Iowa care facility tied to alleged fraudster cited for 62 violations, including case of gangrene

A West Des Moines nursing home has been cited for 62 violations in recent weeks, one of which is tied to a resident who contracted gangrene and had to have a leg amputated.

Since August, the Iowa Department of Inspections, Appeals and Licensing has visited Pine Acres Rehabilitation and Care Center twice and cited it for violating a total of 47 federal regulations and 15 state regulations — an exceptionally large number of violations. The state agency has proposed a total of $89,500 in fines against the facility during that same three-month period.

The first visit was in response to a backlog of 13 uninvestigated complaints, all of which were substantiated by inspectors. The second visit, in late October, was in response to another 12 complaints, all of which were substantiated. In both instances, the home was cited for failing to employ a sufficient number of workers.

Staffing levels are a growing concern among advocates for the elderly as care facilities struggle to fill staff vacancies. Gov. Kim Reynolds recently joined other Republican governors in opposing federal efforts to impose new staffing requirements on nursing homes that collect taxpayer money through Medicare and Medicaid.

Pine Acres' primary owner, New York investor Akiko Ike, has ties to other nursing home owners who currently stand accused of defrauding the government.

Among the issues cited by state officials during their most recent inspection at Pine Acres is the home's alleged failure to assess and treat a growing pressure sore on the foot of a 70-year-old woman. On the morning of Sept. 12, the woman was found in bed, twitching and jerking, and didn't know where she was or the year. The resident was taken to a hospital and admitted in critical condition after being diagnosed with blood poisoning, septic shock, a serious bone infection and gangrene.

The hospital performed an emergency surgical amputation of the resident's leg, just below the knee, to prevent any further spread of the infection in her foot. The woman later told inspectors she felt that if she had been given the prescribed baths and skin assessments related to the sore on her foot, the amputation could have been prevented.

As a result of the situation, the state proposed a $9,250 fine against Pine Acres for failing to provide residents with the required nursing services. That penalty was then tripled to $27,750 due it being a repeat violation but was held in suspension so the Centers for Medicare and Medicaid Services could consider imposing a federal penalty. According to the Centers for Medicare and Medicaid Services, federal penalties were last imposed at Pine Acres in December 2021.

An additional fine of $6,500 was proposed for resident abuse. That fine was then tripled to $19,500 due to it being a repeat violation and held in suspension. A separate $500 penalty for failing to report resident abuse was also held in suspension.

The home was also cited for failing to investigate, prevent or correct alleged violations, failing to meet professional standards, failing to deliver the minimum quality of care, failing to properly label and store drugs and other issues.

Resident abuse cited in August visit

During their August visit top Pine Acres, inspectors noted that in February 2023 the administrator had received an email from a relative of a resident. The relative expressed concern that when she was "shocked at the sight" of the multiple open sores on the resident's skin. The relative indicated she was "stunned" by this and said she couldn't believe she had not been notified. The director of nursing responded that the staff would be re-educated, but allegedly offered no explanation as to the lack of notification.

Days later, the resident was admitted to a hospital and diagnosed with urine in her bloodstream and acute kidney failure. A Pine Acres staffer told inspectors the hospital staff had concluded the wounds on the resident's skin had been caused by toxins that her kidneys couldn't excrete and were emerging through her skin. Two workers told inspectors they didn't realize anything was wrong with the woman because staffers from the previous shift hadn't reported anything. The state proposed, and then suspended, a $7,500 fine for failing to assess residents and provide the necessary care.

Additional fines that were held in suspension include $7,000 for failing to provide adequate nursing services, and $13,250 for failing to investigate allegations of resident abuse and failing to separate the accused workers from the alleged victims.

State inspectors reported that seven of the home's residents complained that workers were rough with them when providing care. "A serious adverse outcome was likely to occur as the facility additionally failed to report and thoroughly investigate all allegations of abuse," the state inspectors reported.

A nurse's aide told inspectors she had relayed to the director of nursing a female resident's complaint that a worker was being rough with her. The aide said the director of nursing responded by saying the accused worker was needed cover the facility's staffing needs. The administrator acknowledged such issues had been "pushed under the rug."

According to inspectors, staff and residents had also raised concerns about a male employee who was alleged to be rough with residents, had "cussed" at them, "manhandled" them, and forced some of them to go to bed hours before they wanted to retire for the evening. One resident complained the worker had responded to her request for assistance in using the bathroom by entering her room, removing her oxygen supply and then pulling her call-light cord out of the wall. An aide questioned why the man was still working there and told inspectors the facility "needed to get him out of here."

A review of the male worker's personnel file revealed no disciplinary action and no concerns related to resident complaints, inspectors alleged.

Residents complained of being ignored by staff

Two residents complained to inspectors that the overnight-shift workers were rude, sat outside residents' rooms talking loudly on the phone with their ear buds in, and did not engage with them while providing care. A third resident complained half the staff at Pine Acres was "horrible," said mean things, and were physically rough when providing care.

The facility's social services assistant told inspectors the staff had repeatedly failed to provide assistance for one male resident. She told inspectors the man would scream when his call light went unanswered but multiple staffers would ignore him while sitting at the nurse's station. An aide told inspectors that other workers in the home would "verbally abuse" the residents and that when she'd arrive for her morning shift the residents were "soaking wet."

Residents also complained to the home's administration that they couldn't get any assistance from the staff after 9:30 p.m. because the workers were all in the breakroom waiting to clock out and go home.

While an inspector watched, a resident using a walker approached a male employee of the home, identified in state reports as "Staff Z," and asked for some Kleenex for herself and her roommate.

In their written report, the inspectors described the interaction:

"Staff Z, a certified nurse's aide, approached the resident and, while chewing gum with an opened mouth … and told the resident the facility didn't have any Kleenex. The resident asked inquisitively, 'You don't have any Kleenex? Why?' Staff Z continued to chew gum in the same manner and replied, 'Because the delivery truck hasn't come yet!' The resident asked when she could get some Kleenex and Staff Z said in an abrupt tone, 'In about three days!'

"The resident initially responded, 'Oh, OK,' as she turned around to walk away. She furrowed her eyebrows with a bewildered look, turned back toward Staff Z, and said, 'Three days? Why would it take three days to get Kleenex?' Staff Z exclaimed, 'l am not telling you a story!' in a defensive tone, similar to someone accused of lying."

Inspectors also cited Pine Acres for a medication error rate that was approaching 11 percent; for providing residents with cold meals; and for having expired food on hand in the kitchen, including molasses that had expired 43 months earlier, corn muffin mix that had been expired for 16 months, and milk that had expired six days earlier.

The home was also cited for insufficient staff, with inspectors noting that residents complained of "horrible" wait times to have their call lights answered. The home's director of nursing told inspectors she felt the home was "overstaffed."

Pine Acres' owner tied to man accused of fraud

According to federal records, Pine Acres is owned and managed by a New York-based group of investors that includes Akiko Ike, who has a 60% ownership stake in the facility. Other investors include Yisroel Kaplan, who has operational control of Pine Acres and a stake in another Iowa care facility, the Prestige Care Center in Fairfield.

One of Kaplan's partners is Ephram Lahasky, who is the husband of Ike, Pine Acres' primary owner.

In Vermont last year, regulators raised concerns about who was behind the proposed purchase of care facilities in that state — Lahasky or his wife. Ike was the officially designated buyer, but it was Lahasky's name that appeared on the loan documents.

Lahasky is currently being sued by New York Attorney General Letitia James, who has accused Lahasky and others of defrauding the government of more than $18 million while understaffing and neglecting residents at The Villages, a 120-bed facility in northwestern New York.

Lahasky and his partners in The Villages allegedly obtained mortgages to finance the original purchase of the facility, then obtained a $15 million loan to refinance the mortgage. They then claimed $4 million as a cash distribution of loan proceeds.

In 2020, the facility was again refinanced through the U.S. Department of Housing and Urban Development, and an additional $3.6 million was withdrawn as profit for the owners, according to the New York attorney general. The care facility then had to repay the inflated costs of the mortgage out of its operating account, which allegedly led to a dramatic decrease in the quality of care while creating the false impression of a cash-strapped nursing home.

Lahasky has also been part owner of Brighton Rehab and Wellness Center in Pennsylvania, where authorities have accused the operators of falsifying staff hours and overcharging for resident care.