The patient from Long Beach Healthcare Center was rushed to a hospital in August 2018 with an abdomen so distended from constipation that it looked as if she had “three soccer balls inside of her stomach,” according to state records .

She died 12 days later due to respiratory failure and severe sepsis from a urinary tract infection and pneumonia. A state investigation later found that the staff at Long Beach Healthcare Center made several critical errors, including not properly monitoring the woman’s deteriorating condition and failing to report that she had not had bowel movement for seven days.

The Wrigley-area facility in February was issued a rare “AA” citation—the state’s most serious violation when it’s determined that a nursing home directly caused a resident’s death.

Long Beach Healthcare Center is one of two Long Beach facilities that are named on a federal list of nearly 400 nursing homes across the country with serious ongoing health, safety or sanitary problems.

The list, released this month by U.S. senators, notes facilities with a “persistent record of poor care” that haven’t previously been released to the public, according to a Senate report.

The fact that the list has not been released to the public in previous years undermines the federal commitment to ensure transparency for families struggling to find nursing homes for loved ones and raises questions about why the names of some homes are not disclosed while others are publicly identified, according to two senators who released the report.

“We’ve got to make sure any family member or any potential resident of a nursing home can get this information, not only ahead of time but on an ongoing basis,” said Sen. Bob Casey, D-Pa., who along with Sen. Pat Toomey, R-Pa., issued the report.

About 1.3 million Americans live in nursing homes; they are cared for in more than 15,700 facilities. The senators’ report noted that problem nursing homes on both lists account for about 3 percent of the total.

In California, which has the country’s largest concentration of nursing homes, 34 facilities were on the list. Overall, California’s nursing homes average about 12.5 health citations, compared to 7.9 nationwide.

Records show that Long Beach Healthcare Center and the other facility on the federal list—Windsor Gardens Convalescent Center of Long Beach—have a history of health citations, according to the Nursing Home Compare website, which is run by the Centers for Medicare and Medicaid Services.

Long Beach Healthcare Center has 39 citations—more than three times the state average. Windsor Gardens has 22 citations, including one from July when a resident was found restrained in bed and soiled with feces and urine.

Both facilities are rated one of out five stars on the federal website, indicating they are “much below average.”

Jon Peralez, an administrator for Windsor Gardens, in a statement said the facility acknowledges that it is on the list and will “continue to make improvements that maintain and improve the quality of care.” A representative of Long Beach Healthcare Center could not be reached for comment.

Michael Connors, a spokesman for California Advocates for Nursing Home Reform, said the federal ratings provide only a snapshot of problem facilities because they include only federal sanctions, not state violations recorded by state inspectors.

The problem in California, he said, is much worse.

“There are hundreds of poor-quality nursing homes here in California,” he said. “This list only identifies a handful of them.”

Connors said the problem is due to understaffing, poor oversight and a complicated web of “unscrupulous” companies that are allowed to own chains of nursing homes. Connors said for-profit entities have been able to acquire nursing homes even without state approval.

Records show that Windsor Gardens in Long Beach is owned by Blythe/Windsor Country Park Healthcare Center LLC, while Long Beach Healthcare Center’s owner is listed as Long Beach Healthcare Center LLC.

Problem facilities that have faced multiple sanctions are rarely closed, Connors said.

“The state almost never closes them, in fact not only does it not close them, it allows the operators who are responsible for this poor care to continue to operate and acquire more nursing homes,” he said. “It’s really a troubling system.”

Last year, a state audit found that health regulators have failed to address ongoing problems with quality of care in California’s nursing homes. From 2006 to 2015, cases of substandard care jumped by 31% from 2006 to 2015, while cases that were likely to cause injury or death rose by 35%.

In response to the audit, the California Department of Public Health in a statement said it disagrees with this conclusion. “In fact, CDPH believes that the increased number of federal deficiencies cited demonstrates that CDPH has increased its enforcement activities,” Public Health Officer Karen Smith wrote in her response.

California’s nursing homes are now grappling with a new law that went into effect last year that requires facilities to increase their hours of direct patient care from 3.2 to 3.5 hours each day. Under the law, 2.4 of those hours must be filled by certified nursing assistants.

— The Associated Press contributed to this report