Cited for sexual abuse and 23 other violations, nursing home fined $500 by Iowa regulators

by Clark Kauffman, Iowa Capital Dispatch
April 15, 2026

A western Iowa nursing home cited for 24 regulatory violations, including the sexual abuse of a resident, has been fined a total of $500 by the state.

State inspectors working for the Iowa Department of Inspections, Appeals and Licensing visited Hillcrest Health Care Center in Hawarden in March 2026 in response to six separate complaints, all of which were deemed verified. The inspectors cited the home for a total of 24 state and federal regulatory violations — an unusually high number.

The violations included resident abuse; failure to protect resident funds; failure to notify a resident’s emergency contact about a hospitalization; failure to provide a safe, clean, homelike environment; failure to respect residents’ right to be free of chemical restraints; failure to self-report alleged violations; failure to meet standards for overall quality of care; failure to provide sufficient nursing staff; inadequate services or treatment for people with dementia; failure to prevent significant medication errors, and failure adequately prevent infections.

As a result of the inspectors’ findings, DIAL imposed a single fine of $500 that is tied to the violation of a state regulation related to resident abuse. As yet, no federal penalties have been reported for the 23 additional violations that are tied to federal regulations.

According to inspectors, a caregiver at the home approached one of the home’s registered nurses on the afternoon of March 8 and reported that a male resident had just been inside the room of a female resident and had been trying to get in bed with her.

The nurse reported she immediately rushed to the room of the female resident, who had no cognitive issues and who told the nurse: “I was in bed, my door was halfway closed, when this man came in and just kept coming towards me. He touched my leg and I told him to stop immediately. He moved my bedside table away from me and I thought he wanted to take my dentures on the table, but he had this weird look, you know, and placed his hand under my blanket and tried to touch me. I pushed my call light and screamed twice. My neighbor heard me and pushed his call light as well, and he took off then the aide came in.”

Minutes later, workers at the home found the man in bed with a different female resident. The woman’s pants and briefs were pulled “halfway down” and the man was on the bed, with his left hand on the woman’s buttocks. The staff reported the man’s wheelchair was parked near the resident’s bed and the door to the room had been locked.

According to state inspectors, the staff separated the residents and immediately notified the home’s director of nursing.

According to state reports, the female resident involved in the initial incident told state inspectors in late March that she was trying to arrange to leave the home because the alleged perpetrator still lived there. She reported she had trouble sleeping at night and that she had told everyone she would kill the man if he touched her again. She said she didn’t understand why the facility allowed the man to sit in the dining area around people who required assistance to eat, as those residents couldn’t defend themselves, according to state reports.

Workers at the home told inspectors they were initially advised by the director of nursing not to document the two incidents as it wasn’t entirely clear what actually transpired. They indicated that a licensed practical nurse threatened to refuse her work assignment at the home unless the matter was reported to the police and to others.

The administrator of the home, Amanda Birch, allegedly acknowledged the facility failed to report the matter to the state in a timely fashion, but said she immediately reported the matter once she became aware of it. The director of nursing allegedly told inspectors the staff had called her shortly after the two incidents occurred, but said the workers never mentioned the matter.

Workers, residents cite staffing issues

During the state inspection, several staff members and residents at Hillcrest complained about what they felt were “unsafe” or intolerable staffing levels for the 58-resident home.

One female resident complained she was unable to get assistance going to the bathroom at night and had urinated on herself on two occasions, and on a third occasion was left sitting on the toilet for 45 minutes.

Another female resident reportedly complained the home was “severely understaffed” and said she had to wait longer than 30 minutes for responses to her call light.  A third resident voiced similar complaints, saying that at times it could take up to an hour for the staff to answer her call light.

Staff members expressed similar concerns and, according to the inspectors, payroll records showed that only one certified nursing assistant worked from 6 p.m. to midnight on March 8. That CNA said he had to put more than 50 residents to bed that night, without any assistance from the on-duty nurses.

A licensed practical nurse allegedly informed the inspectors she had told the home’s administrator the staffing shortage “really puts the residents and the staff’s licenses at risk.” Inspectors reported the nurse said she had to “put her foot down” and tell management she was uncomfortable being the only nurse scheduled to work at times, adding that “management would not send a staff in until she said she was going to clock out and go home.”

State records indicate the home was cited for insufficient staff in January 2024 and July 2024.

Federal records show Hillcrest Health Care Center is owned by a for-profit California company, Riverside Healthcare Inc., which is part of a chain of nursing homes run by The Ensign Group, also known as Gateway Healthcare. That company operates 329 licensed care facilities in 17 states, according to federal records.

In addition to Hillcrest, The Ensign Group’s Iowa homes include Fort Dodge Health and Rehabilitation Center, Greater Southside Health and Rehabilitation in Des Moines, Clarion Wellness and Rehabilitation Center, Careage Hills Rehabilitation and Healthcare in Cherokee, West Bend Health and Rehabilitation, and Spencer Post-Acute Rehabilitation Center.

Hillcrest Health Care Center currently has a one-star overall rating on the five-star rating scale used by the federal Centers for Medicare and Medicaid Services.

Daniel Dow, the administrator at Fort Dodge Nursing and Rehabilitation Center, was filling in for Hillcrest administrator Amanda Birch on Wednesday. He hung up when asked by the Iowa Capital Dispatch whether he had any comment on the reported violations and did not respond to several subsequent calls and messages.

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