Nursing home COVID-19 outbreaks in Fresno and Madera counties among worst in California

Nov. 24--COVID-19 outbreaks at skilled nursing facilities in Fresno and Madera counties are among the worst this month in California.

Only a few nursing homes elsewhere in the state had more active coronavirus cases Monday than the area's worst current outbreak, at a Chowchilla facility, according to data from the California Department of Public Health.

COVID-19 has been incredibly widespread in skilled nursing facilities. All 132 listed by the state in Fresno, Tulare, Madera, Kings, Kern and Merced counties have reported COVID-19 cases since the pandemic began. There have been coronavirus deaths at 48 of these Valley facilities.

And these lists are just for skilled nursing facilities, not other residential senior homes.

Nursing home outbreaks are among the reasons Valley counties were put on the state's coronavirus watch lists.

New COVID-19 cases had been dropping overall in California skilled nursing facilities since August. That changed this month, with the state reporting cases there sharply increasing, similar to trends within the general population.

Current coronavirus outbreaks and largest total cases

From Merced to Kern County, 13 skilled nursing facilities in the Valley reported active coronavirus cases Monday -- nearly half of those in Fresno County, according to state data updated daily.

Madera County has the largest new outbreak in the area. There were 45 patients at Palms Care Center in Chowchilla currently positive for COVID-19 on Sunday. The next day, some state data wasn't listed for Palms Care -- the only skilled nursing facility in California to show "N/A" Monday beside "today positive residents." The unreported information came after The Bee asked Palms Care to comment about its weekend COVID-19 outbreak. The request for comment wasn't returned.

In total, state data shows there have been 52 patients with COVID-19 at the Chowchilla facility, and 21 total health care workers with coronavirus. In addition, less than 11 residents there with coronavirus have died. The state doesn't report numbers below 11, citing privacy concerns.

In Fresno County, the largest current reported outbreaks are at Willow Creek Healthcare Center in Clovis and Sierra Vista Healthcare Center in Fresno.

State data shows 39 Willow Creek residents now infected of 103 total there to contract COVID-19, along with 53 total health care workers, and less than 11 COVID-19 patient deaths.

Sierra Vista has 26 residents currently infected -- 80 total with COVID-19 -- and less than 11 deaths, along with 62 total health care workers to have contracted the virus.

Farther north, Franciscan Convalescent Hospital in Merced reported 23 active patient cases Monday (26 total), along with less than 11 patient deaths, and less than 11 workers now positive (14 total to have had coronavirus).

A number of other Valley homes reported smaller numbers of new active cases Monday, including Veterans Home of California -- Fresno, and Redwood Springs Healthcare Center in Visalia -- one of the first to report COVID-19 this year.

State data shows the worst current outbreak in California on Monday at Arden Post Acute Rehab in Sacramento, with 75 patients currently positive for coronavirus.

From Merced to Kern County, here are Valley homes with the largest cumulative COVID-19 deaths and cases this year, as of Monday:

-- 35 deaths, 81 patients and 34 health care workers with coronavirus at Porterville Convalescent Hospital.

-- 33 deaths (+ less than 11 worker deaths), 120 patients and 40 workers with coronavirus at Dycora Transitional Health -- Fresno.

-- 29 deaths, 140 patients and 87 workers with coronavirus at Redwood Springs.

-- 20 deaths, 110 patients and 63 workers with coronavirus at Madera Rehabilitation & Nursing Center.

-- 23 deaths, 90 patients and 80 workers with coronavirus at Hacienda Post Acute in Hanford.

-- 19 deaths, 104 patients and 71 workers with coronavirus at Kingston Healthcare Center in Bakersfield.

-- 16 deaths, 59 patients and 45 workers with coronavirus at Linwood Meadows Care Center in Visalia.

-- 15 deaths, 67 patients and 31 workers with coronavirus at Dinuba Healthcare.

-- 12 deaths, 30 patients and 14 workers with coronavirus at Dycora Transitional Health -- Memory Care of Fresno.

Fresno public health officials about nursing homes

Fresno County interim Public Health Officer Dr. Rais Vohra briefly addressed nursing home outbreaks during calls with media last week. He called these outbreaks some of the county's most concerning coronavirus trends, and said his department is working to help while being "very aggressive with messaging" to facilities.

Vohra said his office received reports of personal protective equipment shortages "because the entire country is basically experiencing a surge." In Fresno County, the slope of this surge is steeper than it was in the summer, Vohra said, with a lot of community spread from multiple sources.

"I think everyone is shocked by how extraordinary this surge really is," he said.

If multiple facilities have large outbreaks, then the county will have staffing shortages and "very tragic outcomes in terms of fatalities and hospitalizations."

"We want to overt that as much as possible, so that's one area we are really focusing a lot on," Vohra said of his office's work with skilled nursing facilities.

Fresno County investigation into nursing homes

In response to questions from The Bee, the Fresno County Department of Public Health shared a short emailed statement, noting an ongoing investigation.

Public health officials didn't share specifics about their work this month with nursing homes, if that work has changed since earlier this year, or coronavirus testing information.

The county also declined to share the number of COVID-19 cases and deaths at Willow Creek, although the California Department of Public Health has made those numbers public on its website for months.

Following a statement, a Willow Creek spokesman only answered one of The Bee's follow-up questions: "We're still working through the outbreak and mitigation efforts, and at this point are not aware of what specifically has driven it."

Willow Creek didn't respond to questions about how often residents are tested for COVID-19, and if all in the facility have been tested for coronavirus.

California Department of Public Health about testing

Nursing homes are supposed to develop plans to combat coronavirus in conjunction with the state and their local health departments. They are required to report COVID-19 cases to the state, which makes these numbers public -- noting that reporting cases doesn't imply wrongdoing.

The California Department of Public Health has issued more than 55 "all facility letters" this year with requirements and guidance related to COVID-19.

One of those letters, in September, offered more detailed information about coronavirus testing for skilled nursing facilities.

Baseline testing of all residents and workers was required by June 30. Testing new residents prior to admission is another directive.

The letter also details the need for repeated testing until there are no COVID-19 cases in a facility. The state said if COVID-19 is present in a facility, all residents and health care workers who tested negative upon a prior round of testing should be retested every seven days "until no new cases are identified among residents in two sequential rounds of testing." After that, the state wrote, a regular screening testing schedule can resume for health care workers.

It's unclear whether this has been happening at skilled nursing facilities in Fresno County. These facilities and the Fresno County Department of Public Health have not shared testing schedules with the public.

One of the state's most recent all-facility letters, dated Nov. 9, informs skilled nursing facilities that starting Jan. 1, they will be required to have a full-time infection preventionist on staff with the passage of California Assembly Bill 2644.

Facilities address infection control

A spokesman for Willow Creek provided a general statement about its infection control protocols, including restricting non-medically necessary visits, screening for symptoms and high temperatures, isolating those with symptoms, avoiding group activities "where possible," and only allowing visitors in for end-of-life situations.

"Willow Creek has provided all of the necessary personal protective equipment (PPE) to staff members," Willow Creek's statement continued, "and required its use even before the facility had any positive cases."

The facility said it updates family and residents about new COVID-19 cases, and provides a weekly status update. Leaders there also said their protocols are consistent with guidance from the state health department, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, and other federal, state and local health care authorities.

Sierra Vista in Fresno lists similar practices on its website. There, it also promises to post the "most current information regarding COVID-19." It was last updated a week ago, then noting 10 patients and three health care workers with the virus.

Dozens more cases were reported there Monday by the state.

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