In this Aug. 19, 2020, photo, a pedestrian walks past the Maplecrest Rehabilitation and Living Center shown in Madison. Credit: Rich Abrahamson / Waterville Morning Sentinel via AP

On July 7, state inspectors visited Maplecrest Rehabilitation and Living Center in Madison to see how well the 58-bed facility was following rules meant to prevent the spread of the coronavirus.

Inspectors noted no problems and said in their one-page report that Maplecrest was following the rules.

Five weeks later, a certified nursing assistant reported for work, noted in a log that she was suffering from a number of symptoms associated with COVID-19, and proceeded to put in a 10-hour overnight shift caring for residents. She apparently didn’t tell her supervisors about the symptoms — a sore throat, cough, chills and muscle aches — and her supervisors didn’t check the screening log. The employee tested positive for the coronavirus days later.

The coronavirus outbreak at Maplecrest to which that employee contributed has since infected at least 39 residents and employees, and seven residents have died. It’s one of a number of secondary outbreaks linked to an Aug. 7 wedding in the Katahdin region that’s responsible for about 180 cases of COVID-19 across the state.

The inspection that took place in early July was part of a round of federally required inspections the state performed at all 93 Maine nursing homes specifically to test how well the facilities were following rules meant to limit the coronavirus’ spread. Those visits turned up violations at 13 facilities, according to DHHS spokesperson Jackie Farwell. While Maplecrest passed the July inspection, the state cited the facility for the Aug. 11 lapses following a series of follow-up inspections in late August and early September.

Inspectors looked at how well facilities were screening employees when they reported for work, how well employees were washing hands at critical moments, whether the facilities had enough personal protective equipment and whether their employees were using PPE appropriately.

Nursing homes have been the sites of some of the nation’s most serious coronavirus outbreaks, as the virus spreads easily among residents who live in tight quarters and residents’ health puts them at a distinct risk of succumbing to the virus. Maine has seen coronavirus outbreaks at 22 nursing homes since the start of the pandemic, and 86 of the state’s 140 coronavirus deaths — or 61 percent — have been nursing home residents, according to Maine Center for Disease Control and Prevention spokesperson Robert Long.

Farwell didn’t specifically respond to a question about inspectors’ review of Maplecrest’s screening procedures on July 7. She noted, however, that Maplecrest told state inspectors that the facility had infection control practices in place in response to a state survey of nursing homes in April, before the on-site inspections began.

Maplecrest’s parent company, North Country Associates, hasn’t responded to any questions about the outbreak since it began.

While Maplecrest and the overwhelming majority of Maine’s nursing homes passed the federally required COVID-19 inspections, that shouldn’t have led facilities to let their guards down, said Brenda Gallant, executive director of Maine’s Long-term Care Ombudsman Program, which advocates for nursing home residents.

“Right now, this is one of the most important aspects in terms of providing care to residents, is that vigilance in infection control,” she said. “Think about the consequences.”

The inspections geared toward COVID-19 prevention proved especially useful during a period when the federal government put a stop to states’ routine inspections of the facilities and visitors and ombudsman program staff were kept from entering the buildings, Gallant said.

The state inspectors’ visits provided some of the only outside eyes on nursing facilities. A full list of facilities where inspectors found violations was unavailable Tuesday, but inspectors noted improper use of face coverings among employees and residents and a lack of social distancing during an outdoor visit at two facilities they cited, according to inspection records.

At Mount Saint Joseph Residence and Rehabilitation in Waterville in late June, inspectors observed staff members distributing lunch trays and preparing medications without masks covering their mouths and noses. They saw another employee remove PPE and start handling cleaning supplies without first removing dirty gloves and washing hands.

“We take every opportunity to continually improve the safety of our colleagues and residents, and have resolved the issues identified in the survey,” said Christine Looby, a spokesperson for the home’s parent company, Trinity Health Of New England Senior Communities.

At Harbor Hill Center in Belfast, inspectors noticed a resident wearing a mask below the chin during an outdoor visit. Staff members had multiple opportunities to intervene, the inspectors said, but they didn’t. An employee who was tasked with monitoring the visits was at the facility’s front desk, looking down and sketching a picture. The resident’s visitor also didn’t maintain social distancing during the whole visit, according to the inspection report.

Lori Mayer, a spokesperson for the center’s parent company, Genesis HealthCare, acknowledged the center’s citation. “Since that time, we provided additional staff education and training, and submitted a plan of correction to the state,” she said.

Maine lagged much of the nation in its speed in conducting the COVID-specific inspections because inspectors didn’t have enough personal protective equipment to make the visits early on in the pandemic. But the pace of inspections picked up in June and July, according to a review of state inspection records available on DHHS’ website.

Maine has seen some of the lowest rates of coronavirus infections and deaths among nursing home residents in the nation, according to federal data. In addition, the state’s nursing homes have been required since late April to have an infection preventionist who trains employees in appropriate use of PPE and randomly observes employees to see if they’re following rules.

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