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A series of failures triggered a COVID outbreak that rocked the Windsor Redding Care Center last winter, killing nearly two dozen elderly nursing home residents and causing 43 more to contract the virus. Late last year, state regulators determined that the staff at Windsor Redding — a facility that's part of California's largest for-profit nursing home chain, Bruis Healthcare LLC— was not taking mandatory steps to control infection and educate staff on COVID That left the elderly residents mired in a dangerous health situation over which they had no control.

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A months-long Record Searchlight investigation, based on state records and interviews with union representatives, families and local health authorities, provides the clearest narrative to date of the deadly events last summer. The speed with which the coronavirus raced through the facility after the first two cases were confirmed on Aug. Karen Ramstrom said: "That facility was traumatized. There had been about two dozen deaths at that point. Ramstrom added that 33 of the home's residents had active coronavirus infections then, as did nine members of the nursing home's staff.

Knowing how vulnerable the residents were, some desperate family members told the Record Searchlight they'd considered moving their loved ones to other facilities where the coronavirus threat wasn't so great, or even bringing them home. That wasn't possible, given the tight restrictions in place during the coronavirus lockdown, when only employees and residents were allowed inside nursing homes.

In , california regulators determined that windsor redding care center staff was not taking mandatory steps to control infection of covid

Exceptions were scarce, made mainly for residents nearing the end of life. The federal Centers for Disease Control and Prevention has classified nursing homes as "high risk" for COVID, due to the nature of their clients — older adults who frequently have underlying health conditions — and close-quarters living conditions.

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During the crisis, Ramstrom said her department worked with state officials to help secure additional staff to step in for employees who had gotten sick or had to quarantine. County health workers also conducted site visits, in conjunction with state health care infections experts, to see up close what had gone so wrong and find solutions. Ramstrom has called the extent of COVID cases at the nursing home "the most tragic situation that we've had to manage in the course of this outbreak. She said Shasta County public health staff were on the phone with the facility's leadership every day to hear how bad the situation had become and what was being done to halt the virus' relentless person-to-person spread through the bed nursing home near downtown Redding.

But state public health officials are the ones that regulate all nursing homes, Ramstrom told Baugh, so only the state would have the authority to determine whether to shut down any facility. Plus, Ramstrom added, with nursing home beds so scarce locally, residents might have to be sent to facilities elsewhere in California should Windsor Redding close.

Mapping the cases

Statewide, facilities are in a similar position," Ramstrom said. Redding Windsor was not the only home in Shasta County to report that residents died from COVID last year, when the pandemic was taking hold, masks and other protective gear were sometimes scarce and there was no approved vaccine.

All 10 Shasta County homes have had at least one resident death attributed to the pandemic. Marquis Care at Shasta had 16 coronavirus deaths, according to statistics from the state, while Oak River Rehab in Anderson had Vaccines started to become available to nursing home residents late last year.

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A high proportion of nursing home residents are now vaccinated and there are few active coronavirus cases in the county's nursing homes right now. As of May 7, Crestwood Wellness and Recovery Center in Redding had at least one and as many as 10 new cases of the virus among its residents and health care workers, according to the state's database, which doesn't give an exact count. On July 2, that was listed as zero.

At Windsor Redding last summer, any relief was still weeks away. Cases of infection among residents and employees escalated alarmingly, Shasta County officials said. On Aug. The next day, the first member of the nursing home's staff tested positive, the department said. By late September, at least one resident had died while 36 of the home's residents and 18 of its health care workers had tested positive, according to state records.

Most of the COVID cases officials had identified at Windsor Redding through screening and testing turned out to be among the skilled nursing facility's own health care staff, Ramstrom said at that time. Even members of the home's management, including those not working directly with patients, contracted the virus, said Laticia Sanchez, spokeswoman for SEIU Local None of the center's health care workers died in the coronavirus surge, but 30 ended up testing positive for the virus since the start of the pandemic, state records show.

Whether workers caught the virus while on the job or while out in the community, the virus remained dating in redding Corona threat after the initial outbreak. The report did not specify the of active cases among the home's workers then, listing the only as fewer than As to the cause of the home's outbreak, last year a survey team from the California Department of Public Health inspected Windsor Redding and its workers and practices between Sept.

The team determined the facility lacked a rigorous infection control program. Also, routine staff education related to COVID was not being conducted, according to the survey team's report. The state's finding led regulators on Sept. That status was lifted on Sept. During their survey, the state team interviewed Windsor Redding employees, who told them there were few in-service training sessions on the proper use of personal protective equipment, including masks, as the pandemic took hold.

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One certified nursing assistant said she'd been instructed to reuse protective gowns during a shift, only to be told later by another CNA about a change in procedure to not reuse gowns. A different CNA said she had been provided one gown to wear for the entire day while caring for residents who were staying in the same room rather than change gowns periodically, state records show.

During one survey visit, the team reported seeing a d nurse sitting at the nurses' station wearing a clear face shield atop an N95 mask that was resting below her chin, leaving her mouth and nose exposed, which was not in compliance with public health protocols. Asked whether nurses were to wear the N95 over their nose and mouth while at the nurses' station, the report said the worker replied, "I don't know. The nursing home's director of staff development told surveyors that she had been unable to provide employee training full-time because, "due to staffing issues," she had often been ased to administer medications to the home's residents.

In its report, the survey team faulted what it called the home's "punitive" employee sick leave policy.

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A federal law that went into effect in California in March required many employers to provide paid sick time to workers affected by COVID Redding Windsor's sick leave policy did not conform to that law, the survey team concluded. Instead, the nursing home had required staff to first use their own accrued sick and vacation leave before being eligible for supplemental paid COVID sick time. That led some employees to come to work while sick with coronavirus symptoms, only to test positive for the virus soon afterward, state health investigators said.

For example, one CNA told surveyors she developed body aches and respiratory symptoms on Sept. The home had also asked employees who'd tested positive for the virus but had no symptoms to report to work if there was a staffing crunch. They were asked to work only with residents and staff who were COVID positive, according to the state's report. After a state plan of correction for the home was put in place, the immediate jeopardy status was lifted on Sept.

The latest trends

During a follow-up visit Nov. A letter from the Centers for Medicare and Medicaid Services CMS said the fine was imposed due to the home's various infection control and staff education failures during a period spanning late September through mid-November. Since last year, Windsor Redding has brought in its second local administrator, stepped up its COVID prevention practices and received a clean bill of operational health from California regulators.

Starting Feb. In early July, the home — which is d for beds — had 42 beds available, according to information listed on dating in redding Corona state public health website. Before reopening to new patients, Ramstrom said a new administrator installed last fall by the nursing home's corporate office to repair Windsor Redding's operations waited a bit, first laying the groundwork for that task.

The administrator — whom the nursing home attorney declined to name but was identified as Nate Echols by the nursing home's union representative and by Ramstrom — first spent time preparing "to address and support the recovery of the residents and the staff.

That was good to see," Ramstrom said. According to the union's representative, Echols recently left Windsor Redding. With the arrival of new management, "things have gotten really good. They feel like they are on a good path. That money can go toward face masks and other personal protective equipment, infection control supplies, staff wages and "many other costs directly related to responding to the public health emergency," said Johnson, the nursing home's attorney.

Lapses in infection prevention and control during the pandemic were the basis of a second fine, that one imposed by the state.

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The home paid that fine last year, the spokesperson said. Going forward, attaining adequate staffing levels will be key to Windsor Redding avoiding a relapse into the kind of troubles that contributed to the coronavirus crisis at the home, she said.

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I think that's one of the biggest problems" for the Brius nursing home chain as a whole, said McGinnis. About the fines assessed against the elder facility in connection with its problems, McGinnis said, "No, dating in redding Corona not a big fine, considering how many state deficiencies they've Bruis had and federal deficiencies they've had over the years.

Most times, she added, government fines just don't have a big impact on nursing home companies anyway. Many homes end up not paying the assessed fines or have the amount they ultimately owe reduced, McGinnis said. Staffing and turnover has been a lingering issue at Windsor Redding. InSEIU members conducted a two-day strike at the Redding home, complaining of inadequate staffing levels among other things. Although Bruis applied in for a state to operate the Redding home, its application was denied inin part because of deficiencies at some of the chain's other nursing facilities in the state.

Even so, California law allows nursing homes to be owned by one entity but controlled by another while licensing applications wind their way through the state's approval process. Windsor Redding has "a pending licensure application with the Department of Public Health. In the interim, the facility has a in good standing and there is currently a management agreement in place governing operations," said Johnson, the home's attorney, via .

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He added that operating the facility under an approved management agreement pending the approval of the licensure application "has had no impact on the operations of the facility. This is the industry standard process. The facility "is spending ificant resources on recruiting nurses from other countries such as the Philippines," Johnson said. He added that the company is also operating "staff training and education centers" throughout the state.

Brius founder Rechnitz does not have a role in day-to-day operations at the Redding facility, the attorney said. It's Rockport that provides services to several Brius homes, including Windsor Redding. The state's plan of correction for Windsor Redding included adding regular training about COVID prevention efforts and proper use of personal protective equipment.

The home's personnel policy was also changed to comply with federal law, so workers affected by COVID could quarantine at home for 14 days. Although regulation of nursing homes falls to the state, Ramstrom stressed that Shasta County's health department has an "ongoing relationship" with Windsor Redding and can "engage" with the home should future coronavirus issues arise.

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Ramstrom said she is "reassured and relieved" now that the majority of nursing home residents in the county are vaccinated against COVID Facebook Twitter. Copy text Copy this quote's text The quote has been copied. this story. Share Share this story. Quote icon.

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