Map showing the location of Harmony Waterloo in Waterloo, Iowa
201 West Ridgeway Avenue, Waterloo, IA, 50701

Overall Score

CMS Five-Star Quality Rating
3/5AverageCMS Five-Star overall rating
  1. Much below average
  2. Below average
  3. Average
  4. Above average
  5. Much above average

Where it ranks

  • IowaAbove only 37% of peers388 rated homes · average 3.1★
  • Black Hawk CountyAbove only 27% of peers12 rated homes · average 3.2★
  • United StatesAbove only 41% of peers14,574 rated homes · average 3.0★

How the rating is built

  • Health inspectionsStarting point2★−0.9 vs IA avg
  • StaffingCan add or remove a star3★−0.5 vs IA avg
  • Quality measuresCan add or remove a star5★+1.6 vs IA avg

CMS starts from the health inspection stars, then adds or subtracts a star for staffing and for quality measures. Stars are assigned relative to other facilities in the same state.

  • Abuse citation flagCMS shows an abuse icon: inspectors cited the facility for abuse that led to harm within the past year, or for abuse that could have led to harm in each of the last two years.

Ratings & measures

Tap a row to see what it means
Health inspection ratingCMS stars from the last three on-site inspection cycles2★Above only 19% of peersIA avg2.9★U.S. avg2.8★
What is health inspection rating?

Stars assigned from the last three standard surveys and every complaint investigation in that window, weighted toward the most recent and the most serious findings. CMS assigns these stars relative to other facilities in the same state.

Why it matters

It carries the most weight in the overall rating and is the only domain based on what trained inspectors saw on site rather than what the facility reported.

Staffing ratingCMS stars from payroll-reported hours and turnover3★Above only 19% of peersIA avg3.5★U.S. avg2.9★
What is staffing rating?

Nurse and aide hours per resident day from payroll records CMS collects every quarter, adjusted for how much care residents need, plus staff turnover and weekend coverage.

Why it matters

More hours and lower turnover are the strongest predictors of fewer falls, pressure sores, and avoidable hospital stays.

Quality measures ratingCMS stars from clinical outcomes and resident assessments5★Above 78% of peersIA avg3.4★U.S. avg3.6★
What is quality measures rating?

Clinical outcomes from resident assessments and Medicare claims: falls with injury, pressure ulcers, hospitalizations, antipsychotic use, and more, for both short-stay and long-stay residents.

Why it matters

It shows whether care is working, but part of it comes from the facility’s own assessments, so read it alongside the inspection results.

Total nurse hoursPer resident per day, all nursing staff3.51hrsAbove only 36% of peersIA avg3.83Benchmark4.10
What is total nurse hours?

All licensed nurse and aide hours worked, divided by the number of residents, on an average day. Reported from payroll, not self-reported.

Why it matters

Federal research links 4.1 hours a day to fewer avoidable harms. Below about 3 hours, residents wait longer for help with basics like toileting and repositioning.

RN hoursPer resident per day, registered nurses only0.63hrsAbove only 42% of peersIA avg0.73Benchmark0.75
What is rn hours?

Registered nurse hours only. RNs assess residents, manage medications, and catch changes in condition; LPNs and aides deliver most hands-on care.

Why it matters

RN coverage is the staffing measure most tied to fewer hospital transfers and infections, and it is where thinly staffed facilities cut first.

Nursing staff turnoverShare of nursing staff who left within a year · lower is better44%Above only 44% of peersIA avg44%RN turnover33%
What is nursing staff turnover?

The share of nursing staff who left within the past year, from the same payroll data.

Why it matters

High turnover means residents are cared for by people who do not know them, and it is one of the strongest predictors of inspection problems.

Fines in the last three yearsCivil money penalties imposed by CMS · lower is better$146,830Above only 2% of peersIA avg$21,037Fines · denials1 · 0
What is fines in the last three years?

Civil money penalties CMS imposed after serious or uncorrected deficiencies, and denials of Medicare payment for new admissions.

Why it matters

Penalties follow the worst inspection findings. A recent fine is the clearest sign that inspectors found real harm.

Inspection history

Last three inspection cycles
23citations
9inspection dates
0actual harm (G–I)
1immediate jeopardy (J–L)
Oct 30, 2025most recent

Citations by monthFeb 2023 – Oct 2025

  • No actual harm (D–F)
  • Actual harm (G–I)
  • Immediate jeopardy (J–L)
  • $Fine or payment denial

Click a month or a year to filter the findings below. Arrow keys move between months; Esc clears.

Oct 30, 20251 citationCycle 1worst J · immediate jeopardy$146,830
  1. F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Freedom from Abuse, Neglect, and ExploitationJ · isolatedCorrected Nov 12, 2025
May 1, 20251 citationCycle 1worst D · no actual harm
  1. F602Protect each resident from the wrongful use of the resident's belongings or money.Freedom from Abuse, Neglect, and ExploitationD · isolatedCorrected May 8, 2025
Jan 15, 20255 citationsCycle 1worst D · no actual harm
  1. F658Ensure services provided by the nursing facility meet professional standards of quality.Resident Assessment and Care PlanningD · isolatedCorrected Feb 7, 2025
  2. F550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.Resident RightsD · isolatedCorrected Feb 7, 2025
  3. F584Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.Resident RightsD · isolatedCorrected Feb 7, 2025
  4. F641Ensure each resident receives an accurate assessment.Resident Assessment and Care PlanningD · isolatedCorrected Feb 10, 2025
  5. F645PASARR screening for Mental disorders or Intellectual DisabilitiesResident Assessment and Care PlanningD · isolatedCorrected Feb 7, 2025
Nov 21, 20241 citationCycle 2worst D · no actual harm
  1. Provide appropriate treatment and care according to orders, resident’s preferences and goals.Quality of Life and CareD · isolatedCorrected Nov 22, 2024
Aug 8, 20242 citationsCycle 2worst E · no actual harm
  1. F550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.Resident RightsE · patternCorrected Aug 22, 2024
  2. F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.Pharmacy ServiceD · isolatedCorrected Aug 22, 2024
May 22, 20244 citationsCycle 2worst D · no actual harm
  1. F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Nutrition and DietaryD · isolatedCorrected Jun 12, 2024
  2. F584Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.Resident RightsD · isolatedCorrected Jun 12, 2024
  3. F677Provide care and assistance to perform activities of daily living for any resident who is unable.Quality of Life and CareD · isolatedCorrected Jun 12, 2024
  4. F695Provide safe and appropriate respiratory care for a resident when needed.Quality of Life and CareD · isolatedCorrected Jun 12, 2024
Oct 18, 20231 citationCycle 3worst E · no actual harm
  1. F584Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.Resident RightsE · patternCorrected Nov 9, 2023
Apr 13, 20231 citationCycle 3worst D · no actual harm
  1. F759Ensure medication error rates are not 5 percent or greater.Pharmacy ServiceD · isolatedCorrected Apr 24, 2023
Feb 16, 20237 citationsCycle 3worst D · no actual harm
  1. F690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.Quality of Life and CareD · isolatedCorrected Mar 13, 2023
  2. F791Provide or obtain dental services for each resident.Quality of Life and CareD · isolatedCorrected Mar 13, 2023
  3. Provide appropriate treatment and care according to orders, resident’s preferences and goals.Quality of Life and CareD · isolatedCorrected Mar 13, 2023
  4. F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.Resident Assessment and Care PlanningD · isolatedCorrected Mar 13, 2023
  5. F760Ensure that residents are free from significant medication errors.Pharmacy ServiceD · isolatedCorrected Mar 13, 2023
  6. F880Provide and implement an infection prevention and control program.Infection ControlD · isolatedCorrected Mar 13, 2023
  7. F658Ensure services provided by the nursing facility meet professional standards of quality.Resident Assessment and Care PlanningD · isolatedCorrected Mar 13, 2023

Staffing

From quarterly payroll reports

Hours per resident per day

  • All nursing staffRNs, LPNs and aides combined3.51hrsAbove only 36% of peers−0.32 vs IA avg
  • Registered nursesRN hours only0.63hrsAbove only 42% of peers−0.10 vs IA avg
  • Licensed practical nursesLPN hours0.62hrs
  • Nurse aidesCNA hours2.26hrs
  • Weekend nursingAll staff on Saturdays and Sundays3.17hrs
  • Iowa average
  • Research benchmark (4.10 total, 0.75 RN)

Turnover & capacity

  • Nursing staff turnoverShare who left within a year · lower is better44%Above only 44% of peersIA avg 44%
  • RN turnoverRegistered nurses only33%Not ranked by CMS
  • Administrators who leftIn the past year1Leadership changed
  • Occupancy88 certified beds · ~72 residents a day82%Above only 48% of peersIA avg 81%

Fines & penalties

Roughly the past three years

Enforcement summary

  • $146,830In fines
  • 1Fine
  • 0Payment denials
  • $21,037IA avg in fines
Above only 2% of peersFewer fines than 2% of rated homes in Iowa

Actions on record

  1. Oct 30, 2025Civil money penalty$146,830

Ownership

As filed with CMS

Structure

Ownership type
For profit - Limited Liability company
Chain
Legacy Healthcare90 facilities in the chain3.0★ chain average
Certification
Medicare and Medicaid
Location type
Urban
Ownership change
None in the last 12 months

People and entities on file

Direct owners (5%+)
  • Doros Generation Trust U/A/D 1/3/12
  • Gpn Fam Tr Ua 04282008
  • Oakway Operations LLC
Operational or managerial control
  • Legacy Healthcare Financial Services LLC
Corporate officers
  • Menachem Shabat
Managing employees
  • Justin Knapp

Person Organization

Sources & notes

Public data, updated quarterly

Data sources

  • CMS Care Compare · Provider InformationStar ratings, staffing hours, turnover, penalties and flags · processed February 2026.
  • CMS Health CitationsEvery deficiency from the last three inspection cycles, with scope, severity and inspection cycle.
  • CMS Penalties and Ownership filesCivil money penalties, payment denials, and the owners and managers on file.

Notes

  • CMS Certification Number 165034 · 201 West Ridgeway Avenue, Waterloo, IA, 50701.
  • Percentiles compare this facility with every rated nursing home in Iowa and Black Hawk County. Turnover and fines are inverted so a high percentile is always good.
  • This is an informational summary of public data, not medical, legal, or placement advice. Facilities cannot pay to change it; a facility that believes a record is wrong can dispute it with CMS.

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