A central Iowa nursing home has been cited for an incident in which a resident’s family member had to summon the police to provide critical medical assistance for their relative.
According to state inspectors, at 4 p.m. on Aug. 18, 2025, the staff at Perry Lutheran Home failed to provide a female diabetic resident with her scheduled blood-sugar check and a set of two blood-sugar injections.
About 6:40 p.m., after the resident’s blood sugar had dropped to 27 — a potentially lethal level, with anything below 54 considered dangerous and necessitating immediate intervention — a visiting family member arrived at the home and found the resident slumped over in a chair, unresponsive. Inspectors allege the relative summoned the staff to the woman’s room and asked them to call 911.
According to the inspectors, a staff nurse allegedly refused, stating that wasn’t proper protocol. When the relative insisted, the nurse allegedly told the relative to call 911 herself and left the room to begin searching for the facility’s emergency kit, which is used to administer a drug in cases of low blood sugar. Other staffers eventually joined in the search, which lasted about 15 minutes, but the kit could not be located, according to state inspectors.
At 7 p.m., the relative called 911, and the police dispatcher helped by providing guidance on lowering the resident to the floor. The dispatcher then asked whether there was a defibrillator in the building, but a nursing assistant to whom the question was relayed allegedly indicated she didn’t know.
According to state inspectors, police officers then arrived and, at the relative’s insistence, the officers initiated cardiopulmonary resuscitation. Once paramedics arrived on the scene and administered a drug to stimulate the production of glucose, the resident became responsive and was transferred to a hospital for additional treatment.
State inspection reports indicate the woman’s relative reported that while she, the police and paramedics had been working to revive the woman, the nurse on duty never returned to the room to assist.
The inspectors allege that a subsequent review of medical records at Perry Lutheran Home indicated that on three prior occasions in August 2025, the female resident’s blood sugar was recorded at levels between 55 and 68 — all considered to be potentially harmful levels.
The Iowa Capital Dispatch was not able to reach the home’s administrator, Melissa Gannon, for comment.
The Iowa Department of Inspections, Appeals and Licensing proposed a state fine of $6,750 as a result of the recent findings. The imposed fine was tripled to $20,250 due to the incident representing a repeat, serious violation.
It marks the third time in the past two years that the home has faced trebled fines due to repeat, serious violations, although the penalties were held in suspension in two of those three cases:
Sexual abuse — In December 2023, Perry Lutheran Home was cited for failing to report an incident of sexual nature between two residents who lacked the ability to consent. Inspectors said that despite the facility learning of the incident, and despite having watched video of the incident, the staff concluded they were not required to report the matter. A $6,250 fine was proposed and then held in suspension so that federal officials could consider imposing a fine.
Fall-related death — In January 2024, the home was cited for failing to provide adequate nursing supervision to prevent resident injuries. In that case, a female resident of the home fell nine times over an eight-week period. After the ninth fall, the home allegedly failed to provide neurological checks to rule out a brain injury. Eventually, the woman was taken to a hospital and diagnosed with brain damage that led to her death days later. A $9,250 fine was proposed, tripled to $27,750 due to the repeat nature of the offense, and then held in suspension.
Emergency treatment — In November 2024, the home was cited for failing to send a resident to the nearest emergency room when there was a change in their condition, resulting in the resident later being admitted to a hospital with hypoxemia, bronchopneumonia and dehydration. Because that violation was a repeat offense, a state-imposed $5,000 fine was tripled to $15,000.
