California Department of Public Health records on Lytton Gardens Skilled Nursing Facility show that violations have occurred at the facility in several categories, including food-safety issues as reported on Palo Alto Online in 2007.

State records from 2011 show that for up to three years some wheelchair-bound patients were kept in restraints, with no re-evaluation at any point to determine if the restraints were still necessary.

Investigators noted there is no evidence from health care studies that physical restraints will prevent or reduce falls. And falls that occur while a person is physically restrained often result in more serious injuries, according to a public-health manual. In two of the cases, patients' chairs tipped over, and in one case the patient fell on her face, the investigator noted.

Lytton also had violations last year for having expired medications in its stockroom, which could have been given to patients.

Record-keeping was also a problem. Drugs are tracked on two sets of records: one for the patient's stockpile and a separate record indicating when the drug is actually given to the patient.

Investigators found that when drugs were marked as being removed from the patient's stockpile, there was no indication the medication had been administered to the patient. Sometimes the stockpile record did not indicate the medication had been removed, but the second record showed the patient had been given the drug. The discrepancy was found in 3 out of 3 random patient samples, according to state records. In one case, seven pills used for sleeplessness were removed from stock but six were not accounted for, according to a state finding.

Inaccurate medication records were a repeat problem, state records show. In 2007, Lytton failed to obtain a physician's order to allow a resident to give himself medication. The medicine was supplied in a plastic container that was placed on the floor near the nightstand. Every Saturday the staff refilled the container with a one-week supply of medicines, but there was no documentation the patient was instructed by a licensed nurse or pharmacist on taking the medication. The different medicines were also not separated within the container, the records noted.

In 2007, Lytton was found to have given at least two patients anti-psychotic medication to calm their agitation, but investigators found the treatment was not warranted because the patients were not bipolar or schizophrenic.

In at least one case, the patient was not screened for mental illness and mental retardation to ensure she would receive the care and services needed, the investigator wrote. The patient had Alzheimer's disease, which can cause agitation in the evening, called "sun downing." She had a urinary tract infection and needed frequent trips to the bathroom. She yelled and tried to get out of bed to use the toilet, but staff treated her agitation with anti-psychotic drugs, the record noted.

In the second case, an Alzheimer's patient with no symptoms of mental illness or behavior problems was given anti-psychotic medication, investigators found.

In each violation, the facility filed a corrective plan of action to prevent future incidents, the records show.

Lytton Gardens also settled a medical malpractice lawsuit in 2010 that alleged patient Mildred Schmidt broke her leg while a certified nursing assistant transferred her to bed, according to court papers in Santa Clara County Superior Court. She was allegedly left in bed for several hours before staff sought medical care. Her medical condition steadily deteriorated after her injury and she died, according to court documents.

A second lawsuit regarding patient care is currently wending through the courts.

Atherton Healthcare in Menlo Park was also cited and fined for not properly assessing a patient with neurological disease. The patient fell 14 times and sustained injuries each time, state records show. The San Mateo County Coroner concluded she died from injuries related to falling, according to the state's 2008 citation report.

Failure to have an adequate written plan for patient care and treatment was a common basis for citations, according to health department documents.

Below is a list of most of the substantiated complaints against local facilities, according to state records:

1. Inadequate record keeping or establishment of plans for patient care
2. Medicine errors -- including mislabeling, expired medications, not dosing patients or having incomplete records to indicate whether medications were given, failure to account for the disappearance of controlled medications
3. Giving proper notification regarding admission, transfer and discharge
4. Safety/falls
5. Resident not assessed after change in condition in a timely manner
6. Quality of care or treatment (general category with many causes)
7. Precautions not taken to prevent pressure sores on patients
8. Care/service not received per physician order
9. Theft of personal property
10. Inappropriate use of restraints
11. Inadequate screening of employees for history of abuse
12. Failure to answer call lights in a timely manner
13. Resident not treated with dignity/respect
14. Resident/patient/client abuse by an employee
15. Infection control

Are you receiving Express, our free daily e-mail edition? See a sample and sign-up for Express.