Two Iowa Nursing Homes Added to Federal Worst List

GRUNDY CENTER, Iowa — Two Iowa nursing homes have been added to the federal government's list of the nation's poorest-performing care facilities following citations for resident abuse and numerous regulatory violations, according to the Iowa Capital Dispatch.

The Centers for Medicare and Medicaid Services recently added Caring Acres Nursing and Rehab Center in Anita and Grundy Care Center in Grundy Center to its eligibility list for Special-Focus Facilities, a designation reserved for nursing homes with persistent, serious problems affecting resident care.

The federal Special-Focus Facility program limits each state to two facilities receiving the designation at any given time. Iowa currently has Pine Acres Rehabilitation and Care Center in West Des Moines and Garden View Care Center in Shenandoah holding special-focus status for eight months and six months, respectively. However, the eligibility list includes hundreds of additional facilities nationwide—typically ten per state—that qualify for the designation but have not yet received it.

Violations at Grundy Care Center

Grundy Care Center received citations in November 2024 for twelve regulatory violations, as reported by the Iowa Capital Dispatch. The deficiencies included failure to maintain professional standards, inadequate quality of care, insufficient nursing staff levels, problems with food procurement and preparation, and inadequate quality assurance programs.

In early 2025, federal regulators imposed a $48,796 fine on the facility for resident abuse. State inspectors determined the facility failed to protect a male resident from physical and mental abuse by a certified nursing aide, according to inspection reports. The aide allegedly engaged in inappropriate physical contact with the resident, including kissing and touching, accepted money from him, and sent nude photographs via text message.

The inappropriate relationship between the staff member and resident continued until the aide resigned from the facility, according to inspection documents. The worker later confirmed to police that she had kissed the resident and acknowledged Facebook conversations in which they discussed his moving in with her following her divorce. The facility's internal investigation concluded the relationship was sexual in nature and occurred both during work hours and after shifts ended, according to inspectors.

The case was referred to the Iowa Department of Health and Human Services, which handles dependent adult abuse investigations. According to inspection reports, DHHS rejected the report and closed the case without further action.

Serious Deficiencies at Caring Acres

Caring Acres in Anita faced seventeen regulatory violations in February 2025, an exceptionally high number for a single inspection, as reported by the Iowa Capital Dispatch. The citations included failure to provide a clean, homelike environment, failure to meet professional standards, inadequate nursing staff competency, improper use of psychotropic medications, insufficient infection prevention and control measures, failure to meet COVID-19 immunization requirements, and inadequate training for nurse aides.

In June 2025, the facility received a $9,000 fine for failing to provide required nursing services. Inspectors determined that a male resident experienced a significant change in condition during day and evening shifts on May 8, 2025, according to regulatory documents. Despite concerns raised by other staff members about the resident's health, the nurse on duty failed to assess the resident. The man developed a fever around 7 p.m., but medication was not administered and a physician was not contacted until his vital signs deteriorated significantly eight hours later. The resident was transported to the hospital and died five hours after admission.

Also in June 2025, Caring Acres received citations for verbal abuse of residents by a licensed practical nurse, according to inspection reports. A staff member reported witnessing the nurse use demeaning language toward a resident who had fallen from bed, saying "Aww, did you fall out of bed? That was kind of a dumb idea," and making derogatory comments about the resident's body, according to witness statements documented by inspectors.

Later the same evening, the same licensed practical nurse allegedly harassed another resident by falsely telling her that her pets were either alone at her home or were gone entirely. The nurse then turned to a coworker and reportedly stated, "Sometimes you gotta p— them off to make the night more fun," according to inspection documents.

Special-Focus Facility Program

Federal regulations establish the Special-Focus Facility program to identify and assist nursing homes with the most serious quality-of-care problems. Facilities that receive special-focus designation receive additional oversight and assistance from government agencies aimed at improving resident care. However, facilities that are merely eligible for the designation but not selected remain on the eligibility list without receiving federal assistance. Some facilities remain on the eligibility list for as long as a decade without ever receiving the enhanced oversight intended to address their deficiencies.

The addition of these two Iowa facilities to the eligibility list reflects ongoing concerns about quality of care and resident safety in portions of the state's long-term care system.

Resources for Families

Families concerned about care quality at Iowa nursing homes can contact the National Long-Term Care Ombudsman Resource Center at 1-800-677-1116. The ombudsman program provides free, confidential assistance to residents and families dealing with concerns about nursing home care.

Additional information about nursing home quality ratings and inspection reports is available through Medicare's Care Compare website at Medicare.gov. Families should review facility inspection histories, staffing levels, and quality measures when evaluating care options for loved ones.

Anyone who suspects abuse or neglect in a nursing home should report concerns immediately to local law enforcement and the state survey agency responsible for facility oversight.