The Montana Department of Public Health and Human Services recently conducted a multi-day survey in which staff discovered the Whitefish Care and Rehabilitation Center was not in compliance with infection control and had not implemented federally recommended practices to prepare for and prevent the spread of COVID-19.

The survey concluded on Sept. 1 and was made public last week. Inspectors had entered Whitefish Care and Rehab several days after facility leadership announced the center’s first four COVID-19-related deaths on Aug. 28.

Surveyors found the facility “failed to protect residents from infection,” and in doing so, more than 40 residents were positive or presumptively positive for the virus at the time of the report, four residents had died and three were hospitalized.

As of Friday, that death toll was 13 and a total of 52 residents had tested positive, though the 39 who survived the outbreak had “fully recovered,” according to Whitefish Care and Rehab officials.

According to the survey, the center failed to, among other measures, ensure COVID-19-positive residents were not roomed with COVID-19-negative residents and that staff and housekeeping personnel followed proper personal protective equipment protocols when interacting with positive residents.

“These deficient practices directly contributed to the spread of the COVID-19 infection within the facility, due to unsafe infection within the facility, and due to unsafe infection control practices utilized by staff,” the report notes.

The findings warranted an “immediate jeopardy” deficiency rating from the Centers for Medicare and Medicaid Services (CMS), which was announced to Whitefish Care and Rehab’s administrator and director of nursing. The rating, also known as IJ, represents “a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death.”

CMS-CERTIFIED nursing homes are inspected on a regular basis and any deficiencies that are discovered are given an A to L rating, with IJ being the most egregious.

According to Jon Ebelt, spokesman for the state health department, the facility’s IJ was lifted soon after the state received and approved a Plan of Correction for the deficiencies cited. And although surveys, deficiencies and plans of correction are made public on state and federal websites soon after a plan is approved, “there are no specific CMS requirements to communicate IJs directly to residents and staff,” Ebelt said in an email.

The Daily Inter Lake recently reported on the IJ rating — the survey for which became public shortly after — and a history of other serious deficiencies that have been cited at Whitefish Care and Rehab since its current ownership, Sweetwater Whitefish OPCO LLC took over ownership in 2019. Deficiencies included residents going weeks without showers, residents languishing in filthy conditions and understaffing, among many others.

According to Reid Crickmore, executive director of Whitefish Care and Rehab, previous surveys from the spring in which the deficiencies were cited at the start of the pandemic, “are in compliance and have been revisited. including appropriate staffing levels.”

Crickmore also said the state performed another infection control survey on Sept. 22 and no deficiencies were discovered — a finding that would suggest improvements have been made.

Crickmore, who answered questions via email late last week, said when the facility goes two weeks with no new cases or symptoms the outbreak “will be considered over.” Based on that timeline, Whitefish Care and Rehab’s upsurge would have “ended” last Saturday, with the most recent positive being reported Sept. 12.

When asked if looking back Crickmore believes facility officials and staff were equipped to handle an outbreak of COVID-19 and whether they believe more could have been done to protect residents he said “we accept the findings from September 1, 2020 and are rectifying those concerns, but we believe we were doing as directed at that time to the best of our abilities and to the regulations presented at the time.” He added, “as a facility we take the deaths of our residents like they are our own family.”

Crickmore also maintained the facility has followed all guidelines from local, state and federal offices since March, though deficiency reports suggest otherwise.

AFTER PLACING residents in immediate jeopardy, Whitefish Care and Rehab joined a growing list of CMS-certified nursing homes that have been stamped with the same rating.

In late April, ProPublica reported that federal inspectors had determined nine nursing homes in the country placed residents’ health and safety at risk for their actions and inaction in stopping the spread of COVID-19. The facilities included Life Care Center of Kirkland in Washington, Aperion Care Chicago Heights in Illinois and Advantage Living Center-Roseville in Michigan.

According to the ProPublica article, problems cited in the reports include “a lack of personal protective equipment, failure to maintain social distancing among residents, inadequate staff and not acting quickly enough when residents exhibited symptoms of the disease.”

The findings align with those in Whitefish Care and Rehab’s Sept. 1 survey.

According to the report, during an Aug. 31 interview, one staff member stated when he first started surveying staff for infection control, “no one was complying.” He stated he had not been documenting his auditing efforts, but added “how do I get staff to comply with infection control? My staff is very young and the battle is hard; it’s retention vs. compliance.”

During a separate observation, a staff member walked into a resident’s room without a gown or gloves on and after walking out, did not perform hand hygiene, and then grabbed a disposable gown and gloves and re-entered. The resident’s room had a droplet precaution sign on the door signaling the individual had an infection that can be spread to others by speaking, sneezing or coughing. Another staff member stated “we are all working off of no energy,” and added she “did not remember the last time she had any PPE training related to COVID-19,” though a different employee told surveyors the facility had provided such training during the week of Aug. 24, about one week after residents were already deemed presumptively positive and the facility was waiting on additional test results.

Other details in the report include a staff member stating they had combined COVID-19-positive and COVID-19-negative residents in the same room. Rooms 102 and 109 each had two residents, and those individuals had received a combination of positive and negative test results. Another staff member told surveyors “most of the residents on the 100 and 400 wings have COVID-19 and tested positive and they are not in the COVID-19 wing because they had milder symptoms.”

THE SURVEY also included a lengthy list of corrective actions for Whitefish Care and Rehab.

The facility was asked to bring on a CMS-designated temporary manager to provide stringent oversight, which according to a spokesperson with the Montana Department of Public Health and Human Services, has been done. In addition, corporate management staff is to be onsite two to eight hours per day to work with the temporary manager.

Among other actions, the facility was also tasked with ensuring positive and negative residents are roomed separately, social distancing is maintained and everyone received proper PPE training. Another criteria calls for “system changes,” which calls for facility management to build a comprehensive plan to protect residents from COVID-19 and to provide more aggressive oversight of staff. All told, the facility was asked to implement 26 corrective actions.

Reporter Kianna Gardner can be reached at 758-4407 or kgardner@dailyinterlake.com