Salem Lutheran Home

2027 College Avenue · Elk Horn, IA · 51531 · 7127644201

64 certified beds For profit - Corporation Chain: Good Samaritan Society

  • No federal fines or payment denials in CMS’s 3-year window.
  • Inspection results have improved across recent cycles.

The composite number cleared 73 points, but Recommended is gated: inspection record below the Recommended bar. That rule is part of the published method.

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Red flags

69% of nursing staff left within a year

High turnover disrupts continuity of care; the national median is 45%.

Score breakdown

Inspection record 30% of score 52
Serious harm & abuse 20% 88
Staffing 20% 56
Federal penalties 15% 100
Trend 10% 87
Context 5% 100

Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.

CMS ratings & staffing

Overall: 2 of 5 Inspections: 2 of 5 Staffing: 3 of 5 Quality measures: 2 of 5

Total nurse hours / resident-day3.563.48 min · 4.1 strong
RN hours / resident-day0.540.55–0.75
Weekend hours / resident-day2.70≈ weekday level
Nursing turnover / year69%median 45%
Fines (3-yr window)none

Inspection citations (38 in the current record)

  • Potential for harm · D December 15, 2025 · found via complaint

    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Corrected December 22, 2025 · Resident Rights

  • Potential for harm · D October 8, 2025 · found via complaint

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

    Corrected October 10, 2025 · Quality of Life and Care

  • Potential for harm · D June 26, 2025

    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.

    Corrected July 11, 2025 · Resident Rights

  • Potential for harm · D June 26, 2025

    Develop and implement policies and procedures to prevent abuse, neglect, and theft.

    Corrected July 11, 2025 · Freedom from Abuse, Neglect, and Exploitation

  • Potential for harm · D June 26, 2025

    Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

    Corrected July 11, 2025 · Resident Assessment and Care Planning

  • Potential for harm · D June 26, 2025

    Provide safe and appropriate respiratory care for a resident when needed.

    Corrected July 11, 2025 · Quality of Life and Care

  • Potential for harm · D June 26, 2025

    Provide and implement an infection prevention and control program.

    Corrected July 11, 2025 · Infection Control

  • Potential for harm · D June 26, 2025 · found via complaint

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

    Corrected July 11, 2025 · Freedom from Abuse, Neglect, and Exploitation

  • Potential for harm · D June 26, 2025 · found via complaint

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

    Corrected July 11, 2025 · Quality of Life and Care

  • Potential for harm · D October 22, 2024 · found via complaint

    Protect each resident from the wrongful use of the resident's belongings or money.

    Corrected November 1, 2024 · Freedom from Abuse, Neglect, and Exploitation

  • Potential for harm · E October 22, 2024 · found via complaint

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

    Corrected November 1, 2024 · Resident Assessment and Care Planning

  • Potential for harm · D August 11, 2024

    Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

    Corrected September 5, 2024 · Resident Rights

  • Potential for harm · D August 11, 2024

    Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

    Corrected September 5, 2024 · Resident Assessment and Care Planning

  • Potential for harm · D August 11, 2024

    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

    Corrected September 5, 2024 · Resident Assessment and Care Planning

  • Potential for harm · D August 11, 2024

    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

    Corrected September 5, 2024 · Resident Assessment and Care Planning

  • Potential for harm · D August 11, 2024

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

    Corrected September 5, 2024 · Resident Assessment and Care Planning

  • Potential for harm · D August 11, 2024

    Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

    Corrected September 5, 2024 · Pharmacy Service

  • Potential for harm · E August 11, 2024

    Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

    Corrected September 5, 2024 · Nutrition and Dietary

  • Potential for harm · F August 11, 2024

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    Corrected September 5, 2024 · Nutrition and Dietary

  • Potential for harm · E August 11, 2024

    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

    Corrected September 5, 2024 · Resident Assessment and Care Planning

  • Potential for harm · E August 11, 2024

    Provide and implement an infection prevention and control program.

    Corrected September 5, 2024 · Infection Control

  • Potential for harm · D May 15, 2024 · found via complaint

    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

    Corrected May 31, 2024 · Nursing and Physician Services

  • Potential for harm · D May 15, 2024 · found via complaint

    Provide and implement an infection prevention and control program.

    Corrected May 31, 2024 · Infection Control

  • Actual harm · G June 6, 2023 · found via complaint

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

    Corrected June 26, 2023 · Quality of Life and Care

  • Actual harm · G June 6, 2023 · found via complaint

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

    Corrected June 26, 2023 · Quality of Life and Care

Showing the 25 most recent. The Safety Report includes every citation with full findings.

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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 165155 · certified since May 1, 1990. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.