222 North 15th Street, Onawa, IA 51040 · Monona County · (712) 423-2510
46 certified beds, about 40 residents a day · For profit - Corporation · Medicare and Medicaid since 1995
CMS Care Compare ratings, data as of September 1, 2026 · CCN 165256 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on May 8, 2025, inspectors cited 5 health deficiencies (the Iowa average is 6.5, the national average 9.2).
Of 34 health citations since June 2023, 1 was rated as actual harm or immediate jeopardy to residents.
CMS lists no fines against this home in the last three years.
Nurses and nurse aides worked 3.22 hours per resident per day, against 3.82 across Iowa and 3.86 nationally. Registered nurses accounted for 0.63 of those hours.
50.0% of nursing staff left within the year CMS measured (Iowa average 44.0%).
CMS links it to Accura Healthcare, an affiliated group of 41 nursing homes.
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 34 health citations on file.
Inspectors wroteBased on observations, resident, and staff interviews, the facility failed to display contact information for state and federal agencies in an accessible and prominent location in the facility for 4 out of 4 residents interviewed (Residents #14, #19, #29, #31, and #33). The facility reported a census of 40 residents.
Inspectors wroteBased on observation, review of facility records, resident and staff interviews, and facility policy, the facility failed to ensure that residents and staff were adequately educated regarding the definition of a grievance, the grievance process, and the specific procedures for obtaining forms and filing grievances anonymously for 5 out of 5 residents interviewed (Residents #14, #19, #29, #31, and #33). The facility reported a census of 40 residents.
Inspectors wroteBased on observation, clinical record review, and staff interview, the facility failed to ensure comprehensive care plans were updated to reflect current resident needs including restorative care, CPAP therapy, dietary orders, and fall interventions for 4 out of 12 residents reviewed (Residents #7, #8, #36, and #39). The facility reported a census of 40 residents.
Inspectors wroteBased on clinical record review, observations, staff interviews, and policy review, the facility failed to protect residents from accidents and injuries for 2 of 3 residents (Residents #36, #39). The facility failed to follow fall interventions identified on the Care Plan. The facility reported a census of 40 residents.
Inspectors wroteBased on schedule review, staff interviews and document review the facility failed to ensure that a Registered Nurse (RN) was at the facility for 8 consecutive hours every day. In a review of the 30-day nursing schedule, on 2 days the facility failed to have RN coverage. The facility reported a census of 32 residents.
Inspectors wroteBased on observation, staff interview, resident interviews and record view the facility failed to post the correct lunch menu and failed to ensure residents were offered meal options. The facility reported a census of 32 residents.
Inspectors wroteBased on observation, staff interview and policy review the facility failed to ensure that outdated foods had been discarded in a timely manner. The facility reported a census of 32 residents.
Inspectors wroteBased on resident interview, staff interview, and policy review the facility failed to ensure 1 of 1 resident's (Resident #24) personal property was protected from loss or theft. The facility reported a census of 32 residents.
Inspectors wroteBased on clinical record review, resident interview, staff interviews and policy review the facility failed to accurately document and monitor the use of controlled substances for1 of 1 residenst reviewed. Resident #84 had prescriptions for oxycodone pain medication, scheduled three times a day and as needed (PRN.) The documentation of number of tablets administered on the Controlled Drug Count Record, was not in accordance with the Medication Administration Record (MAR.) The facility reported a census of 32 residents.
Inspectors wroteBased on staff interviews and clinical record review the facility failed to follow medication orders for 1 of 3 residents. Resident #1 had a medication order for treatment of low blood pressure (BP) and staff were directed to hold the medication when the systolic BP (top number) was higher than 130. In the month of June, staff administered the medication many times outside of the parameters. The facility reported a census of 35 residents.
Inspectors wroteBased on staff interviews, clinical record review and hospital record review, the facility failed to provide complete and timely assessments and interventions for 1 of 3 residents reviewed. Resident #1 was readmitted to the facility after a long hospitalization. Staff failed to document current vital signs and failed to obtain a blood glucose level upon admission. The facility reported a census of 35 residents.
Inspectors wroteBased on staff interviews, clinical record review and policy review the facility failed to conduct pre-dialysis assessments for 2 of 2 residents (Resident #1, and #3) reviewed. The facility reported a census of 35 residents.
Inspectors wroteBased on observations, staff interviews, and facility policy review the facility failed to ensure sanitary conditions where staff prepared and stored food. The facility identified a census of 34 residents.
Inspectors wroteBased on clinical record review, staff interview, and facility policy, the facility failed to ensure bed hold notice was sent to the resident and or the resident's responsible person after giving a verbal consent when residents transferred out of the facility for 1 of 3 residents reviewed (Residents #19). The facility reported a census of 34 residents.
Inspectors wroteBased on clinical record review, staff interviews, and policy review the facility failed to resubmit Preadmission Screening and Resident Review (PASRR) with new mental health diagnoses and after initiation of mental health services for 1 of 2 residents reviewed for PASRR requirements (Resident #2). The facility reported a census of 34 residents.
Inspectors wroteBased on clinical record review, staff interviews, and policy review the facility failed to complete assessment and interventions for the necessary care and services, to maintain the residents' highest practical physical well-being. Clinical record review revealed the nursing staff failed to complete all required skilled assessments for 1 out 1 residents reviewed (Resident #2). The facility reported a census of 34 residents.
Inspectors wroteBased on observations, clinical record review, medical equipment manufacturer guide review, policy review and staff interview the facility failed to follow mechanical lift requirements to avoid hazards and prevent accidents for 1 of 2 residents reviewed (Resident #2). The facility reported a census of 34 residents.
Inspectors wroteBased on observation, review of facility menus, staff interviews, and facility policy review the facility failed to follow the menu for mechanical soft diets for 4 of 34 meals observed (Residents #8, #11, #27 and #138). The facility reported a census of 34 residents.
Inspectors wroteBased on observation, staff interviews, Center for Disease Control (CDC) guidelines and infection control policy the facility failed to use universal infection control measures and Enhanced Barrier Precautions (EBP) during wound care for 1 of 3 residents reviewed for infection control (Resident #25). The facility reported a census of 34 residents.
Inspectors wroteBased on clinical record review, staff interviews, and facility policy review, the facility failed to assess skin conditions after discovery to prevent a decline in the pressure wound for 1 of 3 residents reviewed (Resident #3). Resident #3 admitted to the facility with skin conditions of surgical incisions, some skin tears, and bruising on 11/29/23. During his time at the facility, he developed additional skin conditions that lead to a hospitalization due to an infection in his wounds. The hospital records revealed that Resident #3 had a pressure ulcer to his back, coccyx, and left heel. The record included those in addition to his fractures that happened prior to his admission to the nursing home of his left hip and shoulder. Resident #3's clinical record at the nursing home lacked documentation related to the pressure ulcers.
Inspectors wroteBased on clinical record review, staff interviews, and policy review, the facility failed to complete and accurately document pressure and non pressure skin assessments for 1 of 3 resident's reviewed (Resident #4).
Inspectors wroteBased on clinical record review, staff interviews, and facility policy review the facility failed to ensure a resident did not exit the facility unsupervised for 1 of 3 residents reviewed (Resident #1). Resident #1 frequently offered to pay staff to give him a ride home, but the staff denied that he ever tried to leave the facility. On 7/5/23, Resident #1 exited the facility with the assistance of another resident going outside to smoke following breakfast. The staff reported seeing him in the kitchen minutes before a staff member discovered him outside of the laundry room outside of the building. Following, the incident, the facility initiated a safety plan to prevent further attempts to elope for Resident #1 and other residents.
Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to provide food storage in a safe and consistent manner. Specifically, the facility failed to ensure scoops were not left in dry food container, maintain low temperature dishwasher temperatures at 120 degrees Fahrenheit, and discard glassware with white buildup. This had the potential to affect all 39 residents who consumed food from the kitchen.
Inspectors wroteBased on observation and interview, the facility failed to maintain an effective pest control system against household flies. This had the potential to affect 39 of 39 residents who resided at the facility. Findings Include: Observations on 06/26/23 during the initial tour of the 500 hall, between 9:00 AM and 4:00 PM, revealed flies, too many to count, in the residents' rooms. The residents were observed with fly swatters on their wheelchairs and near their beds. Observation on 06/26/23 at 12:50 PM revealed a fly on a resident's food in the assisted residents' dining room. Observation on 06/26/23 at 12:52 PM revealed flies landing on food items provided for residents in the main dining room. Continued observation on 06/27/23 between 10:45 AM and 2:00 PM revealed multiple flies in the kitchen. [...]
Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure one (Resident (R) 22) of one sampled resident reviewed for nebulizer treatments was assessed to self-administer nebulizer treatments.
Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to provide a Form CMS-10123 (Centers for Medicaid and Medicare) Notice of Non-Coverage (NOMNC) and a Form CMS-10055 Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) to one of three residents (Resident (R) R16) reviewed for liability notices out of a total sample of 28 residents. This failure potentially prevented the residents from understanding their rights related to their skilled Medicare coverage and/or appealing the decision of the facility and/or making an informed decision related to the cost of continued therapy services.
Inspectors wroteBased on interview, record review, and review of facility policy, the facility failed to ensure timely reporting of an injury of unknown origin resulting in bruising to law enforcement, the State Agency, and the local Ombudsman for one (Resident (R) 35) of one resident reviewed for abuse. The resident was found with an injury of unknown origin on 05/16/23 (a swollen, edematous, reddened, and painful right ankle and a bruised right second toe). The injury of unknown origin was not reported to the appropriate entities.
Inspectors wroteBased on interview, record review, and review of facility policy, the facility failed to ensure a thorough investigation of an injury of unknown origin resulting in bruising for one (Resident (R) 35) of one resident reviewed for abuse. The resident was found with an injury of unknown origin on 05/16/23 (a swollen, edematous, reddened, and painful right ankle and a bruised right second toe). The injury of unknown origin was not investigated.
Inspectors wroteBased on observation, interview, record review, and review of facility policy, the facility failed to assist dependent residents with Activities of Daily Living (ADL) care for one resident (Resident (R) 6) of three residents reviewed for ADLs.
Inspectors wroteBased on observation, interview, and record review, the facility staff failed to promptly initiate treatment for a newly identified pressure ulcer and failed to administer treatment to the pressure ulcer as ordered by the physician for one (Resident (R) 30) of two sampled residents reviewed for pressure ulcers.
Inspectors wroteBased on observation, record review, interview of facility staff, and interview of Resident 30 (R30) it was determined the facility staff failed to ensure that a restorative walking program was implemented when R30 was discharged from physical therapy. This was evident for 1 of 2 sampled residents.
Inspectors wroteBased on review of facility policy, interviews and record review, the facility failed to ensure two (Residents (R) 11 and R20) of three residents reviewed for accidents were provided with appropriate supervision of their smoking materials. A total of 28 residents were reviewed in the sample.
Inspectors wroteBased on record review, observations, and staff interviews, the facility failed to ensure a medication error rate of less than 5%. Two errors were made with a total of 31 opportunities for error, resulting in a 6.45% error rate. The errors involved two (Resident (R) R21 and R22 of six residents reviewed for medication administration. Iron (a medication indicated Do not crush) was crushed and administered to R21 and lisinopril (an antihypertensive medication used to control blood pressure) was not given to R22 due to it was unavailable in the facility and. A total of 28 residents were reviewed in the sample.
Inspectors wroteBased on observation, record review and interviews of facility staff it was determined the facility failed to ensure respiratory equipment was cleaned and maintained appropriately for two (Resident (R) 22 and R6) of two sampled residents reviewed for nebulizer treatments.
15 fire safety citations on file: 1 on May 8, 2025, 10 on June 13, 2024, 4 on June 29, 2023.
CMS lists no fines or payment denials against this home in the last three years. The national average is 0.9 fines per home.
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | Iowa | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 3.22 | 3.82 | 3.86 |
| Registered nurses | 0.63 | 0.74 | 0.69 |
| All nursing staff on weekends | 2.62 | 3.37 | 3.42 |
| Nurse aides | 2.20 | ||
| Licensed practical nurses | 0.39 | ||
| Nursing staff turnover (share who left in a year) | 50.0% | 44.0% | 45.8% |
| Registered nurse turnover | 77.8% | 42.1% | 42.9% |
| Administrators who left | 0 |
CMS expects 3.34 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 3.47 on weekdays and 2.62 on weekends, 24% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 2.2% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 4.09 in April to June 2025 to 3.22 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 3.22 | 0.63 | 3.47 | 2.62 | 2.2% | 0 of 90 | 40 |
| Oct to Dec 2025 | 3.36 | 0.74 | 3.55 | 2.89 | 3.1% | 0 of 92 | 36 |
| Jul to Sep 2025 | 3.91 | 0.97 | 4.10 | 3.45 | 4.3% | 0 of 92 | 33 |
| Apr to Jun 2025 | 4.09 | 0.91 | 4.27 | 3.65 | 5.2% | 0 of 91 | 32 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| Iowa, Jan to Mar 2026 | 3.80 | 0.71 | 3.98 | 3.36 | 4.7% | 0.3% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Staff pay reports
No staff pay figure for this home has passed review yet. A figure appears only after at least 5 reports from at least 3 different people, sent over at least 60 days, have passed review.
| Job | Median | Middle half | Employed |
|---|---|---|---|
| Iowa, all employers | |||
| CNAs (nursing assistants) | $18.92 | $17.96 to $21.95 | 22,670 |
| LPNs and LVNs | $30.11 | $27.12 to $34.06 | 5,510 |
| Registered nurses | $37.80 | $32.83 to $41.32 | 34,420 |
| United States, nursing care facilities | |||
| CNAs (nursing assistants) | $20.67 | $17.91 to $22.55 | 534,270 |
| LPNs and LVNs | $33.86 | $30.05 to $37.40 | 188,210 |
| Registered nurses | $41.11 | $37.85 to $47.68 | 142,270 |
Hourly wages; the middle half runs from the 25th to the 75th percentile. Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025. BLS has no separate estimate for medication aides. These are survey estimates for whole occupations, not figures for any one home.
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | Iowa | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 28.4 | 17.1 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 3.0 | 1.5 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 0.8 | 2.4 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 0.0 | 3.8 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 11.8 | 2.1 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 18.3 | 16.6 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 3.9 | 4.2 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 29.1 | 19.4 | 15.4 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.0 | 1.5 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.6 | 2.1 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Accura Healthcare of Onawa's Medicare short-stay residents. How to read these, and what Medicare pays for.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
US median of homes 51.5% · Iowa: 28 better, 21 worse
Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 20 eligible stays.
10.3% this home
No different from the national rate
US median of homes 10.7% · Iowa: 1 better, 1 worse
Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (risk-standardized rate). Lower is better. October 2022 to September 2024. 39 eligible stays.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
US median of homes 7.1% · Iowa: 0 better, 0 worse
Percentage of infections residents got during their SNF stay that resulted in hospitalization (risk-standardized rate). Lower is better. October 2023 to September 2024. 16 eligible stays.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Iowa56.7% · US 56.6%
Percentage of residents who are at or above an expected ability to care for themselves and move around at discharge. Higher is better. October 2024 to September 2025. 17 residents counted.
0.0% this home
Median of homes: Iowa0.0% · US 0.0%
Percentage of SNF residents who experience one or more falls with major injury during their SNF stay. Lower is better. October 2024 to September 2025. 20 residents counted.
0.0% this home
Median of homes: Iowa1.8% · US 1.7%
Percentage of residents with pressure ulcers or pressure injuries that are new or worsened (adjusted rate). Lower is better. October 2024 to September 2025. 20 residents counted.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Iowa100.0% · US 98.7%
Percentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge. Higher is better. October 2024 to September 2025. 4 residents counted.
Source: CMS Skilled Nursing Facility Quality Reporting Program - Provider Data, released 2026-09-30. Better, no different and worse are CMS's own comparisons with the national rate, after adjusting for how sick residents were. Medians of homes and the state counts are worked out by us from the same file.
Legal business name: ACCURA HEALTHCARE OF ONAWA LLC. CMS links this home to Accura Healthcare, a group of 41 nursing homes averaging 2.5 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Aviv Healthcare of the Midwest LLC | Direct ownership interest | Organization | 02/01/2025 | |
| Avenue94 LLC | Indirect ownership interest | Organization | 02/01/2025 | |
| Aviv Healthcare Holdings LLC | Indirect ownership interest | Organization | 02/01/2025 | |
| Kimmons Healthcare Investments LLC | Indirect ownership interest | Organization | 02/01/2025 | |
| Ktl Enterprises LLC | Indirect ownership interest | Organization | 02/01/2025 | |
| Little River Investments LLC | Indirect ownership interest | Organization | 02/01/2025 | |
| Zrr Opco LLC | Indirect ownership interest | Organization | 02/01/2025 | |
| Allen, Brady | Indirect ownership interest | Individual | 02/01/2025 | |
| Glaser, Kristopher | Indirect ownership interest | Individual | 02/01/2025 | |
| Kleinsasser, Megan | Indirect ownership interest | Individual | 02/01/2025 | |
| Leneave, Ted | Indirect ownership interest | Individual | 02/01/2025 | |
| Toti, Lisa | Indirect ownership interest | Individual | 02/01/2025 | |
| Accura Management Consulting Services LLC | Operational/managerial control | Organization | 02/01/2025 | |
| Allen, Brady | Operational/managerial control | Individual | 02/01/2025 | |
| Dudley, Paul | Operational/managerial control | Individual | 02/01/2025 | |
| Glaser, Kristopher | Operational/managerial control | Individual | 02/01/2025 | |
| Infante, Jordan | Operational/managerial control | Individual | 02/01/2025 | |
| Kleinsasser, Megan | Operational/managerial control | Individual | 02/01/2025 | |
| Leneave, Ted | Operational/managerial control | Individual | 02/01/2025 | |
| Slemp, Jessica | Operational/managerial control | Individual | 02/01/2025 | |
| Toti, Lisa | Operational/managerial control | Individual | 02/01/2025 | |
| Accura Management Consulting Services LLC | Adp of the SNF | Organization | 02/01/2025 | |
| Aviv Financing II LLC | Adp of the SNF | Organization | 02/01/2025 | |
| Aviv Healthcare of the Midwest LLC | Adp of the SNF | Organization | 06/12/2025 | |
| Aviv Healthcare Properties Operating Partnership I LP | Adp of the SNF | Organization | 02/01/2025 | |
| Aviv Op Limited Partner LLC | Adp of the SNF | Organization | 02/01/2025 | |
| Iowa Lincoln County Property LLC | Adp of the SNF | Organization | 02/01/2025 | |
| Ohi Healthcare Properties Limited Partnership | Adp of the SNF | Organization | 02/01/2025 | |
| Omega Healthcare Investors Inc | Adp of the SNF | Organization | 02/01/2025 | |
| Allen, Brady | Adp of the SNF | Individual | 02/01/2025 | |
| Dudley, Paul | Adp of the SNF | Individual | 02/01/2025 | |
| Glaser, Kristopher | Adp of the SNF | Individual | 02/01/2025 | |
| Infante, Jordan | Adp of the SNF | Individual | 02/01/2025 | |
| Kleinsasser, Megan | Adp of the SNF | Individual | 02/01/2025 | |
| Leneave, Ted | Adp of the SNF | Individual | 02/01/2025 | |
| Slemp, Jessica | Adp of the SNF | Individual | 02/01/2025 | |
| Toti, Lisa | Adp of the SNF | Individual | 02/01/2025 |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Chosen from this home's own inspection record.
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