Reprinted with permission by the Times Union
VALATIE – Three Capital Region nursing homes have been fined by the state Department of Health for infection control and other lapses during the coronavirus pandemic, state health records show.
The Grand Rehabilitation and Nursing at Barnwell in Columbia County received one of the largest fines statewide at $22,000 for multiple violations that had “potential to cause more than minimal harm,” according to inspection reports. Violations centered around inadequate or improper use of personal protective equipment, failure to clean hands, improper groupings of suspected Covid-19 patients, and failure to notify residents of positive cases or deaths.
The state Department of Health has conducted 1,908 on-site inspections (1,165 at nursing homes and 743 at adult care facilities) since the pandemic’s March arrival in New York to ensure facilities are following proper infection prevention and control protocol, spokeswoman Jill Montag said. It has issued 95 citations to 77 nursing homes and levied $328,000 in fines against 23 facilities as a result.
“This only represents a portion of the total number of cases for which we are actively pursuing fines,” Montag said. “The department will continue to hold providers who violate regulations accountable for their actions.”
State health inspectors cited the Barnwell nursing home, a 236-bed facility located in the village of Valatie, for a number of regulatory violations that were allegedly observed during two visits in May, inspection reports show.
On a May 11 visit, inspectors said they observed at least four different members of staff violate PPE and hand hygiene protocols.
In one instance, a resident assistant was seen moving between resident rooms, including several marked with signs to indicate a Covid-19 patient inside, without changing PPE, despite being within six feet of the residents.
Inspectors said they observed another resident assistant deliver meal trays to a Covid-positive room, then a Covid-negative room — all without donning fresh PPE or washing their hands in between. A certified nurse aide did the same thing when passing lunch trays, inspectors wrote.
An activities aide, meanwhile, was observed moving from a Covid-positive room to a Covid-negative room and speaking within six feet of a resident who was not wearing a mask. They then moved to a Covid-positive room, sat on the resident’s bed and read to the resident, who was seated in a wheelchair less than six feet away not wearing a mask. The aide wore a gown and face mask, but no gloves, and did not change PPE or wash their hands in between visits, inspectors wrote.
A number of staff who were interviewed afterward said they either couldn’t recall what they learned during infection control and PPE trainings or weren’t sure what to do because they had been given differing instructions over the past weeks. The CNA said she was told she didn’t need to change PPE when passing meal trays, and a licensed practical nurse said she always wore the same PPE throughout a shift unless performing a treatment on a resident.
On a separate visit May 20, inspectors said they observed residents with Covid-19 symptoms staying in the same rooms as residents who had tested negative for the disease. Neither of the rooms were marked with signage alerting staff they must wear PPE, the report says.
A regional administrator for the home and two nursing directors told inspectors residents were supposed to be grouped together by Covid status — positive, negative and unknown/suspected.
On the same visit, inspectors said they observed a licensed practical nurse place fail to disinfect a glucometer after using it on a resident and before placing it on a medication cart.
Barnwell was additionally cited for violating Gov. Cuomo’s executive order requiring 24-hour notification to residents and family members every time a new Covid-19 case was discovered. Two residents who were interviewed said they were never given written or verbal notification of positive cases, but instead learned of them whenever a PPE sign went up next to a resident’s door.
At least 174 cases of coronavirus have been linked to the Barnwell nursing home, which has come under intense scrutiny for its handling of the outbreak. ProPublica reported in August that county officials believed the home was pushing dying residents into hospitals so that their deaths would not be attributed to the facility. New York only counts as nursing home deaths those that actually occur inside a senior facility, and has to date refused to reveal how many nursing home residents died after being transferred to a hospital.
A spokesperson for the Barnwell nursing home did not respond to a Times Union request seeking comment for this story.
Inspection reports show the state health department approved plans in late spring designed to correct issues uncovered by the inspections.
As part of those plans, the facility said it would immediately educate staff on correct protocol and ensure they demonstrate proper PPE usage. The facility’s infection control nurse would also audit 10 random staff members from each department on the use of PPE and hand washing. Anyone who failed would be required to pass a competency test.
The facility also agreed to immediately move suspected Covid-19 patients to their own rooms, place signage on their doors, and educate staff with respect to the proper grouping, or cohorting, of patents. The infection control nurse would conduct random room audits to ensure cohorting was taking place.
Similarly, staff would be educated and audited on the procedures for when to disinfect equipment.
The facility also agreed to have social workers notify residents and family members of positive cases within the facility. It also agreed to implement a tracking system for such notification.