Federal inspectors have found that a Kirkland nursing home’s delayed response to the novel coronavirus that claimed 37 lives caused a “systemic failure” to provide care for residents.

In a scathing review, the federal Centers for Medicare and Medicaid Services (CMS) threatened to terminate Life Care Center of Kirkland’s Medicaid and Medicare reimbursement if it did not resolve the deficiencies by Sept. 16. Life Care faces a fine of $611,325.

The review revealed new details of  COVID-19’s rampant spread through the nursing home, and Life Care leadership’s failure to respond to early signs of the outbreak. There have been at least 167 COVID-19 cases linked to Life Care, and the disease killed a fourth of the nursing home’s residents.

The CMS investigators found the facility did not promptly report a respiratory outbreak, which Life Care first believed to be the flu.  A nurse also told investigators that flu tests came back negative for sick residents weeks before Life Care said it reported the outbreak to officials.

Life Care has the opportunity to appeal the findings and the fine can be increased or reduced, depending on its compliance. In a statement, Life Care said it would continue to work with CMS to address its concerns.

“We are confident that with guidance from CMS we will be able to continue to be a top-rated facility going forward,” Life Care said, referring to its high overall rating from CMS in a previous survey.

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The outbreak at Life Care has been a cautionary tale as the novel coronavirus illness spreads to other nursing homes across the country, including at least 90 in Washington, according to a Seattle Times analysis.

A New England Journal of Medicine report last week found the disease likely spread from the facility to at least three other nursing homes in the area, including two where Life Care staff also worked and one where two Life Care patients had been transferred.

Multiple findings in documents that CMS released on Wednesday reflect previous reporting by The Seattle Times, including that the nursing home continued to admit residents after noticing a respiratory outbreak on Feb. 10, “placing these residents at risk for infection and death.”

Four residents admitted to Life Care in the weeks that followed contracted COVID-19 and died.

In addition, Life Care admitted a patient the same day it said it reported an outbreak to state health officials on Feb. 26.

Judie Shape, 81, was likely the last of 27 residents in February to move into Life Care, which said it stopped new admissions right after reporting to officials. Shape arrived on Feb. 26, and her daughter said her stay was expected to last less than a week. She remained at Life Care for a month, where she contracted the virus but was not among those who became seriously ill as a result.

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She moved out last week.

“It just doesn’t fly,” said Lori Spencer, Shape’s daughter. “Why did they continue to fill beds?”

In preliminary findings released last month, CMS identified three areas of serious noncompliance at Life Care: failure to rapidly identify and manage sick residents; failure to promptly report a respiratory outbreak to officials; and failure to have a backup plan after the nursing home’s primary clinician fell ill.

Those violations resulted in “immediate jeopardy” to residents’ safety — the most serious violation for nursing homes.

At the end of March, CMS conducted another evaluation and removed the “immediate jeopardy” designation. While “substantial noncompliance” with regulations remained at Life Care, the nursing home had taken steps toward addressing the issues previously cited.

The Washington State Department of Social and Health Services also found Life Care violated state requirements and ordered the facility Thursday not to admit new residents until it is back in compliance. The nursing home will be required to hire a consultant who specializes in infectious disease.

Killian previously acknowledged that staff were aware of a respiratory outbreak as early as Feb. 10, but an analysis of 911 calls by The Seattle Times found it may have started earlier.

CMS inspectors found that one resident developed pneumonia in January, though it wasn’t until late February that the resident went to the hospital. The resident tested positive for COVID-19 and died in March.

CMS also found cases of pneumonia or lower respiratory illness as early as Feb. 3 at Life Care, although the report did not link those cases to COVID-19.

The facility’s infection-prevention nurse told investigators she noticed the spike in illnesses around Feb. 12, but did not consider alerting authorities because it didn’t seem abnormal during flu season.

Under the nursing home’s policy, and state and local requirements, Life Care should have alerted officials within 24 hours of a suspected influenza outbreak.

At the time, sick residents were receiving rapid influenza tests, which can provide results in around 15 minutes. All the tests came back negative, the nurse said.

One resident went to the hospital on Feb. 18 with shortness of breath, as The Seattle Times found in a review of 911 calls from the facility. The resident ultimately tested positive for COVID-19 and died.

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A Life Care medical provider noticed the unusual outbreak on Feb. 19, when eight residents were sick. She told the infection-prevention nurse and the medical director, but neither of them attended a required monthly meeting with Life Care leadership that day, where the outbreak wasn’t discussed.

More than a dozen residents had fallen ill a week later when Life Care leadership, after consulting medical staff, decided to report to officials.

Even after the outbreak was identified through positive test results on Feb. 28, the nursing home struggled to contain it.

While Life Care said it shut its doors to visitors, one woman said she was able to visit her mother inside the facility on March 1.

The nursing home’s medical director, who was the primary care provider for 90% of residents, became sick himself. His last day in the facility was March 2, although he was able to provide some guidance over the phone.

This left most of the burden on one medical provider, who had to assess and decide how to treat 25 residents in the days before a physician showed up on March 5. CMS found that documentation of residents’ vital signs and oxygen levels was not consistent throughout the outbreak, particularly for this stretch of time.

“It was very chaotic” during that time, Life Care leadership told CMS. “We were triaging residents as the residents were crashing, so there wasn’t going to be a lot of documentation.”