The Department of Public Health’s actions, announced over the past two weeks, follow concerns about resident safety and care at facilities operated by Sweetwater Care and RegalCare. The shift comes after scrutiny of out-of-state chains that have expanded across Massachusetts in recent years, even as care ratings fell at many of their homes.

On Tuesday, the state rejected Sweetwater’s application to permanently acquire 11 of 14 nursing homes formerly operated by Next Step Healthcare. Sweetwater had been managing the homes under a court-appointed receivership. The facilities serve about 1,000 residents.

Regulators cited the company’s history of serious safety violations and poor care in other states. In July, California authorities reached a $15 million settlement with Sweetwater and affiliated companies over allegations involving widespread understaffing and neglect. Sweetwater is still managing the Massachusetts facilities while the state works with the receiver on their ongoing management. A lawyer for the company did not respond to a request for comment.

The department has also been making unannounced visits to RegalCare homes, and has filed plans to revoke the licenses of the chain’s 12 Massachusetts facilities. The homes serve about 1,200 residents. Owner Eli Mirlis, a New Jersey businessman, has said he plans to appeal; he did not respond to requests for comment sent to his lawyers.

At RegalCare at Taunton, an employee shared messages sent by the director of nursing as state inspectors arrived last week. The messages urged staff to check areas including a utility room, medication room and bathrooms. The facility’s rating fell from five stars to one after Mirlis bought it.

At RegalCare at Worcester, inspectors issued an “immediate jeopardy” finding on Oct. 14, meaning they determined conditions put residents at risk of serious injury or death. The facility was ordered to stop admitting new residents until conditions improve. Among the concerns, an older resident with dementia left a locked unit and was not found for hours. Worcester police said the resident was located at a restaurant and taken to a hospital.

The state also said it would allow the license for RegalCare’s Lowell facility, which has about 60 residents, to expire Oct. 31. The department has not said how the home will be run after that date.

The enforcement marks a break from years in which the state had not denied a nursing home license application or revoked an operator’s license, according to the reporting that prompted the latest scrutiny. A September investigation highlighted declining care at some facilities owned by out-of-state chains and financial arrangements that sent operating funds to companies affiliated with Mirlis.

Massachusetts Health Commissioner Dr. Robbie Goldstein said the department is strengthening oversight and intends to identify problems earlier. “Owning a nursing home is an extraordinary responsibility and a privilege,” he said in a statement, adding that operators would be held accountable for the care residents and families deserve.

Workers at RegalCare at Wakefield, represented by 1199SEIU United Healthcare Workers East, have also raised concerns about staffing, broken equipment and labor-law violations. The union said staffing problems have worsened since May and put care at risk. It represents about 90 nurses and other employees at the facility.

Paul Lanzikos, cofounder of Dignity Alliance and a former state elder affairs secretary, said the state’s actions were encouraging but must be sustained. “It cannot be one and done,” he said.