Based on resident record, family and staff interviews, change of condition and dietary policy, the facility failed to serve a resident the correct textured meal. Resident #4 required a pureed diet due to a diagnosis of dysphagia. On 6/27/26, during the dinner meal time, a facility CNA assisted Resident #4 to eat a pureed meal provided by the facility culinary staff. The facility CNA prepared a second meal plate from the steam table for Resident #4 which consisted of scrambled eggs, sausage and hash browns and did not alter the consistency of the food. The resident told the staff member no and the staff continued to feed the resident. At 5:21pm, Resident #4 began to cough up phlegm and scrambled eggs after eating the meal. …
F805 citations in Iowa
Food in a form residents can eat · Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Iowa cites F805 more often than its own record predicts
2.07 times the share F805 takes of citations nationally.
Of every deficiency written in Iowa in 2025, this is the portion that was F805.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Iowa surveyors wrote
F805 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 observations, interviews, and record review, the facility failed to follow Doctor's Orders for 2 out of 3 residents reviewed (Resident #2 and Resident #3). Resident #2 had an order for a mechanical soft diet with ground meat. Resident #2 received cut up sausage links instead of ground up sausage for breakfast. Resident #2 had a coughing/choking spell and five days later they admitted to the hospital with aspiration pneumonia. Resident #3 had an order for cut up meat. The kitchen staff prepared to serve Resident #3 a cheeseburger without cutting the meat cut up, as ordered by the Doctor. The facility reported a census of 34 residents.Findings include:1. …
Based on observation, staff interviews and facility policy review the facility failed to ensure residents received the proper diet texture to meet the residents needs.The facility reported a census of 92 residents. Findings Include:During observation on 08/05/2026 starting at 10:40 a.m., of the puree process. Staff A, [NAME] dished 3 servings of cauliflower into the robo coupe (blender) and pureed the cauliflower. Staff A took a 4 ounce scoop and scooped 2 portions out of the robo coupe and dished into the dish and took the same scoop and filled it half full and placed it into a dish for service. Staff A then took 3- 6 ounce portions of hot chicken and noodles and placed into the robo coupe and blended until smooth. Staff A dished out 3- 6 ounce servings into serving dishes. …
The short window
Recent years
| Year | Share of Iowa citations | vs expected |
|---|---|---|
| 2023 | 0.35% | 1.00× |
| 2024 | 0.65% | 1.80× |
| 2025 | 0.63% | 2.07× |
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