Surveyors complete 115 infection control surveys in Idaho nursing homes

Nursing homes in Idaho are working hard to protect their residents and staff from COVID-19, even as it spreads widely in many Idaho communities. Regulatory inspections are one way to know whether they are meeting their goal to prevent the spread of COVID-19 in their facilities. Surveyors from the Department of Health and Welfare’s Division of Licensing & Certification and Centers for Medicare and Medicaid Services (CMS) are working with them in this fight against COVID-19 and have completed 115 targeted infection control surveys in Idaho nursing homes, as of Aug. 21, 2020.

This is part of the joint response from CMS and the Centers for Disease Control and Prevention (CDC) and previous direction issued in March, when CMS required all state survey agencies to complete an initial infection control survey in every nursing home in the state. Idaho completed all the initial infection control surveys in Idaho’s 82 nursing homes by the July 31 deadline.

Some nursing homes have had more than one infection control survey during this time as CMS also is requiring states to conduct infection control surveys in the following circumstances:

1. Perform on-site surveys of nursing homes with previous COVID-19 outbreaks that meet one of the following criteria:
   1. Cumulative confirmed cases/bed capacity at 10 percent or greater; or
   2. Cumulative confirmed plus suspected cases/bed capacity at 20 percent or greater; or
   3. 10 or more deaths reported due to COVID-19.
2. Perform on-site surveys (within three to five days of identification) of any nursing home with three or more new COVID-19 suspected and confirmed cases since the last National Healthcare Safety Network (NHSN) COVID-19 report, or one confirmed resident case in a facility that was previously COVID-19-free.
3. Starting in Federal Fiscal Year 2021 (which begins in October 2020), perform annual focused infection control surveys of 20 percent of nursing homes based on state discretion or additional data that identifies facility and community risks.

Results of Infection Control Surveys Conducted (as of Aug. 21, 2020)

Common opportunities for better infection control practices found in facilities include:

• Isolating or cohorting residents with COVID-19
• Use of personal protective equipment (PPE) (fitting, doffing/donning, disposal)
• Hand hygiene
• Dedicated staff for COVID-19 residents
• Screening staff, outside healthcare providers, and visitors

“With the daily challenges facilities face during this pandemic, a deficiency-free survey is difficult to achieve, so the fact that 49 surveys have been deficiency-free speaks highly of Idaho’s nursing homes,” said Licensing & Certification Administrator Tamara Prisock. “Nursing homes are deeply committed to preventing the spread of COVID-19, and those facilities with deficiencies are usually quick to address any gaps in infection control. The survey results also help DHW staff connect facilities with state and federal training and resources to help them strengthen their infection control practices.”

All surveys for long-term care facilities are posted on the DHW website when they are completed. If deficiencies are found, the surveys are posted after the department has approved the facility’s plan of correction, which is the plan for how the facility will address the deficiencies. That process can take a few weeks, but the department is looking at ways to shorten that process so the surveys and plans of correction are available to the public sooner. Immediate jeopardy citations result in immediate enforcement actions that could include fines, a ban on new admissions, or a revocation of the license or certification.

All surveyors wear full PPE when they are conducting surveys on-site. They are screened in the division as well as by each facility before they begin on-site surveys. If they show any signs of illness, they do not conduct any surveys, and they are tested for COVID-19 and asked to self-isolate while test results are pending.

Ten surveyors in the department conduct infection control surveys in nursing homes. In mid-July, two surveyors tested positive for COVID-19. The nursing home surveyors who tested positive didn’t know they were ill when they conducted surveys, and they were immediately isolated for 14 days once they were diagnosed.

The nursing home facilities visited by these two surveyors were notified of the positive results, but not as quickly as we would have liked. The department now has a policy and process in place to notify facilities within 24 hours if a surveyor tests positive for COVID-19. At this time, no positive cases among staff or residents have been traced back to potential exposure from either surveyor.

There are also 13 surveyors in the department who conduct surveys of assisted living facilities. One surveyor on the assisted living team also tested positive for COVID-19, but that surveyor had not been on-site in any facilities for several weeks before testing positive.

For more information about Idaho’s response to long-term care facilities, please visit https://coronavirus.idaho.gov/ltc/. Data summaries for ongoing and resolved outbreaks in long-term care facilities are posted weekly on Fridays.