Federal inspection record · CMS data as of October 1, 2026
Hillcrest Health Care Center
2121 Avenue L, Hawarden, IA · (712) 551-1074
- Cited for abuse (CMS abuse icon)
- Certified beds
- 64
- Residents per day
- 46
- Ownership
- For-Profit
- Chain
- The Ensign Group
- Medicare / Medicaid
- Medicare + Medicaid
- Certified since
- November 16, 1994
1
How this home got 1 star
The overall rating isn't an average. CMS starts from the inspection rating and nudges it at most two steps. Here is the arithmetic for this home, using CMS's own rules.
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Health inspections
★★★★★starting point
Everything starts from what state inspectors found on site. This is a ranking against other homes in Iowa.
-
Staffing
★★★★★no change
Only a 5-star staffing rating adds a star, and only a 1-star rating removes one. Ratings of 2 to 4 change nothing.
-
Quality measures
★★★★★no change
Same rule: 5 stars adds one, 1 star takes one away. These measures are mostly reported by the home itself.
-
Overall
★★★★★1 of 5
Matches the rating CMS publishes on Care Compare.
This home carries CMS's abuse icon, which caps its inspection rating at 2 stars and so its overall rating at 4.
2
Where it sits among Iowa homes
Hillcrest Health Care Center carries 149.5 inspection points. That is fewer than 6% of Iowa's 385 rated homes.
Inspectors' citations earn points by how serious and how widespread they were (the grid below). CMS then ranks every home in Iowa: the 10% with the fewest points get 5 stars, the 20% with the most get 1 star, and the middle 70% split evenly into 2, 3 and 4.
- 5★ 0–7 pts
- 4★ 7–21 pts
- 3★ 21–41 pts
- 2★ 41–86.5 pts
- 1★ over 86.5 pts
Bars show every rated home in Iowa by its weighted inspection score. CMS recalibrates the cut points monthly but holds a home's rating until its own score changes, so a home can sit just outside today's band.
3
What inspectors found
72 health citations on record since 2024. Each one gets a letter: the row says how badly residents were affected, the column how many.
Immediate jeopardyResidents at risk of serious injury or death
Actual harmA resident was hurt
Potential for harmNo one was hurt, but could have been
Minimal harmPaperwork-level problems
Read the rows, not the total. Most citations nationwide are a D: one problem, nobody hurt. Rows G–I mean a resident was harmed; J–L mean inspectors found residents in immediate danger of serious injury or death.
Small numbers in each cell are the inspection points CMS assigns per citation. Those points are what the state curve above ranks.
Harm and immediate-jeopardy citations (3)
-
G
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
-
J
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
-
K
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Everything else, by area of care
Resident Rights17E
- D
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- E
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- D
Reasonably accommodate the needs and preferences of each resident.
- D
Honor the resident's right to manage his or her financial affairs.
- D
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
- D
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
- D
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
- E
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
- D
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
- D
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- D
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- D
Reasonably accommodate the needs and preferences of each resident.
- E
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- E
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
- D
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- D
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
- D
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Quality of Life and Care12E
- D
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
- D
Provide safe and appropriate respiratory care for a resident when needed.
- E
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Provide care and assistance to perform activities of daily living for any resident who is unable.
- D
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
- D
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
- D
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
- E
Provide care and assistance to perform activities of daily living for any resident who is unable.
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- D
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Nutrition and Dietary11E
- E
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
- E
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
- E
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
- E
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
- E
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
- D
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
- E
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
- E
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
- E
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
- E
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
- E
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Resident Assessment and Care Planning9D
- D
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
- D
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
- D
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
- D
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
- D
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- D
Ensure each resident receives an accurate assessment.
- D
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
- D
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- D
Ensure services provided by the nursing facility meet professional standards of quality.
Infection Control5F
- E
Provide and implement an infection prevention and control program.
- D
Provide and implement an infection prevention and control program.
- E
Provide and implement an infection prevention and control program.
- F
Provide and implement an infection prevention and control program.
- D
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Nursing and Physician Services4E
- E
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
- D
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
- E
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
- E
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Pharmacy Service4D
- D
Ensure that residents are free from significant medication errors.
- D
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
- D
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
- D
Ensure that residents are free from significant medication errors.
Administration4E
- D
Have a plan that describes the process for conducting QAPI and QAA activities.
- D
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
- E
Have a plan that describes the process for conducting QAPI and QAA activities.
- E
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Freedom from Abuse, Neglect, and Exploitation3E
- D
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
- D
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- E
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Inspection history
2026-03-26
27 health deficiencies · 3 fire-safety deficiencies
Top issue: Quality of Life and Care (7 deficiencies)
2025-03-11
10 health deficiencies · 15 fire-safety deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
2024-01-31
35 health deficiencies · 6 fire-safety deficiencies
Top issue: Nutrition and Dietary (11 deficiencies)
4
Nursing time per resident, per day
Each resident here gets about 3 h 43 min of nursing staff time a day, 1 h 3 min of it from a registered nurse.
This home
3 h 43 min
Iowa average
3 h 52 min
U.S. average
3 h 54 min
- Registered nurse
- Licensed practical nurse
- Nurse aide
Turnover: 72% of nursing staff and 86% of registered nurses left in the past year.
Reported hours from payroll data the home submits to CMS, divided by its daily resident count. Not adjusted for how sick residents are.
5
Fines and payment denials
$93,606 in federal fines on record over the past three years.
| Date | Penalty | Amount |
|---|---|---|
| 2026-03-26 | Fine | $68,156 |
| 2026-03-26 | Payment Denial · 22 day denial | $0 |
| 2024-07-28 | Fine | $8,649 |
| 2024-01-31 | Fine | $16,801 |
6
Resident outcomes
Quality measures compared with state and national averages. Most come from assessments the home itself reports.
| Measure | This home | State | U.S. |
|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days0.8 pts worse | 2.2 | 1.4 | 1.8 |
| Number of outpatient emergency department visits per 1000 long-stay resident days1.8 pts worse | 3.7 | 1.9 | 1.7 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine3.2 pts worse | 91.0% | 94.2% | 93.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine14.2 pts worse | 81.6% | 95.8% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injuryAbout the same | 3.9% | 3.9% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms9.3 pts worse | 13.5% | 4.2% | 13.5% |
| Percentage of long-stay residents who lose too much weight1.9 pts worse | 6.3% | 4.4% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication0.9 pts better | 20.1% | 21.0% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication7.8 pts worse | 27.6% | 19.8% | 15.4% |
| Percentage of long-stay residents who were physically restrained0.2 pts better | 0.0% | 0.2% | 0.1% |
| Percentage of long-stay residents whose ability to walk independently worsened6.2 pts better | 9.0% | 15.2% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased0.4 pts worse | 17.0% | 16.6% | 13.5% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder1.4 pts better | 0.0% | 1.4% | 0.7% |
| Percentage of long-stay residents with a urinary tract infection2.8 pts worse | 5.2% | 2.4% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence1 pts better | 24.0% | 25.0% | 18.3% |
| Percentage of long-stay residents with pressure ulcers0.5 pts better | 3.6% | 4.1% | 4.5% |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine45.8 pts worse | 38.2% | 84.0% | 82.3% |
| Percentage of short-stay residents who newly received an antipsychotic medication2.1 pts better | 0.0% | 2.1% | 1.5% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine48.5 pts worse | 25.9% | 74.4% | 80.1% |
·
Who owns and runs it
23 owners and managers reported to CMS. The last column counts how many nursing homes each one is tied to.
Show ownership list
| Name | Role | Share | Homes |
|---|---|---|---|
| Aerofund Holdings Inc | Operational/Managerial Control · Organization | 0% | 2 facilities |
| Blu Medstaff LLC | Operational/Managerial Control · Organization | 0% | 1 facilities |
| Burnam, Soon | Managing Control - Governing Body · Individual | 0% | 353 facilities |
| Burnam, Soon | Corporate Officer · Individual | 0% | 353 facilities |
| Caretrust Gp LLC | Adp Of The SNF · Organization | 0% | 95 facilities |
| Caretrust Reit Inc | Adp Of The SNF · Organization | 0% | 102 facilities |
| Ctr Partnership LP | Adp Of The SNF · Organization | 0% | 104 facilities |
| Ensign Services Inc | Adp Of The SNF · Organization | 0% | 299 facilities |
| Heart Medical Solutions LLC | Operational/Managerial Control · Organization | 0% | 1 facilities |
| Helping Hands Nursing Solution Inc | Operational/Managerial Control · Organization | 0% | 5 facilities |
| Jorgensen, David | Corporate Director · Individual | 0% | 56 facilities |
| Kamstra, Lee | Managing Control - Governing Body · Individual | 0% | 3 facilities |
| Kamstra, Lee | Operational/Managerial Control · Individual | 0% | 3 facilities |
| Kamstra, Lee | Adp Of The SNF · Individual | 0% | 3 facilities |
| Keetch, Chad | Corporate Officer · Individual | 0% | 301 facilities |
| Koenig, Debra | Corporate Officer · Individual | 0% | 7 facilities |
| Onshift Inc | Operational/Managerial Control · Organization | 0% | 20 facilities |
| Port, Barry | Corporate Director · Individual | 0% | 203 facilities |
| Sato, Ami | Corporate Officer · Individual | 0% | 151 facilities |
| The Ensign Group Inc | Adp Of The SNF · Organization | 0% | 135 facilities |
| Wilkins, Melodee | Managing Control - Governing Body · Individual | 0% | 1 facilities |
| Wilkins, Melodee | Operational/Managerial Control · Individual | 0% | 1 facilities |
| Wilkins, Melodee | Adp Of The SNF · Individual | 0% | 1 facilities |
·
Fire safety
24 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Smoke8F
- F
Install corridor and hallway doors that block smoke.
- F
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
- F
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- F
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
- F
Install corridor and hallway doors that block smoke.
- F
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
- F
Install corridor and hallway doors that block smoke.
- D
Properly select, install, inspect, or maintain portable fire extinguishes.
Miscellaneous6F
- F
Have simulated fire drills held at unexpected times.
- F
Provide a written emergency evacuation plan.
- F
Have simulated fire drills held at unexpected times.
- F
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
- F
Have simulated fire drills held at unexpected times.
- D
Have restrictions on the use of highly flammable decorations.
Emergency Preparedness6F
- F
Develop Emergency Preparedness policies and procedures.
- F
Address subsistence needs for staff and patients.
- F
Establish roles under a Waiver declared by secretary.
- F
List the names and contact information of those in the facility.
- F
Develop and maintain an Emergency Preparedness Program (EP).
- F
Include a process for Emergency Preparedness collaboration.
Gas, Vacuum, and Electrical Systems3F
- F
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
- F
Have generator or other power source capable of supplying service within 10 seconds.
- D
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Egress1F
- F
Keep aisles, corridors, and exits free of obstruction in case of emergency.
·
Other homes nearby
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Alcester Care And Rehab Center, Inc
Alcester, SD
★★★★★- Worst citation, 3 yrs
- D
- Nursing / resident / day
- 2 h 36 min
- Fines
- $0
-
Akron Care Center, INC
Akron, IA
★★★★★- Worst citation, 3 yrs
- D
- Nursing / resident / day
- 3 h 52 min
- Fines
- $0
-
Bethesda Of Beresford
Beresford, SD
★★★★★- Worst citation, 3 yrs
- G
- Nursing / resident / day
- 3 h 42 min
- Fines
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