222 of the 388 Medicare-certified nursing homes in Iowa (57%) are chain-owned, and all are listed below. 43 of the 222 graded homes earn an A and 11 earn a D or F. They average 3.62 nursing hours per resident per day, 0.2 hours below the 3.82 for every home in Iowa. Deerfield Health Care Center in Urbandale grades highest at A (100 out of 100).
How chain-owned homes in Iowa compare
This group set against every nursing home in Iowa, from the current CMS release.
Accura Healthcare Of Cresco is a 46-bed for-profit home where the numbers matter more than any single grade. Its nurse staffing sits at 3.91 hours per resident day, only about 1% above the national average, and that thin margin erodes on weekends, when coverage drops roughly 21% below the home's own weekday level. Annual turnover is 80.6%, well above the 45.8% national figure, meaning the people caring for residents are constantly changing. The inspection record shows 57 deficiencies, including one at the harm or jeopardy level and six tied to abuse. The last inspection was January 29, 2026. Every CMS star rating here, health inspections, quality measures, and staffing, comes in at the lowest tier. Ask about weekend coverage and how they keep residents safe when staff turns over that fast.
Altoona Nursing and Rehabilitation Center carries 48 deficiencies on its current record, including one tied to abuse, though none reached the harm or jeopardy level. The 106-bed for-profit home in Polk County was inspected most recently on March 19, 2026. Where the numbers get harder to explain away is staffing: CMS gives it 1 out of 5 stars there, and its annual turnover sits at 97.8 percent against a national average of 45.8 percent. That means the aides and nurses caring for residents are, almost without exception, new to the building each year. Inspection and quality measures each land at 2 stars. Families weighing this home against others nearby should ask directly how they hold onto caregivers.
Norwalk Nursing and Rehabilitation Center is a 45-bed for-profit home in Warren County, and the numbers pull in different directions. Its last inspection, at the end of 2025, produced seven deficiencies, none at the harm level, but one abuse-related, and CMS gives it solid marks on health inspections. Staffing is the problem: a one-star rating there, with annual turnover of 95.3% against a national average of 45.8%, meaning nearly the whole workforce turns over every year. Quality measures sit at two stars. A recent, mostly clean inspection record matters, but a building where almost nobody stays on staff is hard to run consistently, and that's what holds the overall picture down.
Accura Healthcare of Toledo runs about 2.89 nurse hours per resident per day, roughly a quarter below the national average of 3.86, and weekends drop another 9% below its own weekday staffing. That thin coverage shows up in the numbers: a 56.5% annual turnover rate against a national average of 45.8% means the aides and nurses at the bedside keep changing. Inspectors cited 18 deficiencies on the current record, one serious enough to reach harm or jeopardy level, with the most recent visit in January 2026. Ownership is corporate, for-profit. Nothing here is abuse-related, but the staffing, turnover, and inspection history are the parts worth pressing the administrator on before you decide.
Hillcrest runs on 3.11 nursing hours per resident day, roughly a fifth below the national average, and weekends drop another 18 percent below its own weekday coverage. Staff turnover sits at 75 percent against a national rate near 46 percent, so the people providing care change often. The inspection record carries 73 deficiencies, including three at the level where residents were actually harmed or put in jeopardy, plus four tied to abuse; two fines total $25,450, and the most recent inspection was March 2026. Ownership is a for-profit limited liability company. The quality measure score looks acceptable, but that reflects charted care, not the staffing and oversight problems the state has repeatedly cited.
Crystal Heights runs lean on nursing staff, 3.07 hours per resident per day against a national average of 3.86, and weekends dip about 16% below its own weekday coverage. That's a gap families feel on Saturday afternoons, not on a tour. Annual turnover sits at 63.5% versus 45.8% nationally, so the aide who knows your mother may not be there in six months. Sixteen deficiencies are on the current record, none at harm or jeopardy level and none abuse-related, and the last inspection was June 2025. A corporate owner took over within the past year and has paid $10,489 in fines. The pattern reads as a building in transition, not crisis.
The numbers out of Fort Dodge Health and Rehabilitation describe a 65-bed for-profit home where nurse staffing runs about 3.18 hours per resident day, roughly 18% under the national average, and drops another 14% on weekends, when families often visit and needs don't pause. Staff turnover sits at 48.8%, above the national figure, and the inspection record shows 48 deficiencies, six of them serious enough to put residents at risk of harm, two tied to abuse, with $166,043 in fines across two penalties. The most recent inspection was in February 2026, so that record is current. A 1-out-of-5 health inspection rating and 2s for staffing and quality measures aren't isolated problems, they line up with what the underlying numbers already show.
Westwood Specialty Care is a nonprofit home with 85 beds in Sioux City, and the numbers families tend to ask about first are the inspection ones. Its record carries 79 deficiencies, including two at the harm level and one tied to abuse, plus two fines totaling $181,086, and the most recent inspection was in April 2026, so this isn't a stale file. Staffing sits at 3.20 nurse hours per resident day, roughly 17 percent under the national average, with weekends running about 13 percent thinner than weekdays and turnover at 49.3 percent. Ownership being nonprofit doesn't offset any of that on its own.
Dubuque Specialty Care runs about 2.89 nurse staffing hours per resident day, roughly a quarter below the national average of 3.86, and weekends drop another 17% below its own weekday coverage. Staff turnover sits at 57.1% against a national 45.8%, meaning more than half the nursing team leaves each year. The inspection record carries 23 deficiencies, two of them serious enough to involve harm or jeopardy, plus a $53,372 fine, and the most recent inspection was July 30, 2025. Quality measures score mid-range, but thin staffing and high turnover are the numbers that matter most for day-to-day care.
Osage Rehab runs 46 beds under for-profit LLC ownership, and the staffing numbers are where I'd start: 3.06 nurse hours per resident per day against a national average of 3.86, with weekends about 12% thinner than weekdays. Turnover sits at 56.3%, well above the 45.8% national figure, so the people caring for residents keep changing. The inspection record is heavier still, 44 deficiencies, two at harm or jeopardy level and three tied to abuse, plus a $14,433 fine. That inspection was recent, December 2025. If you're weighing this one, ask about weekend coverage and how abuse-related findings were resolved.
Regency Care Center runs about 3.15 nurse hours per resident per day, roughly 18% under the national average of 3.86, and weekends are thinner still, about 14% below its own weekday staffing. The inspection record is heavy: 49 deficiencies, three of them at the level where residents were actually harmed or put in jeopardy, plus one tied to abuse, and a $78,497 fine. The most recent inspection was in April 2025. Ownership is a for-profit limited liability company, with 101 certified beds. Federal staffing and health inspection ratings both sit at one star out of five.
Harmony House is a for-profit home in Waterloo with 65 certified beds. The staffing numbers sit just under the national average, but the real problem is turnover: about 61.5% of nursing staff leave each year, against a national average near 46%, and weekend coverage drops roughly 7% below its own weekday level. On inspections, this home has drawn 33 deficiencies, including four at the harm or jeopardy level and four tied to abuse, plus one fine totaling $48,825. CMS has placed it in the Special Focus Facility program, which is reserved for homes with a persistent record of serious problems. Its last inspection was August 6, 2025.
Greater Southside runs on 3.44 nurse hours per resident per day, about 11% under the national average, and weekends drop roughly 22% below its own weekday staffing. That thinner coverage adds up over time: 62.3% of staff left last year against a 45.8% national rate, and CMS flags the home as a Special Focus Facility. The inspection record backs that up, 66 deficiencies, including 8 at harm or jeopardy level and 8 tied to abuse, with four fines totaling $166,443. The most recent inspection was June 2025. For a family weighing this one, the staffing and inspection numbers are the ones that matter most.
Azria Health Park Place carries 70 certified beds under for-profit LLC ownership, and the numbers tell a hard story. Three-and-a-half nurse staffing hours per resident day sits about 9% under the national average, and weekends dip roughly 12% below the home's own weekday levels, so the thinnest coverage lands when families are most likely to visit. Staff turnover near 70% runs well above the national 46%, which means the people providing care keep changing. On inspections, the record shows 70 deficiencies, including three at harm or jeopardy level and five tied to abuse, plus $36,875 in fines. CMS has placed this home in its Special Focus Facility program, a designation reserved for the most persistently troubled nursing homes.
Northgate Care Center in Waukon carries 20 deficiencies on its current record, and two of those are serious enough to involve actual harm or jeopardy to residents. One is abuse-related, and CMS has placed the home in its Special Focus Facility program, which is reserved for the homes with the most persistent problems. A single fine of $71,110 is on record, and the last inspection was March 4, 2026.
Nurse staffing sits at 2.97 hours per resident day, roughly 23% below the national average, and weekends run about 12% thinner than weekdays. Turnover of 34.3% is better than the national 45.8%, so that's not the issue here.
Ivy At Davenport is a for-profit LLC home with 75 beds, and the numbers behind its record deserve a close look. Nurse staffing sits at 3.23 hours per resident per day, about 16% under the national average, and weekends drop roughly another 10% below its own weekday level, so coverage is thinnest exactly when families tend to visit. Staff turnover runs 58.8% against a national 45.8%, meaning more than half the caregivers leave within a year. The current inspection record shows 58 deficiencies, including 5 at harm or jeopardy level and 6 abuse-related, with four fines totaling $141,036. CMS has placed it in the Special Focus Facility program, which is reserved for homes with a persistent pattern of poor care.
Bishop Drumm is run by a church-affiliated nonprofit, and its staffing numbers tell two stories. Nurse hours sit at 3.64 per resident day, about 6% under the national average, and weekends drop roughly 13% below its own weekday coverage. Turnover is the bright spot: 34.9% against a national 45.8%, which suggests people stay. But the inspection record is where this home falls apart, 77 deficiencies, 9 of them at harm or jeopardy level, four fines totaling $258,177, and a place in CMS's Special Focus Facility program, reserved for the country's most troubled homes. A July 2025 inspection is recent, so the picture isn't stale.
Garden View Care Center is a 50-bed for-profit home in Shenandoah, and the numbers here deserve a hard look. Staff turnover runs at 55.3% a year against a national average of 45.8%, and the home carries 93 deficiencies on its current record, including 10 serious enough to involve harm or jeopardy to residents and 10 tied to abuse. Three CMS fines add up to $168,858, and the agency has placed Garden View in its Special Focus Facility program, a designation reserved for homes with a persistent record of poor care. The most recent inspection was December 8, 2025. If you're considering this home for someone you love, ask the administrator directly what's changed since that inspection and how they're keeping residents safe.
Royal Oaks is a 115-bed for-profit home in Urbandale that CMS has placed in its Special Focus Facility program, a designation reserved for the homes with the most persistent problems. The inspection record backs that up: 71 deficiencies, seven serious enough to put residents in harm's way, two tied to abuse, and three fines totaling $122,945. Staffing runs about 6% under the national average, and the gap widens on weekends, when coverage drops roughly 9% below its own weekday level. Turnover sits at 66.7%, well above the 45.8% national figure, so the people caring for residents are constantly changing. If you're considering this one, ask hard questions about what's changed since the May 2025 inspection.
Prestige Care Center of Fairfield runs on 3.33 nurse hours per resident per day, about 14 percent under the national average, and weekends dip roughly 8 percent below its own weekdays. Turnover sits at 66.2 percent against a national 45.8, most of the people caring for your relative this year probably won't be there next year. The inspection record is the harder problem: 65 deficiencies, five serious enough to put residents in harm's way, eight tied to abuse, and $106,751 in fines. A recent June 2025 inspection doesn't erase that history. For-profit ownership through a limited liability company means decisions here answer to a bottom line, not a community board.
Frequently asked questions
How many chain-owned nursing homes are there in Iowa?
There are 222 chain-owned Medicare-certified nursing homes in Iowa, 57% of the 388 nursing homes there.
Are chain-owned nursing homes better staffed?
In Iowa they average 3.62 total nursing hours per resident per day, against 3.82 for all nursing homes in Iowa, a difference of -0.2 hours. Staff turnover averages 46.1% against 44.1%.
Which chain-owned nursing home grades best in Iowa?