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IOWA CITY — A nursing assistant who worked while sick likely brought the coronavirus into an Iowa nursing home where fifteen residents later died, according to a new state inspection report.

The employee was allowed to keep working because the Crystal Heights Care Center in Oskaloosa failed to adequately screen staff for symptoms at the beginning of their shifts, inspectors wrote.

Rather than have an employee take temperatures and ask health questions, those arriving were "permitted to self-screen" without independent monitoring, their investigation found.

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"The lack of effective screening resulted in a staff member being able to work while knowingly ill and failing to report it," the inspection report said. "The spread of COVID-19, once introduced to the facility, was rampant."

A total of 79 residents and staff members at the home have tested positive for the virus, one of the state's largest nursing home outbreaks to date, the Iowa Department of Public Health says.

Fifteen residents died and the other 64 who were infected have recovered. Among the dead was 86-year-old Roger Coe, a U.S. Air Force veteran and grandfather whose daughter has said she believes his death was preventable.

The Iowa Department of Inspections and Appeals cited the facility last week for its alleged screening failure and proposed a $8,750 fine, which has been suspended pending potential further action from federal regulators.

Crystal Heights Care Center administrator Jay Wills said Monday that the home is disputing the violation and would appeal. He said the department previously approved its plan to screen employees, including the use of a self-assessment.

In their report, inspectors said the home was not in "substantial compliance" with practices recommended by federal agencies to stop the spread of the coronavirus.

Under the form used by the home, employees and visitors were supposed to have their temperature checked, be asked questions about symptoms and directed to wash their hands before entering, among other things, the report said.

It is the second major finding this month against an Iowa nursing home that has had a deadly coronavirus outbreak. The department has proposed a $10,000 fine for Dubuque Specialty Care, where 11 residents died after symptomatic employees were allegedly allowed to work before testing positive for the virus.

The report on the Oskaloosa home said the certified nursing assistant had a fever and vomited on April 24. She called in sick that day to her second health care job, which ordered her to stay away for at least two weeks.

But the aide kept showing up to work at Crystal Heights in the following days and reporting she was symptom-free.

While at work May 4, she said she began experiencing more symptoms, "feeling feverish, headaches and weakness" but finished her shift. She was tested for coronavirus on May 9. Two days later, she showed up for a shift while awaiting the results. She completed the self-assessment and claimed she was symptom-free, noting she didn't want to call in sick, the report said.

But the home's director of nursing found out that the aide had been tested and reported the fever April 24 to her other job, the report said. The aide was confronted at the door and sent home, and she learned the next day that she had tested positive.

Three other staff members called in sick that day and soon tested positive. The first residents started showing symptoms on May 15, the report said. By May 20, 62 residents and employees had received confirmed positive tests.

Home managers since then have educated employees on the "proper use of the thermometer and implemented a staff person on post to ensure proper screening of staff prior to entering the facility," the report said.

Inspectors also cited the home for failing to conduct annual performance evaluations of nursing aides or offering them required in-service training.