Iowa Nursing Homes: Violations, Fines and Worst Records

During the most recent three inspection cycles, Iowa inspectors issued 526 citations for accident hazards and supervision. Resident harm or immediate danger was found in 192 of those citations. Complaint visits, not routine inspections, produced 42.4% of the 7,953 citations issued statewide. Statewide, inspectors counted 104 facilities with one or more immediate danger citations, issuing 177 citations of that kind in all. In February 2026, Royal Oaks Nursing and Rehabilitation Center in Urbandale received the state's largest single federal fine, which was $311,880.

All 387 homes in Iowa are covered in CMS nursing-home data files, the federal Medicare agency publication behind these figures. According to those records, 221 facilities are part of a chain, and Care Initiatives runs 43 Iowa locations. The state average is 3.82 hours of nurse staffing per resident day, near 3.86 hours nationwide. Still, 103 of 381 reporting homes sat under the nurse hours CMS expects. The share of nursing staff who left within a year, known as nursing staff turnover, is 44.0% statewide versus 45.8% across the country.

The Department of Inspections, Appeals, and Licensing regulates these nursing facilities; families can find their state inspection reports and fine information in the DIAL Health Facilities database. Federal records for Iowa's 387 homes are on Medicare's Care Compare (formerly named Nursing Home Compare). A home's page opens its federal inspection reports, the Form CMS-2567 deficiency statements spanning the state's 7,953 recent citations.

To file a complaint about a nursing home in Iowa, use the website of the state survey agency, the Department of Inspections, Appeals, and Licensing (DIAL), or call 1-877-686-0027. Another contact for residents and relatives is the Office of the State Long-Term Care Ombudsman, within the Iowa Department of Health and Human Services; call 866-236-1430. Suspected abuse involving a dependent adult anywhere in the state can be reported by families to Adult Protective Services at 1-800-362-2178.