Winneshiek County, Iowa · Nursing home
The Highlands
2 of 5 overall from CMS
607 Highland Drive, Decorah, IA 52101
At a glance
- Overall rating 2 of 5 Below the state average of 3.1
- Nurse time per resident, per day 3.90 hours Above the state average of 3.82
- Nursing staff who left in a year 53.3% Above the state average of 44.0%
- Health citations, last 3 inspection cycles 26 3 at the harm level or above
- Fines in 3 years $93,839 2 fines
- Certified beds in use 87.7% of 86 beds, on an average day
Arrows only show whether a figure is above or below the state average. They are not a judgment of the home.
The Highlands is a 86-bed nursing home in Decorah, Iowa (Winneshiek County). CMS rates it 2 of 5 stars overall as of Sep 2026. It reports 3.90 nurse staffing hours per resident per day, above the Iowa average of 3.82. CMS lists 2 fines totaling $93,839 in the past three years.
- Certified beds
- 86
- Residents per day (average)
- 75.4
- Certified since
- 1993 (33 yrs)
Non profit - Corporation Participates in Medicare and MedicaidContinuing care retirement community
Bed use is this site's calculation: average residents per day divided by certified beds. It is an average, so it does not show today's openings.
Terms used on this page
- CMS
- The Centers for Medicare & Medicaid Services, the federal agency that publishes the ratings, staffing figures, inspection results and penalties shown here.
- Certified beds
- The number of federally certified beds CMS lists for the home.
- Deficiency or citation
- A federal requirement that inspectors found the home did not meet. Each one gets a letter from A to L for how serious it was and how many residents were affected. What the letters mean
- Actual harm
- Letters G, H and I: actual harm to a resident that is not immediate jeopardy.
- Immediate jeopardy
- Letters J, K and L: the problem caused, or was likely to cause, serious injury, harm, impairment or death to a resident.
- Inspection cycle
- A standard inspection plus the complaint and infection-control citations CMS assigns to it. This page shows the three most recent cycles.
- Special Focus Facility (SFF)
- A home CMS has placed under closer oversight because of its inspection record. More about the program
Questions to ask The Highlands
Chosen from this home's public data.
- CMS lists 2 fines totaling $93,839 in the past three years. What changed after the most recent one?Penalties in CMS data
- CMS counts 7 health deficiencies in the latest inspection cycle (the standard inspection on Jul 22, 2026 plus complaint and infection-control inspections); the Iowa average is 6.5. Which have been corrected?Inspection results in CMS data
- Nursing staff turnover is 53.3%, above the Iowa average of 44.0%. How often would the same aides care for my relative?Turnover in CMS data
More in what to ask on a nursing home tour.
CMS star ratings
- Overall 2 of 5 Iowa average 3.1
- Health inspections 2 of 5 Iowa average 2.8
- Staffing 4 of 5 Iowa average 3.7
- Quality measures 3 of 5 Iowa average 3.3
The vertical line marks the Iowa average. Ratings run from 1 to 5. How to read CMS star ratings
Nurse staffing
Hours of care per resident per day, as the home reported to CMS.
What these roles do
Nurse aides give most hands-on daily care, such as help with bathing, dressing and meals. Licensed practical nurses give medications and routine nursing care. Registered nurses assess residents and direct their care.
- All nursing staff 3.90 h Iowa average 3.82
- Nurse aides 2.79 h Iowa average 2.52
- Licensed practical nurses 0.66 h Iowa average 0.56
- Registered nurses 0.44 h Iowa average 0.74
- All staff, weekends 3.59 h Iowa average 3.37
How much nurse staffing is enough? All bars share one scale, 0 to 11 hours. The vertical line marks the Iowa average; the national average for all nursing staff is 3.86 hours.
- Nursing staff turnover53.3%
- Iowa average44.0%
- Registered nurse turnover44.4%
- Iowa average42.1%
- Administrators who left1
Quality measures
CMS calculates these from residents' assessments and Medicare claims. They are shown as published, next to the Iowa and national averages. marks the measures CMS uses in its quality star rating; for those, the rating gives more points for a lower rate.
Long-stay residents
| Measure | This home | Iowa | U.S. |
|---|---|---|---|
| ★ Percentage of long-stay residents whose need for help with daily activities has increased | 27.6% | 17.1% | 13.9% |
| Percentage of long-stay residents who lose too much weight | 4.0% | 4.6% | 5.2% |
| ★ Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.2% | 1.5% | 0.8% |
| ★ Percentage of long-stay residents with a urinary tract infection | 0.0% | 2.4% | 1.6% |
| Percentage of long-stay residents who have depressive symptoms | 0.9% | 4.2% | 12.8% |
| Percentage of long-stay residents who were physically restrained | 0.0% | 0.2% | 0.1% |
| ★ Percentage of long-stay residents experiencing one or more falls with major injury | 2.1% | 3.8% | 3.2% |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 89.5% | 94.0% | 93.6% |
| ★ Percentage of long-stay residents whose ability to walk independently worsened | 24.0% | 16.6% | 14.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 17.9% | 20.8% | 19.5% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 95.2% | 95.3% | 95.5% |
| ★ Percentage of long-stay residents with pressure ulcers | 4.1% | 4.2% | 4.6% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 26.0% | 25.6% | 19.0% |
| ★ Percentage of long-stay residents who received an antipsychotic medication | 25.6% | 19.5% | 15.4% |
| ★ Number of hospitalizations per 1000 long-stay resident days | 1.48 | 1.49 | 1.90 |
| ★ Number of outpatient emergency department visits per 1000 long-stay resident days | 2.20 | 2.08 | 1.78 |
Short-stay residents
| Measure | This home | Iowa | U.S. |
|---|---|---|---|
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 46.8% | 84.0% | 82.0% |
| ★ Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% | 2.1% | 1.6% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | Too few residents or stays to report | 73.3% | 79.8% |
| ★ Percentage of short-stay residents who were rehospitalized after a nursing home admission | 18.9% | 20.9% | 23.8% |
| ★ Percentage of short-stay residents who had an outpatient emergency department visit | 9.9% | 13.2% | 12.0% |
Measure periods: April 2025 to March 2026 for most measures; July 2024 to June 2025 for the flu vaccine measures; January to December 2025 for the hospital and emergency department measures, which CMS risk-adjusts. See the measures on Medicare.gov
Inspection history
Inspectors cited 26 health deficiencies in the three most recent inspection cycles. Of these, 1 was at the immediate jeopardy level and 2 involved actual harm; the rest were graded as no actual harm. 12 were cited in connection with a complaint investigation. The most recent citation at the harm level or above was on Dec 9, 2024: Provide appropriate treatment and care according to orders, resident’s preferences and goals.
| Standard inspection | Health | Fire safety |
|---|---|---|
| Jul 22, 2026 | 7 | 6 |
| Jun 12, 2025 | 6 | 8 |
| Jul 25, 2024 | 13 | 14 |
Iowa homes averaged 6.5 health deficiencies in the latest cycle; the national average is 9.2. Each cycle's health count covers the standard inspection on that date plus the complaint and infection-control citations CMS assigns to that cycle.
Health citations, three most recent inspection cycles (26)
-
EPotential for more than minimal harm, pattern
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary · Deficient, Provider has date of correction (Aug 3, 2026)
-
DPotential for more than minimal harm, isolated
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Resident Rights · Deficient, Provider has date of correction (Aug 10, 2026)
-
DPotential for more than minimal harm, isolated
Assess the resident when there is a significant change in condition
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Jul 27, 2026)
-
DPotential for more than minimal harm, isolated
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Aug 10, 2026)
-
DPotential for more than minimal harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Jul 1, 2026)
Show 21 more
-
EPotential for more than minimal harm, pattern
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Complaint investigation · Resident Rights · Deficient, Provider has date of correction (Sep 24, 2025)
-
EPotential for more than minimal harm, pattern
Have enough outside ventilation via a window or mechanical ventilation, or both.
Complaint investigation · Environmental · Deficient, Provider has date of correction (Sep 24, 2025)
-
DPotential for more than minimal harm, isolated
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Resident Rights · Deficient, Provider has date of correction (Jun 26, 2025)
-
DPotential for more than minimal harm, isolated
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
Freedom from Abuse, Neglect, and Exploitation · Deficient, Provider has date of correction (Jun 26, 2025)
-
BPotential for minimal harm, pattern
Ensure each resident receives an accurate assessment.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Jun 26, 2025)
-
JImmediate jeopardy, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Dec 10, 2024)
-
DPotential for more than minimal harm, isolated
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Complaint investigation · Resident Rights · Deficient, Provider has date of correction (Sep 26, 2024)
-
DPotential for more than minimal harm, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Sep 26, 2024)
-
GActual harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care · Deficient, Provider has date of correction (Jul 26, 2024)
-
EPotential for more than minimal harm, pattern
Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs.
Nutrition and Dietary · Deficient, Provider has date of correction (Jul 26, 2024)
-
EPotential for more than minimal harm, pattern
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Nutrition and Dietary · Deficient, Provider has date of correction (Jul 26, 2024)
-
EPotential for more than minimal harm, pattern
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary · Deficient, Provider has date of correction (Jul 26, 2024)
-
DPotential for more than minimal harm, isolated
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Jul 26, 2024)
-
DPotential for more than minimal harm, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care · Deficient, Provider has date of correction (Jul 26, 2024)
-
CPotential for minimal harm, widespread
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.
Nutrition and Dietary · Deficient, Provider has date of correction (Jul 26, 2024)
-
GActual harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Feb 8, 2024)
-
DPotential for more than minimal harm, isolated
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Complaint investigation · Resident Rights · Deficient, Provider has date of correction (Feb 8, 2024)
-
DPotential for more than minimal harm, isolated
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.
Complaint investigation · Resident Rights · Deficient, Provider has date of correction (Feb 8, 2024)
-
DPotential for more than minimal harm, isolated
Ensure each resident receives an accurate assessment.
Complaint investigation · Resident Assessment and Care Planning · Deficient, Provider has date of correction (Feb 8, 2024)
-
DPotential for more than minimal harm, isolated
Ensure services provided by the nursing facility meet professional standards of quality.
Complaint investigation · Resident Assessment and Care Planning · Deficient, Provider has date of correction (Feb 8, 2024)
-
DPotential for more than minimal harm, isolated
Provide care and assistance to perform activities of daily living for any resident who is unable.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Feb 8, 2024)
What severity letters A to L mean
Each sentence above is the requirement that was not met, in CMS's wording. For the inspection results as Medicare publishes them, open this home's page on Medicare.gov and look under "Health inspections".
Penalties, past three years
| Date | Type | Amount |
|---|---|---|
| Dec 9, 2024 | Fine | $50,211 |
| Jul 25, 2024 | Fine | $43,628 |
| Jul 25, 2024 | Payment Denial | 10 days |
Iowa homes averaged 0.6 fines and $19,286 in fine amounts; the national averages are 0.9 and $30,972.
Cost
Not in the public data. CMS does not publish what a nursing home charges.
Ask the home for its daily private-pay rate and whether a bed is open for your coverage. See what Medicare covers and how Medicaid pays for a nursing home.
Compared within Iowa
- Size62 of 387 by certified beds
- Iowa average residents per day52.4
- ChainNone listed
- Resident or family councilResident
- Homes in Winneshiek County3
Common questions
What is the CMS star rating for The Highlands?
The Highlands has an overall rating of 2 of 5 stars from CMS as of Sep 2026. Its health inspection rating is 2, staffing is 4 and quality measures is 3.
How many beds does The Highlands have?
The Highlands has 86 certified beds. It averages 75.4 residents per day, about 87.7% of its certified beds.
How much nursing care do residents get at The Highlands?
The home reports 3.90 hours of nurse staffing per resident per day, including 0.44 hours from registered nurses. The Iowa average is 3.82 hours and 0.74 hours from registered nurses.
Has The Highlands been fined?
Yes. CMS lists 2 fines totaling $93,839 in the past three years. It also lists 1 payment denial.
Does The Highlands accept Medicare or Medicaid?
CMS lists its participation as "Medicare and Medicaid". Ask the home whether a bed is open for your coverage.
Guides for families looking at this home
- Understanding the recordWhat to ask on a nursing home tourQuestions that turn a home's public record into a useful conversation when you tour, plus what to look for yourself.
- Understanding the recordInspection severity letters A to LHow inspectors grade each deficiency by harm and by how many residents were affected.
- Understanding the recordHow to read CMS star ratingsWhat the overall, health inspection, staffing and quality measure ratings cover, and what they leave out.
Nearest nursing homes
- 4 of 5 Wellington Place 56beds 91.2%in use 3.47nurse hours a day
- 2 of 5 Ossian Care Center 46beds 79.3%in use 4.63nurse hours a day
- 1 of 5 Green Lea Senior Living 41beds 70.5%in use 2.37nurse hours a day
Sorted by straight-line distance. This is not a ranking or a recommendation. Compare all homes in Winneshiek County
Who to call in Iowa
These offices serve residents of every nursing home in Iowa.
- Long-term care ombudsman Office of the State Long-Term Care Ombudsman 866-236-1430 (Toll-free. Relay Iowa TTY: 1-800-735-2942. The page also offers an online complaint form.) An advocate for residents and their families.
- File a complaint about a nursing home Health Facilities Complaints Hotline 1-877-686-0027 (Email hfd_complaint@dia.iowa.gov; complaints fax 515-281-7106. DIAL's complaints page links to an online complaint form (stateofiowa.seamlessdocs.com/f/DIA_Contact_Form).) The state agency that inspects nursing homes.
Iowa staffing, bed-hold and Medicaid rules · Residents' rights in every state
Source: CMS Provider Data Catalog, nursing home datasets processed Sep 1, 2026. CMS Certification Number 165178. See this home's official record on Medicare.gov
See something shown incorrectly? Tell us. This site shows each record as CMS publishes it and cannot change the underlying record.