Prestige Senior Living Orchard Heights on May 15, 2020. (Amanda Loman/Salem Reporter)

Over the last three months, the only time Annie Elkins leaves her room at Prestige Senior Living Orchard Heights in west Salem is to walk her dog, Copper. She carries a Lysol wipe in her hand and leaves hand sanitizer outside her door.

The 74-year-old said she feels doomed living in a long-term care facility with the worst outbreak in the state. More than half of the 58 residents have tested positive for COVID-19. Ten have died.

Healthcare at Foster Creek in Portland previously had the largest outbreak of cases before state officials forced it to shut down because of inadequate infection control after nearly 30 people died.

“It could be me next no matter how hard I try,” Elkins said.

A Salem Reporter analysis of DHS records and interviews with nearly a dozen residents, former staff and family members show the facility was slow to put procedures in place that would have kept the virus from spreading among the vulnerable, elderly population.

Records obtained from the state through public records requests also showed the facility took days to implement changes recommended by the state agency overseeing senior care. Orchard Heights has subsequently done everything asked by the state, but there is still no explanation from the state or the facility on how the coronavirus spread so rapidly and with such deadly impact.

Ekins, a retired nurse, said she watched as gowns were hung outside the room of her infected neighbor to be reused weeks after the first case was reported at the senior living community.

“Because of the carelessness and the lack of urgency, it went like a wildfire,” Elkins said.

Facility reviews from the state Department of Human Services indicated that the facility didn’t assign staff to work only with infected residents, that staff reused protective equipment and rooms lacked instructions on how to take off gowns to prevent the spread of the virus.

The Polk County Health Department notified Orchard Heights on Thursday, April 30, that a resident had tested positive for COVID-19 while at Salem Health.

Mia Mullins, Prestige’s senior regional director of operations, said in an interview that the facility tested all residents by Saturday, May 2.

By the following day, tests for COVID-19 proved positive for 15 residents, according to a letter Prestige sent to residents.

In that May 4 letter, Prestige said three of the residents who tested positive were at local hospitals “while the others continue to heal within our community with rigorous prevention measures in place.”

Two staff had also tested positive, the letter said.

That same day, the facility was placed under an executive order from state regulators that required all employees to be trained on infection control policies and required the facility to notify relatives that there was a confirmed case in the building.

The Department of Human Services arrived for a facility review on Tuesday, May 5, finding that employees weren’t designated to COVID-19 rooms and non-COVID-19 rooms.

“All confirmed they were providing care to both covid + and covid – residents in the course of their shifts,” the report states.

The review said rooms with COVID-19 patients lacked hand sanitizer, trashcans or instructions on how to take off gowns.

Mullins said at that time, the facility was still waiting for all the residents’ tests to come back and would have only had precautions in place for residents that screened symptomatic.

Prestige issued a statement this week that said the facility has consistently followed the recommendations and guidelines set by the Centers for Disease Control and Prevention, Oregon Health Authority, DHS and Polk County Public Health.

“As we began receiving test results between May 3 and May 5, DHS was on site to help us establish and implement many of our systems for caring for both COVID positive and negative residents. In some cases, it was necessary for staff to don the appropriate PPE to care for positive residents and then doff PPE per our infection-control procedures before interacting and caring for other residents,” the statement said.

A sign on the lawn in front of Prestige Senior Living Orchard Heights on May 15, 2020. (Amanda Loman/Salem Reporter)

A surveyor with DHS returned three days later and wrote “no changes from Wednesday” when both DHS and Oregon Health Authority staff walked through the building.

The surveyor on that Friday, May 8, witnessed an uncovered trashcan full of PPE in a hallway outside a resident’s room. The review said the facility didn’t have adequate PPE but noted the registered nurse had requested more gowns from the parent company, Prestige.

By then, 31 of the facility's 58 residents had tested positive, according to a letter Prestige sent family members on May 8.

Former employees at Orchard Heights and Prestige’s sister facility Southern Hills described in interviews what they said was inadequate training and a lack of protective gear.

When DHS visited on Wednesday, May 13, Orchard Heights had implemented changes from past inspections, including providing trash cans in resident’s rooms and giving out a second face shield to staff members.

But a registered nurse with state Health Authority emailed Orchard Heights that the state agency didn’t want to see staff gowns recycled.

“We do not support the reuse of gowns – too much risk of contamination. There are better ways to optimize gown supply,” according to the email, cited in a state review.

Mullins with Prestige said the facility was conserving gowns at the time and following guidelines from the Centers for Disease Control and Prevention.

In a statement Prestige said: “Initially DHS was satisfied with our strategy, and our conservation methods have since evolved to satisfy additional recommendations from the Oregon Health Authority, which recommends reusing gowns only among positive residents whose rooms are located near each other.”

By May 14, a total of 32 residents and 16 employees tested as infected, according to a letter sent by Prestige to families.

Resident Angie Byers started wearing a mask at the beginning of March. She said she expressed her concerns to nurses then and was told the staff couldn’t start wearing masks until a resident showed symptoms.

“One by one some of the employees started wearing homemade stuff but by that time it was way too late,” she said.

Byers said she only leaves her room to smoke three times a day and doesn’t touch anything when she’s out.

One of the residents she smokes with is almost 90, and told her “Yep, it’s going to get us all,” she said.

“There’s really not words for it. None of us have really dealt with anything like this,” Byers said.

Michelle Nelson moved her mother out of Orchard Heights two weeks before the coronavirus cropped up in Oregon.

She said she didn’t consider staff properly trained and she found bed sheets left soiled while both of her parents lived in the facility’s memory care unit.

Nelson recalled seeing the number of residents that had gotten infected in news reports.

“Me and everyone close to me, is in a way not surprised that they got hit because of all their problems that they had,” she said.

DHS’s Office of Aging and People with Disability has cited Orchard Heights for neglect nine times in the last four years.

One violation report from August 2019 said staff failed to check bandages on a resident’s leg during a four-month span and when the resident went to the hospital it was noted that their bandages were moldy and soaked in urine.

In 2018, the facility was flagged for failing to report abuse three separate times.

Addressing the facility’s previous violations, Prestige said: “We recognize that there were areas we needed to improve in past years, and we worked collaboratively with state regulators to immediately address those issues. We have also had a change in leadership and management which resulted in immediate improvement since the surveys.”

In dealing with the current pandemic, Orchard Heights by May 20 had implemented the measures recommended by OHA and DHS and developed a new PPE procedure, state documents show.

Prestige said 20 residents have recovered from the coronavirus, two are receiving care outside the community and one remains under special care as of June 4.

Elkins continues to limit her contact as much as possible, preparing her own meals and only allowing a couple people into her room.

Prestige didn’t respond to a question on how it is handling current resident’s concerns.

Seth Alderete, a family friend, said Elkins is worried staff aren’t doing their job well enough to protect her life.

“Annie texts me once or twice a week asking me if she’s going to die because she feels that they’re letting her down,” he said. 

Have a tip or story idea? Contact reporter Saphara Harrell at 503-549-6250, [email protected] or @daisysaphara.