Feds cited 1 in 4 Arizona nursing homes during the coronavirus pandemic

Government inspectors since April have cited more than one in four Arizona nursing homes for errors that could spread COVID-19.

Inspectors conducting special reviews during the pandemic saw staff not wearing masks properly, neglecting to sanitize their hands or medical equipment and failing to keep residents six feet apart. These infection-control measures are seen as key to preventing the spread of the highly infectious coronavirus.

Forty-three nursing homes were cited for such errors during the pandemic. Of those, 26 had been cited for infection control errors prior to the pandemic, and a few made infection control mistakes in three previous surveys. 

The nursing homes that were cited included for-profits, non-profits and government-run facilities. More than half were not short-staffed around the time of the inspection, according to their own reporting to the Centers for Medicare and Medicaid Services, the agency responsible for federal quality standards at the nation's 15,600 nursing homes.

Many of the inspection reports note facilities failed to follow their own policies and that the shortcomings "could result in the spread of infection, including COVID-19 to residents and staff.”

Collectively the facilities serve more than 3,400 residents. 

They reported to the federal government 277 deaths from the disease and 1,084 infected residents, as of Aug. 23. The infection count excludes patients who were transferred from hospitals who were already infected. 

Among the facilities was Sapphire of Tucson Nursing and Rehabilitation in Tucson and Providence Place at Glencroft in Glendale, which reported more deaths than any other nursing home in the state.

The number of cases and deaths is actually higher because nursing homes didn't have to start reporting to the federal government until May. In addition, the federal data are known to contain errors. But they are the only available measure of Arizona nursing home cases and deaths because state public health officials have refused to share that information, which they've been collecting since April.

The Arizona Department of Health Services won't share the total number of nursing home deaths and cases statewide. 

Brian Lee, executive director of Families For Better Care, a nonprofit group that advocates for nursing home residents, said infection-control measures at nursing homes have never been more important.

"It’s the difference between life and death in a nursing home right now," he said. 

He said it's concerning that one in four Arizona nursing homes didn't meet basic infection controls, especially as long-term care facilities in the state recently got the green light to open to visitors after being closed to nearly all outsiders for more than five months. 

"It just concerns me there’s going to be much more spread happening in these facilities," he said.

'A lot of employee fatigue' 

At Allegiant Healthcare of Mesa, inspectors watched staff without proper protection care for residents who presumably had COVID-19 and then leave to care for residents who did not have the virus. 

Staff also didn't properly clean and disinfect a blood pressure cuff used on several COVID-19 positive residents.

"These failures increased the likelihood for serious injury, serious harm or death," the inspector wrote.

The July infection citation was the facility's fourth in the last several years. Allegiant has reported 24 confirmed COVID-19 cases and one COVID-related death, according to data reported to CMS. Allegiant's administrator did not respond to a request for comment. 

Inspectors cited Haven of Show Low when they discovered an employee with symptoms had returned to work in the COVID-19 unit five days after testing positive for the virus. 

At Devon Gables Rehabilitation Center in Tucson, inspectors saw 17 residents eating in the dining room within arm's length of another person. One of them reached across a table and took a roll-off someone else's plate.

The director of nursing witnessed the heist and quickly confiscated the roll.

Inspectors also watched staff help residents eat without using hand sanitizer between each person. 

That happened at the end of May, and Devon Gables' administrator said the facility has corrected the errors. Two subsequent state reviews found no issues, said Heather Friebus, the administrator. 

She said she didn't think the error contributed to the spread of COVID-19 at the site, which reported just one additional case in the week following the incident.

Devon Gables has reported nine resident cases and two deaths.

"We take the infection control regulations very seriously," Friebus said. 

At Pueblo Springs Rehabilitation Center in Tucson, the first employee spotted by inspectors on May 18 was wearing her mask below her nose. Another employee observed shortly after wasn't even wearing a mask but put a mask on after seeing inspectors. Pueblo Springs did not return a call seeking comment, though the inspection report notes the deficiency has been corrected. 

Search by nursing home or county to read about errors inspectors found during the pandemic. If a nursing home doesn't appear in the data that means inspectors found no errors or the state has not posted reports including citations. 

David Voepel, executive director of the Arizona Health Care Association, an advocacy group for the long-term care industry, said he doesn't think infection control errors found by inspectors are a major contributor to the virus' spread through facilities. 

He said nearly every nursing home has been hit by COVID-19. 

And, he said, citations of Arizona nursing homes during the pandemic have generally represented one-off issues that were resolved. 

Keeping staff informed of new protocols and properly trained is a 24/7 task in nursing homes, he said.

"And people are fatigued. We've been going through this doggone thing since the first of the year," he said. "There is a lot of employee fatigue. There is a lot of policy and procedure fatigue." 

Focused on infection control

Infection control has always been a focus at nursing homes. But the precautions have taken on increased urgency as long-term care facilities have become the deadliest settings for COVID-19, the respiratory disease caused by the new coronavirus. 

More than 70,200 deaths have been reported in U.S. long-term care facilities as of early September, according to the nonprofit Kaiser Family Foundation, accounting for about 41% of all COVID-related deaths nationwide. 

Many nursing home residents are over 65, live in close quarters and have underlying health conditions, all of which makes them vulnerable to the virus.

In a typical year, nursing homes are inspected for infection control during annual visits that examine other facets of the operation such as staffing ratios, quality of care, food service and safety.

But in March the Centers for Medicare and Medicaid Services ordered state health inspectors to suspend routine inspections and focus on infection control because of the pandemic. CMS gave states until July 31 to complete the inspections or risk losing some federal money set aside for the pandemic response. Just last month, CMS announced routine inspections of nursing homes would resume. 

In Arizona, Christian Care Nursing Center in Phoenix was cited after a May inspection when inspectors found a resident with a fever over 100 degrees for several days who wasn't being isolated from others and a doctor wasn't notified for five days. 

The facility’s policy requires that any resident running a fever or showing symptoms of a respiratory illness must be quarantined for 14 days. The resident later tested positive for COVID-19, and an employee told inspectors that the doctor should have been notified sooner. 

In a statement, Christian Care officials said their facilities welcome inspections as a way to confirm they are providing the finest care possible and to identify areas where they can improve. The facility has already taken actions to correct deficiencies, they said, and the Arizona Department of Health Services has approved the course of action.

'They make mistakes' 

Some of Arizona's nearly 150 nursing homes were visited twice by inspectors during the coronavirus pandemic with different results.

Inspectors who visited the Wellsprings Therapy Center of Gilbert on May 19 found employees were taking their own temperatures after entering the nursing unit. The inspector also was unable to find the thermometer used to test staff. But when inspectors returned to Wellsprings on Aug. 11, they found no deficiencies.

At least one nursing home that experienced a large coronavirus outbreak in May was cited on two occasions for infection-control deficiencies, in May and again in July. 

An inspector visiting Providence Place at Glencroft in Glendale on May 13 saw a nursing assistant pull off her mask with her bare hands and prepare a drink for a resident without washing her hands.

On July 9, an inspector discovered there wasn’t enough chlorine sanitizer being used to wash dishes. The inspector noted that eating from dishes that aren’t sanitized poses a “high likelihood of serious infection for all people who eat from the dishes.”

The violation was classified as “immediate jeopardy,” meaning it was considered a risk of serious harm and had to be corrected as soon as possible.

Scott McClintock, Glencroft's chief strategy officer, said in a statement that the May 13 deficiency, which involved only one of the nursing home's six units, was corrected.

During the July 9 inspection, he said there was a miscommunication between the employee and the inspector and the violation was corrected.

An inspector at the Rehabilitation Center at the Palazzo in Phoenix also found issues in the kitchen. During a May 21 inspection, more than 10 flies were spotted in the kitchen. A staffer said the flies had been around "for the past few days. The bug zappers are supposed to take care of that but they haven't been working."

The inspector said the flies landed on bowls and on a baking sheet filled with banana bread dough. 

The inspector also found the facility did not follow federal guidance for disinfecting reusable face shields. The Rehabilitation Center at the Palazzo did not respond to a request for comment. 

Before the pandemic, about half of the nearly 150 nursing homes in Arizona had been cited for infection-control violations during their last three published inspections, according to an Arizona Republic analysis of reports by state inspectors. That's 74 homes with about 8,400 beds, collectively. Most of those inspections were within the last three years.

Voepel, the executive director of the advocacy group for nursing homes, said it's important to remember that these are humans taking care of humans. 

"Humans aren't infallible. They make mistakes," he said. "What we want to stop are the mistakes that happen without intelligence around the issue or we want to stop those mistakes that are habitual because there is no place for that."  

Reach the reporter at anne.ryman@arizonarepublic.com or 602-444-8072. Follow her on Twitter @anneryman.

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