01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-04-09 | 1 | 2026-04-09 | 1 |
| Cycle 2 | 2025-04-03 | 7 | 2025-04-03 | 1 |
| Cycle 3 | 2024-04-11 | 2 | 2024-04-11 | 2 |
CMS CCN 1654952026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Clarksville Skilled Nursing & Rehab Center
115 North Hilton St · Clarksville, IA 50619 · Butler County
Certified beds42CMS provider file
Recent citation rows14current CMS citation release
Penalty rows0current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
14 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 0 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-04-09 · HEALTHF0628Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Correction field: Deficient, Provider has date of correction · 2026-04-102026-04-09 · FIREK0133Severity F · widespread; potential for more than minimal harm
Construction Deficiencies
Install a two-hour-resistant firewall separation.
Correction field: Deficient, Provider has date of correction · 2026-04-082025-07-10 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-07-10 · HEALTHF0805Severity G · isolated actual harm
Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-04-03 · HEALTHF0641Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Correction field: Deficient, Provider has date of correction · 2025-04-22 · complaint2025-04-03 · HEALTHF0710Severity D · isolated; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care.
Correction field: Deficient, Provider has date of correction · 2025-04-22 · complaint2025-04-03 · HEALTHF0755Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has date of correction · 2025-04-22 · complaint2025-04-03 · HEALTHF0760Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2025-04-22 · complaint2025-04-03 · HEALTHF0812Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2025-04-222025-04-03 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-04-042024-04-11 · FIREE0026Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish roles under a Waiver declared by secretary.
Correction field: Deficient, Provider has date of correction · 2024-04-172024-04-11 · HEALTHF0625Severity B · pattern; potential for minimal harm
Resident Rights Deficiencies
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Correction field: Deficient, Provider has date of correction · 2024-04-22 · complaint2024-04-11 · HEALTHF0657Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Correction field: Deficient, Provider has date of correction · 2024-04-22 · complaint2024-04-11 · FIREK0222Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Correction field: Deficient, Provider has date of correction · 2024-04-1903 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- MARTIN, DEANIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST6% · since 07/21/2011
- AMUNSON, DALEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 11/17/2021
- ARENHOLZ, JANEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 04/11/2025
- ARENHOLZ, STEVENIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 04/01/2018
- BACKER, CHRISIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 04/01/2018
- KOLB, JEFFERYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 11/17/2021
- LODGE, SUSANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 04/21/2016
- ARENHOLZ, STEVENIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/01/2018
- MENNENGA, CALVINIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/11/2024
- METZ, JANICEIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/28/2009
- WYATT, ROBERTIndividual · CORPORATE OFFICERNOT APPLICABLE · since 03/01/2021
- CRAMER, REBECCAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/22/2013
- DERFIELD, BRANDIIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/01/2023
- FAGRE, LEEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/01/2016
- MAYER, TAMELAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/01/2023
- MYERS, JONATHANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/15/2008
- PIERCE, JORDANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/28/2023
- SELLS, HEATHERIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/04/2013
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours3.87per resident day
RN hours0.62per resident day
Weekend nurse hours3.30per resident day
Staff turnover33.3%CMS reported field
06 / LOCAL RECORDS
Open the Iowa ledger →Other published facilities nearby
No second facility in the same city met the directory rule.