Salem Transitional Care (Amanda Loman/Salem Reporter)
Employees at a Salem nursing home hit hard by the coronavirus re-used protective masks and didn’t sanitize or change protective equipment in between sick patients and those not yet tested for COVID-19, according to a report by the Oregon Department of Human Services.
Salem Transitional Care, owned by Wilsonville-based Avamere, has been the site of Marion County’s worst coronavirus outbreak in a nursing home or care facility, with 25 residents and employees testing positive for the virus, and three deaths.
Nursing homes in Oregon have been hotspots for COVID-19 infections and account for nearly half of all deaths reported from the virus.
Records obtained by Salem Reporter shed light on how the virus may have spread among residents at Salem Transitional Care, 3445 Boone Rd SE.
DOCUMENTS: DHS report from April 29 and May 5 visits to Salem Transitional Care
The home, which currently has 42 residents, reported a resident had tested positive for COVID-19 to state regulators on March 24 and was placed under an order designed to limit the spread of the virus further.
On April 3, DHS lifted that order after Cheryl LaCombe-Anderson, Salem Transitional Care administrator, reported via email the resident had been discharged home, according to records obtained by Salem Reporter. LaCombe-Anderson told the state that no other residents were showing symptoms of the virus after a 14-day isolation period and all employees had tested negative.
But on April 24, the facility again reported COVID-19 cases to DHS, spokeswoman Elisa Williams said, and was put back under more restrictive state rules, including weekly visits by DHS workers to assess infection control protocols.
During an April 29 visit, DHS workers observed a nursing assistant and nurse adjusting face masks and shields without washing their hands, and moving from patients who were infected with COVID-19 positive to the nursing station and other patient rooms without sanitizing the shield or changing the mask, according to a state report.
The nurse “reported she had been wearing the same N-95 mask and same face shield all day and had gone in and out of the COVID19 positive (redacted) and into other resident rooms without changing her N-95 mask or changing nor cleaning her face shield,” DHS workers wrote.
The facility had a supply of personal protective equipment during the inspection, according to the report.
Avamere didn’t respond to detailed questions sent by Salem Reporter about why staff were re-using masks or whether it contested anything identified in the state reports. In response to a request to interview the facility’s director or Brad Litle, Avamere’s division president for skilled nursing facilities, it provided a written statement from Litle.
“Throughout this pandemic, Salem Transitional Care has followed all guidance from the CDC and local health departments. Salem TC has had several onsite visits from state and federal regulators that resulted in no deficiencies. We have ensured that our staff have the appropriate PPE needed to provide care to our residents. The care and safety of our residents and staff are our highest priority,” Litle said in his statement.
Williams said the conditions found by the state violated CDC infection control guidelines.
By May 3, Salem Transitional Care had reported 26 cases of the virus among residents and employees, a near-tripling from the week before.
That number was later changed to 25 in subsequent Oregon Health Authority reports and has not changed since.
A follow-up DHS report from a May 5 visit found the infection control issues were corrected, with Salem Transitional Care workers properly sanitizing goggles and washing hands between patient rooms.
Williams said DHS did not take any regulatory or punitive action and didn’t cite the facility for violations.
“If DHS sees anything egregious in these weekly visits that is not addressed, the nursing facility licensing staff would conduct the federal focus infection control survey and cite the facility as appropriate, which would require a plan of correction and a revisit to ensure they are in compliance,” Williams said in an email.
She said DHS prefers to work with facilities to correct problems so operators don’t hide issues from regulators.
DHS has cited Healthcare at Foster Creek, a Portland nursing home, for infection control violations following a COVID-19 outbreak there that sickened nearly every resident, with 29 deaths, and eventually suspended the facility’s license.
Documents obtained by The Oregonian show an extensive list of problems identified during multiple visits to that home.
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Contact reporter Rachel Alexander: [email protected] or 503-575-1241.
Rachel Alexander is Salem Reporter’s managing editor. She joined Salem Reporter when it was founded in 2018 and covers city news, education, nonprofits and a little bit of everything else. She’s been a journalist in Oregon and Washington for a decade. Outside of work, she’s a skater and board member with Salem’s Cherry City Roller Derby and can often be found with her nose buried in a book.
