Based on observation, interview, and record review, the facility didn't clarify and implement an emergency overdose medication order upon admission, failed to maintain an available stock of emergency medication, didn't provide staff with access or training for the automated medication storage system, and failed to accurately measure and administer titrated liquid narcotic doses for 1 of 1 resident reviewed (Resident #1).The State Agency informed the facility of the Immediate Jeopardy (IJ) on [DATE] at 1:45 PM that began as of [DATE]. …
F760 citations in Iowa
Significant medication errors · Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Iowa cites F760 more often than its own record predicts
1.39 times the share F760 takes of citations nationally.
Of every deficiency written in Iowa in 2025, this is the portion that was F760.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Iowa surveyors wrote
F760 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 clinical record review, policy review, and staff and resident interviews, the facility failed to ensure nursing staff administered the right medications to the right resident for 1 of 3 (Resident #2) residents reviewed for significant medication error. The error caused Resident #2 to become unresponsive and required hospitalization. The facility reported a census of 40 residents.Findings include:The Minimum Data Set (MDS), dated [DATE], list of diagnoses for Resident #2 included heart failure, diabetes (a disease which caused abnormalities in blood sugar), and non-Alzheimer's dementia. The MDS listed a Brief Interview for Mental Status (BIMS) score of 15 out of 15, indicating intact cognition. A 2/10/26 11:53 a.m. …
Based on observation, clinical record review, staff interviews, and policy review, the facility failed to correctly administer insulin by failing to prime a newly attached insulin pen needle before administering it for 1 of 1 resident (#8). The facility reported a census of 43 residents.Findings include:Resident #8's Minimum Data Set (MDS) assessment dated [DATE] identified a BIMS score of 15 out of 15 which indicated completely intact cognition. It included diagnoses of heart disease, kidney failure, and diabetes mellitus. It revealed the resident took insulin in the 7-day look-back period. …
The short window
Recent years
| Year | Share of Iowa citations | vs expected |
|---|---|---|
| 2023 | 1.12% | 1.01× |
| 2024 | 1.26% | 1.08× |
| 2025 | 1.81% | 1.39× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Iowa surveyors cite →
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