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COVID-19 turned their Miami Springs nursing home into a death trap. The virus killed 52

Miami Herald - 8/24/2020

Aug. 24--After the Miami Springs nursing home Fair Havens Center locked down in March, Maria Garcia would still drive 50 miles a day round trip to talk to her esposo through a window.

COVID-19 was sweeping through the nation, and Maria was worried. But her husband, Jose Garcia, better known as "Cheo," was fine as far as she could tell. Cheo was a jokester and would play tricks on her, like pretending to be asleep, to lighten the mood.

Then in late April, a private laboratory tested all the residents. The day the results came back, the nursing home reported 86 new positive cases. By the end of August, COVID-19 had claimed 52 residents.

Cheo, 78, was among them, his death dropping the curtain on more than 50 years of marriage to Maria.

What happened at Fair Havens seemed sudden and shocking to family members on the outside. But confidential data viewed by the Miami Herald, May inspection reports and interviews with several staffers shed considerable light on the events that took place behind the facility's closed doors, leading it to have the second-highest virus death toll in Florida.

Altogether, they paint a grim picture of mismanagement and neglect.

At first, workers said they didn't know which of their patients had COVID-19 and weren't given adequate personal protective equipment.

Then later, a week after the testing was done, state inspectors discovered that about a dozen residents who had been exposed to COVID-19 were being housed in the same rooms as a slew of residents who hadn't.

Inspectors also found that staff didn't always wear all the necessary PPE, take the PPE on and off properly or adequately sanitize the gear. Some of them blatantly disregarded social distancing and basic hand washing policies and didn't separate COVID-19 patients' and non-COVID patients' laundry.

By then, 32 of the staffers had tested positive.

"These people had nowhere to go. It was their home," said one nursing assistant, who acknowledged the staff's role in the spread of the virus. "We're the reason it kept on going on."

As for administrators, they couldn't answer a state surveyor's questions about the facility's COVID-19 practices. In one particularly troubling instance, the assistant director of nursing was unable to identify the contents of a spray bottle that was being used to disinfect face shields of staffers who were caring for COVID-19 patients, according to official reports.

The list of findings goes on and on. And residents weren't the only victims.

One nursing assistant who contracted the virus survived, but passed it on to her son, who died.

Bad as it was, it could have been worse. The state halted new admissions to the facility in May after inspectors determined residents were at immediate risk.

The inspectors told the nursing home to transfer all 68 stable COVID-positive patients -- symptomatic and asymptomatic -- to hospitals, according to Menashe Shapiro, a spokesman for Fair Havens' ownership.

"What occurred to those patients once they were at the hospital is not something we can comment on, since we were no longer involved in their care," he said in a written statement.

Shapiro added that it would be "insensitive and irresponsible to our residents, family members, and community" to engage in speculation on why so many Fair Havens residents died.

Today, most of the 269 beds sit empty and it's Fair Havens that could be on life support next.

Once a crown jewel

Like many of the men and women who landed there after a life of hard work and family responsibilities, Fair Havens looked its age. Built on a 4.5-acre property in the late 1920s, set alongside leafy, shaded Curtiss Parkway, it was once the crown jewel in aviation pioneer Glenn Curtiss' blueprint for the city of Miami Springs.

The facility was originally conceived as a luxury hotel, featuring a five-story central tower, terraced roofline and a west facade adorned with a thunderbird motif, a Pueblo Indian symbol of peace and prosperity. The Great Depression killed that dream.

At various times it would become a health retreat run by Dr. John Kellogg, the cereal king (who bought it for $1 and hosted the likes of Thomas Edison), a rest center for convalescing troops during World War II and a nursing home run by Lutheran Services for the Elderly.

In 2000, it was sold to a group including Morris Esformes, a Chicago-based rabbi. He handed control over to his son, Philip, who made it part of a chain of more than 15 homes and assisted living facilities.

Philip Esformes was a man of expensive tastes. The profits from the nursing homes fueled his luxury cars, elegant homes and other extravagances, including, famously, a $360,000 watch. In 2019, he was sent to prison for committing what the U.S. Justice Department called the largest healthcare scam in U.S. history.

Esformes and other convicted co-conspirators paid kickbacks to doctors to admit patients into his skilled nursing facilities, including Fair Havens. They also corrupted state inspectors.

The illegality generated more than $1 billion in fraudulent claims to Medicare and Medicaid. Esformes even bribed the basketball coach at the University of Pennsylvania to classify his son as a scholarship athlete, according to a trial witness.

Not to mention, Fair Havens generated a bevy of lawsuits and fines under Esformes' leadership.

The facility, along with a group of others in Florida, was sold last year. The new management includes New York nursing home owners with their own troubled track records.

Cases start to climb

The earliest sign that COVID-19 had breached the facility was a virus-related 911 call March 27, nearly two weeks after the state forced all nursing homes to shut their doors to visitors.

Three days later, Fair Havens reported its first positive test.

Patricia Hartigan, 82, appears to have been the first to die, showing up on the Miami-Dade medical examiner log on April 22.

Next came Jose Collazo, 87, who perished on April 23. Then Maria Penton Juvier, 86, on April 25; followed by Edelberto Rodriguez, 81, on April 26; Raul Araya, 96, on April 28; and Raul Fernandez, 67, and Eulalia Alonso, 84, both of whom died April 30.

At a place like Fair Havens, seeing death is part of the job, but not with such alarming frequency. Eventually, nearly one-fifth of Fair Havens' full capacity would perish of COVID-19 complications, according to the Herald's analysis of data.

'Horrible ordeal'

Cheo's family checked him into Fair Havens about two years ago after a fall left him weak in the legs. A tall man, he was too big and heavy for his wife, Maria, to move. He also had diabetes and heart problems.

Cheo was a Cuban immigrant who drove trucks for the Associated Grocers cooperative before retiring due to high blood pressure. He was always happy, had a great sense of humor and quickly bonded with others at the nursing home, said Carmen Marin, his sister-in-law.

"When he first got in there, he made friends with the other patients and with the nurses and assistant nurses and he was always joking with them," Marin said. "He was very much liked by all the people who worked there."

Cheo and nursing assistant Niurka Solano were particularly close, Maria said. He loved her like a daughter.

"He adored her," Maria said.

On April 27, Cheo tested positive for COVID-19, according to the confidential data. The family said he was moved upstairs to the COVID unit.

"It was the beginning of the horrible ordeal," the sister-in-law said.

Maria said she spoke with her husband the following day. He told her he was fine and not to worry.

A few days later, she received a call that Cheo was having difficulty breathing and was being rushed to the hospital. He had to be intubated and put into a coma. Less than 24 hours later, he was dead.

"'How did this happen?" Maria said. "Everyone has to die, I understand that. But he went so fast that it was the fault of the home."

Left in the dark

Early in the pandemic, Florida was determined to keep a lid of secrecy on the spread of COVID-19 in long-term care facilities. The state refused to identify homes where positive tests had occurred until the Miami Herald and other news organizations banded together and filed a public records lawsuit.

As for Fair Havens specifically, multiple workers said they weren't initially told which residents had COVID-19, or given the proper PPE (a claim Fair Havens disputes). There also wasn't adequate training, inspection reports confirm.

"They didn't want to say anything to the personnel working there," Solano said, a sentiment shared by others who worked there.

As of the beginning of May, the facility's infection control nurse did not keep a surveillance map of infections within the facility, according to an inspection report.

Staff weren't the only ones feeling out of the loop.

Six families, barred from entering the home by a March state order banning visitors to long-term care facilities, say they were also kept in the dark about what was happening as the case count began to climb.

"When they said no visitors, we said 'Geez that sucks,'" said Marilyn Bush, the daughter of Elmis Fernandez, an 84-year-old former Fair Havens resident with dementia. "But we said 'Okay if this is what it takes, fine no problem.' "

On May 3, Fernandez's wife called Fair Havens to check in on her husband and was told everything was fine, Bush said.

But just an hour later, the wife received a call from the home telling her that his condition had deteriorated and he was being sent to Hialeah Hospital.

Fernandez tested positive for the virus at the hospital, Bush said. It was the first the family had heard of it.

Fair Havens had previously reported a positive COVID-19 test for him April 27, the Herald learned, but Bush said she and her mother were told he had tested negative.

"Why would they lie about something like that?" Bush said.

Fernandez died two weeks later.

Denying negligence

A spokesman for the nursing home said administrators "maintained constant and required communications with all the appropriately designated loved ones of our residents."

The nursing home also pushed back on other criticism, saying there was "never any negligent care at Fair Havens."

"The facility has had official policies and procedures in place that comply with all government regulatory agencies and bodies," Shapiro, the spokesman, said.

In February, "comprehensive general training" took place, he said, but he would not share the training materials.

On March 18, Fair Havens implemented a policy that all employees and visitors were required to wear masks and full PPE around patients with any type of respiratory symptoms, according to Shapiro.

This policy wasn't always followed, according to one of the inspection reports, which said an occupational therapist was observed feeding a resident in the COVID-19 unit while wearing only a surgical mask and gloves.

On the same date, the facility also started restricting employees with symptoms or who had recently traveled from entering the building. Employees were given temperature and oxygen checks every shift, Shapiro said.

In April, Fair Havens began mandated COVID specific training for all licensed staff, he said. He would not share this training either.

The assistant director of nursing told a state surveyor that the staff developer had done "a tremendous amount of training," according to one of the reports. However, when asked what specific education had been provided to the workers, the staff developer replied "none."

Shapiro went on: "Throughout this pandemic, government guidance has evolved and changed, and in each and every instance where there was a new set of instructions and procedures, we rushed to implement these new directives."

Yet as of the inspection in May, the facility's policies for the COVID-19 unit had last been updated March 18. Educational in-service logs were neither updated nor organized, and several logs did not identify the material or participants by title or department, one of the reports says.

At some point, a COVID unit was established on the second floor, though the nursing home could not specify when. Nursing assistants, some paid just $11 an hour, were offered a few extra dollars an hour to work upstairs, potentially putting their lives and their families at risk.

"Supposedly everyone was asymptomatic," Solano said. "But everyone started getting worse and dying."

'Fertile ground for the virus to spread'

By the beginning of May, Fair Havens' problems had started to seep into public view.

In the span of 48 hours on May 4 and 5, Florida'sAgency for Health Care Administration received five complaints against Fair Havens. Days later, it conducted the inspection that shut off new admissions, also looking into seven federal complaints for the Centers for Medicare and Medicaid Services.

The agency described the nursing home as "a fertile ground for the virus to spread."

The finding that 11 residents who had been exposed to the virus had been placed in rooms with 15 who hadn't was particularly troubling.

The facility's director of nursing, who also served as the facility's risk manager, told a state surveyor that the home did not consider a resident who had not been tested for the virus to require isolation for 14 days even if the resident had experienced known exposure to a COVID-positive resident.

"The identification of potential COVID infection of a resident is of no value to mitigation of spread where the identified potential resident is placed in proximity with residents who had not suffered exposure," AHCA said in its report.

Fair Havens' vice president of operations said the home would have run out of PPE in a week had it isolated all 11 residents who were exposed, according to the federal inspection report. He added that 32 staffers had tested positive and if everyone who was exposed to them had to be isolated "it will be the entire facility."

Among the other findings were the following:

-- A nurse was seen exiting a COVID-positive resident's room in full PPE. The nurse kept her PPE on and told the surveyor that in order to preserve PPE stocks, she would only wash her hands and change gloves.

-- Five staffers were found sitting "almost elbow to elbow" at a table in a small lunchroom. Only two were allowed in the room at a time, according to one of the workers. The staff at the table saw the surveyor walk by the room three times and did not attempt to move, the report said. One staffer said: "We got the education, but I did it wrong today."

-- A nursing assistant was observed going from room to room, putting on a glove without hand sanitizer when entering the room, removing the gloves after leaving and not sanitizing her hands in between. The facility's policy said staffers should use hand sanitizer or wash their hands with soap and water before and after wearing gloves.

-- In one instance, two residents were observed sitting three feet apart from each other, not six. In another instance, two other residents were found three feet apart and one was wearing her mask underneath her chin.

-- A staffer was seen placing dirty laundry from the COVID-19 unit in the linen chute without a face shield.

After the visit, AHCA instituted the ban on Fair Havens accepting new patients. But by then, irreversible damage had been done to residents -- and staff.

Workers pay steep price

As people in desk jobs switched to working from home, other nursing home staff still had to go to work and potentially be exposed to the virus. Either that or quit.

When their shifts ended, the workers prayed they weren't bringing the disease home with them. Several of them did.

Solano said they initially got a pay raise but not a lot: $1.50 an hour. Eventually, management at Fair Havens paid staffers a little more to work upstairs.

When she tested positive, Solano was told to quarantine at home for two weeks, she said.

Though the nursing home said any staffer who tested positive and quarantined was paid for up to 14 days for the time they missed, Solano said she wasn't paid the full amount. She has since left Fair Havens and said she now works at a different long-term care facility.

Another worker suffered a far steeper loss.

Antonia Hernandez, a 21-year veteran at Fair Havens, also caught the virus and her family got it as well.

Hernandez is a certified nursing assistant like Solano. But instead of directly working with patients at the home, she said she normally accompanied them to and from medical appointments and hospitals.

When the COVID crisis slammed the nursing home, Hernandez -- who is diabetic, has high blood pressure and leukemia in remission -- said she started helping with all sorts of tasks, including bathing and feeding residents.

"The only thing we had was a mask and we didn't know who had COVID," Hernandez said. "Everyone with and without COVID, we were all scrambled together."

On April 21, Hernandez said she started to feel feverish, had a bad headache and her entire body hurt. She tested positive for COVID-19 two days later, the Herald learned, and was hospitalized for two weeks at the beginning of May, she said.

"Nobody cares. Nobody is doing anything for them," said Margarette Nerette, vice president of the South Florida chapter of Local 1199 of the Service Employees International Union, which represents more than 25,000 healthcare workers in Florida.

By the time Hernandez went to the hospital, her 33-year-old son, Edelberto Hernandez, already had a fever, she said. He checked into the hospital about a week after she did. By then he had chest pains and difficulty breathing.

"He had all the symptoms, but it wasn't until the hospital that we knew he had coronavirus," Antonia said. Her husband also tested positive for the virus but was asymptomatic and recovered.

Antonia said she couldn't visit Edelberto in the hospital since the intensive care unit was off limits, especially as she was recovering from the virus herself.

She said they talked by phone as much as possible and that they tried a range of treatments. But nothing worked.

He died May 21.

"[Edelberto] was a happy guy. He was a very hard worker, a good son, and everything was wonderful about him," Antonia said through tears, adding that she's still struggling to process his death.

For Edelberto's brother, Amilcar Hernandez, the death has been piercing and painful.

"It's been terrible. He was my only brother. When you grow up with somebody for so long, you get used to them," he said. "I honestly don't know what to say about it. Nothing I could say would bring my brother back."

Pre-COVID troubles

Even before the novel coronavirus swept through its halls, Fair Havens didn't have the best track record.

Since 2013, the nursing home has been sued at least 15 times for alleged negligence. The most common complaints: Residents developed infections, sepsis or bed sores and/or suffered falls and unexplained injuries that in some cases led to death.

In a case from just last year, a lawsuit alleges the then-resident suffered from deterioration of wounds and gangrene. Eventually, she had to undergo amputation, the lawsuit says.

About half of the cases against Fair Havens were settled out of court and six are still open.

In the same time frame, Fair Havens, along with Golden Glades Nursing and Rehabilitation Center, South Dade Nursing and Rehabilitation Center, Harmony Health Center and North Dade Nursing and Rehabilitation Center -- all now part of a group called Ventura Services of Florida -- racked up more than $43,000 in fines from Florida'sAgency for Health Care Administration.

None of this deterred Bent Philipson from buying into the homes in 2018 and 2019. Benjamin Landa, Philipson's former business partner, also has ownership interests in Fair Havens and Harmony Health.

The two came to Florida with their own troubled past.

SentosaCare LLC, the New York nursing home company that Landa and Philipson previously owned together, has been plagued by allegations of negligence.

In 2017, a class-action lawsuit was filed against Landa, Philipson and their partners, alleging that they had kept 200 Filipino nurses in their New York facilities in "indentured servitude." Last October, a federal judge ruled that the duo's actions amounted to human-trafficking.

Shapiro, the Philipson spokesperson, said the decision is being appealed and that Philipson is no longer affiliated with SentosaCare. Landa did not respond to multiple attempts to reach him for comment.

A month after the two took on ownership interests, AHCA cited Fair Havens for failure to complete adequate background checks on staff and keep resident records. In February of this year, an inspection conducted by the national Centers for Medicare and Medicaid Services earned the facility a one-out-of-five-star review.

On Aug. 11, the daughter of Eulalia Alonso, a Fair Havens resident who died from COVID-19 on April 30, filed a lawsuit against the nursing home, alleging negligence.

If the lawsuit and complaints feel like a throwback to the Esformes era, the new ownership resembles the old in another way: deep pockets and a lavish lifestyle. As families continue to grieve the loss of their loved ones, Philipson purchased a $9.3 million home in Bal Harbour on Aug. 5.

Miami Herald staff writers Jay Weaver and Christina Saint Louis and Herald writer Theo Karantsalis contributed to this report.

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