State Inspectors Likely Stumbled Early When COVID-19 Virus Initially Hit Nursing Homes
From LA Times

LOS ANGELES – In early April, state inspectors completed a survey of Magnolia Rehabilitation and Nursing Center in Riverside as part of a federal effort to make sure nursing homes were protecting elderly residents from the coronavirus.

 
Their one-page report concluded: “No deficiencies.”
 
The next day, April 8, a fleet of ambulances lined up outside Magnolia to evacuate all 83 residents after the staff refused to show up for work, terrified of the deadly infection already spreading within the facility.
 
Similar scenarios played out across California this spring, survey records show. Time and again, inspectors sent to assess nursing homes’ ability to contain the new virus found no deficiencies at facilities that were in the midst of deadly outbreaks or about to endure one.
 
At Hollywood Premier Healthcare in Los Angeles, inspectors found the facility to be in compliance on March 30. Three days later, the home had 68 confirmed cases, county records show. Later that month, the National Guard was deployed to assist the overwhelmed facility.
 
State officials conducted five surveys this spring at Kingston Healthcare Center in Bakersfield, which is on a federal shortlist of the worst nursing homes in the country. Each time, the surveyors found the home in compliance with infection control protocols, even as the virus would eventually spread to 158 residents and staff, killing 21.
 
A Times review of inspection records found that, as of mid-June, California Department of Public Health inspectors had carried out more than 1,700 “COVID Focused Surveys” at skilled nursing facilities since late March and had issued just 14 infection control citations as a result of those visits.
 
Nursing homes have become hotbeds of coronavirus deaths in California, accounting for 43% of all fatalities across the state. The failure of the inspections to identify problems is just the latest indication of how the industry and regulators were unprepared for the coronavirus and failed to act quickly to slow its spread. Nursing homes lacked basic supplies when COVID-19 began sweeping through the facilities. And even after the tragic scope of the crisis became obvious, regulators failed to require universal testing of residents and staff.
 
A California health department spokeswoman said inspectors were instructed to focus on providing support to the beleaguered facilities rather than enforcement. At the same time, she said, many homes struggling with the pandemic were still technically in compliance with infection control rules for skilled nursing facilities, but those rules were woefully inadequate for battling the highly contagious new virus.
 
Relatives of residents at several homes told The Times that they witnessed obvious failures by staff members to contain the virus. And elder-care advocates said the lack of enforcement shows that state regulators abdicated their primary responsibility to police nursing homes at a critical moment.
 
“These weren’t real inspections; they were more like courtesy call visits. At a time when residents desperately needed the California Department of Public Health to help protect their lives, it tolerated infection control violations that have proven so deadly,” said Patricia L. McGinnis, executive director of California Advocates for Nursing Home Reform.
 
“Why even have nursing home inspectors if they are not going to enforce life-threatening infection control violations in the midst of a pandemic?” McGinnis asked.
 
Like most states, California’s nursing home population has suffered a heavy toll due to the pandemic. As of Tuesday, 2,441 employees and residents of the state’s skilled nursing facilities had died of COVID-19, state data show. That does not include staff and elderly residents at assisted living centers, which are not regulated by the health department and have also been hard hit.
 
The COVID Focused Surveys were designed by the federal Centers for Medicare & Medicaid Services but carried out by state and local health departments.
 
Inspectors were instructed to put almost everything else aside and concentrate on ensuring that the homes were prepared to face the pandemic. The goal was to prevent the virus from entering facilities, if possible. When not, regulators hoped to contain it with rigorous adherence to testing, quarantining, use of protective gear and hand-washing.
 
“Focusing only on enforcement in the rapidly changing environment of the early pandemic response would not have been beneficial to the vulnerable nursing home residents we work every day to serve,” Kate Folmar, a spokeswoman for California Health and Human Services, said in a statement. “We needed to find solutions to save as many lives as we could, and to limit the spread of COVID-19 among this very vulnerable population.”
 
In an announcement earlier this month, federal CMS administrators said more than 5,700 COVID Focused Surveys — roughly a quarter of them in California — were completed nationwide. They described the program as “part of the Trump Administration’s historic transparency efforts to ensure residents, families and the general public have information about COVID-19 in nursing homes.”
 
But the Center for Medicare Advocacy, a nonprofit patient activist group in Washington, D.C., noted that only 163 of the surveys — less than 3% — had cited any problems with infection control.
 
With tens of thousands of nursing home residents and staff already dead from the virus, “it is simply not plausible that facilities have no problems in their infection prevention and control practices,” said Toby Edelman, the center’s senior policy attorney.
 
In a call with reporters on June 4, President Trump’s CMS administrator, Seema Verma, essentially blamed nursing home employees for outbreaks at homes that had been given a clean bill of health, suggesting that some stopped following infection control protocols once inspectors were gone.
 
“When the inspector leaves the nursing home, things can change,” Verma said. “There’s some staff that may not be washing their hands at the frequency that we suggest, or in the situations that we suggest. There could be some lax practices around isolating patients.”
 
The California health department spokeswoman defended her agency’s April 7 inspection of Magnolia Rehabilitation, saying it confirmed the facility had “infection protocols in place.”
 
“When staffing levels dramatically fell, the situation at Magnolia rapidly changed,” Folmar said in her statement, referring to the work stoppage the day after.
 
But some staff had refused to show up for work on the day the inspectors were in the facility, and Riverside County health officials were already aware of at least two Magnolia employees testing positive in the days leading up to the inspection.
 
When the staff abandoned the facility the day after the inspection was completed, Riverside County health officials scrambled to evacuate all of the residents.
 
Dan Erwig was shocked to hear that inspectors had found no problems with infection control measures at Magnolia, where his 85-year-old dad, Bernie, resided for about two weeks before the mass evacuation.
 
“What kind of deficiencies were they looking for?” Erwig asked. “This nursing home was a joke.”
 
Magnolia’s administrators did not respond to calls for comment.
 
Erwig’s father had been transferred from a local hospital to Magnolia in late March for rehab. At that point, Erwig and his family were unaware of any COVID-19 cases at the home. Soon after, his dad’s doctor stopped entering the facility, informing the family that employees were not wearing masks or other protective equipment.
 
“He was concerned about the conditions,” Erwig said.