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County of Bremer

No longer in CMS list This agency is not in CMS's current list of Medicare-certified home health agencies (file dated 2026-05-27), but it has federal inspection records. It may have closed, changed ownership, or changed its certification number. Address shown is from its inspection records.
403 3RD Street SE, Waverly, IA 50677
CMS Certification Number 167237
13deficiencies since 2018
0serious
1inspections
n/aCMS quality stars
Data from CMS inspection reports (Form 2567), 2018-01-02 to 2026-10-15, downloaded 2026-10-20; CMS agency list file dated 2026-05-27. What the labels mean

Inspection 2018-10-31

· Recertification · 13 deficiencies · CMS source report (PDF)
Moderate Hha Comprehensive Assessment In Disaster

The home health agency failed to ensure the clinical record included a copy of the patient's individualized emergency plan developed as part of the comprehensive assessment for 6 of 7 sampled patients (Patients #1, #2, #3, #4, #5 and #7) with a record review which included a comprehensive…

Source: CMS Form 2567, inspection 2018-10-31, tag E0017 · view on CMS
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Moderate Homebound Hha/Hospice Inform Ep Officials

The agency failed to ensure the development of a procedure to inform State and local officials of homebound patients in need of evacuation due to an emergency situation.

Source: CMS Form 2567, inspection 2018-10-31, tag E0019 · view on CMS
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Moderate Hha- Procedures For Follow Up Staff/Pts.

The agency failed to have a policy and procedure to notify State and local officials of any on-duty staff or patients the agency was unable to contact.

Source: CMS Form 2567, inspection 2018-10-31, tag E0021 · view on CMS
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Moderate Ep Training And Testing

The agency failed to ensure all contracted employees received training in the agency's emergency preparedness policies and procedures.

Source: CMS Form 2567, inspection 2018-10-31, tag E0036 · view on CMS
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Minor Health, Psychosocial, Functional, Cognition

The agency failed to ensure accurate and thorough completion of all pertinent components of comprehensive assessments for 5 of 7 sampled patients (Patients #1, #2, #3, #4 and #6).

Source: CMS Form 2567, inspection 2018-10-31, tag G0528 · view on CMS
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Minor A Review Of All Current Medications

The agency failed to complete a drug regimen review of all the patient's current medications with the completion of each comprehensive assessment for 2 of 3 sampled patients (Patients #1 and #3) with a home visit observation.

Source: CMS Form 2567, inspection 2018-10-31, tag G0536 · view on CMS
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Minor Within 48 Hours Of The Patient'S Return

The agency failed to ensure accurate completion of all pertinent components of the resumption of care comprehensive assessment within 48 hours of the agency's knowledge of return home from an inpatient facility for 1 of 3 sampled patients requiring a Resumption of Care Assessment (Patient #6).

Source: CMS Form 2567, inspection 2018-10-31, tag G0548 · view on CMS
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Minor Plan Of Care Must Include The Following

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all supplies and equipment used by the patient to meet his/her needs, an accurate list of the patient's current medications and physician orders for 2 of 3 sampled patients with home visits…

Source: CMS Form 2567, inspection 2018-10-31, tag G0574 · view on CMS
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Minor All Orders Recorded In Plan Of Care

The agency failed to update the Plan of Care with all new physician orders for 6 of 6 sampled patients with interim orders.

Source: CMS Form 2567, inspection 2018-10-31, tag G0576 · view on CMS
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Minor Treatments And Therapy Services

The agency failed to provide the patient and caregiver with a copy of written instructions outlining any treatments to be administered by the agency personnel and personnel acting on behalf of the agency, including therapy services, for 3 of 3 sampled patient's with home visits (Patient #1, #2 and…

Source: CMS Form 2567, inspection 2018-10-31, tag G0618 · view on CMS
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Minor Other Pertinent Instructions

The agency failed to provide the patient and caregiver with a copy of written instructions outlining any other pertinent instructions related to the patient's care and treatments that the home health agency will provide, specific to the patient's care needs for 3 of 3 sampled patient's with home…

Source: CMS Form 2567, inspection 2018-10-31, tag G0620 · view on CMS
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Minor Provide Services In The Plan Of Care

The agency failed to ensure skilled professionals provided care as ordered by the physician in the Plan of Care for 4 of 7 sampled patients (Patients #1, #3, #6 and #7).

Source: CMS Form 2567, inspection 2018-10-31, tag G0710 · view on CMS
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Minor Required Items In Clinical Record

The agency failed to ensure all interim physician orders were signed by a physician for 2 of 7 sampled patients (Patients #6 and #7).

Source: CMS Form 2567, inspection 2018-10-31, tag G1012 · view on CMS
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