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| Forty-five of 68 residents have had the virus, a rate of 66% - at Avantara Saint Cloud in Rapid City. Five have died. Jeff Easton |
Avantara
Arrowhead has seen 45 of 49 residents — or 92% — contract the virus as
of Thursday, said Tatiana Johnson, regional director of operations at
Legacy Healthcare, which operates the nursing homes. Eight of those
residents have died while 32 have already recovered. Nineteen of 21
staff members infected with the virus have recovered.
At
Avantara Saint Cloud, 45 of 68 residents, or 66%, have had the virus.
Five have died while 19 are recovered. Twenty-four staff members tested
positive for the virus and 10 have recovered.
Both
facilities have a history of infection control violations related to
staff not following proper procedures for cleaning, disinfecting, hand
washing, glove wearing and making sure residents are cleaned properly.
The
most recent violation was found when the Department of Health inspected
Arrowhead on June 9, after 15 residents and nine employees had already
contracted the virus.
The
inspector found staff failed to properly clean and disinfect shared
equipment, insulin injection devices and the unit for residents who
tested positive for the virus or were exposed but tested negative. A
logbook said the unit had been cleaned nine out of nine mornings, two
out of eight afternoon shifts, and none of the evening shifts. Staff
also wore their N-95 masks outside of the building and then stored them
in a paper bag inside their cars, which would have exposed them to
heat.
"All residents are at risk for adverse
effects related to failure to maintain an infection prevention and
control program," Arrowhead wrote in its plan of correction, which
involved random audits and educating staff on proper cleaning,
disinfecting and mask storage.
DOH spokesman Derrick Haskins said visits on July 14 and this week showed Arrowhead had addressed these issues.
An experienced
certified nursing assistant who works at Saint Cloud says her facility
could have better prepared for the pandemic.
“Things could have been done better from the beginning," said the woman, who contracted COVID-19 and passed it on to relatives.
Saint
Cloud is the fourth-lowest ranked of South Dakota's 104 long-term care
facilities that participate in Medicare and Medicaid. It also has Medicare’s lowest possible overall and health inspection ratings of “much below average.”
Arrowhead is the lowest-ranked facility in the state. It's also the only one labeled a Special Focus Facility,
which means it's subject to frequent inspections and possible
Medicare/Medicaid termination due to “a history of persistent poor
quality of care.”
Arrowhead was designated a Special
Focus Facility in August 2019 and is inspected every six months, Haskins
said. Johnson said Arrowhead has graduated the program and is expected
to be taken off the list.
"Avantara
Saint Cloud and Avantara Arrowhead and their heroic staff have been on
the front lines fighting against this unforgiving virus, protecting our
residents, who are among some of the most vulnerable in our community,"
she said.
Johnson said the
nursing homes are unsure how the virus first entered their facilities
but have and continue to take "full precautionary measures" based on
guidance from the DOH, CDC, and Centers for Medicare and Medicaid.
CNA speaks out
The
CNA was granted anonymity for this story because she fears retaliation
for speaking out. The Journal has seen a photo of the woman in personal
protective gear and a document confirming her job title and place of
work.
The woman began working
at Saint Cloud this year but has been a CNA for more than two decades.
She said the nursing home has taken some steps to prevent the virus: no
visitors are allowed, there have been at least four mass testings, and
staff have their temperatures taken daily and wear personal protective
equipment.
She
said the first mass testing was in late May or early June and it took a
week to learn the results. It turned out that one staff member — who
was asymptomatic and continued to work — and two residents were
positive. She said she’s not sure who provided the equipment but it was
Saint Cloud's medical staff that did the testing.
Saint
Cloud had a few cases at a time until late June or early July when “all
of a sudden it was boom, boom, boom … it was all over the building,"
the CNA said.
She said staff
wore loose-fitting surgical masks until N-95 masks arrived on July 6
after about 20 residents were already infected. She said the facility
still needs more masks so they can change them more often.
Staff
who clean and disinfect areas need to do a better job, the CNA said.
For example, she said rooms aren’t properly disinfected when a resident
is moved to a different area after contracting the virus.
The
CNA said she knows three staff members who had high temperatures when
they arrived at work, but instead of leaving they took their temperature
again after 30 minutes and wrote down the new, lower one. She said
staff who miss work because they develop symptoms or a confirmed case of
the virus have to use their saved paid time off.
She
said Saint Cloud’s residents are “very susceptible” to the virus and
since they all have Alzheimer's or other forms of dementia many do not
understand the pandemic and continue walking into the hallways and each
other's rooms.
The CNA said she’s considering looking for work elsewhere even though she is well paid.
“Is that money worth my health? No.”
DOH, Legacy respond
Legacy
Healthcare operates Arrowhead, Saint Cloud and 16 other long-term care
facilities in South Dakota, according to its website. They are owned by
Cascade Capital Group and both for-profit companies are based in a
Chicago suburb. Legacy Healthcare operates 52 facilities, mostly in
Illinois and South Dakota but also in Montana and Utah.
Cascade says it bought 16 of its South Dakota facilities in July 2019. The nursing homes were previously operated by Skyline Health Care.
Legacy
took over "a struggling operator who had previous issues with clinical
results and public health violations resulting in subpar Medicare
ratings," Johnson said. "While this posed some challenges at first, our
selfless staff have been instrumental in improving many different facets
of the facilities, which has created many positive results in the last
year."
Arrowhead was labeled a
Special Focus Facility a month after Legacy took over and all but one
of the inspections reviewed by the Journal occurred after Legacy became
the operator. The company's South Dakota facilities range from
low-ranking ones like Arrowhead and Saint Cloud to ones rated by
Medicare as "much above average."
Johnson
said Arrowhead and Saint Cloud have worked to prevent the virus by not
allowing visitors, stopping group meals and activities, and following
masking and social distancing when possible. She said staff are screened
for symptoms each day and have proper Personal Protective Equipment.
Both nursing homes voluntarily mass tested all residents and staff with
help from local and state health departments, Johnson added.
Haskins
said the department has been holding weekly calls, providing Personal
Protective Equipment and conducted 18,598 mass tests of staff and
residents at long-term care facilities. The facilities are also
conducting random testing of staff and residents each week.
During
the pandemic, the DOH has conducted 145 infection control inspections
at all 104 South Dakota long-term care facilities that use Medicare and
Medicaid, Haskins said. The department does an extra inspection and
provides daily check-ins facilities after a resident develops the
virus.
Saint Cloud inspections
Nursing
homes that are part of Medicare and Medicaid programs are inspected
once a year for re-certification and more often if there is a complaint
or they are a Special Focus Facility, according to Medicare's "Nursing Home Compare" website.
The inspections are conducted by trained inspectors and at least one
nurse with the South Dakota Department of Health on behalf of the
federal government.
The
inspectors note any violations and the facility must explain how they
will correct them within a certain amount of time, Haskins said.
Medicare then gives ratings for health inspections, staffing and quality
of resident care by using a five-star system ranging from “much below
average” to “much above average.” Those three ratings are used to
determine the overall rating.
Medicare
gave Saint Cloud its lowest ranking — one star or “much below average” —
for its overall and health inspection ratings during its September 2019 annual inspection. It was ranked average for staffing and above average for quality of resident care.
Saint
Cloud, which used to be called Bella Vista, was fined $19,321 after
being cited for 14 health violations. South Dakota facilities have an
average of 3.5 health deficiencies while U.S. ones have an average of
8.2, Medicare says.
One
infection prevention issue was a dirty salon/spa area, including dirty
toilets. Inspectors saw a staff member fail to properly clean a
different shower area. Some staff members did not follow proper
hand/glove hygiene for themselves and sanitation for residents while
cleaning residents after they went to the bathroom.
Saint Cloud said it re-educated staff on disinfecting these areas, hand/glove hygiene, bathroom hygiene and infection control.
DOH staff inspected Saint Cloud in March 2020 after a complaint about resident safety related to falls and infection control but found the facility was following all rules. They inspected the facility in April and on June 17 and found it was following infection procedure and was prepared for the coronavirus pandemic.
Arrowhead inspections
Arrowhead, which
used to be called Meadowbrook, specializes in caring for people in need
of medical and rehabilitative treatment. It has no Medicare rankings
due to its Special Focus Facility status.
Inspections show that Arrowhead has yo-yoed in its preparedness for infections and the coronavirus since March.
DOH
staff found Arrowhead was following infection and coronavirus protocols
during a visit this week and on July 14, Haskins said. Those visits
came after staff found the facility wasn't following infection rules
during the June 9 visit.
Federal
inspectors previously found the facility implemented COVID-19 practices
and was following infection control regulations during an April 23 visit, Haskins said. But that visit came after a March 12 visit in which inspectors found the facility was not meeting professional or infection standards.
Inspectors
found some staff failed to properly care for incontinent patients and
follow medical procedures. They also found some staff failed to properly
disinfect a whirlpool tub and follow hand hygiene and glove use rules,
including while caring for a patient with a contagious infection.
The inspectors also found Arrowhead was
violating a South Dakota law that says new employees must be evaluated
for vaccines and contagious diseases within 14 days of being hired.
Arrowhead said it would remedy the problems in the April 23 and June 9 inspections by educating staff and conducting audits.
But
those weren't the first time the facility had violations it said would
be remedied through training and audits. DOH staff also found violations
— including infection control ones related to hand/glove hygiene and
disinfection — during inspections in January, September and December 2019.
Arrowhead was fined $6,805 in January 2019 after inspectors found 13 health deficiencies.
Full Article & Source:
Rapid City nursing homes with 13 coronavirus deaths have recent history of infection violations
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