The U.S Department of Housing and Urban Development (HUD) recently inspected the 139 nursing homes that it insures. HUD gave a Philadelphia nursing home its lowest possible rating. On a scale of 100, Bala Nursing and Rehabilitation Center in Wynnefield Heights scored a 2.

Federal inspectors found 58 “safety and health” violations at Bala Nursing, including 37 that put residents in jeopardy. The violations including missing or broken handrails, blocked or locked fire exits, exposed wiring and missing protective plates, m broken “call-for-aid” devices, and rodent infestation.

Bala Nursing’s HUD score was based on the physical safety of the building and its residents. An examination of the nursing home’s quality of care, based on inspections, revealed 20 years of violations and fines. When HUD inspected Bala Nursing in November 2011, inspectors cited six “life-threatening” problems, all of them electrical wiring issues, and 12 “non-life-threatening” deficiencies, including mold and broken circuit breakers. A July 2016 Medicare inspection report also noted that Bala failed to follow a safety plan for a patient who fell three times in a one-year period.

Bala Nursing disputed HUD’s findings, saying the agency used safety standards that are typically applied to apartment buildings. The most recent HUD inspection involved citations for windows that could not be used as emergency escapes. HUD had labeled these as “life-threatening” defects, contributing to the facility’s low ranking. The nursing home installed stops on the windows to prevent them from being opened wider than six inches so that residents cannot climb out. Bala claimed the windows were not intended as emergency escape routes, but never sought a variance for the window stops.

Medicare, which has a five-star rating system, gives Bala an overall two-star rating. Medicare rated six of Philadelphia’s 45 nursing homes with one star. Bala has a one-star rating for its staffing levels.

These findings raise the issue whether regulators are doing enough to enforce the rules applicable to nursing homes. Since 2015, 14 nursing homes in Philadelphia have been fined by the state Department of Health. Bala was not one of them.