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    Wednesday, August 10, 2022

    State says deficient infection control jeopardizes lives at Norwich nursing home

    Norwich — The Three Rivers nursing home, where 21 residents have contracted COVID-19 and three have died, is putting lives in "immediate jeopardy" due to its deficient infection control practices, the state Department of Public Health said Monday.

    Five staff also have contracted the virus, according to the DPH, and one resident is hospitalized currently, the rest recovering at the Three Rivers facility, segregated from other residents who have not tested positive, the DPH said.

    One of those now recovering is Edward Pratt Sr. of Norwich, who believes he was the one who alerted state officials to the problems at the nursing home. Pratt said he was told by a doctor at Backus Hospital that he was near death when he was hospitalized for the second time with COVID-19 on Aug. 19, suffering a high fever and sweats that left him soaking wet.

    "I was in really bad shape," Pratt said in a telephone interview Monday. "I almost died. I couldn’t eat or drink for a week. They (the nursing home) said I had a stomach bug. I was sweating so bad. I had a temperature of 102. I kept asking all day for the supervisor, and they wouldn’t come. My wife had to threaten to call (911) to call an ambulance."

    The nursing home did call an ambulance, and he was taken to Backus and treated with remdesivir and a steroid, which worked. He was discharged back to Three Rivers and now is segregated and quarantined in a COVID-19 room with another patient who had contracted the virus.

    Pratt, 57, went to Three Rivers in December to recover after he had one leg amputated below the knee due to diabetes. Before contracting COVID-19, he was expecting to be fitted with a prosthesis and sent home Aug. 27.

    Pratt is waiting to be tested again but complained that staff won't tell him when. While he has his prosthetic, he is not allowed to leave the room to walk around to try it out. He is worried about contracting the virus again, since he now is rooming with another COVID-19 patient.

    "It's still in my system, but the medicine is not doing too bad of a job," Pratt said. "My stomach still hurts. ... The biggest thing is, I want to get out of here because I’m scared for my life."

    Pratt's wife, Elizabeth, and son, Edward Jr., went to the facility Monday afternoon to drop off snacks for him. They were not allowed in the home to see him, or even have an outdoor visit through a window.

    "Hopefully, all this coverage will help change things," Elizabeth Pratt said of the media attention given to Monday's findings by the state.

    During his daily coronavirus news conference Monday, Gov. Ned Lamont said, "There were some severe deficiencies that we're going to look at and hold people accountable."

    The state Department of Public Health gave the nursing home 10 days to present a plan of correction in response to the findings. The finding of immediate jeopardy means the violations are serious enough to risk imminent harm to life. In addition to these findings of violation of federal standards, DPH is investigating whether state regulations, laws or executive orders were violated by the 114-bed facility, located at 60 Crouch Ave.

    A representative of the facility could not be reached to comment and did not return messages left with staff by Day reporters Monday evening.

    The finding threatens the facility's ability to continue to collect Medicare and Medicaid funds, which are a major source of funding for nursing homes throughout the country. The statement of deficiency issued Monday is a federal enforcement action made by DPH as the investigatory agent for the Centers for Medicare and Medicaid Services, or CMS, the federal entity that regulates nursing home participation in the Medicare and Medicaid programs.

    "We are on the ground inside Three Rivers with our DPH team from our facility licensing and investigation teams to ensure they are doing what they need to be doing," Av Harris, a spokesman for DPH, said by phone Monday afternoon. "This is the first enforcement action against Three Rivers and there will likely be more to follow."

    Pratt said he spoke twice on the phone to state health officials and once in person at the home.

    He is still dissatisfied with the nursing home's response to the pandemic. He said he still feels the home is understaffed and that staff don't respond promptly to residents' requests for help or complaints about pain and other problems.

    Harris said other nursing homes have received similar findings of deficiency but could not immediately say how many were involved.

    About 70% of the 4,465 deaths from COVID-19 in Connecticut have involved nursing homes. Most of Connecticut's nursing homes and assisted living facilities experienced outbreaks earlier in the coronavirus outbreak and greatly reduced the number of cases and deaths more recently. Weekly testing of staff and residents is required at the facilities, by executive order of Gov. Lamont, until there are no positive cases, at which time the facilities can "pause" testing, according to Harris.

    The DPH investigation found that the Three Rivers outbreak began July 24, when a staff member tested positive through routine weekly testing. The investigators said they found serious violations, facilitywide, in general infection control practices, staffing, cohorting (grouping together) residents who tested positive, and use of personal protective equipment, or PPE.

    Pratt said he believes the third-shift nurse, who routinely gave him medication, was the source of his infection. He said the nurse was sick and did not wear a mask or gloves when giving him his pills.

    "To me, they weren’t prepared for this, or just didn’t know what they were doing," Pratt said.

    "DPH is deeply saddened by the further loss of life in nursing homes related to COVID-19. We will continue our robust monitoring and enforcement activities in partnership with CMS to ensure that nursing homes are providing a safe environment for their residents," acting DPH Commissioner Deidre S. Gifford said. "Our investigation uncovered system-wide failures in this nursing home in infection control practices, that merited the finding of immediate jeopardy. DPH is committed to holding facilities accountable and ensuring that improvements in patient care are made so residents' lives are not put in danger."

    Key findings of the investigation include that the facility failed to do the following:

    • Ensure appropriate cohorting of residents to prevent the transmission of COVID-19.

    • Utilize personal protective equipment in accordance with Centers for Disease Control and Prevention standards.

    • Ensure appropriate designation of staff.

    • Maintain an updated, accurate or accessible outbreak listing of the COVID-19 status of the residents.

    • Ensure that a required 14-day quarantine was maintained for a resident exposed to COVID-19.

    • Ensure that an aerosolized medication was administered to that resident in a manner consistent with current infection control standards, putting that resident and staff at risk of exposure to COVID-19.

    • Ensure that visitor screening regarding a person's recent travel history was conducted in accordance with an executive order dated June 25, 2020, that was issued by the governor.

    • Ensure appropriate storage of reusable isolation gowns to maintain infection control standards.



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