The church-affiliated company that owns troubled Shady Grove Adventist Hospital in Rockville has been battling state and federal regulators over deficiencies in the quality of care at five of its seven nursing homes in Maryland, state health officials say.

One of the facilities run by Adventist HealthCare Inc., Sligo Creek Nursing and Rehabilitation Center in Takoma Park, was dropped from the Medicare and Medicaid programs in April after failing three consecutive inspections over six months. In each visit, regulators found a different patient suffering from bedsores--cases of "actual harm" that represent a red flag for federal and state inspectors.

After six weeks and a series of changes in patient care procedures, 102-bed Sligo Creek was recertified by state officials to receive Medicaid funds. Money from the state-administered federal insurance program for the poor and disabled represents about 65 percent of the facility's income.

Four other area nursing homes run by Adventist HealthCare Inc., which is controlled by the Seventh-day Adventist Church, also have been cited in the past year for deficiencies that regulators said could have led to expulsion from Medicare and Medicaid. However, those facilities righted themselves before enforcement efforts reached that point, officials said.

Of Maryland's 261 nursing homes, only Sligo Creek and nine others persistently failed inspections to the point that officials cut off their Medicare and Medicaid funding in the past year. Among the 10, two facilities closed and relocated all their residents.

After Sligo Creek had its Medicare and Medicaid payments suspended in the spring, Adventist HealthCare hired Ellen Reap, Delaware's former chief nursing home inspector and a frequent adviser to federal officials who oversee Medicare, the federal insurance program for the elderly. As vice president of senior living services, she oversees nursing homes, assisted-living facilities and adult day-care operations.

Reap declined to comment on the problems at Adventist nursing homes, saying she preferred to discuss improvements in care and standards she is planning for the 1,200 employees she supervises.

"People know that I represent quality," she said. "My goal is to be the leader in the state and the nation. . . . I believe that our nursing home residents can receive that kind of care."

About six weeks after cutting taxpayer support for Sligo Creek's residents, state regulators reinspected the nursing home and found that the facility had begun a program to prevent bedsores by having nurses regularly turn over patients and perform more thorough skin assessments. The state resumed Medicaid funding on May 20.

Federal officials at Medicare's regional office in Philadelphia have not decided whether to reopen that program to Sligo Creek. Adventist HealthCare officials say they are still waiting for a requested reinspection by Medicare officials.

"You can argue that it's a single incident and that from time to time something like this will happen for any nursing home operator," said Carol Benner, who heads Maryland's office of health care quality. "On the other hand, you certainly would not want this to happen to someone that you knew."

Georges C. Benjamin, Maryland's health secretary, said nursing home enforcement in the state is more stringent than ever.

"I think it says we're serious," he said of the payment suspensions. "The industry has been working with us to improve. . . . There has been nationwide concern about the quality of care in nursing homes."

Adventist HealthCare operates a total of 838 beds at six nursing and rehabilitation centers in the region in addition to Sligo Creek. They are Bradford Oaks in Clinton; Fairland in Silver Spring; Glade Valley in Walkersville, Frederick County; Shady Grove in Rockville; Springbrook in Silver Spring; and Shore in Denton, Md.

Maryland cited Shore for patient falls, Glade Valley for falls and management problems, Fairland for management problems and Bradford Oaks for patient bedsores, officials said.

The problems at Adventist nursing homes were identified by Maryland health officials long before the medical staff's executive committee at Shady Grove Adventist Hospital complained in October to administrators that staff cuts and other changes at the Rockville facility had damaged patient care.

State officials had not made regular inspections of the hospital as long as it held the highest ranking granted by the Joint Commission on the Accreditation of Healthcare Organizations, a national group that rates hospitals.

But after The Washington Post reported the medical staff's complaints and the death of a patient from the intensive care unit who had been left unattended in a hallway at Shady Grove, the joint commission reversed itself. On Nov. 15, the commission moved to revoke the accreditation of Shady Grove after concluding that patient care at the 263-bed facility had suffered.

A day later, state health officials issued their own report on Shady Grove, citing mistakes in patient care that included medication errors, several patient falls, a chronic failure among staff members to note mistakes and adverse incidents in hospital records, an operation performed on the wrong hip of one woman, and the death of the intensive care patient.

State officials reported that a review of the minutes of hospital board meetings going back a year lacked any "substantive discussion of quality issues or any oversight of the quality of care."

Hospital officials dispute many of the state report's findings and say they will vigorously fight the move to lift its accreditation. Minus accreditation, Shady Grove could lose contracts with health plans and see its bond rating damaged.

Adventist HealthCare spokesman Robert Jepson said the company is committed to providing quality care as part of its Christian mission, adding that the problems reflect the harsh environment facing the nation's nursing home industry. Financial pressures have driven a growing list of nursing home companies into financial trouble as governments heighten their scrutiny of care.