IMPERIAL COUNTY, Calif. — Before they battled major coronavirus outbreaks, Imperial County’s nursing homes had track records riddled with infection control issues, inadequate staffing and low facility ratings.
Some violations were more dire: In 2016, staff at Imperial Heights Healthcare and Wellness Centre in Brawley waited 12 hours to inform a hospital that one of its transported residents may have ingested hand sanitizer.
The 82-year-old woman died of acute ethanol intoxication. The facility was fined $6,000.
Now, as COVID-19 sweeps across the U.S. and devastates nursing homes, studies are finding correlations between the severity of facilities’ outbreaks and their quality of care.
A September report found the majority of California’s 25 worst nursing home outbreaks occurred at facilities with poor inspection records.
“We found that their average federal star rating was lower. We found that they had more infection control violations. We found that they had less staffing, particularly less registered nurse staffing,” said Anthony Chicotel, an attorney with the San Francisco-based California Advocates for Nursing Home Reform.
“So, yeah, we’re less surprised that bad facilities have had worse COVID-19 outbreaks,” Chicotel said.
More than 200,000 people in the U.S. have died from the virus. In California’s nursing homes, it’s killed more than 4,400 residents and roughly 150 employees.
The three skilled nursing facilities in Imperial County, a region that quickly became a hotspot during the pandemic, were no exception.
As of late September, residents and health care workers at the nursing homes are linked to 214 cases and at least 26 deaths, with the state’s most recent public health data reporting two of the homes still with active cases.
None of the facilities, which are all operated by for-profit businesses, responded to inquiries from inewsource.
Infection control, low staffing among citations
The number of citations at some of the county’s nursing homes had already surpassed state and federal averages when COVID-19 began to spread.
Many citations were minor and considered to have carried minimal potential harm at the facility. But some came with financial penalties — and severe consequences for residents.
Last year, Valley Convalescent Center in El Centro was ordered to pay $2,000 after a 96-year-old resident fell near her bed and broke bones in her leg. The injuries resulted in an amputation below the knee.
An inspection later found staff didn’t follow the woman’s care plan and failed to provide mats on both sides of her bed to help prevent injuries.
Valley Convalescent, a two-star facility under the federal government’s quality rating system, was hit with 19 citations in its health inspection last year. The statewide average is about 13 — compared to eight nationwide.
Imperial Heights also was fined $2,000 after officials concluded two employees last year failed to report a resident’s allegation of abuse to management. The three-star facility received 22 citations in its last health inspection.
The county’s third nursing home, Imperial Manor, doesn’t yet have a federal star rating. Its most recent health inspection, conducted in March 2019, found 11 deficiencies.
Each facility has been cited in the past 18 months for infection-control rules:
In September 2019, inspectors at Valley Convalescent found oral hygiene products in a shared restroom were unlabeled, and the facility didn’t follow its own hand hygiene policy.
Imperial Heights didn’t use a hamper to handle soiled laundry and bed linens, and a staff member didn’t use gloves when removing trash, according to a December report.
Imperial Manor was cited in March 2019 after a federal inspector observed “a soiled incontinence brief” lying in the middle of a resident’s unmade bed. It should have been disposed of immediately to prevent cross-contamination, the report said.
Infection prevention is the most common citation for nursing homes. A Kaiser Health News analysis in March found that 63% of skilled nursing facilities, including those with top ratings, have been cited for deficiencies in recent years.
Infections are common in nursing homes: The Centers for Disease Control and Prevention reports 1 million to 3 million serious infections occur annually in long-term care facilities.
“Prior to COVID-19, we would see a couple of infection control deficiencies and say, ‘Well, everyone gets those, not a big deal.’ Even though we know that it is a big deal,” said Chicotel with the nonprofit that advocates for nursing home reform. “And there’s lots of statistics that say even pre-COVID-19, there were a lot of preventable deaths from infectious disease in nursing homes that we were just willing to accept.”
He expects the pandemic will bring more stringent penalties for infection-control issues.
Hit hard by virus
Already suffering from high poverty, poor health indicators and high unemployment, Imperial County has had one of the highest hospitalization rates in the state for COVID-19. Its hospital system became so overwhelmed that officials were forced to divert patients elsewhere in May.
Each nursing home has reported cases among residents and employees. Seventeen residents at Valley Convalescent and nine at Imperial Heights have died.
One of the county’s assisted living facilities, Blossom Valley Inn in Holtville, also has reported fewer than 11 COVID-19 deaths. The actual number is not public because the state doesn’t provide exact numbers if a facility has fewer than 11 cases.
Imperial Manor has yet to comply with a federal requirement to submit coronavirus numbers, but state data shows it has reported zero deaths.
Dr. Stephen Munday, the county’s health officer, said during a June news conference that officials saw earlier outbreaks at nursing homes elsewhere and began to target the local nursing homes for intervention.
The county provided personal protective equipment, made appointments a priority for nursing home staff at public testing sites and processed some of the facilities’ tests in its own lab. Officials are continuing to conduct site visits as needed and are regularly in contact with the homes for any updates.
Each of the county’s nursing homes submitted mitigation plans to the state, and the facilities were found in recent state surveys to be in compliance with infection control regulations and federal COVID-19 recommendations. The county’s request in August to the state to reopen some businesses said the nursing homes had adequate supplies of personal protective equipment.
Chicotel said the pandemic has reinforced many concerns that his nonprofit already had.
“In the best of times, nursing homes don’t do particularly well,” he said. “But with COVID-19, the burden of that really exposed these weaknesses in the system and preyed on it so that we had this huge number of deaths in them.”
inewsource investigative data reporter Jill Castellano contributed to this story.
inewsource is a nonprofit, independently funded newsroom that produces impactful investigative and accountability journalism in San Diego County. Learn more at inewsource.org.