By Lauren J. Mapp, San Diego Union-Tribune, August 14 2020
(Sam Hodgson / The San Diego Union-Tribune)
County says facility’s South County location put it at greater risk for infection
A South Bay nursing home that once was the site of the state’s largest COVID-19 outbreak in a skilled nursing facility is now free of COVID-19, state records show.
Two residents from the 162-bed Reo Vista Healthcare Center in Paradise Hills remain hospitalized, but there have been no new infections reported for three weeks.
Reo Vista is currently tied as having the eighth-worst outbreak in a skilled nursing home in the state as of Aug. 12, according to data from the California Department of Public Health.
Since the beginning of its outbreak two months ago, 118 residents and 40 health care workers have tested positive for the novel coronavirus.
To date, 18 residents from Reo Vista Healthcare have died from COVID-19, including eight in local hospitals, facility Administrator Curtis White said via email.
“While we can’t speculate on how the individuals became infected, we are proud that the facility is now COVID free,” White said via email. “We attribute this feat to our strict adherence to the safety and security protocols and the availability of weekly testing of residents by the County Health and Human Services that began in mid-June.”
Use this map to see how many COVID-19 cases and deaths are attributed to each skilled nursing facility in San Diego County as of Aug. 12, 2020 at noon. Green dots represent facilities with no reported cases of COVID-19, orange dots are facilities with less than 11 cases in one or more category, and red dots are facilities with 11 or more cases in at least one category. (Lauren J. Mapp / The San Diego Union-Tribune)
Sources: California Department of Public Health database, Reo Vista Healthcare
The California Department of Public Health has been tracking COVID-19 cases in skilled nursing facilities — SNFs for short — since the beginning of the pandemic, and working with staff at facilities in an effort to curb the rate of infection and outbreaks for residents.
As older adults living with underlying health conditions, residents at nursing homes are especially vulnerable to respiratory illnesses such as the novel coronavirus, according to the Centers for Disease Control. Living in congregate living facilities — where health care staff from the outside world come in daily — also heightens the risk of infection for residents.
“Their age and fragile health make nursing home residents especially susceptible to the coronavirus,” said Michael Connors, California Advocates for Nursing Home Reform advocate. “People who live in nursing homes are extremely vulnerable to life-threatening infections.”
The San Diego County nursing homes that experienced large outbreaks have several recurring themes, said Sarah Sweeney, the county’s Health & Human Services Agency communications officer. Reo Vista, she said in an email, was “a pretty typical facility in terms of infection control in the beginning.”
“The facility worked really hard on infection control,” Sweeney said. “There were a lot of factors involved, many of them not necessarily under the facility’s control.”
One factor that county officials believe contributed to Reo Vista’s outbreak was its location in the South Bay, and the fact that it was staffed by people who live locally. South Bay has the highest death rate for COVID-19 in the county.
It is likely, she said, that the high prevalence of the virus in the community led to multiple staff members introducing it into the nursing home, especially as there are household members working in the facility who could have infected one another at home.
There are also a lot of rooms at Reo Vista with three beds, which is another factor associated with bigger outbreaks because roommates have a greater risk for infection if one of them catches the virus.
Lastly, Sweeney wrote that testing shortages and delays in receiving results several months ago led to delays when it came to finding positive cases at the facility.
“Though the facility is now COVID-free, we remain vigilant in adhering to the practices and protocols directed by the Centers for Disease Control, Centers for Medicare & Medicaid Services, state, and county guidance to protect the frail and vulnerable residents entrusted to our care,” White said via email.
California Advocates for Nursing Home Reform published a statement this summer about what it believes are some of the systemic issues causing these facilities to become hot spots for novel coronavirus. CANHR also advocates for specific changes so facilities in the state can better protect residents.
It reads in part that “COVID-19 has caused unprecedented devastation and tragedy in nursing homes. Years of understaffing, poor infection control and toothless enforcement of the standards of care have led to dangerous habits and significant tolerance for poor care. When the virus came to California, its nursing homes were universally unprepared to protect their residents and staff, and most were simply incapable of good preventive care because they had never seen it.”
The organization has called for the state to set safer minimum staffing levels, as well as a requirement for at least three-quarters of an hour of registered nurse time dedicated to each resident every day. Advocates said in addition to having more registered nurses and physicians on staff, nursing assistants should be paid a living wage and be provided with sufficient paid sick leave.
“Keeping nursing home residents safe from COVID-19 requires exceptional attention to infection control,” Connors said. “That’s not something many nursing homes have a history of providing. For years, lack of infection control has been the most common violation in California nursing homes.”
In California, 90 percent of nursing homes have had at least one infection control-related deficiency in their last three inspection cycles, according to a nursing home inspection tool by ProPublica.
Lack of infection control and prevention was the top violation cited by the state at skilled nursing homes in fiscal 2018-2019, which is the most recent full fiscal year of data available on the state’s most common violations dashboard. During that period, 862 infection-control deficiencies were recorded.
While the California Advocates for Nursing Home Reform has called for increased staffing, the state has allowed SNFs impacted by COVID-19 to request staffing waivers if there is “increased community spread, school closures, or an emergency such as a fire or public safety power shutoff,” according to an all facilities letter on June 26.
Sufficient access to testing was one of the issues in all sectors of the community, including SNFs, early on in the pandemic. In an all facilities letter on June 2, California Department of Public Health mandated that SNFs throughout the state test all residents and health care workers for COVID-19 to establish a baseline of cases within facilities by June 30. As of last week, the baseline numbers have still not been finalized for all facilities, a CDPH spokesperson said via email.
“Most baseline tests at skilled nursing facilities (SNFs) were completed by June 30, but in very few cases testing took additional time to conduct, and the related results also required extra time to process and validate,” the spokesperson wrote last week. “We expect to have all the results of the remaining baseline tests fully completed for all 1,200-plus SNFs in California, and updated on the page, by the end of next week.”
There have been 65 outbreaks at SNFs in San Diego County, 32 of which remain active, said Public Health Officer Wilma Wooten during a county press conference Thursday. Those outbreaks account for 150 deaths, or 24 percent of the county’s 615 reported deaths.
As of Aug. 12, there have been at least 883 residents and 533 health care workers to test positive for the novel coronavirus throughout San Diego County’s 86 skilled nursing facilities, according to the state’s database, which is updated daily. Since the state data is not specified for facilities with less than 11 cases per category, those numbers could be as high as 1,198 and 1,019, respectively.
Although neither the state nor the county report precise SNF case numbers under 11 cases at each facility, Los Angeles County reports all numbers for long-term care and acute care active outbreaks that have at least one laboratory-confirmed positive resident.
The state Department of Public Health deploys strike teams of nurses and infection control specialists to facilities to help contain and alleviate outbreaks, as well as to conduct contact tracing and coordinate testing efforts. So far, more than 400 skilled nursing facilities in the state have worked with the state’s strike teams.
Since April, three strike teams have been deployed in San Diego County to work with eight facilities — Windsor Gardens, Victoria Post Acute Care, Reo Vista Healthcare Center, Hilldale Habilitation Center, The Royal Home, Astor Healthcare Center, Lemon Grove Care and Rehab, and Brighton Place Spring Valley.
The California Department of Public Health completed a COVID-focused infection control survey on July 2 on behalf of the Centers for Medicare & Medicaid Services. During the inspection, a health facility evaluator nurse found that Reo Vista Healthcare was in compliance with the 42 CFR §483.80 infection control regulations.
The Centers for Medicare & Medicaid Services requires that nursing homes establish protocols that create and maintain an infection prevention and control program to prevent, identify, report, investigate and control infections among staff, residents, volunteers and visitors. The facility’s program must include guidance on isolating residents infected with a communicable disease or virus, as well as guidance on the use of personal protective equipment, according to the Cornell Law School Legal Information Institute.
The evaluator also found that Reo Vista had also “implemented the CMS and Centers for Disease Control and Prevention (CDC) recommended practices to prepare for COVID-19,” according to the state’s report.