SAN ANTONIO — A facility designated in April to house nursing home residents who contract the novel coronavirus has been under investigation by the state for more than a week, the Department of Health and Human Services confirmed Tuesday.
An investigation into River City Care Center was initiated July 6, days after an air conditioning unit in a common area of the facility required servicing, according to information from a spokesperson for HHS, as well as River City Care Center.
The incident drew complaints over the temperature in the nursing facility, and while HHS visited the facility July 6 and concluded the complaints were unsubstantiated, emails obtained Tuesday by the Eyewitness Wants to Know team revealed officials with the city and state found issues during a surprise visit Sunday.
The unannounced visit came one day after Bexar County Commissioner Tommy Calvert e-mailed local leaders sounding the alarm on allegations of substandard conditions at River City Care Center.
Metro Health's medical director, Junda Woo, briefed local leaders, including Calvert, of her observations at the facility, noting "temperatures were unacceptable." Woo wrote that temperatures inside the facility were as high as 84 degrees with portable air conditioners and fans assisting the air conditioning. Woo noted that staff assured a representative from HHS that they would get maintenance to address the air conditioning in the morning, but the HHS representative "firmly" told the staff member that she wanted to know what River City staff would be doing to rectify the temperatures until maintenance arrived.
Woo went on to state "River City has shortfalls in documentation and staff training, including failing to take vitals every 4 hours for all patients as required." Woo told local leaders that, during the visit, the Health and Human Services Commission ordered River City Care Center staff to take temperatures of patients as required and report findings back to the HHS representative; make sure each patient has water by their bed side; and make sure that each bed is covered.
Woo noted "a few" residents were found to be lying on bare, plastic mattresses during the visit.
During the visit, some staff members told Woo the facility did not have enough eye protection in stock and that "multiple" staff members were not wearing eye protection, the e-mail said.
Reports for previously conducted inspections revealed that River City Care Center experienced issues with its air conditioning as recently as last July, when an inspector found temperatures as high as 82 degrees. The facility has also been cited for abuse and has been flagged as having an issue with a "persistent poor quality of care," according to the Medicare Nursing Home Compare website.
Online records show that six River City Care Center patients have died, though those patients were transferred to the facility from Advanced Rehab Live Oak, Rio at Mission Trails, Brookdale Alamo Heights, and St. Luke's Hospital
Local activist Pamela Allen said her mother, Lillie Espurvoa, tested positive for COVID-19 in early June and was released from a hospital to the care of River City Care Center nearly three weeks ago. She described the care her mother has received thus far as upsetting
Allen, who is the founder of Eagles Flight Advocacy, which covers the cost of burials of abandoned or neglected infants and children and lends assistance to families in need, said she feels helpless.
"When it comes to being there for other families, being there for babies and doing what I can do to help as many as I can—and I can't even do it for my own mother, who is going through this? It's infuriating. I get so angry."
Allen said her mother beat coronavirus, but continued to test positive for the illness weeks later and had not been able to be discharged from the facility until Tuesday.
She alleged staff failed to give her mother bed sheets, or give her the meals that family members had delivered to the facility. She also said that, for a week, they did not administer the leukemia medication her mother needed to take on a daily basis.
"As a matter of fact, they did not know that she had leukemia," Allen alleged.
"I understand that (River City staff are) working long, truly hard hours," Allen said. "But those patients are loved by families. Those patients are related to families who aren't just going to be quiet. And especially my mother. She's very loved and she has six children who are going to fight for her and who are going to demand that she get treated with dignity. Asking for bed sheets for her—that's not hard."
In Woo's Sunday e-mail to local leaders, she said she had staff at River City Care Center generate a list of patients who have recovered from coronavirus according to the CDC's time and symptom criteria and would work to get the patients released from River City Care Center.
"Some nursing homes require two consecutive negative COVID tests before accepting the patient back, even after CDC criteria are fulfilled," Woo wrote. "I will directly reach out to those facilities and have them take back their patients now, as long as they can quarantine readmissions for two weeks."
Espurvoa was cleared to be released Monday night, text messages provided by Allen showed.
KENS 5 reached out to Creative Solutions in Healthcare, the company that manages River City Health Care, regarding whether they disputed any of Allen's allegations, questions about the air conditioning situation at the facility, how many patients had been hospitalized and/or died following the July 4 weekend air conditioning incident, discharge protocols, among other
A spokesperson sent the following statement:
"Due to privacy concerns, we are unable to address specific details regarding a resident or patient in one of our facilities, however the conditions described do not in any way represent the standard or level of care we would expect or tolerate at a Creative Solutions in Healthcare facility. During the Fourth of July holiday weekend, an air conditioning unit in a common area of the facility required service and during this time, staff purchased portable air conditioning units and fans for use in patient rooms.
"A subsequent health inspection found a heat complaint there to be unsubstantiated and since then, the building temperature has been well within acceptable ranges. River City Care Center transitioned to a COVID-only facility in April to serve the greater San Antonio community in a time of need, and in the weeks and months since that need has only grown.
"We provide a skilled nursing level of care to patients who do not require hospitalization and the vast majority of our patients recover and leave our care. All discharges meet criteria in compliance with city, state and federal regulations and while we cannot comment on patient outcomes, that information is relayed to local, state, and federal health authorities and we defer to those agencies for distribution of case information."
KENS 5 followed up with questions about the e-mail containing Woo's observations from the Sunday visit and have not yet heard back.
HHSC declined to elaborate on the nature of their investigation, releasing the following statement to KENS 5:
"Protecting the health, safety and well-being of the people residing in facilities we regulate is our top priority. We are actively investigating this facility to assess compliance with all relevant health and safety rules. Once our investigation work is complete, the final report for the investigation can be requested through our open records process.
The Texas Administrative Code outlines rules around cooling, ventilation and heating systems in nursing facilities. For example, see TAC §19.321:
(b) The cooling system must be capable of maintaining a temperature suitable for the comfort of the residents in resident-use areas."
Editor's note: This story has been updated to reflect that Health and Human Services visited the River City Care Center on July 6 and found heat complaints to be unsubstantiated.