An established Sacramento nursing home could lose its license as the result of the deaths of two elderly residents within the past two years, the state Department of Public Health announced Thursday.

Applewood Care Center, a privately owned 50-bed facility on Rio Lane in South Land Park, was fined $100,000 and issued an AA citation, the most severe under state law, in the asphyxiation death of an 82-year-old man on Feb. 2.

The penalty comes exactly one year after an equally severe fine and citation were issued to Applewood due to the death of an 84-year-old woman. The nursing home was issued a $100,000 fine and an AA citation, state officials said, after the woman died in September 2005 when her "skull was crushed in an avoidable fall."

Two AA citations in less than 24 months automatically triggers a process to begin license revocation proceedings.

Applewood also was issued a class A citation and fined $20,000 in June of this year following the death in June 2006 of an 89-year-old resident who suffered repeated bouts of dehydration while living in the facility.

In the first case, Applewood paid $65,000 of the $100,000 fine, but administrator Bill Drennan said the facility will fight the allegations made in the two most recent citations. An informal hearing to review the merits of the citations has not yet been scheduled.

Drennan declined further comment, saying only, "There is nothing to say at this point until we go through this process."

In the most recent case, according to a state investigative report, the male resident was being fed dinner when he starting coughing, then slumped over. When the Heimlich maneuver failed to dislodge anything, a registered nurse started cardiopulmonary resuscitation but discontinued before paramedics arrived. She later told investigators that she stopped because didn't have a mask -- and "I thought he was dead anyway."

Paramedics determined the man's heart was still beating and continued CPR for about 20 minutes until he died. The resident had on file at Applewood a statement that he wanted to be resuscitated in the event he stopped breathing. A county coroner reported later that the resident died from "asphyxia due to obstruction of airway by food."

In the previous case that warranted an AA citation, state officials said the patient had wheeled herself out a side door in the dark and later was found on the asphalt driveway. She had suffered fractures of two ribs, the left clavicle, right wrist and skull, and had a brain hematoma.

In that case the state said the facility had no documented plan to supervise the woman, who was known to have "inappropriate judgment" and a habit of "wandering."

Carole Herman, president of the Sacramento-based Foundation Aiding the Elderly, a nonprofit advocacy organization, filed the complaints that led to the first AA citation and the recent A citation against Applewood.

She argued that the state is too lenient in punishing nursing homes that fail to protect the health and welfare of patients.

"Even though occasionally these facilities get slapped on the hand, they are not afraid of the state or licensing board because there is really no big punitive action taken," she said.

She cited Applewood's first AA citation and the fact that the facility paid just $65,000 of its $100,000 fine.

"If they get a fine, they can pay 65 percent or fight it in court," she said. "There really is no reason for these nursing homes to act differently because they really aren't being punished."