Average — CMS composite of the measures below.
A standard survey is most likely before around December 2026
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at River Hills Village In Keokuk during CMS and state inspections, most recent first.
A cook served incorrect portion sizes to residents ordered mechanical soft and pureed diets during a meal service observation. The Dietary Manager confirmed the portions were smaller than required based on the food prepared and measured. The affected residents had dementia, dysphagia, severe cognitive impairment, and physician-ordered modified diets, with several care plans noting choking and weight loss risk.
Unsanitary Food Handling During Meal Service: A cook served lunch in the memory care dining unit and then continued wearing the same gloves while handling the steam table cart, including the cord, before moving to the main dining room. The cook then served food in the main dining room without changing gloves or washing hands, and was observed touching plated food and areas of the plate with unclean gloves. The DON confirmed the cook should have changed gloves and washed hands before serving in the second dining area.
A resident with severe cognitive impairment, bilateral lower extremity impairment, and wheelchair use was repeatedly transported from the dining room to her room in a non-mechanical stand aid instead of a wheelchair. Staff C told the resident to stand, stay awake, and hold onto the bar while pulling her across the room, and staff later acknowledged the practice had become routine. The DON confirmed this was a dignity concern because the resident was visible to other residents and family during the transport.
Failure to include a resident and the resident's representative in the care plan process. A resident with HF, respiratory failure, cognitive communication deficit, malnutrition, mobility impairments, and a BIMS score indicating moderate cognitive impairment said he was not aware of care planning and was unsure whether family was involved. The record showed only early care conferences, with no documentation of invitations, refusals, or participation for later quarterly and significant change assessments. The resident also reported worn upper dentures that made eating difficult, but the care plan did not address the denture concern, and the POA said they had not been invited to care conferences since the prior year.
A resident with multiple pressure ulcer risk factors and an ordered topical wound treatment developed open buttock and scrotal wounds, but the charting was inconsistent and incomplete. Staff documented only brief descriptions of blanchable redness on earlier dates, while later observation found multiple open wounds with drainage. Interviews showed a CNA reported the wound to an RN, the RN applied Triad cream through a CNA and later admitted he did not document the wound or explain why, and the DON stated the nurse should have documented the open wound and notified the physician and POA.
A resident with diabetes received insulin without the pen being primed, as observed during a medication administration task. The LPN administering the insulin was not aware of the correct priming procedure, which was later clarified by the DON. The facility's policy did not address insulin pen use, contributing to the oversight.
A resident with a history of stroke and hemiplegia suffered a leg fracture due to improper transfer by a CNA who failed to use the prescribed Manual Stand Aid. The CNA mistakenly performed a stand pivot transfer, leading to the resident's leg getting caught and twisted. The incident was not immediately reported, and an X-ray confirmed a fracture. The facility's investigation revealed a lack of adherence to the care plan and communication breakdown among staff.
Incorrect Portion Sizes Served for Modified Diets
Penalty
Summary
The facility failed to ensure dietary staff served the correct portion sizes for residents ordered mechanical soft or pureed diets during one meal service observation. During lunch preparation, the cook ground beef pot roast for mechanical soft and pureed diets, added bread and butter for the pureed mixture, and measured the finished foods. The Dietary Manager reviewed the portion chart and stated the cook should have used two #8 scoops for the pureed meat and a #8 scoop plus a #10 scoop for the mechanical soft meat, but the cook instead served each resident with only one #8 scoop. During the meal service, the cook served six residents with mechanical soft diets and three residents with pureed diets using the smaller portion size. The cook later confirmed she should have used two #8 scoops for the pureed meat and a #8 scoop plus a #10 scoop for the mechanical ground meat. The Dietary Manager also confirmed, based on the amount of food prepared and measured, that the mechanical soft portions should have been larger than what was served. The affected residents had diagnoses and care needs that included dementia, dysphagia, malnutrition, severe cognitive impairment, and dependence or assistance with eating. Their records showed physician orders for mechanical soft or pureed diets, and several care plans identified risks for choking and weight loss. The facility policy stated that food service staff were responsible for serving food as ordered.
Unsanitary Food Handling During Meal Service
Penalty
Summary
The facility failed to ensure dietary staff served food under sanitary conditions during one observed meal service. During an observation in the memory care dining unit, a cook uncovered the pans on the steam table, gloved, uncovered plates, and served the lunch meal to residents. After completing service in memory care, the cook kept the same pair of gloves on while covering the food pans, unplugging the steam table cart, picking the electric cord off the floor, winding the cord, and placing it on the bottom of the cart before pushing the cart to the main dining room. The cook then served lunch in the main dining room while still wearing the same gloves. During that service, the cook was observed touching the gloves with food that had been scooped onto plates and placing food on areas of the plate where the unclean gloves had touched. The Dietary Manager later confirmed that the cook should have changed gloves and washed hands before serving food in the main dining room. The facility policy identified food service staff as responsible for serving food, and the FDA Food Code section cited in the report required food employees to clean their hands and exposed portions of their arms before food preparation and after handling soiled equipment or utensils or engaging in activities that contaminate the hands.
Resident Transported in Stand Aid Across Dining Room
Penalty
Summary
The facility failed to ensure staff transferred Resident #18 in a dignified manner. Resident #18 had severe cognitive impairment with a BIMS score of 2 out of 15, bilateral lower extremity impairment, used a wheelchair, and required partial/moderate assistance with sit-to-stand and dependent assistance for chair/bed-to-chair transfers. The care plan directed staff to use an assist x1 manual stand aid for all transfers and a wheelchair for mobility. During multiple observations, Staff C, a CNA, used the non-mechanical stand aid to transport Resident #18 from the dining room table to the resident’s room. On one observation, Staff C assisted the resident onto the stand aid, asked the resident multiple times to stand, and then transported the resident while telling her she could not be sleeping and needed to hold onto the bar. Staff C reminded the resident to stay awake while pulling her to her room. Staff interviews confirmed this practice had become a pattern, and Staff B stated there was a dignity concern because the resident was visible to other residents and family while being transported across the room. The DON also stated the resident should have been transported in a wheelchair and confirmed the stand aid was meant for a short transfer, not for wheeling across the room.
Failure to Include Resident and Representative in Care Planning
Penalty
Summary
The facility failed to ensure the resident and the resident's representative were included in the care plan process for one sampled resident. The resident's MDS assessment dated 8/20/25 documented diagnoses of heart failure, respiratory failure, cognitive communication deficit, and malnutrition, along with bilateral upper and lower body impairments, wheelchair use, dependence on staff for toileting hygiene and transfers, and a BIMS score of 12 out of 15. On 9/16/25, the resident stated he was not aware of being involved in the care planning process and was unsure whether his family had been involved. Review of the clinical record showed an admission assessment, three quarterly assessments, and one significant change in condition assessment, but the record contained care conference documentation only for two meetings in November and December 2024. Those meetings documented participation by the resident and family, but there was no documentation of care conferences, invitations, or refusal to attend for the later quarterly assessments or the significant change assessment. The ADON/MDS Coordinator stated she was responsible for scheduling care conferences and sending invitations, but she did not keep copies of invitations and confirmed there was no documentation that the resident had been invited or had refused to attend. The resident also reported that his upper dentures were worn out and needed repair or replacement, and that the problem made it difficult to eat. A physician order dated 4/4/25 directed staff to make an appointment for the dentures, but the record lacked other documentation about the issue. The care plan, last revised 9/15/25, addressed risk for weight loss and choking due to dysphagia, but did not identify the denture concern. The resident's POA reported not being invited to care conferences since December 2024 and was unaware of the denture problem, while staff confirmed the resident had been waiting since April 2025 for denture repair.
Wound Care Documentation and Treatment Failure
Penalty
Summary
The facility failed to follow professional standards of practice for wound care documentation and treatment for a resident with multiple risk factors, including heart failure, respiratory failure, malnutrition, chronic kidney disease, diabetes, limited mobility, and a history of pressure injuries. The resident’s care plan identified risk for pressure ulcers and included interventions such as pressure-relieving devices, skin assessment, and turning and repositioning. A physician order was in place for Miconazole antifungal cream mixed with Triad cream to be applied daily to the coccyx, buttock, and right hip until healed. Treatment records showed the ordered cream mixture was applied on several days, but the electronic record contained only brief nursing notes describing blanchable light pink erythema or blanchable redness, with no further documentation of the buttocks condition after 9/14/25 until the wound was observed again. During an observation, staff measured four open wounds on the resident’s buttock and scrotum area, and the LPN reported the wounds had opened that day. The resident also stated he had a sore on his bottom and reported pain with wound care. Interviews with staff showed conflicting accounts about when the wounds opened and who assessed them. A CNA reported open areas and drainage on the resident’s buttocks during the prior shift, and another CNA reported telling an RN about an open, leaking buttock wound. The RN confirmed he had been told about the wound and said he assessed the area, found one open wound, and gave Triad cream to the CNA to apply. The RN later acknowledged he did not document the wounds, could not explain why, and stated he should have documented the assessment, notified the physician, and opened an event record. The DON stated the nurse should have documented the open wound and notified the physician and the resident’s POA when the wound was discovered.
Failure to Prime Insulin Pen Before Administration
Penalty
Summary
The facility failed to ensure proper insulin administration procedures were followed for a resident with diabetes, specifically regarding the priming of an insulin pen. The resident, who had severely impaired cognition as indicated by a score of 4 out of 15 on a mental status exam, was observed receiving insulin without the pen being primed. This observation was made during a medication administration task by an LPN who did not perform the necessary priming step before administering the insulin. The LPN explained that she was informed by the Assistant Director of Nursing (ADON) that priming was not necessary if the bubble was in a specific place in the pen. However, the Director of Nursing (DON) later clarified that the correct procedure involved priming the pen with two units of insulin. The facility's policy on insulin administration did not address the use of insulin pens, and additional documentation provided by the DON outlined the correct priming procedure, which was not followed in this instance.
Failure to Use Prescribed Transfer Equipment Results in Resident Injury
Penalty
Summary
The facility failed to use the necessary transfer equipment when assisting a resident in the bathroom, resulting in a lower leg fracture. Resident #2, who had a history of stroke, arthritis, and hemiplegia affecting the right side, was assessed as dependent on staff for toileting hygiene and chair/bed to chair transfers. The care plan specified the use of a Manual Stand Aid with assistance from one staff member for transfers. However, during a transfer from the toilet to the wheelchair, the CNA used a stand pivot transfer instead of the prescribed Manual Stand Aid, leading to the resident's leg getting caught and twisted, causing pain and a subsequent fracture. The incident occurred when Staff B, a CNA, mistakenly identified Resident #2 as another resident and performed a stand pivot transfer instead of using the stand aid. This error was compounded by the CNA's failure to immediately report the incident to the nursing staff, as she was preoccupied with other duties. The resident expressed pain in her right hip and leg following the transfer, and an X-ray later confirmed a comminuted fracture through the proximal fibula. The facility's investigation revealed that the CNA was not familiar with the resident's transfer status and had not checked the care plan or the whiteboard in the nurse's station where such information was posted. Interviews with staff and the resident highlighted the communication breakdown and lack of adherence to the care plan. Staff A, an RN, and the ADON were informed of the incident after the resident's family raised concerns. The CNA admitted to confusing Resident #2 with another resident and acknowledged her mistake. The facility's Safe Resident Handling Policy emphasized the importance of assessing residents for safe handling and ensuring staff were aware of the correct transfer methods, which were not followed in this case.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Keokuk
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Southeast Iowa Healthcare Center | 0.8 mi | ★★★★★ | 7 | 1 |
| Mississippi Valley | 1.2 mi | ★★★★★ | 7 | 0 |
| Montrose Health Center | 6.4 mi | ★★★★★ | 4 | 0 |
| Birkwood Village Of Fort Madison | 13.4 mi | ★★★★★ | 6 | 0 |
| Clark County Nursing Home | 16.1 mi | ★★★★★ | 1 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.