ANITA, Iowa — Two Iowa nursing homes have been placed on a federal watchlist of the nation's worst care facilities following citations for resident abuse, staff sexual misconduct, and a delayed medical response that contributed to a patient's death, according to multiple Iowa news outlets.
Caring Acres Nursing and Rehab Center in Anita and Grundy Care Center in Grundy Center were both added to the Centers for Medicare & Medicaid Services Special Focus Facility candidate list, as reported by the Iowa Capital Dispatch and confirmed by KCRG, CBS2 Iowa, and other regional outlets. The designation identifies nursing homes with a pattern of serious quality issues that warrant heightened scrutiny from federal regulators.
Allegations of Abuse and Misconduct
At Grundy Care Center in Grundy Center, federal investigators determined that a female certified nurse aide engaged in sexual misconduct with a male resident, according to KCRG. The aide allegedly kissed and inappropriately touched the resident, sent nude photographs to him via text message, accepted money from him, and discussed plans to move the resident into her home following a planned divorce, as reported by KWAY Radio. Investigators concluded the relationship was sexual in nature and occurred both during and outside of working hours, according to the inspection findings. The facility was fined $48,796 for the abuse, as reported by CBS2 Iowa.
Grundy Care Center had also been cited for 12 regulatory violations during a November 2024 inspection, which included deficiencies related to inadequate staffing and food service failures, according to CBS2 Iowa. The Iowa Department of Health and Human Services investigated the abuse allegations but ultimately rejected the report and closed the case, as reported by KWAY Radio.
At Caring Acres Nursing and Rehab Center, a male resident developed a fever on May 8, 2025, but nursing staff did not assess his condition for approximately eight hours, according to KCRG. The resident died five hours after being admitted to the hospital, and the facility was fined $9,000 in June 2025 for the delayed response, as reported by CBS2 Iowa. In a separate incident, a male licensed practical nurse at Caring Acres was cited for abuse after making derogatory and demeaning comments to residents about their weight and appearance. According to inspection documents cited by Des Moines Today, the LPN told investigators: "Sometimes you gotta p--- them off to make the night more fun," referring to his treatment of residents.
Caring Acres had already been cited with 17 violations during a February 2025 inspection, according to multiple reports.
CMS Inspection History
Federal inspection data underscores the severity of concerns at Caring Acres Nursing and Rehab Center. The 41-bed, for-profit facility currently holds the lowest possible overall rating from CMS — one star out of five — with equally poor marks for health inspections. The facility's staffing and quality measures each earn just two out of five stars.
According to CMS records, Caring Acres has accumulated 83 total deficiencies across 14 inspections. The most recent inspection, conducted on October 14, 2025, resulted in citations for failing to report suspected abuse, neglect, or theft in a timely manner and for failing to respond appropriately to all alleged violations — both classified at a severity level indicating the potential for more than minimal harm. Inspectors also found the facility lacked an adequate plan for conducting quality assurance and performance improvement activities.
Earlier in 2025, a February 20 inspection cited the facility for failing to honor residents' rights to a dignified existence, self-determination, and communication, as well as failing to provide a safe, clean, and homelike environment where residents could receive treatment and daily living support safely.
The pattern of deficiencies at Caring Acres reflects persistent problems with both resident safety and basic regulatory compliance that preceded and followed the incidents that ultimately led to its placement on the federal watchlist.
Ownership & Operations
Caring Acres Nursing and Rehab Center operates as a for-profit limited liability company, according to CMS records. The facility's small size — just 41 beds — means that staffing and oversight failures can have an outsized impact on resident care. The combination of a one-star overall rating, repeated abuse-related citations, and a resident death linked to delayed medical attention paints a troubling picture of operational standards at the facility.
The Special Focus Facility Program
The CMS Special Focus Facility program identifies nursing homes with persistent records of poor care for enhanced oversight and more frequent inspections. According to KJAN Radio, Iowa currently has two active Special Focus Facilities: Pine Acres Rehabilitation and Care Center in West Des Moines, which has been on the list for eight months, and Garden View Care Center in Shenandoah, which has been listed for six months.
Federal rules limit each state to two active SFF designations at a time. Facilities that land on the candidate eligibility list, as Caring Acres and Grundy Care Center now have, can remain there for up to a decade without receiving the additional federal oversight that comes with full SFF designation, as reported by KJAN. Eight other Iowa nursing homes are also currently on the eligibility list, according to the report.
The program has drawn criticism from patient advocates who argue that the cap on active designations and lengthy wait times on the candidate list allow problem facilities to continue operating without meaningful federal intervention for years.
Resources for Families
Families with loved ones in Iowa nursing homes who have concerns about care quality or suspect abuse or neglect can contact the Iowa Long-Term Care Ombudsman at 1-866-236-1430. The ombudsman program advocates for residents of nursing homes and assisted living facilities and can assist with complaints, questions about residents' rights, and navigating the regulatory system.
The national Elder Care Locator hotline, 1-800-677-1116, also connects families with local resources and support services. Additional information about long-term care advocacy and residents' rights is available at [ltcombudsman.org](https://ltcombudsman.org).
Suspected abuse or neglect should be reported immediately to the facility administrator, the state ombudsman, and local law enforcement. Federal regulations require nursing homes to report all allegations of abuse, neglect, and exploitation to appropriate authorities and to thoroughly investigate each incident.
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