Dalene Redhorse hadn’t been able to meet her 85-year-old father inside his room at the Four Corners Regional Care Center in Blanding for months. The facility closed its doors to visitors on March 13 to reduce the risk of coronavirus transmission, and when she visited, she usually met him in the gazebo outside.

Her father spoke Diné bizaad, the Navajo language, but little English, and Redhorse felt the visits were necessary to check in and ensure he was getting quality care.

On each of those occasions, she took every precaution possible. She was careful to remain masked and socially distant when she met outside or talked with him through the window.

Redhorse, who lives in the Mexican Water Chapter of the Navajo Nation south of Bluff, had seen the coronavirus sweep through surrounding communities, taking more lives on the Navajo Nation than in the entire state of Utah. She knew the disease needed to be taken seriously, especially when it came to elders like her father, Peter Redhorse, who had multiple underlying health conditions.

For one visit in May, her daughter sewed homemade masks and placed them in a clean zip-close bag for Peter Redhorse. He was instructed not to open it for two days to be certain that if the coronavirus was somehow present, it would not be transmitted.

All of those cautionary measures seemed like common sense to Dalene Redhorse, especially considering San Juan County has the highest per-capita rate of coronavirus infections in Utah. But over the months of interacting with the care center, she realized mask usage wasn’t a regular habit among van drivers, facility staff and nursing home residents.

During a mid-June visit, she said her father was pushed outside in a wheelchair by a member of the facility’s management team. Both were unmasked.

“We asked him, ‘Where’s your mask?’” Redhorse said. “‘Oh, they left it in the room,’ [her father responded]. That’s when we told him, ‘You’ve got to wear your mask. You’ve got to wear your mask.’ Knowing him, he’s so forgetful at his age. But it should have been a precaution taken by those nurses that each of those patients should have left their rooms with a mask.”

According to a March set of guidelines for long-term care centers posted to Utah’s coronavirus website, masks are not required by the Utah Department of Health in long-term care facilities that do not have a confirmed case of COVID-19.

More recent guidelines also on the website, which were updated in April, require long-term care facilities to “create a policy requiring the use of [personal protective equipment such as masks] for all patient encounters” with workers. A spokesperson for the Blanding care center told The Salt Lake Tribune on Friday that the March guidelines were followed at the Four Corners Regional Care Center, and masks were not required for staff before the first case was confirmed in late June.

(The Utah Department of Health, which is involved in the regulation of long-term care centers, did not return a request for comment regarding the state’s rules on Friday.)

At least 90 of the 212 coronavirus deaths in Utah have been residents of long-term care facilities, according to a state database.

On June 28, the Four Corners Regional Care Center joined the two-thirds of Utah long-term care centers that have seen at least one positive coronavirus case. Family members of residents at the facility were informed that a staff member tested positive for COVID-19, but Redhorse said she was initially told the staff member had not been inside the facility.

Two days after the first case was confirmed, on June 30, the care center posted to its Facebook page about a state inspection that took place the week of June 21. “[Inspectors] were impressed with the many extra precautions we have taken and commended us on our success in keeping the facility COVID free,” the care center wrote.

The facility was, in all likelihood, not COVID-free the date that statement was posted; the confirmed case was announced on the facility’s website one day earlier.

Derek White, a spokesperson for the Four Corners Regional Care Center and senior vice president of Cascades Healthcare, which provides support to the management of the facility, said the Facebook post was referring to the inspection that concluded shortly before the positive case was confirmed.

“Although we stand by the accuracy of that statement, we realize it may be confusing to the public because it was posted after [June 28],” he said, adding the facility has stopped using Facebook to release information.

White acknowledged that masks were not mandated for staff under facility rules before the first positive test, but he said staff were required to wear masks after June 28. He said residents were also encouraged to do the same, although some chose not to.

“While sources such as the Centers for Disease Control and Prevention and the Utah Department of Health recommend that residents wear masks during the COVID-19 pandemic,” White said, “residents are not required by law to wear masks and they retain the right to not wear a mask. Residents’ health conditions (for example, breathing difficulties) may prevent them from or make it difficult to wear a mask.”

Residents began developing symptoms over the following week. (Health officials have not released information about whether the outbreak was related to the initial positive case on June 28.)

Redhorse said she received a call on July 6 informing her that her father had tested positive, and she was told he may have been infected during a dialysis treatment.

When Redhorse visited her father on July 7, she said the mask mandate, which went into effect for staff more than a week earlier, was not being followed.

“I waited outside the nursing home for 35 to 40 minutes and through that whole time, watching through that glass door, I could see them not wearing masks inside,” she said. “Four nurses walked out of there without masks. … I wish now I would have taken pictures.”

(“I can’t confirm that four staff members were not wearing masks,” White said, reiterating that it was required for staff at that time.)

Peter Redhorse was taken to the emergency room on Wednesday and was later flown to a hospital in Farmington, N.M. He died on Saturday.

All residents and staff members at the facility were tested last week, and numbers have risen steadily as results have been returned. On Sunday, 50 people had tested positive — 33 residents and 17 staff.

Two residents died inside the Four Corners Regional Care Center, including Dalene Redhorse’s grandfather John Shorty, bringing the death toll for residents infected with the coronavirus at the facility to three.

“We extend our deepest sympathies to the residents’ families, friends, and to our staff who are also mourning their loss,” the care center said in a statement.

Redhorse asked people to pray for those battling the virus.

“Stop any time of the day and take four deep breaths for people who are trying to gasp for air,” she said. “When you’re drinking water or eating food, think of everyone who is sick right now.”

Zak Podmore is a Report for America corps member and writes about conflict and change in San Juan County for The Salt Lake Tribune. Your donation to match our RFA grant helps keep him writing stories like this one; please consider making a tax-deductible gift of any amount today by clicking here.

Clarification: This story has been updated to state that the Four Corners Regional Care Center was following a set of guidelines from the Utah Department of Health that were last updated in March. A more recent set of guidelines, updated in April, recommend that workers in long-term care facilities wear masks, even if no cases of COVID-19 have been confirmed.