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Massachusetts health regulators said this week that they do not have grounds to take serious action against a rapidly expanding nursing home chain that has racked up citations for dozens of violations involving patient safety and care in the past year.

State inspection reports of nursing homes owned by Synergy Health Centers routinely show striking increases in problems since the company bought its first Massachusetts nursing home in December 2012.

In a previously unpublicized case, one of Synergy's nursing homes — Worcester Health Center — received citations from investigators in November and again in December on the grounds that it failed to give patients the right medication and other care.

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In November, a nurse mistakenly put ear drops in a patient's left eye after eye surgery, then denied the mistake when the patient wailed in pain, according to state reports. The nurse waited five hours to call a doctor.

The Worcester nursing home has been cited 21 times in 12 months, according to federal documents, well above the state average.

Yet the state Department of Public Health, which oversees nursing homes, recently deemed Synergy "suitable" to acquire its 11th Massachusetts facility.

Advocates for nursing-home residents said they were befuddled by the state's unwillingness to act against Synergy, given that regulators have a range of options that include denying a company new licenses or placing a moratorium on further admissions at existing properties.

Synergy spokesman Hank Sheinkopf said in an e-mail that the company's nursing homes comply with state rules.

"All of our facilities meet standards above state regulations," he added.

The state health agency would not make officials available for an interview. In a statement, the department said it conducts nursing home reviews "within the limits of existing state and federal regulations with a priority of protecting residents from harm.

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"Based on our review of available patient safety and outcomes data from inspections, surveys, and third parties, there are no quality factors at this time that would trigger an 'unsuitable' finding for Synergy as an operator," the department said.

The position puzzled Wynn Gerhard, an elder-law attorney at Greater Boston Legal Services . She questioned why the Health Department deemed Synergy suitable on June 29 to purchase another nursing home, Grosvenor Park in Salem, given the mounting complaints.

"They could deny it and stop the expansion of Synergy without closing the entire chain down," Gerhard said. "It's all about resident safety and care."

The Globe on Sunday detailed the experience of an 85-year-old resident at Synergy's Braemoor Health Center in Brockton who fell and broke her hip, but was not taken to the hospital for two days despite cries of pain. At the company's New England Health Center in Sunderland, families of residents have complained that there aren't enough nurses, and that dental care and treatment of pressure sores are substandard.

State regulations allow the Department of Public Health to deny a company a license for a new nursing home, or revoke the license of an existing property, if an applicant violates even one of several factors. The list includes owning a nursing home found to have violated the same or similar regulation twice or more within a 12-month period.

Synergy's Braemoor nursing home has been cited three times in the past year for not providing adequate supervision, state records show. In one instance in November, a resident wandered away from the facility at 3 a.m., with nurses later providing conflicting accounts to state investigators about how and when they noticed the resident was missing.

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State regulations provide the Health Department with an alternative to revoking a license, or refusing to issue one; the health commissioner instead can bar a nursing home from accepting new patients until problems are corrected.

"It gives them a fallback if they don't want to say this is an immediate jeopardy situation," Gerhard said.

The state monitors 414 nursing homes, with roughly 40,000 residents, and the public has virtually no role in their licensing or oversight. Decisions by regulators about nursing home sales and closings have been conducted behind closed doors.

The process differs from the one used to review hospital sales, renovations, or expansions, which are subject to public scrutiny through hearings by the state's Public Health Council, an appointed body of academics, consumer advocates, and physicians.

"Residents, their families, and caregivers must have a strong voice in the process," said Arlene Germain, president of Massachusetts Advocates for Nursing Home Reform.

A law passed last summer requires the state Department of Public Health to establish a public hearing process before nursing homes are sold or closed, yet state health officials have not put that into effect. The department is still working on rules to implement the law.

Synergy acquired four of its Massachusetts nursing homes since that law was passed.

State Senator Harriette Chandler, the Senate's majority leader and a Democrat from Worcester, said she is angry the state has failed to act on the law she championed.

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"I thought this was solved legislatively and yet we are still waiting for the regulations," Chandler said. "I am deeply concerned about the message this is sending" to families with relatives in nursing homes.

The union that represents nursing home workers, United Healthcare Workers East, Local 1199 of the SEIU, said in a statement that it is "alarmed and dismayed" the hearing process has been stalled.

The union lobbied for passage of the law last year, saying that conditions in too many nursing homes were declining as out-of-state companies rapidly bought up Massachusetts properties.

"Right now, the nursing home industry is the Wild West of health care, and conditions for many seniors and caregivers are going from bad to worse as a result," said Veronica Turner, Local 1199's executive vice president.


Kay Lazar can be reached at Kay.Lazar@globe.com.
Follow her on Twitter @GlobeKayLazar.