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The anatomy of an outbreak: How COVID-19 wreaked havoc at Grace Villa

Posted: February 10, 2021

(February 9, 2021)

By: Maria Iqbal, Yahoo! News

Hamilton’s worst outbreak was declared over last month, but questions linger about what happened and why.

From Nov. 25 to Jan. 20, Grace Villa long-term-care home on the east Mountain had 234 COVID-19 cases. Of its 156 residents, 44 died with COVID-19. Since then, concerning allegations about neglectful conditions inside the outbreak emerged from the home’s workers.

The Ministry of Long-Term Care has not said if it’s investigating the allegations, though an inspector who visited the home during the outbreak didn’t report any concerns.

Meanwhile, the Lockton Crescent home is back in outbreak as of Jan. 31 with one staff case.

Here’s a timeline of how it all unfolded:

Wednesday, Nov. 25:

Public health declares an outbreak at Grace Villa on 45 Lockton Cres. when two residents test positive for COVID-19.

Friday, Nov. 27

Public health does an inspection that finds a series of issues: staff with masks “pulled down, not covering the nose,” another not wearing either goggles or a shield, personal protective equipment (PPE) not readily available outside resident rooms nor garbage bins to dispose them in, missing signage and an absence of records that the home was monitoring staff compliance with COVID-19 precautions. The inspection report notes the home said its leadership team was doing checks “regularly” and correcting issues. At this time, COVID-positive residents were restricted to the third floor, according to the report.

Saturday, Nov. 28

Public health orders Grace Villa to “immediately” allow staff from Hamilton Health Sciences (HHS) to enter the home and to follow HHS direction with a penalty of up to $25,000 for noncompliance.

Public health reports a total of 34 people — 31 residents and three staff — have tested positive.

The home’s first COVID-related death is an 84-year-old woman.

Saturday, Dec. 5

Registered practical nurse (RPN) Lisa Scott gets moved from working on Grace Villa’s second floor to the third after more of the home’s staff get sick. “What I walked into was awful,” Scott said in an interview later in the month. She noted that with more residents getting sick, staff ran out of poles for IVs and had to use coat hangers to hang the bags instead. In response, Mary Raithby, CEO of APANS Health Services, said that the home had “adequate supplies” for resident care.

Eight residents have died to date.

Thursday, Dec. 10

HHS says it’s improving infection prevention and control practices and training at Grace Villa, testing staff and residents, and providing resident care.

SEIU Healthcare, the union which represents 183 workers at Grace Villa, sends a letter to Premier Doug Ford asking for hospitals to take over the management of two homes, including Grace Villa. The letter expresses concern over staffing levels and “management’s ability to support them” through the outbreaks, and notes one of their members at Grace Villa is in hospital.

10 people have died in the outbreak, and there are 126 cases, including 50 in staff. Grace Villa becomes the city’s largest outbreak, having surpassed Chartwell Willowgrove on Dec. 9.

Friday, Dec. 11

Public health inspectors return and find even more issues. The report notes there are so many COVID-19 cases now that patients are no longer limited to the third floor. Inspectors also saw a resident wandering into a common area without wearing PPE and coughing. HHS staff were working on the first floor. Inspectors noted Grace Villa was short on cleaning staff, resulting in high-touch surfaces being sanitized only once daily instead of twice. Again, there were staff without shields or goggles, missing signage, and one missing record of a staff member’s temperature check when leaving their shift, the inspection report said.

Hamilton Mountain MPP Monique Taylor writes to the province to support SEIU’s calls for a hospital takeover of Grace Villa.

SEIU Healthcare asks the federal government for military intervention at Grace Villa, describing “war zone” conditions in the home because of a shortage of staff. SEIU president Sharleen Stewart said workers were being forced to choose between sanitization and providing care to residents.

The death toll climbs to 11. At this point, the home had 77 resident and 50 staff cases since the outbreak began.

Monday, Dec. 14

Public health reports 18 deaths at Grace Villa. The home is now not only the city’s biggest outbreak, but is tied with Chartwell Willowgrove for deadliest.

Tuesday, Dec. 15

The Ministry of Long-Term Care sends an inspector to Grace Villa in response to a complaint. The provincial inspector lists no infractions in a public report of a tour of the home during which residents and meal service were observed, and interviews took place with staff and residents.

As of 3 p.m. Grace Villa has 19 deaths, surpassing Chartwell Willowgrove to become Hamilton’s deadliest outbreak.

Wednesday, Dec. 16

Public health holds another inspection, which finds continued problems with cleaning. The inspection report says agency staff didn’t have a guide of which areas to clean and said they should be assigned duties so high-touch areas could be sanitized twice daily. It noted six more cleaning staff had been brought on as of Dec. 13, though four of them were working in dietary. Inspectors added dietary staff had not been included in infection prevention and control checks to date. They also called for more signage and for sanitary supplies to be placed at appropriate spots.

Late in the day, the province and HHS announce the hospital is a temporarily taking over management at Grace Villa, effective immediately. The voluntary agreement is in effect for 90 days but can be extended. It means HHS will supervise and direct staff; make daily operational decisions; manage finances, vendors, and service providers; provide education and training; and carry out a “continuous quality-improvement program” at Grace Villa.

As of 3 p.m., the home has seen 186 cases of COVID-19, with 124 resident and 62 staff cases.

Friday, Dec. 18

HHS says not enough of its staff volunteered to work at Grace Villa, so the hospital forced more than half of its roughly 60 staff in the home to work there, and three HHS nurses had already tested positive for COVID-19.

Speaking to The Spectator, RPN Lisa Scott describes “awful” sanitary conditions in the home, including spilled food and drinks, and even feces. She’d last worked in the home Dec. 14. Raithby said the home had “enhanced” its cleaning staff.

The province was reporting 20 deaths as of Dec. 17 at 10:30 a.m., while Scott said staff counted 23 deaths. There were 96 actives cases, according to the province.

Tuesday, Dec. 29

Raithby of APANS Health Services said Grace Villa’s staff began receiving vaccinations this week.

By this date, Grace Villa had 223 cases and 37 deaths.

Wednesday, Dec. 30

An HHS spokesperson says Grace Villa’s clinical staffing levels are “stable” and Red Cross help is “not required.”

Grace Villa had 224 cumulative cases. The home would have 10 more cases and seven more deaths before the outbreak ended.

Thursday, Dec. 31

Grace Villa reports its 38th death as of 3 p.m. the previous day, nearly a quarter of the home’s residents.

Tuesday, Jan. 5

Four more deaths are reported at Grace Villa, bringing its count to 42.

Saturday, Jan. 9

Public health reports a 43rd death at Grace Villa.

Monday, Jan. 18

Another resident dies at Grace Villa. This is the 44th death, and the last in this outbreak.

Wednesday, Jan. 20

Grace Villa’s outbreak is declared over as of Jan. 19. The home had a total of 234 cases since Nov. 25 — worse than any other outbreak in the city. Public health says the outbreak is declared over when 14 days pass without new cases since the last onset of a symptom or the last exposure to COVID-19 in the home. It does not mean there are no more active COVID-19 cases in the facility.

Monday, Jan. 25

Taylor releases letters with serious and disturbing allegations from workers about what happened inside Grace Villa’s outbreak. They described residents moaning in mattresses soiled with urine and vomit, others rummaging through garbage and allege deaths from dehydration, among other things. Taylor said the letters came from staff who were worried what would happen once HHS leaves the facility. Taylor and SEIU call for APANS’ licence to be revoked.

Tuesday, Jan. 26

APANS responds to the allegations, calling them “deeply concerning.” “The safety of our residents, staff and family members is paramount,” said Raithby in an email, adding the home’s outbreak response is being “continually” reviewed. She’s “saddened” that some Grace Villa staff “may have felt” they didn’t have the necessary resources or support to do their jobs. “Our leadership team is working tirelessly to ensure everyone has the knowledge, training and resources to safely care for our residents now and in the future,” she said.

Flamborough-Glanbrook MPP Donna Skelly called the allegations against Grace Villa “disturbing” and said that they were “being looked into” by the Ministry of Long-Term Care.

In response to the reports, the Ministry of Long-Term Care says it takes resident safety “very seriously.” The email statement says the ministry worked directly with public health, the LHIN, and others, including HHS, to improve infection prevention and control at Grace Villa and educate staff on PPE use, and to improve staffing. The minister’s press secretary, Krystle Caputo, says Grace Villa has “adequate” PPE supply and N95 masks are “available when needed.”

Dr. Amit Arya, an assistant professor in palliative care at McMaster University, supports the calls to revoke APANS’ licence.

Thursday, Jan. 28

Public health confirms it never issued fines against Grace Villa related to its outbreak. The ministry doesn’t address a question about whether it issued fines against the home.

The Ontario Health Coalition joins the calls to revoke APANS’ licence.

Saturday, Jan. 30

A retired nurse instructor who worked at Grace Villa in the lead-up to its outbreak says staffing was a problem from before, with at least one worker short every shift.

Monday, Feb. 1

Public health declares Grace Villa back in outbreak as of Jan. 31 with one staff case.

In a media briefing, Hamilton’s medical officer of health, Dr. Elizabeth Richardson, said Grace Villa had “a number of issues” before and during their previous outbreak.

Tuesday, Feb. 2

The ministry doesn’t directly address questions about whether it’s investigating the allegations against Grace Villa or responding to the calls to revoke APANS’ licence. An email statement listed steps the ministry can take if inspectors find a long-term-care home not in compliance, including referring a noncompliance to a ministry director for action, and possibly revoking the licence.

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