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Nursing HomeMedicaid Investigative

Lutheran Living Senior Campus

Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.

2421 Lutheran Drive, Muscatine, IA 52761155 bedsLicensed & Active
1/5
Medicare
Inspection
Quality
Staffing
Google rating
3.3/5

based on 22 Google reviews

5
4
3
2
1
Lutheran Living Senior Campus Nursing Home in Muscatine, IA — Street View
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7/ 10
critical Risk

Quality Concerns Identified

Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.

  • Special Focus Facility (under heightened CMS scrutiny)
  • Low overall rating (1/5 stars)
  • Above-median deficiencies (12 vs median 5)
  • High RN turnover (71%)

Bottom 25% in IA · Below recommended RN staffing · Above average staffing · $303,533 in fines · Special Focus Facility (CMS)

Source: Medicare data

What this means for your family

While some families report a warm and caring environment, there are recurring, serious allegations of neglect and staffing shortages. We strongly advise you to conduct unannounced visits, specifically during weekends or evening shifts, to observe the responsiveness of the staff and the quality of care firsthand.

Google Reviews

Google Reviews

22 reviews on Google
Lutheran Living Senior Campus receives highly polarized feedback, with some families praising the warm, caring staff and clean environment, while others report severe neglect and staffing shortages. Critical concerns include reports of residents being left unattended, missing personal belongings, and lapses in basic care like oxygen management and meal provision. Families considering this facility should be aware of the stark contrast between positive experiences and serious allegations of neglect.

Quality Themes

Tap a score for details
Food5.0Staff5.0Clean8.0ActivitiesN/AMeds2.0MemoryN/AComms4.0ValueN/A

Strengths

  • Warm and attentive nursing staff
  • Clean and well-maintained facility
  • Competent and friendly care team

Concerns

  • Neglect and lack of responsiveness to call lights (mentioned by 3 reviewers)
  • Understaffing leading to staff fatigue and poor care (mentioned by 2 reviewers)

Rating Trends

Tap a year to see what changed

2343.0'16(2)4.81.0'20(1)1.01.0'23(1)4.43.9'25(7)1.0'26(1)

Distribution · 25 analyzed

5
12
4
3
3
3
2
0
1
7

How They Respond to Reviews

64%response rate

This facility responds to some reviews.

Questions for Your Tour

  • 1I noticed that communication is a key focus for your team; how do you keep families updated on changes in a resident's daily health or care plan?
  • 2With 12 recent state violations, what specific steps has the leadership team taken to improve oversight and ensure higher standards of care?
  • 3I appreciate that you actively engage with online feedback; how do you translate those family suggestions into actual improvements for the residents?
  • 4Some families have mentioned concerns about response times to call lights; what is your current protocol for ensuring residents get the assistance they need promptly?
  • 5Given the current staffing levels, how do you ensure that your nursing team has the support they need to maintain the warm, attentive care that many residents enjoy?
  • 6Could you walk me through how you manage medication administration to ensure accuracy and safety for residents?

Personalized based on this facility's data


Key Review Excerpts

My mom has fallen several times due to nobody coming in her room when she calls. She was very weak because her oxygen machine wasnt on.

Long-term resident's family · 2020☆☆☆☆

Not enough staff, and those there work double shifts and too tired to care. Don't leave your family here alone.

Memory care family member · 2024☆☆☆☆

My grandfather was in this nursing home and was constantly neglected. Was not even provided regular 3 meals a day.

Long-term resident's family · 2026
Source: 22 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.45hrs
60%
Registered nurses for medical care
Total Nursing
4.05hrs
99%
All nurses + aides combined
Staff Turnover
43%
Lower is better (< 30% = good)
RN Turnover
63%
Lower is better (< 30% = good)

Both RN and total nursing hours are below national benchmarks. This can mean less clinical attention per resident, so ask about their staffing plan.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 17 measures

Medicare Rating
4/ 5
Better Than Avg

12

measures

Worse Than Avg

3

measures

Mixed Results

2

measures

Long-Stay Residents
💉

Residents vaccinated for pneumonia

↑ Higher is better
This Facility57.9%
Worse than Avg
Here
57.9%
US
93.4%
IA
93.9%
Muscatine
95.0%
💊

Residents on antipsychotic medication

↓ Lower is better
This Facility9.6%
Better than Avg
Here
9.6%
US
15.4%
IA
19.4%
Muscatine
19.2%
🛏️

Residents needing more daily help over time

↓ Lower is better
This Facility12.4%
Better than Avg
Here
12.4%
US
14.4%
IA
17.6%
Muscatine
20.5%
🚶

Residents whose walking got worse

↓ Lower is better
This Facility13.6%
Better than Avg
Here
13.6%
US
15.3%
IA
17.5%
Muscatine
21.2%
😔

Residents with depression symptoms

↓ Lower is better
This Facility5.8%
Mixed vs Avgs
Here
5.8%
US
12.1%
IA
4.1%
Muscatine
7.4%

Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.

💊

Residents on anti-anxiety or sleep medication

↓ Lower is better
This Facility15.7%
Better than Avg
Here
15.7%
US
19.5%
IA
20.7%
Muscatine
21.1%
Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility90.8%
Better than Avg
Here
90.8%
US
79.7%
IA
73.3%
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility93.1%
Better than Avg
Here
93.1%
US
81.8%
IA
84.0%
Muscatine
85.6%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility3.6%
Worse than Avg
Here
3.6%
US
1.6%
IA
2.0%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

10deficiencies
4penalties
Well above state avg (6.2)
24 complaint-triggered
$303,533 in fines

Families have filed numerous complaints triggering 24 deficiencies, indicating ongoing concerns about care quality and safety. The facility repeatedly struggles with accident prevention and hazard management, family notification protocols when incidents occur, and behavioral health staffing. Recent complaints in 2025 show persistent issues with communication and resident safety despite previous corrections, suggesting some problems may not be fully resolved.

Feb 13, 2026Routine
8
0291Potential for harm · WidespreadCorrected

Egress Deficiencies

Install emergency lighting that can last at least 1 1/2 hours.

0345Potential for harm · WidespreadCorrected

Smoke Deficiencies

Have approved installation, maintenance and testing program for fire alarm systems.

0353Potential for harm · WidespreadCorrected

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

0753Potential for harm · WidespreadCorrected

Miscellaneous Deficiencies

Have restrictions on the use of highly flammable decorations.

0552Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Ensure that residents are fully informed and understand their health status, care and treatments.

0584Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

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.

0880Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0732Minimal · WidespreadCorrected

Nursing and Physician Services Deficiencies

Post nurse staffing information every day.

Aug 7, 2025Complaint
6
0740Immediate jeopardy · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure each resident must receive and the facility must provide necessary behavioral health care and services.

0741Immediate jeopardy · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents.

0553Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Allow resident to participate in the development and implementation of his or her person-centered plan of care.

0580Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

0684Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

0628Minimal · PatternCorrected

Resident Rights Deficiencies

Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

Mar 6, 2025Complaint
1
0580Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Dec 12, 2024Routine
7
0321Potential for harm · WidespreadCorrected

Smoke Deficiencies

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

0712Potential for harm · WidespreadCorrected

Miscellaneous Deficiencies

Have simulated fire drills held at unexpected times.

0804Potential for harm · PatternCorrected

Nutrition and Dietary Deficiencies

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

0609Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

0623Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

0658Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Ensure services provided by the nursing facility meet professional standards of quality.

0761Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Sep 30, 2024Complaint
4
0689Immediate jeopardy · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

0677Potential for harm · PatternCorrected

Quality of Life and Care Deficiencies

Provide care and assistance to perform activities of daily living for any resident who is unable.

0684Potential for harm · PatternCorrected

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

0580Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Jul 31, 2024Complaint
1
0689Immediate jeopardy · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Federal Penalties

Fine

Aug 7, 2025

$92,203

Fine

Jul 31, 2024

$134,971

Payment Denial

Jul 31, 2024

46-day denial

Fine

Oct 5, 2023

$26,712

State Inspection History

State Inspections

Source: Iowa Dept. of Inspections, Appeals & Licensing

10total
12deficiencies
Mar 24, 2026Inspection
Clean

Fed violations: 0, State violations: 0

Mar 17, 2026Complaint
Clean

Fed violations: 0, State violations: 0

Feb 13, 2026Inspection
Clean

Fed violations: 4, State violations: 0

Dec 4, 2025Complaint
Clean

Fed violations: 0, State violations: 0

Nov 17, 2025Complaint
Clean

Fed violations: 0, State violations: 0

Oct 28, 2025Complaint
Clean

Fed violations: 0, State violations: 0

Oct 8, 2025Other
Clean

Fed violations: 0, State violations: 0

Aug 7, 2025Complaint
Clean

Fed violations: 6, State violations: 1

Ownership & Operations

Who Operates This Facility

Owner / Operator

Lutheran Living Senior Campus

Organization Type

nonprofit

Chain Affiliation

Chain Name

Health Dimensions Group

Chain Size

10 facilities nationwide

Ownership & Management

Key personnel

Baars, TylerManaging Control - Governing BodyBeckey, VickiManaging Control - Governing BodyBurzlaff, SusanManaging Control - Governing BodyEversmeyer, SusanManaging Control - Governing BodyFrancis, MeganManaging Control - Governing Body
Source: Medicare provider data

Contact

Get in Touch

Contact this facility directly and verify the details that matter most to your family.

References & Resources

EveryPlace is a research directory. Facility information is compiled from public sources — Medicare.gov, state licensing portals, Google Places, and publicly available street-level imagery. Listings do not constitute endorsement, recommendation, or advertisement, and we do not accept payment for placement. Families should verify all details directly with the facility and the original sources linked above before making any care decisions. See our Research Policy for our editorial standards, correction process, and image-removal policy.

Safer Alternatives Nearby

Based on current clinical data, we identified 5 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.

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