The Cottages

Location & what’s nearby

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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

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.

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.

55.8% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 114 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 64.4% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 90 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.

Therapy staffing: this home’s payroll records show 0.23 therapist hours per resident per day in 2026Q1 — more than 29% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 6% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. 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.

Staffing

How full it usually is: this home is certified for 100 beds and averages 87.0 residents a day — about 87% occupied, or roughly 13 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 4.18 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.92 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.63 is at or above 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 3.89 hrs/resident/day on weekends vs 4.30 on weekdays — 10% thinner on weekends. RN hours go from 1.04 to 0.61 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 50% is about the same as the national median of 45%. 1 administrator has left in the past year.

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 more than at the previous inspection — worsening. 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.

23 citations, most serious first. The 13 most serious are shown; the remaining 10 are one tap away and print in full.

• Immediate jeopardy · Kcited before2025-02-24 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — pattern
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  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, clinical record review, policy review, and staff interviews, the facility failed to provide additional interventions, and supervision after Resident#1 displayed exit seeking behaviors. The facility also failed to secured the facility's exterior doors so that cognitively impaired residents could not leave the building without staff knowledge. This resulted in Resident #1 leaving the building without the staff's knowledge in 29 degree Fahrenheit weather. The staff only realized Resident #1 had left the building when a visitor found Resident #1 lying on the ground. This failure resulted in Immediate Jeopardy to the health, safety, and security of the resident and for 3 of 3 additional cognitively impaired, independently mobile residents with access to this door (Residents #5, #6, #7). The facility identified a census of 93 residents. The State Agency (SA) informed the facility of the Immediate Jeopardy (IJ) on 2/19/25 at 3:35 p.m. The IJ began on 1/26/25, the day Resident #1 left the facility…

  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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2026-06-04 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  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, resident interview and policy review the facility failed to ensure resident safety when ambulated and when transferred to a chair without a gait belt for 1 of 3 residents reviewed (Resident #2). The fall resulted in a hip fracture that required surgery. The facility reported a census of 90 residents.Findings include:The Minimum Data Set (MDS) dated [DATE] reflected Resident #2 activity prior to fall documented used a walker, required substantial to maximal assist with sit to stand and lying to sit needed partial to moderate assistance, to lift, hold or support trunk or limb. Resident #2 required supervision or touch assist when walking up to 10 -50 feet. Staff to provide verbal and or touch/steadying and/or contact guard assist throughout activity or intermittently.The Care Plan focus initiated 5/15/24 for Resident #2 revealed is at risk for falls, to use walker through entire transfer, assist of one and a four wheeled walker (4WW) and gait belt.The MDS dated…

  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.

  Quality of Life and Care Deficiencies · Past Non-Compliance
• Actual harm · Gcited before2025-08-25 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on clinical record review, policy review, and staff interviews, the facility failed to create and implement interventions to prevent a fall which resulted in an ER visit for 1 of 3 residents reviewed for falls(Resident #20). The facility reported a census of 95 residents. Findings include:The Minimum Data Set (MDS) assessment tool, dated 5/20/25, listed diagnoses for Resident #20 which included fracture, non-Alzheimer's dementia, and arthritis. The MDS stated the resident sustained a fracture related to a fall in the 6 months prior to admission and stated the resident required partial/moderate assistance for chair and toilet transfers. The MDS listed a Brief Interview for Mental Status (BIMS) score as 11 out of 15, indicating moderately impaired cognition. The facility Accident/Incident Investigation and Reporting Policy and Procedure, revised 4/2025, stated the facility provided an environment that was free from accident hazards over which the facility had control and provided supervision to prevent avoidable accidents. The policy directed staff to initiate new interventions…

  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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-06-04 · tag F0550 — failed to protect resident dignity and rights — isolated
  Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
  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, policy review, staff interviews, resident and family interview the facility failed to provide dignity and respectful treatment for 1 of 3 residents reviewed. The facility reported a census of 90. Findings include:The Minimum Data Set (MDS) dated [DATE] for Resident #1 revealed required assistance with sit to lye or sit to stand or transfer to chair or toilet. Resident #1 required partial to moderate assistance of staff for lifts, holds, or support of trunk or limb and was dependent on toileting hygiene. The Brief Interview for Mental Status (BIMS) exam Coded a score of 13 out of 15 indicating intact cognition. The Medical Diagnosis, in an electronic record dated 4/3/26 listed Resident #1 had acute cystitis with hematuria referring to bladder inflammation with blood in the urine and had an overactive bladder. A Care Plan with an activity focus area initiated on 4/3/26 documented Resident #1 needs assist of one with toileting and perineal cares and needed assist of one and a front…

  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.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-11-25 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  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 investigation file, staff interviews, and policy review, the facility staff failed to treat residents with dignity and respect and honor the resident's right when a resident refused to take a shower, and failed to protect residents from abuse by not conducting a thorough investigation of the incident for 1 of 2 residents reviewed for abuse (Residents #2) The facility reported a census of 86 residents. Findings include:A Complaint/Incident Investigation Report revealed the facility self-reported an allegation of abuse to the Department of Inspections, Appeals, and Licensing (DIAL) on 11/03/25 at 5:29 PM. The incident occurred on 10/31/25 at approximately 9:20 AM. Staff A, Certified Nursing Assistant (CNA) notified Staff E, Registered Nurse (RN) that Resident #2 refused to take a shower. Staff E was upset and said she did not have time for this shit and followed Staff A into the resident's bathroom. Staff E told Resident #2 she had to take a shower and the resident said no. Staff E…

  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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-11-25 · tag F0609 — failed to report abuse allegations — isolated
  Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
  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, facility investigation file review, staff interviews, and policy review, the facility failed to report and allegation of abuse to the Iowa Department of Inspections, Appeals and Licensing within the required time for 2 of 2 residents reviewed for abuse (Residnt#1 and Resident#2). The facility reported a census of 86 residents. Findings include:A Complaint/Incident Investigation Report revealed the facility self-reported an allegation of abuse to DIAL on 11/14/25 at 1:42 PM. The incident occurred on 11/12/25 at approximately 9:40 PM. Resident #1 expressed to Staff F, Certified Nursing Assistant (CNA) anxiety and concerns about an interaction that took place overnight between 11/11/25 to 11/12/25 with Staff I, CNA. Resident #1 told Staff F that Staff I took her bed remote away when she had raised the foot of the bed too high, then Staff I threw the bed remote toward her and struck her wound vac. Staff I was placed on administrative leave on 11/13/25 at 4:30 PM pending 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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-08-25 · tag F0605 — failed to not use drugs as a restraint — isolated
  Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on clinical record review, policy review, and staff interview, the facility failed to ensure staff attempted non-pharmacological interventions prior to the administration of as needed(prn) anti-anxiety medications for 1 of 3 residents reviewed for anti-anxiety medications(Resident #3). Along with the anti-anxiety medication a opiod analgesic (strong pain med) was also given in most cases at the same time with no non-pharmalogical interventions for relief of pain attempted, or waiting for effectiveness of either medication. The facility reported a census of 95 residents.Findings: The Minimum Data Set(MDS) assessment tool, dated 8/1/25, listed diagnoses for Resident #3 which included depression, mild cognitive impairment, and muscle weakness. The MDS stated the resident had physical behavioral symptoms directed toward others (e.g., hitting, kicking, pushing, scratching, grabbing, abusing others sexually) and verbal behavioral symptoms directed toward others (e.g., threatening others, screaming at others, cursing at others) 1 to 3 days out of the 7 day review period. The MDS…

  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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-08-25 · tag F0656 — failed to write and follow a full care plan — isolated
  Develop 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 record review, observation, staff interview, and policy review, the facility failed to ensure that a comprehensive, person-centered care plan that included measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for 2 of 20 residents reviewed for care planning (Resident #7 and #8). The facility reported a census of 95 residents.Findings include:1. The Quarterly Minimum Data Set (MDS) dated [DATE] revealed that Resident #7 had diagnoses of non-Alzheimer's dementia and anxiety. The MDS also indicated that Resident #7 had delusions and rejected care 1 to 3 days in the 7-day look back period. The Physician's Orders revealed that Resident #7 was prescribed 1 milliliter (mL) of a compound ointment topically to inner wrist every 8 hours as needed for agitation. Each mL of compound ointment included: Lorazepam 1 milligram (mg), Diphenhydramine 12.5 mg and Haloperidol 2 mg. In an interview on 8/21/2025 at 9:32 AM Staff C, Licensed…

  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.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-08-25 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolated
  Provide safe and appropriate respiratory care for a resident when needed.
  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, observation, staff interviews, and policy review, the facility failed to ensure safe and accurate delivery of oxygen therapy for one of three residents reviewed for respiratory care (Resident #86). The facility reported a census of 95 residents.Findings include:1. The admission Minimum Data Set (MDS) dated [DATE] revealed that Resident #86 had diagnoses of heart failure, hypertension, respiratory failure, pulmonary hypertension and congestive heart failure with hypoxia.The Care Plan initiated on 7/3/25 indicated that Resident #86 has oxygen therapy related to congestive heart failure (CHF) and gets oxygen via nasal cannula (nc) continuously. It lacked information related to the liters of oxygen flow ordered.The Clinical Physician's Orders dated 6/24/25 directed staff to provide the resident oxygen continuous at 4 liters via nc continuous, and two times a day check oxygen saturation levels with an indefinite end date.The Electronic Treatment Administration Record (EMAR) indicated…

  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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-08-25 · tag F0755 — failed to provide safe pharmacy services — isolated
  Provide 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 clinical record review, policy review, and staff interview, the facility failed to ensure the availability of routine medications for 1 of 4 newly admitted residents(Resident #99). The facility reported a census of 95 residents. Findings:The Minimum Data Set(MDS) assessment tool, dated 4/27/25, listed diagnoses for Resident #99 which included rheumatoid arthritis, weakness, and depression and listed the resident's Brief Interview for Mental Status(BIMS) score as 14 out of 15, indicating intact cognition. The MDS documented that the resident was admitted on [DATE] from a hospital.The undated facility policy Pharmacy-Initiated Order Workflow stated the nurse received a signed order from the prescriber and faxed it to the pharmacy. The pharmacy then processed the medication and delivered it to the facility. The procedure did not address what staff should do if a medication did not arrive from the pharmacy. A 4/25/2025 10:30 a.m. Clinical admission entry stated the resident admitted to the facility. 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.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-08-25 · tag F0759 — failed to keep medication error rate low — isolated
  Ensure medication error rates are not 5 percent or greater.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on clinical record review, observation, staff interview, and policy review, the facility failed to assure a medication error rate of less than 5%. During observation of medication administration, the facility had 3 errors out of 27 opportunities for error resulting in an error rate of 11.11% (Residents #25 and #66). The facility identified a census of 95 residents.1. The Quarterly Minimum Data Set (MDS) Assessment, dated 7/3/25, revealed Resident #25 had a diagnosis of diabetes. The MDS documented the resident took insulin during the 7-day lookback period. The Medication Administration Record (MAR), dated August 2025, for Resident #25 listed Lispro 100 milligrams (mg)/milliliter (ml), inject subcutaneously (SQ) per sliding scale before meals for blood glucose (sugar) 0-150=zero units (U); 151-200=6U; 201-250=8U; 251-300=10U; 301-350=12U; 351-400=14U and scheduled at 7:00 AM, 11:00 AM and 4:00 PM. The MAR revealed Staff E, Registered Nurse (RN), administered 10 U SQ on 8/19/25 at 5:58 PM.On 8/19/25 at 4:26 PM, observation of Staff E, RN, revealed Staff E obtained Resident #25's…

  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.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-08-25 · tag F0760 — failed to prevent significant medication errors — isolated
  Ensure that residents are free from significant medication errors.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on clinical record review, observation, staff interview and review of facility policy, the facility failed to give an insulin prior to the meal as ordered for one of one residents observed who received insulin during medication pass (Resident #25). The facility reported a census of 95 residents.The Quarterly Minimum Data Set (MDS) Assessment, dated 7/3/25, revealed Resident #25 had a diagnosis of diabetes. The MDS documented the resident took insulin during the 7-day lookback period. The Medication Administration Record (MAR), dated August 2025, for Resident #25 listed Lispro 100 milligrams (mg)/milliliter (ml), inject subcutaneously (SQ) per sliding scale before meals for blood glucose (sugar) 0-150=zero units (U); 151-200=6U; 201-250=8U; 251-300=10U; 301-350=12U; 351-400=14U and scheduled at 7:00 AM, 11:00 AM and 4:00 PM. The MAR revealed Staff E, Registered Nurse (RN), administered 10 U SQ on 8/19/25 at 5:58 PM.On 8/19/25 at 4:26 PM, observation of Staff E, RN, revealed Staff E obtained Resident #25's blood glucose level which measured 280. Staff E then pushed 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.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-08-25 · tag F0880 — failed to prevent and control infections — isolated
  Provide and implement an infection prevention and control program.
  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, observation, staff interview, and policy review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 3 residents reviewed for pressure ulcers (Resident #92). The facility reported a census of 95 residents.Findings include:1. The Significant Change in Status Minimum Data Set (MDS) dated [DATE] revealed that Resident #92 had an unhealed, unstageable pressure injury presenting as a deep tissue injury.The Care Plan initiated on 4/8/25 indicated that Resident #92 has a pressure ulcer related to immobility. The Care Plan initiated the focus area with revision date of 4/9/25 documented the resident with self care deficits for activities of daily living related to dementia, and directed the staff to provide two staff to assist with toilet use, and transfers.The Electronic Health Record (EHR)…

  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.

  Infection Control Deficiencies · Deficient, Provider has date of correction

“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.

Fines & penalties

$52,060 in federal fines across 3 penalties.

• $12,006 — penalty dated 2026-06-04
• $26,800 — penalty dated 2025-08-25
• $13,254 — penalty dated 2025-02-24

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Part of a chain

This home belongs to WESLEYLIFE — 10 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 →

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

3 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.

This home reported $1.0M paid to related parties (affiliated landlords or management companies) in its most recent cost report. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.

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