Pa. National Guard leader abruptly retires amid investigations into veterans' nursing home, Horsham air base

By WILLIAM BENDER

PHILADELPHIA, Pa. (Tribune News Service) — Pennsylvania Gov. Tom Wolf's top military affairs official abruptly retired over the weekend amid investigations into dozens of coronavirus deaths at a state-run veterans home in Chester County and allegations of sexual harassment and retaliation at a National Guard station in Montgomery County.

Wolf on Saturday announced that Maj. Gen. Anthony Carrelli was retiring from his cabinet-level position, effective immediately. The administration would not explain the reasons for his departure.

Carrelli, as adjutant general and head of the Department of Military and Veterans Affairs, was in charge of the state's National Guard units, as well as six state-run nursing homes for veterans and their spouses.

Both institutions have faced scrutiny this year.

In August, two Philadelphia-area congresswomen asked Carrelli to address allegations of misconduct at the Horsham Air Guard Station. The letter to Carrelli followed an Inquirer report in which the base's former sexual assault response coordinator said she was unfairly terminated, and other women described years of rampant sexual harassment and discrimination.

A National Guard brigadier general from West Virginia is now investigating the Horsham base, according to people who have recently been interviewed. Carrelli is a former commander there.

Carrelli's department is also facing an outside investigation into how it responded to the coronavirus pandemic at the Southeastern Veterans' Center, where at least 42 people died of COVID-19.

The Inquirer has reported on how the pandemic tore through the 238-bed home in Chester County, while residents and their families struggled to get information. Officials were slow to adopt infection-control procedures and initially discouraged nurses and aides from wearing face masks.

Employees there told The Inquirer in May that the facility had been mismanaged for years under Commandant Rohan Blackwood and his senior staff. Blackwood and his director of nursing were suspended in May as the state investigation got underway.

Pennsylvania Auditor General Eugene DePasquale released a report last week that criticized the nursing home's slow response to the virus.

Carrelli could not immediately be reached Monday about his retirement.

Lyndsay Kensinger, a spokesperson for Wolf, declined to elaborate on the circumstances of Carrelli's departure, other than to say in an email: "Maj. Gen. Carrelli's decision to retire last week after 35 years of public service was not made at the request of the administration."

Wolf has appointed Maj. Gen. Mark Schindler as acting adjutant general.

Carrelli, who was paid $176,760 a year, is a former Air Force fighter pilot who served in Afghanistan and Iraq. He was named adjutant general in January 2016.

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Pa. National Guard leader abruptly retires amid investigations into veterans' nursing home, Horsham air base

Rapid City nursing homes with 13 coronavirus deaths have recent history of infection violations

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

Two Rapid City nursing homes with significant COVID-19 outbreaks are some of the worst-ranked facilities in the state and have a history of infection control violations, public records show.

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.

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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.

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Rapid City nursing homes with 13 coronavirus deaths have recent history of infection violations

California nursing facility devastated by 17 coronavirus deaths will close permanently

Don and Gerry Warren were married for 71 years. She spent her final three at Stollwood Convalescent Hospital in Woodland CA. Before she died in March of Alzheimer’s. Don moved in with her. A month later, he died of COVID-19 as it hit the facility. By David Caraccio | Renée C. Byer

Stollwood Convalescent Hospital, a Woodland skilled nursing facility devastated by 17 coronavirus deaths in the earlier months of the pandemic, will close permanently this fall.

A message posted Wednesday morning to Stollwood’s website, signed by CEO Sean Beloud, says that after a “thorough financial analysis,” the facility “would operate at a significant monthly loss with no assurance the admissions would increase.” Beloud and other Stollwood officials decided to close the skilled-nursing facility and suspend its license effective Sept. 30, a date approved last week by the California Department of Public Health.

Beloud told The Sacramento Bee he has been in talks with each of the remaining 16 residents and their families. Some might be relocated to the assisted-living side of the campus, and others might move to nearby nursing homes.

It was unclear as of Wednesday how many employees might be moved to jobs elsewhere on the campus and how many might be laid off altogether, Beloud said.

“We’ll navigate through it,” said Beloud, who took the top job in August after working as a physical therapy assistant at the campus for 24 years. “I feel that I will be here to lead and grow and transition this into the future.”

Stollwood appears to be the first nursing home in Northern California to close because of the coronavirus, though industry experts have said the financial strains from the pandemic could overwhelm many facilities across the state and country.

The nursing home is part of the larger St. John’s Retirement Village complex on Woodland Avenue. The rest of the St. John’s campus, which includes assisted living facilities providing a lower level of medical care to residents, will remain open, Beloud said.

The horrific coronavirus outbreak at Stollwood was chronicled in depth by The Bee earlier this month, including interviews with Beloud as well as family members of elderly residents of the 48-bed facility who passed away from the highly contagious respiratory disease, with most dying in April.

Many of those who talked to The Bee nonetheless spoke glowingly of the staff and the nonprofit facility, which has a five-star review on the federal government’s Nursing Home Compare website and had boasted a nearly spotless record based on recent inspection reports that only turned up relatively minor issues such as lapses involving hand washing.

Patricia Warren, whose father died of COVID-19 at Stollwood, said in a recent interview she thinks the nursing home “did everything they could … knowing what we knew back then” about the emerging virus.

“I’ve looked and I’ve searched for answers. I’m a caregiver at heart. And to be honest, this whole transition has broken my heart with what could have, or what should have,” Beloud, the CEO, told The Bee weeks prior to the closure announcement. “... And I know we had the policies in place, procedures in place following every guideline that was put forth in front of us.”

Wednesday’s announcement notes how the “infiltration of COVID in nursing homes” brought on “extremely dark days,” but that Stollwood worked diligently with state and county health officials to eradicate the virus, resulting in it being taken off a state list for active outbreaks at skilled nursing facilities in June.

The nursing home’s 17 deaths, which included at least one staff member, continue to represent half of the COVID-19 death toll for all of Yolo County, where 34 have now died of the disease. All told, 32 residents and 34 staff members at Stollwood tested positive for COVID-19, the disease caused by the novel coronavirus, during the outbreak.

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California nursing facility devastated by 17 coronavirus deaths will close permanently

Report: 56 coronavirus deaths at 14 assisted living homes owned by same company

Benchmark Senior Living at Ridgefield Crossing, on Route 7, in Ridgefield, Conn. March 19, 2020.
Photo: Peter Yankowski / Hearst Connecticut Media

At least 56 residents at assisted living facilities operated by one company throughout Connecticut have died after being exposed to the coronavirus, new data shows.

A total of 163 residents have tested positive for COVID-19, the disease caused by the coronavirus, across 14 facilities owned by Benchmark Senior Living in Connecticut. At least 104 employees have also gotten sick after being exposed to the virus.

The data, obtained by Hearst Connecticut Media, is based on Benchmark’s own accounting of the disease’s path through its senior homes and represents only a fraction of the 111 assisted living facilities in Connecticut.

“We are deeply saddened by the significant impact the COVID-19 pandemic has had on the world’s senior population and those who care for them,” said Amanda Cillo, a spokeswoman hired by Benchmark Senior Living from the public relations firm Burson Cohn & Wolfe.

“It is well-documented by public health experts that older people and those with underlying medical conditions are particularly susceptible to this novel coronavirus.”

Cillo did not immediately respond Tuesday to questions about the data.

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Report: 56 coronavirus deaths at 14 assisted living homes owned by same company