During her 10-month stay at Atherton Healthcare nursing home in Menlo Park last year, 51-year-old Atherton resident Debra Nickel fell 14 times, including a late-November fall in which she sustained traumatic brain injuries, according to a California Department of Public Health report. She died several days later, the report said.

Now, state officials have determined that the nursing home staff is at fault for Ms. Nickel's death, and have hit the Menlo Park facility with a $100,000 fine and the most severe citation possible.

The facility was fined a smaller amount earlier this year following an investigation into the October death of a Menlo Park man.

The Department of Public Health announced its decision on June 5, claiming Atherton Healthcare staff was inattentive in caring for Ms. Nickel, who suffered from Huntington's chorea disease and was prone to falls. The facility was hit with an "AA" citation the most severe citation under state standards.

"The facility failed to identify and continuously assess, evaluate and update the resident's needs and plan of care to prevent further falls and injuries," according to the report.

Nana Cocachvili, executive director of Atherton Healthcare, located at 1275 Crane St., said the nursing home is appealing the decision, and that Ms. Nickel's falls were "unavoidable," due to the nature of her condition.

Huntington's chorea disease is a neurological condition that causes uncontrolled movements and emotional disturbance, according to the National Institute of Neurological Disorders and Stroke Web site.

"The patient didn't allow help, and she couldn't control her own behavior," Ms. Cocachvili said.

Ms. Nickel died Dec. 1, a week after an Atherton Healthcare staff member noticed a "deep lacerated wound" on the patient's head while combing her hair, likely from an "unwitnessed fall," according to the Department of Public Health report. The staff member informed a nursing home physician, who stated that Ms. Nickel "does not need to be sent out for stitches because scalp wounds heal easily," the report says.

The staff member notified a second physician, who recommended Ms. Nickel be taken to the emergency room, where she was admitted three hours later with high blood pressure and a heart rate of 128 beats per minute, the report says.

The San Mateo County Coroner's Office confirmed Ms. Nickel died Dec. 1 of swelling of the brain and brain hemorrhages caused by blunt trauma. The coroner's office noted that Ms. Nickel was 51 years old, not 48, as the Department of Public Health and other media outlets have reported.

Another death

The citation linked to Ms. Nickel's death isn't the only Department of Public Health claim Atherton Healthcare is currently fighting.

In April, the state hit the nursing home with a $20,000 fine and citation following an investigation into the Oct. 28 death of a 79-year-old man who fell backwards off a wheelchair lift while being transported to an off-site medical appointment.

The patient, Menlo Park resident Charles Ladeau, suffered major head trauma when he tried to stand up while being lifted into a van, and died shortly after the fall, according to reports filed at the Department of Health Services San Mateo County office in Daly City.

The incident exposed the fact that Atherton Healthcare was outsourcing the driving of patients to off-site appointments through a private company without a formal contract, and without "written standards how transportation services should be provided," according to the reports.

Ms. Cocachvili said Atherton Healthcare has appealed that decision too, and she argued the blame should lie on the transportation provider whose employee was supervising the patient when he fell, not the nursing home.

"That incident should not be connected to us as a facility," Ms. Cocachvili said. "We didn't do anything wrong."

"Vastly improved"

Tippy Irwin, executive director of Ombudsman Services of San Mateo County, a group that supervises and investigates the treatment of seniors, said she doesn't know who is to blame for recent incidents at Atherton Healthcare, but noted the facility has "vastly improved" from its days as Menlo Park Place Health Care Center under different ownership in 2005.

"What happened recently was an absolutely horrible incident," Ms. Irwin said of Ms. Nickel's death. "But that place had plunged to the depths of poor quality. Is it perfect now? No, it has problems. But it has improved under the new ownership."

In 2005, the facility changed ownership and was known as Canaan Healthcare. The current owners took over in early 2007 and the name switched to Atherton Healthcare.

Ms. Irwin said that several years ago, she was sending as many as six Ombudsman representatives a day to inspect the facility. Now she sends one inspector a week, she said.

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