The Yukio Okutsu State Veterans Home was a source of concern for federal regulators even before the pandemic, earning an overall “below average” rating and a citation for failing to provide and implement an infection prevention and control program.

The 95-bed Hilo nursing home, named after a decorated World War II veteran in the 442nd Infantry Regiment, has had seven health citations over the past three years, two of which resulted in thousands of dollars in fines by the Centers for Medicare and Medicaid Services, the federal agency that oversees nursing home facilities.

According to a CMS report in October, the Big Island veterans home failed to clean the suction equipment and canister for one of six residents reviewed, placing the veteran at risk for infection.

Federal inspectors found nearly 7 ounces of clear yellow liquid in the resident’s canister and suction tubing the morning of Sept. 30. The next day, investigators saw the same suction equipment containing the same fluid. A registered nurse who was interviewed did not know how long the liquid had been there and acknowledged it should have been immediately disposed of and the equipment properly cleaned according to nursing home policy, the report said.

“This deficient practice put the resident at risk for the development and transmission of communicable diseases and infections,” the report noted. The problem was deemed corrected Nov. 12.

The veterans home was fined nearly $9,000 in November and more than $20,000 in late 2018. It received only one star for its health inspection rating by CMS, but five stars for each of the staffing and quality ratings. The facility’s overall rating is two stars out of five, or “below average.”

Allison Griffiths, a spokeswoman for Avalon Health Care Group, which has managed the Big Island facility since 2008, said the Yukio Okutsu State Veterans Home has long maintained a four- or five-star CMS rating.

“While a review in recent years revealed some areas for improvement, all issues were quickly addressed. This is evident by our most recent infection control survey, conducted in late June, which found no deficiencies or citations. In fact, our practices were praised by the surveyor,” she wrote in an email to the Honolulu Star-Advertiser. “An additional infection control survey just last Thursday by the Office of Health Care Assurance found only one small issue by a non-employee contractor, which was considered isolated and which was immediately corrected. While independent research shows no correlation between star rating and COVID outbreaks, we take these issues seriously and are always looking for ways to better serve our patients.”

John McDermott, the state long-term care ombudsman in the Department of Health’s Executive Office on Aging, said last year’s report shows “they knew what they had to work on” and were required to follow their plan of correction.

“And if past surveys show a pattern of poor performance in the same area, then the state/feds are supposed to designate them a ‘special focus’ facility, which means an unannounced inspection twice a year instead of once, possible big fines, possible replacement of the administrator, preventing future admissions, even taking away their license and shutting them down,” he said.

“Last year there was no COVID-19; everything has changed because of that. It’s clear that the community is still not taking this as serious as they should be,” he added. “Residents, as far as I know, are not going in and out, so how does the virus get into the facility? Somebody brings it in.”

Based on contact tracing, Avalon said it thinks the coronavirus entered the home through an asymptomatic staff member in late August, as well as through a resident exposed at an outside dialysis appointment.

McDermott said he received a call from a U.S. Department of Veterans Affairs social worker representing one of the residents at the facility who tested positive.

“He was begging them to discharge him. He wanted to get out because he was sure he was going to catch the virus there. The same nursing staff working with COVID residents were working with him. They weren’t separating the staff,” McDermott said. “Sure enough, on Sept. 1 he got it.”

A federal team from the VA specializing in infection control and safety arrived at the home on Thursday to work on putting an end to the COVID-19 outbreak, which has so far resulted in 17 deaths.

Meanwhile, state Department of Health officials Thursday reported four new coronavirus deaths and 160 new infections statewide — 4% of the 3,829 tested —bringing Hawaii’s totals since the beginning of the pandemic to 107 fatalities and 11,105 COVID-19 cases.

The latest Hawaii island deaths have yet to be counted in the DOH tally pending verification.

The four deaths reported Thursday were on Oahu and involved three women and a man, all with underlying health conditions. Two of the women were in their 70s, one woman was in her 80s and the man was in his 60s.

Hawaii’s new cases include 137 on Oahu, 20 cases on Hawaii island and three cases in Maui County. As a result of updated information, one case from Oahu was removed from the tally.

There are 6,750 active infections statewide and 4,248 patients classified as released from isolation, or about 38% of those infected.

The U.S. death toll has surpassed 197,000.