Six Iowa nursing homes run by one company are fined for abuse and neglect

Six Iowa nursing homes run by the same West Des Moines corporation have been cited for major violations in recent weeks.

The homes, which are owned and operated by Care Initiatives, are facing fines of up to $80,250, and additional penalties may yet be imposed by the federal Centers for Medicare and Medicaid Services.

The alleged violations are tied to gangrene that one resident contracted, the verbal abuse of a resident, medication errors and a lack of staffing

Care Initiatives did not respond to a request for comment. The company operates 43 care facilities that are home to as many as 2,800 older Iowans. It is the largest nursing home chain in Iowa and is organized as a tax-exempt, nonprofit corporation.

Tax records indicate it generated $213 million in revenue in 2020 and spent $207 million. Care Initiatives pays its board members $28,000 each, and in 2020 it paid the company’s then-president and CEO, Miles King, $620,000. That total included a severance payout of almost $316,000.

Due to the COVID-19 pandemic, the federal government has provided Care Initiatives and other nursing homes throughout the nation with emergency relief grant money. In 2021, Care Initiatives reported collecting $7.9 million in such grants.

Here‘s a look at a few of the violations found at the six Care Initiatives homes recently cited for violations:

Creston: At Creston Specialty Care, inspectors determined that sometime between 3:45 a.m. and 4:15 a.m. on Aug. 16, a female resident wandered away from the building. Inspectors concluded the door alarms had sounded as designed, but the employees did not respond and were unaware the resident had left the building until a nearby hospital called to report the woman was in their emergency room. The woman had been spotted by a hospital employee at the bottom of a steep hill. An $8,000 state fine was held in suspension with the matter referred to federal officials for further action.

Ottumwa: At Ridgewood Specialty Care, state inspectors recently investigated three complaints, all of which were substantiated. According to inspectors, a physical therapist noticed last December that a resident’s right foot was purple and swollen. A nurse was informed, but no treatment was provided. Six days later, the physical therapist noticed the foot had turned dark purple, was cold, showed no signs of blood flow, and two of the toes were turning black.

At that point, the resident was unable to put any weight on the foot due to the pain. The resident was taken to the emergency room of a nearby hospital, where gangrene was diagnosed. A vascular surgeon told the family the damage was irreversible and discussed amputation of the foot. The family declined surgery and instead placed the resident in hospice. Ridgewood was fined $8,000.

An additional $500 fine was imposed for resident abuse. A nurse aide told inspectors that shortly before midnight on July 22, a resident with traumatic brain dysfunction was moaning in bed and repeatedly crying out, “Mommy,” when another aide went into the resident’s room and yelled, “Just shut up. Shut the f— up.”

Cedar Falls: At Pinnacle Specialty Care, state inspectors recently investigated seven complaints. While the inspectors didn’t report how many of those complaints were substantiated, they cited the facility for a situation in which a resident was given an overdose of fentanyl when the staff applied a medication patch with the drug in it without first removing an older patch that was still delivering fentanyl to the woman’s system.

The situation was first noticed by a visiting family member who said that once alerted, the nurses agreed to send the woman to the emergency room, but then they left him alone to physically prop up the woman until the ambulance crew arrived. In the emergency room, a doctor removed one of the fentanyl patches and the resident immediately began to perk up. The facility was fined $6,750.

Stratford: At Stratford Specialty Care, inspectors reported the staff could not hear the sound of the door alarms warning that an exit door had been opened and some caregivers did not “know what the sound meant.” On Sept. 5, a resident had wandered out of the building around 2:45 p.m., triggering an alarm.

Eventually, two kitchen workers overheard the alarm and yelled to a group of caregivers, who were standing around the nurse’s station, “Doesn’t anyone else hear the alarm going off?” One of the two kitchen workers then located the resident walking on a nearby state highway and returned him to the home around 3 p.m. A $7,500 state fine was held in suspension with the matter referred to federal officials for further action.

Waterloo: At Ravenwood Specialty Care, inspectors recently investigated 19 complaints, 18 of which were substantiated. The inspectors found that one wing of the dementia unit where seven residents lived was left completely unstaffed.

An inspector saw one resident sitting by the nurses’ station, waiting for assistance from the staff. The inspector asked the man where all of the workers were, and the man said he didn’t know. When the assistant director of nursing appeared at the nurses’ station, the inspector alerted her to the fact that the wing was unstaffed. The assistant director of nursing replied that was a “problem,” and then turned and left.

After watching a resident rummage through the trash receptable attached to an unlocked medication cart parked in a hallway, the inspector informed a registered nurse of the incident. The nurse became tearful and said she was doing the best she could but was working alone while trying to cover both wings of the dementia unit.

The home was deemed to have placed residents in immediate jeopardy, but the situation was considered resolved after the administration initiated “staff education.” A $10,000 state fine was held in suspension with the matter referred to federal officials for further action.

Sioux City: At Westwood Specialty Care, inspectors went to the home in August and investigated 15 complaints and four self-reported incidents. The home was cited for 13 regulatory violations, including failure to provide adequate quality of care, failure to employ sufficient nursing staff, failure to maintain a medication error rate of 5% or less, and failure to follow infection-control guidelines.

Inspectors said the home failed to adequately address one female resident’s risk for falling, which contributed to the woman’s hospitalization for multiple rib fractures, a broken collar bone, a fractured pelvis, and a fractured wrist. A $30,000 state fine was held in suspension with the matter referred to federal officials for further action.