Fonda Specialty Care
607 Queen Street, Fonda, IA 50540 · Non profit - Corporation · 46 certified beds · (712) 288-4441 Medicare & Medicaid certified
On the public record, this home looks stronger than most — but visit before you decide.
- a strong health-inspection score (4/5) — the hardest rating to game (though it’s ranked within its own state, not nationally)
- no harm-level citations in the current inspection record
- no federal fines or payment denials on record
- a high payroll-based staffing rating (5/5)
- lower-than-typical staff turnover (23% vs 45% nationally) — better care continuity
One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.
A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 4 of 5 |
| StaffingFrom payroll records (PBJ) | 5 of 5 |
| Quality measuresSelf-reported by the facility | 5 of 5 |
Location & what’s nearby
Open in Google Maps ↗ · Directions ↗ · Larger map ↗
Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.
Quality measures — how residents actually fare
| Overall quality measures | 5 of 5 |
| Long-stay residentspeople who live here | 5 of 5 |
Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.
Trend — is this home getting better or worse?
Over 2025-02 to 2026-06, this home’s CMS overall rating improved from 2 to 5 stars. From monthly CMS archive snapshots.
Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 8.6% | 17.1% | 15.4% | better |
| Long-stay residents who lose too much weight | 0.7% | 4.6% | 5.4% | better |
| Long-stay residents with a catheter left in their bladder | 0.0% | 1.5% | 0.9% | better |
| Long-stay residents with a urinary tract infection | 0.0% | 2.4% | 2.0% | better |
| Long-stay residents with depressive symptoms | 0.7% | 4.2% | 6.5% | better |
| Long-stay residents who were physically restrained | 0.0% | 0.2% | 0.1% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents with falls causing major injury | 1.9% | 3.8% | 3.3% | better |
| Long-stay residents whose ability to walk worsened | 13.6% | 16.6% | 16.1% | better |
| Long-stay residents on antianxiety or hypnotic medication | 35.0% | 20.8% | 18.9% | worse |
| Long-stay residents given the seasonal flu vaccine | 86.4% | 95.3% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 0.0% | 4.2% | 4.7% | check this* — see note marked star below the table |
| Long-stay residents with worsening bladder/bowel control | 18.0% | 25.6% | 21.2% | better |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 24.6% | 19.5% | 17.1% | worse |
* This home reported 0% on a measure where lower is better. That can mean genuinely excellent care — but because the number is self-reported, a zero can also mean the problem was not recorded. Weigh it against the inspection record above.
‡ On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.
§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.
CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.
Short-stay rehab — if you are coming here from a hospital
Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.
Therapy staffing: this home’s payroll records show 0.07 therapist hours per resident per day in 2026Q1 — more than 4% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 2% of this home’s weekday level — it runs therapy on weekdays, with essentially none at the weekend. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.
This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.
See every short-stay measure CMS publishes for this home
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 9.8%CMS range 6.0–16.4 | 10.7% | Oct 2022–Sep 2024 | no different from U.S. |
| Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 0.93 | 1.02 | Oct 2022–Sep 2024 | CMS makes no comparison for this measure |
From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.
Staffing
How full it usually is: this home is certified for 46 beds and averages 41.0 residents a day — about 89% occupied, or roughly 5 beds typically open. It runs fairly full. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.
Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.33 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.56 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.42 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.
Weekend coverage: total nurse staffing is 2.79 hrs/resident/day on weekends vs 3.55 on weekdays — 21% thinner on weekends — a notable drop. RN hours go from 0.62 to 0.42 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 23% is below the national median of 45%.
Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.
Inspection trend
Deficiencies are unchanged from the previous inspection. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.
Inspection deficiencies
State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.
Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.
14 citations, most serious first — scroll within the box to see all.
- Potential for harm · Dcited before2024-04-18 · tag F0658 — failed to meet professional standards of care — isolatedEnsure services provided by the nursing facility meet professional standards of quality.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, facility policy review, and staff interview, the facility failed to ensure residents received medications per the physicians orders for 1 of 3 residents (Resident #1). The facility reported a census of 42 residents. Findings include: According to the Minimum Data Set (MDS) assessment dated [DATE] Resident #1 scored 15 on the Brief Interview for Mental Status (BIMS) indicating no cognitive impairment. The resident had diagnoses including atrial fibrillation and heart failure. The resident received pain medication and had moderate pain. The Care Plan revised 7/1/23 identified the resident had altered respiratory status/difficulty breathing related to chronic reparatory failure with hypoxia. The interventions included oxygen (O2) via nasal prongs at 2 liters. The Progress Notes dated 12/27/23 at 1:08 p.m. documented an order received to obtain an influenza swab due to cough. The Progress Notes dated 12/27/23 at 3:58 p.m. documented the lab called with results. The resident tested positive…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2024-04-18 · tag F0755 — failed to provide safe pharmacy services — isolatedProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, staff and resident interview the facility failed to provide pharmaceutical services to meet the needs of 1 of 3 residents reviewed (Resident #1). The facility reported a census of 42 residents. Findings include: According to the Minimum Data Set (MDS) assessment dated [DATE] Resident #1 scored 15 on the Brief Interview for Mental Status (BIMS) indicating no cognitive impairment. The resident had diagnoses including atrial fibrillation and heart failure. The resident received pain medication and had moderate pain. The Care Plan revised 10/10/22 identified the resident had chronic pain related to cervical disc degeneration. The interventions included administering analgesic medications as ordered by my provider. Due to her diagnosis the resident had a low tolerance for pain, her acceptable level was 3. The resident had as needed (PRN) Tylenol available. She would continue to have a low pain tolerance and high pain rating. The Clinical Physician's Orders dated 4/18/24 documented the resident…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-12-21 · tag F0580 — failed to tell family and doctor about changes — isolatedImmediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, staff interview and policy review, the facility failed to notify the physician and the family of a change in condition for 1 of 3 residents reviewed (Resident #1). The facility reported a census of 43 residents. Findings include: According to the Minimum Data Set (MDS) assessment dated [DATE], Resident #1 entered the facility 12/7/23. The Medical Diagnosis page documented the resident's diagnoses included congenital stenosis of the aortic (heart) valve, abdominal aortic aneurysm (weakened area) without rupture, chronic obstructive pulmonary (lung) disease (COPD), obstructive sleep apnea, chronic kidney disease, wound of the front wall of the thorax (area between the neck and the abdomen), and methecillin resistant staphylococcus aureus (MRSA/infection). The Care Plan dated 12/7/23 identified the resident was a new admit to the facility. The interventions included staff would keep the resident and the resident's family updated on his condition and physician orders. The Care Plan identified…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-12-21 · tag F0684 — failed to provide proper treatment and quality of care — isolatedProvide appropriate treatment and care according to orders, resident’s preferences and goals.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview, the facility failed to provide adequate assessment and timely intervention when a resident had a change in mental status and pain level for 1 of 3 residents reviewed (Resident #1). The facility reported a census of 43 residents. Findings include: According to the Minimum Data Set (MDS) assessment dated [DATE], Resident #1 entered the facility 12/7/23. The Medical Diagnosis page documented the resident's diagnoses included congenital stenosis of the aortic (heart) valve, abdominal aortic aneurysm (weakened area) without rupture, chronic obstructive pulmonary (lung) disease (COPD), obstructive sleep apnea, chronic kidney disease, wound of the front wall of the thorax (area between the neck and the abdomen), and methecillin resistant staphylococcus aureus (MRSA/infection)). The Care Plan dated 12/7/23 identified the resident was a new admit to the facility. The interventions included staff would keep the resident and the resident's family updated on his condition and…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2023-11-20 · tag F0584 — failed to keep a safe, clean, comfortable home — patternHonor 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.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations and interviews the facility failed to maintain a home-like environment with the facility repeatedly having a strong offensive urine odor throughout the facility. The facility reported a census of 43 residents. Findings include: On 11/14/23 at 9:10 AM, entered facility through the front door, upon entrance in facility and during the walk thru the facility, a strong urine odor throughout the entire facility. On 11/15/23 from 7:30 AM to 4:30 PM, during several walkabouts throughout the halls of the facility, have smelled a strong urine odor throughout the facility, intermittently throughout the day. On 11/16/23 at 7:30AM, entered facility through front door, observation of staff stripping and cleaning beds and rooms, no strong urine odor noted in the hallways. On 11/20/23 at 8:49 AM, entered facility through the front door, lounge area and down long hallway with strong urine odor. Interview on 11/16/23 at 3:36 PM, the Ombudsman (state resident advocate) stated she was in the facility on 9/19/23 and the facility smelled very strongly of urine throughout the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-11-20 · tag F0622 — isolatedNot transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, staff interview and policy review the facility failed to communicate necessary information to the receiving facility when a resident was transferred to the hospital emergently due to change in condition for 1 out of 2 residents (Resident #44) reviewed for hospitalizations. The facility reported a census of 43 residents. Findings include: Resident #44 ' s MDS (Minimum Data Set) assessment dated [DATE] identified a BIMS (Brief Interview for Mental Status) score of 12, indicating moderately impaired cognition. The MDS identified Resident #44 required extensive assistance of two persons with bed mobility, and toileting use. The MDS identified Resident #44 was dependent with assistance of two persons with transfers. The MDS included diagnoses of end stage renal disease (kidney), methicillin- resistant staph infection, absence of left leg below the knee and obesity. A Progress Note dated 9/3/23 at 7:25 AM revealed during the night Resident #44 ' s skin became pale in color, and cool to…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-11-20 · tag F0641 — isolatedEnsure each resident receives an accurate assessment.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, staff interviews and policy review the facility failed to accurately complete an MDS (Minimum Data Set) assessment reflective of the resident status for 2 out of 12 residents (Resident #12 and #23).The facility reported a census of 43 residents. Findings include: 1. Resident #12 ' s MDS assessment dated [DATE] identified a BIMS (Brief Interview for Mental Status) score of 05, indicating severely impaired cognition. The MDS identified Resident #12 required maximal assistance with bed mobility, transfers and toileting use. The MDS included diagnoses of thyroid disorder, non-Alzheimer ' s dementia, parkinson ' s disease, anxiety disorder, and bipolar disorder. A Wound Evaluation dated 10/17/23 revealed Resident #12 had an unstageable (inability to see wound bed) pressure ulcer to the right and left heel. A Wound Evaluation dated 10/25/23 revealed Resident #12 had a stage 2 pressure ulcer to the intergluteal cleft (partial thickness loss of dermis presenting as a shallow open ulcer…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-11-20 · tag F0655 — isolatedCreate and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and staff interview, the facility failed to complete a baseline care plan that included the minimum healthcare information necessary to properly care for the immediate needs of a resident with a foley catheter (indwelling catheter to empty urine from the bladder) for one of three residents reviewed, (Resident #45). The facility reported a census of 43 residents. Findings include: Resident #45's Progress Notes documented the resident admitted on [DATE] at 1:46 PM and no catheter present. Observation on 11/14/23 at 11:14 AM, Resident #45 in bed with catheter bag attached to bed, dark colored urine in catheter bag. During interview on 11/15/23 at 2:30 PM, Resident #22 stated she had a catheter. Review of Resident #45's record of bladder elimination on 11/16/23, documented an indwelling catheter 11/9/23 to current date of 11/16/23. Review of Resident #45's Physician Orders lack an order for a foley catheter. Review of Resident #45's Hospice Plan of Care dated 11/8/23, documented…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-11-20 · tag F0656 — failed to write and follow a full care plan — isolatedDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, staff interview and policy review the facility failed to develop a care plan to address risk factors and interventions related to risk for skin impairment and pressure ulcers for 1 out of 12 residents (Resident #12) reviewed for comprehensive care plans.The facility reported a census of 43 residents. Findings include: Resident #12 ' s MDS (Minimum Data Set) assessment dated [DATE] identified a BIMS (Brief Interview for Mental Status) score of 09, indicating moderately impaired cognition. The MDS identified Resident #12 required extensive assistance of two persons with bed mobility, transfers and toileting use. The MDS included diagnoses of thyroid disorder, non-Alzheimer ' s dementia, parkinson ' s disease, anxiety disorder, and bipolar disorder. The MDS identified Resident #12 was at risk for developing pressure ulcers. The MDS documented Resident #12 had a pressure reducing device for the chair and bed. A Wound Evaluation dated 10/17/23 revealed Resident #12 had new unstageable…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-11-20 · tag F0657 — failed to keep the care plan current — isolatedDevelop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review, resident interview and policy review the facility failed to update the resident's care plan after a resident attempted to leave the facility for 1 of 12 residents reviewed (Resident #22). The facility reported a census of 43 residents. Findings include: The Minimum Data Set (MDS) assessment for Resident #22, dated 10/19/23, included diagnosis of depression and heart failure. The MDS documented the resident was independent with transfers, had ability to walk and propel self in a wheelchair at least 150 feet independently, wandering behavior not exhibited, and had a Brief Interview for Mental Status (BIMS) score of 13, indicating mild cognitive impairment for decision-making. Observation on 11/14/23 at 1:03 PM, Resident #22 propelled self in a wheelchair from the dining room to his room. Resident #22's nursing Progress Notes documented: 1.11/11/2023 at 1:42 AM- Has been attempting to leave building for past 30 min. Staff standing in front of him, explaining he cannot go outside due to cold and he has no coat on. Stating he wants to go home. He is…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2023-11-20 · tag F0658 — failed to meet professional standards of care — isolatedEnsure services provided by the nursing facility meet professional standards of quality.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and staff interview, the facility failed to meet professional standards of quality by not having a physician's order for a resident admitted with a foley catheter (indwelling catheter to empty the bladder of urine) for one of twelve residents reviewed, (Resident #45). The facility reported a census of 43 residents. Findings include: Resident #45's Progress Notes documented the resident admitted on [DATE] at 1:46 PM and no catheter present. Observation on 11/14/23 at 11:14 AM, Resident #45 in bed with catheter bag attached to bed, dark colored urine in catheter bag. During interview on 11/15/23 at 2:30 PM, Resident #22 stated she had a catheter. Review of Resident #45's record of bladder elimination on 11/16/23, documented an indwelling catheter 11/9/23 to current date of 11/16/23. Review of Resident #45's Physician Orders lacked an order for a foley catheter. Review of Resident #45's Hospice Plan of Care dated 11/8/23, documented supplies of foley catheter. Resident #45's Baseline Care Plan…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-11-20 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolatedProvide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, staff interview, and policy review the facility failed to provide appropriate incontinence care for one of two residents reviewed, (Resident #27). The facility reported a census of 43 residents. Findings include: The Minimum Data Set (MDS) assessment for Resident #27 dated 8/24/2023, included diagnoses of malignant neoplasm of brain (brain tumor that has spread) and mild intellectual disabilities. The MDS documented the resident required extensive assistance of 2 staff for bed mobility, transfers, and toilet use and was always incontinent of bladder and bowel. The MDS documented a Brief Interview for Mental Status (BIMS) score of 5, indicating severe cognitive impairment for decision-making. Observation on 11/16/23 at 8:53 AM, Staff B, Certified Nurse Aide (CNA) and Staff D, CNA washed hands, applied gloves, and with Resident #27 lying in bed, Staff B lowered the wet brief and cleansed the front perineal area. Staff B and Staff D, assisted the resident to turn to the left side. With bowel movement visible on the resident's buttocks, Staff B cleansed the right…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-11-20 · tag F0880 — failed to prevent and control infections — isolatedProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations, record review, policy review, and staff interview the facility failed to complete proper hand hygiene during cares for two of two residents reviewed (Resident #27, #34) and to maintain standard precaution for infection control. The facility reported a census of 43 residents. Findings include: 1. The Minimum Data Set (MDS) assessment for Resident #27 dated 8/24/2023, included diagnoses of malignant neoplasm of brain (brain tumor that has spread) and mild intellectual disabilities. The MDS documented the resident required extensive assistance of 2 staff for bed mobility, transfers, and toilet use and was always incontinent of bladder and bowel. The MDS documented a Brief Interview for Mental Status (BIMS) score of 5, indicating severe cognitive impairment for decision-making. Observation on 11/15/23 at 8:41 AM, Staff B, Certified Nurse Aide and Staff C, Non-Certified Aide returned Resident #27 to his room in a shower chair. With a bath blanket spread on the bed, Staff B and Staff C transferred Resident #27 to bed with a full body lift and the sling that was…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Ecited before2023-08-08 · tag F0755 — failed to provide safe pharmacy services — patternProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on facility record review, staff interviews, and policy review, the facility failed to ensure drug records are in order and accurate. The facility also failed to implement a system to consistently and accurately reconcile controlled medications. The facility reported a census of 41 residents. Findings include: A facility form titled Control Drugs- Count Record labeled for Medication Cart A documented by signing the form, staff are acknowledging they counted the controlled drugs on hand and have found that the quantity of each medication counted is in agreement with the quantity stated on the Controlled Drug Administration Record. The record required documentation of the date, shift, Nurse on signature and the Nurse off signature. The document directed staff to record any discrepancies or pertinent notes in the comments section. Review of the count record for medication cart A revealed the lack of staff signatures, indicating reconciliation of controlled medications for medication cart A did not occur on the following months, dates and shifts: March 2023: 3/27- 2 PM 3/28- 6 AM…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.
- Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
- Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
- State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Fines & penalties
No federal fines in the current CMS record.
Part of a chain
This home belongs to CARE INITIATIVES — 43 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →
| Rating | This home | Chain avg | |
|---|---|---|---|
| Overall | 5 of 5 | 2.9 | +2.1 vs chain |
| Health inspection | 4 of 5 | 2.5 | +1.5 vs chain |
| Staffing | 5 of 5 | 3.7 | +1.3 vs chain |
| Quality measures | 5 of 5 | 3.7 | +1.3 vs chain |
The other 42 homes this chain runs (chain average 2.9★, per CMS)
Showing 40 of 42; lowest-rated first.
A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.
Who owns this facility
| Owner / manager | Type | Role | Share | Since |
|---|---|---|---|---|
| CARE INITIATIVES | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% | since 09/01/2011 |
| COMPUTERSHARE CORPORATE TRUST COMPANY, NA | Organization | 5% OR GREATER MORTGAGE INTEREST; ADP OF THE SNF | — | since 01/01/2025 |
| BEAL, MICHAEL | Individual | CORPORATE DIRECTOR; CORPORATE OFFICER | — | since 06/01/2020 |
| BOWEN, LANE | Individual | CORPORATE DIRECTOR | — | since 01/01/2021 |
| CAROTHERS, MARY JANE | Individual | CORPORATE DIRECTOR | — | since 01/01/2023 |
| CHILDS, KEVIN | Individual | CORPORATE DIRECTOR | — | since 04/01/2023 |
| CORLESS, PETER | Individual | CORPORATE DIRECTOR | — | since 01/01/2025 |
| KREIN, KEITH | Individual | CORPORATE DIRECTOR | — | since 06/29/2022 |
| RUST, ELIZABETH | Individual | CORPORATE DIRECTOR | — | since 01/01/2023 |
| STURM, DENISE | Individual | CORPORATE DIRECTOR | — | since 01/01/2021 |
| UPMEYER, LINDA | Individual | CORPORATE DIRECTOR | — | since 06/29/2022 |
| DIXON, DAVID | Individual | CORPORATE OFFICER | — | since 06/01/2016 |
| DRAKE, EMILY | Individual | CORPORATE OFFICER | — | since 01/04/2023 |
| GILYARD, TANYA | Individual | CORPORATE OFFICER | — | since 05/23/2025 |
| KUHN, JERAMY | Individual | CORPORATE OFFICER | — | since 06/25/2008 |
| MCDYER, JESSICA | Individual | CORPORATE OFFICER | — | since 02/22/2023 |
| VOLM, JOHANNA | Individual | CORPORATE OFFICER | — | since 01/01/2021 |
| BOEVE, DESTINY | Individual | OPERATIONAL/MANAGERIAL CONTROL | — | since 01/01/2024 |
| DUGDALE, EMILY | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 04/06/2024 |
| EPPERSON, FAITH | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 01/13/2025 |
| WHYMS, BRIAN | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 01/01/2024 |
CMS files one row per role, so the 26 rows in the source record cover these 21 parties — each is shown once here with every role it holds. Nothing is omitted.
2 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.
Follow the money — this home’s finances
Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.
About 76% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $370K paid to related parties — landlords or management companies under common ownership — equal to about 10% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals.
Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.
Cost & finances
Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.
What families pay in IA
This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Iowa Medicaid page.
Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.
Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 165312. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2026-03-19, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →
Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →
Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.