A Twin Cities nursing home with a troubled regulatory past has become the site of one of the state’s largest coronavirus outbreaks — continuing a deadly trend among senior facilities with poor health and safety records.

At North Ridge Health and Rehab, a large senior community in New Hope with a 320-bed nursing home, 44 residents have died and another 68 have been sickened by the COVID-19 respiratory illness in recent weeks. Only one other senior facility in the state has seen more fatalities from the virus.

North Ridge shares a troubling characteristic with many of the nursing homes across Minnesota beset by coronavirus outbreaks: Historically, it has struggled to adhere to basic standards of patient care. The facility has been fined $117,000 by federal regulators and cited for dozens of health and safety violations over the last three years.

Its repeated run-ins with regulators fit a pattern: So far, 75% of the approximately 70 nursing homes in the state with at least one case of COVID-19 have been cited for not following infection control rules over the last two inspection cycles, starting in 2016, according to a Star Tribune analysis of federal health inspection data.

“We have seen this across the country, where facilities that failed to take basic health and safety controls seriously are having the most problems” amid the coronavirus pandemic, said Toby Edelman, senior policy attorney with the Center for Medicare Advocacy in Washington, D.C. “It’s one reason the virus spreads so rapidly.”

Officials at the Minnesota Department of Health said it has been changing its practices to respond to the pandemic. The agency’s health regulation staff has been prioritizing infection control during surveys and conducting onsite visits of facilities with past performance problems. The department has also been sending teams of infection control experts into nursing homes and assisted-living facilities to help contain deadly outbreaks.

Still, long-term care facilities like North Ridge remain ground zero for the pandemic in Minnesota. Together they account for 80% of the 485 deaths statewide from the virus. “This pandemic is shining an even brighter light on the systemic issues” in long-term care, said Health Commissioner Jan Malcolm, in legislative testimony last week.

A spokesman for North Ridge said its size partly explains why it has experienced such a large COVID-19 outbreak. The nursing home was caring for about 300 patients when the pandemic began and is the largest long-term care facility in the state. North Ridge is also one of the few long-term care facilities in Minnesota that has been accepting hospital patients diagnosed with COVID-19. In the last 10 days alone, the nursing home has admitted 15 patients who had previously tested positive for the illness, the spokesman said.

Yet the nursing home is reporting signs that it has turned the corner in its efforts to contain the deadly outbreak. The facility has isolated sickened residents on dedicated “COVID-19 units” within its building, while screening employees daily for symptoms and imposing stringent physical distancing and sanitation measures. Since April 29, the facility has seen a reduction in the number of its residents testing positive for the virus, the facility said. About 30 of its staff have also tested positive for the virus.

Austin Blilie, vice president of operations at North Ridge, noted that the 44 deaths at the facility represent 3.2% of the positive COVID-19 tests, which is below the statewide ratio. “This is an awful virus and the fight against it is extremely difficult,” he said.

Still, even before the pandemic, North Ridge stood out as a repeat violator of basic standards for care.

In early January, inspectors found 23 health violations at the nursing home — nearly three times the average number of citations for Minnesota nursing homes during inspections. The facility has also been fined three times and had its Medicaid or Medicare payments denied on two occasions, a penalty typically imposed when problems persist, according to federal records.

Patti Schuveiller is relieved that she moved her 90-year-old mother, who had an apartment in the independent living section at North Ridge, out immediately after her mother tested positive for COVID-19. Her mother had lost 20 pounds and was suffering from severe nausea and gastrointestinal problems before the facility agreed to her family’s urgent request that she be tested for the virus, Schuveiller said.

Her mother, Joyce Roycraft, is now in stable condition and is recovering from the virus at a rehabilitation facility.

“I firmly believe that, had my mother stayed at [North Ridge], she would not be alive today,” Schuveiller said. “The facility was not set up to provide the quality of care that she needed.”

Health regulators have cited North Ridge for a wide range of violations related to safety, quality of care and resident rights.

These included failing to report allegations of abuse, failing to maintain an adequate supply of insulin, and not monitoring a patient’s rapid weight loss. Last June the facility was cited for failing to thoroughly investigate an incident in which a patient pulled out a knife and threatened another resident. A month later, North Ridge was cited for failing to report potential sexual abuse between two residents with cognitive disabilities who were found undressed together in bed, records show.

All told, North Ridge has 26 complaints over the past three years that resulted in citations. The nursing home earned just two stars (“below average”) on the federal government’s five-star rating system for overall care. However, it received four stars in the category of “quality measures,” which includes care measures such as prevalence of falls and emergency room visits.

Most of the facility’s health and safety violations over the past three years were classified as causing “minimal harm or potential for actual harm,” health records show. “Still, we knew after those inspections that we had significant work to do — and we have made strong progress,” said Blilie, the facility’s vice president of operations.

Eilon Caspi, a gerontologist and adjunct faculty member at the University of Minnesota’s School of Nursing, said the records illustrate the importance of examining a nursing home’s inspection history when searching for a facility. The federal government’s website, Nursing Home Compare, assigns quality-of-care ratings to all nursing homes and contains health inspection reports going back three years.

While flawed, the Nursing Home Compare tool can point to poor standards of care, he noted. For instance, a New Jersey nursing home, where 17 corpses were recently found piled inside a facility where nearly 70 had already died from COVID-19, had the lowest overall ranking of one star. However, using the same rating system, the nursing home with Minnesota’s deadliest coronavirus outbreak, St. Therese of New Hope, where nearly 50 residents have died, earned four out of five stars despite having a large number of health violations.

“You find patterns of citations … that can provide a general sense of the quality of care,” Caspi said.

Staff writer Glenn Howatt contributed to this report