The state of Maryland has started proceedings to close a 210-bed Prince George's County nursing home for repeatedly violating the state's standards for caring for its elderly patients.

Officials of the Department of Health and Mental Hygiene notified the Manor Care nursing home in Adelphi that they intend to revoke the facility's license on April 23. The action followed an inspection in March in which numerous violations of regulations covering patient care, housekeeping, record keeping, safety and infectious disease control were found.

The administrator of the nursing home, Michael Panarese, said yesterday that "the proposed action by the state is completely inappropriate as far as we are concerned," and said the nursing home would request a hearing.

If the state succeeds in closing the home-part of a national chain of nursing homes based in Silver Spring-it would be the largest nursing home to have been closed by the state. The closing can be appealed in an administrative hearing and to the courts.

An inspection team from the division of licensing and certification visited the home March 14 and found patients with dirty fingernails, unkept hair and poor oral hygiene, and tow patients with heavy crusts on their lips and mouths. The team also found catheters that were used improperly, poor record keepting about the use of medication and physician visits, and patients who were positioned improperly in beds and chairs, according to Harold Gordon, chief of the division.

Inspectors also found patients who required assistance to eat who are not being assisted, and patients sitting in lounge and dining areas in wheel chairs with their legs dangling.

Gordon said inspectors also found that only about 5 percent of the patients were participating in any sort of activities program, and that some infection-control procedures were not being followed. For intance, staff were seen carrying both dirty and clean bed linens against their bodies, and a nurse treating one patient in isolation was observed entering the room with unwashed hands and no gloves.

"You've got to remember we're dealing with frail, old people," said Gordon. "Anybody's hands, in cases of potential infectious disease, have to be considered potentially dangerous weapons."

The state found similar violations on earlier visits, Gordon said. "The home has not demonstrated to us that they can consistently comply with the law," said Gordon. The home corrected violations after previous visits but problems and recurred.