(C) Iowa Capital Dispatch
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Hospital reports Cedar Rapids nursing home for 'abuse' related to resident care • Iowa Capital Dispatch [1]
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Date: 2025-07-16
A Cedar Rapids nursing home has been fined $13,000 after a series of alleged medication errors.
According to state inspection records, on May 23, 2025, a resident of the Heritage Specialty Care nursing home received, in error, 12 medications that were to have been administered to another resident.
The resident who received the medications later became lethargic and confused and their oxygen saturation levels dropped, inspectors allege. The resident was taken by ambulance to a hospital, where they were admitted to the intensive care unit and treated for medication-type poisoning. The resident was hospitalized for four days, according to the inspectors’ reports.
The nurse who had administered the drugs reportedly told inspectors she had to give medications to 13 residents that day, there were a lot of call-lights on due to residents needing assistance, and she was the only nurse on duty at the time and was being assisted by one nursing assistant.
A few weeks later, on June 4, the facility allegedly failed to properly assess a female resident and intervene after the woman became unresponsive and was sent to the hospital with a blood glucose level of 25 — anything below 54 is considered dangerous, requiring immediate action — after being given insulin without eating their meal.
Inspectors reported that they were unable to observe the resident during their investigation, which took place in early July, because “she was still hospitalized during the investigation.”
In their written findings, the state inspectors said that when they asked Heritage’s director of nursing “what he felt the cause of the error was, he reported he did not think there was an error.”
The hospital involved in the incident reported Heritage Specialty Care for alleged abuse related to neglect that resulted in a hypoglycemic resident, according to state inspectors.
Six days after that incident occurred, on June 10, an employee of Heritage Specialty Care incorrectly administered 12 or 13 units of insulin for a resident rather than the expected 17 units, inspectors reported. The resident soon became unresponsive with a blood glucose level of 25 and was sent to a hospital for treatment, inspectors alleged.
Heritage Specialty Care is part of a chain of nursing homes operated by Care Initiatives of West Des Moines. A company representative said Tuesday that she not able to comment at that time on the state’s findings.
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