Feds cite 10 Ariz. nursing homes

State: Facilities violated infection-control policies

Ten nursing homes in Arizona have been cited for infection-control deficiencies during the COVID-19 pandemic, including two with some of the largest new coronavirus outbreaks in the state.

State health inspectors visiting skilled nursing homes in April and May saw violations of infection-control standards such as staffers touching potentially contaminated surfaces with their bare hands and failing to screen employees for COVID-19 symptoms before their work shifts.

At one facility, residents were seated too close while playing bingo. Another nursing home lacked written procedures for how to deal with the coronavirus more than a month into the pandemic.

While infection control at nursing homes has always been a focus, it has taken on increased urgency as thousands of nursing homes around the country struggle with COVID-19 outbreaks. Infection control measures, like proper hand-washing and cleaning medical equipment, are seen as key to preventing and controlling the spread of the highly infectious virus.

None of the nursing homes in Arizona that were cited were fined, but many of the inspection reports noted that the shortcomings “could result in the spread of infections, including COVID-19 to residents and staff.” Most of the errors have been corrected, according to the reports.

Nine of the 10 nursing homes with violations have reported COVID-19 cases, including two with some of the largest outbreaks and deaths in the state: Sapphire of Tucson Nursing and Rehab and Providence Place at Glencroft in Glendale. The inspections didn’t focus on identifying the source of the outbreaks, but instead observed conditions the day inspectors visited.

Sapphire’s April 2 inspection report said the nursing home failed to follow infection control policies to protect the safety and health of residents. An inspector saw several staff touching potentially contaminated surfaces with their bare hands and found empty hand sanitizers in two locations.

At the 225-bed Providence Place, an inspector saw a nursing assistant pull a mask off her face with her bare hands and prepare a drink for a resident without washing her hands. One room was an isolation room but had no sign warning people that personal-protective equipment was required.

Sapphire officials declined to comment to The Arizona Republic, except to note that the deficiencies were corrected. Providence Place said in a statement that no deficiencies were found during the May 13 inspection in five of the nursing home’s six units. The coronavirus outbreak happened in one of the units where no violations were found.

“We have always worked diligently on infection control, and staff are effectively trained and retrained as a matter of ongoing routine,” said Scott McClintock, chief strategy officer at Glencroft Center for Modern Aging.

The federal Centers for Medicare and Medicaid Services, which is responsible for federal quality standards at the nation’s 15,000 nursing homes, in March ordered state health inspectors to postpone routine inspections and focus on infection control. CMS gave states until July 31 to complete the inspections or risk losing some of the federal money set aside for the pandemic response.

Before the pandemic, about half of Arizona’s 147 nursing homes 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.

It’s unclear yet how many Arizona nursing homes had violations during the coronavirus pandemic. CMS said most of the state’s inspections were finished though many are not available to the public through the state’s AZCareCheck website. A Republic review of inspection reports found 10 nursing homes with violations, and 68 homes in compliance. Infection-control records were unavailable for more than 50 homes as of June 30.

Nursing homes have proven to be the deadliest settings for COVID-19, the respiratory disease caused by the new coronavirus. Many residents are over 65, live in close quarters and have underlying health conditions, which makes them vulnerable.

More than 111,500 nursing home residents and staffers in the U.S. have been infected and nearly 31,000 have died as of mid-June, according to CMS. And those numbers are an undercount because the federal government only requires nursing homes to report data dating back to May 8.

In Maricopa County alone, more than 450 long-term care residents have died of COVID-19 complications.

Touching surfaces with bare hands

In a typical year, nursing homes are inspected for infection control during routine annual visits that examine many other facets such as staffing ratios, quality of care, dietary services and safety.

The 240-bed Sapphire in south Tucson was inspected under the new, infection-control-only procedure on April 2, within days of two dozen residents and three staffers testing positive for COVID-19. By the end of May, more than 90 people there would become infected with at least 30 deaths.

During the April inspection, Sapphire’s second floor was designated for COVID-19 residents with 27 residents who had tested positive. The report says two of the three hallways weren’t marked with signs warning people to check with the nurse’s station before entering. When questioned, an employee said they “ran out” of signs.

A nurse on the COVID-only floor had her mask pulled down and covering her chin, and the mask was rubbing on the phone receiver, the inspector noted.

In one hallway, trash bins without lids were filled with discarded personalprotective equipment, next to containers filled with clean PPE. Multiple staffers were seen touching the trash can lids with their bare hands and then touching a door and leaving the unit without washing their hands or using hand sanitizer.

On the first floor, the inspector found two empty hand sanitizer dispensers. When the inspector asked a staffer where she could sanitize her hands before leaving the unit, the staffer told her “hopefully there was a dispenser just outside of the unit,” the report said.

Sapphire officials told the inspector staff had been trained on measures to decrease the spread of COVID-19. The report noted that the deficiencies had been corrected on May 8.

No screening for fever, symptoms

Inspectors visiting the 141-bed Scottsdale Village Square on April 14 saw an unmanned reception desk. They watched a staffer clock in and enter the dining room without being screened for fever or respiratory symptoms.

The facility had 20 residents who had tested positive for COVID-19. Inside the COVID unit, the inspector saw a staffer holding a cloth gait belt — used to move patients — in her gloved hand. She was seen going into and out of the room without washing her hands or changing gloves before going to help other patients.

The inspector found a cloth backpack belonging to a staffer, despite staff being told in training that bringing personal belongings into a COVID-19 unit can cause contamination and virus transmission.

The facility also couldn’t provide documentation that 12 employees, who worked a total of 112 shifts, had been trained in COVID-19 protocols, though the director of nursing said all staff had been trained on the proper procedures.

As of June 27, Scottsdale Village Square has had 66 nursing home residents and four assisted-living/memory care residents who have tested positive for COVID-19, according to an email sent to families by Executive Director Ken Green. Another 59 staffers have tested positive. Another email sent in May said six residents have died from COVID-19 complications, though many had underlying health conditions. Green did not return messages from The Republic seeking comment. The inspection report noted the deficiencies have been corrected.

Medical equipment not cleaned

Inspectors visiting Santé of North Scottsdale, a 72-bed rehabilitation center, on May 14 observed a staffer who didn’t wipe off a hydraulic lift before pushing it into a room. He said he thought another employee had already cleaned the equipment.

Inspectors found the nursing home was screening staff and visitors for COVID-19 symptoms, but several staffers had not documented their temperatures between May 12 and May 14. The facility’s director of nursing said the dis

crepancy was because of a change in reporting procedure. Before May 12, staff didn’t have to document their temperatures unless they registered over 99 degrees, she said. Then the procedure changed, and it took time for employees to adjust.

The nursing home was advised that identifying rising temperatures can help nursing homes take early action and prevent disease transmission.

Spokesman Nathan Wagner said the facility has conducted additional training, and corrective action has been taken. He said the healthcare community has been under tremendous strain the last few months.

“We acknowledge this and continue to strive every day to be better and do our best. The health and safety of our patients and staff is our No. 1 priority,” he said.

Sometimes, it took only minutes for inspectors to spot a concern.

The 120-bed Desert Cove Nursing Center in Chandler got dinged when a staffer didn’t make inspectors wash their hands or use hand sanitizer when they entered May 13. The nursing home’s training materials tell employees to wash their hands or use an alcohol-based hand sanitizer with at least 60% alcohol when they enter the building. The report said the deficiency has been corrected.

Desert Cove did not return messages seeking comment. But inspection records show Desert Cove is one of five nursing homes in Arizona that had deficiency citations for infection control in three different inspections: in 2017, 2018 and 2019.

None of the nursing homes in Arizona that were cited were fined.

Playing bingo games, but not socially distancing

In Tucson, inspectors found the 120bed Haven of Saguaro Valley continued to hold group activities for residents and wasn’t using social distancing. Some residents weren’t wearing masks while outside their rooms when inspectors visited on May 12.

A group of residents, who had gathered for music therapy, were closer than 6 feet. When questioned, one staffer revealed the previous day, “we played bingo.”

The inspector had the maintenance director measure the bingo tables, where two residents had sat at each table, and found them to be only 4 feet square.

In the same city, but at the 96-bed Center at Tucson, inspectors found staffers only wearing masks, rather than full PPE, on May 14 while working with quarantined residents. This is contrary to Centers for Disease Control and

Prevention guidance, the inspector wrote.

In northeastern Arizona, the 79-bed Chinle Nursing Home on May 5 had not developed policies related to the coronavirus more than a month into the pandemic. Such protocols cover how to screen workers, isolate residents with symptoms and the procedures for COVID-19 testing.

An administrator told inspectors she had many job responsibilities and “did not have time” to develop and write infection-control policies. She said the staffer who had been in charge of infection prevention resigned in February and hadn’t been replaced.

At the 128-bed Lake Pleasant Post Acute Rehabilitation Center in Peoria, inspectors spotted a staffer whose mask was down under her nose. The staffer told inspectors she often removed the mask when she answered the phone because it was difficult for callers to understand her. She admitted she had been trained to wear a face mask “at all times.”

The facility also was not documenting the temperatures of visitors, according to the report. At the time of the inspection, on April 17, an administrator said 25 staff had tested positive for COVID-19 along with 29 residents.

Inspectors also found staffers entering the building through a back entrance where no one was present to screen them. A follow-up inspection on May 27 found the deficiencies had been corrected.

At one nursing home, inspectors noted only one thing wrong during the May 13 visit.

A staffer at the 48-bed Gardens of Scottsdale reached into her pocket and removed a dry-erase marker and then touched the bare skin of a patient. She admitted she should have removed her gloves and washed her hands before and after getting the marker out of the pocket.

Gardens of Scottsdale, Lake Pleasant Post Acute Rehabilitation Center, the Center at Tucson, Chinle Nursing Home and Haven of Saguaro Valley did not return messages seeking comment from The Republic.

Do you have information about an Arizona nursing home or assisted-living facility with a COVID-19 outbreak? Reach the reporter at anne.ryman@ari zonarepublic.com or 602-444-8072. Follow her on Twitter @anneryman. Support local journalism. Subscribe to azcentral.com today.