Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around January 2027
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 Northcrest Specialty Care during CMS and state inspections, most recent first.
A resident who was dependent on staff for dressing due to hemiplegia was observed wearing the same t-shirt from the previous night, which still had hair clippings from a recent haircut. Staff interviews indicated uncertainty about whether the resident had been changed or had refused a gown, and the facility's policy requiring assistance with ADLs was not consistently followed, resulting in inadequate grooming.
The facility failed to maintain proper food storage and sanitation standards, with undated and expired food items found in storage, and unsanitary conditions observed in the kitchen. The Dietary Manager was unaware of these issues despite regular audits, and cleaning practices were not effectively implemented.
The facility failed to implement Enhanced Barrier Precautions for residents with feeding tubes, dialysis access sites, and urinary catheters, as observed with three residents. Additionally, improper infection control practices were noted during medication administration, with staff handling medications with bare hands or without changing gloves. The DON acknowledged oversights in EBP implementation and confirmed the need for proper glove use during medication handling.
A resident with a history of cerebrovascular accident was incorrectly documented as taking an anticoagulant in the MDS assessment, when they were actually on antiplatelet medications like aspirin and clopidogrel. This error was confirmed by the ADON and DON, and the Reimbursement Specialist noted the misclassification, possibly due to confusion with bleeding risk documentation.
A resident with a history of bowel obstructions and peptic ulcer disease experienced nausea, vomiting, and loose stools without timely assessment or physician notification. Despite receiving medications, the resident's condition worsened, leading to an emergency room visit. Staff interviews revealed communication and documentation lapses regarding medication administration and condition changes.
A resident undergoing hemodialysis was not provided with food during their appointment, leading them to purchase their own lunch. Despite having a dietary care plan, there was no directive for staff to send meals with the resident. Staff interviews revealed a lack of communication and responsibility regarding meal provision for residents attending dialysis, resulting in the oversight.
A resident with a history of stroke and asthma did not receive the flu vaccine despite requesting it during admission. The DON confirmed the absence of documentation explaining the lack of vaccine administration, even though a flu clinic was held after the resident's admission. Facility policy required documentation of vaccine refusal or administration, which was not present in the resident's record.
A resident with a history of stroke and asthma did not receive the flu vaccine despite requesting it during her admission assessment. The facility lacked documentation explaining why the vaccine was not administered, even though a flu clinic was held after her admission. The facility's policy required documentation of vaccine refusal, which was not followed in this case.
A resident with multiple health conditions, including ESRD and diabetes, experienced inadequate skin care and assessment at the facility. Despite having a care plan for skin integrity concerns, the facility missed several scheduled skin evaluations and failed to administer prescribed treatments for itching. The resident's condition worsened, leading to hospitalization for pneumonia, metabolic encephalopathy, and fluid overload.
A facility failed to remove an old fentanyl patch before applying a new one for a resident. The resident reported the issue, and the old patch was eventually removed. Interviews with staff confirmed that the standard procedure was not followed.
Failure to Provide Adequate Grooming and Dressing Assistance
Penalty
Summary
A deficiency was identified when a resident, who was dependent on staff for upper and lower body dressing due to hemiplegia following a stroke and depression, was observed to have inadequate grooming. The resident was seen wearing the same t-shirt from the previous night into the following day, and the shirt still had hair clippings from a haircut received the day before. The resident confirmed that his shirt had not been changed the previous night. Staff interviews revealed uncertainty about whether the resident had been changed into a gown or if he had refused, with staff acknowledging that sometimes the day shift or night shift would change the resident, but there was no clear documentation or recollection of the shirt being changed after the haircut. The facility's policy required staff to provide care and assistance with activities of daily living (ADLs), including dressing and grooming, for residents unable to perform these tasks independently. Despite this, the resident did not receive adequate assistance with changing clothes and removing hair clippings after a haircut, resulting in diminished grooming. The observations, interviews, and record review confirmed that the necessary support for maintaining personal hygiene and grooming was not consistently provided as required by facility policy.
Deficiencies in Food Storage and Sanitation Practices
Penalty
Summary
The facility failed to maintain proper food storage and sanitation standards, as observed during a kitchen tour. In the dry storage area, there was an undated bin of rice, snack bins with unwrapped cheese puffs and corn chips, and an open, undated package of chicken and herb stuffing. Additionally, expired lemon bar mix and gluten-free chocolate chip cookies were found. In the walk-in freezer, an open, undated package of fajita vegetable blend and a box of southern style biscuits with open flaps and ice crystals were noted. The freezer floor had ice chunks and food particles. The Dietary Manager (DM) was unaware of the presence of these items and had previously audited the kitchen for expired items. During a second observation, a cart of clean dishes was placed near a floor drain covered with food particles, foil bits, and dust webs. The Assistant Dietary Services Manager (ADSM) mentioned the drain was previously used for a portable steam table but was not in use at the time of the survey. The DM stated that expired food was regularly audited and expected staff to label opened food with an 'O' and the date. A cleaning schedule was provided, indicating that staff were responsible for sweeping, mopping, and checking for outdated food daily, but these practices were not effectively implemented.
Failure to Implement Enhanced Barrier Precautions and Maintain Infection Control
Penalty
Summary
The facility failed to implement Enhanced Barrier Precautions (EBP) for residents requiring high-contact care activities, such as those with feeding tubes, dialysis access sites, and urinary catheters. Resident #132, who had a feeding tube, did not have a CDC EBP sign on her room door until 1/27/25, despite having orders for EBP due to her feeding tube. Staff F, a registered nurse, confirmed that EBP was not implemented until 1/27/25, and Resident #132 reported that nurses only began using gowns and gloves the day before. The Director of Nursing (DON) acknowledged that some residents, including Resident #132 and #128, were missed in the EBP implementation. Resident #128, who had an arteriovenous fistula for dialysis, also did not have a CDC EBP sign on her room door. Despite having a care plan directing the use of EBP, Resident #128 reported that nurses did not wear gowns and gloves when assessing her fistula. The DON admitted that Resident #128's EBP implementation was overlooked, particularly because she was admitted over the weekend. Additionally, the facility failed to maintain proper infection control practices during medication administration. Staff G, a Certified Medication Aide, was observed handling medications with bare hands, while Staff I, a Registered Nurse, used gloves but did not perform hand hygiene or change gloves between tasks. This improper handling of medications was observed with multiple residents, including Resident #34, #43, and #63. The DON confirmed that staff should use clean gloves if they need to touch medications and should not handle pills with bare hands.
MDS Assessment Error for Antiplatelet Medication
Penalty
Summary
The facility failed to accurately complete the Minimum Data Set (MDS) assessment for a resident who was on antiplatelet medications, leading to a deficiency in accurately reflecting the resident's medication status. The resident, who had a diagnosis of cerebrovascular accident (CVA), was documented in the MDS as taking an anticoagulant medication within the lookback period. However, upon review, it was found that the resident was actually taking aspirin and clopidogrel, which are antiplatelet medications, not anticoagulants. This misclassification was identified during a clinical record review and staff interviews. The Assistant Director of Nursing (ADON) and the Director of Nursing (DON) confirmed that the resident did not receive an anticoagulant medication. The Reimbursement Specialist acknowledged that the MDS assessment was incorrectly coded, possibly due to confusion with clinical documentation on bleeding risk. The facility's use of traveling MDS Coordinators may have contributed to the error. The LTC RAI 3.0 User's Manual specifies that antiplatelet medications should not be coded as anticoagulants, highlighting the importance of accurate coding to reflect the resident's status as required by federal regulations.
Failure to Timely Assess and Notify Physician for Resident with GI Issues
Penalty
Summary
The facility failed to provide timely assessment and physician notification for a resident with a history of bowel obstructions and peptic ulcer disease who exhibited symptoms of nausea, vomiting, and loose stools. The resident, identified as having moderately impaired cognition, was dependent on staff for toileting hygiene and was documented as incontinent of bowel. Despite these conditions, the facility did not conduct necessary abdominal assessments or notify the primary physician provider in a timely manner. The resident experienced multiple episodes of nausea and vomiting over several days, during which various staff members administered medications such as Milk of Magnesia and ondansetron without conducting proper assessments or notifying the physician. The progress notes consistently lacked documentation of abdominal assessments or physician notifications, even as the resident's symptoms persisted and worsened. It was only after the resident's condition became severe, with symptoms including abdominal distension and firm abdomen, that the resident was sent to the emergency room. Interviews with staff revealed a lack of clarity and communication regarding the administration of as-needed medications and the reporting of changes in resident conditions. Staff members were unsure of the protocols for notifying nurses and physicians, and there was a noted absence of a Change of Condition Evaluation form in the resident's electronic health record during the critical period. This deficiency in communication and documentation contributed to the delay in addressing the resident's acute medical needs.
Failure to Provide Meals for Resident During Dialysis
Penalty
Summary
The facility failed to provide food to a resident while they were out of the facility for renal dialysis. The resident, who was alert and oriented with intact cognition, was admitted to the facility and required hemodialysis at a local center. Despite having a dietary care plan in place, there was no direction for staff to send meals with the resident to dialysis appointments. On the resident's first dialysis appointment since admission, they left the facility in the morning and returned in the late afternoon without being provided any food, resulting in the resident having to purchase their own lunch. Interviews with staff revealed a lack of communication and responsibility regarding the provision of meals for residents attending dialysis. The Registered Nurse and Certified Nursing Aide were unsure of who was responsible for ensuring meals were sent with residents, and the Assistant Dietary Services Manager was not informed of the resident's dialysis appointment. The Director of Nursing acknowledged the communication breakdown, particularly as the resident was admitted over the weekend, which led to the oversight in providing a meal for the resident during their dialysis appointment.
Failure to Administer Flu Vaccine to Resident
Penalty
Summary
The facility failed to administer the flu vaccine to Resident #9, who was one of six residents reviewed. Resident #9, who had a history of stroke and asthma, requested the flu and COVID vaccines during her admission assessment. However, she reported not receiving any vaccines while at the facility. The Director of Nursing (DON) confirmed that there was no documentation in Resident #9's record explaining why she did not receive the vaccine, despite a flu clinic being held in October after her admission. The facility's policy required documentation of vaccine refusal or administration, but no such documentation was found in Resident #9's medical record.
Failure to Administer Flu Vaccine to Resident
Penalty
Summary
The facility failed to administer the flu vaccine to one resident, despite the resident's request during her admission assessment. The resident, who had a history of stroke and asthma, reported during an interview that she did not receive any vaccines at the facility, including the flu and COVID vaccines, which she had requested upon arrival. The facility's documentation did not include any record of why the resident did not receive the flu vaccine, even though a flu clinic was held at the facility after her admission. The Director of Nursing confirmed that there was no documentation explaining the absence of the vaccine administration for the resident, and the facility lacked an original consent or declination form. The facility's policy on influenza vaccination, revised in October 2019, stated that all residents without medical contraindications should be offered the vaccine annually, and any refusal should be documented. However, this procedure was not followed in the case of the resident, leading to the deficiency noted in the report.
Failure to Provide Adequate Skin Care and Assessment
Penalty
Summary
The facility failed to provide appropriate assessment and intervention for a resident with multiple health conditions, including anemia, malnutrition, ESRD, diabetes, and heart failure. The resident required staff assistance for mobility and had a care plan in place to address skin integrity concerns due to venous insufficiency. Despite this, the facility did not consistently perform weekly skin evaluations as directed, missing several scheduled assessments in April and May. Additionally, the staff failed to administer prescribed Benadryl cream for itching from May 21 to May 29, 2024. The resident's clinical records indicated ongoing skin issues, including a rash and blisters on the lower extremities, which were not adequately addressed. The resident experienced itching and skin breakdown, leading to open wounds and infections. Despite receiving new orders for treatment, such as Nystatin powder and Eucerin cream, the resident continued to suffer from skin issues, and the facility did not document or manage these concerns effectively. The resident's condition worsened, resulting in a hospital admission for pneumonia, metabolic encephalopathy, and fluid overload. The facility's failure to conduct regular skin assessments and administer prescribed treatments contributed to the resident's deteriorating condition. The staff did not follow the facility's policy on skin breakdown management, which required documentation and intervention for new skin concerns. The lack of timely and appropriate care led to the resident's hospitalization and subsequent discharge to a care facility with hospice services.
Failure to Remove Old Pain Medication Patch Before Applying New One
Penalty
Summary
The facility failed to ensure the proper removal of a pain medication patch before applying a new one for a resident. On 3/3/2024, a Certified Medication Aide (CMA) applied a new fentanyl patch to the resident without removing the old one. The resident reported the issue to the nursing staff the following morning, revealing that two patches were present on his body. The resident initially refused to have the old patch removed until he could speak with the Advanced Registered Nurse Practitioner (ARNP). Upon assessment, the ARNP found no overdose symptoms, and the old patch was eventually removed with a witness present. Interviews with the facility's staff, including the Director of Nursing (DON) and Assistant Director of Nursing (ADON), confirmed that the standard procedure is to remove the old patch before applying a new one. The facility's policy on administering medications also supports this practice. The resident's pharmacist indicated that having two patches on simultaneously might result in a small amount of additional medication from the old patch, but it is designed to deliver medication for only three days. The facility's policy and the pharmacist's input highlight the importance of adhering to proper procedures for transdermal medication administration.
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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.
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Nursing homes near Waterloo
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Harmony Waterloo | 3.7 mi | — | 17 | 1 |
| Ravenwood Specialty Care | 3.9 mi | — | 10 | 0 |
| Friendship Village Retirement | 3.9 mi | — | 4 | 0 |
| Pillar Of Cedar Valley | 4.5 mi | — | 13 | 0 |
| Pinnacle Specialty Care | 6 mi | — | 6 | 0 |
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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.