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A Tucson assisted-living home placed on probation last May for numerous violations of state rules has since been cited for seriously neglecting an 87-year-old woman.

Casita de Hope, 4232 E. Fifth St., was fined $1,500 and agreed not to admit new residents for 90 days after state health investigators found the woman was so neglected that she suffered severe bedsores, became seriously dehydrated and had to be hospitalized for a week.

The Arizona Department of Health Services released the report on Casita de Hope this month, five months after investigating the home after a complaint was filed in October. The report does not identify the woman, who had multiple health problems including Alzheimer's disease, or the source of the complaint.

The woman went from the hospital to a local nursing home where she later died, said Esperanza Sanchez, owner of Casita de Hope and two other assisted-living homes: House of Hope, 1938 W. Riverview; and Villa de Hope, 920 W. Ina Road.

Asked to respond to the state's finding of neglect, Sanchez said she and her staff did "everything to code, everything that was supposed to be done" to care for the woman. Sanchez said the woman was "declining severely" by the time her family brought her to Casita de Hope last September.

"It was her time to go," Sanchez said.

Casita de Hope and Villita Care — another assisted-living home Sanchez owned but sold late last year — came under state enforcement last May. Health department investigators at that time found numerous instances of records falsified to appear that staff members had been fingerprinted, tested for tuberculosis and trained in CPR and first aid.

Investigators also documented that Sanchez and her managers instructed caregivers not to report residents' bedsores to their doctors or families.

Sanchez was required to pay $7,500 in fines, and the two homes were placed on one-year "provisional licenses."

The state has conducted unannounced inspections of the homes since then. But the inspection on Oct. 12 and 13 was in response to a new complaint about resident care.

Although Sanchez determined the woman was "declining severely" when she arrived at Casita de Hope on Sept. 1, state investigators found that the woman was still able to walk at least a few steps with the aid of a walker, and was able to feed herself. Records also showed the woman had no bedsores or other skin problems when she arrived at the home.

The woman's condition declined steadily. The state's report says a manager at Casita de Hope told an outside agency nurse on Oct. 6 that the woman needed more care than the home was able to provide. The nurse agreed and said the patient should be discharged immediately to a facility that could provide a higher level of care.

That did not happen until the family took the woman to Devon Gables nursing home on Oct. 11. But when the nursing home saw what bad shape the woman was in — contrary to what Casita de Hope told the nursing home — the nursing home declined to admit her, arranging instead to have her taken immediately to Tucson Medical Center.

According to the state's report, TMC documented that the woman was admitted with extensive bedsores and skin discolorations, that she was severely dehydrated and in kidney failure, and apparently had had a recent heart attack. The woman remained in the hospital for seven days.

Lisa Wynn, deputy assistant director of the Arizona Department of Health Services, said department investigators have made unannounced visits to Casita de Hope since the home was put on probation last May. On the department's last visit Nov. 17, Wynn said, state investigators found no signs of resident neglect or any serious violations.

"We are optimistic" that Casita de Hope can get its regular license back when its provisional license expires at the end of April, Wynn said.

Stewart Grabel, ombudsman for the Pima Council on Aging, reviewed the state's Oct. 20 summary of what happened to the woman who spent less than six weeks at Casita de Hope.

"It's terrible what happened to her," Grabel said. But the woman's story points to a larger issue, he said.

Clearly the woman needed a higher level of care than she was getting at Casita de Hope — but a higher level of care may have cost more than the family could afford, he said.

Sanchez, the Casita de Hope owner, said the family may have been in denial about how little time the woman had left.

"Sometimes the family gets in denial," Sanchez said. "They cannot understand that it is time to go. It was pretty sad. But I knew when I first saw her, I told my daughter Patty, 'I don't think this lady is going to live too long.' "