All citations for Tweeten Lutheran Health Care Center

State inspectors check nursing homes that take Medicare or Medicaid against federal rules, usually about once a year, and also look into complaints. Each rule a home did not meet is a citation.

Back to Tweeten Lutheran Health Care Center

Last standard health inspection on record

April 2, 2026

Showing 1 to 25 of 26 citations

  1. Immediate jeopardy to resident health or safety

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Isolated (one or a few residents). CMS level J.

    Health citation F-0684, Quality of Life and Care Deficiencies. Inspection of June 8, 2026. Found during a complaint inspection.

    The home gave a date the problem would be corrected (July 17, 2026).

  2. Harm to a resident

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

    Isolated (one or a few residents). CMS level G.

    Health citation F-0686, Quality of Life and Care Deficiencies. Inspection of December 19, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (April 27, 2026).

  3. Harm to a resident

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    Isolated (one or a few residents). CMS level G.

    Health citation F-0689, Quality of Life and Care Deficiencies. Inspection of December 19, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (March 12, 2026).

  4. No harm, with potential for more than minimal harm

    Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

    Widespread (many residents). CMS level F.

    Health citation F-0867, Administration Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  5. No harm, with potential for more than minimal harm

    Install smoke barrier doors that can resist smoke for at least 20 minutes.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0374, Smoke Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  6. No harm, with potential for more than minimal harm

    Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0926, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  7. No harm, with potential for more than minimal harm

    Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

    Widespread (many residents). CMS level F.

    Health citation F-0727, Nursing and Physician Services Deficiencies. Inspection of December 19, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (January 23, 2026).

  8. No harm, with potential for more than minimal harm

    Have simulated fire drills held at unexpected times.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0712, Miscellaneous Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  9. No harm, with potential for more than minimal harm

    Develop and implement policies and procedures to prevent abuse, neglect, and theft.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0607, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of June 8, 2026. Found during a complaint inspection.

    The home gave a date the problem would be corrected (July 17, 2026).

  10. No harm, with potential for more than minimal harm

    Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0726, Nursing and Physician Services Deficiencies. Inspection of June 8, 2026. Found during a complaint inspection.

    The home gave a date the problem would be corrected (July 17, 2026).

  11. No harm, with potential for more than minimal harm

    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0842, Resident Assessment and Care Planning Deficiencies. Inspection of June 8, 2026. Found during a complaint inspection.

    The home gave a date the problem would be corrected (July 17, 2026).

  12. No harm, with potential for more than minimal harm

    Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0561, Resident Rights Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  13. No harm, with potential for more than minimal harm

    Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0582, Resident Rights Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  14. No harm, with potential for more than minimal harm

    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0656, Resident Assessment and Care Planning Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  15. No harm, with potential for more than minimal harm

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0686, Quality of Life and Care Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  16. No harm, with potential for more than minimal harm

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0689, Quality of Life and Care Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  17. No harm, with potential for more than minimal harm

    Provide enough food/fluids to maintain a resident's health.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0692, Quality of Life and Care Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  18. No harm, with potential for more than minimal harm

    Provide care or services that was trauma informed and/or culturally competent.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0699, Quality of Life and Care Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  19. No harm, with potential for more than minimal harm

    Provide or obtain dental services for each resident.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0791, Quality of Life and Care Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  20. No harm, with potential for more than minimal harm

    Provide and implement an infection prevention and control program.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0880, Infection Control Deficiencies. Inspection of April 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 11, 2026).

  21. No harm, with potential for more than minimal harm

    Develop and implement policies and procedures to prevent abuse, neglect, and theft.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0607, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of December 19, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (March 12, 2026).

  22. No harm, with potential for more than minimal harm

    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0609, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of December 19, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (March 12, 2026).

  23. No harm, with potential for more than minimal harm

    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

    Isolated (one or a few residents). CMS level D.

    Health citation F-0655, Resident Assessment and Care Planning Deficiencies. Inspection of December 19, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (January 23, 2026).

  24. No harm, with potential for more than minimal harm

    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0657, Resident Assessment and Care Planning Deficiencies. Inspection of December 19, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (January 23, 2026).

  25. No harm, with potential for more than minimal harm

    Ensure services provided by the nursing facility meet professional standards of quality.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0658, Resident Assessment and Care Planning Deficiencies. Inspection of December 19, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (January 23, 2026).

Source: CMS Provider Information, Fire Safety Deficiencies, Health Deficiencies, Citation Code Look-up, data as of September 30, 2026. Inspection results describe the home at the time of each inspection.