Pillar Of Cedar Valley
Inspection Findings
F-Tag F0600
F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
at someone. As the CNAs started running toward the person and Resident #1, the other resident struck Resident #1 in the right ear. The staff separated the residents and escorted the other resident (Resident #2) to her room. Resident #2 gave no reason for hitting Resident #1.The Progress Notes dated 12/9/25 at 7:14 AM Resident #1 sat at a table with another resident. Resident #2 saw Resident #1 and approached him,
she called him a name and hit him on the back of the head. Resident #1 then hit Resident #2 in her right hip. The staff separated both residents.3. Resident #5 MDS assessment dated [DATE REDACTED] documented a BIMS score of 14, indicating intact cognition. The MDS documented the resident had verbal behavior symptoms directed toward others that occurred 1 to 3 days during the look back period. The MDS included diagnoses of anxiety and bipolar disorder. The Progress Notes dated 12/15/25 at 10:35 AM indicated Resident #5 and
the Social Worker met following an altercation between Resident #5 and Resident #2 in the common area.
The staff witnessed Resident #2 approach Resident #5 from behind and, without provocation, struck Resident #5 on the shoulder and back of the head. In addition, the staff reported Resident #2 stated, I am going to take a big sh*t and put it on you. Staff immediately intervened, separated the residents, and redirected Resident #2 to her room to de-escalate. Resident #5 reported as she sat in the common area, Resident #2 struck her from behind three times. Resident #5 stated she felt fine physically but expressed emotional distress related to feeling Resident #2 didn't like her. Resident #5 Progress Notes lacked documentation of the resident-to-resident altercation from 12/10/25.
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Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
12/23/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pillar of Cedar Valley
1410 West Dunkerton Road Waterloo, IA 50703
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0609
F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
injuries of unknown sourceReporting determinations will be made promptly and in consultation with facility leadership as appropriate.Review of the facility policy titled Skilled and Senior Living Abuse, Neglect and Exploitation Policy and Procedure dated October 2022 directed any employee who suspects an alleged violation immediately notify the Administrator. The Administrator notifies the appropriate state agency of allegations of neglect, exploitation, misappropriation of resident property or mistreatment that do not result
in serious bodily injury in no later than 24-hours. Allegations of abuse resulting in serious bodily injury must report immediately, but not later than 2 hours after the allegation is made. Initial reports must include sufficient information to describe the alleged violation with as much information as possible based on the knowledge at the time of the submission and indicate how resident(s) are being protected. The results of all investigations are reported to the Administrator and to the appropriate state agency as required by state law and/or within five (5) working days of the alleged violation.
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
12/23/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pillar of Cedar Valley
1410 West Dunkerton Road Waterloo, IA 50703
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0610
F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
the incident on 12/10/25 between Resident #1 and Resident # 5. Review of the facility policy titled Skilled and Senior Living Abuse, Neglect and Exploitation Policy and Procedure dated October 2022 directed any employee to take appropriate steps to ensure that all alleged violations of the federal and state laws which involve abuse are reported immediately to the administrator of the community. The community investigates each such alleged violation thoroughly and reports the results of all investigations to the administrator, as well as to the State agencies, as required by State and Federal law.
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If continuation sheet
Pillar of Cedar Valley in Waterloo, IA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Waterloo, IA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Pillar of Cedar Valley or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.