The corporate headquarters of the West Des Moines nursing home chain Accura Healthcare. (Photo via Google Earth)
An Iowa nursing home where a resident choked to death has been cited by the state for a rodent infestation, insufficient staff and employing a noncertified nurse aide.
The Iowa Department of Inspections, Appeals and Licensing has proposed, but held in suspension, an $8,250 state fine against Accura Healthcare of Lake City, one of 31 care facilities run by a for-profit West Des Moines company, Accura Healthcare LLC.
With the state penalty held in suspension, the federal Centers for Medicare and Medicaid Services are now expected to determine whether a federal fine is warranted.
According to DIAL, the Lake City home failed to provide adequate supervision of residents to ensure timely intervention on Dec. 4, 2024, when a resident choked on a meal and died. The 46-resident home is also alleged to have failed to ensure that appropriately trained staff were on hand to supervise and feed residents who were at risk for choking.
According to the state inspectors, a male resident of the home was eating supper in the assisted-dining area on Dec. 4, 2024, when a non-certified nurse aide noticed the man, who required extensive assistance when eating, was choking on a tenderloin sandwich. At the time, she and two residents were the only people in the assisted-dining area. The noncertified aide “couldn’t do the Heimlich,” inspectors later reported, as she couldn’t fit her arms around him. The walkie-talkie she carried failed to work, inspectors alleged, and so she yelled for help.
A dietary aide responded, then left the room to find someone else to assist the resident who was choking. The noncertified aide then “pounded” on the resident’s back, but without success, inspectors reported, inspectors alleged. After three minutes, by which time the man’s lips had turned blue and his teeth were clenched, a nurse arrived in the area and the staff was able to dislodge a small piece of bread from the resident’s airway.
An ambulance arrived and transported the man to a hospital where he was diagnosed with aspiration pneumonia, indicating regurgitated food was in both lungs. The man was given end-of-life care and died within four hours. The cause of death was cardiac arrest due to acute respiratory failure and a choking incident.
State inspectors later interviewed the noncertified aide who reportedly stated that while she not certified to work as a nurse aide, the administrator had been “willing to give her a shot at being an aide” with the intent of arranging for a skills test. The aide allegedly told inspectors she had never been certified in CPR but knew how to do it and the Heimlich maneuver.
Employment records showed that from 2021 through July 2024, the noncertified aide had worked in a restaurant serving food. In late August 2024, she was hired at another care facility where she worked four weeks as a “training CNA” before applying for work at Accura in anticipation of taking the test to become certified.
Under Iowa law, a care facility can employ a full-time noncertified nurse aide for up to four months. To work in that capacity beyond four months, they must be trained and certified or otherwise be deemed competent.
Inspectors alleged the noncertified aide involved in the choking incident had not completed a training and competency evaluation or worked full time within a state-approved training program as required.
Accura chain owes taxpayers for unpaid fees
As a result of the state’s findings, Accura’s vice president of operations “educated the administrator and director of nursing” on the need to ensure that only licensed nurses or certified nurse aides were used to assist residents during meals, according to the state inspection report.
As of Jan. 7, 2025, there were no longer any noncertified aides working in the facility, inspectors reported. In addition, state records indicate the administrator educated the staff on the need to make sure the walkie-talkies they use to communicate with each other and respond to call lights are working properly.
The home was cited for failing to employ sufficient staff and for inadequate pest control, with mice reported in nine separate rooms of the building.
One resident reported opening up a bureau drawer and finding a mouse sitting atop her underwear. The same resident reported she later found a mouse stuck to a glue trap in her room, inspectors said.
A nurse aide allegedly told inspectors the home had a mouse infestation with droppings found inside various drawers and cabinets, and that she felt the problem was not getting any better. A licensed practical nurse said the issue “had been going on for a while,” inspectors reported.
Lisa Toti, the president of Accura Healthcare LLC, said Tuesday in a written statement that the home “took immediate action when signs of mice were reported and hired a professional pest control service, effectively eradicating the concern.”
Last fall, state officials reported that 19 of Accura Healthcare’s care facilities were on payment plans with the state due to the fact that they owed taxpayers a combined $4 million in unpaid fees.
Campaign finance records show that since 2021, Toti has made $36,000 in political donations in Iowa. Since 2015, Accura’s CEO, Ted LeNeave, has personally donated more than $239,000 to GOP campaigns in Iowa and to the political action committee of the industry’s main lobbying organization.
According to data from CMS, the Accura chain has been hit with more than a $1.1 million in fines for quality-of-care violations that have put elderly residents at risk, and regulators have suspended Medicaid payments to various Accura facilities at least 11 times.