Canterbury Rehabilitation and Healthcare Center has announced that four more people have died in the past 48 hours at the nursing home, bringing the total to death count in that facility alone to 32. According to news outlets, 49 residents are experiencing COVID-19 symptoms, while 25 have tested negative. James Wright, the facility’s medical director, has said that the death rate is about one in every four patients who have tested positive.

According to Medicare.gov, Canterbury Rehabilitation and Healthcare Center has a poor track record based on the government’s five-star rating system. As of April 2020, the facility received only one star out of five on health inspection ratings, meaning the facility grades much below the state average. The facility only receive one star out of five on staffing, meaning the facility graded much below average on the amount of staff the facility has available to care for patients. The overall rating is two stars out of five, which grades below average.

Medicare also reports that the facility received 23 health citations in the last governmental inspection of October 3, 2019, which is available here. In the past 3 years, the facility has received 7 complaints resulting in citations. Most importantly, Canterbury, as recently as its last inspection, has been cited for failing to provide an implement an infection prevention and control program.

Statewide, there have been more than 3,000 Coronavirus cases and 63 deaths. The Centers for Disease Control and prevention has instructed long-term care facilities to develop comprehensive coronavirus response plans. The CDC has advised the following steps to prevent or limit the outbreak of the coronavirus in nursing homes:

• Restrict all visitation except for certain compassionate care situations, such as end of life situations
• Restrict all volunteers and non-essential healthcare personnel (HCP), including non-essential healthcare personnel (e.g., barbers)
• Cancel all group activities and communal dining
• Implement active screening of residents and HCP for fever and respiratory symptoms

Nursing homes also should provide appropriate supplies to prevent infection, including:

• Hand hygiene supplies:
  • Put alcohol-based hand sanitizer with 60–95% alcohol in every resident room (ideally both inside and outside of the room) and other resident care and common areas (e.g., outside dining hall, in therapy gym).
  • Make sure that sinks are well-stocked with soap and paper towels for handwashing.
• Respiratory hygiene and cough etiquette:
  • Make tissues and facemasks available for coughing people.
  • Consider designating staff to steward those supplies and encourage appropriate use by residents, visitors, and staff.
• Make necessary Personal Protective Equipment (PPE) available in areas where resident care is provided. Put a trash can near the exit inside the resident room to make it easy for staff to discard PPE prior to exiting the room, or before providing care for another resident in the same room. Facilities should have supplies of:
  • facemasks
  • respirators (if available and the facility has a respiratory protection program with trained, medically cleared, and fit-tested HCP)
  • gowns
  • gloves
  • eye protection (i.e., face shield or goggles).
• Consider implementing a respiratory protection program that is compliant with the OSHA respiratory protection standard for employees if not already in place. The program should include medical evaluations, training, and fit testing.
• Environmental cleaning and disinfection:
  • Make sure that EPA-registered, hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident care equipment.
  • Refer to List Nexternal icon on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2

On March 25, 2020, the Virginia Department of Health issued its own guidance for nursing homes following the lead of the CDC. According to the Virginia Department of Health, facilities must take actions to prevent an outbreak, including:

• Developing  an action plan
• Restricting visitors
• Identifying infection early
• Enforce social distancing among staff and residents

Once an outbreak has occurred, facilities must:

• Notify the local health department
• Test to confirm infection
• Implement facility-wide disinfection
• Consider suspending new admission
• Restrict visitors
• Use PPE

Nursing homes that do not take the necessary steps to prevent coronavirus from spreading can be held legally responsible for damages and death caused by the virus. For example, if an infected nursing home staff member exposes a nursing home resident to the virus after not wearing protective gear, the nursing home resident may have a valid claim for a negligence lawsuit.