Massachusetts is taking its crusade against potentially misleading nursing home ads one step further, citing more than four dozen facilities for advertising dementia care when they don’t technically offer it, according to the Boston Globe.

In a letter to the president of the Alzheimer’s Association of Massachusetts and New Hampshire sent last week, Sherman Lohnes, director of the state’s Division of Health Care Licensure and Certification, said that letters of deficiency are being sent to 52 nursing homes that advertise dementia care without proper certification.

Those nursing homes not in compliance with the state’s rules advertised memory, dementia or cognitive care without documenting the required training, staffing and design improvements needed to receive designation as a dementia care facility, the Boston Globe reported.

“Each of these facilities must remedy the violation cited against them either by modifying their advertising, or complying with all of the dementia special care unit requirements in the regulations,” Lohnes wrote.

The Massachusetts Department of Public Health found an additional 40 nursing homes also had been improperly advertising dementia care. They, however, fixed their ads following letters clarifying the rules of advertising dementia care sent to nursing homes last month.

A July review by the Alzheimer’s Association of Massachusetts and New Hampshire found nearly 60% of facilities that advertised Alzheimer’s or dementia care had not met the requirements to be called a dementia special care facility.