RegalCare Cited For Deficient Covid Control

State health inspectors found that a Fair Haven Heights nursing home hard hit by Covid-19 had an inadequate supply of protective gowns, an incomplete system of screening temperatures and oxygen levels, and an overall deficient infection control program to protect residents, visitors, and staff.

The state Department of Public Health (DPH) published that report Wednesday following unannounced inspections on May 1 and May 2 at RegalCare New Haven, a three-story, 150-bed short-term rehab and long-term nursing home located at 181 Clifton St. in the Heights.

Gov. Ned Lamont said in an email press release Wednesday that DPH posted the ​“findings of deficiency” report online after conducting infection control surveys at all 213 nursing homes in Connecticut in partnership with the Connecticut National Guard and the federal Centers for Disease Control and Prevention.

Staff and visitors to RegalCare had spoken up anonymously in April with concerns about high rates of infection, insufficient supplies of personal protective equipment, and improper responses from management.

The new DPH report, which can be read in full here, bears out some of those concerns, at least as of the state’s inspections at the beginning of May.

“Based on observations, review of facility documentation, and interviews, the facility failed to provide staff working on the COVID-19 designated area with an adequate number of gowns, failed to ensure the gowns maintained protection, failed to utilized [sic] gowns and the facility failed to maintain active surveillance to prevent the spread of infection amongst visitors and healthcare personal [sic] in accordance with the facilities infection prevention program for COVID-19 and the recommendations of the Center of Disease control(CDC) during a pandemic to ensure staff and residents were protected from the transmission of infection,” the report reads.

The six-page report also describes a corrective plan of action that RegalCare had agreed to implement starting May 20. That plan included such ​“systemic changes” as re-educating staff on the appropriate use of PPE and on not reporting to the Covid-19 unit of the nursing home until they’ve completed a surveillance questionnaire and had their temperature and oxygen levels taken.

The report states that nursing home’s administrators obtained additional gowns on May 1. It also states that ​“there were no residents identified to be affected” by any of the deficient practices, though ​“all residents have the potential to be affected” by said practices.

According to a May 18 report by city Health Director Maritza Bond, RegalCare has 20 Covid-19 positive staff, 50 Covid-19 positive patients, and five coronavirus-related deaths.

“The guidelines from DPH and the CDC to our industry have been fluid and constantly being changed and revised so our plan to protect our staff and residents has been that as well, always with the intention to keep everyone safe,” RegalCare spokesperson Ami Dagan told the Independent Thursday afternoon in an email statement.

“Since the initial deficiency findings, the team at RegalCare at New Haven have been continuously educating the staff on the appropriate usage of PPE. Competencies and weekly audits are being done to ensure accuracy of the implemented Plan of Correction that was submitted successfully.

“Between the LTC-MAP, DPH and our own sources, we have an ample amount of PPE for our entire staff and reuse is only occurring within CDC guidelines.”

CTMirror reported that, at the 26 nursing homes that DPH has identified so far as having had infection control problems weeks into the pandemic, 313 elderly residents with the virus have died and 1,100 residents been infected. DPH spokesperson Av Harris told the Mirror that problems in some of the state’s 187 other nursing homes should be released soon. Click here to read all of DPH’s recently published reports, as collected by the Mirror. Click here for the DPH nursing homes inspection documents database.

Day 1: Short On Gowns

The report states that the purpose of the May 1 and May 2 inspections at RegalCare were to determine if the nursing home was in compliance with state infection control mandates. The relevant section of state law reads, ​“The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.”

That program must include ​“a system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility,” as well as when and to whom such incidents should be reported, standard precautions to take to prevent further spread, and a system for recording said incidents once identified. It must also include protocols around the handling, storage, and transporting of linens so as to prevent the spread of infection.

The investors found that these requirements were not met at RegalCare.

On a May 1 tour of RegalCare’s supply storage areas with the facility’s director of nursing, inspectors found a total of 24 washable gowns available.

A subsequent tour of the third floor designated area for residents with Covid-19 identified seven rooms with 18 positive Covid-19 residents. That unit was staffed by five nursing aides and two licensed practical nurses (LPN).

One LPN told inspectors that she was provided with one washable gown at the start of a shift on the Covid-19 unit, and that she would wear that single gown for the entirety of a shift caring for Covid-19 positive residents.

That nurse indicated ​“that was a short supply” of gowns in the facility. Another registered nurse also said that the facility was ​“short on personal protective equipment.”

“RN #1 identified a single gown was used all shift by each staff, and because of being washed the gowns were falling apart, and the ties were broken.”

Administrators confirmed for the inspectors that each staff member wore one washable gown per shift, and said the gowns were laundered at the end of each shift.

“The Administrator identified she thought there were more gowns available. The DON and Administrator were unable to provide documentation of the CDC recommendations on the use of gowns when caring for positive COVID-19 residents.”

Day 2: Where’s The Thermometer?

On May 2, the survey team came back to the facility to inspect RegalCare’s infection surveillance program.

The day got off to a bit of a rocky start.

“The survey team entered the facility on 5/2/20 at 11:25 AM, it was identified the front desk receptionist was unable to find the thermometer
for the temperature screening process prior to entering the facilities work area.”

A nurse from the second floor brought a no contact thermometer down to the front desk. She said she had been checking staff temperatures on the unit after they had filled out a surveillance questionnaire in a conference room before entering the work area.

“RN #1 was unable to identify why the facility staff members had not had their temperatures checked prior to entering the work area.”

The site’s infection prevention nurse, RN#3, told the inspectors that all facility staff members have to have a temperature screening and fill out a surveillance questionnaire before entering the work area.

“RN #3 identified staff members had been having temperature screenings prior to entering the work area and was unable to identify why the process had not been conducted today.”

The site’s administrator told the inspectors that staff and visitors should have had their temperature taken and should have completed a questionnaire prior to entering the nursing unit.

“Review of facility documentation identified that 10 facility employees did not have temperature screenings documented on 5/2/20. Subsequent to surveyor inquiry, facility employees had temperature screenings and were provided in-service education on the temperature screening process.

“Review of facility policy for Active Surveillance for Respiratory Infection among resident and healthcare personal, directed in part, that a temperature screening and surveillance questionnaire would be completed upon arrival to facility and prior to entering a work area.”

RegalCare Spirit Day

On Friday afternoon, RegalCare spokesperson Ami Dagan told the Independent that the Heights nursing home celebrated ​“RegalCare Spirit Day” to honor its staff during these trying times.

“With the high numbers we’ve had and all the difficulties we’ve gone through, we have been doing our best to keep our staff happy, healthy and strong,” he wrote in an email. ​“They certainly have been working very hard.

“Today we celebrated RegalCare Spirit Day and I really wanted to share this photo with you. Throughout the trials, worry and uncertainties our staff has faced, they are indeed proud, strong and inspired.”