DES MOINES, Iowa (AP) — A state regulatory agency has fined a southwestern Iowa disability treatment center $30,000 and notified Iowa Medicaid officials they should terminate the center’s federal certification if improvements aren’t made by April. The Iowa Department of Inspections and Appeals on Friday released a report on its abuse investigation at the Glenwood State Resource Center.

It details incidents of patients struck on the head with spoons, knives and taunted with explicit sexual conversations that made them cower in discomfort. Glenwood serves 230 people with behavioral challenges or severe medical conditions.

The Iowa Department of Human Services, which runs the center, announced Jan. 4 that six workers were fired, six resigned and five others were disciplined after finding seven patients were physically abused and 13 others were subjected to verbal abuse or neglect.