1/5
CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
1/5
CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
Peacefully nestled in the harmonious neighborhood of Avoca, IA, Avoca Lodge Assisted Living is a blissful haven that offers assisted living. A compassionate and well-trained team provides top-tier care tailored to residents’ daily living activities around the clock. Purposely built and secure accommodations are provided, ensuring residents are comfortable and safe.
Residents are encouraged to live actively and have fun with a well-thought-out calendar of engaging activities and fun recreational programs. Mealtimes promote social interactions and satisfy dietary needs with delicious and healthy dining options. For convenience and safety, medication management is provided. The community is a good option for those seeking exceptional assistance for the finest retirement experience.
The Overall CMS Rating combines results from health inspections, staffing levels and quality measures. Health inspections carry the most weight. Staffing and quality scores can increase or decrease the final rating based on performance compared to state and national standards.
Based on the results of the facility's three most recent standard inspections and any complaint investigations. CMS reviews the number, scope, and severity of deficiencies, with more recent findings weighted more heavily.
Measures average nursing staff hours per resident per day, including Registered Nurses (RNs) and total nursing staff. Ratings are adjusted based on the level of care residents require and are compared to state and national benchmarks.
Based on clinical and physical health indicators reported to CMS, such as hospital readmissions, falls, pressure ulcers, and improvements in mobility. These measures reflect how well residents' health needs are being managed.
Daily nursing hours per resident by staff type, reported to CMS. Higher is generally better — compare this facility to state and national averages to see where staffing stands.
Total adjusted nursing hours per resident per day, combining RN, LPN, and aide time. CMS adjusts this for case-mix so facilities can be fairly compared.
| Staff type | Hours / Day / Resident | vs state avg |
|---|---|---|
|
Registered Nurse (RN)
RNs hold the highest nursing license and can assess residents, interpret test results, and direct care plans. More RN hours per day often signals stronger clinical oversight and faster response to health changes.
| 49m per day | |
|
LPN / LVN
Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs) deliver routine hands-on care — medication administration, wound dressing, and monitoring vital signs. They work under RN supervision and make up a large share of daily bedside care.
| 20m per day | |
|
Nurse Aide
Certified Nurse Aides (CNAs) provide the most direct day-to-day assistance: bathing, dressing, feeding, and mobility. Nurse aide hours are typically the largest staffing category and directly affect residents' quality of life.
| 2h 8m per day | |
|
Weekend Total Nursing
Combined nursing hours (RN + LPN + Nurse Aide) per resident per day on weekends. Staffing often drops on weekends — this figure reveals whether the facility maintains adequate coverage outside of weekday hours.
| 2h 56m per day | |
|
Physical Therapist
Hours per resident per day provided by licensed Physical Therapists (PTs) or PT Assistants. PT services help residents recover mobility after injury or illness and are especially important for post-acute (short-stay) rehabilitation.
| 2m per day | |
|
Weekend RN
Registered nurse hours specifically on weekends. Facilities sometimes reduce RN presence on Saturdays and Sundays — a low weekend RN figure compared to weekday hours can indicate reduced clinical oversight when most administrative staff are absent.
| 34m per day |
Avoca Lodge Assisted Living is administered by Marquita Monroe.
In Iowa, the Department of Inspections, Appeals, and Licensing conducts unannounced health and safety surveys to monitor compliance and protect residents in long-term care settings.
This scorecard compares key inspection, deficiency, and complaint metrics at this facility against the Iowa state average. Metrics rated ≥15% worse than average are highlighted in red; those ≥15% better are highlighted in green.
Deficiencies
| This Facility | IA Average | vs. IA Avg |
|---|---|---|---|
|
Total deficiencies
Formal regulatory issues recorded by inspectors across all inspection types.
| 8 | 27 | This facility has 70% fewer total deficiencies than a typical Iowa assisted living residence (8 vs. IA avg 27).↓ 70% better |
|
Deficiencies per year
Average deficiencies per year since 2004.
| 0.4 | 1.2 | This facility has 67% fewer deficiencies per year than a typical Iowa assisted living residence (0.4 vs. IA avg 1.2).↓ 67% better |
|
Deficiencies per inspection
Average deficiencies per inspection.
| 0.7 | 1.8 | This facility has 61% fewer deficiencies per inspection than a typical Iowa assisted living residence (0.7 vs. IA avg 1.8).↓ 61% better |
Inspections
| This Facility | IA Average | vs. IA Avg |
|---|---|---|---|
|
Total inspections
Combined count of all routine and focused inspections. Excludes complaint investigations.
| 11 | 15 | This facility has 27% fewer total inspections than a typical Iowa assisted living residence (11 vs. IA avg 15).↓ 27% better |
An editor-reviewed summary of the themes and findings across this facility's recent inspection reports.
State average N/A
Last Health inspection on Oct 2025
State average N/A
State average N/A
Health citations are formal notices following inspections when they fail to comply with safety and care standards.
34 of 66 citations resulted from standard inspections; 28 of 66 resulted from complaint investigations; and 4 of 66 came from combined inspections (standard and complaint).
In line with State averageState average: N/A
In line with State averageState average: N/A
Corrected
Corrected
Corrected
Corrected
Reporting period: October 1 – December 31, 2025 (Q4 2025). Source: CMS Payroll-Based Journal report.
0% compared with State averageState average ratio: 0 : 0
0% compared with State averageState average: 0 hours
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Manages medical care and health needs.
All 7 RN Staff are full-time employees. No contractors work on this role.
7
Average shift length. Calculated as total hours divided by days worked and average staff per day.
7.6 hoursAssists with medical care and medications.
All 4 LPN Staff are full-time employees. No contractors work on this role.
4
Average shift length. Calculated as total hours divided by days worked and average staff per day.
7.6 hoursHelps with daily care and mobility.
All 25 CNA Staff are full-time employees. No contractors work on this role.
25
Average shift length. Calculated as total hours divided by days worked and average staff per day.
6.8 hours
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Total hours from contractors
726 contractor hours this quarter
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
| Certified Nursing Assistant | 25 | 0 | 25 | 4,934 | 92 | 100% | 6.8 |
| Registered Nurse | 7 | 0 | 7 | 1,485 | 92 | 100% | 7.6 |
| Medication Aide/Technician | 4 | 0 | 4 | 1,037 | 84 | 91% | 7.1 |
| Licensed Practical Nurse | 4 | 0 | 4 | 927 | 82 | 89% | 7.6 |
| Administrator | 2 | 0 | 2 | 488 | 62 | 67% | 7.7 |
| Nurse Practitioner | 2 | 0 | 2 | 416 | 51 | 55% | 8 |
| Dietitian | 1 | 0 | 1 | 385 | 66 | 72% | 5.8 |
| Clinical Nurse Specialist | 3 | 0 | 3 | 377 | 51 | 55% | 6.5 |
| Speech Language Pathologist | 0 | 2 | 2 | 282 | 60 | 65% | 4.4 |
| Physical Therapy Assistant | 0 | 3 | 3 | 217 | 66 | 72% | 3 |
| Mental Health Service Worker | 1 | 0 | 1 | 177 | 26 | 28% | 6.8 |
| Respiratory Therapy Technician | 0 | 2 | 2 | 107 | 36 | 39% | 2.9 |
| Qualified Social Worker | 0 | 3 | 3 | 75 | 40 | 43% | 1.8 |
| Medical Director | 0 | 1 | 1 | 45 | 3 | 3% | 15 |
| Other Dietary Services Staff | 1 | 0 | 1 | 43 | 7 | 8% | 6.2 |
Federal penalties imposed by CMS for regulatory violations, including civil money penalties (fines) and denials of payment for new Medicare/Medicaid admissions.
Source: CMS Penalties Database
No penalties in the past 3 years
No civil money penalties or payment denials were reported in the last 3 years.
These measures show how residents usually do over time at this home, based on health outcomes and preventive care.
A composite score based on pressure ulcers, falls with injury, weight loss, walking ability decline, and activities of daily living decline.
11.7
14% worse than State averageState average: 10.2
A composite score based on activities of daily living decline, walking ability decline, and incontinence.
24.9
15% worse than State averageState average: 21.6
Percent of long-stay residents whose need for help with daily activities has increased
19.1%
In line with State averageState average: 18.8%
Percent of long-stay residents whose ability to move independently worsened
29.9%
52% worse than State averageState average: 19.7%
Percent of low risk long-stay residents who lose control of their bowels or bladder
25.7%
In line with State averageState average: 26.2%
Percent of long-stay residents experiencing one or more falls with major injury
2.4%
32% better than State averageState average: 3.6%
Percent of long-stay high risk residents with pressure ulcers
6.1%
39% worse than State averageState average: 4.4%
Percent of long-stay residents with a urinary tract infection
4.1%
64% worse than State averageState average: 2.5%
Percent of long-stay residents who lose too much weight
1.1%
79% better than State averageState average: 5.0%
Percent of long-stay residents who have depressive symptoms
5.0%
30% worse than State averageState average: 3.9%
Percent of long-stay residents who received an antipsychotic medication
16.4%
14% better than State averageState average: 19.0%
Percent of long-stay residents assessed and appropriately given the pneumococcal vaccine
91.9%
In line with State averageState average: 94.4%
Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine
97.3%
In line with State averageState average: 95.3%
Percent of short-stay residents assessed and appropriately given the pneumococcal vaccine
85.8%
In line with State averageState average: 85.1%
Percent of short-stay residents who newly received an antipsychotic medication
0.0%
100% better than State averageState average: 1.8%
Percent of short-stay residents assessed and appropriately given the seasonal influenza vaccine
81.5%
11% better than State averageState average: 73.3%
Quality measures are calculated from Minimum Data Set (MDS) assessments. For most measures, lower percentages indicate better care quality.
29% of new residents, usually for short-term rehab.
43% of new residents, often for short stays.
28% of new residents, often for long-term daily care.
Source: CMS Long-Term Care Facility Characteristics (Data as of Jan 2026)
Total residents
38Residents meet regularly to discuss policies, care quality, and activities
Family members meet regularly to discuss policies, care quality, and activities
Conducts clinical research trials to develop and test new treatments
Organized group of family members that meets regularly to discuss facility policies, resident care, and activities.
Organized group of residents that meets regularly to discuss facility policies, quality of life, and activities.
Data sourced from CMS Long-Term Care Facility Characteristics quarterly report. Payer mix reflects the current resident census by primary payment source.
Historical financial and operational data for Avoca Lodge Assisted Living from 2011–2023, based on CMS SNF Cost Reports.
Based on CMS SNF Cost Report for fiscal year ending in 12/2023.
Net patient revenue — what the home actually collects for resident care, after contractual allowances, bad debt and discounts are subtracted from its gross charges (CMS cost report, Worksheet G-3). It covers resident care only; money the home earns from other sources is shown separately as "Other income."
Net patient income: net patient revenue minus the home's total operating expenses. A positive figure means it earns more from resident care than it spends to deliver it; a negative figure means the opposite. It excludes non-operating "other income."
Net patient revenue — what the home actually collects for resident care, after contractual allowances, bad debt and discounts are subtracted from its gross charges (CMS cost report, Worksheet G-3). It covers resident care only; money the home earns from other sources is shown separately as "Other income."
Net patient income: net patient revenue minus the home's total operating expenses. A positive figure means it earns more from resident care than it spends to deliver it; a negative figure means the opposite. It excludes non-operating "other income."
Money the home earns outside of resident care — such as investments, grants, rentals and other non-operating sources (CMS cost report, Worksheet G-3). It is tracked separately from net patient revenue: it is not part of that figure, and it is not included in net patient income.
Staff salaries plus wage-related costs — benefits such as payroll taxes, health insurance and retirement — from the home's own accounting records (CMS cost report, Worksheet A). Contract or agency labor is counted separately, under other operating costs.
Rank #225 / 251Payroll — State benchmarkedThis home is ranked 225th out of 251 homes in Iowa. Shows total annual staff payroll benchmarked to the Iowa average. Higher payroll investment relative to peers often signals better staffing and less reliance on cheaper contract labor.Rankings are based only on facilities in Iowa that report data for that category. Facilities without available data are excluded from the ranking.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
Payroll as a share of revenue: staff salaries and wage-related benefits divided by net patient revenue. A higher figure means more of each revenue dollar goes to staff pay.
Rank #243 / 251Payroll % — State benchmarkedThis home is ranked 243rd out of 251 homes in Iowa. Shows payroll as a percentage of revenue versus the Iowa average. Well-run Iowa facilities typically land around 61–69% — the top third Statewide. Below 25% may signal understaffing or heavy agency use — read with Staffing ratings.Rankings are based only on facilities in Iowa that report data for that category. Facilities without available data are excluded from the ranking.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
Everything it costs to run the home apart from payroll — food, utilities, supplies, maintenance, contract labor and administration. Calculated as total operating expense minus payroll (staff salaries and wage-related benefits).
The home's total operating expense for the year — all the costs of running it, salaries included (CMS cost report, Worksheet G-3).
Housing Options: Semi-Private / 1 Bed
Building Type: Single-story
Housekeeping Services
Social and Recreational Activities
This home supports both short-term rehab and long-term care, with residents staying for a wide range of durations.
New residents most often arrive under private pay (43% of admissions), and a typical private pay stay runs around 4 - 5 months.
Coverage residents most often arrive under.
Coverage residents most often leave under.
3.2 miles from city center
Estimated distance in miles from Avoca's city center to Avoca Lodge Assisted Living's address, calculated via Google Maps.
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The information below is reported by the Iowa Department of Inspections, Appeals, and Licensing.
| Avoca Lodge Assisted Living | NH AL | Avoca | - | 40 | - | 0 | Semi-Private / 1 Bed |
| Valley View Village | NH AL HC IL MC RC | Des Moines (Fairmont Park) | - | 79 | - | 38 | Studio / 1 Bed / 2 Bed |
According to IA state health department records, Avoca Lodge Assisted Living's license number is S0138.
According to IA state health department records, Avoca Lodge Assisted Living's license expires on February 27, 2028.
Avoca Lodge Assisted Living's occupancy is 80.1%.
The team at Avoca Lodge Assisted Living can be reached at mmonroe@careinitiatives.org.
Avoca Lodge Assisted Living is registered as a for-profit in IA.
Marquita Monroe is the administrator of Avoca Lodge Assisted Living.
Avoca Lodge Assisted Living has 40 beds.
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