01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-03-26 | 3 | 2025-03-26 | 3 |
| Cycle 2 | 2024-04-02 | 6 | 2024-04-02 | 2 |
| Cycle 3 | 2023-03-09 | 3 | 2023-03-09 | 4 |
CMS CCN 2850622026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Midwest Covenant Home
615 East 9Th Street · Stromsburg, NE 68666 · Polk County
Certified beds51CMS provider file
Recent citation rows21current 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
21 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 4 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-03-26 · 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 · 2025-04-15 · complaint2025-03-26 · 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 · 2025-04-152025-03-26 · 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 · 2025-04-152025-03-26 · FIREK0324Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2025-04-012025-03-26 · 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 · 2025-04-012025-03-26 · 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 · 2025-04-012024-04-02 · 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 · 2024-05-17 · complaint2024-04-02 · 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 · 2024-05-172024-04-02 · 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 · 2024-05-17 · complaint2024-04-02 · HEALTHF0759Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2024-05-172024-04-02 · 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 · 2024-05-172024-04-02 · 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 · 2024-05-172024-04-02 · 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 · 2024-05-172024-04-02 · 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 · 2024-05-172023-03-09 · FIREE0041Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Implement emergency and standby power systems.
Correction field: Deficient, Provider has date of correction · 2023-03-292023-03-09 · HEALTHF0623Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Correction field: Deficient, Provider has date of correction · 2023-04-152023-03-09 · HEALTHF0677Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2023-04-152023-03-09 · 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 · 2023-04-152023-03-09 · FIREK0291Severity D · isolated; 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 · 2023-03-292023-03-09 · FIREK0754Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
Provide properly sized and located linen or trash receptacles.
Correction field: Deficient, Provider has date of correction · 2023-03-292023-03-09 · 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 · 2023-03-2903 / 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
- BJERRUM, SHEILAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2020
- BORG, TERRYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/29/2025
- BOROVIAK, RICHARDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/25/2023
- BURKE, PHILIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/19/2022
- COOKSLEY, SUSANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/25/2023
- DUBAS, MICHELLEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/27/2025
- GIANNOU, CHERIIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/19/2022
- HUTSELL, TAMARAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/25/2023
- MCIVOR, TIMOTHYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/19/2022
- PINLEY, MARYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/29/2025
- SCHREIBER, BONNIEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/25/2023
- TEEGERSTROM, TIMOTHYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/13/2025
- BURKE, PHILIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/30/2024
- GIANNOU, CHERIIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/25/2023
- HUTSELL, TAMARAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/29/2025
- MCIVOR, TIMOTHYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/29/2025
- IENN, FAWNIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/18/2024
- JAMESON, DAVIDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/01/2021
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 hours4.30per resident day
RN hours0.59per resident day
Weekend nurse hours3.71per resident day
Staff turnover49.2%CMS reported field
06 / LOCAL RECORDS
Open the Nebraska ledger →Other published facilities nearby
No second facility in the same city met the directory rule.