Heritage Management Inc., the state's largest nursing home chain, could be fined more than $75,000 for allegedly failing to provide proper nutrition, monitor patients and provide activities and restorative nursing services.

Acting on complaints lodged by the Disability Law Center on Aug. 7, the Utah Department of Health launched a review of the Bountiful Health Care and Rehabilitation Center the next day.Five health department workers conducted the review, which ended Aug. 20 and resulted in a 181-page inspection report.

"The breadth and depth of the problems were such it took us a long time," said Ann E. Lee, manager of the Utah Department of Health's long-term care survey section.

The health department has recommended that the 80-bed facility be fined $3,000 a day from Aug. 20 until the problems are corrected.

The federal Health Care Financing Administration's regional office in Denver will make a final determination of any fines imposed, said Paul Curtis of the Disability Law Center.

The Disability Law Center, the state-designated advocacy center for people with disabilities, said the report concluded the center had " `widespread deficiencies' which constitute `actual harm' to residents living there."

In a prepared statement issued late Friday afternoon, Heritage Management said it "does not agree with all of the assertions made in that report, and it has initiated its first level of appeal which deals with the factual accuracy of its contents. In addition, Heritage Management is conducting its own investigation."

Some alleged findings contained in the inspection report include:

- The facility was not maintaining acceptable nutritional standards. Some patients were not receiving diets ordered by physicians.

"A resident was admitted to the facility on May 5. By June 1998, he had lost 23 pounds," Lee said. The man was 85 years old, she said.

During this time, the center's weight committee - a team assembled to ensure dietary needs are being met and patient weights are tracked - was not meeting regularly, Lee said.

- Patients were not being properly supervised, the report said.

In the center's secure unit, two residents in adjoining rooms got into a fight, one of whom required emergency-room treatment.

- Patients could not take trips out of the center.

"The facility van did not have a lift and it was broken," Lee said. "There was no way to get out as they had requested for months."

- Patients were not receiving "restorative nursing services," meaning they were not stretching their limbs adequately to maintain their range of motion. The extremities of patients were observed to be "self-contracting" from atrophy.

Heritage Management officials said in a prepared statement that "all patients at Bountiful Health Care and Rehabilitation are receiving services which are consistent with state and federal regulations. The facility has invited the State Department of Health into the facility for reinspection."

Heritage Management Inc. owns 13 nursing homes in Utah, Lee said.

Since March, three of the 13 have been found to be providing subquality care, Lee said.

"That is unusual. Prior to that, no Heritage facility had been found to be providing subquality care," said Lee.

Heritage officials said, "The (Bountiful) facility was under regulatory pressure in 1997 under previous ownership when Heritage Management acquired a leasehold interest in it. Since it acquired ownership, Heritage has been working to raise the facility's quality of care to its companywide standard. Under Heritage Management, the facility received a positive survey earlier this year.

"For over a decade Heritage management has had an excellent survey record with the State Department of Health despite taking over facilities in regulatory distress and bringing them into compliance."