Based on observations, clinical record review, resident and staff interviews, and facility policy review the facility failed to accurately complete elopement risk assessments for 4 of 13 residents reviewed (Resident #4, 6, 11, and 18). The facility reported a census of 33 residents. Findings include:1. Record review revealed a Brief Interview of Mental Status (BIMS) score assessment completed on 5/28/2026. The assessment documented Resident #4 had a BIMS score of 12. A BIMS score of 12 suggested moderate cognitive impairment. …
F641 citations in Iowa
Accuracy of assessments · Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Iowa cites F641 more often than its own record predicts
1.30 times the share F641 takes of citations nationally.
Of every deficiency written in Iowa in 2025, this is the portion that was F641.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Iowa surveyors wrote
F641 findings written in Iowa, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on record review and staff interviews the facility failed to complete a Discharge Minimum Data Set (MDS) and Reentry MDS for 1 of 1 residents reviewed for hospitalizations (Resident #41). The facility reported a census of 64 residents. Findings include: Record Review of Resident #41 Census in his Electronic Health Record (EHR) on 6/11/25 documented a discharge to the hospital on 4/5/25 and a return to the facility on 4/7/25. Record Review of Resident #41 MDS log in his EHR on 6/11/25 at 10:21 AM revealed the facility has not opened, started, or completed a 4/5/25 Discharge MDS and a 4/7/25 Reentry MDS as required. …
The short window
Recent years
| Year | Share of Iowa citations | vs expected |
|---|---|---|
| 2023 | 2.24% | 1.31× |
| 2024 | 1.95% | 1.16× |
| 2025 | 2.40% | 1.30× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Iowa surveyors cite →
Deficiency Index is independent and is not affiliated with, endorsed by, or approved by CMS, Medicare, or any government agency. About this data · Report a correction