01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-10-02 | 7 | 2025-10-02 | 5 |
| Cycle 2 | 2024-09-26 | 19 | 2024-09-26 | 2 |
| Cycle 3 | 2024-01-03 | 15 | 2024-01-03 | 3 |
CMS CCN 1650492026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Ridgecrest Village
4130 Northwest Boulevard · Davenport, IA 52806 · Scott County
Certified beds137CMS provider file
Recent citation rows51current CMS citation release
Penalty rows4current 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
51 rows in the current release
3 rows carry G–L scope/severity codes; 2 carry J–L. 11 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-12-10 · 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 · 2026-01-15 · complaint2025-10-02 · HEALTHF0600Severity G · isolated actual 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 · 2025-10-27 · complaint2025-10-02 · HEALTHF0698Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2025-10-27 · complaint2025-10-02 · 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 · 2025-10-272025-10-02 · 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 · 2025-10-272025-10-02 · HEALTHF0868Severity F · widespread; potential for more than minimal harm
Administration Deficiencies
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Correction field: Deficient, Provider has date of correction · 2025-10-272025-10-02 · 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 · 2025-10-272025-10-02 · 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 · 2025-12-102025-10-02 · 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 · 2025-12-102025-10-02 · 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 · 2025-12-122025-10-02 · FIREK0914Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Correction field: Deficient, Provider has date of correction · 2025-12-052025-10-02 · 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 · 2025-11-262025-03-19 · 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 · 2025-04-18 · complaint2024-09-26 · 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 · 2024-10-242024-09-26 · HEALTHF0636Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Correction field: Deficient, Provider has date of correction · 2024-10-242024-09-26 · HEALTHF0638Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Assure that each resident’s assessment is updated at least once every 3 months.
Correction field: Deficient, Provider has date of correction · 2024-10-242024-09-26 · HEALTHF0640Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
Correction field: Deficient, Provider has date of correction · 2024-10-242024-09-26 · 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 · 2024-10-242024-09-26 · 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 · 2024-10-242024-09-26 · 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 · 2024-10-242024-09-26 · 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 · 2024-10-242024-09-26 · HEALTHF0757Severity J · isolated immediate jeopardy
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2024-10-142024-09-26 · 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 · 2024-10-242024-09-26 · 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 · 2024-10-2403 / 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 |
|---|---|---|---|
| 2025-10-02 | Fine | $50,986 | 0 |
| 2025-10-02 | Payment Denial | $0 | 42 |
| 2024-09-26 | Fine | $26,501 | 0 |
| 2024-08-08 | Fine | $41,399 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- ARP, STEPHANIEIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 10/20/2014
- FILLMORE, BRENTIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 03/18/2013
- MCDONALD, PATRICKIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 03/07/2022
- ANDERSON, JOHNIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2015
- ANDREWS, JAMESIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2021
- BEADERSTADT, MICHAELIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2021
- BOETTCHER, DAWNIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- BOWLES-EDWARDS, MARTHAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2013
- BREUMMER, DIANAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2021
- CONGDON, RALPHIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2016
- DORHMANN, KRISTINEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2020
- ENGSTROM, ERICIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2017
- KRIEG, CHRISIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2018
- MCAFOOS, PATRICIAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2014
- MCDONALD, ELLIOTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- MCDONALD, PATRICKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/07/2022
- TIEDJE, JIMIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2017
- WAGNER, JOHNIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2021
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 hours3.69per resident day
RN hours0.95per resident day
Weekend nurse hours3.43per resident day
Staff turnover97.4%CMS reported field
06 / LOCAL RECORDS
Open the Davenport ledger →Other published facilities nearby
Davenport Lutheran Home98 beds · CMS overall 2/534 citation rowsGood 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 rows