01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-08-12 | 6 | 2025-08-12 | 7 |
| Cycle 2 | 2024-09-04 | 6 | 2024-09-04 | 3 |
| Cycle 3 | 2023-10-05 | 2 | 2023-10-05 | 5 |
CMS CCN 2852492026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
St. Joseph'S Villa, Inc.
927 Seventh Street · David City, NE 68632 · Butler County
Certified beds58CMS provider file
Recent citation rows29current CMS citation release
Penalty rows2current 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
29 rows in the current release
1 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.
2025-08-12 · 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 · 2025-08-292025-08-12 · 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 · 2025-08-292025-08-12 · 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 · 2025-08-292025-08-12 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2025-08-292025-08-12 · 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 · 2025-08-292025-08-12 · 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 · 2025-08-29 · complaint2025-08-12 · FIREK0211Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Correction field: Deficient, Provider has date of correction · 2025-08-292025-08-12 · FIREK0291Severity F · widespread; 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 · 2025-08-292025-08-12 · FIREK0293Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Have properly located and lighted "Exit" signs.
Correction field: Deficient, Provider has date of correction · 2025-08-292025-08-12 · 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 · 2025-08-292025-08-12 · 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 · 2025-08-292025-08-12 · FIREK0363Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2025-08-292025-08-12 · FIREK0374Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Correction field: Deficient, Provider has date of correction · 2025-08-292024-10-24 · HEALTHF0678Severity J · isolated immediate jeopardy
Quality of Life and Care Deficiencies
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
Correction field: Deficient, Provider has date of correction · 2024-11-18 · complaint2024-09-26 · 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 · 2024-10-17 · complaint2024-09-04 · 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 · 2024-09-20 · complaint2024-09-04 · HEALTHF0645Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
PASARR screening for Mental disorders or Intellectual Disabilities
Correction field: Deficient, Provider has date of correction · 2024-09-20 · complaint2024-09-04 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2024-09-20 · complaint2024-09-04 · 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 · 2024-09-20 · complaint2024-09-04 · FIREK0321Severity F · widespread; 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 · 2024-09-202024-09-04 · FIREK0700Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Meet requirements for operating features, such as evacuation plans, fire drills, smoking regulations, draperies, decorations and the inspection, testing and maintenance of fire doors.
Correction field: Deficient, Provider has date of correction · 2024-09-202024-09-04 · FIREK0900Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Meet Health Care Facilities Code mechanical requirements.
Correction field: Deficient, Provider has date of correction · 2024-09-202023-10-05 · 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 · 2023-10-272023-10-05 · 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 · 2023-10-27 · 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 |
|---|---|---|---|
| 2024-09-26 | Fine | $27,115 | 0 |
| 2024-09-26 | Payment Denial | $0 | 3 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- ROSS, MATTHEWIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 04/17/2025
- PYTLIK, FRANCESIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 07/01/2003
- KOBZA, LAURAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/08/2015
- ADAMY, MICHAELIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/14/2017
- BIRKEL, SUSANIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/12/2021
- HOEFT, JACKIEIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/12/2021
- JAKUB, JEANNEIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/12/2021
- MEISTER, GARYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/01/2023
- MORAVEC, ALLENIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/13/2016
- POLACEK, KENNETHIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/13/2016
- PYTLIK, FRANCESIndividual · CORPORATE OFFICERNOT APPLICABLE · since 07/01/2003
- RURAL HEALTH DEVELOPMENT INC.Organization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/14/2008
- DARO, ROBERTIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/27/2019
- ROSS, MATTHEWIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/14/2008
- ROSS, RONIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/14/2008
- SHANNON, CHRISTINAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/17/2025
- RURAL HEALTH DEVELOPMENT INC.Organization · ADP OF THE SNFNOT APPLICABLE · since 04/25/2025
- DARO, ROBERTIndividual · ADP OF THE SNFNOT APPLICABLE · since 05/21/2025
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 hours3.79per resident day
RN hours0.42per resident day
Weekend nurse hours3.27per resident day
Staff turnover52.9%CMS reported field
06 / LOCAL RECORDS
Open the David City ledger →