Welcome to the State of California 


Date: 7/19/2007 

Number: PH07-04 

Contact: Suanne Buggy or Norma Arceo (916) 440-7259 


Dr. Mark Horton, director of the California Department of Public Health (CDPH), announced today that Applewood Care Center in Sacramento County has received the most severe penalty under state law and could lose its license following an investigation involving poor care leading to the death of an 82-year-old resident.

The incident is the second death and second “AA” citation, the most severe under state law, in the last two years for Applewood Care Center. Under state Health and Safety Code section 1424.5, a second “AA” citation in less than 24 months triggers automatic action by CDPH to begin revocation of a facility’s license after the facility exhausts the citation review conference process. This process includes an informal hearing requested by the facility to review merits of the citation, which also carries a $100,000 fine.

The “AA” citation results from CDPH's investigation that determined the facility failed to ensure a resident received emergency interventions as requested by the resident and ordered by a physician. The investigation also showed that Applewood Care Center failed to follow its policies related to emergency resuscitation.

On Feb. 4, 2007, the resident was found sitting in a chair unresponsive, but still breathing. After calling paramedics, staff assisted the resident to bed and initiated cardiopulmonary resuscitation (CPR). Paramedics reported that no facility staff were performing CPR when they arrived. They performed CPR for about 20 minutes until the resident was pronounced dead. The coroner’s report cited “asphyxia due to obstruction of airway by food” as the cause of death.

Records show that the resident required limited assistance with daily living activities. He had a “full resuscitation” physician’s order in file in the event of an emergency.

In June 2006, the facility received an “AA” citation and $100,000 fine after an investigation by CDPH concluded that inadequate care of an 84-year-old female resident led to her death.

All nursing facilities in California are required to be in compliance with applicable state and federal laws and regulations governing health care facilities. Facilities are required to comply with these standards to ensure quality of care.

California has the statutory authority to impose fines against nursing facilities it licenses as part of enforcement remedies for poor care. The “AA” citation process is part of CDHS’ ongoing enforcement efforts in improving the quality of care provided to residents of the state’s approximately 1,400 skilled nursing facilities.

State citations that require a civil monetary penalty be imposed are categorized as Class B, A or AA. The associated fines range from $100 to $1,000 for Class B, $2,000 to 20,000 for Class A and $25,000 to $100,000 for Class AA. The citation class and amount of the fine depend upon the significance and severity of the substantiated violation, as prescribed and defined in California law. By providing nursing facilities it licenses with consequences for substantiated violations, CDPH strives to protect the health and safety of vulnerable individuals.

Last modified on: 6/2/2009 10:15 AM