A Sioux Falls nursing home that has seen a spike in COVID-19 cases received the lowest score possible in a federal metric that grades health conditions during its last health inspection, which occurred a year ago.
Now, some close to the facility are concerned conditions inside are contributing to the deadliest known hot spot for the coronavirus in South Dakota, despite multiple attempts to get the concerns addressed, they said.
The Evangelical Lutheran Good Samaritan Society's Sioux Falls Village location was rated “much below average” in its 2019 health inspection. Overall, the facility has a below average rating from the federal government, which administers a national nursing home quality-of-care comparison program
Within the last month, about a third of the southwest Sioux Falls facility's residents have contracted COVID-19, Good Samaritan Society officials said.
Of the more than 60 residents infected, 20 have died as of Tuesday. No other single facility in the state has reported as many deaths from an outbreak.
As of this week, despite having a dedicated COVID-19 isolation wing and a second wing with positive cases separated from healthy residents, the virus continues to spread inside with cases confirmed now in a third wing placed in precautionary isolation after two roommates who were healthy recently tested positive.
Yet, Good Samaritan Society officials say they're doing everything they can to prevent further spread within the facility.
"There's an intense effort, and it's just hard work right now for our staff," said Dr. Greg Johnson, the Chief Medical Officer for the Good Samaritan Society.
History of health violations
A multi-day inspection that occurred in May 2019 found a litany of health issues, and it followed a 2018 inspection in which the facility was fined $38,587 for violations, according to government records. The facility did, in the most recent inspection, get high marks for the level of nursing and staffing per resident.
More: Despite COVID-19 hot spot, Good Sam exec says its nursing homes fare better than most
Overall, an inspector with the South Dakota Department of Health noted 14 health deficiencies at the facility – well above the statewide and national averages, which were 5.4 and 8.2 deficiencies respectively.
The inspection evaluated the facility’s safety plans, security, emergency management plan and treatment of residents. The 110-page report also included the detailed observation of a number of residents to determine if they were receiving appropriate care.
One was a 96-year-old man suffering from Parkinson’s Disease and dementia, identified as resident 37, who was monitored by an inspector during a survey that occurred from May 20 to May 23. The inspector noted that resident 37 was not assisted when trying to eat meals in the dining room, and he would slump forward with his chin on the table. Dried food was on his clothing, face, fingers and wheelchair.
“As the day progressed he: Appeared to fatigue more and lean forward at the waist,” the inspector noted. “Started to drool large amounts of sputum from his mouth and did not have the strength and capability to clean it up himself; his clothes remained dirty with dried-on food particles along with his fingers and face.”
The inspector noted that resident 37’s room was dirty: There were food particles caked in areas and the floor was sticky. A housekeeper interviewed by the inspector claimed he had cleaned the room two days prior, but there was no documentation to support that. The housekeeper’s supervisor noted that she had trouble getting her staff to finish their tasks.
“Education,” the supervisor told the inspector, “is a concern: (housekeeper name) had no idea what the chemicals are or used for. He will spray disinfectant around the residents’ rooms, even those with breathing problems.”
The inspector also noted that the nursing home was failing to follow its own environmental cleaning principles policy for infectious disease control. That policy said: “While most infections result from person-to-person transmission, the spread of infections from contaminated surfaces is significant and supports the need for good procedures and practices related to cleaning and disinfecting of surfaces.”
Housekeeping staff used chemicals but didn’t know how long those chemicals should be on surfaces to kill germs, negating the facility’s disinfectant program.
The inspector found other residents had issues with wound and dental care, blisters and skin irritations, skin ulcers, accident hazards, proper measurements of medications administered through a feeding tube and a lack of documentation on when the breathing tube for one patient had been changed.
The inspection found that nurses were not changing soiled gloves or washing hands after changing diapers and cleaning residents who had soiled themselves, nor were they using hand sanitizers or washing hands when they entered a resident’s room.
“They had not realized their process for providing perineal care was not performed in a sanitary manner,” the inspector noted.
The facility has since updated its infectious control measures, and is following new guidance around disinfectants. A professional firm has been brought in to clean, and there's also mandatory infection prevention and PPE training for staff, Johnson said.
'Prayers aren't enough'
When Village resident Bernice Lovrien contracted her third E. coli infection in less than a year, her daughter demanded answers.
The response: Caregivers weren't wiping her mother – a double amputee – properly, Lovrien's daughter Rita Dozal said.
Dozal, who lives in Arizona, tried to take her mother out of the facility, but no other place in Sioux Falls had the space or the capabilities to care for the 90-year-old woman who had lost both her legs.
She was stuck at the Village, where she's been the last nine years, with no alternative.
"I'd love to be gone from here," said Lovrien, a diabetic. "If I had feet, I'd run out of here in 10 minutes – if I had legs that would work."
Dozal has tried to raise concerns to officials higher up, addressing everything from employees who got her mother's medication mixed up with another resident's, to declined physical therapy, to missed meals and mouse droppings found on lemon bars, she said.
But she often ends up going round and round, hearing things like, "Let's say a prayer, Let's have a conversation," she said. Though she considers herself a staunch Lutheran, she knows prayers aren't enough in this situation, she said.
"No matter how hard we pray together or how hard my mother prays, God will not come and wipe my mother's ass," Dozal said.
More: Son of coronavirus patient at Good Samaritan Society says family feels helpless
Concerns from staff, families
Officials have said employees who are assigned to the virus-infected areas are not allowed to move to non-infected areas to limit exposure, but schedules obtained by the Argus Leader shows instances exist where employees have been assigned and moved between infected wings and non-infected wings in a matter of days, despite the policy.
"We have specifically dedicated staff to work on the (COVID-19) unit, and are very specific or very intentional that they do not cross over to other units," said Rochelle Rindels, vice president of nursing and clinical services for the society, which merged with Sanford Health in early 2019.
Employees have also been seen not wearing masks, or have said there's limited use of personal protection equipment, including being asked to use single-use surgical masks for five consecutive shifts or five days after placing them in individual bags every time they clock in or out to mark their use.
Only recently have employees started changing masks more frequently, with caregivers and CNAs getting a new mask every day or every shift, Rindels said. When the pandemic first hit the U.S., guidelines from federal health officials were unclear about who should be wearing masks and when, Good Samaritan and Village employees said.
The Village has also been through mass testing of every employee and resident, though at this point testing is more selective based on those showing signs or symptoms, officials said.
Letters obtained by the Argus Leader also show the Village violated no state health department rules as of April 30, despite recent complaints.
More: 15 people have died at Good Sam Sioux Falls Village. Here's what top officials say is happening inside.
Others concerned about the facility reported "bare minimum" care, including residents who missed doctors appointments because staff didn't take them on time or a lack of cleanliness in bedrooms because of the workload employees are trying to carry, they said.
"My mom is saying, 'The only thing we have to look forward to here now since we're isolated and stuck in our rooms is the grave,'" Dozal said. "I asked the management over there, 'What should I say to my mother when she tells me that?'"
How ratings compare
The Village isn't alone among Sioux Falls area nursing homes that were rated below average.
Bethany Home Sioux Falls and Avantara Norton also earned below average ratings from their last inspections. And like The Village, both have been fined by the federal government: Avanatara was fined $80,760 in 2018 and Bethany $49,579 last year, according to federal records.
But of the three, The Village is the largest, licensed for 177 nursing home beds, according to the federal records. The average number of residents in South Dakota nursing homes is 53.
At max capacity, including services aside from nursing home care, the Village houses 217 residents.
The quality scores vary among Good Samaritan facilities: Good Samaritan Society Luther Manor earned the highest rating possible, much above average. The Sioux Falls Center and facility in Lennox were both rated average, while the Good Sam facility in Canton was rated above average.
The only other nursing home to have the highest rating of much above average was Avera Prince of Peace, which has reported one death since the pandemic came to Sioux Falls.
More: Coronavirus: 25 people have died at Sioux Falls senior living facilities. Here's what we know.
'It's supposed to be a place to live,' not die
Lanny Olson, whose 100-year-old mother Dorothy Olson was one of the first five positive COVID-19 cases to be reported within the Village in early April, hasn't seen his mother in weeks, but he hasn't had any issues with her care so far. Though she's still in isolation, she's doing quite well, Olson said.
He has daily phone calls with staff and his mother, he said. Without those, though, he wouldn't know what was happening inside and things would be different.
"As long as she gets up, and they put her in her chair, and she gets her coffee and Ensure in the morning and can watch her TV, she's fine," Lanny said.
Still, the fear of what could happen next concerns Dozal and Lovrien, especially now that the virus has been found only one wing away from Lovrien's room, they said.
Because of previous concerns, and especially because of the pandemic, Dozal holds a weekly call with Village staff to jot down progress and concerns and regularly argue for the best care possible for her mother, she said.
"It's supposed to be a place you go to live, not a place to die," she said.
Meanwhile, Daniel Ballard, a close friend, still finds a way to see his best friend, Lovrien, making visits to her window before the sun sets to have a daily chat in a lawn chair, he said.
That's something he'll continue as long as he can, he said, though recently employees have started expressing concerns about Lovrien's window being cracked during the pandemic.
It's Lovrien's life that's at stake after all, Ballard said.
"If they're at capacity, who are the 177 most likely people in the state to die of the coronavirus?" he said. "Everybody at Good Sam."
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