01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-01-22 | 3 | 2026-01-22 | 2 |
| Cycle 2 | 2025-01-09 | 4 | 2025-01-09 | 2 |
| Cycle 3 | 2023-09-28 | 5 | 2023-09-28 | 3 |
CMS CCN 1656052026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Kennybrook Village
200 Sw Brookside Drive · Grimes, IA 50111 · Polk County
Certified beds40CMS provider file
Recent citation rows19current 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
19 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.
2026-01-22 · 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 · 2026-02-062026-01-22 · HEALTHF0812Severity E · pattern; 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 · 2026-02-062026-01-22 · 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 · 2026-02-062026-01-22 · 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 · 2026-01-272026-01-22 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2026-02-042025-01-09 · 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 · 2025-01-212025-01-09 · HEALTHF0803Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Correction field: Deficient, Provider has date of correction · 2025-01-312025-01-09 · 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 · 2025-01-312025-01-09 · HEALTHF0812Severity E · pattern; 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 · 2025-01-312025-01-09 · HEALTHF0865Severity F · widespread; 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 · 2025-01-312025-01-09 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Waiver has been granted · 2025-02-142023-09-28 · HEALTHF0584Severity D · isolated; 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 · 2023-10-202023-09-28 · HEALTHF0676Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Correction field: Deficient, Provider has date of correction · 2023-10-202023-09-28 · HEALTHF0803Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Correction field: Deficient, Provider has date of correction · 2023-10-20 · complaint2023-09-28 · 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 · 2023-10-202023-09-28 · HEALTHF0812Severity E · pattern; 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 · 2023-10-202023-09-28 · 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 · 2023-10-162023-09-28 · FIREK0911Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Meet requirements for the installation and maintenance of electrical systems.
Correction field: Deficient, Provider has date of correction · 2023-10-162023-09-28 · FIREK0923Severity E · pattern; 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 · 2023-10-1603 / 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
- SCENIC DEVELOPMENT LLCOrganization · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/16/2012
- SCENIC HOLDINGS LLCOrganization · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/31/2018
- 3RK, LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 01/01/2021
- 5 R CATTLE, LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/16/2012
- CADET INVESTMENT LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/16/2012
- LMRAY, LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/16/2012
- POKY FEEDERS INCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/16/2012
- WSG LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/16/2012
- ANDERSON, JORDANIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 10/01/2021
- ANDERSON, MARLENEIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/16/2012
- ANDERSON, WAYNEIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/16/2012
- GULLEDGE, SCOTTIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/16/2012
- GULLEDGE, TRAVISIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 10/01/2021
- HOWARD, STEVENIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/16/2012
- WOOD, GILBERTIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/16/2012
- PIVOTAL HEALTH CARE LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/16/2012
- SCENIC DEVELOPMENT LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/16/2012
- ANDERSON, JORDANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2025
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 hours4.54per resident day
RN hours0.78per resident day
Weekend nurse hours4.00per resident day
Staff turnover49.1%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.