SOUTH SIOUX CITY (KMTV) — When a state inspector visited Continental Springs in mid-May, the director of nursing of the South Sioux City nursing home told the inspector about their cough and sore throat.
"I don’t know if I should be here right now," they told the inspector.
At the time, Continental Springs was experiencing a coronavirus outbreak. The inspection was the result of a complaint. Facility administration said 14 residents there died of COVID-19 in 2020.
The inspection report paints a picture of confusion at the facility. It received an L-level citation for infection control and prevention, the worst possible rating, meaning the Nebraska Department of Health and Human Services determined that immediate jeopardy to residents was widespread.
That 3 News Now Investigators know of, three other Nebraska facilities have received L-level citations for infection control during the pandemic, but Continental Springs in South Sioux City had about 53 residents at the time of its citation, more than the others we know of from the summer, and Continental Springs' immediate jeopardy status persisted longer. At the end of January, we submitted another records request to update our records.
The Continental Springs inspection found issues in nine other categories as well, including "Quality of Care," which was also placed at an immediate jeopardy level. We have not yet come across another facility that has received citations in more than two categories on top of infection control during the pandemic.
A letter notifying the facility of the inspection's findings says "the facility failed to implement monitoring, interventions, and physician communication" for two diabetic residents.
"Subsequently, these two residents were hospitalized and expired," the letter says.
The director of nursing wasn't the only one working at the nursing home with symptoms of the virus. The director of nursing told the inspector that the facility allowed staff with symptoms of COVID-19 to work. On 14 occasions in six days prior to May 19, a staff member reported symptoms at the beginning of a shift. On other occasions, employees only marked their temperature or didn't write their name down.
Facility administration blamed at least one of the facility's problems on a lack of staffing, which the facility was also cited for. The director of nursing told the inspector that they "don't have the staff" and neither did staffing agencies when questioned about a resident that hadn't received a bath in 24 days. But the inspection report also details examples of poor communication with staff in place.
One staffer told the inspector they were from a staffing agency and had been given "very little" information in a report.
In another case, a resident angrily removed a sign from their door and facility administration said they made no other attempts to inform staff that the resident was on isolation precautions.
The administrator of the facility at the time told the inspector that he didn't know if they had anything written down regarding coronavirus polices, but said they were "always talking about it."
Continental Springs was inspected again in July after allegations, according to records provided by DHHS. It found that the facility failed to prevent skin breakdown and did not properly handle a resident identified as a runaway risk, and failed to serve food at an appropriate temperature. The inspector did not substantiate four other allegations.
Most inspections at the state's long-term care facilities have found no issues. There are about 2.5 inspections finding no issues for every one that does, according to a 3 News Now Investigator analysis of 220 inspection reports related to infection control. However, we were more likely to obtain inspections that found no issues because the state said some records for facilities that hadn't yet submitted a plan of correction were withheld.
The ability to prevent the spread of the coronavirus to and around long-term care facilities plays a huge factor in the virus' overall death toll.
Nearly half of Nebraskans who have died of the coronavirus were residents of the state's 206 nursing homes and 289 assisted living facilities, DHHS said this week.
As of Feb. 7, nearly 1,000 Nebraska long-term care facility residents had died of COVID-19, and about 4,700 had tested positive, meaning more than 20% of long-term care facility residents who have tested positive have died related to the virus. In addition, five long-term care facility staff members have died related to COVID-19 in Nebraska.
"COVID didn't create any of these problems," Todd Stubbendieck, with the Nebraska AARP, said. It just made us realize that they were there before and maybe we all should have been paying attention to them before COVID."
Stubbendieck wouldn't comment specifically on Continental Springs, but told 3 News Now the last year has been heartbreaking. He says nursing homes have borne the brunt of this disease, even though most residents have followed all the rules and stayed home.
"They've been wearing mask, they've had limited visitors, they've done everything right. The problem is that we on the outside haven't been doing what's right... it's the community spread, and our inability to get control of the virus outside the facilities that brought it inside the facilities and caused it," he said.
Heath Boddy with Nebraska Healthcare Association said in the last year, so much of the information provided by health officials has changed in regard to COVID-19, making things difficult on long-term care facilities.
"We learned that day by day, really hour by hour, frankly sometimes, minute by minute," said Boddy. He said sometimes a morning bulletin would be contradicted by lunchtime.
Boddy has provided guidance to several nursing homes dealing with outbreaks, but said he does not recall working with Continental Springs.
"I don't know of a situation of a provider that didn't try to take the information that we had at the time and do the very best they could to serve the elders in their care," said Boddy.
The latest data from Centers for Medicare and Medicaid Services shows a total of 46 residents at Continental Springs have tested positive for COVID-19. Throughout the pandemic the facility has housed roughly 40 to 50 residents.
Continental Springs told 3 News Now they have increased staffing and now have approximately 75 employees. They denied an interview request, saying the current administrator and director of nursing didn't work at the facility at the time of the May inspection.