Cycle 1
Health 2025-07-17 · Fire 2025-07-17
0 health deficiencies
No concentrated health issue counts in this cycle.
2 fire-safety deficiencies
Top issue: Egress (1 deficiency)
De Witt, IA
Fieldstone of Dewitt
5-star overall rating with 5-star inspections with 2 fire-safety deficiencies in the latest cycle
1301 Maynard Way, De Witt, IA
(563) 659-4210
Overall
5 / 5
CMS overall stars
Health inspections
5 / 5
Survey and complaint cycles
Staffing
4 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
70
Certified beds
Average residents
66
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
Wesleylife
Operator or chain grouping
Approved since
2017-08-04
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
11 facilities
Chain averages 4 overall / 3 health / 4 staffing / 4 quality stars
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
1.10
Registered nurse staffing · state 0.73 · national 0.68
LPN hours / resident day
0.31
Licensed practical nurse staffing · state 0.57 · national 0.87
Aide hours / resident day
2.54
Nurse aide staffing · state 2.53 · national 2.35
Total nurse hours
3.95
All reported nurse hours · state 3.83 · national 3.89
Licensed hours
1.42
RN + LPN hours · state 1.30 · national 1.54
Weekend hours
3.68
Weekend nurse staffing · state 3.35 · national 3.43
Weekend RN hours
0.92
Weekend registered nurse coverage · state 0.50 · national 0.47
Physical therapist
0.03
Reported PT staffing · state 0.04 · national 0.07
Adjusted RN hours
1.19
CMS adjusted RN staffing hours
Adjusted total hours
4.27
CMS adjusted total nurse staffing hours
Case-mix index
1.27
Higher values indicate more complex resident acuity
RN turnover
50%
Annual RN turnover · state 44% · national 45%
Total nurse turnover
37%
Annual nurse turnover · state 44% · national 46%
SNF VBP
Value-based purchasing
Program rank
8,730
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
25.84
Composite VBP score used to determine payment impact.
Payment multiplier
0.9839
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
0
Baseline 17.07% · Performance 22.64% · Measure score 0 · Achievement 0 · Improvement 0
Healthcare-associated infections
0
Baseline 5.24% · Performance 7.81% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
6.01
Baseline 26.87% · Performance 39.13% · Measure score 6.01 · Achievement 6.01 · Improvement 0
Adjusted total nurse staffing
4.33
Baseline 3.88 hours · Performance 4.31 hours · Measure score 4.33 · Achievement 4.33 · Improvement 1.74
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.71% |
10.72%
About the same
|
No Different than the National Rate · Eligible stays 117 · Observed rate 11.11% · Lower 95% interval 7.35% |
| Discharge to community | 66.74% |
50.57%
16.2 pts better
|
Better than the National Rate · Eligible stays 96 · Observed rate 64.58% · Lower 95% interval 59.26% |
| Medicare spending per beneficiary | 0.7 |
1.02
0.3 pts better
|
|
| Drug regimen review with follow-up | 97.03% |
95.27%
1.8 pts better
|
Numerator 98 · Denominator 101 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 101 |
| Discharge self-care score | 53.16% |
53.69%
0.5 pts worse
|
Numerator 42 · Denominator 79 |
| Discharge mobility score | 59.49% |
50.94%
8.6 pts better
|
Numerator 47 · Denominator 79 |
| Pressure ulcers or injuries, new or worsened | 5.94% |
2.29%
3.7 pts worse
|
Numerator 6 · Denominator 101 · Adjusted rate 6.45% |
| Healthcare-associated infections requiring hospitalization | 7.81% |
7.12%
0.7 pts worse
|
No Different than the National Rate · Eligible stays 74 · Observed rate 8.11% · Lower 95% interval 4.68% |
| Staff COVID-19 vaccination coverage | 6.47% |
8.2%
1.7 pts worse
|
Numerator 11 · Denominator 170 |
| Staff flu vaccination coverage | 8.7% |
42%
33.3 pts worse
|
Numerator 18 · Denominator 207 |
| Discharge function score | 59.49% |
56.45%
3 pts better
|
Numerator 47 · Denominator 79 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 20 · Denominator 20 |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 50 · Denominator 50 |
| Resident COVID-19 vaccinations up to date | 23.53% |
25.2%
1.7 pts worse
|
Numerator 12 · Denominator 51 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.6 |
1.5
0.1 pts worse
|
1.9
0.3 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.6 · Observed 1.7 · Expected 2.0 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 2.1 |
2.1
About the same
|
1.8
0.3 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.1 · Observed 2.0 · Expected 1.5 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
94.0%
6 pts better
|
93.4%
6.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 96.7% |
95.2%
1.5 pts better
|
95.5%
1.2 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 96.7% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 3.1% |
3.7%
0.6 pts better
|
3.3%
0.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.7% · Q3 5.7% · Q4 5.6% · 4Q avg 3.1% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 1.4% |
4.0%
2.6 pts better
|
11.4%
10 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 3.5% · Q3 2.0% · Q4 0.0% · 4Q avg 1.4% |
| Percentage of long-stay residents who lose too much weight | 6.1% |
4.9%
1.2 pts worse
|
5.4%
0.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.8% · Q2 8.0% · Q3 2.6% · Q4 9.8% · 4Q avg 6.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 17.2% |
20.6%
3.4 pts better
|
19.6%
2.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 13.2% · Q2 13.5% · Q3 20.9% · Q4 22.7% · 4Q avg 17.2% |
| Percentage of long-stay residents who received an antipsychotic medication | 13.8% |
19.8%
6 pts better
|
16.7%
2.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 13.0% · Q2 15.8% · Q3 12.1% · Q4 14.3% · 4Q avg 13.8% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.2%
0.2 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 16.7% |
18.5%
1.8 pts better
|
16.3%
0.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.2% · Q2 22.3% · Q3 21.2% · 4Q avg 16.7% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 23.0% |
18.3%
4.7 pts worse
|
14.9%
8.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 15.4% · Q2 26.0% · Q3 31.0% · Q4 20.9% · 4Q avg 23.0% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
1.7%
1.7 pts better
|
1.0%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 3.8% |
2.5%
1.3 pts worse
|
1.7%
2.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.6% · Q2 7.0% · Q3 0.0% · Q4 3.9% · 4Q avg 3.8% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 23.8% |
26.0%
2.2 pts better
|
19.8%
4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 19.8% · Q2 18.2% · Q3 37.0% · Q4 22.8% · 4Q avg 23.8% |
| Percentage of long-stay residents with pressure ulcers | 4.0% |
4.3%
0.3 pts better
|
5.1%
1.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.1% · Q2 3.2% · Q3 5.1% · Q4 6.2% · 4Q avg 4.0% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 94.7% |
84.3%
10.4 pts better
|
81.7%
13 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 98.6% · Q2 97.4% · Q3 95.7% · Q4 88.8% · 4Q avg 94.7% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 8.8% |
13.1%
4.3 pts better
|
12.0%
3.2 pts better
|
Short Stay · 20240701-20250630 · Adjusted 8.8% · Observed 8.2% · Expected 10.4% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.9%
1.9 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 87.2% |
73.3%
13.9 pts better
|
79.7%
7.5 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 87.2% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 29.4% |
21.3%
8.1 pts worse
|
23.9%
5.5 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 29.4% · Observed 26.5% · Expected 21.5% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-08-22 · Fire 2024-08-22
2 health deficiencies
Top issue: Infection Control (1 deficiency)
2 fire-safety deficiencies
Top issue: Miscellaneous (1 deficiency)
Cycle 3
Health 2023-10-12 · Fire 2023-10-12
0 health deficiencies
No concentrated health issue counts in this cycle.
4 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (2 deficiencies)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2025-07-17
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2025-07-29
F · Potential for more than minimal harm
2025-07-17
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2025-08-17
F · Potential for more than minimal harm
2024-08-22
K347 · Smoke Deficiencies
Fire Safety
Properly provide smoke detection systems in areas open to corridors.
Corrected 2024-09-29
E · Potential for more than minimal harm
2024-08-22
K753 · Miscellaneous Deficiencies
Fire Safety
Have restrictions on the use of highly flammable decorations.
Corrected 2024-09-29
F · Potential for more than minimal harm
2023-10-12
K341 · Smoke Deficiencies
Fire Safety
Install a fire alarm system that can be heard throughout the facility.
Corrected 2023-11-03
F · Potential for more than minimal harm
2023-10-12
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2023-10-18
F · Potential for more than minimal harm
2023-10-12
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2023-10-19
D · Potential for more than minimal harm
2023-10-12
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2023-10-17
Inspection history
Recent health citations
E · Potential for more than minimal harm
2024-08-22
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-09-15
E · Potential for more than minimal harm
2024-08-22
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-09-15
Penalties and ownership
What sits behind the stars
Ownership
Wesleylife
5% Or Greater Direct Ownership Interest · Organization
Genesis Health System
5% Or Greater Direct Ownership Interest · Organization
Cropper, Douglas
Corporate Director · Individual
Flanagan, Craig
Corporate Officer · Individual
Hoeksema, Nicole
Corporate Director · Individual
Hoeksema, Nicole
W-2 Managing Employee · Individual
Kretzinger, Robert
Corporate Director · Individual
Malas, Joseph
Corporate Director · Individual
Vanderwiel, Kristy
Corporate Director · Individual
Nearby options
Other facilities in reach
#1
Wheatland Manor
Wheatland, IA
2-star overall rating with 3-star inspections with 2 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
#2
Kahl Home for the Aged & Infirmed
Davenport, IA
2-star overall rating with 2-star inspections with 7 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
#3
Davenport Lutheran Home
Davenport, IA
2-star overall rating with 2-star inspections with $43,310 in total fines with 4 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
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