Nursing homes struggle to control virus

Redwood Springs, Lindsay Gardens make up nearly half of all coronavirus cases in Tulare County

By Reggie Ellis

TULARE COUNTY – Skilled nursing facilities in Visalia and Lindsay continue driving up the numbers of coronavirus deaths and cases in Tulare County far beyond more populated counties to the north and south.

Eighteen Tulare County residents have died from COVID-19, compared with just three in Kern County and seven in Fresno County, as of press time. Only 11 counties have more deaths from the virus than Tulare County.

Eight of those deaths have come at Redwood Springs Healthcare Center, a skilled nursing facility located at 1925 E. Houston Ave. in Visalia. The facility also has more cases of COVID-19 than any other nursing home in the state. When the California Department of Public Health (CDPH) released its list of outbreaks at nursing homes on April 17, Redwood Springs had 46 staff members and 91 patients test positive for coronavirus, just behind Oak Brier On Sunset in Los Angeles, which had a total of 142 cases between residents and employees. But as of press time, county officials were reporting 161 total cases at Redwood Springs. Just to put that in perspective, there are 1,224 skilled nursing facilities in California and 258 have reported having one or more COVID-19 case by either a resident or a health care worker as of April 17, 2020.

Tammie Weyker-Adkins, public information officer for the Tulare County Health and Human Services Agency, said the county’s Public Health Department continues to partner with Redwood Springs staff on site and through its corporate office by participating in any State interactions. County health officials are providing a nurse liaison to work directly with the skilled nursing facility, providing personal protective equipment (PPE) and lab collection kits as well as sharing information and instruction on infections control.

“We are actively involved daily in working toward the control of the infection within this facility,” Weyker-Adkins said.

HHSA and CDPH are also extending their assistance to Lindsay Gardens Nursing and Rehabilitation Facility in Lindsay, where 40 residents and six employees test positive for COVID-19. The rate of spread seems to be equally aggressive at the Lindsay nursing home as cases have more than tripled in the last week since the initial outbreak of 11 cases was announced. As of press time, Tulare County reported 422 cases of the virus, with over half of those from person to person contact. That’s not surprising since Redwood Springs and Lindsay Gardens combine to represent nearly half of all cases in the county.

Individuals 65 and over may have a weaker immune system to fight the virus. They may also have underlying conditions that make them more vulnerable to fighting the virus, such as diabetes, obesity, lung or heart disease, asthma, a history of smoking or other co-occurring illnesses. It is important for residents over the age of 65 to shelter at home, limit activities in the community other than going out for essential services such as groceries, healthcare, and medication. They should wash their hands often, social distance in public settings and wear a face mask when in public.

Weyker-Adkins said county public health staff are working actively with the CDPH’s Healthcare-Associated Infection program on ensuring Lindsay Gardens’ staff understand the guidelines for caring for COVID-19 patients and appropriately keeping them separate from the residents who are non-symptomatic.

“Additionally, hospital-associated infection control has been informed and began an initial investigation as soon as the facility reported the first positive case,” she said.

Tulare County Public Health is helping coordinate all skilled nursing facilities and health care centers with weekly or bi-weekly calls to strategize how to overcome and mitigate outbreaks. The CDC has issued guidelines on key strategies to preventing infection within skilled nursing facilities including prohibiting visitors, screening anyone entering the facility before each shift, send ill personnel home, restrict all residents to their rooms and ensure all residents wear a cloth face covering whenever they must leave their room.

Checking up

Both facilities lie in the County Supervisor District 1 represented by Kuyler Crocker who is calling for an investigation of Redwood Springs. Crocker reached out through staff to the California Department of Public Health (CDPH) and says an investigation could lead to a shutdown of the facility. Any investigation at the facility will be slowed by the number of patients who have the coronavirus. CDPH is working through their channels to potentially launch an investigation. Crocker said he wants to know why there was an outbreak there when other nursing homes, Twin Oaks Assisted Living Center in Tulare and Magnolia Rehabilitation and Nursing Center in Visalia, have had patients contract the virus but only spread to less than a handful of people.

“After this is all said and done, everyone may have it [at Redwood Springs],” Crocker said.

This is not the first time that Redwood Springs has struggled to control the spread of infection at its facility.

Since 2016, Redwood Springs has had 91 health-related deficiencies, more than four times the state and national average. The nursing facility has been cited for having deficiencies in its program to investigate, control and keep infection from spreading in all three of its most recent inspections.

In 2017, Redwood Springs had several infection control deficiencies including not properly labeling a biohazard storage area and cleaning and disinfecting products and not using those products according to directions, according to the Centers for Medicare and Medicaid Services (CMS). Also in 2017, the facility had a scabies outbreak in 14 patients because staff failed to implement a control plan for the rash caused by a microscopic mite that burrow into the upper layer of the skin and lays eggs. This was the facility’s only infection citation since 2017.

In 2018, the facility failed to prevent the spread of bacteria in eight separate incidents including not washing hands, not changing gloves, leaving soiled linens on the ground, not cleaning bathrooms after use and handling trash without gloves. That same year, Redwood Springs was fined $100,000, the most severe penalty issued by the state, in the death of 81-year-old woman. Two certified nursing assistants left the woman unattended while she was using the commode, a plastic chair on wheels which goes over the toilet. The woman fell and hit her head and died six days later.

The skilled nursing facility is owned by Plum Healthcare Group LLC, which has struggled with sanitary conditions at many of its facilities. Plum owns 42 nursing homes throughout California, seven of which have been fined for health-related violations totaling $115,775, according to data from Medicare.gov compiled by Review.care, a web site that evaluates and compares nursing homes. Plum’s facilities overall were rated four of five stars, but 14 of its facilities received two stars or less for health inspections. Since 2017, half of Plum’s facilities have had at least one infection citation that could have led to harming patients or staff, but no one was hurt, according to a recent report by Kaiser Health News. A dozen were cited multiple times and one facility, the Pine Creek Care Center in Roseville, was cited four times in the last three years.

Infection control has been a problem at Lindsay Gardens in the past as well. The facility has had sanitary deficiencies (employees not washing their hands) during inspections in 2017, 2018 and 2019 but has not had any infection citations. Since 2016, the facility has 44 deficiencies, more than twice the state and national average.

The facility is owned by Providence Group Inc. Providence owns 17 nursing homes in California and Kentucky. Three of their facilities have been fined for health-related violations totaling $48,191, according to Review.care. Only two of Providence’s 17 facilities were cited for poor infection control in the last three years.

During an inspection on April 27, 2017, Lindsay Gardens failed to make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public, according to the CMS, the federal agency that inspects nursing homes. During an inspection on June 23, 2016, inspectors said the facility failed to have a detailed, written plan for disasters and emergencies and on June 18, 2015 that the facility failed to train all employees on what to do in an emergency.

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