Above average — CMS composite of the measures below.
A standard survey is most likely before around November 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 Stonehill Care Center during CMS and state inspections, most recent first.
The facility did not establish or maintain an infection prevention and control program as required, resulting in a deficiency identified by surveyors.
Two residents received insulin via Kwik pen without the required priming step, as a RN failed to follow proper administration procedures. This led to an 8% medication error rate, with staff interviews confirming knowledge of the correct process but non-compliance during administration.
Failure to Implement Infection Prevention and Control Program
Penalty
Summary
The facility failed to provide and implement an infection prevention and control program. This deficiency was identified during the survey process, indicating that the required measures to prevent and control infections were not established or maintained as per regulatory standards. The report does not provide specific details about the actions or inactions of staff, nor does it mention any particular residents or incidents that led to the deficiency. The observation is limited to the absence or inadequacy of the infection prevention and control program itself.
Failure to Prime Insulin Pens Results in Medication Errors
Penalty
Summary
The facility failed to properly administer insulin using a Kwik pen for two residents, resulting in a medication error rate of 8%. For both residents, staff did not prime the insulin pen prior to administration as required. Specifically, a registered nurse administered 2 units of Lispro insulin to one resident and 8 units to another without priming the pen, which is necessary to remove air from the needle and cartridge and ensure accurate dosing. The medication administration records confirmed sliding scale insulin orders for both residents. Staff interviews revealed that the nurse responsible did not prime the insulin pen due to nervousness, despite being aware of the correct procedure. Other staff and the co-director of nursing confirmed that priming with at least 2 units is the expected practice, and the manufacturer’s instructions also require priming before each injection. The facility had a census of 158 residents at the time of the survey.
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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.
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Nursing homes near Dubuque
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Sunnycrest Manor | 0.6 mi | ★★★★★ | 6 | 0 |
| Bethany Home | 1 mi | ★★★★★ | 0 | 0 |
| Dubuque Specialty Care | 2.4 mi | ★★★★★ | 0 | 0 |
| Harmony Dubuque | 2.7 mi | ★★★★★ | 10 | 0 |
| Luther Manor At Hillcrest | 3 mi | ★★★★★ | 18 | 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 July 2026) and official state health department websites.