MADISON — Maplecrest nursing home has submitted a corrective plan in the wake of violating federal regulations amid a coronavirus outbreak there, but state officials said Wednesday the plan isn’t good enough. 

A Maine Department of Health and Human Services official said in an email Wednesday morning that a plan of correction submitted by the nursing home “does not meet all of the requirements for approval.”

“The Division of Licensing and Certification is in communication with the facility to gather more information and support their submission of a revised plan,” said Jackie Farwell, the department spokeswoman.

The Morning Sentinel requested a copy of the corrective plan, but Farwell declined Wednesday. “Per CMS requirements, we may release only an acceptable plan of correction,” she responded via email, citing a U.S. Centers for Medicare and Medicaid Services statute.

Last week, Maine DHHS provided documents that showed that a staff member at the Maplecrest nursing home failed a coronavirus screening questionnaire yet was still allowed to work a 10-hour shift, an oversight and violation of federal regulations.

The Maplecrest Rehabilitation and Living Center is still reeling from an outbreak of the COVID-19 illness that, Farwell confirmed Wednesday, now numbers 40 cases and seven deaths. 

Documents provided by Maine Department of Health and Human Services following a survey of the facility suggest Maplecrest was not in compliance with federal requirements for infection prevention and control practices.

The facility was directed to develop a plan of correction to address deficiencies within 10 days of the issuance of the Sept. 16 letter. Additionally, the U.S. Centers for Medicare and Medicaid Services requires Maplecrest to hire an independent nurse consultant to ensure the health and safety of residents and a temporary manager to ensure compliance with requirements.

North Country Associates, the business that oversees Maplecrest, has not responded to multiple requests for comment, including a Wednesday afternoon message for spokesperson Mary Jane Richards.

The nursing home announced in August through a Facebook post that all visitations would be restricted after an employee tested positive for COVID-19.

A patient at Maplecrest recently told the Morning Sentinel about the emotional toll the outbreak is taking on the nursing home community, as all residents are confined to their rooms, and has called for greater transparency amid the outbreak.

The outbreak at Maplecrest has been linked by state health officials to a now-infamous Aug. 7 wedding in the Millinocket area, where crowd restrictions were ignored and masks were not required.

None of those who died at Maplecrest were attendees of the Aug. 7 wedding, but rather an adult wedding guest later came into contact with someone who then came into contact with a staff member at the nursing home.

In an email, a spokesperson for Maine DHHS said that in April, they contacted Maplecrest as part of the statewide Infection Control Assessment and Response survey. At that time, the facility was provided with education and responded that they had infection and control policies in place.

The Maine DHHS Division of Licensing and Certification subsequently conducted on-site visits at Maplecrest on Aug. 25, 28 and Sept. 4 to ensure compliance with federal requirements for infection prevention and control practices to prevent the development and transmission of COVID-19.

According to the documents, an employee or visitor should be considered to fail a screening if they have a cough, difficulty breathing, new shortness of breath, fever, loss of sense of smell or taste, new muscle aches or soreness not from exercise, repeated shaking with chills, sore throat or headache.

On the Aug. 11 questionnaire, a certified nursing assistant answered ‘yes’ to having new muscle aches, a cough, repeated shaking with chills and a sore throat, according to the documents.

The employee then worked a 10-hour shift. A day after these symptoms were documented, the employee called and informed the facility that she had been exposed to a person that was positive for COVID-19. On Aug. 18, the same employee produced a positive COVID-19 test.

A charge nurse was also interviewed by telephone by Maine DHHS and stated that she “did not notice a cough, but (the CNA) had that for some time.” The charge nurse also told DHHS that she does not look at the daily employee/visitor screening log as “everyone knows it’s their responsibility to let the Charge Nurse (know) if they are not feeling well,” and “as far as I know, there’s nobody looking at the screening tools. Nobody had ever checked it on my shift, and nobody has checked mine.”

In the statement of deficiencies provided by DHHS, the facility failed to implement recommendations and guidance provided by the U.S. CDC and Centers for Medicare and Medicaid Services regarding staff who presented with symptoms of COVID-19. Additionally, Maplecrest failed to have a system in place for the monitoring of systems during the screening process, and these failures contributed to an outbreak there, the documents said.