River Hills Village in Keokuk
20 Village Circle, Keokuk, IA 52632 · Lee County · (319) 524-5772
84 certified beds, about 65 residents a day · For profit - Limited Liability company · Medicare and Medicaid since 1998
CMS Care Compare ratings, data as of September 1, 2026 · CCN 165396 · See it on Medicare.gov · Compare with other homes
The record in brief
At its most recent standard inspection, on September 18, 2025, inspectors cited 5 health deficiencies (the Iowa average is 6.5, the national average 9.2).
Of 8 health citations since March 2024, 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 4.28 hours per resident per day, against 3.82 across Iowa and 3.86 nationally. Registered nurses accounted for 0.40 of those hours.
40.0% of nursing staff left within the year CMS measured (Iowa average 44.0%).
CMS links it to Unlimited Development, Inc., an affiliated group of 10 nursing homes.
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.
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 8 health citations on file.
September 18, 2025Standard inspection · 5 citations
- E Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Inspectors wroteBased on observation, clinical record review, facility policy review and staff interview, the facility failed to ensure dietary staff served the correct portion size to meet the nutritional needs of the 9 residents (Residents #2, #3, #13, #20, #28, #30, #36, #56, #62) with a mechanical soft or puree diet order for one of one meal service observation. The facility reported a census of 65 residentsFindings include: 1. During an observation on 9/16/2025 at 10:04 AM, observation of the lunch meal preparation for mechanical soft and pureed diets revealed the following: Staff N, Cook, placed eight servings, four ounces each serving, of beef pot roast into a machine that mechanically ground the meat and added beef broth. The total amount of ground meat measured seven cups. [...]
- E Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on meal services observation, facility policy review, review of the Federal Food and Drug Administration Code, and staff interview, the facility failed to ensure dietary staff served food under sanitary conditions for one of one meal service observations. The facility reported a census of 65 residents.
- D Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Inspectors wroteBased on observation, clinical record review, facility policy review, and staff interviews the facility failed to ensure staff transferred a resident in a dignified manner for 1 of 1 resident (Resident #18) reviewed for dignity. The facility reported a census of 65 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 clinical record review, review of facility policy, staff, resident and resident representative interview, the facility failed to ensure the resident and the resident's representative were included in the care plan process for 1 of 1 resident sampled (Resident #4) for care plans. The facility reported a census of 65 residents.
- D Ensure services provided by the nursing facility meet professional standards of quality.
Inspectors wroteBased on clinical record review, resident interview, observation, staff interview and policy review, the facility failed to following professional standards of practice regarding the provision of wound care documentation and treatment for 1 of 1 residents sampled (Resident #4) with a pressure ulcer wound. The facility reported a census of 65.
September 12, 2024Standard inspection · 1 citation
- D Ensure services provided by the nursing facility meet professional standards of quality.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure an insulin pen was primed prior to insulin administration for one of two residents reviewed for insulin during the medication administration task (Resident #26). The facility reported a census of 65 residents.
July 16, 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, facility policy, resident and staff interviews, and facility investigation documentation the facility failed to use the necessary transfer equipment when assisting a resident in the bathroom, resulting in a lower leg fracture for 1 of 3 residents (Resident #2) reviewed. The facility reported a census of 64 residents.
March 11, 2024Standard inspection · 1 citation
- D Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Inspectors wroteBased on interviews, record review, and the facility policy review the facility failed to ensure accurate records for residents' code status for 2 of 24 residents reviewed for records (Resident #54 and Resident #121). The facility reported a census of 68 residents.
Fire safety inspections
9 fire safety citations on file: 1 on September 18, 2025, 5 on September 12, 2024, 3 on March 11, 2024.
Every fire safety citation9 citations
- F Ensure that testing and maintenance of electrical equipment is performed.
- F Conduct testing and exercise requirements.
- F Have approved installation, maintenance and testing program for fire alarm systems.
- F Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
- F To conduct inspection, testing and maintenance of fire doors by qualified individuals.
- E Install emergency lighting that can last at least 1 1/2 hours.
- F Have approved installation, maintenance and testing program for fire alarm systems.
- F Ensure that testing and maintenance of electrical equipment is performed.
- F Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.
Fines and payment denials
CMS lists no fines or payment denials against this home in the last three years. The national average is 0.9 fines per home.
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) | 4.28 | 3.82 | 3.86 |
| Registered nurses | 0.40 | 0.74 | 0.69 |
| All nursing staff on weekends | 3.99 | 3.37 | 3.42 |
| Nurse aides | 3.06 | ||
| Licensed practical nurses | 0.82 | ||
| Nursing staff turnover (share who left in a year) | 40.0% | 44.0% | 45.8% |
| Registered nurse turnover | 28.6% | 42.1% | 42.9% |
| Administrators who left | 0 |
CMS expects 4.23 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 4.39 on weekdays and 3.99 on weekends, 9% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 0.0% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 4.19 in April to June 2025 to 4.28 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 | 4.28 | 0.40 | 4.39 | 3.99 | 0.0% | 0 of 90 | 65 |
| Oct to Dec 2025 | 3.96 | 0.42 | 4.09 | 3.63 | 0.0% | 0 of 92 | 69 |
| Jul to Sep 2025 | 4.14 | 0.48 | 4.30 | 3.73 | 0.0% | 0 of 92 | 63 |
| Apr to Jun 2025 | 4.19 | 0.41 | 4.37 | 3.74 | 0.0% | 0 of 91 | 64 |
| 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 | 23.5 | 17.1 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 0.5 | 1.5 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 0.0 | 2.4 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 5.1 | 3.8 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 0.0 | 2.1 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 19.9 | 16.6 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 2.7 | 4.2 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 9.2 | 19.4 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 25.4 | 20.9 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 23.8 | 13.2 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.2 | 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 |
Owners and operators
Legal business name: UNLIMITED DEVELOPMENT, INC. CMS links this home to Unlimited Development, Inc., a group of 10 nursing homes averaging 2.2 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Unlimited Development, Inc | 5% or greater direct ownership interest | Organization | 100% | 06/01/2010 |
| Ballew, Heather | W-2 managing employee | Individual | 04/27/2022 | |
| Finke, Audrey | Corporate director | Individual | 06/01/2010 | |
| Gilmore, Jerry | Corporate director | Individual | 06/01/2010 | |
| Haney, David | Corporate director | Individual | 06/01/2010 | |
| Wagner, Robert | Corporate director | Individual | 06/01/2010 | |
| Wilson, Ronald | Corporate officer | Individual | 06/01/2010 |
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.
- When is the care plan meeting, and can family attend it?Inspectors cited 4 problems in this area, most recently on September 18, 2025: "Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals."
- Can we see a week of menus and the kitchen, and how are special diets handled?Inspectors cited 2 problems in this area, most recently on September 18, 2025: "Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident."
- How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 1 problem in this area, most recently on September 18, 2025: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights."
- How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 1 problem in this area, most recently on July 16, 2024: "Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents."
Other nursing homes nearby
- Southeast Iowa Healthcare Center Keokuk, 0.8 mi · 4 of 5 stars · 7 citations
- Mississippi Valley Keokuk, 1.2 mi · 3 of 5 stars · 12 citations
- Montrose Health Center Montrose, 6.4 mi · 3 of 5 stars · 15 citations
- Birkwood Village of Fort Madison Fort Madison, 13.4 mi · 3 of 5 stars · 25 citations
- Clark County Nursing Home Kahoka, 16.1 mi · 2 of 5 stars · 27 citations
- West Point Care Center Inc West Point, 20 mi · 5 of 5 stars · 9 citations
- Lewis County Nursing Home District Canton, 21.3 mi · 1 of 5 stars · 42 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 River Hills Village in Keokuk's Medicare star rating?
- CMS rates River Hills Village in Keokuk 3 out of 5 stars overall, with 3 for health inspections, 3 for staffing and 4 for quality measures (CMS data as of September 1, 2026).
- How many deficiencies did River Hills Village in Keokuk get at its last inspection?
- 5 health deficiencies at the standard inspection on September 18, 2025. The Iowa average is 6.5.
- Has River Hills Village in Keokuk been fined?
- CMS lists no fines in the last three years.
- Does River Hills Village in Keokuk 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 River Hills Village in Keokuk?
- CMS lists 7 owners and managers, and links the home to Unlimited Development, Inc.. Legal business name: UNLIMITED DEVELOPMENT, INC.
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.