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Nursing home report

The Highlands

Decorah, IA · Medicare-certified · 86 beds

Needs attention
Non-profit
2 of 5 overall

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.

Facility ratings

Health inspections

Staffing

3.5707 hrs/resident/day

Quality measures

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).

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).

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.

View the original federal record

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

  1. STAFFING

    Reported nurse staffing was below the federal recommendation of 4.1 hours per resident per day.

  2. INSPECTION

    Health inspection found 2 health deficiencies.

    See what inspectors found
  3. INSPECTION

    Health inspection found 3 health deficiencies.

    See what inspectors found
  4. PENALTY

    A federal fine of $50,211 was recorded.

  5. INSPECTION

    Health inspection found 1 health deficiency.

    See what inspectors found
  6. PENALTY

    A federal payment denial was recorded.

  7. 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.