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Complaint Investigation

Pine Acres Rehabilitation And Care Center

August 26, 2025 · West Des Moines, IA · 1501 Office Park Road
Citations 4
Beds 140
Provider ID 165350
Healthcare Facility
Pine Acres Rehabilitation And Care Center
West Des Moines, IA  ·  View full profile →
Inspection Summary

Pine Acres Rehabilitation and Care Center in West Des Moines, IA — inspection on August 26, 2025.

Found 4 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

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Inspection Findings

FF0584
Resident Rights Deficiencies
Potential for More Than Minimal Harm

further documented Resident #8 required substantial/maximal assistance total from staff for performing activities of daily living but he was able to independently use the wheelchair. In an interview with Resident #8 on 8/24/25 at 10:30 am it was noted the wheelchair was visible soiled and a buildup of debris around the structural parts.

The cushion seat had multiple cigarette burns extending from the center towards the edge of the seat.

The lock on the left side of the wheel was not functional. Resident #8 stated the lock did not work properly for a long time and he wanted his wheelchair to look clean and the brakes fixed.In an interview with the Director of Nursing (DON) on 8/26/25 at 10:30 am she stated that the facility staff were to clean residents' wheelchairs at a minimal weekly and on as needed basis.

She further stated that the carpet in room [ROOM NUMBER] had been shampooed multiple times but the stains were not lifted successfully.

The DON further stated that her expectations were for the wheelchairs to be clean and the carpets to be stain-free to promote a homelike environment for the residents.

The facility provided policy titled Safe and Homelike Environment revised 1/2025 documented: Housekeeping and maintenance services will be provided as necessary to maintain a sanitary, orderly and comfortable environment.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

08/26/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Pine Acres Rehabilitation and Care Center

1501 Office Park Road West Des Moines, IA 50265

SUMMARY STATEMENT OF DEFICIENCIES

Based on observation, staff interview, and policy review the facility failed to provide appropriate incontinence care for one (#11) of three residents reviewed.

The facility reported a census of 79 residents.

Findings include:The Minimum Data Set (MDS) assessment for Resident #11, dated 5/22/25, included diagnoses of stroke, Non-Alzheimer's Dementia, and hemiplegia (paralysis of one side of the body).

The MDS identified the resident was dependent on staff for toilet hygiene and was always incontinent of urine and frequently incontinent of bowel.

The MDS indicated the resident had a Brief Interview for Mental Status score of 9, indicating moderate cognitive impairment.

Observation on 8/20/25 at 8 AM, Staff A, Certified Nursing Assistant (CNA) and Staff C, CNA entered Resident 11's room and washed hands and donned gloves.

With the resident lying in bed, Staff A removed the resident's visibly wet brief, cleansed above the penis, the penis, and the scrotum, without cleansing the inner thighs.

The resident was turned to his side and Staff A cleansed between the resident's buttocks and inner buttocks, didn't cleanse the outer buttocks and hips.Facility policy Perineal Care, revised 08/2025, documented cleanse buttocks and anus.Interview on 8/26/25 at 11:10 AM, the Director of Nursing stated expectation to cleanse all areas of buttocks and hips when completing incontinence care.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

08/26/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Pine Acres Rehabilitation and Care Center

1501 Office Park Road West Des Moines, IA 50265

SUMMARY STATEMENT OF DEFICIENCIES

Observation on 8/19/25 at 11:30AM, Resident #11 in his room, reclined in a wheelchair approximately 5 feet from the bed with the call light down between the resident’s bed and wall, not within reach of the resident.

Observation on 8/26/25 at 7:50AM, Resident #11 in his wheelchair approximately 4 feet from his bed, with the call light cord draped over the resident’s bed foot board, with the call button down between the mattress and footboard, not within reach of the resident.

Resident asked where the call light was and confirmed he was not able to reach the call light.

Facility Policy Call Lights: Accessibility and Timely Response revised 10/202 documented staff will ensure the call light is within reach of resident and secured, as needed Interview on 8/26/25 at 11:10 AM, the Director of Nursing stated the facility policy did not address the timeliness of answering a call light but her expectation was for call lights to be answered within 15 minutes and for call lights to be within reach of the residents.

  • The MDS for Resident #5 dated 7/24/25 documented BIMS of 15 indicating no cognitive impairment.

The MDS further documented Resident #5 had diagnoses of anxiety, depression and diabetes type 2 with daily insulin injections.

In an Interview on 8/25/25 at 12:00 pm Resident #5 revealed call light is not answered for up to 1 hour sometimes. Resident #5 further revealed she watched the clock and often had to leave the room in her wheelchair and look for staff herself to get help.

The call light in her room was functioning.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

08/26/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Pine Acres Rehabilitation and Care Center

1501 Office Park Road West Des Moines, IA 50265

SUMMARY STATEMENT OF DEFICIENCIES

resident’s roommate’s bedside tray table.

Interview on 8/26/25 at 11:10 AM, the Director of Nursing (DON) stated expectations for the urine graduate container to be placed on a barrier and to not allow the drain spout to touch the inside of the graduated container when emptying the catheter bag.

The DON further stated expectation for staff to complete hand hygiene between assisting residents and a resident’s package of wipes used for cares to not be placed on another resident’s bedside table.

  • The MDS dated [DATE] for Resident #5 documented the following diagnoses: multidrug-resistant
  • organism (MDRO), neurogenic bladder, pressure ulcers, cellulitis of right upper limb, and yeast infection.

The MDS also indicated use of an indwelling catheter and ostomy.

An observation on 8/21/25 at 1:50 pm of Resident #4 revealed a staff member was in the room providing ostomy care without a personal protective gown on.

In an interview with Staff G, Registered Nurse (RN) on 8/21/25 at 1:52 pm she visualized staff completing the ostomy care and confirmed the staff in Resident #4’s room should have been following enhanced barrier precautions and utilizing Personal Protective Equipment (PPE) but was not and she was told it was because there were no gown available.

Staff G proceeded to look into the supply bin located outside of Resident #4’s room and there were no gowns.

Staff G proceeded to walk down the hallway and opened 6 other supply bins with enhanced barrier items/PPE, but only found 1 cart had gowns in it.

She stated she will restock the PPE bins and she wasn’t aware of the bins not being stocked with PPE.

Facility ID:

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in West Des Moines, IA, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Pine Acres Rehabilitation and Care Center or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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