Nursing home cited for violation last year

Facility with outbreak failed health codes, federal reports say

The Texas City nursing home where more than 80 residents and employees have tested positive for the coronavirus was recently cited for failing to provide a safe and sanitary environment for its residents and the public.

At the Resort at Texas City, 83 residents have been confirmed to be infected with COVID 19. One of them, 87-year-old Peggy Smith, died Saturday, according to her family. The outbreak — the largest in the region — was traced to March 28, when an employee tested positive for the virus, leading the Galveston County Health District to test 146 residents and employees in partnership with the University of Texas Medical Branch at Galveston.

Experts said the Resort’s inspection violations, all of which were deemed “corrected” a month later, are symptomatic of a larger problem when it comes to health and sanitary practices of long-term care facilities, as well as lax regulatory oversight.

Infection control failings at nursing homes across the country are remarkably basic — such as staff not properly washing hands, which happens to be the primary way coronavirus spreads, said Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit advocacy organization for long-term care facilities.

“Things that pretty much every 8-year old knows is what we’re talking about here,” Mollot said. “It really comes down to extremely poor enforcement of those standards. They know they can get away without following the proto

cols and they do. They’re sent a message by the state and the federal government that those things are OK.”

It is not yet clear how the virus was introduced at the 135-bed nursing home. The Galveston County Health District declined to give a breakdown of how many residents and employees tested positive, nor did it give an exact number of hospitalizations out of this group.

Philip Keiser, the county’s local health authority, said at a news conference Friday evening that he suspects the mass infection at the Resort came from multiple part-time employees who may have unknowingly carried the coronavirus with them from other long-term care facilities they worked at in Galveston County.

When asked if the nursing home could have prevented the coronavirus outbreak, Keiser said he believed they were largely a victim of “bad luck,” and said the health district was more focused on testing and isolating coronavirus-positive residents and employees than scanning inspection reports for red flags.

“When we did visit there, we found the staff to be on top of things, they’ve been following all of the (Centers for Disease Control and Prevention) guidelines, we found them to be professional and caring and doing everything that they could,” Keiser said.

But federal reports indicate that the Resort was falling short of health and safety standards even before the outbreak occurred. The facility recently received the second-lowest possible ratings — 2 out of 5 stars — for health and fire inspections, staffing levels and quality of resident care. Experts called the violations a symptom of what experts say is a larger problem when it comes to health and sanitary practices of long-term care facilities, as well as lax regulatory oversight.

The reports documented incidents where Resort staff failed to exercise proper sanitation and infection control measures.

A report from July cited the nursing home for failing to maintain mechanical and electrical equipment in safe operating condition, specifically noting two industrial washing machines that were not kept in proper working condition.

“This failure could place all residents who had their clothes laundered by the facility at risk of infection from not having their clothes properly cleaned and sanitized,” the report said.

In the same report, the nursing home was cited for failing to store, prepare, distribute and serve food in accordance with professional standards, as well as stained ceiling tiles and dirty airconditioning units that “placed (residents) at risk of an unsafe environment and decreased quality of life.”

The Resort at Texas City administration has not released any public statement since the initial outbreak at the facility was first reported Wednesday. A woman who answered the phone at the facility Saturday hung up on a reporter several times before declining to comment.

Amanda Fredriksen, state director for advocacy and outreach for AARP in Austin, said Texas regulations allow facilities with violations that “cause actual harm” to residents — the violations at The Resort were deemed “minimal harm” — to correct them to avoid paying a fine. If the violation hasn’t been corrected within 2 years, the facility can charge them triple the penalty.

“I have no idea how often (penalties for failing to correct) happen, to be quite frank,” Fredriksen said. “I think it probably doesn’t happen very often because there’s always more (violations) to find.”

Nursing home staff working at multiple facilities have also proven to be vectors for coronavirus infections. In Washington state, CDC officials found that staff members who worked while sick at multiple long-term care facilities contributed to the spread of coronavirus among vulnerable elderly in the Seattle area.

“It’s a real worry. Even if you’ve got a facility that is just being as vigilant as they possibly can be, if they can’t control what happens when the staff leave their facilities, they can only control what happens when they try to come back,” Fredriksen said.

The Galveston County Health District on Friday issued a public health order requiring all longterm care facilities in the county to prohibit workers at facilities with positive coronavirus residents from working at other longterm care facilities. The county is also committing to eventually test residents and employees at all of its long-term care facilities for the coronavirus.

Across Southeast Texas, however, Galveston County’s nursing home restrictions are an outlier.

While almost all Houston-area counties are restricting nonessential visitors from accessing long-term care facilities, some of those county officials detailed a more reactive approach to battling the coronavirus in those places. Among the counties that responded to requests for comment — Harris, Liberty, Brazoria and Waller — none intends to conduct more widespread testing at nursing homes.

The Department of State Health Services, which acts as the local health authority for some counties in the state such as Waller, has not found a need for widespread testing at nursing homes in counties it oversees.

“It really is driven by the need at the time and the disease investigation,” said Chris Van Deusen, the department’s director of media relations. “That really guides what testing looks like.”

But there have already been consequences to this reactive approach. The Montgomery County judge last Monday issued a shelter-in-place order at the Conservatory of The Woodlands, a luxury retirement community, after at least 12 people tested positive for the new coronavirus. Three elderly men from that community died shortly after the order was issued.

For Larry Edrozo, whose mother, Helen, 87, is a resident at the Resort at Texas City who tested positive for the coronavirus but is asymptomatic, doesn’t blame the Resort staff, knowing that the virus is indiscriminate, regardless of how it entered the facility.

“I feel sorry for them,” Edrozo said. “I know they must feel like they’re in a war zone and they’re doing what they can. I recognize the severity of the situation, but I’ll be very upset if I don’t get to say goodbye to Mom.”