Most of the nursing homes in Napa County have avoided serious violations during state inspections in recent years, while others are alleged by state regulators to have abused and, in some cases, endangered their residents. However, state health inspectors are slow to make public their findings on allegations of health and safety violations.

A review of state Department of Health Services' inspections of local nursing homes from 2000 to 2005 revealed that only one local facility drew no citations in the last five years. Two had minor violations, and two had been fined in excess of $38,000 for neglecting patients or placing them at risk.

At the former Sunbridge Care and Rehabilitation Center in Calistoga, now known as Calistoga Healthcare Center, a 67-year-old woman with dementia had problems chewing her food in 2002, leading nursing home staff to puree her meals. But state records show that when the woman refused to eat, employees gave her a Polish sausage. The woman choked on the sausage and had to be rushed to the emergency room. She was saved. The home was fined $10,329.

The then-owners of Sunbridge sold the facility in August. Its new owners, G.S. Calistoga, say only that the incident and others occurred under previous management.

"It probably gave them some incentive to sell," said James Preimesberger, president of G.S. "Other than that I can't really comment."

Problems like the one that affected that 67-year-old woman accounted for seven of the 42 violations doled out to active nursing homes in the county between 200 and 2005. Two nursing homes have closed in recent years: Pleasant Care Nursing Home on Redwood Road was shuttered in 2004 after regulators cited numerous problems. Previously, Roberts Nursing Home on Browns Valley Road quietly went out of business.

The county's remaining nursing homes include Meadows of Napa Valley, Napa Nursing Center, Piner's Nursing Home, Sierra Vista Center and Calistoga Healthcare Center. The county is also home to several assisted living facilities that offer less encompassing levels of care and are regulated by different authorities.

Most nursing home violations cited by DHS were for minor problems that did not place residents in serious danger, but two of five homes have been fined for violations that threatened the health of their residents. None of the homes studied were blamed for mistakes that resulted in the death of any residents, the most serious violation.

Yet the inspection reports revealed problems with the regulatory process. State agencies sometimes issued fines to nursing homes more than a year after violations were alleged to have taken place.

The state's sluggish release of public records and the time-consuming process of accessing them leaves the public partly in the dark when choosing the best home for their loved ones.

State inspectors visit homes once a year unless a complaint is filed against a home. But even advocates for the elderly, such as the Napa County Long-term Care Ombudsman's office -- itself part of a state program -- have trouble getting recent records and often are dealing with official information that is more than a year old.

As a result, information available to the public is often out of date.

One Bay Area nonprofit agency, the California Healthcare Foundation, posts a compilation of ratings data -- praised for its user-friendliness by elder safety advocates -- on its Web site. But the information is so old that even today it reports on two local nursing homes -- Roberts and Pleasant Care -- that are out of business.

The Napa County Long-term Care Ombudsman's office regularly tours local homes and investigates complaints made about nursing home care. Part of its practice is to educate the public by making available nursing home state inspection reports. Local residents would otherwise have to schedule an appointment with DHS and travel to its Santa Rosa office to see them, or go to each prospective home individually and ask for the facility's latest report. Because of state regulators' practices, the ombudsman's information is sometimes more out of date than what DHS will release to the public at its office.

Serious incidents

In addition to the case of the 67-year-old woman who was rushed from Sunbridge to the hospital in 2002, these are the other serious incidents that resulted in fines, according to DHS records.

In 2003 at Sunbridge, a 96-year-old woman was given thin liquids despite the fact she had documented difficulties swallowing them. That woman also had to be sent to the emergency room, resulting in a $34,430 fine, the largest state regulators levied on local homes in the last five years.

Also at Sunbridge, an 84-year-old man with memory problems had trouble staying on his feet. Employees knew he was at risk for injuring himself in a fall, but didn't replace a battery for a mattress alarm that sounded once the man left his bed. As a result, one night the man got out of bed and fell in his room, fracturing three ribs and his left arm. The home was fined $11,477.

Sunbridge scored the worst in the county with four serious violations. The most recent was in November 2003 for failing to fix a broken wheelchair that led to a woman fracturing her ankle. The home was fined $10,329.

Napa Nursing Center was cited for three serious violations in Napa, the most recent in 2002. Watchdog groups say Napa Nursing has turned itself around since its current administrator, Georgia Otterson, took office in late 2003.

In one 2002 incident, side effects from anti-psychotic drugs tired out an 84-year-old man with dementia to such an extent he stopped eating and drinking. Inspectors found staff didn't document many of the serious side effects the man had with the drugs, and ultimately staff had to send him to the hospital to treat him for, among other things, dehydration. The home was fined $10,000.

In another 2002 incident, a 98-year-old woman fell in the shower, and state inspectors blamed staff for not identifying her needs correctly. Inspectors also blamed employees the same year for forcibly restraining a wheelchair-bound 95-year-old woman against her will -- a violation of federal law -- and taking her outside with them on their smoke break, forcing the woman to inhale second-hand smoke. The home was fined $10,400.

Inspections revealed other homes routinely passed state scrutiny with flying colors. Piner's Nursing Home in Napa has a spotless record, followed closely by Meadows of Napa Valley's skilled nursing care center, also in Napa. Records for Sierra Vista Center in Napa show a series of minor violations.

The Register looked at all operating nursing homes operating in Napa. The paper did not investigate homes that have shut down in past years or skilled nursing units attached to hospitals or the Veterans Home of California at Yountville, because these facilities either did not offer long-term care or did not offer treatment to the general public.