A series of failures triggered a COVID-19 outbreak that rocked the Windsor Redding Care Center last winter[1], killing nearly two dozen elderly nursing home residents and causing 43 more to contract the virus.
Late last year, state regulators determined that the staff at Windsor Redding — a facility that's part of California's largest for-profit nursing home chain, Bruis Healthcare LLC— was not taking mandatory steps to control infection and educate staff on COVID-19.
That left the elderly residents mired in a dangerous health situation over which they had no control. A months-long Record Searchlight, a part of the USA TODAY Network, investigation, based on state records and interviews with union representatives, families and local health authorities, provides the clearest narrative to date of the deadly events last summer.
The speed with which the coronavirus raced through the facility after the first two cases were confirmed on Aug. 27, the level of death left in its wake — and the grim emotional toll that it had on the resident's families and the center's staff — are what made the Windsor Redding situation so devastating, Shasta County Health Officer Dr. Karen Ramstrom said: "That facility was traumatized."
About 60 of the home's approximately 83 residents had tested positive for COVID-19 in the weeks between late August and early October, Ramstrom told the Shasta County Board of Supervisors at their meeting on Oct. 6. There had been about two dozen deaths at that point. Ramstrom added that 33 of the home's residents had active coronavirus infections then, as did nine members of the nursing home's staff.
Knowing how vulnerable the residents were, some desperate family members told the Record Searchlight they'd considered moving their loved ones to other facilities where the coronavirus threat wasn't so great, or even bringing them home. That wasn't possible, given the tight restrictions in place during the coronavirus lockdown, when only employees and residents were allowed inside nursing homes. Exceptions were scarce, made mainly for residents nearing the end of life.
The federal Centers for Disease Control and Prevention has classified nursing homes as "high risk" for COVID-19, due to the nature of their clients — older adults who frequently have underlying health conditions — and close-quarters living conditions.
During the crisis, Ramstrom said her department worked with state officials to help secure additional staff to step in for employees who had gotten sick or had to quarantine. County health workers also conducted site visits, in conjunction with state health care infections experts, to see up close what had gone so wrong and find solutions.
Ramstrom has called the extent of COVID-19 cases at the nursing home "the most tragic situation that we've had to manage in the course of this outbreak."
She said Shasta County public health staff were on the phone with the facility's leadership every day to hear how bad the situation had become and what was being done to halt the virus' relentless person-to-person spread through the 113-bed nursing home near downtown Redding, California.
Recently, she elaborated on the impact of the epidemic on everyone involved.
"The real tragedy was the illness and loss of life suffered by those residents and their families, as well as the facility staff," Ramstrom said. "And our staff that were working to support the facility were also exposed to those same losses … so that was very difficult."
The situation led Shasta County Supervisor Les Baugh to ask Ramstrom during the Oct. 6 board meeting why the troubled home wasn't just shut down and its residents evacuated.
"It looks as if they simply weren't able to manage it," Baugh said.
But state public health officials are the ones that regulate all nursing homes, Ramstrom told Baugh, so only the state would have the authority to determine whether to shut down any facility.
Plus, Ramstrom added, with nursing home beds so scarce locally, residents might have to be sent to facilities elsewhere in California should Windsor Redding close.
"One of the big challenges is: Where would these individuals go? Statewide, facilities are in a similar position," Ramstrom said.
Redding Windsor was not the only home in Shasta County to report that residents died from COVID-19 last year, when the pandemic was taking hold, masks and other protective gear were sometimes scarce and there was no approved vaccine.
Vaccines started to become available to nursing home residents late last year. A high proportion of nursing home residents are now vaccinated and there are few active coronavirus cases in the county's nursing homes right now.
As of May 7, Crestwood Wellness and Recovery Center in Redding had at least one and as many as 10 new cases of the virus among its residents and health care workers, according to the state's database, which doesn't give an exact count. On July 2, that number was listed as zero.
At Windsor Redding last summer, any relief was still weeks away. Cases of infection among residents and employees escalated alarmingly, Shasta County officials said.
On Aug. 27, the first two Redding Windsor residents tested positive for the virus, according to the Shasta County Department of Public Health. The next day, the first member of the nursing home's staff tested positive, the department said.
By late September, at least one resident had died while 36 of the home's residents and 18 of its health care workers had tested positive, according to state records.
Most of the COVID-19 cases officials had identified at Windsor Redding through screening and testing turned out to be among the skilled nursing facility's own health care staff, Ramstrom said at that time.
Even members of the home's management, including those not working directly with patients, contracted the virus, said Laticia Sanchez, spokeswoman for SEIU Local 2015.
"It was everywhere," said Sanchez, whose union represents about 73 employees at the elder facility, including certified nursing assistants, licensed vocational nurses, housekeeping workers, kitchen staff and dietary aides.
Ultimately, 23 Windsor Redding residents died from COVID-19.
None of the center's health care workers died in the coronavirus surge, but 30 ended up testing positive for the virus since the start of the pandemic, state records show.
Whether workers caught the virus while on the job or while out in the community, the virus remained a threat after the initial outbreak. At least one health care worker at Windsor Redding had an active case of COVID-19 as of May 7, according to the state's report. The report did not specify the number of active cases among the home's workers then, listing the number only as fewer than 11.
As to the cause of the home's outbreak, last year a survey team from the California Department of Public Health inspected Windsor Redding and its workers and practices between Sept. 22 and Sept. 25.
The team determined the facility lacked a rigorous infection control program. Also, routine staff education related to COVID-19 was not being conducted, according to the survey team's report.
The state's finding led regulators on Sept. 25 to declare "a situation of immediate jeopardy to resident health and safety" at the nursing home. That status was lifted on Sept. 29, after the nursing home adopted a corrective action plan.
During their survey, the state team interviewed Windsor Redding employees, who told them there were few in-service training sessions on the proper use of personal protective equipment, including masks, as the pandemic took hold.
One certified nursing assistant said she'd been instructed to reuse protective gowns during a shift, only to be told later by another CNA about a change in procedure to not reuse gowns. A different CNA said she had been provided one gown to wear for the entire day while caring for residents who were staying in the same room rather than change gowns periodically, state records show.
During one survey visit, the team reported seeing a licensed nurse sitting at the nurses' station wearing a clear face shield atop an N95 mask that was resting below her chin, leaving her mouth and nose exposed, which was not in compliance with public health protocols. Asked whether nurses were to wear the N95 over their nose and mouth while at the nurses' station, the report said the worker replied, "I don't know."
The nursing home's director of staff development told surveyors that she had been unable to provide employee training full-time because, "due to staffing issues," she had often been assigned to administer medications to the home's residents.
These failures resulted in a significant amount of residents and staff contracting and spreading illness throughout the building, which placed everyone at significant risk.
In its report, the survey team faulted what it called the home's "punitive" employee sick leave policy.
A federal law that went into effect in California in March 2020 required many employers to provide paid sick time to workers affected by COVID-19. Redding Windsor's sick leave policy did not conform to that law, the survey team concluded. Instead, the nursing home had required staff to first use their own accrued sick and vacation leave before being eligible for supplemental paid COVID-19 sick time.
That led some employees to come to work while sick with coronavirus symptoms, only to test positive for the virus soon afterward, state health investigators said.
For example, one CNA told surveyors she developed body aches and respiratory symptoms on Sept. 4, but was asked to return to work on Sept. 6, 7 and 8. Her COVID-19 test came back positive on Sept. 9. The month before, that same staff CNA reported she had worked with a nursing registry CNA "who had been positive for COVID-19." While the two were caring for patients, neither professional had worn a mask, according to the state's report.
The home had also asked employees who'd tested positive for the virus but had no symptoms to report to work if there was a staffing crunch. They were asked to work only with residents and staff who were COVID-19 positive, according to the state's report.
Subsequent COVID-19-focused surveys conducted by the state on Oct. 2 and Oct. 21 found the facility "was not in substantial compliance" with the federal requirements for nursing homes participating in the Medicare and Medicaid programs.
"These failures resulted in a significant amount of residents and staff contracting and spreading illness throughout the building, which placed everyone at significant risk," said the state survey team's report.
After a state plan of correction for the home was put in place, the immediate jeopardy status was lifted on Sept. 29. During a follow-up visit Nov. 9, state inspectors found the facility had corrected the problems identified in the earlier report.
The federal government originally imposed a $152,495 civil fine on Windsor Redding. A letter from the Centers for Medicare and Medicaid Services (CMS) said the fine was imposed due to the home's various infection control and staff education failures during a period spanning late September through mid-November.
After Windsor Redding appealed, the fine was cut to $106,747, which the facility paid in May, according to CMS.
Since last year, Windsor Redding has brought in its second local administrator, stepped up its COVID-19 prevention practices and received a clean bill of operational health from California regulators.
Starting Feb. 9, the home began admitting new residents again, said Windsor Redding attorney Mark Johnson of Los Angeles-based Hooper, Lundy & Bookman, P.C. In early July, the home — which is licensed for 113 beds — had 42 beds available, according to information listed on the state public health website[4].
Before reopening to new patients, Ramstrom said a new administrator installed last fall by the nursing home's corporate office to repair Windsor Redding's operations waited a bit, first laying the groundwork for that task.
The administrator — whom the nursing home attorney declined to name but was identified as Nate Echols by the nursing home's union representative and by Ramstrom — first spent time preparing "to address and support the recovery of the residents and the staff. That was good to see," Ramstrom said.
According to the union's representative, Echols recently left Windsor Redding. In May, he was replaced by an interim administrator, John Spaun, who works for Brius-affiliated Rockport Administrative Services LLC.
With the arrival of new management, "things have gotten really good. They’re really on it," said Sanchez, the spokeswoman for SEIU 2015. "(Union) members have been working very hard to get things back in order. They feel like they are on a good path."
Along with intense scrutiny following the surge of resident cases and deaths during the pandemic, the complex near downtown Redding has also collected $872,611 in COVID-19 relief funding earmarked for medical providers under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
That money can go toward face masks and other personal protective equipment, infection control supplies, staff wages and "many other costs directly related to responding to the public health emergency," said Johnson, the nursing home's attorney.
Later this year, all facilities that received CARES Act funds could be subjected to an audit, Johnson noted. "We are confident that any such audit will demonstrate perfect compliance with the requirements on the part of Windsor Redding," he added.
Lapses in infection prevention and control during the pandemic were the basis of a second fine, that one imposed by the state.
Windsor Redding received that $15,000 civil penalty on Aug. 10. The amount was reduced to $9,750 after the facility waived its right to a hearing to contest the results, according to a CMS spokesperson. The home paid that fine last year, the spokesperson said.
Even before the pandemic erupted, about 80% of California's nursing homes had been cited for infection control and prevention deficiencies, said Patricia McGinnis, executive director of the consumer advocacy group California Advocates for Nursing Home Reform.
"So they weren't ready for it" when COVID-19 began sweeping through nursing facilities statewide, McGinnis said.
Going forward, attaining adequate staffing levels will be key to Windsor Redding avoiding a relapse into the kind of troubles that contributed to the coronavirus crisis at the home, she said.
"What kind of staffing do they have? I think that's one of the biggest problems" for the Brius nursing home chain as a whole, said McGinnis.
About the fines assessed against the elder facility in connection with its problems, McGinnis said, "No, it's not a big fine, considering how many state deficiencies they've (Bruis) had and federal deficiencies they've had over the years."
Most times, she added, government fines just don't have a big impact on nursing home companies anyway. Many homes end up not paying the assessed fines or have the amount they ultimately owe reduced, McGinnis said.
Staffing and turnover has been a lingering issue at Windsor Redding. In 2018, SEIU 2015 members conducted a two-day strike at the Redding home, complaining of inadequate staffing levels among other things.
Windsor Redding continues to be overseen by a Brius-related management company, Rockport Healthcare Services LLC.
Johnson said Windsor Redding is taking steps to address staffing challenges.
The facility "is spending significant resources on recruiting nurses from other countries such as the Philippines," Johnson said. "As with all facilities, there are ongoing recruitment and retention efforts."
He added that the company is also operating "staff training and education centers" throughout the state.
Brius founder Shlomo Rechnitz does not have a role in day-to-day operations at the Redding facility, the attorney said.
It's Rockport that provides services to several Brius homes, including Windsor Redding.
"This organization has the top clinical executive team of any nursing home consulting organization in the country," said Johnson, referring to Los Angeles-based Rockport. "Its talented team provides services to the facility and staff nearly every day and often provides onsite services."
The state's plan of correction for Windsor Redding included adding regular training about COVID-19 prevention efforts and proper use of personal protective equipment. The home's personnel policy was also changed to comply with federal law, so workers affected by COVID-19 could quarantine at home for 14 days.
Although regulation of nursing homes falls to the state, Ramstrom stressed that Shasta County's health department has an "ongoing relationship" with Windsor Redding and can "engage" with the home should future coronavirus issues arise.
"You know, we might be having a little more eagle eye, but I wouldn't say we in particular have more scrutiny on Windsor Redding," she said. "They're vulnerable, just like all our facilities."
Ramstrom said she is "reassured and relieved" now that the majority of nursing home residents in the county are vaccinated against COVID-19.
In Shasta County, 73% of people aged 75 and above and 67% of residents aged 65-74 had received at least one vaccine dose as of late June, the county's public health agency said. That compares with 29% of people aged 20-49 and 51% of individuals aged 50-64.
"We're continuing to work to encourage staff in these facilities to get vaccinated too," said Ramstrom. "I think all of that's really important to move forward and to ensure that experiences like Windsor don't happen again."
600,000 COVID-19 deaths in U.S. with only about half fully vaccinated
Coronavirus deaths reach 600,000 in the United States, a stark reminder of the pandemic’s enduring toll even as states edge toward normalcy.
STAFF VIDEO, USA TODAY
Follow Michele Chandler on Twitter: @MChandler_RS[5].
References
- ^ COVID-19 outbreak that rocked the Windsor Redding Care Center last winter (bit.ly)
- ^ Read the Document (www.documentcloud.org)
- ^ Read the Document (www.documentcloud.org)
- ^ state public health website (www.cdph.ca.gov)
- ^ @MChandler_RS (twitter.com)
from GANNETT Syndication Service https://ift.tt/3kBtLIp
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