Nursing homeActive
On With Life Long Term Care
1002 W Washington Ave., Polk City, IA 50225515421920040 certified beds · 39 residentsNon profit - CorporationMedicare and Medicaid
Surveys on file
4
since 2023
Deficiencies
7
● 0● 7● 0
Penalties · 3 yrs
—
none on file
Last survey
2025-12-31
Standard
CMS overall
5 / 5
stars as published by CMS
CMS overall 5/5
Health 5
Staffing —
Quality 2
Star ratings as published by CMS · CMS’s caveats
Survey history
Source: CMS · Iowa Department of Inspections, Appeals & Licensing · data as of 2026-08-01| Date | Kind | Deficiencies | Official record | Archived PDF |
|---|---|---|---|---|
| 2025-12-31 | Standard | 000 | CMS-2567 (Care Compare) | — |
| 2025-08-05 | Complaint | 010 | CMS-2567 (Care Compare) | — |
| 2024-12-12 | Standard | 020 | CMS-2567 (Care Compare) | — |
| 2023-09-28 | Standard | 040 | CMS-2567 (Care Compare) | — |
Counts by class: paperwork · standard · harm.
Deficiencies
CMS · Iowa Department of Inspections, Appeals & Licensing publishes each citation’s tag, official description and scope/severity letter. The surveyor’s written findings are in the Statement of Deficiencies (CMS-2567) for each survey, linked above.
F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.Scope/severity DStandard
Medication
Isolated; no actual harm, potential for more than minimal harm.Corrected 2025-08-27Record 165281-20250805-F755
F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Scope/severity EStandard
Food & nutrition
Pattern; no actual harm, potential for more than minimal harm.Corrected 2024-12-31Record 165281-20241212-F812
F880Provide and implement an infection prevention and control program.Scope/severity DStandard
Infection control
Isolated; no actual harm, potential for more than minimal harm.Corrected 2024-12-31Record 165281-20241212-F880
F641Ensure each resident receives an accurate assessment.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-10-20Record 165281-20230928-F641
F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-10-28Record 165281-20230928-F656
F695Provide safe and appropriate respiratory care for a resident when needed.Scope/severity DStandard
Care planning
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-09-29Record 165281-20230928-F695
F883Develop and implement policies and procedures for flu and pneumonia vaccinations.Scope/severity DStandard
Infection control
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-10-20Record 165281-20230928-F883
Quality measures
CMS MDS quality measures · 2025Q2-2026Q1 · definitions| Measure | Facility | Iowa | National |
|---|---|---|---|
| Percentage of long-stay residents with pressure ulcers lower is better | 7.2% | 4.2% | 4.6% |
| Percentage of long-stay residents experiencing one or more falls with major injury lower is better | 0.0% | 3.8% | 3.2% |
| Percentage of long-stay residents who received an antipsychotic medication lower is better | 21.4% | 19.5% | 15.4% |
| Percentage of long-stay residents with a urinary tract infection lower is better | 3.8% | 2.4% | 1.6% |
| Percentage of long-stay residents who were physically restrained lower is better | 14.1% | 0.2% | 0.1% |
| Percentage of long-stay residents whose need for help with daily activities has increased lower is better | 13.0% | 17.1% | 13.9% |
| Percentage of long-stay residents who lose too much weight lower is better | 3.8% | 4.6% | 5.2% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication lower is better | 41.7% | 20.8% | 19.5% |
Figures verbatim from CMS, with the state and national figures from the same release. The direction that counts as better is CMS’s own and is stated on every row.
Ownership
As reported to CMS (Provider Enrollment)| Entity | Role | Interest | Since | Registry |
|---|---|---|---|---|
| Lewis, Jennifer Individual | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE | — | — |
| On With Life Extended Services Ltd Organization | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE | — | — |
| On With Life Inc Organization | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE | — | — |
| Shelton, Jeanette Individual | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE | — | — |
| Benson Larson, Kate Individual | MANAGING CONTROL - GOVERNING BODY | NOT APPLICABLE | — | — |
| Foreman, Jim Individual | W-2 MANAGING EMPLOYEE | NOT APPLICABLE | — | — |
| Fors, Rudy Individual | MANAGING CONTROL - GOVERNING BODY | NOT APPLICABLE | — | — |
| Fors, Rudy Individual | INDIRECT OWNERSHIP INTEREST | NOT APPLICABLE | — | — |
| Hoogestraat, Diana Individual | MANAGING CONTROL - GOVERNING BODY | NOT APPLICABLE | — | — |
| Hoogestraat, Diana Individual | INDIRECT OWNERSHIP INTEREST | NOT APPLICABLE | — | — |
| Shelton, Jeanette Individual | CORPORATE OFFICER | NOT APPLICABLE | — | — |
| Snyder, John Individual | MANAGING CONTROL - GOVERNING BODY | NOT APPLICABLE | — | — |
Ownership as reported to CMS/state. CMS ownership data has known gaps; merges between entities are published only after human review.
Cost context
County figures from public surveys. Not this facility’s price. Nursing-home rates are not published by CMS or Iowa.
No county cost figures on file for Polk.
Nearby nursing homes
| Facility | Distance | Last survey | Deficiencies · 3 yrs |
|---|---|---|---|
| Brio of Johnston, LLC Johnston | 6.1 mi | 2026-04-09 | 0111 |
| Bishop Drumm Retirement Center Johnston | 7.2 mi | 2026-06-11 | 0548 |
| Granger Nursing & Rehabilitation Center Granger | 5.5 mi | 2026-02-26 | 0240 |
| The Bridges at Ankeny Ankeny | 6.2 mi | 2026-06-10 | 1382 |
| Sunny View Care Center Ankeny | 6.2 mi | 2026-04-30 | 0411 |
Watch this facility
One email when a new survey, harm-class deficiency, penalty, Special Focus change or ownership change is recorded. Nothing else, ever.
Sources & provenance
| Section | Agency · dataset | Retrieved |
|---|---|---|
| Facility, ratings | CMS Provider Data · Nursing Home Provider Information | 2026-08-01 |
| Surveys | CMS · Survey Summary | 2026-08-01 |
| Deficiencies | CMS · Health Deficiencies (CMS-2567 findings via Care Compare) | 2026-08-01 |
| Penalties | CMS · Penalties | 2026-08-01 |
| Quality measures | CMS · MDS Quality Measures | 2026-08-01 |
| Ownership | CMS · Ownership | 2026-08-01 |