Seven more residents and one additional employee at the Spokane Veterans Home tested positive for COVID-19 on Wednesday, bringing the total number of cases related to the nursing home to 21.

All 19 resident cases, including one death, are attributed to the same floor of the home, according to the Washington state Department of Veterans Affairs. A total of 52 residents have been tested, and some have been tested more than once due to symptoms and exposure.

The facility, which is home to 84 people, is limiting access to the affected area of the facility, so only necessary staff are entering resident rooms and providing care, according to the state Department of Veteran Affairs.

No residents were hospitalized as of Wednesday, according to Heidi Audette, a Department of Veterans Affairs spokesperson.

Spokane County public health officials say it’s the largest cluster of cases in a single local facility.

No residents or staff at other Washington Department of Veterans Affairs nursing homes had tested positive for COVID-19 as of Wednesday. Those locations include facilities in Port Orchard, Orting and Walla Walla.

“It is heartbreaking to face a challenge like COVID-19, please know that my thoughts are with all of our residents and their families,” said Patrick McNabb, administrator of the Spokane Veterans Home, in a statement. “I am grateful for the understanding and support that has been shared and want to reassure residents, staff and family members that we are working closely with the MultiCare Team provided by the Department of Health and the Spokane Regional Health Department to do everything we can to keep our veterans, their families and our staff safe.”

MultiCare tested 29 residents on Tuesday, with six of those tests coming back positive Wednesday, according to the state Department of Veterans Affairs. Three were negative, and results for 20 are pending.

The facility received enough test kits to begin sampling residents on all floors starting Wednesday, regardless of whether a resident has symptoms.

Two employees at the Spokane Veterans Home tested positive for COVID-19 as of Wednesday. The first employee tested positive in March and returned to work without symptoms while the test result was pending.

That employee, who has since recovered, cared for the nursing home’s first two cases in residents, which were confirmed last week. The employee also worked in the area where 10 more cases were confirmed during the weekend, along with one other part of the facility.

One resident, who was one of the facility’s first two cases and had been in end-of-life care before the COVID-19 diagnosis, died last Wednesday.

The Spokane Veterans Home is also working to test all employees regardless of symptoms, according to the state Department of Veterans Affairs. A total of 37 have been tested with 16 negative results so far, in addition to the two positives.

The facility continues to check residents for symptoms every four hours and isolate anyone feeling ill, according to Department of Veterans Affairs. All staff members are screened before work, have their temperatures taken twice a day and wear additional protective equipment.

“We know that this news is difficult to hear and want to reassure residents, families and staff that we are doing everything within our power to keep them safe and healthy,” McNabb said in a statement.

“Whenever we face tribulation we also see positive moments and acts,” he continued. “It is humbling to see the support of staff who come to work each day and are committed to their responsibilities.”