Mississippi Valley
500 Messenger Road, Keokuk, IA 52632 · Lee County · (319) 524-5321
83 certified beds, about 57 residents a day · For profit - Limited Liability company · Medicare and Medicaid since 1989
Certified for Medicaid Certified for Medicare
Overall
3 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
2 of 5
CMS Care Compare ratings, data as of September 1, 2026 · CCN 165151 · See it on Medicare.gov · Compare with other homes
The record in brief
At its most recent standard inspection, on May 21, 2026, inspectors cited 4 health deficiencies (the Iowa average is 6.5, the national average 9.2).
Of 12 health citations since December 2023, 3 were rated as actual harm or immediate jeopardy to residents.
CMS lists 2 fines totaling $19,663 in the last three years; the largest was $10,839, and the latest is dated June 19, 2024.
Nurses and nurse aides worked 5.67 hours per resident per day, against 3.82 across Iowa and 3.86 nationally. Registered nurses accounted for 1.57 of those hours.
36.8% of nursing staff left within the year CMS measured (Iowa average 44.0%).
Health inspections
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.
112/23
101/24
506/24
004/25
103/26
405/26
Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit
Where its citations fall on CMS's grid
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 12 health citations on file.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
0K
0L
Actual harm
3G
0H
0I
Potential for more than minimal harm
6D
3E
0F
Potential for minimal harm
0A
0B
0C
May 21, 2026Standard inspection · 4 citations
- E Ensure that residents are fully informed and understand their health status, care and treatments.
Inspectors wroteBased on observations, clinical record review, facility policy review, resident and staff interviews, the facility failed to complete an informed consent prior to the administration of psychotropic medications for 5 of 5 (Resident #1, Resident #2, Resident #3, Resident #4 and Resident #7) residents reviewed for unnecessary medications. The facility reported a census of 54 residents.
- E Ensure each resident receives an accurate assessment.
Inspectors wroteBased on clinical record review, Center for Medicare and Medicaid (CMS) Resident Assessment Instrument (RAI) User's Manual, and staff interview, the facility failed to code diagnoses used of psychotropic medications for 4 of 5 residents (Resident #2, Resident #3, Resident #4, and Resident #7) reviewed for unnecessary medications; and failed to accurately code restraint use for 2 of 2 residents (Resident #19 and Resident #51) reviewed for restraints. The facility identified a census of 54 residents.
- D Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Inspectors wroteBased on record review, staff interviews, and the facility discharge to another facility checklist, the facility failed to complete a recapitulation of stay discharge summary for 1 of 1 residents reviewed for discharges (Resident #63). The facility reported a census of 54 residents.
- D Ensure medication error rates are not 5 percent or greater.
Inspectors wroteBased on observation, record review, staff interviews, the facility policy, and the manufacturer's insulin pen instructions, the facility failed to follow manufacturer instructions for administration of insulin and failed to administer an inhaler and nebulizer treatment at the physician prescribed time for 2 of 6 residents (Resident #22 and Resident #26) observed for medication administration causing a 10% medication error rate. The facility reported a census of 54 residents.
March 12, 2026Complaint inspection · 1 citation
- G Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on observations, clinical record review, policy review, resident and staff interviews, the facility failed to provide staff with clear resident specific directions for the level of assistance a dependent resident required for repositioning and the use of a bed pan for 1 of 4 residents (Resident #1) who experienced a fall with fracture when assisted with the use of a bed pan. The facility reported a census of 56 residents.
April 3, 2025Standard inspection · 0 citations
June 19, 2024Standard inspection · 5 citations
- G Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on observation, staff interview, and record review the facility failed to ensure a seizure pad remained present to both sides of the resident's bed while the resident was left unattended in bed and failed to ensure adequate supervision of the resident during this time by a staff member for one of four residents reviewed for accidents (Resident #1). Resident #1 fell from the bed, was found on the floor by staff member, sustained a laceration and hematoma to the back of the head, and was sent to the hospital. The facility reported a census of 63 residents.
- D Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the Care Plan reflected a resident's current liquid consistency order for one of twenty-one residents reviewed for care plan revision (Resident #17). The facility reported a census of 63 residents.
- D Provide care and assistance to perform activities of daily living for any resident who is unable.
Inspectors wroteBased on observation, interview, and record review, the facility failed to trim and clean fingernails for 1 of 3 residents reviewed (Resident #62) The facility reported a census of 63 residents.
- D Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure catheter drainage bags were maintained off of the floor for three of three residents reviewed for catheters (Resident #17, Resident #30, Resident #41). The facility reported a census of 63 residents.
- D Ensure each resident’s drug regimen must be free from unnecessary drugs.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident remained free from unnecessary medication when a resident who experienced loose stools was administered a laxative and stool medication for one of six residents reviewed for unnecessary medications (Resident #17). The facility reported a census of 63 residents.
January 24, 2024Complaint inspection · 1 citation
- G Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on clinical record review, observation and staff interviews the facility failed to identify increased water temperatures during a shower that resulted in second degree burns to one of three residents reviewed (Resident #1). The facility reported a census of 60 residents.
December 6, 2023Complaint inspection · 1 citation
- E Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Inspectors wroteBased on clinical record review, resident and staff interviews, the facility failed to provide sufficient staff to meet the needs (bathing)for 4 of 4 residents reviewed. (Residents #1, #2, #3, #4) The facility census was 58.
Fire safety inspections
6 fire safety citations on file: 2 on May 21, 2026, 2 on April 3, 2025, 2 on June 19, 2024.
Every fire safety citation6 citations
- E Keep aisles, corridors, and exits free of obstruction in case of emergency.
- E Install corridor and hallway doors that block smoke.
- E Have properly located and lighted "Exit" signs.
- E Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- E Have properly installed hallway dispensers for alcohol-based hand rub.
- E Properly select, install, inspect, or maintain portable fire extinguishes.
Fines and payment denials
| Date | Penalty | Amount or length |
|---|---|---|
| June 19, 2024 | Fine | $10,839 |
| January 24, 2024 | Fine | $8,824 |
A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.
Staffing
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) | 5.67 | 3.82 | 3.86 |
| Registered nurses | 1.57 | 0.74 | 0.69 |
| All nursing staff on weekends | 4.49 | 3.37 | 3.42 |
| Nurse aides | 3.39 | ||
| Licensed practical nurses | 0.71 | ||
| Nursing staff turnover (share who left in a year) | 36.8% | 44.0% | 45.8% |
| Registered nurse turnover | 11.8% | 42.1% | 42.9% |
| Administrators who left | 0 |
CMS expects 7.43 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Staffing by quarter, from daily payroll records
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 6.15 on weekdays and 4.49 on weekends, 27% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 4.2% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 5.26 in April to June 2025 to 5.67 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 | 5.67 | 1.57 | 6.15 | 4.49 | 4.2% | 0 of 90 | 57 |
| Oct to Dec 2025 | 5.38 | 1.43 | 5.85 | 4.15 | 2.4% | 0 of 92 | 59 |
| Jul to Sep 2025 | 5.60 | 1.40 | 6.08 | 4.37 | 2.6% | 0 of 92 | 58 |
| Apr to Jun 2025 | 5.26 | 1.35 | 5.73 | 4.09 | 2.1% | 0 of 91 | 60 |
| 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.
Quality measures
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 | 17.2 | 17.1 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 4.7 | 1.5 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 10.6 | 2.4 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 3.5 | 3.8 | 3.2 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 11.0 | 16.6 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 8.3 | 4.2 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 11.8 | 19.4 | 15.4 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 0.9 | 1.5 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.2 | 2.1 | 1.8 |
Owners and operators
Legal business name: LEXINGTON SQUARE LLC.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Lexington Square Irrevocable Trust | Direct ownership interest | Organization | 04/07/2017 | |
| Bell Bank Arrowhead Office | 5% or greater mortgage interest | Organization | 06/15/2022 | |
| Abell, Terri | Managing control - governing body | Individual | 01/20/2016 | |
| Anderson, Halley | Managing control - governing body | Individual | 10/18/2023 | |
| Blume, Michael | Managing control - governing body | Individual | 01/20/2016 | |
| Hoskins, Heather | Managing control - governing body | Individual | 03/15/2011 | |
| Israel, David | Managing control - governing body | Individual | 08/12/2025 | |
| Peterson, Paige | Managing control - governing body | Individual | 04/07/2022 | |
| Stanley, Murray | Managing control - governing body | Individual | 04/07/2022 | |
| Lexington Square Irrevocable Trust | Operational/managerial control | Organization | 04/07/2017 | |
| Abell, Terri | Operational/managerial control | Individual | 03/03/2022 | |
| Blume, Michael | Operational/managerial control | Individual | 04/01/2023 | |
| Hoskins, Heather | Operational/managerial control | Individual | 03/20/2024 | |
| Stanley, Murray | Operational/managerial control | Individual | 04/01/2017 | |
| Peterson, Paige | Trustee of the SNF | Individual | 04/06/2022 | |
| Stanley, Murray | Trustee of the SNF | Individual | 04/01/2017 | |
| Anderson, Halley | Adp of the SNF | Individual | 04/17/2025 | |
| Blume, Michael | Adp of the SNF | Individual | 08/20/2024 | |
| Stanley, Murray | Adp of the SNF | Individual | 04/01/2017 |
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.
Questions to ask on a visit
Chosen from this home's own inspection record.
- How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 5 problems in this area, most recently on March 12, 2026: "Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents."
- How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 2 problems in this area, most recently on May 21, 2026: "Ensure that residents are fully informed and understand their health status, care and treatments."
- When is the care plan meeting, and can family attend it?Inspectors cited 2 problems in this area, most recently on May 21, 2026: "Ensure each resident receives an accurate assessment."
- How are medications reviewed, and how often are antipsychotic or sedating drugs used?Inspectors cited 2 problems in this area, most recently on May 21, 2026: "Ensure medication error rates are not 5 percent or greater."
Other nursing homes nearby
- Southeast Iowa Healthcare Center Keokuk, 0.6 mi · 4 of 5 stars · 7 citations
- River Hills Village in Keokuk Keokuk, 1.2 mi · 3 of 5 stars · 8 citations
- Montrose Health Center Montrose, 7.3 mi · 3 of 5 stars · 15 citations
- Birkwood Village of Fort Madison Fort Madison, 14.1 mi · 3 of 5 stars · 25 citations
- Clark County Nursing Home Kahoka, 17.1 mi · 2 of 5 stars · 27 citations
- Lewis County Nursing Home District Canton, 20.9 mi · 1 of 5 stars · 42 citations
- West Point Care Center Inc West Point, 20.9 mi · 5 of 5 stars · 9 citations
Iowa contacts for a concern about a nursing home
These are the official offices in Iowa. NursingHomeClear cannot take or act on complaints.
- Inspections and complaints: Iowa Department of Inspections, Appeals, and Licensing, Health Facilities, the state agency that inspects nursing homes for CMS and takes complaints about care.
- Resident advocate: Iowa Office of the State Long-Term Care Ombudsman, 866-236-1430. The long-term care ombudsman is a free, confidential advocate for residents and families, set up under the federal Older Americans Act.
- State inspection reports: Iowa Health Facility Database, Entity Search, where Iowa publishes its own records on licensed homes.
Common questions
- What is Mississippi Valley's Medicare star rating?
- CMS rates Mississippi Valley 3 out of 5 stars overall, with 3 for health inspections, 3 for staffing and 2 for quality measures (CMS data as of September 1, 2026).
- How many deficiencies did Mississippi Valley get at its last inspection?
- 4 health deficiencies at the standard inspection on May 21, 2026. The Iowa average is 6.5.
- Has Mississippi Valley been fined?
- Yes. CMS lists 2 fines totaling $19,663 in the last three years.
- Does Mississippi Valley accept Medicaid?
- It is certified to take Medicaid (CMS lists it as "Medicare and Medicaid"). Certification does not mean a Medicaid bed is open: ask the admissions office.
- Who owns Mississippi Valley?
- CMS lists 19 owners and managers. Legal business name: LEXINGTON SQUARE LLC.
Sources
- Ratings, staffing and fines: CMS Provider Information, released September 30, 2026, data as of September 1, 2026.
- Citations: CMS Health Deficiencies and Fire Safety Deficiencies.
- Owners: CMS Ownership. Penalties: CMS Penalties.
- Staffing by quarter: CMS Payroll Based Journal Daily Nurse Staffing, April 2025 to March 2026, summed by NursingHomeClear.
- Inspector summaries: CMS Full Statement of Deficiencies (CMS-2567 text), data as of September 1, 2026. Each quote is the part of the statement before the detailed findings.
- Inspection reports with the inspectors' full notes are on this home's Medicare.gov page.
- Something wrong on this page? Ask for a correction. We fix errors in our copy of the data; findings themselves can only be changed by CMS and the state.
- NursingHomeClear is independent and not affiliated with CMS, Medicare or any state agency. This page reports federal records; it does not rate, recommend or endorse any home, and it is not medical or legal advice.