By Kelly Puente, Long Beach Post, May 16 2020
Eight nursing homes with the most coronavirus cases in Long Beach have been hit with a high number of health violations during the past two years for problems ranging from staff members failing to wash their hands to failing to properly monitor a resident who later died, a Post analysis has found.
The facilities, which the city has named as having at least two coronavirus cases, have fared poorly on a key measure of the federal government’s five-star ratings system for skilled nursing facilities.
While some of the eight Long Beach facilities have an average three-star rating for overall care, all scored two stars or less for health inspections, according to the federal Nursing Home Compare website. Experts say these kinds of problems can lay the groundwork for infectious disease outbreaks among a highly vulnerable population.
Long Beach’s nursing homes have represented a particularly difficult challenge for the city’s health officials. Of Long Beach’s 51 coronavirus deaths, 40 of them are linked to long-term care facilities—a percentage much higher than in other jurisdictions, including Los Angeles. As of Thursday, 333 coronavirus cases have been reported in 22 of the city’s long-term care facilities.
Among the violations uncovered by federal inspectors at the Long Beach facilities: Staff in one facility left clean oxygen masks sitting next to a stuffed animal, a plastic bag of clothes and a black purse, increasing the chances of contamination. In another facility, staff left catheter tubing and a drainage bag on the floor. Staff in another location were cited for not properly washing residents and not bagging dirty laundry before passing it down the laundry chute.
These types of health citations are not uncommon for most skilled nursing facilities in California, and even the most highly-rated facilities can receive citations for infection control without reporting COVID-19 cases. But as nursing homes have become epicenters for coronavirus, their inspection records can provide a glimpse into problems that experts say can lead to mass outbreaks.
In California, more than 180 of the state’s 1,225 nursing homes have reported coronavirus deaths, with some of the deadliest outbreaks located in Los Angeles and San Bernardino counties, according to the California Department of Public Health.
California overall has higher numbers of federal health violations for its nursing homes, with an average of about 13 per facility, compared to eight nationwide.
Michael Connors, a spokesman for California Advocates for Nursing Home Reform, has accused state officials of failing to hold long-term care facilities accountable to the industry’s highest standards.
“California has hundreds of lowly-rated, poorly staffed nursing homes that routinely neglect their residents,” he said. “It’s no surprise that these facilities are experiencing outbreaks because they are dangerous places to live during the best of times. Far too little is being done now to monitor substandard nursing homes and to ensure the safety of their residents.”
In Long Beach, Broadway by the Sea, a 95-bed center located in the dense Bluff Heights neighborhood, has the city’s highest number of coronavirus cases, with 31 staff and 56 residents infected. The facility has also experienced the highest number of deaths—11 as of Thursday.
Broadway by the Sea was the only one of the top eight facilities with coronavirus infections to have two citations last year for infection control deficiencies—one for a registered nurse who didn’t wash her hands before giving intravenous medication and another for failing to report a suspected scabies outbreak.
In addition to violations issued by federal inspectors, many of the facilities on the city’s list also have a higher-than-average number of violations under state requirements.
In March, Broadway by the Sea was issued a serious “Class A” citation and fined $20,000 after a resident fell from her bed and died from her injuries. The state found that the facility failed to ensure the resident was turned and repositioned in bed by two staff members to prevent falls.
Records show the state issued four enforcement actions to Broadway last year for patient care violations. The state average is less than one per facility each year.
Broadway by the Sea in a statement said it has a “long and positive history of collaboration with Long Beach Public Health and the California Department of Public Health. When our facility was cited we worked diligently to issue plans of correction, provide additional training, and complete refinements to our service prior to deadline.”
Another Long Beach facility with higher-than-average state and federal violations, Long Beach Healthcare Center, was cited for six state violations last year and nine in 2018.
The Wrigley-area facility, which appears on a federal watch list of the nation’s worst nursing homes, has reported six deaths and 37 positive COVID-19 cases among residents and staff as of Thursday.
Last year, Long Beach Healthcare was issued a rare “AA” citation—the state’s most serious violation—when a resident was rushed to the hospital with an abdomen so distended from constipation that it looked as if she had “three soccer balls inside of her stomach,” according to state records.
The woman later died from pneumonia and severe sepsis from a urinary tract infection. A state investigation found that the staff made several critical errors, including failing to report that she had not had bowel movement for seven days.
An administrator for Long Beach Healthcare could not be reached for comment.
Dr. Mehrdad Ayati, a geriatrician who teaches at Stanford University’s School of Medicine, said skilled nursing facilities nationwide have long struggled to provide quality care but that their staffs are often overworked and underpaid.
Ayati said many facilities may have one employee assigned to 20 residents a day, leading to problems with care and infections.
“These are very vulnerable environments,” he said. “They’re the perfect place for bacteria and viruses to spread.”
Ayati said coronavirus has exposed deep problems in the nation’s skilled nursing system that can only be fixed with better oversight and better pay and staffing ratios.
“COVID is showing us what’s the reality in many of these facilities and I think now is the time we learn from it and move forward with changes,” he said.
But for now, Ayati said he’s concerned about another possible wave of infections this fall. To slow the number of deaths, he said, the state should make nursing homes its top focus with mass testing.
California has ramped up coronavirus testing of the general population, but the state is still about two weeks away from mandatory testing in nursing homes, according to CalMatters.
In Long Beach, which has its own health department, health officials last month began mass testing in nursing homes for those with and without symptoms.