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Residents with COVID weren't isolated in southwest Illinois nursing home, state says

Belleville News-Democrat - 11/14/2020

Nov. 14--A second metro-east nursing home has received the most serious citation available to regulatory agencies because it kept six residents who tested positive for COVID-19 in the same rooms as residents who tested negative for the disease, according to a state investigation.

From Sept. 16-29, an Illinois Department of Public Health team investigated Integrity Healthcare of Smithton's compliance with regulations to prevent or control the spread of the new coronavirus that causes COVID-19.

The team determined on Sept. 25 that the nursing home's failure to isolate the infected residents put the roommates in "immediate jeopardy" because it increased their risk for severe illness from COVID-19 and possible death.

The virus can spread when an infected person coughs, sneezes, sings, talks or breathes around other people, especially those within about 6 feet, experts say.

Nursing home residents are among the most vulnerable to the virus; older people and those with existing health conditions are more likely to become severely ill after contracting it, according to the Centers for Disease Control and Prevention.

In St. Clair County, where Integrity Healthcare of Smithton is located, 131 of the 231 COVID-19 deaths countywide as of Friday were from long-term care facilities like nursing homes.

Since September, when the state investigation took place, Integrity Healthcare of Smithton has consistently reported shortages of nurses, aides and other staff to the federal government.

BEHIND OUR REPORTING

Why we did this story

During a BND investigation of nursing home inspections during the coronavirus pandemic, we found an "immediate jeopardy" citation at Integrity Healthcare of Smithton. Because it is the most serious citation a nursing home can receive, we decided to post the story about Integrity now as we continue our region-wide investigation.

How we did this story

We learned about the findings of the Illinois Department of Public Health's investigation at Integrity from a Sept. 29, 2020, inspection report that the state published online.

How to learn more

To read the state's inspection reports, go to the website ltc.dph.illinois.gov/webapp/LTCApp/ltc.jsp, search for a nursing home and then click "surveys."

How to share your experience with us

Help the BND report on nursing homes. We're looking for nursing home owners, managers, workers, residents and family members who are willing to share their experiences of the pandemic with us. Contact investigative reporter Lexi Cortes at acortes@bnd.com or 618-239-2528.

During the investigation, the nursing home did not provide documentation showing that six residents who tested positive on Sept. 4, before the state inspectors arrived, were separated from their roommates, according to the state. All six of the roommates tested positive for COVID-19 between Sept. 9-14, the state's investigation found.

The facility's regional clinical nurse/infection control specialist told a state inspector that Integrity Healthcare of Smithton did not have "room moves" documented on a log. The specialist said residents with COVID-19 are either moved to a designated hallway for only those who are infected or to Integrity's sister facility, according to the state's report on Integrity Healthcare of Smithton. The report did not name the sister facility.

"With so many positives coming in all at once, it is hard to keep the census up to date," the specialist told the inspector. "We triage room moving by who is positive, look at who their roommates are, and decide where to move them as soon as we can."

State inspectors noted in the report that a resident who tested positive for COVID-19 was sharing a room with a resident who tested negative when they arrived on Sept. 16. The specialist "did not realize" that was happening, according to a state inspector's notes from their interview.

Integrity Healthcare of Smithton's administrator did not respond to the Belleville News-Democrat's phone calls or emails requesting comment.

Nursing homes can appeal any state findings or sanctions in the investigation process, which is still underway for Integrity Healthcare of Smithton, according to the federal regulatory agency U.S. Centers for Medicare and Medicaid Services.

The Illinois Department of Public Health said the "immediate jeopardy" to residents ended on Sept. 26 because, at the time, there were no longer any residents with COVID-19 in the facility and two residents with possible exposure to the virus were placed in private rooms away from others. Integrity Healthcare of Smithton also reviewed its policies and updated staff training as a result of the investigation, according to the state.

Only two federally-regulated nursing homes in the metro-east had received an "immediate jeopardy" citation for violating COVID-19 regulations as of Oct. 21: Integrity Healthcare of Smithton in September and Granite City'sStearns Nursing and Rehabilitation Center in August, according to a BND analysis of publicly available state inspection reports for the seven-county area. Oct. 21 was the most recent date of the reports available on the state's website this week.

Illinois Department of Public Health spokeswoman Melaney Arnold said previously that the serious citation was "not common" in investigations related to COVID-19 statewide; she did not say how many nursing homes had received it.

The state investigations were prompted by a federal directive to agencies like the Illinois Department of Public Health to focus nursing home inspections on "the most serious health and safety threats like infectious diseases and abuse" during the coronavirus pandemic.

When the Illinois Department of Public Health team traveled to Smithton in September, it also investigated seven complaints that had been filed against Integrity Healthcare, according to the report on the facility.

State inspectors conducted onsite observations at the 101-bed facility, read documents, including policies and resident medical records, and interviewed employees, state and local health officials and an ombudsman, a resident rights advocate through the Illinois Department on Aging.

They found the following violations, according to the state report:

--There were not enough employees working on Sept. 16 to meet residents' needs, including medications and meals. Integrity's regional clinical nurse/infection control specialist told a state inspector that the facility was having "a staffing emergency issue" that day.

--There was not a registered nurse working the required time of at least eight hours per day for four days, Sept. 14, Sept. 20 and Sept. 23-24, based on the nursing schedule.

--Four residents were not monitored for COVID-19 as often as Centers for Disease Control and Prevention guidelines and the facility's policy said they should have been. State inspectors cited the residents' available medical records. Integrity's infection control specialist acknowledged that it is a challenge to check on residents with COVID-19 every four hours but said papers documenting residents' vital signs are sometimes stacked at the nurse's station waiting to be logged and "may not get entered," according to the notes from a late September interview with a state inspector.

--Three residents who were identified as at risk for bedsores did not receive help turning and repositioning as often as the facility's policy said they should have. One of the residents was lying on his back for almost six hours, from 8:51 a.m. to 2:36 p.m. on Sept. 16.

--Employees did not properly wash a resident's skin after her adult diaper was saturated with urine and did not "assess the necessity" of another resident's catheter, which was in place when he came to the facility from a hospital.

--Six employees did not wear the required personal protective equipment around residents with COVID-19, including an N95 mask, gloves, gowns and eye protection. A licensed practical nurse said eye shields "give me a headache, so I don't wear them," and a maintenance worker forgot to put on the personal protective equipment, according to a state inspector's interview notes.

--Three residents did not wear face masks inside the facility -- even when an employee told one of the residents to put on a mask. Two of the residents also did not stay at least 6 feet away from other people. Distance and masking are measures that experts believe help prevent the coronavirus from spreading.

--There was no trash can or laundry basket near the exit of the hallway of residents with COVID-19 for staff members to discard contaminated personal protective equipment.

--The facility's infection control specialist was not a member of its quality assessment and assurance committee.

Virus spreads to Smithton nursing home residents, staff

The St. Clair County Health Department has reported a total of 61 cases of the virus tied to Integrity Healthcare of Smithton, with the latest case announced Wednesday after almost a month of no new infections.

Of the 61 people who tested positive for COVID-19, including residents and employees at Integrity, 10 people have died from the disease, according to the health department. Local health officials do not say whether any person who tests positive or dies is a nursing home resident or an employee.

Like many other nursing homes, Integrity was facing staff shortages while battling the coronavirus.

The facility reported a shortage of aides, in particular, to the federal government nearly every week between May and October. That could include certified nursing assistants, nurse aides, medication aides and medication technicians. Reporting on any shortages from November was not yet available this week.

'We don't have enough help here to get the care done'

At 11 a.m. on Sept. 16, employees had not been by to help two residents eat their breakfast, according to the state's account of the day. Their meal trays were not touched, and the food was cold.

"I can't feed them cold food," a certified nursing assistant said. "Lunch is going to be here soon, and I will just feed them the lunch tray."

At 1:25 p.m., a registered nurse was still passing out morning medications. She had to answer call lights and help residents get to the bathroom at the same time.

One resident waited for assistance in the bathroom for about 20 minutes, according to the state.

"We don't have enough help here to get the care done here that needs to be done," the registered nurse told a state inspector that afternoon.

The Illinois Department on Aging's long-term care ombudsman program had been getting "a lot of complaints" from residents at Integrity Healthcare of Smithton, an ombudsman said in a Sept. 25 interview with a state inspector.

The residents complained that they were not getting what they needed because there was not enough staff. Some said there had been many nights when only one certified nursing assistant was working, according to the ombudsman.

The pandemic has made staffing at nursing homes even more of an issue than it already was, according to the facility medical director quoted in the state's report on Integrity Healthcare of Smithton.

"If they are not on an emergency staffing plan they should be," the medical director said of Integrity in an interview with a state inspector.

Sanctions for southwestern Illinois nursing homes

"Immediate jeopardy" carries the most serious sanctions because it is the most serious citation, the Centers for Medicare and Medicaid Services says.

The federal agency had not made a final determination about sanctions for Integrity Healthcare of Smithton or Stearns Nursing and Rehabilitation Center as of early November; they were still under review. The Illinois Department of Public Health did not respond to the BND's requests for comment about the status of a decision on possible sanctions for either location.

The Department of Public Health imposed a "discretionary denial" of payment for new Medicare and Medicaid admissions at Integrity on behalf of the federal government until the deficiencies found in the investigation are corrected, according to the Centers for Medicare and Medicaid Services.

The state agency also required Integrity to submit a plan for how it will correct the deficiencies, but as of Friday, that document was not available online with the inspection report.

The report on Integrity stated that the severity of the nursing home's citation would remain at a level two out of four after "immediate jeopardy" was removed Sept. 26 because "additional time is needed to evaluate the implementation and effectiveness of in-service training."

A level two designation is for situations with the potential for "more than minimal harm," according to the federal definition. Level four is "immediate jeopardy" to resident health or safety.

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