Of the 20 Iowa nursing homes with the biggest, active COVID-19 outbreaks, 14 were cleared by state inspectors of any infection-control violations earlier this year.

In some cases, facilities with as many as seven dozen confirmed COVID-19 infections have undergone two, three or even four infection-control inspections since the pandemic began and been cleared by state inspectors each time.

At the Hiawatha Care Center in Linn County, for example, state officials performed an infection-control inspection on June 18 and found zero violations. Responding to a complaint, inspectors returned and did another infection-control review on July 29 and again found no violations. On Sept. 24, inspectors returned in response to a second complaint and again found no violations. On Oct. 14, inspectors responded to a third complaint and, for the fourth time, found no infection-control issues.

On Nov. 1, two weeks after that last state inspection, the Hiawatha Care Center