(August, 2019) Nursing homes are highly regulated and must adhere to hundreds of standards and regulations. There is one nursing home locally that continues to provide a high level of care and service and meet every regulation. In the most recent state inspection and survey (June, 2019) administered by the Iowa Department of Inspections and Appeals, Avoca Specialty Care received zero deficiencies. There are 412 nursing facilities in Iowa. Generally, only 5 percent are found to be deficiency-free.