Below average — CMS composite of the measures below.
A standard survey is most likely before around August 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Southridge Specialty Care during CMS and state inspections, most recent first.
A resident with a history of psychiatric and mood disorders, who was prescribed multiple psychotropic medications and developed new diagnoses including bipolar and paranoid personality disorder, did not have their PASRR updated to reflect these changes. Staff interviews indicated uncertainty about when the new diagnoses were received and acknowledged that PASRR updates were expected but not completed. Facility policy required PASRR updates for residents with mental illness, but this was not followed.
Staff failed to follow infection control protocols during care for three residents, including an LPN who did not change gloves or perform hand hygiene between tracheostomy and gastrostomy care, and left and re-entered a resident's room wearing the same gown. The same LPN also did not sanitize hands between glove changes during a wound dressing change for another resident. Additionally, a CNA did not wear a gown while providing catheter care to a resident with an indwelling device, despite EBP signage and available PPE.
A resident with severe cognitive impairment and a history of falls was found on the bathroom floor by staff and assessed for injuries after a fall. Although the resident's family should have been notified promptly, the nurse did not inform them until the following day, contrary to facility policy requiring timely family notification after such incidents.
A resident with a facial lesion diagnosed as basal cell carcinoma did not receive a timely dermatology appointment after a physician's referral order. Despite the order being signed and the family notified, there was a two-month delay before the appointment was scheduled, with no documentation of efforts or reasons for the delay. Staff later discovered the initial referral was denied by insurance and only then sent a second referral, but the timing of this was not documented. Both the resident and her daughter reported no contact from the dermatology office.
A resident with severe cognitive impairment and a history of falls and skin picking developed multiple undocumented bruises that were not identified or assessed according to care plan directives and facility policy. Despite photographic evidence of bruising, staff failed to document or communicate these findings, resulting in missed interventions and incomplete records.
A resident with a physician's order for a mechanically soft diet was served a regular textured meal, including a lettuce salad with ham, during lunch service. Although staff believed the resident could have a regular diet, there was no documented physician order for this change at the time of the meal. The order for a regular diet was only obtained after the meal was served, resulting in the resident receiving a diet inconsistent with the documented order.
A resident with a history of diabetes, seizure disorder, alcoholic cirrhosis, and COPD experienced significant oral pain due to decayed teeth. Despite multiple dental visits and recommendations for urgent care, the facility failed to arrange necessary appointments and provide adequate pain management. The resident's condition worsened, affecting her ability to eat and drink, and leading to hospitalization. Interviews revealed a lack of follow-through on scheduling and acting on dental orders, highlighting the facility's failure to maintain the resident's well-being.
The facility failed to respond to call lights within 15 minutes, particularly during overnight shifts, due to inadequate staffing. Residents reported prolonged waits and staff turning off call lights without providing care. Staffing challenges were exacerbated by the use of uncertified aides who could not assist with direct care, impacting timely assistance for residents requiring two staff members.
A facility failed to document a PRN dose of Morphine for a resident in the controlled narcotic log book. The resident had orders for Morphine for chronic pain, and while scheduled doses were recorded, a PRN dose was missed. The DON acknowledged the oversight, noting the administering nurse was in training. The nurse confirmed their orientation included documentation procedures but could not recall the specific incident.
The facility failed to schedule timely dental services for two residents, leading to prolonged dental pain and inadequate care. One resident experienced severe dental issues and pain due to delayed follow-up on referrals for urgent dental care. Another resident suffered from ill-fitting dentures causing mouth sores, with inadequate follow-up on requests for denture refitting. Staff interviews revealed systemic issues in scheduling and communication, contributing to the delays in providing necessary dental care.
A significant medication error occurred in an LTC facility when a CMA mistakenly administered the wrong medications to two residents. One resident, with a history of heart failure and hypertension, received medications intended for another, leading to severe lethargy and hypoglycemia, requiring emergency intervention. The other resident experienced increased anxiety after receiving incorrect medications. The error was due to the CMA carrying medications for both residents simultaneously, resulting in immediate jeopardy to their health and safety.
A medication administration error occurred when a CMA failed to follow protocol, administering medications to two residents simultaneously. One resident received another's medications, including sedatives and antidiabetics, leading to severe lethargy and hospitalization. The error was identified when the resident reported unusual symptoms, prompting an investigation that revealed the breach in medication administration policy.
A resident with multiple health issues, including hypertension and pulmonary edema, experienced a change in condition, appearing drowsy and lethargic with a swollen hand and arm. Despite an increase in oxygen flow and consultation with a nurse practitioner, the facility failed to document the ongoing assessment of the resident's condition, leading to a deficiency in care standards.
The facility failed to maintain adequate staffing levels, leading to delayed call light responses for several residents. The PBJ Staffing Report showed low weekend staffing, confirmed by interviews with the Administrator and Scheduling Coordinator. Residents reported significant delays, with one waiting up to one and a half hours for assistance. The facility's policy on call light responses lacked a specified timeframe, contributing to inconsistent care delivery.
The facility failed to maintain resident dignity for two individuals. One resident, with intact cognition, was spoken to disrespectfully by staff, making her feel undervalued. Another resident, with moderately impaired cognition, was seen in a common area with a visible incontinent pad, contrary to dignity policies. The DON acknowledged the issue, noting the use of larger pads at residents' requests.
A resident with intact cognition and diagnoses of anxiety disorder, diabetes, and depression reported missing clothing items, including T-shirts and pants, to the facility's Administrator. Despite providing a list of missing items, the facility failed to take prompt action to resolve the grievance. A grievance form noted the complaint about a missing pair of pants, which were later found, but other items remained unaddressed, contrary to the facility's grievance policy.
Failure to Update PASRR Following New Mental Health Diagnoses
Penalty
Summary
The facility failed to submit a status change in the Preadmission Screening and Resident Review (PASRR) for a resident who received new mental health diagnoses. Clinical record review showed that the resident had a history of psychiatric and mood disorders, including depression and bipolar disorder, and was prescribed multiple psychotropic medications such as antipsychotics, antianxiety, and antidepressants. The resident's care plan was updated to reflect new diagnoses, including bipolar and paranoid personality disorder, as well as symptoms like tactile hallucinations. However, the PASRR Level I screening on file only documented depression and did not reflect the new mental health diagnoses or recent mental health symptoms, nor did it indicate that the resident was receiving mental health services. Staff interviews revealed that the social services staff was informed of new diagnoses during Quality Assurance meetings but was unsure when the resident received the new diagnoses. The staff member also indicated that managing PASRR updates was a new responsibility and acknowledged that updates are expected with new mental health diagnoses. The facility administrator agreed that the PASRR should have been updated. Facility policy required evaluation of residents on antipsychotic medications and completion of PASRR screenings for those with mental illness, but this process was not followed for the resident in question.
Failure to Follow Infection Control Guidelines During Resident Care
Penalty
Summary
The facility failed to adhere to infection prevention and control guidelines for three residents during direct care activities. In one instance, an LPN provided tracheostomy care to a resident with a history of stroke, quadriplegia, and respiratory failure, and then, without changing gloves or performing hand hygiene, proceeded to remove and clean the resident's gastrostomy tube dressing. The LPN also left the resident's room wearing the same gown, walked down the hall, and returned still wearing the gown to complete the dressing change, contrary to facility policy and infection control protocols. In another case, the same LPN performed a wound dressing change for a resident with cancer, coronary artery disease, and two Stage II pressure ulcers. After removing the old dressing, the LPN failed to sanitize her hands before donning new gloves and continuing with wound care. The LPN acknowledged this lapse immediately after the procedure. There was also no Enhanced Barrier Precautions (EBP) sign outside the resident's room, as required for residents with certain conditions. Additionally, a CNA provided catheter care to a resident with a history of stroke, hemiplegia, and seizure disorder, but did not wear a gown as required by EBP for high-contact care activities involving indwelling medical devices. The resident's room had signage and gowns available, but the CNA stated that gowns were only used when a resident had an active infection. The facility's policies required the use of PPE, including gowns, for such care activities, but these were not followed during the observed care.
Failure to Timely Notify Family After Resident Fall
Penalty
Summary
A resident with severely impaired cognitive functioning, as indicated by a BIMS score of 5, experienced a fall in the facility's bathroom. The resident required substantial to maximal assistance with activities of daily living and had a history of safety concerns, including a risk for falls and skin picking. On the evening of the incident, staff found the resident on the bathroom floor, assessed her for injuries, and noted complaints of hip and knee pain, but no visible injuries or swelling were observed. Neurological checks were initiated and found to be within normal limits. Despite the fall and the resident's condition, the nurse on duty did not notify the resident's family on the day of the incident. The family was informed the following day, after the facility became aware that notification had not occurred as required. Facility policy directs staff to document the date and time of family notification following accidents or incidents, but this was not followed in this case.
Failure to Timely Arrange Dermatology Referral for Resident with Skin Lesion
Penalty
Summary
The facility failed to follow a physician's order to arrange a dermatology appointment within a reasonable timeframe for a resident with an open lesion on the left cheek, which had been biopsied and identified as basal cell carcinoma. The physician's order for a dermatology referral was given and signed off by nursing staff, and both the resident and her family were notified of the referral. However, there was a two-month gap between the order and the actual dermatology appointment, with no documentation in the clinical record of attempts to make the appointment or any rationale for the delay. Staff interviews revealed that the initial dermatology referral was denied by insurance, and no appointment was scheduled as a result. The Assistant Director of Nursing was unaware of whether the dermatology office had contacted the resident or her family regarding the denial. Once it was discovered that no appointment had been made, a second referral was sent, but the clinical record did not specify when this occurred. Both the resident and her daughter confirmed they had not received any calls from the dermatology office. The facility's policy required consistent and effective order management, but this was not followed in this case.
Failure to Identify and Document Resident Bruising
Penalty
Summary
The facility failed to identify, assess, and implement interventions for a resident who exhibited multiple undocumented bruises on her body. The resident had severely impaired cognitive functioning, required substantial to maximal assistance with activities of daily living, and had a history of falls and skin picking. Despite care plan directives for weekly skin assessments and specific interventions for skin concerns, documentation and assessment of new bruises were not completed as required. Photographic evidence showed bruising on the resident's forehead, knees, and buttocks over several days, but these were not recorded in the weekly skin observation tools, which indicated no new skin issues during the same period. Interviews revealed that CNAs did not alert nurses to new skin concerns, assuming nurses were already aware due to prior assessments after a fall. The facility's policy required thorough documentation, including physician and family notification, completion of incident reports, and investigation of causation for any abrasions, skin tears, or bruises. However, these steps were not followed for the resident's bruises, resulting in a lack of appropriate assessment and intervention according to the resident's care plan and facility policy.
Resident Served Incorrect Diet Due to Lack of Updated Physician Order Documentation
Penalty
Summary
A deficiency occurred when a resident with a physician's order for a mechanically soft textured diet was served a regular textured meal during lunch service. The resident, who had a diagnosis of seizure disorder and a history of dental problems, was observed eating a large lettuce salad with ham, which did not conform to the prescribed mechanically altered diet. The resident's Minimum Data Set (MDS) indicated intact cognition and independent eating, and the dietary order for a regular diet was not documented in the clinical record at the time of the meal service. Staff, including the Licensed Nursing Home Administrator (LNHA) and Assistant Director of Nursing (ADON), acknowledged that the order for a regular diet had not been entered into the resident's record prior to the meal. The ADON confirmed that the order for a regular diet was obtained after the lunch observation. The facility was unable to provide documentation supporting a physician's order for a regular diet at the time of the survey, resulting in the resident receiving a diet inconsistent with the current documented physician's order.
Inadequate Pain Management and Follow-Up Care for Resident with Dental Issues
Penalty
Summary
The facility failed to provide adequate pain management and follow-up care for a resident experiencing significant oral pain due to grossly decayed and non-restorable teeth. The resident, who had a history of diabetes, seizure disorder, alcoholic cirrhosis, and COPD, reported mouth pain in July 2024 and was seen by a dentist in August 2024. The dentist referred the resident to a university dental office for further evaluation and treatment, but the facility did not arrange the necessary appointment. As a result, the resident continued to experience oral pain, which affected her ability to eat and drink. Despite multiple visits to the dentist and recommendations for urgent care, the facility did not ensure timely transportation to the university hospital emergency room for the necessary dental extractions. The resident's pain was managed only with Tylenol, mouthwash, Orajel, and viscous lidocaine, which were insufficient to alleviate her discomfort. The resident's condition worsened, leading to a change in mental status, difficulty breathing, and heart irregularities, which required hospitalization. Interviews with facility staff revealed a lack of follow-through on scheduling the recommended dental appointments and a failure to act on the dentist's orders for immediate care. The facility's policies on pain assessment and management were not effectively implemented, resulting in prolonged, unrelieved pain for the resident. The deficiency highlights the facility's failure to maintain the resident's highest practical physical well-being and function.
Inadequate Response to Call Lights Due to Staffing Issues
Penalty
Summary
The facility failed to consistently answer call lights within a reasonable amount of time, specifically within 15 minutes, for both of its nursing units. Observations and interviews revealed that call lights were often left unanswered for extended periods, with some residents reporting waits of up to an hour. Residents expressed frustration over staff turning off call lights without providing the requested care, and some staff admitted to ignoring call lights due to being overwhelmed or annoyed. The issue was particularly pronounced during overnight shifts when staffing levels were lower. Interviews with staff, including CNAs and RNs, highlighted the challenges faced during overnight shifts. Typically, the facility staffed each unit with one nurse and two aides, one of whom might be uncertified and unable to provide direct care or assist with lifting. This staffing pattern made it difficult to provide timely care, especially for residents requiring assistance from two staff members. The facility's Director of Nursing acknowledged the staffing challenges and noted that the facility relied on PRN staff or volunteers to fill gaps when regular staff called in sick. The facility's assessment and staffing patterns were reviewed, revealing that the facility's staffing decisions were based on resident acuity, census, and budget considerations. However, the assessment lacked specific information on the acuity of residents and the amount of ADL assistance required. The facility's staffing program aimed to align staffing with resident needs and budget constraints, but the current staffing levels were insufficient to meet the needs of residents, particularly during overnight shifts when the number of CNAs was reduced.
Failure to Document PRN Morphine Administration
Penalty
Summary
The facility failed to maintain accurate records for the administration of controlled substance medications for a resident. The resident had orders for Morphine 0.25 ml to be administered three times a day for chronic pain and as needed for pain every eight hours. On a specific date, the scheduled doses were documented correctly, but a PRN dose administered late at night was not recorded in the Liquid Controlled Narcotic log book. This log book is separate from the one used for other forms of narcotics, such as patches or pills. The Director of Nursing acknowledged the missing documentation during an interview, noting that the staff member responsible was still in training. The staff member, a registered nurse, confirmed that their orientation included instructions on documenting narcotic administration, which involves both computer charting and signing the narcotic book. However, the nurse could not recall the specific incident but agreed it was possible due to their newness to the position. The facility's policy on controlled substances requires detailed documentation for each administration, which was not followed in this instance.
Failure to Schedule Timely Dental Services for Residents
Penalty
Summary
The facility failed to schedule routine and emergency dental service appointments for two residents, leading to prolonged dental pain and inadequate care. One resident, with a history of diabetes, seizure disorder, and chronic pain, experienced significant dental issues, including non-restorable carious teeth and severe pain, which were not promptly addressed. Despite multiple referrals and recommendations for urgent dental care, the facility did not ensure timely follow-up or transportation to the necessary dental services, resulting in the resident suffering from increased pain and difficulty eating. Another resident, diagnosed with muscular dystrophy and diabetes, experienced issues with ill-fitting dentures that caused mouth sores and pain. Although the resident requested a referral for denture refitting, the facility failed to ensure timely follow-up appointments. The resident's clinical records lacked documentation of necessary dental appointments, and there was a lack of consistent administration of prescribed pain relief measures, such as Orajel and warm salt water rinses. Interviews with staff revealed systemic issues in scheduling and following up on dental appointments, as well as communication breakdowns within the facility. Staff members acknowledged the challenges in coordinating transportation and appointments, which contributed to the delays in providing necessary dental care. The facility's routine dental care policy, which mandates timely dental consultations and follow-ups, was not adhered to, resulting in inadequate care for the residents involved.
Significant Medication Error in LTC Facility
Penalty
Summary
The facility failed to prevent a significant medication error involving two residents. During a morning medication pass, a Certified Medication Aide (CMA) mistakenly administered the wrong medications to two residents. The CMA carried the oral medications for both residents in clear plastic cups in one hand and placed them on the bedside tables of each resident. As a result, one resident received the medications intended for the other, leading to severe adverse effects. The resident who received the incorrect medications became lethargic and difficult to arouse during a morning activity. This resident, who had a history of heart failure, hypertension, asthma, and cerebrovascular accident, was found to be somnolent and required emergency medical intervention. The resident was sent to the emergency room and admitted with adverse effects, including hypoglycemia and lethargy. The medications mistakenly administered included diabetes, hypertension, and sedative medications, which significantly impacted the resident's health. The other resident, who was supposed to receive the medications, experienced increased anxiousness and crying episodes throughout the day. This resident had a history of hypertension, GERD, diabetes, anxiety, and depression and was independent with ambulation using a wheelchair. The error was identified when the resident reported receiving a green pill that was not part of their usual medication regimen. The incident highlighted a critical lapse in the facility's medication administration process, leading to immediate jeopardy to the health and safety of the residents involved.
Removal Plan
- Medication Administration Education
- Has Medication Administration Record (MAR) with medication cart
- Checks medication against MAR for the following: Right Medication, Right resident, right route, Right time, Right dose
- Completes 3 checks against MAR: Before removing from drawer, As medication is being removed from card, Before returning drug to drawer
- Locks Cart and provides privacy screen to computer
- Delivers medication to ONE resident and visualizes medication being swallowed
- Performs hand hygiene
- Returns to med cart and signs off medications
- The staff will follow the Medication Administration policy, the facility educated the nursing staff who administer medication regarding the policy
- Medication will be administered to one resident at a time
- The facility will conduct audits to assure staff perform the medication pass appropriately
- The facility educated the nursing staff, who pass residents' medication, regarding medication administration expectations regarding the 5 rights
- Corrective action taken for resident(s) affected: Resident #1 sent to hospital for treatment
- Risk management completed for Resident #1 and Resident #2
- The nursing staff monitored Resident #2 for any changes in condition
Medication Administration Error Leads to Hospitalization
Penalty
Summary
The facility failed to adhere to professional standards of medication administration, resulting in a significant medication error involving two residents. The Certified Medication Aide (CMA) did not follow the protocol of administering medications to one resident at a time, leading to a mix-up where one resident received another's medications. This error was identified when a resident reported feeling unusually lethargic and seeing double, prompting an investigation that revealed the CMA had administered medications to both residents simultaneously without ensuring the correct distribution. Resident #1, who was cognitively intact and independent with ambulation, received medications intended for Resident #2, including multiple sedating medications and antidiabetic drugs, despite not having diabetes. This led to Resident #1 experiencing severe lethargy, hypotension, and toxic metabolic encephalopathy, necessitating emergency medical intervention and hospitalization. The incident was compounded by the CMA's inability to confirm whether the correct medications were given, highlighting a breach in the facility's medication administration policy. Resident #2, who also had no cognitive impairments and was independent with a wheelchair, reported receiving a green pill she had never taken before, which was not part of her prescribed medication regimen. This resident experienced anxiety and facial flushing following the medication error. Interviews with staff confirmed that the CMA had improperly handled the medication pass by carrying and administering medications for both residents simultaneously, contrary to the facility's policy of verifying and administering medications to one resident at a time.
Failure to Document Resident's Change in Condition
Penalty
Summary
The facility failed to provide necessary services in accordance with professional standards for a resident, identified as Resident #11, who was reviewed for assessment and intervention. Resident #11 had a Minimum Data Set (MDS) assessment indicating intact cognition and was independent in activities of daily living. The resident had multiple diagnoses, including hypertension, anemia, cerebral palsy, asthma, and chronic pulmonary edema, and required continuous oxygen therapy. The care plan included interventions for managing these conditions, such as administering medications, monitoring for side effects, and documenting any abnormalities. On the day of the incident, the nurse observed Resident #11 appearing drowsy and lethargic during lunch, with an almost empty oxygen tank, which was subsequently replaced. Later, the resident was found with a swollen left hand and arm, purple lips, and pale skin, while complaining of shortness of breath. The nurse increased the oxygen flow and contacted the on-call nurse practitioner, who advised sending the resident to the emergency room. Despite the EMTs questioning the decision due to a 97% oxygen reading, the nurse insisted on the transfer due to the resident's unusual behavior and condition change. The Assistant Director of Nursing confirmed that the clinical record lacked documentation of an ongoing assessment of Resident #11's change in condition. The facility's policy required documentation of all services provided, progress toward care plan goals, and any changes in the resident's condition. The deficiency was identified as a failure to document the resident's condition and response to care, which is essential for communication among the interdisciplinary team.
Inadequate Staffing Leads to Delayed Call Light Responses
Penalty
Summary
The facility failed to maintain adequate staffing levels, resulting in delayed responses to call lights for several residents. The Payroll Based Journal (PBJ) Staffing Report indicated excessively low weekend staffing, which was confirmed by interviews with the Administrator and Scheduling Coordinator. The facility's staffing schedule typically included three aides on each side during the day and one aide on each side overnight, with a float. However, on weekends, the facility lacked restorative or shower aides, and staff were often required to find their own coverage if they called in sick. This led to situations where only two aides per side and a float were available, slowing down care delivery. The Director of Nursing acknowledged past staffing shortages on second and third shifts, although she believed the situation was improving. The Daily Staffing Sheet revealed multiple weekend shifts with unfilled positions, confirming the staffing deficiencies. Residents reported significant delays in call light responses, with one resident waiting between one to one and a half hours for assistance. Another resident described unpredictable wait times that could exceed half an hour, while a third resident reported consistently waiting about 30 minutes. A fourth resident noted that weekend staffing was particularly inadequate, with minimal staff presence and prolonged response times. The facility's policy on answering call lights lacked a specified response time, contributing to the inconsistency in addressing residents' needs. All residents involved had intact cognition, as indicated by their Brief Interview of Mental Status (BIMS) scores.
Failure to Ensure Resident Dignity in Communication and Personal Care
Penalty
Summary
The facility failed to ensure a dignified existence for two residents, as observed during a survey. For one resident, who had intact cognition and diagnoses including heart failure and non-Alzheimer's dementia, staff failed to communicate respectfully. A Certified Nursing Assistant (CNA) reported that another CNA told the resident that the aides were on their time, not the resident's, which was perceived as rude. The resident later expressed feeling undervalued when a staff member told her that other residents were sicker than she was, especially after her recent hospitalization. Another resident, with moderately impaired cognition and diagnoses including heart failure and schizophrenia, was observed in a common area with a disposable incontinent pad visibly protruding from under him. This situation persisted for several hours, during which the resident was in view of staff and other residents. The facility's policy on dignity, which emphasizes treating residents with respect and promoting their self-esteem, was not adhered to in these instances. The Director of Nursing acknowledged the issue, noting that larger pads were used at the residents' request, which often led to them sticking out.
Failure to Promptly Resolve Resident's Grievance on Missing Items
Penalty
Summary
The facility failed to promptly resolve a grievance related to missing items for a resident with intact cognition, as indicated by a BIMS score of 15. The resident, who had diagnoses of anxiety disorder, diabetes, and depression, reported that several clothing items, including T-shirts and pants, had disappeared. Despite providing the Administrator with a list of missing items, the resident stated that no action had been taken. A grievance form dated over a month prior noted the resident's complaint about a missing pair of pants, which were later found, but the facility had not yet replaced the other missing items as promised. The facility's grievance policy, revised in April 2017, required investigation and corrective action for all grievances, which was not adhered to in this case.
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Illustrative
What surveyors actually found near you
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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.
Illustrative
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Illustrative
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Nursing homes near Marshalltown
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Accura Healthcare Of Marshalltown | 0.3 mi | ★★★★★ | 14 | 0 |
| Harmony Marshalltown | 1.4 mi | ★★★★★ | 18 | 0 |
| Iowa Veterans Home | 2.9 mi | ★★★★★ | 6 | 0 |
| State Center Specialty Care | 13.1 mi | ★★★★★ | 11 | 0 |
| Oakview Nursing Home | 14.8 mi | ★★★★★ | 1 | 0 |
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