. An LPN also moved between multiple treatment sites for one resident without washing hands between several glove changes.
A facility failed to keep resident rooms, bathhouses, corridors, and the dining room clean and in good repair. Surveyors observed feces-soiled trash, urine odor, stained mattress, dust-covered bed frame and fan, soiled wheelchair parts, missing or damaged baseboards, chipped and peeling paint, rusted and damaged bathhouse fixtures, plastic-covered windows, dusty vents, and worn flooring and wall coverings. The SSD, Maintenance Supervisor, and head of housekeeping acknowledged multiple of these conditions and confirmed several areas needed cleaning or repair.
A resident with quadriplegia and intact cognition was not evaluated for self-administration of bedside meds, despite facility policy requiring an interdisciplinary assessment before self-administration is allowed. The care plan had no related focus, goal, or interventions, and an LPN confirmed there was no eval or MD order for self-administration. Surveyors also observed Enemeez Mini Enemas left on the resident's vanity, making them accessible to others.
Care plans were not complete or accurate for residents with MDROs and psychotropic use. Two residents had VRE or MRSA and needed assistance with high-contact care, but their care plans did not include EBP despite posted signage outside their rooms. Another resident had dementia, was receiving Haloperidol, and had repeated administrations documented on the MAR, but the care plan did not identify the antipsychotic medication. The MDS Coordinator and DON confirmed the omissions.
A resident with fragile skin, falls, and blood thinner use developed extensive bruising after repeated falls and episodes of agitation and unsafe mobility. Staff documented bruising to the arms, but the record did not fully identify or assess all bruised areas, including the left eye and bilateral lower legs, and the resident was observed without the ordered protective long sleeves or arm protectors.
The facility failed to implement a water management plan to prevent Legionella and did not ensure proper handling of a urinary catheter bag for a resident with severe cognitive impairment. The maintenance person could not locate the water management documentation, and observations showed the catheter bag was improperly placed on the floor, risking cross-contamination. The facility's policy requires aseptic techniques and keeping catheter bags off the floor, which was not followed.
The facility failed to ensure kitchen cleanliness and maintenance, affecting most residents. Observations revealed food buildup on the prep table and mixer, and unsecured floor tiles under the convection oven, leading to debris accumulation. The Kitchen Manager confirmed these issues.
The facility failed to submit a written investigation to the State Agency within the required five working days for a resident who experienced a fall with significant injury, including a brain bleed and facial fracture. The investigation was submitted on the sixth business day, violating the facility's policy and state regulations.
Failure to Obtain Consent Before Psychoactive Medications
Penalty
Summary
The facility failed to notify residents and/or their representatives of the potential risks or benefits before starting psychoactive medications for 3 of 5 sampled residents. The cited requirement stated that residents would not receive psychotropic medications unless they were clinically indicated and necessary, and that prior to initiating, increasing, or switching such medications, staff and the physician would review nonpharmacological alternatives, the indication and rationale, the potential risks and benefits, and the representative’s right to accept or decline treatment before documented consent or refusal was obtained. Resident 2 was admitted with cirrhosis, kidney disease, diabetes, and anxiety, and was cognitively intact and independent with dressing, transfers, bed mobility, and toileting. The resident’s record showed active orders for Buspirone 5 mg three times daily for anxiety and Zolpidem 5 mg at bedtime for insomnia, both started on 8/18/25. Review of the consent record showed no documentation that consent for Buspar and Zolpidem had been obtained before the medications were administered. Resident 5 was admitted with renal disease, bipolar disorder, PTSD, and chronic lung disease, and was cognitively intact and independent with ambulation, dressing, and bed mobility, while requiring assistance with toileting. The resident received Vraylar 3 mg at bedtime for bipolar disorder and Amitriptyline 100 mg at bedtime for depression; the record also showed a fax indicating an increase in Vraylar to 3 mg and Amitriptyline to 50 mg, and a progress note stating the resident was aware of the Amitriptyline increase one day after it started. Resident 8 had anemia, heart failure, bipolar disorder, and schizophrenia, had moderate cognitive impairment, and required assistance with toileting, hygiene, dressing, and transfers. The resident’s active order included Fluvoxamine 100 mg in the morning and 200 mg at bedtime for schizoaffective disorder, and the consent record showed no documentation that consent for Fluvoxamine was obtained before administration. The DON confirmed the facility did not have documentation showing consents were obtained prior to administration for these residents’ psychoactive medications.
Failure to Notify Ombudsman of Resident Discharges
Penalty
Summary
The facility failed to notify the State Ombudsman of resident discharges as required for 3 of 3 residents reviewed. The facility policy for Transfer and Discharge stated that transfer/discharge notices were to be provided to the resident, the resident's representative if appropriate, and the LTC Ombudsman as soon as practicable before transfer or discharge, and that the facility was to maintain evidence that the notice was sent to the Ombudsman. The facility census was 46. Resident 4 had diagnoses including anemia, coronary artery disease, non-Alzheimer's dementia, schizophrenia, anxiety, diabetes, bipolar disorder, and COPD. The resident was sent to the emergency room multiple times for acute changes in condition, including coffee ground emesis, weakness with difficulty standing and ambulating with pain on breathing and fever, inability to bear weight with right leg swelling and pain, and emesis with lethargy, fever, and tachycardia; the resident was admitted to the hospital each time. Review of the medical record showed no evidence that the Ombudsman was notified of the resident's hospital discharges on 6/4/25, 9/4/25, 11/24/25, and 1/4/26. Resident 48 was admitted to the facility and later discharged on 10/28/25, with no evidence that the State Ombudsman was notified and no evidence the facility had been submitting discharge reports to the State Ombudsman. Resident 3 was admitted to the facility and later admitted to the hospital, with no evidence that the State Ombudsmen were notified of the discharge to the hospital.
Medication labeling and storage failures
Penalty
Summary
Drugs and biologicals were not consistently labeled and stored in accordance with facility policy and accepted professional principles. During a tour of the medication carts and medication room, multiple opened insulin pens and vials were found without the required opened dates, including insulin for several residents on two medication carts. One vial of Lantus insulin for a resident was documented as opened on 11/30/25, and staff were unable to identify when many other insulin pens had been opened. A medication aide stated she was unsure how long insulin could be used after opening and confirmed that undated insulin had been administered to residents. Another medication aide also stated she was unaware insulin pens had to be dated when opened and was unsure how long they could be used. The facility also failed to monitor medication refrigerator temperatures and failed to remove expired medications from availability. In the medication room, two refrigerators containing resident medications had no evidence of daily temperature checks, and the only completed log was for December 2025 with no log for January 2026. Stock medications were observed in the room, including an opened and undated vial of Tuberculin, acetaminophen suppositories expired in 9/2025, an unopened bottle of Acidophilous expired in 4/2025, and unopened bottles of antacid expired in 10/2025. The RN confirmed refrigerator temperatures were to be checked daily and that outdated medications were to be destroyed so they were not available for resident use. The facility also failed to securely store medications for residents who were permitted to self-administer and failed to secure medications in another resident's room. Resident 7, who had emphysema and was assessed as safe to self-administer an albuterol inhaler, had the inhaler sitting on top of the dresser on multiple observations rather than in a secure location. Resident 31, who had quadriplegia and no documented evaluation supporting self-medication, had three Enemeez Mini Enemas sitting on the vanity on multiple observations, making them available to staff, visitors, or other residents. An LPN confirmed Resident 31 did not self-administer medications and should not have medications in the room.
Improper Hand Hygiene and Glove Use During Food Preparation and Service
Penalty
Summary
The facility failed to change gloves and wash hands at appropriate intervals during food preparation and meal service. The deficiency was identified during observation, record review, and interview, and it involved dietary staff handling food in ways that did not follow the facility’s handwashing and glove-use policies. The facility census was 46. During food preparation on 1/12/26 at 10:55 AM, Cook-F was observed already wearing gloves while preparing ground meat and puree meal items for residents requiring altered food consistencies. Cook-F used the same gloves while handling food containers, tongs, a saucepan handle, a ladle, blender lid, and blender buttons, then reached into the blender with the gloved hand to grab large chunks of ham and rip them up before continuing to puree the food. Cook-F continued wearing the same gloves while transferring the puree to a clean metal container, then removed the gloves without any observed hand hygiene. Later, Cook-F put on new gloves without performing hand hygiene and repeated similar actions while preparing another batch of ham for puree, again handling food and equipment with the same gloves and removing them without observed hand hygiene. During lunch service at 11:50 AM, Cook-F brought food from the main kitchen to the serve-out kitchen and applied gloves without hand hygiene. Cook-F then served lunch while continuing to wear the same gloves, including placing pureed ham in a microwaveable bowl, handling bread, opening packaged turkey and cheese, assembling a sandwich, handling buns, opening a can of chicken noodle soup, and touching the microwave handle and buttons. No hand hygiene or glove changes were observed during these tasks. Cook-F confirmed not performing handwashing and glove changing at appropriate intervals, and the Certified Dietary Manager confirmed hand washing should be completed after removing gloves and gloves should be changed when moving from non-food items to food items.
Failure to Follow EBP, Hand Hygiene, and Equipment Cleaning Practices
Penalty
Summary
The facility failed to implement Enhanced Barrier Precautions during high-contact care for two residents who were identified as having multidrug-resistant organisms. One resident had MRSA and was incontinent at times, and the other resident had VRE and required assistance with toileting, dressing, hygiene, and transfers. During observed care, a nurse aide entered the room of the resident with MRSA, wore gloves but no gown, and assisted with changing a soiled brief and providing peri-care. During another observation, a nurse aide entered the room of the resident with VRE, wore gloves but no gown, and assisted with changing a soiled brief while the resident was in bed. The aide later stated awareness of the sign outside the room but denied knowing the residents were on EBP because they did not have catheters or dialysis and was not aware of other criteria requiring EBP. The facility also failed to perform hand hygiene and glove changes at appropriate intervals during toileting and personal care for another resident. That resident was occasionally incontinent of urine, dependent on staff for perineal hygiene, dependent for transfers, and required extensive assistance with dressing. During observed care, two nurse aides completed hand hygiene and donned gloves, then performed dirty tasks such as perineal care and removing a wet brief and wet sheet. One aide did not change gloves or wash hands before moving to clean tasks such as applying a clean brief and assisting with dressing, and later changed gloves without washing hands before continuing care. The director of nursing confirmed staff were expected to wash hands when gloves were removed and to change gloves and wash hands when moving from a dirty task to a clean task. The facility further failed to clean reusable resident care equipment used for transfers and failed to clean or disinfect a gait belt used across residents. During observations, a sit-to-stand lift and a full lift were used for transfers of residents on EBP, but the equipment was not observed to be cleaned after use. A gait belt worn by staff around the waist was placed directly on a resident for transfer, then returned to the staff member without being cleaned or disinfected; in another observation, the same gait belt was draped on a toilet tank during toileting and then reused without cleaning. During treatment care for another resident, an LPN changed gloves multiple times without washing hands between different treatment areas and moved from one body site to another while continuing care. The LPN completed care to both great toes, the face rash, abdominal folds and groin, the bottom, and wounds to the back of both legs, with repeated glove changes but no hand hygiene between several of the tasks.
Failure to Maintain Clean and Safe Resident Areas
Penalty
Summary
The facility failed to maintain the cleanliness and condition of resident rooms, bathrooms, bathhouses, corridors, and the dining room. In three occupied resident rooms, surveyors observed unsanitary and deteriorated conditions, including a bathroom trash receptacle containing pre-moistened cleansing cloths and an incontinent brief soiled with feces, a feces odor in the room, a window covered with plastic, and a chipped window frame. In another room, there was a urine odor, a mattress with brown discoloration and an outline of a urine stain, a bed frame and headboard covered with a heavy layer of dust and debris, a wheelchair with brown spots on the wheels and handles, a missing baseboard under the vanity, and brown stains on the ceiling extending down the wall above the light fixture. In a third room, a personal fan blowing across the resident's bed had a heavy layer of dust and debris, the baseboard heater cover was missing, and portions of the baseboard under the vanity were pulled away from the wall. Environmental observations also identified poor condition in the bathhouses. In the 300 hall shower room, the ceiling above the shower chair had a peeled and hanging section of paint with additional chipped paint. In the 500 hall whirlpool room, the heating/cooling unit panel had missing knobs, exposed prongs, and brown discoloration that appeared to be rust. The window next to the whirlpool tub was covered with plastic and secured with masking tape, and the ceiling vent above the tub had a heavy layer of dust and debris. Bath aides confirmed the shower room ceiling concern and stated the whirlpool room window did not close completely, the plastic and tape were used to keep the cold out, and the vent needed to be cleaned. Additional observations showed the corridor windows between the dining room and the 500 hall were spotted and soiled, wall covering was peeled away on both sides of the hall between the fire doors and the windows, the commons area floor leading to the 300 hall was scuffed with areas worn away or missing, and the dining room floor had several scuffed areas under resident tables and chairs and at the entrance by the 300 hall. The Assistant SSD/previous Administrator acknowledged the room odor and soiled trash in one resident room, the need for cleaning of corridor windows, the need for wall repair, and that flooring in the dining room and hallways needed replacement. The Maintenance Supervisor confirmed the shower room ceiling needed repair, knobs needed replacement on the whirlpool room heating/cooling unit, and baseboards and a heater cover in resident rooms needed repair, while the head of housekeeping confirmed staff were responsible for cleaning bed frames, fans, and ceiling vents in resident rooms and bathhouses.
Failure to Evaluate Self-Administration of Medication
Penalty
Summary
The facility failed to evaluate one resident for self-administration of bedside medications. The resident was admitted with quadriplegia and had a quarterly MDS showing a BIMS score of 15, indicating the resident was cognitively intact. The facility policy stated that residents could self-administer medications only after the interdisciplinary team assessed cognitive and physical abilities and documented that self-administration was safe and clinically appropriate in the medical record and care plan. Record review showed no evidence of an evaluation of the resident's ability to self-medicate from admission through the date of the survey. The care plan contained no focus issue, goal, or interventions related to self-administration of medication. The January 2026 MAR included an order for Enemeez Mini Enema at bedtime, and surveyors observed three Enemeez Mini Enemas on the resident's vanity on three separate observations, making them available to staff, visitors, or other residents. An LPN confirmed that the facility had not completed an evaluation for the resident's ability to self-administer medications and that there was no physician order for the resident to self-administer medication.
Care Plans Did Not Reflect EBP or Antipsychotic Use
Penalty
Summary
The facility failed to ensure care plans were complete and accurately reflected residents’ current needs. The facility policy required comprehensive, person-centered care plans that described services to be furnished, reflected recognized standards of practice, and were updated for significant changes in condition. Surveyors found that the care plans for Residents 8 and 41 did not include Enhanced Barrier Precautions (EBP), even though both residents had multidrug-resistant organisms and required staff assistance with high-contact care activities such as toileting, hygiene, brief changes, bathing, dressing, and transfers. Resident 8’s care plan, revised 11/4/25, showed the resident was dependent on staff for physical needs due to cognitive and physical limitations, including toileting and brief changes, and had VRE. Resident 41’s care plan, revised 9/2/25, showed the resident had MRSA, mild incontinence, wore a brief, and needed staff assistance with incontinence care. In both records, there was no evidence that staff were directed to use EBP, despite facility signage posted outside the rooms instructing staff to wear gloves and gowns for high-contact resident care activities. The facility also failed to document antipsychotic use in Resident 1’s care plan. Resident 1’s MDS showed cognitive impairment, diagnoses of kidney disease and non-Alzheimer’s dementia, and use of antipsychotic and antidepressant medications. The order summary showed Haloperidol 2 mg every 6 hours for dementia, and the MAR showed the medication was administered repeatedly over multiple months. However, the care plan last revised 12/15/25 only documented antidepressant use and hospice care, with no documentation that the resident was receiving an antipsychotic medication. The MDS Coordinator and DON confirmed that EBP was not on the care plans for the residents identified and that the antipsychotic medication was not on Resident 1’s care plan.
Failure to Thoroughly Assess and Document Resident Bruising
Penalty
Summary
The facility failed to thoroughly assess bruising and to implement interventions to prevent ongoing bruises for a resident admitted with spinal stenosis, atrial fibrillation, repeated falls, a history of TIAs, anxiety, and depression. The resident was identified as at risk for skin breakdown related to fragile skin and blood thinner use, and the care plan included interventions such as avoiding scratching, keeping fingernails short, documenting causative factors, and using long sleeves or geri-sleeves to protect the arms. After the resident was found on the floor on multiple occasions and later became increasingly active, anxious, and resistive with care, nursing notes documented bruising to the arms and a bruise above the left eye. During observation, the resident was seen wearing a short-sleeved shirt with visible dark purple bruising to both arms from mid-bicep to wrist, bruising to both lower legs from ankle to mid-shin, and a bruise above the left eye. No protective sleeves or long sleeves were observed on the resident at that time. The record showed that staff documented scattered bruising to the bilateral arms and requested a medication review, but the bruising to the left eye and bilateral lower legs was not identified in that communication. The DON and RN stated that charge nurses were responsible for assessing and documenting areas of skin breakdown and that bruising should be described in detail, including exact location, color, and extent, but the documentation in the record did not reflect a thorough assessment of all bruised areas.
Deficiencies in Water Management and Catheter Care
Penalty
Summary
The facility failed to implement a comprehensive water management plan to prevent potential illnesses such as Legionella. Despite having a policy and procedure for a water management program, the maintenance person was unable to locate a Water Management Plan or a schematic plan of the facility's water system, indicating that the facility did not have one in place. This lack of documentation and implementation of the water management program was confirmed during an interview with the maintenance person. Additionally, the facility staff failed to ensure proper handling of a urinary catheter bag for a resident with severe cognitive impairment. The resident required extensive assistance with daily activities, including toileting. Observations revealed that the urinary catheter bag was improperly placed on the floor and on a fall mat, which was confirmed to be dirty. This improper placement of the catheter bag was observed during catheter care performed by two LPNs, and it was confirmed that such placement could lead to cross-contamination. The facility's policy on catheter care directs staff to use aseptic techniques and ensure that catheter tubing and drainage bags are kept off the floor to prevent urinary catheter-associated complications, including infections. However, the observations and interviews indicated that the staff did not adhere to these guidelines, resulting in a deficiency in infection prevention and control practices.
Kitchen Cleanliness and Maintenance Deficiency
Penalty
Summary
The facility failed to maintain cleanliness and proper maintenance in the kitchen, which could potentially affect the majority of its residents. During an observation, food buildup and debris were found on the bottom shelf of the prep table and the stand-up mixer. Additionally, the floor tiles under the convection oven were not secured properly, allowing food debris to accumulate underneath. These issues were confirmed by the Kitchen Manager during an interview, who acknowledged the presence of buildup and debris and the loose flooring under the convection oven.
Failure to Timely Report Investigation of Resident Injury
Penalty
Summary
The facility failed to provide a written investigation to the State Agency within the required five working days for a resident who experienced a fall with significant injury. The resident was found at the bedside with bleeding on the left side of the face and was sent to the hospital for evaluation. The hospital confirmed that the resident had a brain bleed and a facial fracture. Despite the severity of the injury, the facility did not submit the written investigation to the State Agency within the required timeframe, submitting it instead on the sixth business day after the incident. The facility's policy on Abuse, Neglect, and Exploitation mandates that all alleged violations be reported to the Administrator/DON, a state agency, Adult Protective Services, and other required agencies within specified time frames. The policy also requires that a summary of the investigation be provided to the state agency within five business days. An interview with the DON confirmed that the written investigation for the resident's fall was not submitted within the required timeframe, thus failing to comply with the facility's own policy and state 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 South Sioux City
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Adept Nursing & Rehab Of South Sioux City | 0.5 mi | ★★★★★ | 7 | 0 |
| St Luke's Regional Medical Center Snf | 2.5 mi | ★★★★★ | 0 | 0 |
| Sunrise Retirement Community | 3.6 mi | ★★★★★ | 4 | 0 |
| Casa De Paz Health Care Center | 3.9 mi | ★★★★★ | 11 | 0 |
| Holy Spirit Retirement Home | 4.1 mi | ★★★★★ | 10 | 0 |
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