One facility was cited for allowing an assistant director of nursing, who tested positive for COVID, to work for five days. Plans of correction were submitted by each home. None of the facilities were fined.

The unannounced, in-person inspections resulted in enhanced staff training and additional deliveries of personal protective equipment (PPE), according to the Department of Public Health (DPH). During the pandemic, health care workers have complained about a lack of PPE, having to reuse their equipment.

Here’s a summary of the homes and the violations:

• Abbott Terrace Health Center of Waterbury was cited for failing to ensure that residents wore masks outside of their rooms and that residents maintained social distancing while outside their rooms.

• A registered nurse at Apple Rehab Coccomo of Meriden was observed not wearing a mask while walking through the facility and a nurse aide entered a unit without wearing a mask or face covering. Yellow gowns were found hanging outside rooms of residents rather than inside.

• Avon Health Center was cited for failing to ensure that a curtain was drawn between a resident who was awaiting the results of a COVID-19 test and a resident who did not have the virus.

• An inspector observed a certified nursing assistant exit a resident’s room at Bayview Health Care in Waterford without wearing the proper PPE. Also, the inspection found the potential cross-contamination of monitoring devices, such as the oxygen saturation scanner, which was set down on a table after use, cleaned, but then returned to the table which was not cleaned.

• Beacon Brook Health Center of Naugatuck was cited for allowing several residents to eat meals together, when communal dining should have been stopped.

• An inspector found that Bethel Health Care failed to separate residents with the virus from residents without the virus and that a nurse aide used the same PPE while caring for COVID and non-COVID residents.

• At Cassena Care, New Britain, an inspector found that the facility failed to ensure that room curtains were drawn between residents’ beds.

• At Countryside Manor, Bristol, a transportation service crew was observed removing a COVID resident from the COVID-positive wing through a non-infected wing without proper facial covering for the resident.

• During an inspection at Evergreen Health Care Center, Stafford Springs, a housekeeping staff member was observed removing soiled linen bags from soiled linen carts without wearing protective equipment, including a gown. The linens hit rubbed against the staffer’s body.

• Fox Hill Center of Rockville was cited for failing to notify a responsible party when a resident’s condition changed.

• Groton Regency Center was cited after an inspector observed that the dietary manager was not practicing proper hand hygiene when working in the facility.

• A licensed practical nurse at Madison House was observed exiting a resident’s room and placing a used face shield on a cart that contained PPE.

• Nathaniel Witherell of Greenwich was cited for failing to have signage outside a room indicating that a COVID-19 test was pending.

• RegalCare at New Haven was cited for the incorrect use of PPE, for not having enough PPE, and for not checking staff members’ temperatures before allowing them to enter the work area.

• A staff member at St. Camillus Rehabilitation & Nursing Center, Stamford, was observed leaving a room that has a droplet precaution sign on door and proceeding down the hallway and then removing the gown and gloves. Staff should have removed PPE inside the room before exiting.

• An inspection found that an assistant director of nursing at The Suffield House worked for five days at the nursing facility despite testing positive for COVID-19. Inspector wrote “she reported to work in the long-term care facility for five days and potentially placed other staff and residents at risks for contracting coronavirus.”

• Twin Maples Healthcare in Durham was cited for staff members’ incorrect usage of protective eyewear while caring for a resident who was on droplet transmission-based isolation. The resident was a recent admission to the facility. The home was also cited for a housekeeper’s practice of touching a soiled utility-room doorknob and then touching clean linens; and for the mixing of clean and used incontinence briefs.

• West Hartford Health & Rehabilitation was cited for failing to separate a COVID-positive resident from a resident who did not have COVID.

• An inspector observed a licensed practical nurse at Windsor Health & Rehabilitation Center working at a medication cart without wearing a mask. The LPN indicated that she did not need to wear a mask because she had recovered from coronavirus, but was told that all staff need to wear masks.

In response to the inspection findings, Matt Barrett, president and CEO of the Connecticut Association of Health Care Facilities, and Mag Morelli, president of LeadingAge Connecticut wrote in a press release, “We believe Connecticut nursing homes are performing at an extraordinary level given the challenges of fighting this insidious virus while faced with changing guidance, an inadequate PPE supply chain and a statewide testing initiative that has only recently begun. And while we would prefer that these focused inspections did not result in any findings, we absolutely welcome the Department’s oversight and efforts in ensuring that Connecticut nursing home infection control procedures are in adherence with the latest of what has been ever-changing CDC guidance.”

This week, Dr. Deidre Gifford, acting commissioner of public health and commissioner of the Department of Social Services, said that the state is conducting a “point prevalence surveys in every nursing home and testing every resident” to better understand the high rate of infections.

The testing is also being done to provide information to facilities so that they can cohort COVID positive residents from residents who are virus free, which will further decrease the chance of spread, Gifford said.

On Monday, the Centers for Medicare & Medicaid Services issued new guidelines for the reopening of nursing homes. CMS recommends “baseline” testing of residents (which CT is doing) and staff followed by weekly testing of staff. Facilities should ensure that they have adequate protective gear. CMS also recommends that nursing homes be “among the last” of entities in the state to reopen.   The guidelines are nonbinding, leaving it up to each state to determine when nursing homes should be reopened to visitors.

CORRECTION: An earlier version of this story reported that Twin Maples Healthcare in Durham had a COVID resident. It does not.

In all, four nursing homes were recently fined by the state Department of Public Health (DPH) for various violations.

Apple Rehab Avon received two fines, totally $5,625, connected to a March incident in which a resident died and a nurse misinterpreted the medical file to contain a Do Not Resuscitate (DNR) Order, according to documents.

In the first citation, the facility was fined $3,000. According to the citation, on Feb. 24 the resident—who was bipolar and suffered from depression, atrial fibrillation and pulmonary embolism—signed an advance directive order waiving all advanced directives; it was signed by the attending physician and said, in part, that the resident wanted “efforts to prolong life and want(ed) life-sustaining treatment to be provided.”

Less than two weeks later, on March 2, a registered nurse checking on the resident found the resident with no heartbeat, not breathing, and pale and cool to the touch, according to DPH. The nurse looked at the resident’s file and “interpreted the code status as Do Not Resuscitate.”

The nurse told the attending physician that the resident had a DNR. The nurse obtained a RN Pronounce Order from the doctor and pronounced the resident dead, according to DPH.

The nurse was suspended immediately. In follow-up interviews, the attending physician said he assumed the nurse had read the code correctly and did not question giving the RN Pronounce Order, DPH said.

Following the incident, licensed staff members at the facility were educated on the importance of verifying advance directive documents and participated in a mock code drill.

The facility was also fined $2,625 for not following its policy regarding CPR, the second citation said. The policy says, in part, that CPR is the first treatment for someone who doesn’t have a DNR status and has no pulse and has stopped breathing, according to DPH. The policy says CPR should be initiated per physician’s orders.

A spokesperson for the facility could not be reached for comment.

Countryside Manor of Bristol was fined $3,000 for various violations in which staff didn’t know how 10 residents were injured.

Between August 2015 and May 2016, 10 residents sustained a total of 47 injuries, according to the citation. DPH found that in each case the cause of the injuries was unknown and that the staff failed to conduct proper investigations to try and find the causes.

The patients—who all had diagnoses such as Alzheimer’s disease, dementia and Parkinson’s disease and who depended on staff for help with mobility—suffered bruises, skin tears, rashes and, in one case, a swollen lip, according to DPH.

Officials at the facility did not respond to a call seeking comment.

New London Rehabilitation and Care of Waterford was fined $3,000 for an incident in which nurses failed to perform proper spot checks on residents and one resident left the facility.

The resident had Korsakoff Syndrome, a chronic memory disorder, as well as depressive order, anxiety and dementia, according to the citation. The resident, who was kept in a secured unit, had threatened to leave the facility multiple times and wore an ankle bracelet monitor.

According to the citation, staff realized the resident was missing during a routine check at 6 a.m. Feb. 13. The resident had shown up at a local hospital at 2:30 a.m. and was admitted for altered mental status after complaining of frostbite from hiking.

DPH found that staff failed to ensure they knew the resident’s whereabouts between 11:30 p.m. Feb.12 and 6 a.m. Feb. 13, despite policy dictating that spot checks were to be done. A nursing assistant later said that although she signed documentation stating she had done spot checks every 30 minutes, she didn’t actually look behind the resident’s privacy curtain and assumed the resident was in bed, according to DPH.

Also, staff did not properly page a “Dr. Hunt” code for the missing resident, as is policy, and didn’t realize how the resident had left until another resident was seen in an outdoor courtyard and staff noticed a nearby open window with a broken latch.

DPH requested from the facility an action plan in which all supervisors will be educated about protocols that staff providing direct care must follow. A registered nurse supervisor will be responsible for ensuring rounds are completed every two hours, and audits will be conducted to ensure compliance, according to the citation.

Officials at the facility did not respond to a call seeking comment.

Harrington Court in Colchester was fined $330 for a Jan. 16 incident in which one resident was mistakenly given another resident’s medications.

A registered nurse gave a resident—who suffered from congestive heart failure and other diagnoses, but was feeling well and alert—Oxycontin and insulin meant for another resident, according to DPH. The nurse realized as she left the resident’s room that she had administered the wrong drugs, and a physician was notified.

According to the citation, the resident became dizzy and lethargic and subsequently required Narcan and oxygen therapy. An investigation found the nurse administered the original medications without first checking the resident’s name band.

Officials at the facility did not respond to a call seeking comment.