Employees at Avalon Health Care in San Andreas have alleged negligence in the prevention and management of an ongoing COVID-19 outbreak that has infected more than half of the nursing home’s 100 residents and left 11 dead.
The two employees, who wish to remain anonymous, told the Enterprise that most staff members at the facility have displayed a “nonchalant” attitude toward the use of personal protective equipment (PPE) before and during the outbreak.
Both sources believe the recent deaths at the facility could have been prevented.
“People are dying and suffering unnecessarily,” the first source said. “How much longer could they have made it, as healthy as they could be, if it wasn’t for the negligence of staff members bringing corona to them?”
Salt Lake City-based Avalon Health Care Group maintains that its facilities have been following state and federal COVID-19 guidance, including that of the Centers for Disease Control and Prevention (CDC). However, the San Andreas facility and others managed by the private health care company have come under scrutiny in recent weeks due to concerns about preventative practices.
One Avalon-managed veterans home in Hilo, Hawaii is under federal review at the request of U.S. Senator Brian Schatz (D-Hawaii) due to a COVID-19 outbreak at the facility that has claimed the lives of 14 residents. A U.S. Department of Veterans Affairs disaster response team is expected to arrive at Yukio Okutsu Veterans Home later this week.
In a letter to Avalon Health Care Chairman Charles “Randy” Kirton, obtained by the Hawaii Tribune Herald, Schatz urged the company to review staffing and infection control practices at each of its facilities, which provide care to more than 6,800 patients throughout the Western United States.
At Avalon’s San Andreas facility, sources say the past few weeks have been “one big, nonstop violation” of COVID-19 safety guidelines.
According to Avalon administration, it is suspected that an asymptomatic staff member introduced the virus to the nursing home – a situation which would not have occurred with proper use of PPE, the first source said.
The source also stated that she observed a staff member feeding a resident “with her (face shield) up and her mask down,” while telling another staff member that she herself was experiencing COVID-19 symptoms and “probably has it.”
According to the second anonymous source, N95 masks were first distributed in early September to employees during the peak of the outbreak, which has infected at least 58 residents and 21 staff members. The source stated she has witnessed staff members working with their N95 masks dangling from their faces.
The source also recalls watching a staff member stow a protective gown required for contact with COVID-19-positive patients in a resident’s personal clothing drawer for later reuse, which is reportedly against protocol.
Both sources say a lack of PPE training has left them feeling inadequately prepared during the outbreak. Most information regarding COVID-19 protocol and the general situation at the facility has been received informally “by word of mouth” and through the news, they said.
Safety concerns raised with local administration before and during the outbreak were allegedly disregarded, discouraging the two employees from taking further action.
Yet their anxiety increased in early September as COVID-19 patients who were initially outsourced to other facilities were returned to a dedicated COVID unit at the San Andreas location. Some of those patients were placed back in a non-isolated wing after being deemed “recovered,” though a few still displayed symptoms, they said.
Residents who test positive for the virus or display strong symptoms are being placed under isolation with their roommates prior to being moved to the designated unit, the sources said. Yet when the infected patient is removed, the remaining occupants are no longer under quarantine.
The sources believe weekly COVID-19 tests performed on all residents and staff have been largely ineffective in preventing the spread of the virus due to a several-day lag in receiving results. Meanwhile, staff members move between isolated and non-isolated rooms, dispensing used protective gowns in a universal laundry bin.
“One resident in my wing, who shared a room with a positive case and is currently a suspected case, got in a wheelchair and spent all day wandering up and down the hallway, talking to everybody with no mask (on),” the first source said, adding that she was recently coughed on by another symptomatic patient who was not in isolation.
In response to these allegations, Avalon Health Care has stated that CDC guidance is being followed in clearing mild to moderate COVID-19 patients as “no longer contagious” 10 days after the onset of symptoms, rather than implementing a test-based approach.
“Facility leadership has conducted a review of protocols and has not identified any instances where staff were failing to properly follow PPE guidelines. However, we encourage any staff that thinks there are areas for improvement to talk with their team leaders so it can be addressed. The safety of our residents and staff are paramount and we will do everything we can to keep them safe,” Avalon spokesperson Allison Griffiths wrote in a Sept. 16 email.
Presently, Avalon Health Care has reported COVID-19 cases among residents at more than half of its 10 facilities in California, resulting in at least 29 fatalities. An Avalon facility in Sonora has reported six cases, five of whom tested positive upon admission and were transferred back to their original facility.
On Tuesday, Calaveras County Public Health confirmed the three latest deaths of residents from Avalon’s San Andreas facility, though the nursing home has only publicly reported eight deaths since last updating its website on Sept. 12.
“The current outbreak within Avalon has accelerated our increased rate of COVID-19 infections for the whole county,” Health Officer Dean Kelaita, MD, stated in a Sept. 8 press release. “Addressing this situation is our top priority. Calaveras County is still among California counties where the county risk level is substantial.”
Kelaita told county supervisors during a Sept. 8 meeting that Public Health has been working closely with Avalon administration during the outbreak and that state resources were being deployed to aid the facility.
The state Department of Public Health (CDPH), which regulates skilled nursing facilities in California, stated that they have also “worked closely” with such facilities to ensure proper infection control protocols are in place and to ensure necessary corrections are made. However, CDPH could not confirm whether an investigation has been initiated regarding complaints at the Avalon San Andreas facility.
Throughout California, the death toll among the most vulnerable continues to rise, with more than 4,300 nursing home residents constituting roughly 30% of the state’s total COVID-19-related deaths.
A statement from CDPH on Tuesday read, “(All) nursing homes in California are required to have plans in place for infection control, testing, and response to COVID cases. This testing is critical to managing COVID-19. CDPH conducts surveys to check on compliance. Nursing homes have both regularly scheduled surveys, and unscheduled surveys which are the result of complaints filed by residents, employees or family members. Additionally, CDPH currently has strike teams with experts from the Healthcare Associated Infection Program who are being deployed throughout the state in an effort to assist healthcare facilities with preventing and improving infection control, while taking enforcement action as warranted.”