Lakewood Health and Rehabilitation, 2115 E. Woodstock Place, was cited for four federal violations and substandard care as a result of the abuse. The home also was cited with one state Class B violation, one step down from the most serious. Lakewood has about 176 residents, most of whose stays are paid for by public funding. Only about 12 residents pay with their own funds, state records show.

According to state inspectors, four residents were abused in April and May by two certified nursing assistants. The nursing assistants both carried squirt guns "for . . . when they (the residents) get out of line," state reports quote one of the abusive caregivers as saying.

Three other certified nursing assistants were not involved in the abuse but witnessed some or all of it. None of them reported it to administrators until early June when one was questioned about why she had requested a transfer to another floor. Administrators then reported the abuse to state officials, as required by state law.

Thomas Zwicker, executive director of Summit Health Care, which owns Lakewood, said Monday that the nursing assistants responsible for the abuse were immediately suspended and then terminated after he was told June 4 of the abuse allegations.

The three caregivers who failed to report the abuse still work at Lakewood, he said, but have undergone additional training.

"It's a tremendous heartache when we encounter something like this," Zwicker said. "We have increased the education component to individuals and house-wide. We are reinforcing systems and procedures. "

One of the nursing assistants worked at Lakewood for about a year and the other for about four months, said Zwicker, who is chairman of a national organization working to improve wages and training for caregivers. He said the abusive caregivers were paid about $8 an hour.

In addition, Zwicker said, he was questioning the state's findings on two of the four incidents because his internal investigation was able to confirm only two instances of abuse.

According to state records:

In April, the two abusive caregivers used squirt guns to spray a resident in the face with an unidentified liquid.

"Watch this, watch him scream like a girl," both abusive caregivers were quoted as saying as they laughed.

In late May, a male resident was struck three times with his wet incontinence pad after he kicked a nursing assistant who was attempting to change him.

"While Staff E (the nursing assistant) was striking the resident with the pad, she also called him obscenities," another nursing assistant who witnessed the situation told state inspectors.

On that same day, the second abusive nursing assistant sprayed a cleaning solution into a resident's mouth to keep her "quiet" after the resident asked caregivers to leave her room. That same caregiver is alleged to have sprayed a cold cleaning solution on the feet of a fourth resident to "make her be quiet" on another day.

The home has until Aug. 9 to correct the problems that led to the abuse and could face substantial fines. The citations were based on a July 9 state investigation made public Monday, after the nursing home was notified of the results.