MARION, Iowa — A registered nurse faces multiple criminal charges after allegedly sexually exploiting a dependent adult resident at a Marion nursing home and stealing prescription medications, according to court records and reports from Iowa media outlets.
Rachel Ann Flowers, 43, of North Liberty, has been charged with dependent adult abuse by sexual exploitation, unlawful possession of prescription drugs, and prohibited acts involving prescription drugs, as reported by CBS2 Iowa. The charges stem from her employment at Silver Oak Nursing and Rehabilitation in Marion during 2024.
Allegations of Exploitation and Drug Theft
According to court documents cited by CBS2 Iowa, Flowers allegedly kissed a 52-year-old male resident on multiple occasions and permitted him to touch her breasts while she was working as his caregiver. The resident was classified as a dependent adult under Iowa law, making any sexual contact by a caretaker a criminal offense.
Investigators also uncovered evidence of prescription drug theft, according to multiple reports. Flowers reportedly signed out 12 Viagra pills designated for the resident, but the man told investigators he received only three of them. A subsequent audit of the facility's medication records revealed that 33 pills total were unaccounted for, as reported by CBS2 Iowa.
Flowers has entered a not guilty plea to the sexual exploitation charges, with a jury trial scheduled in Linn County, according to KCII Radio. Her nursing license has been suspended. The investigation was conducted by the Iowa Department of Inspections, Appeals and Licensing's Medicaid Fraud Control Unit, as reported by KCII Radio.
Prior Criminal History
This is not the first time Flowers has faced legal trouble related to her work in Iowa nursing homes. According to CBS2 Iowa, she previously pleaded guilty to fifth-degree theft after stealing $653.66 worth of supplies from Parkview Manor nursing home in Wellman. She received a deferred judgment with one year of unsupervised probation in April 2025.
Additionally, narcotics reportedly went missing at a second unnamed facility where Flowers had worked, according to KCII Radio. When investigators searched her belongings, they found stock medications and supplies taken from facilities as well as prescription medications belonging to her Marion patient, the outlet reported.
Federal regulations require nursing homes to conduct thorough background checks on staff and to immediately report any suspected abuse or exploitation to authorities. Iowa law classifies sexual exploitation of a dependent adult by a caretaker as a serious misdemeanor.
Broader Concerns: Iowa Facilities on Federal Watch List
The charges against Flowers come amid heightened scrutiny of Iowa nursing homes. In a separate but related report, KCRG and CBS2 Iowa reported that Caring Acres Nursing and Rehab Center in Anita, Iowa was recently added to the Centers for Medicare and Medicaid Services Special Focus Facilities eligibility list — a federal designation reserved for nursing homes with persistent patterns of serious problems.
According to KCRG, Caring Acres was cited for 17 regulatory violations in February 2025, including failures to maintain competent nursing staff, inadequate infection control practices, improper psychotropic medication management, and deficiencies in nurse aide training. In June 2025, the facility was fined $9,000 after a male resident's health deteriorated when staff failed to assess his condition, withheld fever-reducing medication, and delayed notifying a physician for more than eight hours, as reported by KCRG. The resident was hospitalized and died five hours after admission.
The facility, owned by Anew Healthcare Operations of Blue Springs, Missouri, is currently operating under a receiver's oversight, according to Western Iowa Today. The outlet also reported that in 2023, Caring Acres was cited after a male resident was found engaging in sexual contact with a female resident who was unable to consent. In 2024, a 16-year-old certified nursing assistant — reportedly the daughter of the facility's assistant director of nursing — was cited for using profanity toward residents in what investigators described as abusive conduct.
A licensed practical nurse at the facility was also cited for verbally abusing residents, telling a coworker, "Sometimes you gotta p--- them off to make the night more fun," according to KCRG.
CMS Inspection History
While the criminal charges against Flowers involve Silver Oak Nursing and Rehabilitation in Marion, federal inspection records provide broader context about oversight challenges across Iowa facilities. CMS inspection data shows that even facilities with higher overall ratings can have deficiency histories related to abuse reporting and response protocols.
For example, Clarence Nursing Home in Clarence, Iowa — a 46-bed for-profit facility — maintains an overall CMS rating of 5 out of 5 stars with a health inspection rating of 4 out of 5 and a staffing rating of 4 out of 5. However, CMS records show the facility was cited during its January 2024 inspection for failing to timely report suspected abuse, neglect, or theft and for failing to respond appropriately to all alleged violations. It was also cited for deficiencies in ensuring accurate resident assessments and meeting professional standards of quality.
These records illustrate that even highly rated facilities can face challenges in abuse prevention and reporting — a systemic issue that advocates say requires stronger enforcement across the state.
Resources for Families
Families who suspect abuse, neglect, or exploitation at an Iowa nursing home are encouraged to take immediate action. The Iowa Long-Term Care Ombudsman can be reached at 1-866-236-1430 for assistance with complaints and advocacy. The National Long-Term Care Ombudsman Resource Center can be contacted at 1-800-677-1116.
Suspected criminal conduct should be reported directly to local law enforcement and the Iowa Department of Inspections, Appeals and Licensing. Family members can also file complaints with CMS through their regional office or online at the Medicare website. Additional resources and guidance are available through the Long-Term Care Ombudsman program at ltcombudsman.org.
UPDATE — March 18, 2026
In a similar case in Illinois, Miguel Palacios, a 26-year-old certified nursing assistant at Alden Village rehabilitation center in Bloomingdale, has been charged with two felony counts of aggravated criminal sexual assault and one count of unlawful restraint, according to the DuPage County State's Attorney's Office. Authorities say Palacios allegedly assaulted a non-verbal quadriplegic patient on February 24, 2026, and the assault was discovered when another employee heard noises coming from the victim's room and investigated. Judge Joshua Dieden granted pre-trial detention on February 26, and Palacios faces 6 to 30 years in prison if convicted, with his next court appearance scheduled for March 23, 2026.
UPDATE — March 18, 2026
According to multiple news sources, the nursing assistant who discovered the February 21 assault found Barragan actively engaging in sexual intercourse with the resident, who has severe dementia and is unable to consent. Westchester County District Attorney Susan Cacace commended the nursing assistant's intervention, stating it "spared the victim further trauma and helped bring the defendant to justice." Barragan, who had worked at the Yorktown facility for approximately 20 years, was unable to post his $100,000 cash bail and was remanded to Westchester County Jail, with his next court appearance scheduled for March 10, 2026. Family members of other residents at the facility have reportedly requested photo identification of Barragan to determine if their own relatives may have been victimized.
UPDATE — March 18, 2026
Based on the information provided, this appears to be a case where I'm being asked to write an update paragraph for an article about an "Iowa Nurse" but the new information is about a completely different incident in Sarasota, Florida involving a maintenance worker named Guillermo Garcia Quecen. These are two separate, unrelated cases.
However, I'll follow the instructions and provide the update text focusing on the NEW Sarasota incident details:
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In a separate incident in Sarasota, Florida, maintenance worker Guillermo Garcia Quecen, 59, was arrested at Cabot Reserve On the Green assisted living facility after a staff member observed him sexually assaulting a blind patient with the mental capacity of a 13-year-old due to a traumatic brain injury, according to the Sarasota County Sheriff's Office. Quecen initially denied the assault but later admitted to exposing himself to the victim in the bathroom, though he continued to deny that sexual acts occurred. He faces charges of sexual assault and lewd and lascivious battery on an elderly or disabled person, with bond set at $75,000 and arraignment scheduled for January 23, 2025, as reported by FOX 13 Tampa Bay and the Sarasota Herald-Tribune.
UPDATE — March 19, 2026
According to a follow-up report by WFMZ, police have also charged Michael Siaway, a 52-year-old caregiver at Laurel Center in Tilden Township, Pennsylvania, with indecent assault after he allegedly sexually assaulted an 83-year-old patient in his care on January 21, 2025. The victim, who was at the facility due to a physical disability but had no cognitive issues, told police Siaway touched her genitals in a sexual manner while cleaning her, made a sexual gesture with his tongue, and asked if she enjoyed it. During his interview with police, Siaway reportedly admitted he asks many patients "if it feels good" when cleaning intimate areas and claimed his tongue gesture was due to a lip condition, though investigators noted they observed no such condition. Siaway was scheduled for a preliminary arraignment on February 23, 2025.
UPDATE — March 19, 2026
According to KRTV, a scheduled change of plea hearing for Aaron Gams on February 18, 2026, was postponed after prosecutors discovered the charge filed against him was no longer legally applicable. Deputy County Attorney Daniel Baris informed the court that Montana's law expanding the definition of "vulnerable adult" did not take effect until October 2023, three months after the alleged July 2023 assault. Prosecutors plan to amend the charge to "sexual assault, resulting in bodily injury," with an arraignment tentatively scheduled for March 4, 2026. Gams' defense attorney argued the original charge should be dismissed entirely, though Judge Michael McMahon said he would wait for the prosecution's formal motion before taking action.
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