600 West 6th Street, Wall Lake, IA 51466 · Sac County · (712) 664-2488
39 certified beds, about 28 residents a day · Non profit - Corporation · Medicare and Medicaid since 2003
CMS Care Compare ratings, data as of September 1, 2026 · CCN 165488 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on December 18, 2025, inspectors cited 3 health deficiencies (the Iowa average is 6.5, the national average 9.2).
None of its 7 health citations since October 2023 was rated as actual harm or immediate jeopardy.
CMS lists no fines against this home in the last three years.
Nurses and nurse aides worked 4.07 hours per resident per day, against 3.82 across Iowa and 3.86 nationally. Registered nurses accounted for 0.73 of those hours.
34.5% of nursing staff left within the year CMS measured (Iowa average 44.0%).
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 7 health citations on file.
Inspectors wroteBased on observation, record review, and staff interview, the facility failed to ensure a resident received care, consistent with professional standards of practice, to prevent pressure ulcers for 1 of 3 residents reviewed (Resident #2). The facility reported a census of 29 residents.
Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure a consistent code status between the IowaPhysician's for Scope of Treatment (IPOST), and the Electronic Health Record (EHR) for 3 of 12 resident reviewed for advanceddirectives (Resident #18, #23 and #26). The facility reported a census of 26 residents.
Inspectors wroteBased on clinical record review, staff interviews and policy review, the facility failed to offer to provide pneumococcal vaccine for 5 of 5 residents reviewed for Resident #2, #3, #10, #11, and #24. The facility reported a census of 26 residents.
Inspectors wroteBased on record review, staff interview, and policy review, the facility failed to ensure as needed (PRN) orders for psychotropic medications were limited to 14 days unless the attending physician or prescribing practitioner believed it appropriate for the PRN order to be extended beyond 14 days, and documented their rationale in the resident's medical record and indicated the duration for the PRN order, for 2 of 5 resident's reviewed (Resident #7 and #24). The facility reported a census of 26 residents.
Inspectors wroteBased on record review and staff interview the facility failed to asses and provide interventions for residents who displayed respiratory symptoms for 2 of 2 residents reviewed, (Residents #1 and #16). The facility reported a census of 23.
Inspectors wroteBased on record review, staff interview, Resident Assessment Instrument (RAI) manual, and policy review the facility failed to complete a significant change Minimum Data Set (MDS) within 14 days for a resident who started on hospice care for 1 of 3 residents reviewed (Resident #8).
Inspectors wroteBased on record review, staff interview, and policy review, the facility failed to have the necessary required members (Infection Preventionist) attend the quarterly Quality Assurance (QA) meetings. The facility reported a census of 24 residents.
34 fire safety citations on file: 1 on January 29, 2026, 19 on December 18, 2025, 11 on December 12, 2024, 3 on October 19, 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) | 4.07 | 3.82 | 3.86 |
| Registered nurses | 0.73 | 0.74 | 0.69 |
| All nursing staff on weekends | 3.73 | 3.37 | 3.42 |
| Nurse aides | 2.44 | ||
| Licensed practical nurses | 0.91 | ||
| Nursing staff turnover (share who left in a year) | 34.5% | 44.0% | 45.8% |
| Registered nurse turnover | 28.6% | 42.1% | 42.9% |
| Administrators who left | 1 |
CMS expects 3.55 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 4.21 on weekdays and 3.73 on weekends, 11% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 20.4% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 4.62 in April to June 2025 to 4.07 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 | 4.07 | 0.73 | 4.21 | 3.73 | 20.4% | 0 of 90 | 28 |
| Oct to Dec 2025 | 4.23 | 0.98 | 4.40 | 3.80 | 26.9% | 1 of 92 | 25 |
| Jul to Sep 2025 | 4.80 | 1.00 | 4.98 | 4.35 | 14.6% | 0 of 92 | 21 |
| Apr to Jun 2025 | 4.62 | 1.05 | 4.76 | 4.27 | 17.2% | 0 of 91 | 22 |
| 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. If you work here, your report helps start one.
| 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 | 4.8 | 17.1 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 1.5 | 1.5 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 2.5 | 2.4 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 9.9 | 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 | 8.8 | 16.6 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 0.0 | 4.2 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 9.4 | 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 | 1.2 | 2.1 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Twilight Acres'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. 21 eligible stays.
10.1% 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. 27 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. 12 eligible stays.
65.0% this home
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. 20 residents counted.
4.3% 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. 23 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. 23 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. 5 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: TWILIGHT ACRES INC..
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Aschinger, Marilyn | Corporate director | Individual | 01/01/2014 | |
| Stoltenberg, Ann | Corporate director | Individual | 01/01/2024 | |
| Vilhauer, Ann | Corporate director | Individual | 01/19/2010 | |
| Hundling, Melanie | Corporate officer | Individual | 04/18/2023 | |
| Schmitz, Sandra | Corporate officer | Individual | 04/18/2023 | |
| Schroeder, Diane | Corporate officer | Individual | 04/18/2023 | |
| Geibe, Nicole | Operational/managerial control | Individual | 07/29/2024 | |
| Harman, Tony | Operational/managerial control | Individual | 09/24/2024 | |
| Helm, Cindy | Operational/managerial control | Individual | 03/28/2002 | |
| Horsley, Alison | Operational/managerial control | Individual | 04/13/2015 | |
| Pek, Zoltan | Operational/managerial control | Individual | 01/06/2023 | |
| Steinkamp, Jenna | Operational/managerial control | Individual | 12/14/2015 | |
| Bcg Holdings Inc | Adp of the SNF | Organization | 10/01/2024 | |
| Brighton Consulting Group LLC | Adp of the SNF | Organization | 10/01/2024 | |
| Cattail Bcg LLC | Adp of the SNF | Organization | 10/01/2024 | |
| Cattail Inc | Adp of the SNF | Organization | 10/01/2024 | |
| Ecsi Inc | Adp of the SNF | Organization | 10/01/2024 | |
| Iowa Health Care Association | Adp of the SNF | Organization | 10/01/2024 | |
| Key Rehabilitation Inc | Adp of the SNF | Organization | 08/01/2023 | |
| Olsen, Muhlbauer & Co, LLP | Adp of the SNF | Organization | 06/01/2007 | |
| Horsley, Alison | Adp of the SNF | Individual | 12/10/2025 | |
| Pek, Zoltan | Adp of the SNF | Individual | 12/10/2025 |
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.
These are the official offices in Iowa. NursingHomeClear cannot take or act on complaints.