A Washington state nursing home tied to at least 37 COVID-19 deaths faces a fine of more than $611,000, federal inspectors said, and could also lose Medicare and Medicaid funding if it does not correct a slew of deficiencies that led to the country’s first major outbreak of the novel coronavirus.
In a letter Wednesday to Life Care Center of Kirkland, the Centers for Medicare and Medicaid Services (CMS) wrote that the nursing home failed to report an outbreak of respiratory illness to local authorities for two weeks as required by law, gave inadequate care to its residents during the outbreak and failed to provide 24-hour emergency doctor services.
The inspectors said that if the nursing home northeast of Seattle “does not correct all deficiencies and return to full compliance by September 16, 2020, then CMS will terminate your facility from participating in the Medicare/Medicaid program.”
Life Care did not immediately respond to a request for comment on the inspection findings and the penalties, which it has a right to appeal.
Inspectors levied a per-day civil penalty of $13,585 for the alleged deficiencies, dating to Feb. 12, around the time that the outbreak is thought to have taken hold, and continuing through March 27. They said the fine could be raised, or lowered, depending on the facility’s compliance with its correction plan.
In addition to losing its federal payments under the Medicare and Medicaid programs, the facility also could lose its Nurse Aide Training and Competency Evaluation Program and forfeit federal payment for the patients it admitted from March 21 to March 27.
“These remedies will continue in effect until the effective date of the termination of your Medicare provider agreement, or the facility is found back in substantial compliance,” said Patrick Thrift, branch manager for CMS’s long-term-care survey and enforcement division in Seattle.
Officials said that 129 residents, staff and visitors were infected with the coronavirus, which causes mild to moderate symptoms in most people but can prove fatal to the sick and elderly. Thirty-seven people associated with Life Care had died as of March 23, according to Seattle’s King County.
In a summary of its findings issued last month, CMS said inspectors had found that Life Care failed to swiftly notify regional authorities that it had a surge in respiratory infections, and continued to admit new patients and hold events such as a Mardi Gras party for dozens of residents and guests.
The Washington Post found that Life Care did not file a report with authorities for more than two weeks after it began discouraging visitors on Feb. 10 because of the illness among residents, which it assumed to be seasonal influenza.
King County said it received notification of an increase in respiratory illnesses at the nursing home late on Feb. 27. Life Care has said it also left a voice message with county officials the day before.
State law and county regulations required Life Care to report any suspected flu outbreak within 24 hours.
Federal records requested by The Post contained new details of the pandemonium as the virus descended on Life Care. The facility had failed to follow basic protocols required to prevent infection, inspectors said, and instead created conditions that could have allowed it to spread from room to room.
The report showed that Life Care failed to hold “consistent or effective” quality-assurance and performance-improvement (QAPI) meetings in 2019, which are intended to flag infection control and other issues.
Managers at the facility held quality-assurance meetings on Jan. 27 and Feb. 19, after the virus had been detected in a neighboring county.
The home’s director, who joined the facility in January, told CMS inspectors: “Normally if there are concerns in infection control it would have been discussed in the QAPI meeting.”
CMS said infection concerns did not come up at either meeting, including the one in February, which was held days after Life Care said it posted signs warning visitors about the respiratory outbreak that staff thought was the flu.
“Further review of the 02/19/2020 monthly QAPI meeting minutes under the nursing section revealed: no reports of infection concerns at the facility,” the CMS report said.
The nursing home’s medical director, who was not identified, did not attend either of those meetings, the report states. Life Care’s “Infection Preventionist” nurse attended the January meeting, but did not attend the Feb. 19 meeting.
The executive director and two unidentified administrative staff members said “it was very chaotic” inside Life Care, as patients and dozens of staff members fell ill in February and March. Patient records were incomplete. Staff members were sick and unable to tend to the residents, they told inspectors.
“We were triaging residents as the residents were crashing, so there wasn’t going to be a lot of documentation,” one nursing home official, who was not identified in the report, told CMS inspectors.
CMS said the facility “did not have effective systems in place” to prevent the infection or respond to it. Life Care officials did not notify health-care authorities of the outbreak until Feb. 26 and did not have a 24-hour emergency physician or adequate staff to respond to the outbreak.
The facility lacked a “clear medical plan of action,” inspectors said, leading to a “systemic failure.”
On March 7 — nearly a month into the outbreak — inspectors said two certified nursing assistants, a man who had worked at Life Care for 15 years and a woman who had been there for four years, said they had not been trained to properly sanitize items with bleach wipes.
Also that day, inspectors spotted a laundry staff member who delivered clothing to residents in multiple rooms without changing her gown, gloves and other protective gear despite warning signs that patients might have been contagious.