Inspection Reports for Edgewood Convalescent Home
513 Bell Street, IA, 520420038
Back to Facility ProfileInspection Report Summary
The most recent inspection on November 18, 2025, found the facility in substantial compliance with no specific deficiencies noted. Earlier inspections showed some deficiencies related to vaccination documentation, nursing staffing levels on weekends, and medication administration practices. Complaint investigations were mostly unsubstantiated, except for one substantiated complaint regarding insufficient nursing staff that resulted in missed care. No fines, immediate jeopardy findings, or license actions were listed in the available reports. The facility’s record shows some recurring issues with staffing and care processes but also evidence of corrective actions and improvement over time.
Deficiencies (last 6 years)
Deficiencies (over 6 years)
0.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
82% better than Iowa average
Iowa average: 4.4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
41 residents
Based on a September 2025 inspection.
Census over time
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Nov 18, 2025
Visit Reason
The document is a statement of deficiencies and plan of correction following a survey ending September 25, 2025, related to the facility's compliance status.
Findings
The facility was found to be in substantial compliance based on acceptance of the credible allegation and plan of correction, resulting in certification effective October 25, 2025. No specific deficiencies are detailed in this document.
Report Facts
Survey end date: Sep 25, 2025
Certification effective date: Oct 25, 2025
Inspection Report
Annual Inspection
Census: 41
Deficiencies: 1
Date: Sep 25, 2025
Visit Reason
The inspection was conducted as part of the facility's annual recertification survey and investigation of complaint #1714110-C from September 22 to September 25, 2025.
Complaint Details
The deficiency resulted from the investigation of complaint #1714110-C.
Findings
The facility failed to offer updated pneumococcal vaccination to 2 of 5 residents sampled (Resident #7 and Resident #36) despite having a census of 41 residents. Documentation and offering of updated pneumococcal vaccines were lacking, and the facility policy was to assess pneumococcal vaccination upon admission but did not ensure annual assessment.
Deficiencies (1)
Failure to offer updated pneumococcal vaccination to Resident #7 and Resident #36 as required by CDC guidelines.
Report Facts
Resident census: 41
Residents sampled: 5
Residents not offered updated vaccine: 2
BIMS score: 6
BIMS score: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Interim Director of Nursing | Reported no documentation of updated pneumococcal vaccination offered to Resident #7 and Resident #36 and stated the facility would start annual pneumococcal vaccination assessments. |
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Dec 16, 2024
Visit Reason
The document serves as a Plan of Correction following a prior inspection, indicating acceptance of the facility's credible allegation of substantial compliance.
Findings
The facility will be certified in compliance effective November 30, 2024, based on acceptance of the Plan of Correction and credible allegation of substantial compliance.
Inspection Report
Annual Inspection
Census: 43
Deficiencies: 1
Date: Oct 31, 2024
Visit Reason
The inspection resulted from the facility's annual recertification survey and investigation of complaint #124467-C conducted from October 28, 2024 to October 31, 2024.
Complaint Details
Complaint #124467-C was substantiated based on the investigation conducted during the annual recertification survey.
Findings
The facility was found to have insufficient nursing staff, particularly on weekends, failing to meet resident needs as evidenced by staff and resident interviews and staffing data reviews. The complaint was substantiated.
Deficiencies (1)
The facility failed to employ sufficient numbers of nursing staff on weekends to meet resident needs, including licensed nurses and nurse aides, resulting in missed care such as toileting.
Report Facts
Resident census: 43
Certified Nursing Aide (CNA) absent days: 23
Certified Nursing Aide (CNA) absent days: 19
Nurse absent days: 3
Certified Nursing Aide (CNA) absent days: 1
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Oct 24, 2023
Visit Reason
The document serves as a statement of deficiencies and plan of correction related to the facility's certification compliance.
Findings
Based on acceptance of the credible allegation of substantial compliance and the Plan of Correction, the facility will be certified in compliance effective October 6, 2023.
Inspection Report
Annual Inspection
Census: 48
Deficiencies: 1
Date: Oct 5, 2023
Visit Reason
The inspection was conducted as the facility's annual recertification survey from October 2, 2023 to October 5, 2023.
Findings
The facility failed to prime the insulin pen with 2 units of insulin prior to administration for one resident, resulting in a deficiency related to meeting professional standards of care in comprehensive care plans and medication administration.
Deficiencies (1)
Failure to prime the insulin pen with 2 units of insulin prior to administration for Resident #5.
Report Facts
Census: 48
Mental Status Score: 14
Insulin injections: 7
Units of insulin: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Registered Nurse (RN) | Named in medication administration finding related to insulin pen use |
| Director of Nursing | Provided re-education and competency documentation for insulin pen use | |
| Staff B | Registered Nurse (RN) | Reported training on insulin pen administration |
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Jul 13, 2022
Visit Reason
The document is a plan of correction following a previous inspection, indicating acceptance of a credible allegation of compliance and certification of the facility effective June 10, 2022.
Findings
The facility was found to be in compliance based on the accepted plan of correction and credible allegation of compliance, with no specific deficiencies detailed in this document.
Report Facts
Certification effective date: Facility certified in compliance effective June 10, 2022
Inspection Report
Annual Inspection
Census: 42
Deficiencies: 2
Date: Jun 9, 2022
Visit Reason
The inspection was conducted as part of the facility's annual health survey with a facility reported incident #99977 from 6/6/22 to 6/9/22.
Complaint Details
Facility reported incident #99977-I was not substantiated.
Findings
The facility failed to offer Bed Hold agreements to 2 of 2 residents who transferred to the hospital, and failed to hold routine quarterly Quality Assurance and Performance Improvement (QAPI) meetings in 2021 and 2022, including lack of Medical Director attendance at one meeting in 2021.
Deficiencies (2)
Failure to offer Bed Hold agreements to residents transferring to hospital (Residents #7 and #23).
Failure to have routine quarterly Quality Assurance and Performance Improvement (QAPI) meetings in 2021 and 2022, and lack of Medical Director attendance at one 2021 meeting.
Report Facts
Census: 42
QAPI meetings held in 2021: 2
QAPI meetings missed: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gisele Carbone Kruger | Administrator | Signed report and responsible for monitoring compliance |
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Aug 19, 2021
Visit Reason
The Iowa Department of Inspections and Appeals conducted a Medicare Recertification Survey and Investigation of complaints and Facility Reported Incident.
Complaint Details
Complaint numbers #95186-C, #99014-C, and #99158-I were reviewed and found not substantiated.
Findings
The facility was found to be in compliance. Three complaints and one facility reported incident were reviewed and all were not substantiated.
Inspection Report
Routine
Census: 46
Deficiencies: 0
Date: Nov 12, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey and an investigation of a Facility Reported Incident #93435 were conducted by the Department of Inspections and Appeals from 11/5/20 to 11/12/20.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices to prepare for COVID-19. The Facility Reported Incident was not substantiated.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jun 30, 2020
Visit Reason
Complaint #91669-C was investigated from 2020-06-25 to 2020-06-30.
Complaint Details
Complaint #91669-C was investigated on 6/25/20-6/30/20 and was not substantiated.
Findings
The complaint investigation was completed and the complaint was not substantiated.
Inspection Report
Routine
Deficiencies: 0
Date: Jun 10, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspection and Appeals to assess the facility's compliance with CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices to prepare for COVID-19.
Report
Sep 25, 2025
Report
Oct 31, 2024
Report
Oct 31, 2024
Report
Oct 5, 2023
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