Valley View Village: Choking Risk During Meals - Des Moines, IA
Inspectors were watching.
The resident, identified in federal records only as Resident #31, had a cognitive status score of 2 out of 15, placing her in the severely impaired range. She required partial to moderate assistance eating. Her care plan, written the previous year, directed staff to help her with meals and ensure she received a general diet with thin liquids.
At 8:22 a.m. on April 28, 2026, inspectors observed her seated in a Broda chair, a specialized reclining wheelchair, with the chair tilted back. At 8:41, a dietary aide placed food on the table in front of her. Two minutes later, a certified nursing assistant identified as Staff D set beverages and additional food on an overbed table and walked away. The chair remained reclined. The resident remained reclined in it.
At 8:47, the food was still untouched. At 8:48, a second CNA, Staff E, picked up a glass of chocolate milk and offered it to her. The chair was still tilted back. Resident #31 struggled to move her head up and forward to bring her mouth to the cup. Staff E then offered hot cereal. The resident said later.
Five minutes after that, Staff D returned and offered another drink of chocolate milk. The Broda chair remained in the tilted position.
Nobody adjusted the chair. Not once, across the entire observation period.
A reclined position during eating or drinking is a recognized aspiration risk. When a person cannot sit upright and must strain to reach a cup, liquid can enter the airway instead of the esophagus. For a resident with Alzheimer's and documented weakness, the margin for error is narrow.
When inspectors interviewed the Director of Nursing on April 30, she said the facility had no written policy specifically addressing positioning during meals. Staff learned about positioning through general facility training and their CNA certification coursework. She said she expected residents to be placed upright whenever food or drink was offered.
The facility did have a relevant policy. A document titled "Feeding of Residents by Staff," last reviewed in February 2026, stated that residents unable to feed themselves would be assisted per their care plan and that each resident "shall be positioned comfortably in an upright position." That policy existed. It simply was not followed on the morning inspectors observed Resident #31 struggling to lift her head toward a cup of chocolate milk.
The gap between what a policy says and what staff actually do is where harm lives in nursing homes. The Director of Nursing acknowledged she expected upright positioning. The written policy required it. Two CNAs served food and drinks to a reclined resident anyway, then walked away.
Inspectors classified the violation as causing minimal harm or potential for actual harm, the lower end of the federal harm scale. Valley View Village, located at 2571 Guthrie Avenue, reported a census of 76 residents at the time of the inspection.
Resident #31 sat in her tilted chair, eyes closed, a plate of food going cold in front of her, and when someone finally offered her something to drink, she had to fight her own body just to reach the cup.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Valley View Village from 2026-04-30 including all violations, facility responses, and corrective action plans.
Download the official CMS inspection PDF from Medicare.gov
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 6, 2026 · Our methodology
Valley View Village in Des Moines, IA was cited for violations during a health inspection on April 30, 2026.
The resident, identified in federal records only as Resident #31, had a cognitive status score of 2 out of 15, placing her in the severely impaired range.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.