CMS PUBLIC RECORD · AUGUST 2026 RELEASERECORDS ARE ONE INPUT—NOT A PLACEMENT RECOMMENDATION
NURSING HOMELEDGERINSPECTIONS · OWNERSHIP · PENALTIES
CMS CCN 3852072026-08-01 PROCESSING DATE

NURSING HOME PUBLIC RECORD

Dallas Retirement Village Health Center

377 Nw Jasper Street · Dallas, OR 97338 · Polk County

CMS OVERALL RATING★★★★☆4/5CMS field—not our score or recommendation
Certified beds121CMS provider file
Recent citation rows50current 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.

01 / INSPECTION LEDGER

Survey cycles in this release

CycleHealth dateHealth deficienciesFire dateFire deficiencies
Cycle 12026-04-1062026-04-105
Cycle 22024-12-0642024-12-061
Cycle 32023-07-31252023-07-319
02 / CITATION DETAIL

50 rows in the current release

0 rows carry G–L scope/severity codes; 0 carry J–L. 3 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.

2026-04-10 · 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 · 2026-05-25
2026-04-10 · HEALTHF0655Severity D · isolated; potential for more than minimal harm

Resident Assessment and Care Planning Deficiencies

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

Correction field: Deficient, Provider has date of correction · 2026-05-25
2026-04-10 · HEALTHF0684Severity D · isolated; potential for more than minimal harm

Quality of Life and Care Deficiencies

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

Correction field: Deficient, Provider has date of correction · 2026-05-25
2026-04-10 · HEALTHF0689Severity D · isolated; potential for more than minimal harm

Quality of Life and Care Deficiencies

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

Correction field: Deficient, Provider has date of correction · 2026-05-25
2026-04-10 · HEALTHF0690Severity D · isolated; potential for more than minimal harm

Quality of Life and Care Deficiencies

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Correction field: Deficient, Provider has date of correction · 2026-05-25
2026-04-10 · HEALTHF0880Severity E · pattern; potential for more than minimal harm

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

Correction field: Deficient, Provider has date of correction · 2026-05-25
2026-04-10 · 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 · 2026-05-30
2026-04-10 · FIREK0355Severity F · widespread; potential for more than minimal harm

Smoke Deficiencies

Properly select, install, inspect, or maintain portable fire extinguishes.

Correction field: Deficient, Provider has date of correction · 2026-05-30
2026-04-10 · FIREK0712Severity F · widespread; potential for more than minimal harm

Miscellaneous Deficiencies

Have simulated fire drills held at unexpected times.

Correction field: Deficient, Provider has date of correction · 2026-05-30
2026-04-10 · FIREK0916Severity F · widespread; potential for more than minimal harm

Gas, Vacuum, and Electrical Systems Deficiencies

Have a battery powered remote alarm panel in a location accessible by operating personnel.

Correction field: Deficient, Provider has date of correction · 2026-05-30
2026-04-10 · FIREK0923Severity D · isolated; potential for more than minimal harm

Gas, Vacuum, and Electrical Systems Deficiencies

Have proper medical gas storage and administration areas.

Correction field: Deficient, Provider has date of correction · 2026-05-30
2024-12-06 · HEALTHF0761Severity E · pattern; potential for more than minimal harm

Pharmacy Service Deficiencies

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Correction field: Deficient, Provider has date of correction · 2025-01-17
2024-12-06 · 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 · 2025-01-17
2024-12-06 · HEALTHF0880Severity F · widespread; potential for more than minimal harm

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

Correction field: Deficient, Provider has date of correction · 2025-01-17
2024-12-06 · FIREK0920Severity D · isolated; potential for more than minimal harm

Gas, Vacuum, and Electrical Systems Deficiencies

Ensure proper usage of power strips and extension cords.

Correction field: Deficient, Provider has date of correction · 2024-12-19
2024-11-13 · HEALTHF0600Severity D · isolated; potential for more than minimal harm

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Correction field: Deficient, Provider has date of correction · 2024-11-21 · complaint
2023-07-31 · FIREE0006Severity F · widespread; potential for more than minimal harm

Emergency Preparedness Deficiencies

Conduct risk assessment and an All-Hazards approach.

Correction field: Deficient, Provider has date of correction · 2023-09-19
2023-07-31 · FIREE0007Severity F · widespread; potential for more than minimal harm

Emergency Preparedness Deficiencies

Address patient/client population and determine types of services needed.

Correction field: Deficient, Provider has date of correction · 2023-09-19
2023-07-31 · FIREE0015Severity F · widespread; potential for more than minimal harm

Emergency Preparedness Deficiencies

Address subsistence needs for staff and patients.

Correction field: Deficient, Provider has date of correction · 2023-09-19
2023-07-31 · FIREE0018Severity F · widespread; potential for more than minimal harm

Emergency Preparedness Deficiencies

Establish procedures for tracking staff and patients during an emergency.

Correction field: Deficient, Provider has date of correction · 2023-09-19
2023-07-31 · FIREE0035Severity F · widespread; potential for more than minimal harm

Emergency Preparedness Deficiencies

Provide family notifications of emergency plan.

Correction field: Deficient, Provider has date of correction · 2023-09-19
2023-07-31 · HEALTHF0550Severity D · isolated; potential for more than minimal harm

Resident Rights Deficiencies

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Correction field: Deficient, Provider has date of correction · 2023-09-19
2023-07-31 · HEALTHF0557Severity D · isolated; potential for more than minimal harm

Resident Rights Deficiencies

Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.

Correction field: Deficient, Provider has date of correction · 2023-09-19
2023-07-31 · HEALTHF0561Severity E · pattern; potential for more than minimal harm

Resident Rights Deficiencies

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

Correction field: Deficient, Provider has date of correction · 2023-09-19
03 / 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.

DateTypeFine amountPayment-denial days
No penalty row appeared in the August 2026 penalties file.
04 / OWNERSHIP DISCLOSURES

Who appears in the CMS file

  • DALLAS MENNONITE RETIREMENT COMMUNITY, INC.Organization · 5% OR GREATER DIRECT OWNERSHIP INTEREST
    100% · since 01/01/2010
  • LUMENT REAL ESTATE CAPITAL LLCOrganization · 5% OR GREATER MORTGAGE INTEREST
    NOT APPLICABLE · since 04/19/2003
  • LUMENT REAL ESTATE CAPITAL LLCOrganization · 5% OR GREATER SECURITY INTEREST
    NOT APPLICABLE · since 04/19/2003
  • ADAMS, NANCYIndividual · CORPORATE DIRECTOR
    NOT APPLICABLE · since 01/01/2022
  • BUCKINGHAM, JOHNIndividual · CORPORATE DIRECTOR
    NOT APPLICABLE · since 01/01/2022
  • FAST, MICHAELIndividual · CORPORATE DIRECTOR
    NOT APPLICABLE · since 01/01/2024
  • HUMPHREY, SUSANIndividual · CORPORATE DIRECTOR
    NOT APPLICABLE · since 01/01/2022
  • MCCLEERY, DEBRAIndividual · CORPORATE DIRECTOR
    NOT APPLICABLE · since 01/01/2024
  • NEWMAN, JOSEPHIndividual · CORPORATE DIRECTOR
    NOT APPLICABLE · since 01/01/2025
  • OTTAWAY, ROBERTIndividual · CORPORATE DIRECTOR
    NOT APPLICABLE · since 01/01/2022
  • PAULS, DEBRAIndividual · CORPORATE DIRECTOR
    NOT APPLICABLE · since 03/26/2020
  • OTTAWAY, ROBERTIndividual · CORPORATE OFFICER
    NOT APPLICABLE · since 01/01/2020
  • LIFE CARE SERVICES LLCOrganization · OPERATIONAL/MANAGERIAL CONTROL
    NOT APPLICABLE · since 10/28/2012
  • PARRETT, DAVIDIndividual · OPERATIONAL/MANAGERIAL CONTROL
    NOT APPLICABLE · since 01/01/2025
  • SANBORN, STEFANIEIndividual · OPERATIONAL/MANAGERIAL CONTROL
    NOT APPLICABLE · since 01/01/2025
  • SUAREZ, YOLANDAIndividual · OPERATIONAL/MANAGERIAL CONTROL
    NOT APPLICABLE · since 02/01/2026
  • VELLODY, NITAIndividual · OPERATIONAL/MANAGERIAL CONTROL
    NOT APPLICABLE · since 08/01/2020
  • LIFE CARE SERVICES LLCOrganization · ADP OF THE SNF
    NOT APPLICABLE · since 06/16/2025

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 hours5.40per resident day
RN hours0.90per resident day
Weekend nurse hours4.69per resident day
Staff turnover44.0%CMS reported field
06 / LOCAL RECORDS

Other published facilities nearby

Open the Oregon ledger →

No second facility in the same city met the directory rule.

BEFORE A CARE DECISION

Verify the current record and visit in person.

Use this ledger to frame questions—not to choose care on its own. Recheck Medicare Care Compare, contact the state survey agency and long-term care ombudsman, and ask the facility about anything you find.