On Wednesday, the California Department of Public Health announced that it had cited Goldstar Rehabilitation and Nursing Center in Santa Monica and fined the facility $100,000. The class AA citation stemmed from the choking death of a patient two years ago.

The AA citation is the most severe one allowable under state law for a long-term-care facility, and $100,000 is the maximum allowable fine. The Department of Public Health issues an AA citation after it has proved that a facility's violation was a direct proximate cause of a patient's death and that the death happened due to an occurrence "of a nature that the regulation was designed to prevent," according to California Health and Safety Code Section 1424(c).

Goldstar administrators have not responded to Santa Monica Patch's request for comment. A Department of Public Health representative said he is not allowed to disclose the name of the patient who died.

This is not the first time Goldstar has been cited with a serious violation, Santa Monica Patch has found. On Nov. 4, 2009, the 15th Street facility was hit with a $19,500 fine after receiving a class A citation, which states that a patient was in imminent danger of death or serious harm, or that there was a substantial probability of death or serious physical harm to a patient. On May 27, 2010, it received a class A citation in the amount of $12,000.

Along with those citations, what appears to be numerous complaints have been made against Goldstar. Since March 2004, the facility—which employs 227 skilled nurses—has received 150 complaints, 55 of which have been substantiated. The substantiated complaints include:

• 23 relating to quality of care/treatment 

• 7 to resident/patient/client rights

• 4 to admission, transfer and discharge rights

• 3 pertaining to resident/patient/client neglect

• 3 to nursing services

• 3 relating to physical environment

• 2 to falsification of records/reports

• 2 pertaining to infection control

• 2 to resident/patient/client abuse

• 1 to accidents

• 1 to administration/personnel

• 1 relating to fraud/false billing

• 1 to pharmaceutical services

• 1 to rehabilitation services

• 1 to other/undisclosed occurrence

In contrast, Berkley East Convalescent Hospital, which employs 207 skilled nurses and is located at 2021 Arizona Ave has not received a single citation since March 2004, according to research by Santa Monica Patch. Also, 36 complaints have been made against Berkley East, eight of which have been substantiated.

When a facility receives an AA citation and is identified as having a deficiency, administrators are required to submit a plan of correction by a given deadline. The plan is evaluated by state and federal officials, who together decide whether to accept or reject it. If a facility refuses to submit a plan, it could be shut down.

If the plan is accepted, "We go back and make sure they've done what they said they were going to do and make sure the plan has been implemented—and that's done with a surprise inspection," California Department of Public Health spokesman Ralph Montano told Santa Monica Patch.

The deficiency must be corrected in order for the facility to continue operating in California, and to receive federal Medicare and Medicaid funds. Officials decide on penalties, if any, after the plan of correction has been put in place.

If a penalty is issued, the facility can appeal it to the public health department or in court. The facility must notify the department about its appeal within 30 days.

California's health and safety code provides for the citations and fines to become final only after all appeals have been exhausted. A facility that does not contest the citation, and pays it within 30 days of its issuance, has to pay only 65 percent of the fine. If the facility appeals and loses, or fails to pay the fine within 30 days, it must submit the full amount, according to the health and safety code.

If a second AA citation is issued within a 24-month period and the citation is sustained after review—or if the facility chooses not to appeal it—the department can take steps to suspend or revoke the facility's license.