Troubling Inspections At NC Long-Term Care Facilities With Major Outbreaks
Four North Carolina long-term care facilities with substantial outbreaks of the new coronavirus have a recent history of deficiencies in inspections, according to state records.
State health officials on Wednesday reported outbreaks of two or more cases in at least 20 long-term care facilities. Carolina Public Press asked the N.C. Department of Health and Human Services on Tuesday for a list of the names of facilities with outbreaks and the number of cases, but as of Thursday morning, DHHS has neither acknowledged nor complied with this request.
However, CPP has gathered information about four of the larger outbreaks of COVID-19, the disease caused by the new coronavirus, at long-term care facilities and in each case reviewed their recent reports.
Cherry Springs Village, an adult care home in Henderson County, has at least 23 confirmed cases of coronavirus infection, a spokesperson for the residence has acknowledged. Cherry Springs Village also received citations for multiple problems, including one in November 2019 for “failure to control vermin,” in this case bedbugs.
Pine Forest Rest Home, an adult care home in Northampton County, has at least 30 confirmed cases of COVID-19, a spokesperson for the Northampton County Health Department told CPP on Tuesday. Last year North Carolina inspectors cited the facility for multiple problems, including “failure to follow CDC guidelines to prevent infection.”
Pinehurst Healthcare and Rehabilitation Center, a nursing home in Moore County, has at least 30 confirmed cases, the county Health Department said Wednesday. Federal inspections over the last year show the facility has been cited for multiple problems with tracking patient care and handling CPAP breathing devices for patients with severe respiratory problems.
PruittHealth-Carolina Point, a nursing home in Orange County, has more than 60 confirmed cases of coronavirus in staff and residents, county Health Department officials confirmed Wednesday. Recent inspection records describe a series of problems at the facility, including failure to report a sexual abuse allegation to law enforcement.
Inspections of long-term care homes
The N.C. Department of Health and Human Services, through its Division of Health Services Regulation, oversees licensing of several types of long-term care facilities. Although many of these facilities cater to an elderly population, they may also house adults of any age, such as those with mental health issues or cognitive disabilities.
The licensing categories that North Carolina uses include “nursing homes” and “adult care homes.” Generally, adult care homes are inspected by state and county agencies. They receive a rating on a four-star scale, but the formulaic system does not always reflect recent or shocking violations.
Nursing homes, which are authorized to provide medical care, face federal inspection guidelines if they receive funding through Medicaid or Medicare. Although the state doesn’t assign star ratings to nursing homes, the federal website medicare.gov evaluates them based on inspection reports.
In these four cases, the state had licensed PruittHealth for 138 nursing home beds, Pinehurst Healthcare for 144 nursing home beds, Pine Forest for 24 adult care home beds and Cherry Springs for 60 adult care home beds.
CPP conducted a major investigation into the state’s oversight of adult care homes in 2017, raising questions about inconsistencies and effectiveness, as well as drawing attention to the state’s lack of full compliance with a related federal settlement.
Cherry Springs Village
As of Sunday, 23 confirmed cases of COVID-19 were identified in residents and staff at Cherry Springs Village in Hendersonville, according to a statement the Henderson County Health Department.
“Those individuals are being treated in isolation by health professionals, and the community is under quarantine until further notice,” James Harvey, a spokesperson for Cherry Springs Village, said in a statement Sunday.
Harvey emphasized the facility’s adherence to strict health guidelines from the state and the Centers for Disease Control and Prevention to prevent infections.
Asked by CPP about the facility’s recent history of deficient inspections, Harvey responded in an email, “We immediately corrected these deficiencies.” He added that those points were irrelevant to the new infection control measure the facility put in place in February.
“Cherry Springs Village continues to follow strict infection control protocols, including the use of personal protective equipment when providing care, wearing masks at all times and changing clothes and following decontamination procedures each time they enter or exit the building.”
The facility issued a press release with a posed image of staff members, announcing them as “heroes,” on Wednesday.
Asked by CPP whether this might be perceived as a cynical marketing move during the crisis, Harvey responded that the company wasn’t doing any marketing currently.
“Right now, we have genuinely heroic staff in our communities all over the state of North Carolina trying to prevent COVID-19 from spreading,” he said. “They are saving people’s lives at the risk of their own.”
An inspection at Cherry Springs Village in November 2019 came in response to a complaint about bedbugs. The surveyor who completed the inspection wrote that the facility was out of compliance with sanitation rules requiring “effective measures” to keep out vermin.
“Interview with the administrator revealed a current bedbug problem has been ongoing since October of 2018,” the surveyor wrote on Nov. 22. Records indicated multiple rooms had been treated on at least two occasions for bedbugs, but the surveyor observed live bedbugs. The facility agreed to pest control treatment in additional rooms, plus ongoing treatment.
The report also found that the facility was not effectively cleaning rooms, which was interfering with resolving the infestation. The surveyors described the observation of 15 dead bedbugs that had not been cleaned up in one room.
An annual inspection in September cited the facility for multiple issues with cleanliness and food storage and labeling. Among other issues, an ice machine that had built up a black residue wasn’t being cleaned because different staff members thought it was someone else’s responsibility.
North Carolina rates Cherry Springs Village with 3 out of 4 stars, which has been consistent since 2016 despite the deficiencies cited in inspection reports.
Cherry Springs Village is owned by Hickory-based Affinity Living Group, a for-profit operator of long-term care facilities in eight states.
Pine Forest Rest Home
At least 30 cases of COVID-19 have been linked to Pine Forest Rest Home in Potecasi, according to Northampton County health officials.
James Glascock, 65, a Pine Forest resident admitted to a nearby Virginia hospital in late March, tested positive for the illness and later died from related complications, according to a report from WRAL.
His family said he was new to Pine Forest and had been there just over a week when he was admitted to Southampton Memorial Hospital in Franklin, Va.
A statement from county Health Director Andy Smith issued March 28 said all patients and residents at the facility had been tested “out of an abundance of caution.” At that time, he described the additional cases as asymptomatic.
“The Health Department’s investigation into the matter remains ongoing, but Mr. Smith confirms the overwhelming majority of these cases have had good outcomes,” a county spokesperson said Tuesday in response to questions from CPP.
An annual inspection in September found multiple issues at Pine Forest Rest Home, including failure to implement an “infection control policy consistent with Centers for Disease Control and Prevention guidelines to be followed, with staff was exposed to bodily fluids of a resident that posed significant risk of transmission of pathogens.”
According to the report, special procedures were put in place for a resident with a severe colon infection but were not consistently followed.
A housekeeper told inspectors that she was advised to wear personal protective equipment when entering the resident’s room but had not been given any protocol about what do to when she entered the room and found “urine and feces all over the room when he first arrived.”
Although she used water and bleach, she had no guidance about the proper proportions to disinfect the room.
Other personnel apparently did not consistently handle soiled items from the resident’s room with sufficient care to prevent contamination, according to the report.
Separately, the same report found that food at the facility was being stored improperly and without proper labeling. It also found that nutritional requirements, including those of residents with special dietary needs, were not being met consistently.
Following this inspection, Pine Forest Rest Home’s state rating dropped to two stars in early 2020, after having been rated at four stars since 2012.
Pine Forest is registered with the state of North Carolina as an independent nonprofit company.
Pinehurst Healthcare and Rehabilitation
The Moore County Health Department worked with FirstHealth Regional Hospital early this week to have all residents and employees at Pinehurst Healthcare & Rehabilitation center tested for COVID-19 by Tuesday after an initial positive test was linked to the facility over the weekend, according to a statement Wednesday from the Health Department.
Of 96 current residents, 26 tested positive, as did five of 115 staff members. However, some results have not yet been received, according to health officials, who said there were no severe cases so far and those with confirmed cases have been isolated.
“To date, Pinehurst Healthcare & Rehabilitation Center has consistently followed all local and state directives meant to curb the spread of the virus, including restricting visitation of all visitors and nonessential health care personnel as well as strictly adhere to infection prevention practices,” the Health Department statement said.
Pinehurst Healthcare and Rehabilitation is rated much below average, according to the federal website medicare.gov.
A state recertification inspection conducted in January found a long list of problems with accurately recording and maintaining the status of multiple patients under the mandated federal minimum data set guidelines, or MDS.
In some cases, patients did not receive required care, such as regular blood screening for a diabetic patient receiving insulin.
The report also cited the Moore County nursing home for not clearly dating medication and failing to dispose of expired medication.
An earlier inspection report last July, in response to a complaint, found problems with the facility’s handling of CPAP devices to help patients breathe, including questions about whether they were being cleaned properly.
Pinehurst Healthcare and Rehabilitation is part of the for-profit Yadkinville-based Triad Group, which operates 25 long-term care companies.
Orange County health officials said strike teams from UNC Hospitals, Duke Hospitals and Orange County Emergency Services are focusing on prevention and response at the county’s long-term care facilities and had tested all staff and residents at PruittHealth-Carolina Point even if they had no symptoms.
Seven residents of PruittHealth have been taken to Duke University Hospital, according to Kristin Prelipp, a spokesperson for the Orange County Health Department.
PruittHealth-Carolina Point, which has a Durham address but is located in Orange County, is rated much below average, according to medicare.gov.
The state conducted a complaint investigation at the facility in February and found that officials failed to tell law enforcement about the alleged sexual abuse of a resident by staff.
A state complaint investigation in January found that the facility failed to notify a patient’s doctor when the patient refused to accept medication.
Georgia-based PruittHealth is a for-profit corporation operating more than 90 long-term health care facilities throughout the Southeast.
Editor’s note: CPP lead investigative reporter Kate Martin also contributed to this report
North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.