The Milton Nursing & Rehabilitation Center failed to protect staff and residents by not implementing preventative measures to avoid the spread of COVID-19, the respiratory disease attributed to 35 resident deaths during an August outbreak, according to the latest report from the state Department of Health.
Upon questioning two employees about multiple violations of the use of protective gear like gowns and face shields, state inspectors wrote in the report that the employees said they were “winging it.”
The full detailed report, called a survey, can be found here.
“Based on observation and resident and staff interview, the facility failed to have sufficient nursing staff, with the appropriate competencies and skills sets, to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident on one of two nursing units (West),” the report states.
The deficiencies reported by state inspectors — allowing staff to work while symptomatic, failures in standard use and storage of protective gear, failure to properly communicate with residents and families — are specific to the nursing facility’s East and West wings. At one point, all residents in the West wing were diagnosed as COVID-positive, the report states. The investigation ended Aug. 14.
A temporary management firm appointed by the Department of Health, Senior Health Care Solutions of Scranton, continues to oversee operations of the facility, according to Press Secretary Nate Wardle.
Potential sanctions against Milton Nursing, if any are approved, would take additional time to finalize, Wardle said. In 2018, the facility was fined $12,250 in 2018 for multiple violations including infection prevention and control.
Attempts to reach a representative of Milton Nursing’s corporate operator, Bedrock Care, were unsuccessful. An update on the facility's webpage state one resident has an active case of COVID-19, five staffers tested positive and are in quarantine, and 52 patients have recovered. No tests are currently pending, according to the online update.
According to the state, 59 staff members and 108 residents tested positive for the disease. Geisinger employees, National Guard members and other staff from the facility’s corporate operator, Bedrock Care of New York, were used to help fill gaps as staffers fell ill.
Inspectors found that four employees, including three nurse’s aides, worked at the nursing home while experiencing symptoms of COVID-19, the report states. Sore throat, fever, headache, body aches are among the symptoms the employees experienced. They continued to work while ill, as early as July 25 and as late as Aug. 9, the report shows.
They were tested in the initial days of August but according to the state report, the facility didn’t notify the Department of Health that employees were working while symptomatic until Aug. 7.
At the very least, guidelines from the Centers for Disease Control and Prevention (CDC) state that 10 days must pass before employees return to work whether they were symptomatic or tested positive for the disease but weren’t feeling physically ill.
Staffers converted the West unit into a Red isolation zone on Aug. 7. That’s the highest level of isolation. Staff are required to dress in full Personal Protective Equipment (PPE): gloves, isolation gowns, masks and face shields.
Inspectors walked through the facility Aug. 11 and found multiple violations of infection control practices, the report states. Isolation gowns were hung on resident doors, and an employee said she wasn’t sure if they were used or clean. There were no readily available masks or face shields, no signage that PPE was necessary, no instructions on the proper use of PPE, no proper storage containers for used materials and no hand sanitizer.
A sink area used by employees to wash hands was without paper towels and sanitizer. The lack of proper storage for used gowns, the inspection report notes, “allowed aerosolization of the gowns.”
The inspection found that little time elapsed between breakfast and lunch, with residents having trays for both in their rooms. Also, some residents weren’t being roused to get out of bed, the report found. In one case, a resident had to wait 44 minutes from the time they rang a bell for a nurse’s aide until the time she was helped to the bathroom, the report states.
The state inspection found that communication with residents, their representatives and families was insufficient. It noted specifically that a website updating information about the outbreak failed to initially include the count of staff infected with the disease; it only included residents. That’s since been corrected, the state report states, adding that additional measures were taken to improve communication. Employee screening forms were expanded to include additional symptoms, a virtual town hall was held and daily reports are given to management on the conditions of staff and residents.
Among the many corrective measures implemented, as per the report, was that COVID testing at the facility was occurring every four to five days beginning Aug. 18. An “appropriate” infection control and intervention plan was implemented with random audits of staff at least five times daily each shift. Family members are to be contacted directly upon request. Symptomatic staff didn’t return to work until cleared using the CDC guidelines. Staff members are given clear guidance on daily tasks and expectations. Five residents will be interviewed weekly to ensure they’re being properly cared for.
“Current facility staff have been brought back to work post their quarantine periods and provided a special training day by Nursing personnel,” the report states.
“The Infection Preventionist, Director of Nursing and other nursing leadership will conduct rounds throughout the facility to ensure staff is exercising appropriate use of infection control procedures and are being followed,” the report states.