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The Los Angeles County Department of Public Health is investigating 11 nursing homes and other facilities for outbreaks of the coronavirus, the agency’s head said Monday.

“Today, there are 11 facilities that have three or more cases of COVID-19,” Health Director Dr. Barbara Ferrer said. “And for us, this is the mark of an outbreak at a facility.”

Coronavirus infections have surfaced at 25 different institutions, according to Ferrer, and 18 of them are either nursing homes or skilled nursing facilities. Six of the 44 people in L.A. County who have died from the virus were residents at nursing homes or similar facilities, Ferrer said.

Three residents from a single facility in Burbank died of the virus. A spokesperson for the Alameda Care Center, an 89-room assisted-living facility, confirmed on Monday that another resident died following the deaths of two other residents last week.

The facility said an additional eight cases of COVID-19 have surfaced among residents. A total of 11 employees have tested positive for the novel coronavirus; 14 others are awaiting test results while another 23 have tested negative.

On Saturday, officials at the Alameda Care Center said five residents had tested positive including three who were hospitalized. The wife of one of the residents who died told KTLA she believes her husband was “cheated.”

“I miss him so much,” said Willa Robinson, whose husband of 55 years, Vernon, died. “I feel he was cheated because he was not given the protection that he needed, and he didn’t have the strength to fight it.”

All 10 staffers who tested positive did not show any symptoms, the facility said.

A report from the U.S. Centers for Disease Control and Prevention said sick staff members at a nursing home in the Seattle area contributed to the swift spread of the deadly virus there. More than more than 30 COVID-19-related deaths have been linked to the facility.

“The findings in this report suggest that once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members, and visitors,” the report states. “In the context of rapidly escalating COVID-19 outbreaks in much of the United States, it is critical that long-term care facilities implement active measures to prevent introduction of COVID-19.

Ferrer said members of the Los Angeles Department of Public Health visit a facility whenever a case of COVID-19 is reported, working with management to ensure infection control protocols are in place, and patients and residents are being quarantined.

In national rankings for nursing homes, U.S. News & World Report describes the Alameda Care Center as having for-profit, corporate ownership. It gave the facility a “Below Average” ranking for short-term rehabilitation and “Average” for long-term care.

Across California, 135 people have died from the virus and more than 5,700 in the state have tested positive, health officials said. Cases of COVID-19 have surfaced at nursing homes in other parts of Southern California including in Riverside and San Bernardino counties.

The Rancho Mirage facility’s 94 residents and 140 employees and vendors have since been tested; health officials said over the weekend they were still awaiting the results.