The California Department of Public Health is moving to suspend the licenses of seven Southern California nursing facilities that have been repeatedly cited in recent years for contributing to patients’ deaths.

The state health department sent letters last month to seven companies in Los Angeles County that received at least two “AA” violations within the last two years, indicating a failure that contributed substantially to the death of a resident.

The facilities include Ararat Nursing Facility, a Mission Hills nursing home cited last year over lapses related to two residents’ deaths less than three months apart.

Mark E. Reagan, an attorney for Ararat, said the facility plans to appeal the suspension.

“Not only is any action for suspension unwarranted, it is also not in the best interests of the community or residents of the facility,” Reagan said. “The facility’s top priority is and always has been the safety and well-being of its residents.”

In addition to Ararat, the state said other facilities targeted for license suspension were Antelope Valley Care Center in Lancaster, Brier Oak on Sunset in Hollywood, Golden Haven Care Center in Glendale, Kei-Ai Los Angeles Healthcare Center in Lincoln Park, Santa Anita Convalescent Hospital in Temple City and Seacrest Post-Acute Care Center in San Pedro.

None of those facilities sent letters by the state responded to requests for comment Thursday.

An AA violation is a relatively rare penalty within state enforcement. Only 99 have been issued to the more than 1,200 skilled nursing facilities in California since the start of 2020, according to state data.

According to California law, the state can move to suspend or revoke a nursing home’s license once the facility gets two such violations within two years.

In practice, the AA citation has been issued so infrequently that few facilities crossed that threshold, said Tony Chicotel, a senior staff attorney with California Advocates for Nursing Home Reform.

Chicotel said he was “pleasantly surprised” by the state’s recent vigor in issuing AA violations and moving forward with license suspensions.

“As far as I know — and I’ve been doing this a long time, a couple decades — this is new,” Chicotel said.

Representatives from the state public health department didn’t immediately respond to requests for comment.

In each case, state investigations found failures and oversights that contributed directly to residents’ deaths.

At Golden Haven in Glendale, which previously operated as Glenoaks Convalescent Hospital, an investigation revealed that staff withheld a diabetic resident’s insulin and failed to monitor the person’s blood sugar for 61 days, resulting in the patient’s hospitalization and death in April 2024, according to the state’s report.

At Brier Oak on Sunset, a resident died in August 2024 after rolling off a bed while her nurse was tending to a different patient, the state said in its citation report, which noted that paramedics found the woman lying on the floor in a pool of blood.

Facilities in violation frequently resolve citations through appeals, settlements or other alternate routes that lower the severity level of their violation, their fine amount or both, Chicotel said.

All seven of the companies cited were informed by letter that their license would be suspended in 30 days from the sending date if they did not exercise their right to appeal. Advocates said they expected all of them to appeal.

Rachel Tate, vice president of ombudsman services at the nonprofit Wise & Healthy Aging, said she was troubled by the fact that many facilities recorded multiple patient deaths before the state took action.

“I understand that we need to be giving facilities due process and these other opportunities, but it seems we are sacrificing patient care in the process,” Tate said. “How many people are you allowed to kill and still get to appeal and keep your license? That’s very concerning.”

It was one of the largest, longest and most lethal harmful algae blooms in Southern California’s recorded history, claiming the lives of hundreds of dolphins and sea lions between Baja California and the Central Coast. And now, finally, it’s over.

Levels of toxic algae species in Southern California coastal waters have declined in recent weeks below thresholds that pose a threat to marine wildlife, according to the Southern California Coastal Ocean Observing System, or SCCOOS, which monitors algae blooms.

Although this provides a much-needed respite for marine mammals and the people working to save them from neurotoxin poisoning, scientists warned that the coastal ecosystem isn’t in the clear yet.

Just as January’s firestorms struck well outside Southern California’s typical fire season, this explosion of harmful algae appeared earlier in the year than have previous blooms. Further outbreaks are still possible before the year is up, said Dave Bader, a marine biologist and the chief operations and education officer for the Marine Mammal Care Center in San Pedro.

“It’s definitely over, but we still have the work of rehabilitating the [animals] that we have saved,” Bader said Wednesday. “And we’re not out of the woods with this year at all.”

Bader was among a group of ocean specialists who gathered at the AltaSea complex at the Port of Los Angeles to brief Mayor Karen Bass on the coastal effects of January’s fires.

That disaster didn’t cause the algae blooms. This is the fourth consecutive year such outbreaks have occurred along the Southern California coast, fueled by an upwelling of nutrient-rich waters from the deep ocean.

Yet multiple research teams are currently investigating whether the surge of additional runoff into the sea resulting from the firestorms may have contributed to the recent bloom’s intensity.

No data on the subject are available yet. But given the relationship between nutrients and harmful algae species, Mark Gold of the Natural Resources Defense Council said he would not be surprised if the fires played a role in this year’s severity.

“As a scientist who’s been looking at impacts of pollution on the ocean for my whole career, … one would expect that [fire runoff] is also having impacts on harmful algal blooms, from the standpoint of the intensity of the blooms, the scope, the scale, etc.,” said Gold, the organization’s director of water scarcity solutions. “We’ll find that out when all this analysis and research is completed.”

In terms of animal mortality, this year’s bloom was the worst since 2015-16 outbreak that killed thousands of animals between Alaska and Baja California, said SCCOOS director Clarissa Anderson of UC San Diego’s Scripps Institution of Oceanography.

Four different algae species were present this year. The two most dangerous produce powerful neurotoxins that accumulate in the marine food chain: Alexandrium catenella, which produces saxitoxin, and Pseudo-nitzschia australis, which produces domoic acid.

The toxins accumulate in filter-feeding fish, and then poison larger mammals who gobble up the fish in mass quantities. (This is why the blooms don’t pose the same health risks to humans — very few people eat up to 40 pounds of fish straight from the sea each day.)

Beginning in February, hundreds of dolphins and sea lions started washing up on California beaches, either dead or suffering neurotoxin poisoning symptoms such as aggression, lethargy and seizures. A minke whale in Long Beach Harbor and a gray whale that stranded in Huntington Beach also succumbed to the outbreak. Scientists believe countless more animals died at sea.

The outbreak was more lethal than those in recent years, Bader said, and veterinarians were able to save fewer animals than they have in the past.

Researchers are still grappling with the catastrophe’s full impact on marine mammal species. The outbreak was particularly deadly for breeding females. California sea lions typically give birth in June after an 11-month gestation. At the blooms’ peak, “they were actively feeding for two,” Bader said.

Domoic acid crosses the placenta. None of the pregnant animals the center rescued delivered live babies, he said.

“We don’t really know what the environmental impact, long term, is of [blooms] four years in a row, right during breeding season,” Bader said. “The full impact of this is going to be hard to know, especially at a time when research budgets are being cut.”

As climate change has shifted the timing and intensity of the strong wind events that drive upwellings, “we’re coming into a future where we unfortunately have to expect we’ll see these events with recurring frequency,” Bader told Bass at the roundtable. “The events that drove the fires are the events that drove the upwelling.”

During the breeding season, the center sees a lot of underweight, malnourished elephant seal pups, many of which are still too young to fend for themselves or even swim. Sometimes, they also see elephant seals with parasites or traumatic injuries, such as dog bites or blunt force trauma from boat propellers.

For the last few years, the Marine Mammal Center has been testing any patients with bird-flu-like symptoms, which include respiratory and neurological problems, for the virus.