Citing hellish conditions, COVID-19 cases, Florida suspends 2 nursing home administrators

2020-04-20 | The Miami Herald

April 20-- Apr. 20--Nursing home staff members worked without masks while unused N95 masks sat in an office. Some resident rooms lacked hand sanitizer or gloves. A COVID-19 isolation area was placed in the area of least separation -- a main hallway to the cafeteria.

And, when 35 residents were tested Tuesday, eight (22.9 percent) came back positive.

These snapshots from Cross Landings Health Care Rehabilitation Center in Monticello, a town near Tallahassee, were from Friday's emergency suspension orders on Mark Daniels' and Sebrina Cameron's nursing home administrator licenses.

The revelations come amid a tug-of-war between news media outlets and the administration of Gov. Ron DeSantis over whether information on elder-care facilities that have had positive tests for the coronavirus, which causes COVID-19, should be made public.

Until this weekend, the governor had refused to divulge any records at all, even as the Miami Herald and other news outlets gave formal notice that they planned to file a public records lawsuit challenging his refusal.

On Saturday, DeSantis relented somewhat and published a list of nursing homes with positive tests, although the list doesn't indicate how many residents or staffers had tested positive and whether anyone had died.

The news organizations plan to proceed with the litigation, noting that other states with less robust public records laws, including Illinois and California, have been more forthcoming.

Nursing homes and assisted living facilities have become coronavirus hot spots all over the country, with one in five deaths in Florida linked to elder-care facilities.

Daniels, Cross Landings head administrator, and Cameron, the regional nursing home administrator for Cross Landings' parent company, are the first nursing home administrators disciplined by the state for failing resident safety during the coronavirus pandemic.

Daniels, 63, has had his license since August 1992. Cameron, 53, has had her license since June 2009.

After two residents tested positive for COVID-19, a Florida Department of Health testing team of four registered nurses went to Cross Landings eight times from April 9 through last Monday.

The suspension orders, one for each administrator, said Daniels' and Cameron's "antagonistic relationship with the team members that were sent to try to assist [them] and Cross Landings' staff and [their] repeated failure to enact or enforce reasonable safety measures are more than mere mistakes, but rise to the level of negligence and incompetence."

State records say Cross Landings' owner and licensee is CL Golden LLC, a company owned wholly by Broward County resident Joyce Plourde. Plourde has been a Florida-licensed nursing home administrator since 1986.

The Herald left messages on the cell phones of Cameron, Daniels and Plourde. None responded as of early evening on Sunday.

The Agency for Health Care Administration (AHCA) found no deficiencies on its last two visits to the 60-bed facility, in October from a complaint and in January to check the generator. Deficiencies cited in a March 2019 standard inspection were corrected by May 2019.

But after spending eight to 12 hours a day at Cross Landings, the Department of Health team of nurses saw "a systemic failure" in the use of safety measures to slow the spread of the the novel coronavirus.

"Moreover," the suspension orders say, "[Cameron and Daniels] willfully resisted the team's recommendations and obstructed their attempts to ensure the safety of the residents at Cross Landings."

Screening

During the pandemic, each person entering a nursing home must be screened, with temperature taken, questions about symptoms asked, contacts with COVID-19-positive individuals explored and travel history discussed. The answers are supposed to be logged.

The DOH nursing team saw screening done erratically and often done after the person was already inside the facility. The team saw people with signs of a respiratory illness allowed inside.

Also, "staff failed to sanitize the thermometer between individuals seeking entry" and didn't always use the thermometer properly.

"A team member requested to review the screening log book after Cameron entered the facility without being screened," the suspension orders say. "Daniels slammed the log book shut on the nurse's hand, yelled at her and hid the book in his office."

Masks and gloves

"Cross Landings staff failed to properly wear PPE [personal protective equipment]; failed to wash or sanitize their hands after removing their PPE; and failed to sanitize their hands when going in and out of the facility," the suspension orders noted. "Many staff members did not have masks. Many of those that did failed to wear them correctly, negating their effectiveness. Other staff wore soiled and used masks."

This was after the team saw "several" new N95 masks in Daniels' office "that he refused to distribute to staff or residents."

"Cross Landings did not have an adequate supply of gloves and hand sanitizer in the residents' rooms," the orders said.

'Isolation' on a busy hallway

Calling Cross Landings' isolation of COVID-19-positive residents "woefully inadequate," the suspension orders stated "the designated 'isolation area' was located in a hallway that served as a main thoroughfare for the facility. Staff and residents had to walk through the 'isolation' area to access the cafeteria, kitchen and other resident rooms."

"Cross Landings staff carried open and uncovered dinner trays through the 'isolation area' to residents in the rest of the facility."

This continued even after two more residents tested positive April 11. One of those two residents not only wasn't isolated, but was "allowed ... to wander around the halls without a mask," the orders stated.

Pushback

According to the suspension orders, Cameron, Daniels and the Cross Landings staff eventually started telling other staff to ignore the DOH nursing team's instructions and "not to speak to them because they were 'trouble.' "

When Cross Landings staff asked for the DOH nurse's help with a resident, the nurse saw a floor littered with soiled underwear, a room with soiled wipes, a bed with no sheets and a patient with ulcers on her heels and an open wound on her back. Both she and her roommate were coughing.

After they looked at the resident's recent history and tried to see vital sign records, the director of nursing scolded them that viewing charts wasn't among their duties. Also, the DOH nurses were told, all conversations going forward would be recorded and Cross Landings' owner would be calling in an attorney.

A later attempt to check the charts of COVID-19 positive residents was ended when the director of nursing "snatched the charts from them and stated they were not allowed to review patient charts or direct staff at the facility."

The nursing team was banned from the center by Cross Landings administration. But they were back the next day, Tuesday, anyway.

Final tests

The Department of Health wanted four of the residents who had tested positive and one suspected of being positive moved to another home with better anti-transmission safeguards. The nurses were to help with the moves. That's when they tested 35 residents and found eight with novel coronavirus.

"While conducting the tests inside Cross Landings, the team members observed multiple residents soaked in urine and feces," the suspension orders stated. "It appeared that the residents had been in that condition for an extended period of time."