DES MOINES, Iowa (By Clark Kaufmann, IOWA CAPITAL DISPATCH) – After being accused in a lawsuit of wrongful death and cited for violations that led to two residents having their legs amputated, a West Des Moines nursing home has been added to the federal list of the worst care facilities in the nation. Pine Acres Rehabilitation and Care Center is one of the two Iowa nursing homes that are now considered by the Centers for Medicare and Medicaid Services to be Special-Focus Facilities that are experiencing a serious recurrence of major regulatory violations related to quality of care. Late last year, state inspectors cited Pine Acres for failing to ensure a male resident of the home received special shoes for diabetic patients, as ordered by a physician, and then failed to treat the resident’s worsening foot ulcers.

In October 2024, the man was seen at a hospital and diagnosed with an inflammation of the bone and pseudomonas, a bacterial infection. Days later, the resident’s left leg was amputated between the ankle and the knee. Six weeks later, inspectors spoke to the man, who, according to the inspectors’ written report, “stated he had to have his leg amputated and he was upset about it. He stated he did not know how this happened.” The federal government subsequently fined Pine Acres $177,240. That was in addition to a federal fine of $71,169 that was imposed eight weeks earlier for other quality-of-care violations. In late 2023, Pine Acres was cited for 62 violations, one of which was tied to a resident who contracted gangrene in the home and had to have a leg amputated.

After two residents had their legs amputated due to quality-of-care issues, an Iowa nursing home (Pine Acres) has been added to a federal watch list. (Photo courtesy Polk County Assessor’s Office)

The home’s most recent inspection was in June 2025, when state inspectors cited the home for 10 additional regulatory violations related to patient assessments, accident hazards, the competency of the nursing staff, and infection controls. No fines were imposed as a result of those violations. The Iowa Capital Dispatch was unable to reach Pine Acres’ administrator, Michael Ewalt, for comment.

Earlier this year, CMS gave Pine Acres one-star ratings for quality measures and inspection results on the government’s five-star quality scale. The ratings for Pine Acres are currently suspended due to what CMS calls “serious quality issues” at the home. Pine Acres is being sued by the family of the late Richard M. Cox, which alleges that on Oct. 21, 2024, Cox was able to exit the Pine Acres building unattended and without detection. He then sustained severe injuries in a fall about two blocks from Pine Acres and he died on Nov. 4, 2024, allegedly as a result of those injuries. Pine Acres has denied any wrongdoing, and a trial is scheduled for May 17, 2027. 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 has been 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.

At any given time, no more than two nursing homes per state appear on the list of federally designated Special-Focus Facilities, although the list also includes hundreds of other nursing homes — typically, 10 per state — where ongoing quality-of-care violations have made them eligible for that status. Once a home is designated a Special-Focus Facility, it receives additional oversight and assistance from the government that’s intended to improve resident care. The other homes that are merely deemed eligible do not receive that assistance. They appear on the list, some for as long as 10 years, and then drop off without ever receiving the federal help.