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C
Below Standard

The Highlands

607 Highland Drive · Decorah, IA 52101

5633823603 · Non profit - Corporation

86 beds67.4 residents124 staff
CMS Five-Star Ratings
Overall
★★★★★
Staffing
★★★★★
Quality
★★★★★
Inspections
★★★★★
Staffing Grades
C
Below Standard
Total Staff
C
Below Standard
RN Staff
C
Below Standard
Overall
✗CMS Benchmark(≥ 3.48 HPRD)
✗RN Recommendation(≥ 0.75 HPRD)
✗Research Standard(≥ 4.10 HPRD)
📋

What This Means in Plain English

The Highlands receives an overall staffing grade of C (Below Standard). With 3.31 total nurse hours per resident per day, this facility falls below the CMS staffing benchmark of 3.48 HPRD and has RN staffing of 0.536 HPRD, below the recommended 0.75. It is 0.59 HPRD below the national average.

Weekend staffing decreases noticeably — dropping 20.86% compared to weekdays. The facility relies heavily on temporary agency staff (28.99% of hours), suggesting potential workforce instability.

Staffing levels have been declining over recent quarters — worth monitoring.

🔍 Areas of Concern (3)

🚨Does not meet the CMS staffing benchmark of 3.48 HPRD. Current: 3.31 HPRD — needs 0.17 more hours per resident per day.
⚠️RN staffing (0.536 HPRD) is below the research-recommended minimum of 0.75 HPRD. This means less clinical oversight per resident.
⚠️28.99% of nursing hours come from agency/contract workers. High contractor reliance often means less continuity of care — staff who don't know the residents.

✨ Strengths (1)

✅No days with zero registered nurse hours this quarter
Total Nurse HPRD
3.31hrs/resident/day▼ 0.59
CMS benchmark: 3.48
RN HPRD
0.536hrs/resident/day▼ 0.15
Recommended: 0.75
Weekend Drop-off
20.86%
3.5174 weekday → 2.7837 weekend
⚠ Significant weekend reduction
Agency Staff
28.99%
0% of RN hours from contractors
⚠ High contractor reliance
Days with Zero RN
0days this quarter
4+ days = auto 1-star
CNA HPRD
1.7931hrs/resident/day
Direct care aides
LPN HPRD
0.5772hrs/resident/day
Licensed practical nurses
Consistency
0.4249std dev
Lower = more predictable

HPRD Over Time

Total nurse staffing hours per resident per day, by quarter

Total HPRD (shaded area)RN HPRDCMS Benchmark (3.48) — staffing standardResearch Standard (4.10) — recommended level

How Does This Facility Compare?

Compared to county, state, and national averages for total nurse HPRD

vs. Winneshiek County Average-0.40 HPRD
3.71
03.31 HPRD
vs. Iowa State Average-0.51 HPRD
3.82
03.31 HPRD
vs. National Average-0.59 HPRD
3.90
03.31 HPRD
■ Colored bar = this facility · | Black line = average · Based on 2025Q3 data

Nearby Facilities

Compare with other nursing homes in the area

FacilityDistanceGradeTotal HPRDRN HPRDCMS Rating
The Highlands ★
Decorah · This facility
—
C
3.310.536★☆☆☆☆
Northgate Care Center
Waukon
15.8 mi
D
2.80550.3671★★★☆☆
Good Samaritan Society - Waukon
Waukon
16.3 mi
C
3.30750.9476★★★☆☆
Good Samaritan Society - West Union
West Union
24.4 mi
C
3.32680.7637★★★★☆
Thornton Manor Nursing and Care Center
LANSING
28 mi
A
4.29660.902★★★★☆
New Hampton Nursing & Rehab Center
New Hampton
31.8 mi
C
3.3671.1385★★★★☆

Inspection History & Penalties

Health inspection results from state surveys — most recent first

9
Inspections
38
Total Deficiencies
$153,679
Fines Assessed
Sep 23, 2025Health
2 deficiencies cited
▼
Jun 12, 2025Health
3 deficiencies cited
▼
Dec 9, 2024Health
1 deficiency cited· Includes actual harm
▼
Sep 25, 2024Health
2 deficiencies cited
▼
Jul 25, 2024Health
7 deficiencies cited· Includes actual harm
▼
Feb 7, 2024Health
6 deficiencies cited· Includes actual harm
▼
Sep 18, 2023Health
6 deficiencies cited
▼
Jul 11, 2023Health
7 deficiencies cited· Includes actual harm
▼
Apr 3, 2023Health
4 deficiencies cited
▼

Penalty History

Dec 9, 2024Fine
$50,211
Jul 25, 2024Fine
$43,628
Jul 25, 2024Payment Denial
Jul 11, 2023Fine
$59,840
CMS Severity Scale
A–C: No Harm / PotentialD–F: No Harm but ConcernG–H: Actual HarmI–L: Immediate Jeopardy

Source: CMS Staffing & Quality Data — 2025Q3 · data.cms.gov

Staffing grades are based on CMS-published thresholds and research recommendations. CMS is not affiliated with and does not endorse this website.