Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around December 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Midlands Living Center L L C during CMS and state inspections, most recent first.
A CNA failed to follow infection control protocols during catheter care for a resident with a suprapubic catheter, including not performing hand hygiene before donning gloves, not changing gloves or sanitizing hands between clean and dirty tasks, and attempting to use a gauze package that had fallen on the floor. These actions did not comply with facility policy and infection prevention standards.
The facility failed to update care plans for two residents, one with edema and another receiving antidepressant and antianxiety medications. The care plans lacked necessary information and interventions related to their conditions, as acknowledged by the MDS nurse and confirmed by the DON.
A facility failed to ensure safe transfer techniques for a resident, as a CNA assisted the resident with ambulation without using a gait belt, contrary to the care plan. The resident, who had a history of cognitive decline and was at high risk for falls, was found ambulating without assistance during an unwitnessed fall. The facility lacked policies on gait belt use, contributing to the deficiency.
A facility failed to implement Enhanced Barrier Precautions (EBP) during catheter care for a resident with an indwelling suprapubic catheter. Despite being trained, a CNA forgot to don gowns while providing care. The Director of Nursing confirmed the expectation for staff to use EBP, as outlined in facility policy and CDC guidelines, for residents with indwelling medical devices.
The facility failed to include Enhanced Barrier Precautions (EBP) in the care plans of three residents who required them due to the use of catheters. Despite staff expectations for EBP to be part of care plans, these precautions were not documented for residents with cognitive impairments and catheter use, indicating a deficiency in infection control measures.
The facility failed to follow physician's orders for three residents, leading to medication administration errors. A resident with severe cognitive deficits received medications outside prescribed parameters due to staff confusion. Another resident with heart failure was given medications despite blood pressure readings outside set parameters, and weight records were missing. A third resident with asthma did not receive prescribed nebulizer treatments. The facility lacked policies on monitoring blood pressures and following physician's orders.
A resident with mild cognitive impairment was treated without dignity by a Nurse Aide in Training (NAT) who recorded a Snapchat video of their interaction. The NAT responded condescendingly to the resident's request for help, stating she couldn't assist because the resident hadn't listened. The Assistant Director of Nursing (ADON) intervened, educating the NAT on appropriate interaction with dementia residents. The Director of Nursing (DON) described the NAT's tone as borderline demeaning, highlighting a failure to uphold the facility's policy on Residents' Rights.
Failure to Maintain Infection Control During Catheter Care
Penalty
Summary
A deficiency was identified when a certified nurse aide (CNA) failed to follow proper infection control practices during catheter care for a resident with a suprapubic catheter. The resident, who had intact cognition and diagnoses including paraplegia and neurogenic bladder, required daily catheter site care as documented in the care plan and treatment administration record. During the observed procedure, the CNA entered the resident's room, donned an isolation gown, and put on gloves without performing hand hygiene. The CNA proceeded to handle the resident's catheter and supplies without changing gloves or performing hand hygiene at appropriate intervals, as required by facility policy. The CNA removed and replaced the gauze dressing on the suprapubic catheter tubing, but when a new package of gauze was dropped on the floor, the CNA initially attempted to use it rather than discard it, only disposing of it after repeated instruction from the Assistant Director of Nursing (ADON). Throughout the procedure, the CNA continued to touch various surfaces and supplies, including opening drawers and cabinets, and handling a graduated cylinder for urine measurement, all while wearing the same pair of gloves. Hand hygiene was not performed between clean and dirty tasks, nor after glove removal until the end of the procedure. Facility policy and the catheter care audit tool both require hand hygiene before and after glove use, and after contact with potentially contaminated items. The observed actions did not align with these protocols, as the CNA failed to perform hand hygiene at critical points and did not change gloves when indicated, leading to a breach in infection prevention and control practices for the resident with an indwelling catheter.
Failure to Update Care Plans for Residents with Specific Medical Needs
Penalty
Summary
The facility failed to update care plans for two residents, leading to deficiencies in addressing their specific medical needs. Resident #22, who was admitted with a diagnosis of heart failure, conduct disorder, adjustment disorder, and edema, had a care plan that did not include information or goals related to his edema and subsequent skin issues. Despite having orders for daily treatments and the removal of TED hose due to edema, these were not reflected in the care plan. Observations showed that Resident #22 had tightly wrapped lower extremities with blue elastic bandages and edematous legs, indicating a need for updated care planning. Resident #12, who had severe cognitive deficits and was dependent on staff for daily activities, was receiving sertraline for depression and lorazepam for anxiety related to Alzheimer's Disease. However, her care plan lacked focus areas or interventions related to the use of these antidepressant and antianxiety medications. The MDS nurse acknowledged the oversight, and the Director of Nursing confirmed the absence of a policy for establishing or updating care plans, contributing to the deficiency.
Failure to Use Gait Belt During Resident Ambulation
Penalty
Summary
The facility failed to provide safe transfer techniques for a resident, leading to a deficiency in accident prevention. A Certified Nurse Aide (CNA) was observed assisting a resident with ambulation without using a gait belt, instead holding onto the elastic of the resident's pants. This occurred despite the resident's care plan indicating the need for substantial assistance with transfers and supervision during ambulation with a front wheel walker. The resident had a history of cognitive decline, as evidenced by a decrease in her Brief Interview for Mental Status (BIMS) score from 15 to 10, indicating a moderate cognitive deficit. Additionally, the resident was on anti-anxiety medication, which required monitoring for side effects such as drowsiness and clumsiness. The resident had a documented history of falls and was identified as high risk for falls due to conditions such as hypotension, vertigo, Parkinson's Disease, seizures, osteoporosis, and delirium. An incident report noted an unwitnessed fall in the resident's room, where she was found confused and ambulating without assistance. Despite these risks, the facility did not have policies on gait belt use or safe transferring techniques, as acknowledged by the Director of Nursing (DON). This lack of policy and the improper assistance provided by the CNA contributed to the deficiency in ensuring a safe environment for the resident.
Failure to Implement Enhanced Barrier Precautions During Catheter Care
Penalty
Summary
The facility failed to implement Enhanced Barrier Precautions (EBP) during catheter care for Resident #29, who was diagnosed with benign prostatic hyperplasia, renal insufficiency, neurogenic bladder, and had a stroke. The resident relied on an indwelling suprapubic catheter, which was to be changed monthly. During an observation, two Certified Nurses Aides (CNAs) completed hand hygiene and repositioned the resident using a mechanical lift, performed peri care, and drained the resident's catheter without using the required EBP. Staff interviews revealed that one of the CNAs had been trained on the use of Personal Protective Equipment (PPE) for EBP but forgot to don gowns during the procedure. The Director of Nursing (DON) confirmed that the expectation was for staff to wear EBP while providing care for residents with catheters. The facility's policy and the Centers for Disease Control and Prevention guidelines indicated that EBP should be used for residents with indwelling medical devices, regardless of their infection or colonization status with multidrug-resistant organisms (MDROs).
Failure to Implement Enhanced Barrier Precautions in Care Plans
Penalty
Summary
The facility failed to develop comprehensive care plans for Enhanced Barrier Precautions (EBP) for three residents who required them. Resident #39, who entered the facility with moderate cognitive impairment and a diagnosis of urinary retention requiring a Foley catheter, did not have any focus, goals, or interventions related to EBP in their care plan. Similarly, Resident #29, diagnosed with benign prostatic hyperplasia, renal insufficiency, neurogenic bladder, and stroke, relied on a suprapubic catheter but lacked a comprehensive care plan addressing EBP. Interviews with facility staff, including the MDS Coordinator and the Director of Nursing, confirmed the expectation for EBP to be included in care plans, yet it was not implemented. Resident #40, admitted with a moderate cognitive deficit and an indwelling catheter, also lacked a care plan referencing EBP despite having a sign outside their room indicating the need for such precautions. The care plan for Resident #40, updated months prior, noted self-care deficits and the use of a Foley catheter but did not address EBP. The facility's failure to incorporate EBP into the care plans of these residents highlights a deficiency in meeting the residents' needs for infection control and prevention.
Medication Administration Errors and Lack of Policy
Penalty
Summary
The facility failed to adhere to physician's orders for three residents, leading to medication administration errors. Resident #160, who had severe cognitive deficits and multiple health issues including heart failure and orthostatic hypotension, received metoprolol and midodrine outside the prescribed blood pressure parameters on multiple occasions. The staff found the orders confusing, which contributed to the improper administration of these medications. Resident #55, with intact cognitive ability and diagnoses including heart failure and hypertension, was administered atenolol and furosemide despite blood pressure readings that were outside the parameters set by the physician. Additionally, there were missing weight records, which were crucial for monitoring the resident's condition as per the care plan. Staff interviews revealed confusion regarding the medication parameters, and the Director of Nursing acknowledged the lack of a policy on monitoring blood pressures. Resident #39, with moderate cognitive impairment and asthma, did not receive the prescribed nebulizer treatments as ordered. Staff H, an LPN, admitted to not administering the noon treatment because the resident allegedly refused it, and also failed to properly monitor and document the morning treatment. The Director of Nursing and the Administrator confirmed the absence of policies or procedures on following physician's orders or medication administration, which contributed to these deficiencies.
Resident Dignity Compromised by Inappropriate Staff Interaction
Penalty
Summary
The facility failed to ensure that a resident was treated with dignity, as evidenced by an incident involving a Nurse Aide in Training (NAT), referred to as Staff A, and a resident with mild cognitive impairment. The resident, who had a Brief Interview of Mental Status Score of 5, indicating mild cognitive impairment, was heard asking for help in a Snapchat video recorded by Staff A. In the video, Staff A responded to the resident in a condescending manner, stating that she could not help the resident because the resident had not listened to her. This interaction was overheard by the Assistant Director of Nursing (ADON), who intervened and provided education to Staff A on appropriate interaction with residents. The incident occurred in a common area where the resident was sitting in a wheelchair, not attempting to leave or being disruptive. Staff A was recorded on Snapchat while interacting with the resident, and the video was shared with a small group of friends. Staff A admitted to not knowing how to handle residents with dementia and expressed feeling stressed and confused during the interaction. The ADON had previously educated Staff A on how to address the needs of dementia residents, emphasizing the importance of treating them with respect and dignity. The Director of Nursing (DON) and the facility's Administrator were made aware of the Snapchat video, which led to an investigation. The DON described Staff A's tone as borderline demeaning and acknowledged that Staff A might not have understood how to interact with residents with dementia, despite having received training. The facility's policy on Residents' Rights emphasizes the importance of treating residents with respect and dignity, which was not upheld in this incident.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 336 citations issued within 25 miles in the last 12 months — including the 2 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Council Bluffs
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| North Crest Living Center | 0.8 mi | — | 0 | 0 |
| Bethany Lutheran Home | 1.6 mi | — | 12 | 1 |
| Prairie Gate | 2.2 mi | — | 0 | 0 |
| Prairie Gate | 2.2 mi | — | 0 | 0 |
| Prairie Gate | 2.3 mi | — | 3 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Midlands Living Center L L C.
100% money-back within 48 hours.
Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.