The California Department of Public Health fined a Santa Monica nursing home $100,000 after an investigation concluded that inadequate care led to the death of a patient in 2009.

According to a report by the CDPH, a 60-year-old male residing at the Goldstar Rehabilitation and Nursing Center choked to death in April 2009 when an employee at the center violated a doctor-prescribed meal program.

The patient, who had been diagnosed with multiple sclerosis, had difficulty chewing his food. His physician ordered a therapeutic, soft diet in December 2008 to avoid choking hazards.

On April 16, 2009, the center’s activities director involved the patient in a candlelight dinner, at which she served pork chops that she had prepared at her home and brought to the facility.

According to the report, the activities director was unaware that the man had a special dietary plan.

He choked on a poorly-chewed piece of pork chop, and was admitted to a nearby hospital. He died on April 23.

At the end of the investigation, the CDPH charged that the facility failed to provide the patient with a prescribed therapeutic diet and implement his plan of care.

The agency fined the facility the maximum amount possible under California State law.

It would not confirm if the case was referred for possible criminal charges.

— Daily Press

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