01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-12-11 | 4 | 2025-12-11 | 6 |
| Cycle 2 | 2024-10-31 | 8 | 2024-10-31 | 5 |
| Cycle 3 | 2023-07-27 | 9 | 2023-07-27 | 2 |
CMS CCN 1655102026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Davenport Lutheran Home
1130 W 53Rd Street · Davenport, IA 52806 · Scott County
Certified beds98CMS provider file
Recent citation rows34current CMS citation release
Penalty rows1current 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
34 rows in the current release
3 rows carry G–L scope/severity codes; 1 carry J–L. 4 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-12-11 · HEALTHF0804Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Correction field: Deficient, Provider has date of correction · 2026-01-012025-12-11 · HEALTHF0812Severity F · widespread; 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 · 2026-01-012025-12-11 · HEALTHF0865Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
Have a plan that describes the process for conducting QAPI and QAA activities.
Correction field: Deficient, Provider has date of correction · 2026-01-012025-12-11 · HEALTHF0880Severity D · isolated; 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 · 2026-01-012025-12-11 · FIREK0341Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Install a fire alarm system that can be heard throughout the facility.
Correction field: Deficient, Provider has date of correction · 2025-12-172025-12-11 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2025-12-172025-12-11 · 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 · 2025-12-222025-12-11 · FIREK0753Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have restrictions on the use of highly flammable decorations.
Correction field: Deficient, Provider has date of correction · 2025-12-102025-12-11 · FIREK0761Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2025-12-102025-12-11 · FIREK0921Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure that testing and maintenance of electrical equipment is performed.
Correction field: Deficient, Provider has date of correction · 2025-12-222024-10-31 · HEALTHF0578Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Correction field: Deficient, Provider has date of correction · 2024-11-262024-10-31 · HEALTHF0584Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Correction field: Deficient, Provider has date of correction · 2024-11-262024-10-31 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2024-11-26 · complaint2024-10-31 · HEALTHF0610Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Deficient, Provider has date of correction · 2024-11-26 · complaint2024-10-31 · HEALTHF0804Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Correction field: Deficient, Provider has date of correction · 2024-11-262024-10-31 · HEALTHF0880Severity D · isolated; 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 · 2024-11-262024-10-31 · FIREK0291Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Install emergency lighting that can last at least 1 1/2 hours.
Correction field: Deficient, Provider has date of correction · 2024-11-122024-10-31 · FIREK0321Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2024-11-182024-10-31 · FIREK0344Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Have an alternate power supply for its alarm system.
Correction field: Deficient, Provider has date of correction · 2024-11-212024-10-31 · FIREK0347Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Properly provide smoke detection systems in areas open to corridors.
Correction field: Deficient, Provider has date of correction · 2024-11-082024-10-31 · 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 · 2024-11-182024-08-30 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2024-09-03 · complaint2024-08-30 · HEALTHF0684Severity J · isolated immediate jeopardy
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 · 2024-09-03 · complaint2024-07-11 · 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 · 2024-08-25 · complaint03 / 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 |
|---|---|---|---|
| 2024-08-30 | Fine | $16,913 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- CASPERS, LESAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/20/2025
- DEVRIES, KEVINIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/01/2023
- HESSON, ASHLEYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/19/2023
- KLOPPENBORG, DANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/20/2022
- LICHT, BRIANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2022
- LOSS, GARYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/01/2024
- NEWTON, DANIELIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/20/2022
- PAYNE, SUSANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/30/2021
- WEGENER, JAMESIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/30/2021
- WOOD, DOROTHEAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/21/2021
- CAMPBELL, CHARLESIndividual · CORPORATE OFFICERNOT APPLICABLE · since 06/21/2021
- LINDSTROM, JERRYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/22/2008
- WOLTEMATH, DOUGLASIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/22/2013
- WOOD, DOROTHEAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 06/21/2021
- BLECHLE, KEVINIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/01/2013
- BROWN, ROBERTIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/29/2012
- GLOEDE, DIANEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/14/1978
- MCREYNOLDS, AMIIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/25/2024
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 hours4.19per resident day
RN hours0.41per resident day
Weekend nurse hours3.61per resident day
Staff turnover36.0%CMS reported field
06 / LOCAL RECORDS
Open the Davenport ledger →Other published facilities nearby
Good Samaritan - Davenport119 beds · CMS overall 3/536 citation rowsHarmony Davenport88 beds · CMS overall 2/550 citation rowsHarmony Utica Ridge115 beds · CMS overall 2/543 citation rowsIvy At Davenport75 beds · CMS overall 1/589 citation rowsKahl Home For The Aged & Infirmed135 beds · CMS overall 3/526 citation rowsRidgecrest Village137 beds · CMS overall 1/551 citation rows