The Highlands in Decorah, IA has a 2-star overall rating, with 2 stars for health inspections and 3 stars for staffing, while quality measures are 4 stars. It has a recent federal penalty with $93,839 in fines over the last 24 months, and reported nurse staffing is 3.57 hours per resident per day versus the 4.1 federal benchmark.
Last inspection: September 23, 2025Penalties, last 24 months: $93,839recent federal penalty
Federal guidance recommends at least 4.1 nursing hours per resident each day. This facility reports 3.5707.
Staffing detail
Registered nurses
0.54
Licensed practical nurses
0.52
Nurse aides
2.51
Weekend nursing
3.14
Hours per resident per day.
Total staff turnover: 55%
Registered nurse turnover: 38%
Resident outcomes
Each measure compares a year ago with the most recent quarter. Green means the facility moved the right way; red means the wrong way.
Negative outcomes
Lower is better — fewer affected residents. A decrease is good (green); an increase is concerning (red).
Last yrNowTrend
Long-stay residents on antipsychotic medication
18.8%29.4%Worsening
Residents with a fall causing major injury
0%3.2%Worsening
Residents with pressure ulcers (bedsores)
6.3%6.5%No change
Residents with a urinary tract infection
0%0%No change
Residents who lost too much weight
6.8%4.4%Improving
Residents who were physically restrained
0%0%No change
Residents needing more help with daily activities
20%26.2%Worsening
Residents whose ability to walk got worse
15%21.3%Worsening
Long-stay residents on antianxiety or sleep medication
13.6%23.9%Worsening
Short-stay residents newly given an antipsychotic
—0%—
Residents with a long-term catheter
1.9%2.5%Worsening
Residents with new or worsening incontinence
22.8%33%Worsening
Residents with depressive symptoms
5.9%0%Improving
Positive outcomes
Higher is better — e.g. vaccinations. An increase is good (green); a decrease is concerning (red).
Last yrNowTrend
Long-stay residents given the seasonal flu vaccine
—95.2%—
Long-stay residents given the pneumonia vaccine
81.5%90.5%Improving
Short-stay residents given the pneumonia vaccine
85%37%Worsening
What the inspectors found
The nursing home failed to provide appropriate treatment and care according to residents' orders, preferences, and goals. Cited December 2024 — isolated incident, immediate jeopardy to residents.
View the original federal record
F-Tag 684 — 42 CFR §483.25 — S/S: J
The nursing home failed to keep the area free of hazards and provide enough supervision to prevent accidents. Cited July 2024 — isolated incident, actual harm.
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F-Tag 689 — 42 CFR §483.25(d) — S/S: G
The home failed to ensure residents were treated with dignity and could make their own choices and communicate freely. Cited September 2025 — limited pattern, potential for harm.
View the original federal record
F-Tag 550 — 42 CFR §483.10(a) — S/S: E
The home failed to ensure there was enough outside ventilation in the area, through windows, mechanical systems, or both. Cited September 2025 — limited pattern, potential for harm.
View the original federal record
F-Tag 923 — 42 CFR §483.90 — S/S: E
The home failed to make sure each resident got a nourishing, balanced diet that met daily nutrition and special dietary needs. Cited July 2024 — limited pattern, potential for harm.
View the original federal record
F-Tag 800 — 42 CFR §483.60 — S/S: E
Recent history
STAFFING
Reported nurse staffing was below the federal recommendation of 4.1 hours per resident per day.
INSPECTION
Health inspection found 2 health deficiencies.
See what inspectors found
INSPECTION
Health inspection found 3 health deficiencies.
See what inspectors found
PENALTY
A federal fine of $50,211 was recorded.
INSPECTION
Health inspection found 1 health deficiency.
See what inspectors found
PENALTY
A federal payment denial was recorded.
PENALTY
A federal fine of $43,628 was recorded.
Penalties & enforcement
On record with Medicare: 3 fines · $153,679 in total fines · 1 payment denial.
Federal fine
Dec 9, 2024
$50,211
Medicare/Medicaid payment denial
Jul 25, 2024
10 days
Federal fine
Jul 25, 2024
$43,628
Federal fine
Jul 11, 2023
$59,840
Operator & ownership
Ownership
Non profit - Corporation
Occupancy
69.9 residents on an average day (81% of 86 beds)
Resident voice
Resident council
Medicare history
Certified for 33 years
Things at a nursing home change — inspections, staffing, ownership, news.
Source: Centers for Medicare & Medicaid Services — public records, updated monthly. GoodStanding presents official records with plain-language summaries. Always visit a facility in person.