2/5
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.
2/5
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.
Azria Health Winterset is a 70-bed skilled nursing and post-acute rehabilitation facility in Winterset, Iowa, providing long-term care, short-stay rehabilitation, memory care, and respite stays for residents in Madison County. The facility is privately owned and operated by Kristin Merron and accepts Medicare, Medicaid, and private pay.
CMS rates the facility at 2 stars overall, with all three sub-ratings below the Iowa average — Health Inspection 30% below, Staffing 15% below, and Quality Measures 39% below. Nurse staffing averages 3 hours and 42 minutes per resident per day, roughly 14% below Iowa’s average of 4 hours and 18 minutes, with weekend RN staffing at 17 minutes per day compared with the state’s average of 30. A payment denial was issued in May 2024 and lasted for two days; the facility carries no federal fines, ranking first among 246 Iowa skilled nursing facilities on that measure.
The facility’s on-site therapy — physical, occupational, and speech — supports the rehabilitation program. Lifestyle amenities include chef-prepared menus and a private dining room. The facility’s occupancy rate is 65.8%, below the Iowa average of 75.4%, suggesting current availability.
The facility is structured for residents seeking post-acute rehabilitation or long-term skilled nursing care in Winterset, with current availability and on-site therapy capacity.
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.
| 22m per day | ▼ 50% State avg: 44m per day · National avg: 41m 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.
| 49m per day | ▲ 45% State avg: 34m per day · National avg: 52m 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 23m per day | ▼ 6% State avg: 2h 32m per day · National avg: 2h 20m 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.
| 3h 12m per day | ▼ 5% State avg: 3h 21m per day · National avg: 3h 26m 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.
| 6m per day | ▲ 212% State avg: 2m per day · National avg: 4m 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.
| 14m per day | ▼ 53% State avg: 30m per day · National avg: 28m per day |
Average number of days residents stay at this facility, based on CMS cost report data. Shorter stays often reflect post-acute or rehab care; longer stays reflect long-term care.
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 4 RN 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.
9.6 hoursAssists with medical care and medications.
All 11 LPN Staff are full-time employees. No contractors work on this role.
11
Average shift length. Calculated as total hours divided by days worked and average staff per day.
9 hoursHelps with daily care and mobility.
All 42 CNA Staff are full-time employees. No contractors work on this role.
42
Average shift length. Calculated as total hours divided by days worked and average staff per day.
7.4 hours
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Total hours from contractors
135 contractor hours this quarter
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
| Certified Nursing Assistant | 42 | 0 | 42 | 11,222 | 92 | 100% | 7.4 |
| Licensed Practical Nurse | 11 | 0 | 11 | 3,545 | 92 | 100% | 9 |
| Registered Nurse | 4 | 0 | 4 | 855 | 70 | 76% | 9.6 |
| Dietitian | 3 | 0 | 3 | 527 | 62 | 67% | 5.3 |
| Respiratory Therapy Technician | 4 | 0 | 4 | 498 | 64 | 70% | 6.7 |
| Administrator | 1 | 0 | 1 | 480 | 60 | 65% | 8 |
| Nurse Practitioner | 1 | 0 | 1 | 472 | 59 | 64% | 8 |
| Clinical Nurse Specialist | 4 | 0 | 4 | 441 | 60 | 65% | 6.7 |
| RN Director of Nursing | 1 | 0 | 1 | 401 | 49 | 53% | 8.2 |
| Physical Therapy Assistant | 3 | 0 | 3 | 399 | 63 | 68% | 6.1 |
| Medication Aide/Technician | 6 | 0 | 6 | 153 | 18 | 20% | 7 |
| Mental Health Service Worker | 2 | 0 | 2 | 118 | 18 | 20% | 6.6 |
| Occupational Therapy Aide | 0 | 1 | 1 | 79 | 18 | 20% | 4.4 |
| Qualified Social Worker | 2 | 0 | 2 | 46 | 18 | 20% | 2.5 |
| Occupational Therapy Assistant | 0 | 3 | 3 | 32 | 7 | 8% | 4.5 |
| Medical Director | 0 | 1 | 1 | 25 | 32 | 35% | 0.8 |
Includes penalties issued in 2024
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 (Data as of Jan 2026)
100% lower than State averageState average: $48K
100% fewer fines than State averageState average: 1.7
Serious action where Medicare and/or Medicaid temporarily stops payments for new residents until issues are fixed.
1 
88% more payment denials than State averageState average: 0.5
Penalties are imposed by CMS for violations of federal nursing home regulations.
1 penalty in the past 3 years
May 9, 2024 · 2 days
Serious action where Medicare and/or Medicaid temporarily stops payments for new residents until issues are fixed.
May 9, 2024Last updated: Jan 2026
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.
14.6
42% worse than State averageState average: 10.2
A composite score based on activities of daily living decline, walking ability decline, and incontinence.
28.6
33% worse than State averageState average: 21.6
CMS star rating based on long-stay quality measure performance. 5 stars = significantly above average, 1 star = significantly below average.
Percent of long-stay residents whose need for help with daily activities has increased
31.9%
69% worse than State averageState average: 18.8%
Percent of long-stay residents whose ability to move independently worsened
31.4%
59% worse than State averageState average: 19.7%
Percent of low risk long-stay residents who lose control of their bowels or bladder
22.6%
14% better than State averageState average: 26.2%
Percent of long-stay residents experiencing one or more falls with major injury
0.5%
85% better than State averageState average: 3.6%
Percent of long-stay high risk residents with pressure ulcers
6.6%
51% worse than State averageState average: 4.4%
Percent of long-stay residents with a urinary tract infection
1.1%
56% better than State averageState average: 2.5%
Percent of long-stay residents who lose too much weight
2.5%
50% better than State averageState average: 5.0%
Percent of long-stay residents who have depressive symptoms
0.6%
86% better than State averageState average: 3.9%
Percent of long-stay residents who received an antipsychotic medication
18.9%
In line with State averageState average: 19.0%
Percent of long-stay residents assessed and appropriately given the pneumococcal vaccine
100.0%
6% better than State averageState average: 94.4%
Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine
94.0%
In line with State averageState average: 95.3%
Number of hospitalizations per 1,000 long-stay resident days.
1.57
6% worse than State averageState average: 1.48
Number of outpatient emergency department visits per 1,000 long-stay resident days.
3.66
75% worse than State averageState average: 2.09
Percent of short-stay residents assessed and appropriately given the pneumococcal vaccine
97.3%
14% better than State averageState average: 85.1%
Percent of short-stay residents who newly received an antipsychotic medication
2.4%
29% worse than State averageState average: 1.8%
Rate of successful return to home or community from a skilled nursing facility.
54.0%
7% better than State averageState average: 50.6%
Quality measures are calculated from Minimum Data Set (MDS) assessments. For most measures, lower percentages indicate better care quality.
20% of new residents, usually for short-term rehab.
79% of new residents, often for short stays.
1% of new residents, often for long-term daily care.
Source: CMS Long-Term Care Facility Characteristics (Data as of Jan 2026)
Total residents
50Residents meet regularly to discuss policies, care quality, 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 Azria Health Winterset from 2011–2023, based on CMS SNF Cost Reports.
Key figures below are for fiscal year ending in 12/2023.
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 #192 / 246Payroll — State benchmarkedThis home is ranked 192nd out of 246 homes in Iowa for Payroll. 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.Facilities with the same value for a metric share the same rank. 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 #156 / 246Payroll % — State benchmarkedThis home is ranked 156th out of 246 homes in Iowa for Payroll %. 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.Facilities with the same value for a metric share the same rank. 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).
Pets Allowed
Residents typically stay for brief periods, with frequent admissions and discharges throughout the year.
Most new residents arrive under private pay (79% of admissions), and a typical private pay stay runs around 3 - 4 months.
Coverage residents most often arrive under.
Coverage residents most often leave under.
0.0 miles from city center
Estimated distance in miles from Winterset's city center to Azria Health Winterset's address, calculated via Google Maps.
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The information below is reported by the Iowa Department of Inspections, Appeals, and Licensing.
| Bethany Home Retirement Center | NH IL MC SNF | Dubuque (Eagle Point District) | - | 66 | - | 69 | 1 Bed / 2 Bed |
| Friendship Village | NH AL IL MC SNF | Waterloo | - | 72 | - | 52 | 2 Bed / 3 Bed |
| Prairie Vista Village | NH AL IL SNF | South Altoona | - | 68 | A | 29 | - |
| St Francis Manor | NH AL HOS SNF | Grinnell | - | 78 | - | 82 | - |
| Azria Health Winterset | NH IL SNF | Winterset | - | 65 | - | 72 | - |
Azria Health Winterset has a walk score of 72. Very walkable. Most errands can be accomplished on foot, and many essentials are within a short walk.
Azria Health Winterset's occupancy is 65.8%.
Azria Health Winterset is registered as a for-profit.
Yes — there are 20 photos of Azria Health Winterset in the photo gallery on this page.
Azria Health Winterset is located at 1015 West Summit, Winterset, Ia 502732209.
(515) 462-1711 will put you in contact with the team at Azria Health Winterset.
Yes — Azria Health Winterset is a CMS-certified provider of Medicare and Medicaid.
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