Pandemic CONTINUITY OF OPERATIONS (COOP) PLAN

Providence Rest Nursing Home

3304 Waterbury Avenue]

Bronx, NY 10464

 

This publication was supported by Cooperative Agreement Number 5U90TP000546-03 from the Centers for Disease Control and Prevention and/or Assistant Secretary for Preparedness and Response.  Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention and/or the Assistant Secretary for Preparedness and Response.

Contents

Introduction.. 3

How to Use This Template. 3

Executive Overview… 4

Facility Profile. 5

COOP Planning Team… 5

Essential Functions. 7

Essential Personnel 9

Critical Resources and Assets. 10

Alternate Facilities. 13

Emergency Communication.. 15

Alert and Notification.. 16

Staff 16

Key Contacts. 17

Devolution.. 18

Devolution Scenarios. 18

Delegation of Authority. 18

Reconstitution.. 19

Reconstitution Objectives. 19

Reconstitution Phases. 19

Phase I: Preparedness – Planning and Preparing for Reconstitution.. 19

Phase II: Reconstitution Operations—Transitioning To Normal Operations. 20

Phase III: Post-Reconstitution—Resuming Normal Operations and Conducting After Action Review   20

Appendices. 22

 

 

Introduction

 

This template is provided to use in coordination with the material from Continuity of Operations Planning Toolkit, Part One, and Part Two to create a comprehensive Continuity of Operations Plan for their facility.  The planning areas are provided as examples and recommendations based upon best practices in COOP planning.  COOP planning teams should modify material as appropriate for their facility.

 

As with other plans, the COOP plan should be a part of the training, testing, and exercise process. COOP plans should be updated annually, or after activations or other significant events that may necessitate plan revisions.

How to Use This Template

 

This template should be used in coordination with the Continuity of Operations Planning Team, Organization leadership, and key personnel to develop a robust continuity of operations program, covering the following topics:

• Continuity of Operations Planning Team
• Essential Functions
• Essential Personnel
• Critical Resources and Assets
• Alternate Facilities
• Emergency Communication
• Devolution
• Reconstitution

User instructions are provided in blue italics. [Brackets] are used to indicate where information should be provided.

 

Executive Overview

Continuity of Operations (COOP) is defined by the Federal Emergency Management Agency (FEMA) as the effort to ensure that an organization’s essential functions continue to be performed during a wide range of emergencies, including localized acts of nature, accidents, and technological or attack-related emergencies.

 

Providence Rest recognizes the importance of COOP planning for the safety and wellbeing of its residents and staff and has undertaken the COOP planning process to protect the welfare of those entrusting their lives and livelihood to Providence Rest.

 

COOP includes the identification of a COOP planning team, essential functions and the essential personnel and resources (including communication) to conduct those functions.  In the case where Providence Rest is not able to conduct the essential functions at its primary location, alternate facilities have been identified in the plan.

 

Facility Profile

Name: Providence Rest

Physical address: 3304 Waterbury Avenue

Telephone: 718-931-3000

Fax: 718-514-8447

Primary emergency contact: Richard J. Lohne   Administrator

Secondary emergency contact: Peter Troy Director, Security, Safety & EM 203-246-1943

 

Facility type: Nursing home

Number of staff: 322

Licensed capacity:  200 beds and 2 respite beds

Average daily census: 182

Surge capacity: 25

Special populations: special populations our facility cares for that require special consideration including residents with dementia and mobility impairments.

Back-up generator: [yes/no]

Wired to receive a back-up generator: [yes/no]

 

COOP Planning Team

 

Providence Rest NH has identified the personnel in the chart below as being a part of the COOP Planning Team. These individuals will help inform the COOP planning process for Providence Rest NH.

 

The COOP Planning Team represents personnel with knowledge of an experience with essential functions. These personnel have expertise in organizational operations that are identified as essential functions, information technology, communications, human resources, logistics, facilities and legal counsel. These personnel will include organizational leadership.

 

COOP Planning Team
LTC Facility Leaders
Role	Name
Administrator	Richard J Lohne
CEO	Sr. Seline Mary Flores
Director of Nursing	Ernesto Antonino
COOP Planner/Program Manager
Role	Name
Director, Security ,Safety & EM	Peter Troy
COOP Team Members
Role	Name
Coordinator Human Resources	Cristina  Arias
IT Manager	Sr. Josephine
Infection Control/ Director of Nursing	Ernesto Antonino
Manager of Environmental Services	Lisa Baerga

Essential Functions

 

Providence Rest has identified the following essential functions. Essential functions are those functions that must be performed to fulfill the mission statement of the organization and the specific operations of each program.

 

 

At Providence Rest it is our mission to minister with respect and dignity to each individual entrusted to us by providing the highest quality care in a peace filled, safe and secure environment. We consider it our privilege and God’s precious gift of life and love. We commit ourselves to this mission freely and enthusiastically.

Essential Programs/Services Restoration Priorities[1]
Priority	Impact on the health and safety of residents and staff, resident services, and/or business operations	Restoration Timeframe
A	Critical impact	Must be restored within 0-6 hours
B	High impact	Must be restored within 7-24 hours
C	Moderate impact	Must be restored within 25-72 hours
D	Low impact	Can be restored in 72 hours to 2 weeks

 

 

Priority Program and Service Areas[2]
Administration	Medical/Mental/Health Services
Business Operations	Nursing Services
Communications	Pharmaceuticals
Dietary Services	Resident Services
Facility Operations	Safety and Security

 

Instructions:

Complete the Template, identifying and prioritizing the essential functions for one program / service (to be assigned)

 

Essential Functions by Program and Service	Priority A, B, C, or D
Administration
Decides to activate the Emergency Mgt.  Plan Authorize key personnel to take immediate action Act as PIO	A A A
Business Operations
Have checks available for emergency payments Purchasing	A B
Communications
Dietary Services	A
Robert Gorlic,k Director
Facility Operations	A
Yakov Katsnelison, Director
Medical/Mental/Health Services	A
Dr. Vela, Medical Director
Nursing Services	A
Ernesto Antonino DON
Pharmaceuticals	B
Resident Services	A
Rosemarie Hofstein,  Director
Safety and Security
Peter Troy, Director
Other

 

Essential Personnel

 

Providence Rest has identified the following personnel as essential staff for a COOP event. Essential personnel are identified as the personnel required supporting the essential functions. These personnel have the essential skills, training, and knowledge to support the organization during a COOP event.

 

Based on the essential function that you planned in the last activity, identify the minimum staffing level needed to support the function.  Complete the Template, identifying the skills, roles, quantities, and alternate personnel needed to sustain that function or paste in the table created using the Continuity of Operations Planning Toolkit, Part One.

 

Critical Resources and Assets

Providence Rest  has identified the following critical resources for a COOP event. Critical resources are those resources required to maintain an essential function.

 

 

PROVIDENCE REST

EMERGENCY CONTACT LISTING

Trade / System	Company	Phone Number	Contact / Notes/ Comments
Plumber	L. Glashow, Inc.	718-432-8600 718-881-6000	Tom Fascaldi
Electrician	Day Electrical Contracting, Inc.	914-403-1764 718-994-7769	Dave Pasquerella
Fire Alarm	TSS	212-233-8505
Central Station	Tyco/ Johnson Controls	800-289-2647
Boiler Issues	Miller Proctor Nickolas	914-332-0088 800-228-2471
Drain Stoppages	L. Glashow, Inc.	718-432-8600 718-881-6000	Tom Fascaldi
Laundry Machine Service	H.K. Sales	800-229-4572
Nurse Call System	Sound Pro	866-934-4864	Tim McGuire
Door Alarms	TIGroup	917-647-8003	Aaron Cutler
Wandering Prevention	TIGroup	917-647-8003	Aaron Cutler
CCTV System	Sentry Communication & Security	516-822-7770
Elevator Service	Nouveau Elevator	718-349-4700	Dispatch
Heating, Ventilation and Air Conditioning	Kelair	845-278-1996	Dispatch
Refrigeration ( Kitchen )	Rivers Refrigeration	516-641-7819	George
Emergency Generator	National Standby Repair	914-734-1400	Dispatch
Fuel Oil (Emergency Generator)	Sprague	914-381-6600	Service
Sprinkler & Standpipe	Sirina Fire Protection	516-942-0400
Locksmith	Galaxy Locksmith	718-863-1365	Barry Gelfand
Trade / System	Company	Phone Number	Contact / Notes/ Comments
Hardware Store	Flannery Hardware	718-792-9060
Telephone	Sr. Josephine	917-375-8615
Compactor and open Containers	Falso Carting Inc.	718-292-0649
Emergency Materials and Equipment	Grainger	800-225-5994	Will open Branch for Emergency

 

 

Alternate Facilities

 

 

POLICY:         It is the policy of this facility to contact and maintain relationships with other facilities that will serve as alternate sites for our residents during an evacuation situation.

 

PURPOSE:     To identify alternate sites to which our residents will be evacuated during an emergency.

           

RESPONSIBILITY:    Incident Command

Isabella Geriatric Center

515 Audubon Avenue

New York, New York,      10040

212-342-9556

 

Pelham Parkway Nursing Care & Rehabilitation Facility

2041 Laconia Avenue

Bronx New York10469

 

Ozanam Hall of Queens Nursing Home

42-41 201^ST  Street

Bayside, New York 11361

718 – 423-2000

 

St. Joseph’s Medical Center

127 South Broadway

Yonkers  New York,  10701

914-378-7000

 

Methodist Home for Nursing & Rehabilitation

4499 Manhattan College Parkway

Riverdale, New York 10471-3998

718-548-5100

 

NYU Hospitals Center

560 1st Ave.

New York, NY 10016

212-263-5198

 

Mount St. John Convent

150 Anderson Hill Rd

Purchase, New York,  10577

914-761-7965

 

Documentation                                  On file in Administration:

Pelham Parkway                   Transfer agreement

Isabella Geriatric Center      Transfer agreement

Methodist Home                    Transfer agreement

Ozanam Hall                           Transfer agreement

NYU  Hospitals Center           Transfer agreement

Mt. St. John                             Memorandum of

Understanding

Team              Notify identified facilities that a decision has

been made to evacuate residents to their

facilities as per agreements.)

 

Administrator                                                Initiate and maintain agreements with alternate

site facilities.

 

 

[A cooperative or mutual aid agreement with this facility can be found as an Appendix to this document.] 

Emergency Communication

Insert information as indicated below and/or paste in content developing using Continuity of Operations Planning Toolkit, Part Two.

 

It is vital that Providence Rest be able to contact all personnel and resident’s families to keep them abreast of information regarding the COOP event and eventual return to normal operations. An updated personnel roster for Providence Rest and resident contact list, complete with contact information, is provided as an Appendix to this document.

 

Recognizing that in a wide-spread event, communications may be limited, Providence Rest has the following communication methods:

Internal Staff Notification

Announce activation of the evacuation plan by paging “CODE   D”

Internal Staff Response

Upon activation of the evacuation plan, all staff should return to their respective units / departments.  Resident Care Staff shall prepare residents for evacuation.  Support departments shall send staff to the Labor Pool.

Off-Duty Staff Notification

Notify off-duty staff as needed.  Off-duty staff notification will take place by  use of Providence Rest’s mass notification system further notifications will be made by the Director of Human Resources or designee and Director of Nursing or designee Off-duty staff shall be instructed to report directly to the Labor Pool when they arrive.

External Notifications

Consider the need to make various external notifications including:

• Resident families / emergency contacts
• Resident primary physicians
• Facility Ombudsman
• Media
• Vendors

Designate staff to prepare for and conduct notifications.  Access to specific notification information is identified in the Notification Matrix (Appendix B).

Internal Communications

The Incident Commander shall designate a staff member to ensure communications between the Command Center and the following:

• All Command Center ICS positions
• Each resident care area / unit
• Holding area(s)
• Loading area(s)
• Staffing Pool

Communications shall take place utilizing the following, as appropriate:

• Standard telephones
• Runners
• Portable radios
• Cell phones
• E-mail

 

There are a number of local partners and stakeholders that Providence Rest may need to communicate with in case of a COOP event.

Once a mandatory evacuation is ordered by a governing body or an internal emergency warrants the evacuation, the Administrator or Administrator on Call will notify the New York State Department of Health Regional Office.   The Incident Command Team will conduct full agency notification.

 

New York State Department of Health Regional Office:  212-613-2566

Federal Emergency Management Agency (FEMA):  212-680-3609

New York City Office of Emergency Management (OEM):  718-422-4800

Ombudsman:   212-962-2723

Police Department – 45^th Precinct:  718-822-5411

Fire Department:  718-665-2200

Con Edison:  212-780-6752

 

Alert and Notification

Staff

During a COOP event, staff will be regularly updated on business operational status including weather or not they should report to work, what work conditions are like, alternate work site information, and other key information. The following describes the staff alert and notification process for Providence Rest:

• Staff member with primary responsibility for initiating notification: [insert name and contact information of person with primary responsibility]
• Staff member with secondary responsibility for initiating notification: [insert name and contact information of person with secondary/back-up responsibility]
• Staff will be notified via: [insert method(s) such as phone tree, blast email, automatic notification system, text message, etc. and details regarding that method such as email addresses]
• Staff will respond via: [insert method(s) such as email, automatic response system, calling a live person, etc. details regarding that method such as email addresses or telephone numbers]
• Plan triggers/incidents
  • [List conditions under which alert/notification will be initiated]
• Key contacts list can be found as an Appendix to this document.

 

Key Contacts

During a COOP event key contacts including resident relatives, key vendors, and other stakeholders will be regularly updated on operations status such as operational capability, operations at alternate facility, hours, orders in progress, etc. The following describes key contacts alert and notification process for [Insert Name of Organization]:

• Staff member with primary responsibility for initiating notification: [insert name and contact information of person with primary responsibility]
• Staff member with secondary responsibility for initiating notification: [insert name and contact information of person with secondary/back-up responsibility]
• Key contacts will be notified via: [insert method(s) such as phone tree, blast email, automatic notification system, text message, etc. and details regarding that method such as email addresses]
• Key contacts will respond via: [insert method(s) such as email, automatic response system, calling a live person, etc. details regarding that method such as email addresses or telephone numbers. Include under which circumstances key contacts will be asked to respond.]
• Plan triggers/incidents
  • [List conditions under which alert/notification will be initiated]
• Key contacts list can be found as an Appendix to this document.

 

Devolution

Insert information as indicated below and/or paste in content developing using Continuity of Operations Planning Toolkit, Part Two.

To accomplish its mission, Providence Rest must ensure that operations continue efficiently, with minimal disruption to essential functions, especially during an emergency. While the severity and consequences of an emergency cannot be predicted, effective contingency planning can minimize the impact on Providence Rest missions, personnel, and facilities. In instances where essential functions cannot be continued by Providence Rest, devolution will be evaluated. If appropriate, devolution will include transfer of statutory authority to other employees and facilities.

Devolution Scenarios

Devolution scenarios may include the following:

• The Providence Rest primary operating facility and staff is unavailable or incapable of executing the Providence Rest] mission as a result of a disaster, attack, or catastrophe (e.g. severe snow and ice storm, pandemic influenza, widespread power outages, etc.).
• [Enter primary operating facility metropolitan region here] is incapable of conducting normal business activities as a result of an incapacitation of critical information and communications systems, extreme natural disaster, Weapons of Mass Destruction (WMD) event, hazardous material incident or biological event rendering the all alternate operating facilities unavailable.

Delegation of Authority

Orderly succession of officials to the position of [Organization Lead] in the case of the [Organization Lead]’s absence, a vacancy at that office, or the inability of the [Organization Lead] to act during an emergency

 

[Organization Name] has informed those individuals who might be expected to assume authorities during a continuity situation. The names and contact information of these individuals can be found as an Appendix.

Reconstitution

Insert information as indicated below and/or paste in content developing using Continuity of Operations Planning Toolkit, Part Two.

 

Reconstitution consists of resuming normal operations after a continuity event or devolution. Organizations should be prepared to resume operations no matter the size of the COOP event. Reconstitution may occur in a new location, or in the original, restored location.

Reconstitution Objectives

The following are the objectives of Providence Rest COOP reconstitution process:

• Provide an executable plan for transitioning back to efficient normal operational status from continuity operations status or devolution status, once a threat or disruption has passed.
• Coordinate and pre-plan options for organization reconstitution regardless of the level of disruption that originally prompted the organization to implement its continuity plans. These options must include moving operations from the continuity facility or devolution site to the primary operating facility, a temporary operating facility, or a new or rebuilt operating facility.
• Outline and execute the necessary procedures, whether under a standard continuity of operations event or under a devolution event, for conducting a smooth transition from the continuity facility to the primary operating facility, a temporary operating facility, or a new/rebuilt operating facility.
• Ensure a safe location for organization staff to resume normal organization operations.
• Reduce or mitigate disruptions to organization operations.
• Ensure and validate reconstitution operations readiness through an integrated continuity test, training, and exercise program and operational capability.

 

Reconstitution Phases

The activities of reconstitution are divided into 3 phases: preparedness, reconstitution operations, and post-reconstitution.

 

Phase I: Preparedness – Planning and Preparing for Reconstitution

This section should describe the process of planning and preparing to implement the organization’s Reconstitution Plan/Annex; it describes the activities to be performed to support an organization’s readiness and ability to conduct reconstitution operations.  Sample text for this section is provided below, however, organizations should tailor this section to meet their specific continuity planning and operational needs.

 

During Phase I, the Providence Rest will focus on staff and resource readiness to perform and/or support reconstitution and post-reconstitution operations. Key activities during this phase include those listed below:

• Develop reconstitution plans, procedures, and processes
• Develop checklists and key personnel contact lists
• Develop vital records list
• Develop reconstitution packet informing stakeholder of activities and timelines
• Identify the Reconstitution Manager and potential Reconstitution Team members
• Identify, train, and exercise building damage assessment and recovery team
• Establish and enter into memorandums of understanding/memorandums of agreement (MOU/MOA)
• Conduct training and exercises for continuity/reconstitution personnel

Phase II: Reconstitution Operations—Transitioning To Normal Operations

This section should describe the process of moving from continuity or devolution operations to normal operations. The focus for this phase is the transfer of essential functions back to the primary operating facility, a temporary operating facility, or a new or rebuilt operating facility. Sample text for this section is provided below, however, organizations should tailor this section to meet their specific continuity planning and operational needs.

 

During Phase II, the Providence Rest will focus on transferring the essential functions from the continuity facility or devolution site back to normal operations either at the primary operating facility, a temporary operating facility, or a new or rebuilt operating facility. Specific actions and activities performed during this phase include, but are not limited to, those listed below:

• Convene the Reconstitution Team
• Assess the threat/hazard
• Evaluate safety and habitability of primary operating facility
• Recover salvageable equipment, supplies, and records
• Conduct system and communications checks
• Assess reconstitution level
• Conduct facility safety inspection of primary operating facility, temporary operating facility, or new/temporary operating facility
• Coordinate and collaborate with senior leadership and key stakeholders
• Maintain communications with staff and key contacts

 

Phase III: Post-Reconstitution—Resuming Normal Operations and Conducting After Action Review

This section should describe the process of resuming normal and reviewing and evaluating the reconstitution process after the continuity/devolution event is over and the organization has transitioned back to normal operations. The activities and actions associated with this step focus on conducting facilities, communications, and information technology tests focused on resuming normal operations and identifying lessons learned, best practices, and improvement needs and documenting those findings in an after action report. Sample text for this section is provided below, however, organizations should tailor this section to meet their specific continuity planning and operational needs.

During Phase III, the Providence Rest will focus on conducting normal operations, shutting down operations at the continuity or devolution site, and reviewing and evaluating the overall reconstitution process by conducting an after action review for the purpose of evaluating the effectiveness of the reconstitution policy, plans, processes, and procedures. Through this review, the Providence Rest will identify lessons learned, best practices, and improvement needs. An after action report (AAR) and improvement plan (IP) will be developed. Specific activities performed during this phase include those listed below:

• Conduct normal operations
• Conduct post-reconstitution hot wash
• Document and evaluate review findings
• Develop after action report and improvement plan
• Update or revise COOP plan/annex

Appendices

The following are the suggested appendices to the plan. Develop/add these documents as necessary to tailor this plan to your organization.

 

• Acronyms
• Risk Assessment and Vulnerability Analysis
• Delegation of Authority list
• Information Technology Inventory and Details
• References and Authorities
• Information on alternate facilities
• Any supporting MOAs/MOUs

Authority to Evacuate

 

Policy:   As part of Providence Rest’s overall Emergency Management Plan, the Evacuation Plan details procedures, staff roles and responsibilities and preparedness activities associated with a full or partial evacuation of the Home.

 

Purpose:

The purpose of this policy is to define how, when and by whom the Evacuation Plan is to be activated.

 

Responsibilities:

 

CEO or Administrator	Decides to activate when Home cannot sustain or support resident care.  Authorizes key personnel to take immediate action in the event of an evacuation.
Administrator or Administrator on Call	Initiate Evacuation Plan in the absence of the Administrator.
Director Security/Safety	Initiate elements of the Evacuation Plan through the Incident Command Structure when authorized by Administrator.
Incident Command Team Comes Together	Administrator, Director Operations, Director Nursing, CFO, Director Human Resources, Director Security, Medical Director, Director Social Services
Dietary Services	Prepare and package nutritional items to accompany (or follow) residents and staff to evacuation site, time permitting.

 

Incident Command Team	Notifies:  Department Managers and Supervisors Local, State and Federal Agencies Transportation providers Alternate site facilities   Assigns employees to alternate roles, responsibilities and shifts as needed, including accompanying residents to evacuation sites.    One member of team acts as spokesperson/media liaison.
Department Managers and Supervisors	Notify staff members of impending evacuation in conjunction with Human Resources which has maintained staff roster of readily accessible classes of (local) employees.
Director Social Services/Designee	Notify family members.  Identify designated re-location sites.
Unit Nurses	Assign unit staff to gather necessary medical documentation to travel with residents.  Put together medication packets to travel with each resident.
Maintenance Staff/ Nursing	Prepare medical equipment in coordination with nursing, for transporting with residents, i.e. tube feeding, oxygen, suctioning machines, etc. if necessary.
Environmental Services/Nursing	Prepare packages of resident clothing, personal care items, blankets, time permitting.
eFinds Team	Maintain station at points of egress, check identification of residents and staff, Have two staff members one to fill out tracking forms for eFind and one to put coded bracelet on each resident and mark tracking forms as to destination site of each resident and accompanying staff.
Security Staff	Provide traffic/transportation control while residents are being evacuated.  In absence of assigned business office personnel, maintain station at points of egress and mark tracking forms as to destination site of residents and staff.

 

All Staff

 

Upon notification of the Home’s Code D Activation all breaks, lunches, and meetings are cancelled.

All employees will report back to their assigned areas and await further instructions. At this time all staff not assigned specific duties will report to the staffing pool.

 

Command Post

Coordinate all activities per incident including but not limited to the following:

Plan to move residents as necessary and track their movements- relay information to the Family Center.

Coordinate and track interactions and activities with outside agencies.

 

Unified Command

Coordinate and track interactions and activities with outside agencies.

Send a Home Representative with a radio/ cell phone to Fire/Police/EMS command post so all activities are coordinated.

 

Staffing Pool

 

Coordinate all staff.

Know who is where.

Who you need where?

Call in all necessary staff.

Coordinate staff so you have some staff for relief if prolonged incident.

Schedule staff coverage for prolonged incidents for food and rest breaks.

Track staff movement internally and externally for their location if transporting a Resident.

 

Family Center

 

This area is for families that arrive at the Home during a disaster to check on their loved ones.

Designate a Telephone number to give to the PIO to share with the media so families can call in to check on their loved ones.

 

Public Information Center

 

This is a location for the media to gather preferably in a controlled area out of the main stay.

Area should be good location for the PIO to give regular press releases.

Press releases should be given at specified times and usually just prior to their regular broadcasts.

 

CISD Area

 

Critical incident Stress Debriefing area should be located where staff can comfortably sit and talk to someone or a team about what they experienced.

 

Lead Time and Evacuation Decision-Making

Any evacuation of residents may be expected to take a certain amount of time.  Major elements of this time include mobilizing staff, transportation resources, alternate destinations, and the residents themselves.  Circumstances such as inclement weather, staff shortages, loss of electrical power, limited transportation assets, or long travel distances may contribute exponentially to this time factor.  A non-emergent full-scale evacuation of the facility will take many hours.

For this reason, when considering a planned evacuation, leadership shall be cognizant of lead time until the time when the facility must be vacant, and plan accordingly.  For example, when evacuating the facility in anticipation of an impending hurricane, sufficient time must be allowed to ensure that all occupants are clear and the facility is safely shut down and secured before the storm’s arrival.

Alternatives to Facility Evacuation

There are several alternatives to facility evacuation that should be considered prior to ordering evacuation.  These include:

Shelter-in-place.  Also known as “defend in place,” sheltering in place involves isolating the facility or a space within the facility from an external threat.  Shelter-in-pace actions might include locking down the facility to protect from an external crowd or security threat.  It may also include shutting windows and closing ventilation systems to outside airflow, which might be necessary to protect the facility and occupants from an external environmental hazard such as a hazardous materials incident with airborne threat, or smoke from an external fire.

Establish a buffer zone.  Creation of a safety buffer zone around the facility may be effective in isolating the facility from a human-caused threat.  Sufficient resources are positioned between the threat and the facility to eliminate the need for evacuation or provide more time to effect a more safe and orderly evacuation.  Such a strategy may be utilized during community emergency situations or civil unrest.  For a flood threat, a buffer zone may be created using sandbags or other flood barriers.

Add resources.  Assignment of additional resources to insure safe levels of service may be an effective strategy to offset a temporary loss of utilities or essential services such as power or medical gasses.  Allocation of governmental and/or private resources may alleviate the need for partial or complete evacuation.

Partial or localized relocation/evacuation.  When portions of a facility are determined to be damaged and unsafe, the Incident Commander will order relocation of residents and staff to safe, unaffected areas of the facility.  This may allow time for a more thorough engineering assessment and occupancy determination, avoiding an urgent or emergent departure.  For a lower floor threat, such as a flash flood, relocation of residents to upper floors may be an effective strategy.

 

 

Alteration in the standard of care.  Implementing austere care measures, or a graceful degradation in the level of medical care provided, are strategies to be used only after considering all other options.  Such strategy might be appropriate under circumstances where all regional healthcare facilities are similarly affected and thus evacuation would be an ineffective option to improve the level or environment of care.  Unless conditions are prohibit, the Incident Commander will confer with the Medical Director, Director of Nursing Services, and/or the NYSDOH Regional Office prior to any such activities.

PLAN IMPLEMENTATION

Plan Activation

To activate the evacuation plan, the individual in-charge of the building at the time will Notify one of the following positions to activate the Emergency Management plan.  This role will change based on staff positions in the building at the time the plan is activated.  The Incident Commander position will be filled by staff in the following order:

CEO

Administrator

Command Center

 

Establish a Command Center if one has not already been established.

 

COMMAND CENTER LOCATION
PRIMARY	ALTERNATE
Occupational Therapy 1st floor C Building	1st   floor Auditorium

 

CEO or Administrator	Decides to activate the Emergency Management Plan when necessary.   Authorizes key personnel to take immediate action in the event of a Code “D”.
Administrator or Administrator on Call	Initiate Emergency Management Plan in the absence of the Administrator.   Acts as Public Information Officer(PIO)
Director Security and Safety	Initiate elements of the Emergency Management Plan through the Incident Command Structure when authorized by Administrator.
Incident Command Team	Administrator, Director Nursing, Director Human Resources, Director Safety and Security, Medical Director, Director Social Services, Director of Operations

It will likely be necessary to assign an individual more than one incident command role.

Provide individuals with Taskers (Appendix I).

 

Key Notifications

When possible, the decision to evacuate should be made in conjunction with emergency service and government agencies.  The Incident Commander will ensure the following notifications are made when the possibility of evacuation exists:

• Fire, Police, EMS Agencies
• Local Office of Emergency Management
• NYSDOH Regional Office
• Local Health Department

Utilize the Notification Matrix (Appendix B) for the location of specific contact information.

Evacuation Decision Making

Determine the facility’s ability to continue to provide resident care.  Consider the following factors:

• Structural integrity
• Utilities
• Weather conditions
• Transportation resource availability
• Receiving facility availability
• Supplies
• Ability to receive supplies

Utilize the Facility Systems Status Report (Appendix C).

Evacuation Extent

Determine the extent of the evacuation:

• Level 1 – Alert for Potential Evacuation
• Level 2 – Limited Area / Horizontal Evacuation
• Level 3 – Limited Area / Vertical Evacuation
• Level 4 – Large Area / Entire Building Evacuation

Utilize the Evacuation Extent Matrix (Appendix D).

NOTIFICATIONS AND COMUNICATIONS

Internal Staff Notification

Announce activation of the evacuation plan by paging “CODE   D”

Internal Staff Response

Upon activation of the evacuation plan, all staff should return to their respective units / departments.  Resident Care Staff shall prepare residents for evacuation.  Support departments shall send staff to the Labor Pool.

Off-Duty Staff Notification

Notify off-duty staff as needed.  Off-duty staff notification will take place by the Director of Human Resources or designee and Director of Nursing or designee Off-duty staff shall be instructed to report directly to the Labor Pool when they arrive.

External Notifications

Consider the need to make various external notifications including:

• Resident families / emergency contacts
• Resident primary physicians
• Facility Ombudsman
• Media
• Vendors

Designate staff to prepare for and conduct notifications.  Access to specific notification information is identified in the Notification Matrix (Appendix B).

Internal Communications

The Incident Commander shall designate a staff member to ensure communications between the Command Center and the following:

• All Command Center ICS positions
• Each resident care area / unit
• Holding area(s)
• Loading area(s)
• Staffing Pool

Communications shall take place utilizing the following, as appropriate:

• Standard telephones
• Runners
• Portable radios
• Cell phones
• E-mail

Census Reduction

Identify opportunities to reduce census.  Consider the following discharge categories:

1. Home with No Aftercare Needs: These are residents who typically have a stable medical condition, are ambulatory, alert and oriented, and have family support.  During evacuation, the facility will contact the resident’s family / caregiver as necessary to discuss opportunities for discharge.  They will also arrange for transportation by the most appropriate means if the family / caregiver is unable to provide transportation.
2. Home with Home Care:  These are residents who require continuation of skilled care after discharge that can be managed safely in a residential environment.  During evacuation, the facility will contact the resident’s family / caregiver as necessary to discuss opportunities for discharge with home care assistance.  They will arrange for transportation by the most appropriate means if the family / caregiver is unable to provide transportation including transportation and delivery of medical supplies and equipment.  Home Care providers will be contacted by the facility and coordinated with families / caregivers.  Home care agencies will be expected to activate their internal surge plans as needed to accommodate the influx of resident discharges.

Categorize residents being discharged by mobility level utilizing the NYSDOH Standardized Transportation Assistance Levels (TAL) (See Section 10.5 and Appendix G).

  Resident Packaging

Prepare residents for evacuation.  For non-emergent situations, resident “packaging” shall be conducted by clinical staff on the resident units.  Staff should follow the Resident Packaging Guide (Appendix E&F).  Provide copies of the Resident Packaging Guide to each unit.

  Medications

POLICY:  To the extent possible, Providence Rest will ensure medications; treatment supplies and crucial medical documentation will be provided to alternate care sites for each resident during or immediately following an evacuation.

 

PURPOSE:  To define who, what and how essential medical information and supplies are provided for residents during an evacuation condition.

 

PROCEDURE:

 

RESPONSIBILITY                                           ACTION

 

Charge Nurse                        Place Medicine Administration Record (MAR), Treatment Administration Record (TAR) and face sheet folded for privacy with medication and resident’s picture in resident bag, time permitting.

Secure bag on the resident.

 

 

Clinical Care Coord/             Inform Pharmacy of resident’s destination if time does

Unit Manager                         not permit medication to accompany resident.  Send

face sheet to alternate site within 24 hours.  Ensure

resident information is updated weekly and as needed

so that current data is readily available.

 

Pharmacy                               Provide 5-day supply of medication with MAR, TAR and doctors’ orders to alternate site for each resident

within 24 hours.       

 

Medical Director                   Sign triplicate form for pharmacy to send 3-day

supply of controlled substance directly to alternate

site.

 

 

Resident information is updated constantly.  These policies will be reviewed annually and as needed and will be maintained on each unit in the Environment of Care binder.

 

 

 Controlled Substances

All ordered controlled substances should be evacuated with a resident.

Anyone who is authorized by law to prescribe, dispense, or administer controlled substances may transport these medications.

If an authorized individual is not available to accompany a resident at the time of the evacuation, controlled substances may be taken to a receiving facility by an authorized individual after the evacuation is complete.  A controlled substance count will be done and documented at the receiving facility.

 

  Transportation Assistance Levels

Categorize residents by mobility level utilizing the NYSDOH Standardized Transportation Assistance Levels (TAL) (See Appendix G).  TAL categorization shall be conducted by clinical staff on the resident units.

The mobility TAL category determined for each resident shall be identified by a sticker.  These stickers will id residents with a person walking, wheelchair, or stretcher.

 

  Resident Evacuation Prioritization

Determine evacuation prioritization for all units / departments with feedback from and in consultation with:

• Safety and/or Security
• Command Center Personnel (Section Chiefs)
• Emergency Services (Fire, EMS, etc.)

Consider evacuating residents by mobility status and acuity level if possible (consider the following order):

• General Resident Population

1. Ambulatory
2. Non-ambulatory, low acuity
3. Non-ambulatory, high acuity
4. Non-ambulatory bariatric (consider transferring non-ambulatory bariatric residents directly to EMS stretchers to avoid multiple transfers)

• Dementia Population

1. Lower Elopement Risk
2. High Elopement Risk

Consider holding higher acuity units for later evacuation since this gives a chance to assemble additional staff in the Labor Pool.  This also allows more time to stabilize the resident and prep him/her for evacuation.

During a planned evacuation, partial evacuation of the facility may be an option.  Consider evacuating residents by the same evacuation prioritization or consider reversing the order if the facility intends to only keep its ambulatory / low acuity population.

  Resident Confidentiality

 

Maintain resident confidentiality throughout the evacuation process.

The HIPAA Privacy Rule allows resident information to be shared to assist in emergency relief efforts, thus providers and health plans covered by the HIPAA Privacy Rule can share resident information in all the following ways:

Health care providers can share resident information as necessary to provide treatment.  Treatment includes:

• Sharing information with other providers (including hospitals and clinics)
• Referring residents for treatment (including linking residents with available providers in areas where the residents have relocated)
• Coordinating resident care with others (such as emergency relief workers or others that can help in finding resident appropriate health services)
• Providers can share resident information to the extent necessary to seek payment for these health care services.

 

EVACUATION ROUTES

  Horizontal and Vertical Evacuation Routes

Horizontal and/or vertical evacuation routes will be given when resident evacuation is to commence. This is to assure that resident and staff safety is not compromised by using a pre determined route that may be unsafe. If the emergency affects the building structure (e.g. fire, collapse, power failure) elevators should not be utilized unless permitted by the fire department.

 

  Evacuation Room Markers

 

POLICY:                     It is the policy of Providence Rest to ensure the safety of our residents during any emergency or disaster situation by providing a simple, thorough room evacuation process.

 

PURPOSE:                 To describe resident room evacuation protocol.

 

EQUIPMENT:            Red and white evacuation tags on the side of each resident’s

door inside the room.  Blue tags on the room door if an alternating

pressure mattress is in the room plugged into an outlet.           

 

RESPONSIBILITY:    The Charge Nurse will assign unit staff including Certified

Nursing Assistants, Service Workers and Unit

Receptionists to specific sections of the unit to conduct

the room searches and remove residents and assure all residents have been evacuated.

 

 

 

PROCEDURE:                        Check room.

Remove resident.

Unplug bed if blue tag is on the door and the emergency is a

smoke or fire condition.

Remove tag from inside room and place on door knob.

Close the door.

RESPONSIBILITY:

 

Director Security                   Ensures all new employees receive disaster protocol during

orientation.

 

Keeps disaster manual/policies current and                                                                                 conducts drills.

 

Department Managers         Ensure all staff participates in disaster drills and review

annual mandatory disaster plan.

 

All Staff                                   Participate in drills

Keep up to date on mandatory training

 

 

 

Evacuation Equipment Collection

All residents have a wheelchair and/or walker assigned to them.

 

Assign an individual to collect evacuation equipment from throughout the facility.

Designate an equipment staging location for these items.  If there is no elevator service, items should be gathered on each floor and staged in a single location for pick-up as necessary.

Notify the individual in-charge of the Labor Pool of the equipment staging location.  Evacuation Groups from the Labor Pool can pick-up equipment when they are dispatched to evacuate an area.

 

TRANSPORTATION

  Transportation Resources

Designate a staff member to oversee transportation resources (Transportation Unit Leader).  Provide this individual with the Transportation Unit Leader Tasker.

Coordinate the request for transportation resources with the Senior Fire Official on site via their field incident command location if they are on-site.

Coordinate the request for transportation resources with the Senior Fire Official on site.

 

POLICY:                     It is the policy of Providence Rest to ensure transportation resources have been secured in the event our residents need to be evacuated to alternate care sites.

 

PURPOSE:                 To identify transportation resources

 

RESPONSIBILITY:

 

Administrator                                    Secure agreements with transportation

resources

 

Chief Financial Officer                      Review and maintain contracts

 

 

RESOURCES:                         Senior Care Ambulette Services (ambulette)

 

 

Documentation:                              Senior Care                Evacuation Agreement

Trailways  Buses       Verbal Agreement

US Coachways           Verbal Agreement

 

Kept Current:                                  Periodic review and renewal

 

Residents’ Needs:                           All three companies provide proper vehicles for

transportation of ambulatory, wheelchair-                                                      bound and bed-bound residents.

 

Recurrent Assessment of

Residents’ Transport Needs        Updated Resident Roster (updated weekly) by

Clinical Care Coordinators/Unit Managers

 

24-hour Resident Report (updated daily) by

Unit Charge Nurses

Updated Care Plans (quarterly and as needed)(updated by Interdisciplinary Care Plan Team)

Receiving Facilities

 External Holding Location

 POLICY:        It is the policy of this facility to contact and maintain relationships with other facilities that will serve as alternate sites for our residents during an evacuation situation.

 

PURPOSE:     To identify alternate sites to which our residents will be evacuated during an emergency.

 

RESPONSIBILITY:    Incident Command

Isabella Geriatric Center

515 Audubon Avenue

New York, New York,      10040

212-342-9556

 

Pelham Parkway Nursing Care & Rehabilitation Facility

2041 Laconia Avenue

Bronx New York10469

 

Ozanam Hall of Queens Nursing Home

42-41 201^ST  Street

Bayside, New York 11361

718 – 423-2000

 

St. Joseph’s Medical Center

127 South Broadway

Yonkers  New York,  10701

914-378-7000

 

Methodist Home for Nursing & Rehabilitation

4499 Manhattan College Parkway

Riverdale, New York 10471-3998

718-548-5100

 

NYU Hospitals Center

560 1st Ave.

New York, NY 10016

212-263-5198

 

Mount St. John Convent

150 Anderson Hill Rd

Purchase, New York,  10577

914-761-7965

 

 

 

Documentation                                  On file in Administration:

Pelham Parkway                   Transfer agreement

Isabella Geriatric Center      Transfer agreement

Methodist Home                    Transfer agreement

Ozanam Hall                           Transfer agreement

NYU  Hospitals Center           Transfer agreement

Mt. St. John                             Memorandum of

Understanding

Team              Notify identified facilities that a decision has

been made to evacuate residents to their

facilities as per agreements.)

 

           

 

Administrator                                                Initiate and maintain agreements with alternate

site facilities.

 

PROCESS:

  Determining Receiving Facilities

Designate an individual (Liaison Officer) to contact receiving facilities to confirm and coordinate the number and type of residents that each receiving facility can accept.

Ensure that resident receiving facilities are appropriate based on the clinical needs of the resident.

 

TRACKING AND ACCOUNTABLITY

 Resident Tracking

POLICY:  During emergency situations involving evacuation Providence Rest will account for the location and safety of every resident.

 

PURPOSE:     To outline the process of tracking the pre-destination of each resident during an evacuation.

 

RESPONSIBILITY:

           

eFinds Team                          Maintain station at points of egress, check identification of residents and staff, Have two staff members one to fill out tracking forms for eFind and one to put coded bracelet on each resident and mark tracking forms as to destination site of each resident and accompanying staff.

 

(IT Manager)                         Generate two copies of weekly updated listing of all

in-house residents with emergency contact

information.  One set goes to Social Service to be

used for tracking family notification.

 

PROCEDURE:

In the event of a power outage the resident list will be updated and used as a tracking form for the residents being transferred to other facilities.

If power is restored during the emergency a new list will be generated and used.

During the evacuation the eFinds Team will Maintain stations at points of egress, check identification of residents and staff, Have two staff members one to fill out tracking forms which consist of resident’s name, date of birth gender and time for eFind and one to put coded bracelet on each resident and mark tracking forms Resident’s name as to destination site of each resident and accompanying staff. If evacuation occurs after normal business hours, security officer will assign available staff until arrival of Emergency eFinds Teams. All this information will then be forwarded to the Department of Health (DOH).

When evacuation is complete the IT manager will log onto the e-FINDS system  and verify the residents have arrived safely and provide copy of completed form to The EOC and Social Services.

In the event of an evacuation, a mass notification message will be sent to resident and Family members social service staff members will be responsible for notifying each resident’s designated representative/emergency contact of the evacuation and location of the resident.  If time is a major factor in the process, then contacts will be notified once evacuation is over.

Once authorities clear Providence Rest for re-entry, the social service department will contact the alternate care facilities and arrange for residents to return.  The DOH tracking system will be used. This tracking form will be used for both transfers out and returning residents. As tracked on the DOH eFinds system.

A Resident Evacuation Critical Information and Tracking Form should be completed for each resident.  This form will track residents throughout the entire evacuation process including:

• Leaving the unit
• Arriving at an internal holding area
• Arriving at an internal loading area
• Departure of the facility
• Arrival and departure at an external holding area (where applicable)
• Arrival at a receiving facility

If time permits, the form should be initially completed by clinical staff members on each resident unit.  Ensure forms are available on each unit.  Otherwise, the form will be completed in a holding area.

 Staff Accountability

As the residents are being evacuated business office or assigned personnel staff will

fill out tracking forms for eFind and one to put coded bracelet on each resident and

mark tracking forms as to destination site of each resident and accompanying staff.

 

All other staff leaving the building will be tracked through the labor pool.  All staff will exit the building through the labor pool.

  Visitor Accountability

All visitors will sign out of the facility prior to leaving the building during an evacuation.  The individual in-charge of each unit / department shall conduct a walk-through of their area once the evacuation of the unit / department is complete to ensure all staff and visitors have evacuated.  Inform the Command Center that evacuation of the area has been verified.

 

FACILITY SHUTDOWN

  Physical Plant Shutdown

Determine the need to shutdown the following systems where applicable

• Emergency Electrical Shutdown
• Emergency Water Supply
• Severe Weather
• Loss of Heating System

 

Contact external vendors where necessary to shutdown or secure systems.

Shutdown of utilities should be the final steps performed in an evacuation, and should only be initiated by order of the Incident Commander.

As utilities are secured, the mechanic/technician securing shall follow all necessary lock out/tag out procedures.

  Stay Team

Depending upon the circumstances, consider developing a Stay Team that will be left behind to secure and safeguard the facility and/or effect the physical plant shutdown.

The Stay Team, typically led by a manager within the Logistics Section, consists of Security, Maintenance, and Environmental Services staff.  The number of team members will be based on the work to be done and the risk assessment for the Stay Team.  For example, if evacuating due to an impending storm, the team should be minimal and focus on securing the facility.  If the evacuation is secondary to a fire, the team size may be significant and focused on recovery, restoration, and clean-up activities.

  Stay Team Welfare and Security

If a Stay Team is developed to remain at the facility following a facility evacuation, the following general safety considerations shall be paramount:

A safety and security assessment shall be conducted by the Incident Management Team, with a clear understanding of the risks to Stay Team personnel.

Mitigation measures or considerations shall be addressed in the Stay Team’s mission assignment.  This includes a critical assessment of a shelter-in-place/evacuation decision for the team members in the event that conditions deteriorate beyond expectations.

The Stay Team shall have an Emergency Action Plan (EAP), including incident-appropriate provisions for site safety and hazard mitigation, and emergency equipment available for use.  The EAP shall include provisions for emergency team evacuation and recovery, should conditions become untenable.

The Stay Team shall have at least two alternate means of emergency communications with off-site leadership and public safety agencies in addition to landline telephone service (e.g., satellite telephone and portable radio).  In addition, team members shall have an internal radio communications system for communications between team members on site.

Food, water, and other life-sustaining provisions shall be provided for at least 50 percent longer than the projected period of isolation.

Shelter and environmental considerations (e.g., protection from heat, cold, or adverse weather) suitable to the incident shall be addressed.

 

RECOVERY AND REPATRIATION

  Recovery Planning

From the moment that an evacuation begins, leadership planning should initiate recovery and re-occupancy planning.  Once the cause of an evacuation has been resolved, the facility can apply full focus and energies to a timely re-occupancy.

  Repatriation and Re-occupancy

Re-occupying the facility will typically follow the reverse sequence of the evacuation.  The major difference will be the pace of events and the associated urgency.  The following general sequence will be applied.  Resident Evacuation Critical Information and Tracking Forms should be utilized during the repatriation process to ensure tracking is maintained.

  Re-occupancy Planning

Assign an individual (Planning Section Chief) to oversee the development of an Incident Action Plan (IAP) for re-occupancy.  The re-occupancy IAP shall include (but not be limited to) the operational periods (time line), re-occupancy objectives, priorities and sequencing, resource allocation and needs projection, safety analysis and mitigation measures, and leadership assignments.

Resident clinical abilities will be reviewed to determine the appropriateness of individual resident return to the facility.  Clinical diagnosis such as severe dementia may prohibit resident return do to the emotional stress placed the resident.

  Re-occupancy Decision

The Incident Commander shall ultimately determine if facility is safe for re-occupancy and the appropriate sequencing for re-occupancy.  Such determination shall be based on input and recommendations from stakeholders including (as applicable), but not limited to:

• The authority having jurisdiction
• Other agency participants in the Unified Command organization
• State and/or local health department
• Community public safety agencies
• Nursing leadership
• Staff representatives
• Resident representatives
• Community representatives

Utilize the Facility Recovery and Inspection Guidelines (Appendix F) to assist in the decision making process.

 

  Communications and Notifications

Notification to all concerned parties shall be carried out, in accordance with the Notifications Matrix.

 

  Resources and Assets

Mobilize and stage resources as needed, including the pre-stocking/re-stocking of facility assets, as well as arrangements for those resources (including transportation assets) required to effect the repatriation.

 

  Staff Scheduling

Plan staff redeployment to ensure adequate coverage by position and unit.  Include staff accompaniment of residents being returned to the facility.

  Utilities and Physical Plant

Conduct incident-appropriate physical plant re-activation and system inspections and checks, including fire and emergency alarm systems, security, electrical systems, generators, potable and non-potable water, chillers, elevators, telecommunications, data, and other mechanical and utility systems.

 

 

 

  Clinical Systems and Equipment

Conduct incident-appropriate equipment inspection and testing.

Housekeeping

Conduct incident-appropriate general housekeeping and facility cleanup.

Infection Control

Coordinate environment of care certification and approvals for re-occupancy as needed.

1                          APPENDIX H – FACILITY RECOVERY and INSPECTION GUIDELINES[3]

Prior to re-opening a healthcare facility (or portion thereof) that has undergone extensive water, wind, or other damage, or environmental contamination, inspections need to be conducted to determine if the building is salvageable.  If the decision is made to proceed with recovery and remediation, building and life safety inspections must be completed before any restoration work is done to the facility.  The following information describes those activities that need to be completed.  This if followed by guidance for infection control review of facilities to be done before the facility can reopen.

Prior to re-occupying any portion of the facility, adequate support services need to be available to establish and maintain a safe, suitable environment of care.  Contracting with outside services may be considered, and should be managed through the Finance Section.

1.1          Structural and Life Safety Inspections

As conditions warrant, the following should be evaluated by facilities experts:

• Structural integrity and missing/damaged structural items
• Assessment of air quality, including testing for carbon monoxide, hazardous materials, or remnants of products of combustion
• Assessment of hidden moisture
• Electrical system damage, including high voltage, insulation, and power integrity
• Water distribution system damage
• Sewer system damage
• Fire emergency systems damage
• Air handling system damage
• Medical waste and sharps disposal system

1.2          Water Removal

Water should be removed as soon as possible once the safety of the structure has been verified, using the following process:

• Pump out standing water
• Wet vacuum residual wetness from floors, carpets and hard surfaces
• Clean wet vacuums after use and allow to dry

1.3          Water Damage Assessment and Mold Remediation

• Open the windows in the damaged areas of the building during remediation
• Remove porous items that have been submerged or have visible mold growth or damage
• Minimize dispersion of mold spores by covering the removed items and materials with plastic sheeting (dust-tight chutes leading to dumpsters outside the building may be helpful)
• Dispose of these items as construction waste
• Seal off the ventilation ducts to and from the remediation area and isolate the work area from occupied spaces, if the building is partially occupied
• Scrub and clean hard surfaces with detergents to remove evident mold growth (If a biocide is used, follow manufacturer’s instructions for use and ventilate the area. Do not mix chlorine-containing biocides with detergents or biocides containing ammonia.)
• Dry the area and remaining items and surfaces
• Evaluate the success of drying and look for residual moisture in structural materials (Moisture detection devices [e.g., moisture meters] or bore scopes could be used in this evaluation.)
• Remove and replace structural materials if they cannot be dried out within 48 hours

2           Inspect, Repair, Disinfect where Appropriate, or Replace Facility Infrastructure

• HVAC system (motors, duct work, filters, insulation) inspection, disinfection, repair and replacement
• Water system (cold and hot water, sewer drainage, steam delivery, chillers, boilers)
• Steam sources (if piped in from other places e.g., utility companies it will impact autoclaves)
• Electrical system (wiring, lighting, paging and resident call systems, emergency generators, fire alarms)
• Electronic communication systems (telephones, paging and patient call systems, computers)
• Hazardous chemicals storage

 

  General Inventory of Areas with Water, Wind, Mold, or Contaminant Damage

Determine what furniture can be salvaged

• Discard wet porous furniture that cannot be dried and disinfected (including particle board furniture)
• Disinfect furniture with non-porous surfaces and salvage
• Discard upholstered furniture, drapery, and mattresses if they have been under water or have mold growth or odor
• Discard all items with questionable integrity or mold damage

Determine what supplies can be salvaged

• Salvage linens and curtains following adequate laundering
• Salvage prepackaged supplies in paper wraps that are not damaged, or have been exposed to water or extreme moisture/humidity, smoke, hazardous vapors, or were in a molded environment
• Discard items if there is any question about integrity, moisture, or mold exposure
• Dry essential paper files and records (professional conservators or recovery vendors may be contacted for assistance)

Inspect electrical medical/biomedical equipment

• Check motors, wiring and insulation for damage
• Inspect equipment for moisture damage
• Clean and disinfect equipment following manufacturers’ instructions
• Do not connect wet electronic equipment to electricity sources

Inspect interior structures and surfaces

• Inspect, clean, repair, refinish, or replace wallboard, ceiling tiles, and flooring
• Repair, replace, and clean damaged structures

 

 

3           Review Issues for Reopening Facilities

The following physical plant requirements must be addressed prior to re-opening a facility:

• Potable water
• Adequate sewage disposal
• Electrical power is restored and reliable
• Adequate waste and medical waste management
• All areas to be opened been thoroughly dried out, repaired, and cleaned
• The number of air exchanges in areas of the facility meet recommended standards

3.1          Post-Reoccupation Surveillance

Focused microbial sampling may be indicated to determine if residents who are receiving care in the reopened facility acquire infections that are potentially healthcare-associated and that may be attributed to Aspergillus spp. or other fungi, non-tubercular mycobacteria, Legionella, or other waterborne microorganisms above expected levels.

 

Reference the following:

• The water in the facility’s water distribution system meets the microbial quality of the Safe Drinking Water Act (http://www.epa.gov/safewater/sdwa/index.html)
• Mold remediation efforts were effective in reducing microbial contamination in the affected areas of the hospital (http://www.epa.gov/mold/mold_remediation.html)

 

Checklist for Infection Control Concerns When Reopening Healthcare Facilities Closed Due to Extensive Water and Wind Damage

 

• Prior to opening a healthcare facility that has undergone extensive water and wind damage, inspections need to be conducted to determine if the building is salvageable. If the decision is made to proceed with recovery and remediation, building and life safety inspections must be completed before any restoration work is done to the facility. Parts I – IV describe those activities that need to be completed. Parts V – VII provide guidance for infection control review of facilities to be done before the hospital can reopen.

Prior to opening any portion of a facility such as emergency rooms or clinics, adequate support services need to be available to provide quality care in a safe environment. Contracting with outside services could be considered.

Certification for occupancy must be obtained prior to reopening the facility. Regulations regarding healthcare facility certification and licensing differ from state to state. Refer to specific state and local government resources for more information.

1. Safety Evaluation

The following should be evaluated by facilities experts:

• structural integrity and missing structural items
• assessment of hidden moisture
• electrical system damage, including high voltage, insulation, and power integrity
• water distribution system damage
• sewer system damage
• fire emergency systems damage
• air handling system damage
• medical waste and sharps disposal system

 

1. Water Removal

Water should be removed as soon as possible once the safety of the structure has been verified.

• pump out standing water
• wet vacuum residual wetness from floors, carpets and hard surfaces
• clean wet vacuums after use and allow to dry

III. Water Damage Assessment and Mold Remediation

• open the windows in the damaged areas of the building during remediation
• remove porous items that have been submerged or have visible mold growth or damage
• minimize dispersion of mold spores by covering the removed items and materials with plastic sheeting (dust-tight chutes leading to dumpsters outside the building may be helpful)
• dispose these items as construction waste
• seal off the ventilation ducts to and from the remediation area and isolate the work area from occupied spaces, if the building is partially occupied
• scrub and clean hard surfaces with detergents to remove evident mold growth (If a biocide is used, follow manufacturer’s instructions for use and ventilate the area. Do not mix chlorine-containing biocides with detergents or biocides containing ammonia.)
• dry the area and remaining items and surfaces
• evaluate the success of drying and look for residual moisture in structural materials (Moisture detection devices [e.g., moisture meters] or borescopes could be used in this evaluation.)
• remove and replace structural materials if they cannot be dried out within 48 hours

1. Inspect, Repair, Disinfect where Appropriate, or Replace Facility Infrastructure

• HVAC system (motors, duct work, filters, insulation) inspection, disinfection, repair and replacement
• water system (cold and hot water, sewer drainage, steam delivery, chillers, boilers)
• steam sources (if piped in from other places e.g., utility companies it will impact autoclaves)
• electrical system (wiring, lighting, paging and patient call systems, emergency generators, fire alarms)
• electronic communication systems (telephones, paging and patient call systems, computers)
• medical gas system
• hazardous chemicals/radioactive storage

1. General Inventory of Areas with Water and Wind Damage

• What furniture can be salvaged?
  • discard wet porous furniture that cannot be dried and disinfected (including particle board furniture)
  • disinfect furniture with non-porous surfaces and salvage
  • discard upholstered furniture, drapery, and mattresses if they have been under water or have mold growth or odor
  • discard all items with questionable integrity or mold damage
• What supplies can be salvaged?
  • salvage linens and curtains following adequate laundering
  • salvage prepackaged supplies in paper wraps that are not damaged, exposed to water or extreme moisture, or in a molded environment
  • discard items if there is any question about integrity or mold exposure
  • dry essential paper files and records (professional conservators may be contacted for assistance)
• Electrical medical equipment
  • check motors, wiring and insulation for damage
  • inspect equipment for moisture damage
  • clean and disinfect equipment following manufacturers’ instructions
  • do not connect wet electronic equipment to electricity
• Structures
  • inspect, repair, or replace wallboard, ceiling tiles, and flooring
  • repair, replace, and clean damaged structures

1. Review Issues for Reopening Facilities

• Requirements needed prior to opening a facility
  • potable water
  • adequate sewage disposal
  • adequate waste and medical waste management
• Have all areas to be opened been thoroughly dried out, repaired, and cleaned?
• Does the number of air exchanges in areas of the facility meet recommended standards?
• Are negative-pressure rooms functioning properly?

VII. Site Specific Check List for Selected Areas of the Facility (see attachment A)

Use the check list to assist in determining if the facility is ready to be opened.

VIII. Post Reoccupation Surveillance

Focused microbial sampling may be indicated to determine if:

• the water in the facility’s water distribution system meets the microbial quality of the Safe Drinking Water Act (see: http://www.epa.gov/safewater/sdwa/index.html);
• mold remediation efforts were effective in reducing microbial contamination in the affected areas of the hospital (see: http://www.epa.gov/mold/mold_remediation.html);

or if patients who are receiving care in the reopened facility acquire infections that are potentially healthcare-associated and that may be attributed to Aspergillus spp. or other fungi, non-tubercular mycobacteria, Legionella, or other waterborne microorganisms above expected levels.

 

VII. Site Specific Check List for Selected Areas of the Facility Attachment A

 

Area	Question	Yes	No	Comments
General	Is emergency power available to operate equipment and safety systems and/or provide necessary ambient conditions?
	Has essential equipment been inspected for damage and heat/humidity exposure and manufacturers contacted for guidance on repair, cleaning, and disinfection?
	Has there been any damage to the sealed flooring and ceilings?
	Do sterile supplies need reprocessing?
	Has an evaluation for electrical hazards been conducted?
	Are there enough air exchanges per hour?
	Have all air filters been changed?
Pharmacy	Have damaged or contaminated medications and solutions been replaced?
	Are refrigerators for medication storage at the proper temperature?
Respiratory Therapy,	Has the equipment processing equipment been inspected?
	Has all equipment been inspected and disinfected?
	Have all damaged or contaminated medications and supplies been replaced?
	Has damaged equipment been recertified?
All Patient Care Areas	Has all furniture and equipment been inspected, repaired, and disinfected?
	Has porous furniture that was wet been discarded?
	Were mattresses discarded if they have been under water or wet?
	Have all linens been laundered?
	Have medications and supplies that were damaged or contaminated been discarded?
	Have ice machines been flushed, cleaned, and disinfected?
	Have cardiac monitors been recertified?
	Have support service areas in the lab been inspected in the same manner as the larger department?
	Have cardiac monitors been recertified?
	Have whirlpool and physiotherapy area been repaired and disinfected?
Laundry Processing Area	Has all laundry equipment been inspected for damage and manufacturers contacted for guidance on repair, cleaning, and disinfection?
	Have containers for stored laundry chemicals and dispensing equipment been inspected?
Food Service	Has stored food (dry and canned goods) been inspected for damage or contamination and discarded if it is unsafe to eat?
	Have ice-machines and refrigerators been cleaned and sanitized?
	Has all perishable food been discarded?
	Have all food-contact surfaces been cleaned and sanitized?
	Have pest control systems been restored?
	Has local food service certification been obtained?

 

 

POLICY:	Pandemic-covid-19 (coronavirus)			POLICY NO:	ic-1 COVID – 19
Dept:  Nsg	clinical operations		☐  New ☒  Revised	Last Date Revised:
				Prev. Date  Revised:	4/2020
				Creation Date:	2/2020
RELATED FORMS:

Policy:        

It is the facility’s policy to mitigate the spread and manage the effects of Coronavirus disease. Coronavirus disease (COVID-19) is an infectious disease caused by a new virus. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, multi-organ failure, including acute kidney injury and cardiac injury    . Older age and co-morbid disease have been reported as risk factors for death.

The facility will conduct education, surveillance and infection control and prevention strategies to reduce the risk of transmission of the novel Coronavirus (2019-nCoV). Actions according to CDC, NYSDOH and World Health Organization (WHO) recommendations will be implemented including screening staff and visitors for symptoms of acute respiratory illness (e.g., fever, cough, difficulty breathing) before entering the building. This guidance is based on the currently limited information available about 2019-nCoV related to disease severity, transmission efficiency, and shedding duration.

 

 

PURPOSE:

• to prevent the transmission of SARS-CoV-2 which is the virus that causes COVID-19
• to provide guidelines to health care workers and residents
• to improve infection control and prevention practices

 

INFORMATION ON HOW THE VIRUS SPREADS:

The virus is thought to spread mainly from person-to-person.

• Between people who are in close contact with one another (within about 6 feet)
• Through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly inhaled into the lungs
• People are thought to be most contagious when they are most symptomatic (the sickest). Some spread might be possible before people show symptoms.
• Spread from contact with contaminated surfaces or objects. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes (mucous membranes), but this is not thought to be the main way the virus spreads

SYMPTOMS:

• 2-14 after exposure
• Fever
• Dry cough
• Runny nose and nasal congesting
• Shortness of breath or difficulty breathing
• Chills
• Muscle pain
• Sore throat
• Diarrhea, nausea and vomiting
• New loss of taste or smell

No vaccine or specific treatment is available for COVID-19

Introduction into facility:

• Post signs at the entrance instructing visitors not to visit if they have symptoms of respiratory infection.
• Ensure sick leave policies allow employees to stay home if they have symptoms of respiratory infection.
• Assess residents’ symptoms of respiratory infection upon admission to the facility and implement appropriate infection prevention practices for incoming symptomatic residents.

Within the facility: (Subject to change as this is a fluid situation)

• Monitor residents and employees for fever or respiratory symptoms.
  • Restrict residents with fever or acute respiratory symptoms to their room.  If they must leave the room for medically necessary procedures, have them wear a facemask (if tolerated).
  • In general, for care of residents with undiagnosed respiratory infection use Standard, Contact, and Droplet Precautions with eye protection unless suspected diagnosis requires Airborne Precautions (e.g., tuberculosis).
  • Healthcare personnel should monitor their local and state public health sources to understand COVID-19 activity in their community to help inform their evaluation of individuals with unknown respiratory illness. If there is transmission of COVID-19 in the community, in addition to implementing the precautions described above for residents with acute respiratory infection, facilities should also consult with public health authorities for additional guidance.
• Support hand and respiratory hygiene, as well as cough etiquette by residents, visitors, and employees.
  • Ensure employees clean their hands according to CDC Guidelines, including before and after contact with residents, after contact with contaminated surfaces or equipment, and after removing personal protective equipment (PPE).
  • Make sure tissues are available and any sink is well-stocked with soap and paper towels for hand washing.
• Identify dedicated employees to care for COVID-19 patients and provide infection control training.
• Provide the right supplies to ensure easy and correct use of PPE.
  • Post signs on the door or wall outside of the resident room that clearly describe the type of precautions needed and required PPE.
  • Make PPE, including facemasks, eye protection, gowns, and gloves, available immediately outside of the resident room.
  • Position a trash can near the exit inside any resident room to make it easy for employees to discard PPE.

Inter-facility spread:

• Notify facilities prior to transferring a resident with an acute respiratory illness, including suspected or confirmed COVID-19, to a higher level of care.
• Report any possible COVID-19 illness in residents and employees to the local health department, including your state HAI/AR coordinator.

Environmental:

• Facility disinfect / clean high touch surfaces (knobs, had rails, tables etc..) on regular basis throughout the day, at a minimum twice a day with increase amount warranted based on facility activity
• Facility should ensure ample amount of alcohol based gel dispensers as well as a system to keep full and ready for use by staff and visitors

PROCEDURE:

1. When scheduling appointments, instruct patients and persons who accompany them to call ahead or inform HCP upon arrival if they have symptoms of any respiratory infection (e.g., cough, runny nose, fever1) and to take appropriate preventive actions (e.g., wear a facemask upon entry to contain cough, follow triage procedures).
2. Take steps to ensure all persons with symptoms of suspected 2019-nCoV or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit.
3. Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and HCP with instructions about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use facemasks or tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.
4. Provide supplies for respiratory hygiene and cough etiquette, including 60%-95% alcohol based hand sanitizer (ABHS), tissues, no touch receptacles for disposal, and facemasks at entrances.
5. On admission residents should be assessed for any respiratory symptoms as well as any recent out of Country travel they may have done recently, specific to locations.
   1. If recent travel is identified / suspected, facility should follow the CDC recommended travel guidance
   2. Facility to utilized “CDC Flowchart and Assess for Corona Virus” as a guide for assessment and decision making
6. Patient Placement:
   1. Residents identified to have COVID-19 should be placed in an isolation room until transfer to the hospital or healthcare facility equipped with treating such infections and reported to local Board of Health.
7. Prior to transfer, resident should wear a face mask and isolated from other residents until transportation is possible with the door closed.
8. Staff entering or caring for resident should follow droplet/airborne precautions specific with an N-95 mask or respirator with the door closed.

 

POLICY:	Pandemic – covid- 19- PREVENTION			POLICY NO:	IC-2 COVID – 19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:	4/26/20
				Creation Date:	3/24/2020
RELATED FORMS:

 

 

Policy:                    

This guidance is based on the currently limited information available about 2019-nCoV related to disease severity, transmission efficiency, and shedding duration. COVID-19 has been incorporated into emergency management planning for the facility.

 

The virus is thought to spread mainly from person-to-person.

• Between people who are in close contact with one another (within about 6 feet).
• Through respiratory droplets produced when an infected person coughs or sneezes.

Spread from contact with infected surfaces or objects

 

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

 

PROCEDURE:

• Staff will be provided appropriate education to COVID-19 and how it spreads
• Facility will provide staff on proper handwashing techniques and competencies
• Facility should restrict visitors – see (COVID-19 policy)
• Staff should be screened and monitored for symptoms – (see COVID-19 staff policy)
• Facility has established an environmental cleaning program to clean high touch / use surfaces
• Facility has establish and environmental cleaning program that includes regular cleaning of isolations rooms during isolation and discontinuation of isolation
• Facility have a system to identify staff displaying any symptoms before and during designated shift
• Facility have a process for screening for potential admissions for potential exposure
• Facility has established policy for isolating and monitoring new admissions a period of time to protect in-house residents – (see COVID-19 admissions policy)
• Facility should restrict out on pass / leaves absence of residents to outside medical necessities only (e.g. oncology, dialysis, orthopedics).
• Facility should consult with attending physician on risk vs. benefits of resident leaving facility
• If a resident does leave the facility:
  • Non-medical leave – facility should place resident on a respiratory line listing and monitor for respiratory symptoms and abnormal vital signs for 3 days.
• ER Transfer, not admitted – facility should place resident on 24-hour report and monitor for respiratory symptoms and abnormal vital signs for at least 72 hours
• Dialysis Center – facility should place resident on 24-hour report and monitor for respiratory symptoms and abnormal vital signs for at least 72 hours

Monitor residents and employees for fever or respiratory symptoms and any new signs and symptoms of conjunctivitis (eye redness, pain, drainage).

• Restrict residents with fever or acute respiratory symptoms to their room. If they must leave the room for medically necessary procedures, have them wear a facemask (if tolerated)
• In general, for care of residents with undiagnosed respiratory infection use Standard, Contact, and modified Droplet Precautions with masking staff and resident (as tolerated) during care and direct contact unless suspected diagnosis requires Airborne Precautions (tuberculosis).
• Healthcare personnel should monitor their local and state public health sources to understand COVID-19 activity in their community to help inform their evaluation of individuals with unknown respiratory illness. If there is transmission of COVID-19 in the community, in addition to implementing the precautions described above for residents with acute respiratory infection, the facility should also consult with public health authorities for additional guidance.

Facility should suspend all group gatherings within facility. This includes group activities and communal dining

• Residents should be offered independent dining in their rooms
• Facility should discourage residents and staff gathering around nurses’ station and other areas of high traffic within the facility

Facility should suspend therapy sessions of 2 or more residents

• Therapy should keep residents at a distance of 6’ between each resident
• Therapy should only allow residents from same unit in gym at the same time
• Therapy should clean equipment between each resident
• Residents under suspicious / positive should receive therapy session in their room and not be transported to the therapy room
• Facility with identified know COVID-19 should close gym until resolution of infections and isolation

Support hand and respiratory hygiene, as well a cough etiquette by residents, visitors, and employees.

• Ensure employees clean their hands according to CDC Guidelines, including before and after contact with residents, after contact with contaminated surfaces or equipment, and after removal of personal protective equipment (PPE)
• Make sure tissues are available and any sink is well-stocked with soap and paper towels for hand washing.

Identify dedicated employees to care for COVID-19 patients and provide infection control training

 

 

Provide the right supplies to ensure easy and correct use of PPE

• Post signs on the door or wall outside of the residents’ room that clearly describe the type of precautions needed and required PPE
• Make PPE, including facemasks, eye protection gowns/coveralls, and gloves available immediately outside the resident (note: 2 rooms next to each other on the same COVID unit may share 1 cart of PPE to minimize the number of carts utilized on the on COVID/PUI unit)
• Position a trash can near the exit inside any resident room to make it easy for employees to discard PPE (note: health care providers may utilize the donning/doffing station on the COVID side of the unit)

POLICY:	Pandemic – covid-19 – stAFF			POLICY NO:	IC-3-covid-19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:	5/8/2020
				Prev. Date  Revised:	4/8/2020
				Creation Date:	3/24/2020
RELATED FORMS:

 

Policy:                    

This guidance is based on the currently limited information available about 2019-nCoV related to disease severity, transmission efficiency, and shedding duration.

 

The virus is thought to spread mainly from person-to-person.

• Between people who are in close contact with one another (within about 6 feet).
• Through respiratory droplets produced when an infected person coughs or sneezes.

Spread from contact with infected surfaces or objects

 

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

 

PROCEDURE:

• Staff will be screened for at risk upon arrival to work.
• Any staff with fever (greater than or equal to 100.0F oral, or 100.4 core temperature), significant cough, difficulty breathing, or other respiratory symptoms must be sent home immediately.
• Screening will include :
  • Fever and respiratory symptoms.
  • Actively take their temperature (self – monitor)
  • Sign the attestation form when entering this facility to attest and confirm the following:

1. No signs and symptoms of a respiratory infection, such as fever, cough, difficulty breathing, or presence of any other respiratory symptoms (such as sore throat), at the start of each shift and every 12 hours thereafter, while on duty.
2. In the last 14 days, has had no contact with someone with a confirmed diagnosis of COVID-19, or under investigation for COVIID-19, or are ill with respiratory illness.

• No international travel with the last 14 days to countries with sustained community transmission. For updated information on affected countries visit: http://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html

1. Not residing in a community where community-based spread of COVID-19 is occurring.
2. Not taken any recent trips (within the last 14 days) or cruise ships or participated in other settings where crowds are confined to a common location.
3. NOTICE: You are advised to monitor for signs and symptoms of respiratory infection for at least 14 days after exiting the location. If symptoms occur, self-isolate at home, contact your healthcare provider, and immediately notify the facility of the date you were in the facility, the individuals you were in contact with and the locations within the facility you visited.

• Refer to the New York State Department of Health guidance concerning protocols for personnel returning to work following COVID-19 exposure, available at https://coronavirus.health.ny.gov/information-healthcare-providers, when deciding when staff can return to work. Upon entering the facility, you attest that you took your temperature last night.
• Any staff that develop signs and symptoms of a respiratory infection or above listed symptoms while on-the-job should:
• Immediately stop work, put on a facemask, report to supervisor and self-isolate at home;
• Inform the HR/Designee, and include information on individuals, equipment and locations the person came in contact with and;
• Contact and follow the local health department recommendations for next steps (e.g., testing locations for treatment).
• Staff who test positive for COVID-19:
• Asymptomatic staff are not eligible to return to work for 14 days from first positive test date in any situation
• Symptomatic staff may not return to work until 14 days after the onset of symptoms, provided at least 3 days (72 hours) have passed since resolution of fever without the use of fever-reducing medications and respiratory symptoms are improving
• When staff returns to work:
• Wear a facemask for source control at all times while in the healthcare facility until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer. A facemask instead of a cloth face covering should be used by these HCP for source control during this time period while in the facility.
• Be restricted from contact with severely immune-compromised patients (e.g. transplant, hematology-oncology) until 14 days after illness onset
• Self-monitor for symptoms, and seek re-evaluation from occupational health if respiratory symptoms reoccur or worsen
• Staff with known exposure can work in the absence of symptoms. They must:
• Wear masks at all times in resident areas
• Take and record temperature regularly
• Must take temperature at the beginning of shift and after hours if still on duty
• Facility should initiate an infection line listing for any staff sent home or denied work assignment
• Facility should remain in contact with local Board of Health on length of time away from work
• Staff shall wear a facemask while within 6 feet of any resident
• N95 use – extended wearing is permitted and should be changed when visibly soiled, torn, wet or when as needed
• Surgical facemasks should be changed when visibly soiled, torn, wet or when
• Facility should not float staff from unit where there is an identified positive COVID-19 case of patient under suspicion
• Facility should attempt to arrange assignments based on resident status (positive COVID-19)/under suspicion to maximize staffing pattern and PPE use
• Facility should educate staff regularly on status of facility with COVID-19 residents and updates from CDC, CMS and other regulatory guidance
• Refer to the New York State Department of Health guidance concerning protocols for personnel  returning to work following COVID-19 exposure, available at https://coronavirus.health.ny.gov/information-healthcare-providers , when deciding when staff can return to work.

POLICY:	Pandemic – COVID – 19 ENVIROMENTAL MANAGEMENT			POLICY NO:	ic – 4 COVID – 19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:	5/7/2020
				Prev. Date  Revised:
				Creation Date:	4/15/2020
RELATED FORMS:

 

Policy:                    

Standard Precautions assume that every person is potentially infected or colonized with a pathogen that could be transmitted in the health setting. Additional elements of Standard Precautions that apply to residents with respiratory infections, including COVID-19 is outlined

In order to facilitate the investigation of COVID-19 and other acute respiratory disease outbreaks and implementation of control measures, the following guidelines have been established. These guidelines emphasize priorities regarding prevention and control of influenza and pneumococcal disease including pneumonia as follows:

• To prevent disease transmission
• To prevent outbreaks through proper use of PPE’s
• To detect the occurrence of an outbreak
• To stop transmission of the COVID-19 through control measures
• To measure the level of morbidity and mortality

PROCEDURE:

Hand hygiene is considered as the single most important practice to reduce the transmission of infectious agents in healthcare settings, and is an essential element of Standard Precautions. The term “hand hygiene” includes both handwashing with either plain or antiseptic-containing soap and water, and use of alcohol-based products (gels, rinses, foams) that do not require the use of water. All health care personnel (HCP) and non-essential personnel should practice hand hygiene.

Personal Protective Equipment (PPE) for Healthcare Personnel (HCP

• PPE refers to a variety of barriers and respirators used alone or in combination to protect mucous membranes, airways, skin, and clothing from contract with infectious agents.
• The selection of PPE is based on the nature of the patient interaction and/or the likely mode(s) of transmission.
• All HCP and non-essential personnel should wear appropriate PPE when interacting with residents.
• Facility should ensure ample amount of alcohol-based gel dispensers or alternate disinfecting agent as well as a system to keep full and ready for use by staff and visitors.

 

CLEANING / DISINFECTING:

• Facility disinfect / clean high touch surfaces (knobs, hand rails, tables etc.) on regular basis throughout the day, at a minimum of twice a day with increase amount warranted based on facility activity.
  • Facility should attempt to track
  • Facility should use dedicated equipment for identified isolation rooms
  • Facility should sanitize any rental equipment upon receipt
  • Facility should attempt to limit sharing of personal items between residents
  • If sharing is necessary ensure proper cleaning of item in between residents.
  • Disinfect activity supplies between each resident.
  • Clean activity carts supplies between each resident. Clean activity carts when moving from each resident to another resident
  • Clean computers and kiosk routinely throughout the day, especially with multiple users. Used approved disinfectant wipes.
  • All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instruction and facility policies.
  • Follow environmental cleaning and disinfection procedures consistently and correctly
  • Use disinfectants recommended from list N of the EPA website for EPA-registered
  • Cleaners and disinfectants, including disposable wipes, are used in accordance with manufacturer’s instructions (e.g. dilution, storage, shelf life, contact time)
  • Environmental surfaces in patient care areas are cleaned and disinfected, using EPA-registered disinfectant
• Resident Rooms:

Isolation:

• Resident isolation rooms, cohort areas, and clinical rooms must be decontaminated at least daily.
• Use dedicated medical equipment for isolated residents. Oximeter, B/P cuff, Stethoscope etc.
• Ensure isolation carts with isolation supplies and isolation signs are outside the room. Retrain staff on proper donning and doffing of PPE.

Once isolation is removed; room needs to have a complete and thorough decontamination cleaning.

• All surfaces including bed rails, bed frames, bed controls, call lights etc.
• Privacy curtains should be removed and laundered/replaced
• Water/cleaning solution and supplies should be switched out after each room is terminally cleansed
• Any personal care items left behind should be discarded
• Any unopened supplies left should be discarded

Linen:

• All linen used in the direct care of patients with suspected and confirmed COVID-19 can be managed as all other linen from a room on isolation
• All linen must be handled, transported and processed in a manner that prevents exposure to the skin and mucous membranes of staff, contamination of their clothing and the environment.
• When handling linen do not:
• Rinse, shake or sort linen on removal from beds/trolleys;
• Place used/infectious on the floor or any surfaces e.g. a locker/table top;
• Re-handle used/infectious linen once bagged;
• Overfill laundry receptacles; or
• Place inappropriate items in the laundry receptacle e.g. used equipment/needles.
• Laundry hampers/receptacles should be cleaned at least daily and when visibly soiled

 

POLICY:	Pandemic – COVID – 19 CLEANING AND DISINFECTING RESIDENT EQUIPMENT			POLICY NO:	ic – 4A COVID – 19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:	5/7/2020
				Prev. Date  Revised:
				Creation Date:	4/15/2020
RELATED FORMS:

 

Policy:                    

Resident-care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC recommendations for disinfection and the OSHA Bloodborne Pathogens Standard.

Routine cleaning and disinfection procedures are appropriate for COVID-19 in healthcare settings, including those patient-care-areas in which aerosol-generating procedures are performed. Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2, the virus that causes COVID-19.

PROCEDURE:

1. The following categories are used to distinguish the levels of sterilization/ disinfection necessary for items used in resident care:
2. Critical items consist of items that carry a high risk of infection if contaminated with any microorganism. Objects that enter sterile tissue (e.g., urinary catheters) or the vascular system (e.g., intravenous catheters) are considered critical items and must be sterile.
3. Semi-critical items consist of items that may come in contact with mucous membranes or non-intact skin (e.g., respiratory therapy equipment). Such devices should be free from all microorganisms, although small numbers of bacterial spores are permissible. (Note: Some items that may come in contact with non-intact skin for a brief period of time (e.g., hydrotherapy tanks, bed side rails) are usually considered non-critical surfaces and are disinfected with intermediate-level disinfectants.)
4. Non-critical items are those that come in contact with intact skin but not mucous membranes.
5. Non-critical resident-care items include bedpans, blood pressure cuffs, crutches and computers.
6. Most non-critical reusable items can be decontaminated where they are used (as opposed to being transported to a central processing location).
7. Reusable items are cleaned and disinfected or sterilized between residents (e.g., stethoscopes, durable medical equipment).
8. Single resident-use items are cleaned/disinfected between uses by a single resident and disposed of afterwards (e.g., bedpans, urinals).
9. Single-use items are disposed of after a single use (e.g., thermometer probe covers).
10. Reprocessed single-use devices are those that have been previously used by a resident and then subjected to additional processing (manufacturing) for the purpose of an additional single use on another resident. Use of reprocessed single-use devices is permitted if:
11. The device is reprocessed by an FDA-registered third-party preprocessor; and
12. There is documentation from the third-party processor indicating that it has been cleared by the FDA to reprocess the device.
13. Critical and semi-critical items will be sterilized/disinfected in a central processing location and stored appropriately until use. Equipment to be processed will be labeled with at least the following information:
14. That the equipment is contaminated
15. The address to which the equipment is to be shipped
16. The address from which the equipment was removed (including telephone number)
17. The name of the person labeling the equipment; and
18. The date and time the label was affixed to the equipment
19. Durable medical equipment (DME) must be cleaned and disinfected before reuse by another resident.
20. Reusable resident care equipment will be cleaned / disinfected between residents according to manufacturers’ instructions.
21. Only equipment that is designated reusable shall be used by more than one resident.
22. Single use items will be discarded after a single use.
23. Intermediate and low-level disinfectants for non-critical items include:
24. Ethyl or isopropyl alcohol;
25. Bleach/Water mixed solution 1:10
26. Sani-wipe
27. Phenolic germicidal detergents; Virex II 256 (contact time 10min), n, Oxyvir 5 (contact time 5 min)
28. Iodophor germicidal detergents; and Oxivir TD

 

 

8. High-level disinfectants/liquid chemical sterilant will not be used for disinfection of non-critical items.

 

POLICY:	Pandemic -OUTBREAK MANAGEMENT			POLICY NO:	ic-4B COVID – 19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:	6/11/2020
				Prev. Date  Revised:	5/7/20
				Creation Date:	3/24/2020
RELATED FORMS:

 

Policy:                    

Residents with confirmed or suspected cases of COVID-19 will be cared for in accordance with guidelines as defined by the Center for Disease Control and Prevention (CDC) and Federal and State Health Care regulations. Our ultimate goal is to prevent disease transmission, treat symptoms, and provide care necessary to optimize residents’ overall health.

PROCEDURE:

Outbreak Defined: a COVID-19 outbreak is defined as one confirmed laboratory case of positive SARS- CoV-2 RNA molecular assay in the facility. Additionally, sudden acute respiratory symptoms including a fever over > 100.4F of three or more residents in a unit within 72 hours would be considered an outbreak.

Residents testing positive for COVID-19 will be evaluated by the physician and determine the need for additional testing or hospitalization

1. If hospitalization is not medically necessary, the resident will remain in the facility.

• Patients with known or suspected COVID-19 will be transferred to the isolation room/unit and when feasible provided with a private room. Ideally with their own bathroom
• Current recommendations are to isolate in place when a private room is not available

1. “Roommates of symptomatic residents might already be exposed. It is generally not recommended to separate them in this scenario (CDC 3/2020)

• Residents that have a confirmed case of COVID-19 can cohort with other residents who have confirmed COVID-19.

1. If both residents were in a private room or private scenario (i.e. 1 resident in a semi-private room)

• Assess roommate(s)
• Consider placing roommate(s) and other exposed resident that may be positive in one area of the building: the COVID UNIT (PUI Section)
• Initiate droplet and contact precautions
• Provide and assist resident with wearing surgical or procedural mask, assess resident’s ability to tolerate wearing a mask
• Residents suspected or confirmed COVID-19 will have the door in their room closed
• HCP and other direct care providers should wear gown, gloves, eye protection (goggles or a face shield), and N95 respirators (or equivalent) if the Otherwise, HCP and other direct care providers should wear gown, gloves, eye protection.

1. If caring for resident with a confirmed case of COVID-19, or suspected COVID-19 is actively coughing/sneezing during care
2. If a confirmed or suspected resident requires aerosol or nebulizing medication

• Notify physician
• Notify responsible party
• Immediately contact the local health department for confirmed COVID-19

1. Obtain guidelines from the local health department
2. Follow Department of Health recommendations

• Notify staff of precautionary measures
• When residents with known or suspected COVID-19 require transfer to an acute care hospital setting, the licensed nurse will:

1. Relay to 911 personnel that the resident is suspected of having COVID-19
2. Notify the ambulance transfer of the nature of the transfer for appropriate PPE (for appropriate measures to protect themselves during resident having or suspected COVID-19.

• Alert receiving hospital that resident is confirmed or suspected of having COVID-19.

1. If a resident receives Dialysis, the Dialysis Center will be contacted and informed of resident status
2. Residents should wear a facemask to contain secretions during transport from room for any medically necessary testing

• If transfer/discharge is not possible maintain resident on contact and droplet precautions.
• If resident is stable contact MD to treat in-house with a focus on symptom management
• Place resident on infection control line listing

1. Pertinent information regarding each resident and employee case should be entered in the surveillance log updated prn

• Once an outbreak has been identified, cases should be placed on a “line list”
• Facility will attempt to manage staff assignments based on symptomatic/asymptomatic to streamline care processes and PPE use (gown, gloves, goggles or face shield and mask)

 

• The Covid Unit is a designated unit for cohorting patients who are Covid+ verified by testing AND persons under investigation (PUI’s) or “Unknown”. This designated unit is located on the 2C floor. The dedicated section of the COVID-19 unit is separated by a physical barrier from the main hallway where patients with confirmed +COVID-19 tests are co-horted. The purpose of the unit is to provide the proper isolation for these type of patients, to contain and prevent the spread of the virus, and to provide coordinated interdisciplinary management of the disease.

 

• All admissions will be admitted to the PUI Section of the Covid Unit as “Unknown” and will be assessed for removal of precautions according to infection control disinfection guidelines: Respiratory and other symptoms, temperature will be monitored for 14 days AND Covid-19 testing will be done. Two consecutive negative Covid tests after 14 days are required before a patient is transferred to a non-Covid unit.

 

 

• When caring for asymptomatic residents:

1. Staff should wear mask and provide resident mask as they can tolerate

• Monitor:

1. COVID Positive Residents every 4 hours
2. Symptomatic residents for 14 days

• Asymptomatic residents daily
• Monitoring to include:
• Respiratory Symptoms
  • Vital signs
  • Lung auscultation
  • Pulse oximetry
  • Conjunctivitis symptoms (eye redness, dryness, pain drainage)
  • Assure that all residents in affected unit(s) remain in their rooms.
  • Avoid floating staff between units if possible. Cohort residents with COVID-19 with dedicated HCP and other direct care providers. Minimize the number of HCP and other direct care providers entering rooms.

 

POLICY:	Pandemic – covid-19 – ADMISSIONS			POLICY NO:	ic- 5 covid-19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:	6/11/20
				Prev. Date  Revised:	5/18/20
				Creation Date:	5/1/2020
RELATED FORMS:

 

Policy:                    

Residents with confirmed or suspected cases of COVID-19 will be cared for in accordance with guidelines as defined by the Center for Disease Control and Prevention (CDC) and Federal and State Health Care Regulations. Our ultimate goal is to prevent disease transmission, treat symptoms, and provide care necessary to optimize residents’ overall health.

 

PROCEDURE:

Placement of new patients in the facility once admitted:

When a new patient is admitted with confirmed Covid-19 positive diagnosis:

• • Cohort the positive patient in a dedicated COVID-19 unit during isolation
  • Move patient to regular non-Covid-19 units after discontinuation of transmission-based precautions for patients with COVID-19

 

Providence Rest will not accept any resident with active COVID-19 as per DOH guidelines

(Please note: Providence Rest is following the directive dated May, 11, 2020 10 NYCRR 415.26 “No hospital shall discharge a patient to a NH unless the facility administrator has first certified that they are able to provide that patient with adequate care. In addition, hospitals must test any patient who may be discharged to a NH for COVID-19, using a molecular test for SARS-CoV-2 RNA. No hospital shall discharge a patient who has been diagnosed with COVID-19 to a NH, until that patient has received one negative test result using such testing method. However, with the exception of patients of hospitals who have not yet tested negative, a NH cannot deny admission of a resident based solely on a resident’s COVID-19 diagnosis”).

 

 When a new patient is admitted with Covid-19 negative:

• • Place the new patient in a temporary staging room/unit under isolation, if such space is available (PUI Section of the Covid Unit as “Unknown”) for 14 days.
  • Monitor the new patient for COVID-19 symptoms & perform COVID-19 test 2 times after 14 days of admission and 72 hours of being symptom free.

• New admission under 14-day observation can cohort with another new admission under observation as long as they have been admitted within at least 4 days of each other
  • If the new patient tests negative or remains stable, then:
    • Move the new patient to a regular non-Covid-19 unit after 14 days and 72 hours being asymptomatic.

• • If the patient later tests positive, or develops COVID-19 like symptoms, then:
    • Cohort the new positive patient in the dedicated COVID-19 unit during isolation.
    • Provide and assist resident with wearing surgical or procedural mask, assess resident’s ability to tolerate wearing a mask

 

Patients should wear a facemask or cloth face covering to contain secretions when out of their room. If patients cannot tolerate a facemask or cloth face covering or one is not available, they should use tissues to cover their mouth and nose while out of their room.

DISCONTINUING ISOLATION

Discontinuation of transmission-based precautions for patients with COVID-19:

The decision to discontinue Transmission-Based Precautions should be made using a test-based strategy or a non-test-based strategy (i.e., time-since-illness-onset and time-since-recovery strategy). Meeting criteria for discontinuation of Transmission-Based Precautions is not a prerequisite for discharge.

 

1. Test-based strategy.

• Resolution of fever without the use of fever-reducing medications AND
• Improvement in respiratory symptoms (e.g., cough, shortness of breath), AND
• Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from:
  • Ideally two consecutive nasopharyngeal swab specimens collected ≥24 hours apart  OR
  • One specimen, if shortage of testing availability, performed at least after 2 weeks of onset of symptoms.
  • Tests done on or before 14 days after initial positive Covid Test, and at least 72 hours free from symptoms of fever without fever reducing medications, and improving respiratory symptoms.

 

1. Non-test-based strategy

 

• At least 3 days (72 hours) have passed since recovery, defined as resolution of fever without the use of fever-reducing medications AND
• Improvement in respiratory symptoms (e.g., cough, shortness of breath) AND
• At least 21 days have passed since the onset of symptoms
  • Note: For patients who were asymptomatic at the time of their first positive test and remain asymptomatic, at least 21 days have passed since the first positive test

 

POLICY:	Pandemic – covid-19 – ISOLATION – ROOM PLACEMENT			POLICY NO:	ic-6 COVID – 19
Dept:  Nsg	clinical operations		☐  New ☒  Revised	Last Date Revised:	6/11/20
				Prev. Date  Revised:	5/1/20
				Creation Date:	2/2020
RELATED FORMS:

 

Policy:                    

Residents with confirmed or suspected cases of COVID-19 will be cared for in accordance with guidelines as
defined by the Center for Disease Control and Prevention (CDC) and Federal and State Health Care Regulations.
Our ultimate goal is to prevent disease transmission, treat symptoms, and provide care necessary to optimize
residents’ overall health.

Residents with clinical presentations that suggest the possibility of Covid-19 disease should be managed as potentially infectious with applicable precautions implemented.

 

PROCEDURE:

ROOM PLACEMENT:

COVID-19 POSITIVE:

Step 1

1. Immediately isolate resident in a private room and close the door.
2. Initiate droplet and contact precautions.
3. Provide and assist resident with wearing surgical or procedural mask (face mask). Must wear when HCPs are providing direct care
4. Employees and other health care providers should follow contact and droplet guidelines and wear appropriate PPE including eye protection (goggles or a face shield) and N95 respirators.
5. Obtain resident vital signs including O2 SAT regularly, at least every 8 hours,, notify physician and start oxygen supplementation if <90%
6. Avoid floating staff in between units if possible

 

Step 2

1. Notify physician.
2. Notify responsible party within 24 hours.
3. Rapidly alert the team
4. Notify health care personnel of contact and droplet precautionary measures.
5. Place resident on infection control line listing.
6. Update medical record.

 

 

 

Step 3

1. Initiate Immediate transfer of patient to the Covid Unit
2. Immediately NOTIFY THE LOCAL HEALTH DEPARTMENT.
   1. Obtain guidelines from the local health department.
   2. Follow Department of Health recommendations.

• Notify staff of precautionary measures.

Step 4

1. Arrange emergency transfer to the hospital (as applicable). If resident is stable arrange for treatment in house.
2. Notify hospital of the confirmed case and pending transfer.
3. Notify the ambulance transfer of the nature of the transfer for appropriate PPE precautions.

Step 5

1. Assess roommate(s) and other residents on the affected unit for respiratory and other symptoms including temperature.
2. Place other residents on the affected units on close observation, regardless of the presence of symptoms and regardless of COVID-19 status.
3. Monitor respiratory and other symptoms and temperature of all residents on the unit twice a day for 14 days.
4. Place resident on the infection control line listing log
5. Consider placing roommate (s) and other exposed resident that may be positive in one area of building: the COVID UNIT (PUI Section)
6. Try to arrange rooms and staffing patterns to minimize number of staff caring for residents and entering room
7. HCP and other direct care providers should wear gown, gloves, eye protection (goggles or a face shield), and N95 respirators (or equivalent) if the Otherwise, HCP and other direct care providers should wear gown, gloves, eye protection, and facemasks.
8. All admissions will be admitted to the PUI Section of the Covid Unit as “Unknown” and will be assessed for removal of precautions according to infection control disinfection guidelines: Respiratory and other symptoms, temperature will be monitored for 14 days AND Covid-19 testing will be done. Two (2) negative Covid tests is required before a patient is transferred to a non-Covid unit after 14 days of observation and 72 hours of being asymptomatic.

 

 

Diagnostic and/or serologic testing for COVID-19 in the nursing home shall be authorized by a health care provider when:

• An individual is symptomatic or has a history of symptoms of COVID-19 (e.g. fever, cough, and/or trouble breathing, new pulmonary infiltrate), particularly if the individual is 70 years of age or older, the individual has a compromised immune system, or the individual has an underlying health condition); or
• An individual has had close (i.e. within six feet) or proximate contact with a person known to be positive with COVID-19; or
• An individual is subject to a precautionary or mandatory quarantine; or
• An individual presents with a case where the facts and circumstances – as determined by the treating clinician

in consultation with state or local department of health officials – warrant testing.

• All residents will have a baseline test for COVID-19 per CDC guidance.

 

Cohorting patients with Covid Positive (COVID Unit) or Suspected Disease or Unknown: PUI section of Covid Unit

o Remember, residents who are Covid + with mild symptoms (like a cold or flu) can often be cared for in the facility, even if they have a fever.

o Do not transfer the resident to the Emergency Department solely because of a mild or moderate fever. The emergency symptoms listed below, and the resident’s overall general condition, are more important indicators of when to seek emergency medical care needing transfer to the hospital.

o Any resident who develops emergency warning signs for COVID-19 should be referred for immediate medical attention and management. Emergency warning signs include:

▪ Trouble breathing;

▪ Persistent pain or pressure in the chest;

▪ New confusion or inability to arouse; or

▪ Bluish lips or face.

o The list of emergency warning signs is not all inclusive.  Consult with the resident’s primary care physician for any other symptoms that are severe or concerning.

o If experiencing any of the symptoms above, such information must be shared with the EMS provider before arrival.

o The Covid Unit is a designated unit for cohorting patients who are Covid+ verified by testing AND persons under investigation (PUI’s) and hospital admissions as “Unknown”. This designated unit is located on the 2C floor wing. The purpose of the unit is to provide the proper isolation for these type of patients, to contain and prevent the spread of the virus, and to provide coordinated interdisciplinary management of the disease.

 

 Criteria for transfer to the COVID unit include patients with:

▪ Covid+ confirmed tests

▪ Fever 101.0F and over lasting for>24 hours (3 shifts)

▪ Fever 100.4 to 100.9 intermittent or persistent, lasting for more than 72 hours

▪ Emergency warning signs listed above

▪ Low pulse Oximeter (<90%) not   corrected with supplemental oxygen, associated with any suspected infection

▪ New onset pulmonary infiltrates with or without fever

 

             Individuals will be considered as Patients Under Investigation (PUI) will be transferred to the PUI Section of the Covid Unit for testing and management if they manifest any of the following:

• Cough • Shortness of breath or difficulty breathing • Fever
• Chills • Muscle pain • Sore throat • New loss of taste or smell

 

DISCONTINUING ISOLATION

Discontinuation of transmission-based precautions for patients with COVID-19:

The decision to discontinue Transmission-Based Precautions should be made using a test-based strategy or a non-test-based strategy (i.e., time-since-illness-onset and time-since-recovery strategy). Meeting criteria for discontinuation of Transmission-Based Precautions is not a prerequisite for discharge.

1. Test-based strategy.

• Resolution of fever without the use of fever-reducing medications AND
• Improvement in respiratory symptoms (e.g., cough, shortness of breath), AND
• Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from:
  • Ideally two consecutive nasopharyngeal swab specimens collected ≥24 hours apart  OR
  • One specimen, if shortage of testing availability, performed at least after 2 weeks of onset of symptoms.
  • Tests done after 14 days after initial positive Covid Test, and at least 72 hours free from symptoms of fever without fever reducing medications, and improving respiratory symptoms.

 

1. Non-test-based strategy if test based strategy is not available

• At least 3 days (72 hours) have passed since recovery, defined as resolution of fever without the use of fever-reducing medications AND
• Improvement in respiratory symptoms (e.g., cough, shortness of breath) AND
• At least 21 days have passed since the onset of symptoms
  • Note: For patients who were asymptomatic at the time of their first positive test and remain asymptomatic, at least 21 days have passed since the first positive test

 

Placement of New Patients in the facility once admitted:

• When a new patient is admitted with confirmed Covid-19 positive diagnosis:
  • Cohort the positive patient in a dedicated COVID-19 unit during isolation
  • Move patient to regular non-Covid-19 units after discontinuation of transmission-based precautions for patients with COVID-19

 

Providence Rest will not accept any resident with active COVID-19 as per DOH guidelines

 

(Please note: Providence Rest is following the directive dated May, 11, 2020 10 NYCRR 415.26 “No hospital shall discharge a patient to a NH unless the facility administrator has first certified that they are able to provide that patient with adequate care. In addition, hospitals must test any patient who may be discharged to a NH for COVID-19, using a molecular test for SARS-CoV-2 RNA. No hospital shall discharge a patient who has been diagnosed with COVID-19 to a NH, until that patient has received one negative test result using such testing method. However, with the exception of patients of hospitals who have not yet tested negative, a NH cannot deny admission of a resident based solely on a resident’s COVID-19 diagnosis”).

 

• When a new patient is admitted with Covid-19 negative:
  • Place the new patient in a temporary staging room/unit under observation, if such space is available at the facility (PUI Section of the Covid Unit as Unknown) for 14 days
  • Monitor the new patient for COVID-19 symptoms & perform COVID-19 test.

• Move patient to a regular non-Covid-19 unit after 2 consecutive negative tests.

 

• New admission under 14-day observation can cohort with another new admission under observation as long as they have been admitted within at least 4 days of each other

 

• • If the patient later tests positive, or develops COVID-19 like symptoms, then:
    • Cohort the new positive patient in the dedicated COVID-19 unit during isolation
    • Move patient to regular non-Covid-19 units after discontinuation of transmission-based precautions for patients with COVID-19 after 14 days and asymptomatic for 72 hours and after 2 consecutive negative tests.

 

• • If the new patient tests negative or remains stable after 14 days of observation and asymptomatic for 72 hours
    • Move the new patient to a regular non-Covid-19 unit

 

• Patients seen in the emergency room will be co-horted in the “Unknown” section of the covid unit. They will be observed for 14 days and if remain asymptomatic for 72 hours and have 2 consecutive negative tests they will transferred to a regular non-Covid-19 unit.

 

POLICY:	Pandemic – REHABILITATION SERVICES			POLICY NO:	ic-7 COVID – 19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:	5/7/2020
				Prev. Date  Revised:
				Creation Date:	3/24/2020
RELATED FORMS:

 

Policy:        

Our facility has a process to identify and manage residents with symptoms of respiratory infection (e.g., cough, fever, sore throat) upon admission and daily during their stay in the facility, which includes implementation of appropriate Transmission-Based Precautions in addition, our facility has a protocol for initiating active surveillance for respiratory infection not only among residents but also healthcare personnel. During the COVID-19 Pandemic, the rehabilitation department evaluates the risk-benefits trade-off needs to be made on a case-by-case basis.

PROCEDURE:

Our therapy department has made some therapy-specific changes as appropriate which includes the following steps:

1. Review the resident’s care plan and its goals and discuss with the resident if the current rehabilitation plan needs to continue or be modified:

• Some therapy plans of care can be suspended or modified focusing on essential needs, which may vary depending on the current situation in the facility or with individual residents.
• This should evaluate which, if any specialized rehabilitative services are essential to meet the resident’s health care needs at this time, and which should be deferred.

NOTE: if COVID-19 begins to spread in the facility and staffing levels drip, therapy professionals should anticipate being asked to provide additional public health support activities within the facility and therapy services may need to be suspended in order to meet other residents’ basic needs.

 

2. Individual and concurrent treatment sessions are allowable as long as the 6 foot distance rule is maintained between residents, meaning residents may be treated individually and concurrently as long as there is a minimum of 6 feet distance between residents.
3. Consider delivering care in individual resident rooms rather than in therapy gyms, and individualized one-to-one care should be provided in a manner to maintain social distancing as practicable.
4. Follow CDC guidance when cleaning therapy equipment between use
5. Masks are a requirement when treatment is provided within 6 feet of a resident. With this rule all rehab staff will be required to wear masks when treat in. Masks should be replaced when torn, visibly soiled or moist.
6. Perform hand hygiene with alcohol-based hand rub before and after all resident contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Use and water if hands are visibly souled.
7. Practice how to properly don, use and do PPE in a manner to prevent self-contamination.

POLICY:	Pandemic – covid-19 – visitation			POLICY NO:	ic-8 covid-19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:
				Prev. Date  Revised:	4/2020
				Creation Date:	3/24/2020
RELATED FORMS:

 

Policy:                    

This guidance is based on the currently limited information available about 2019-nCoV related to disease severity, transmission efficiency, and shedding duration.

 

The virus is thought to spread mainly from person-to-person.

• Between people who are in close contact with one another (within about 6 feet).
• Through respiratory droplets produced when an infected person coughs or sneezes.

Spread from contact with infected surfaces or objects

 

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

 

Facility has established policies to attempt to prevent and control the spread of COVID-19, this includes but is not limited to:

 

PROCEDURE:

• Facility should restrict visitation except for the following:
• Current health status (e.g. end of life, critical) is in question
• Visitor should be limited to a specific room (resident they are visiting)
• Visitor is required to go through screening process prior to entry. Visitor displaying any signs/symptoms of concern or fever will be denied access to the facility
• Facility should require visitor to perform hand hygiene regularly and use proper PPE during the visit
• Facility should encourage visitor not to make contact with resident
• Facility should post signage at entrances alerting families of suspended visitation
• Facility should offer alternative means for resident and families to communicate. May include but not limited to:
• Video conferencing (Skype, Facebook, WhatsApp etc.)
• Phone calls
• Emails
• texting
• Facility should attempt to conduct care plan meetings via video conferencing (Facebook, Skype WhatsApp etc.)
• Facility should advise visitors, and any individual who entered the facility (e.g. hospice staff), to monitor for signs and symptoms of respiratory infection for at least 14 days after exiting the facility. If symptoms occur, advise them to self-isolate at home, contact their healthcare provider, and immediately notify the facility of the date they were in the facility, the individuals they were in contact with, and the locations within the facility they visited. Facility should immediately screen the individuals of reported contact, and take all necessary actions based on findings.
• Social Service Department will update the residents and their representatives of the outbreak and the facility’s coordination with the Department of Health guidelines being followed including CDC’s. if possible, Social Service is to follow up with families regarding updates on a weekly basis until last case has recovered.

Vendors

• Facility should have posted signs to alert vendors of warnings prior to making deliveries
• Vendors should be required to complete a screening upon arrival to facility
• Any vendor staff identified to be “at risk” should be denied access to the facility
• When feasible, facility should arrange for curbside or loading dock only deliveries
• Physician/Practitioner visits:
• Facility should restrict all non-emergent (routine) visits from outside practitioners unless physicians are required to be screened prior to being permitted into the facility. Any physician/Practitioners are required to be screened that is identified as “at risk” will not be permitted into the facility

Entertainment:

• Facility should suspend all outside entertainment
• Facility should provide alternative entertainment options in lieu of cancelled outside entertainment

POLICY:	Pandemic – covid-19 – NOTIFICATIONS			POLICY NO:	ic-9 covid-19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:
				Prev. Date  Revised:
				Creation Date:	4/21/2020
RELATED FORMS:

 

Policy:                    

Residents with confirmed or suspected cases of COVID-19 will be cared for in accordance with guidelines as defined by the Center for Disease Control and Prevention (CDC) and Federal and State Health Care Regulations. Our ultimate goal is to prevent disease transmission, treat symptoms, and provide care necessary to optimize residents’ overall health.

 

Facility will keep families informed and apprised of COVID status within the building per regulatory guidelines

 

PROCEDURE:

• Facility should provide updated information to residents, families and their representatives to the conditions inside the facility
• Facility shall inform family members or their next of kin within 24 hours of the occurrence of a single confirmed infection of COVID-19, or three or more residents or staff with new-onset of respiratory symptoms that occur within 72 hours.
• Facility can accomplish this notification with:
• Robocall
• Individual calls
• letters
• Facility shall update residents (overhead announcement) and their representatives (facility web site):
• Weekly, or
• Each subsequent time a confirmed infection of COVID-19, or three or more residents or staff with new on-set of respiratory symptoms occurs within 72 hours
• Facility should include information on mitigating actions implemented to prevent or reduce the risk of transmission, including if normal operations in the nursing home will be altered.
• This information must be reported in accordance with existing privacy regulations and statue
• New York State
• Facility shall notify family/next of kin of all residents if any resident in the building expires due to COVID-19 related illness within 24 hours of expiration
• Facility should maintain an accurate list of contacts for residents, updating routinely for discharges, deaths and new admissions
• Facility should make efforts to identify appropriate next of kin for all residents to identify the primary contact for any communication

 

POLICY:	Pandemic – COVID-19 Discharge planning			POLICY NO:	IC – 10- COVID-19
Dept:  Nsg	clinical operations		☐  New ☒  Revised	Last Date Revised:
				Prev. Date  Revised:	4/2020
				Creation Date:	3/2020
RELATED FORMS:

 

Policy:                    

The Centers for Disease Control and Prevention (CDC) provides guidelines on discharging residents from a health care facility when clinically indicated. The decision to discharge a resident to home should be made in consultation with the patient’s clinical care team and local or state public health departments (as applicable).

Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.

Discharge planning team should take into consideration if the resident can be safely discharged home. Emphasis on discharge planning should include available on-hand medications, support system, resources, supplies, medications and other home care related issues necessary to attain and maintain resident’s condition upon discharge.

GUIDELINES

The facility should assess the suitability of the residential setting for home care. In consultation with state or local health department staff, a healthcare professional should assess whether the residential setting is appropriate for home care. Considerations for care at home should include whether:

 

• The patient is stable enough to receive care at home.
• Appropriate caregivers are available at home.
• There is a separate bedroom where the patient can recover without sharing immediate space with others.
• Resources for access to food and other necessities are available.
• The patient and other household members have access to appropriate, recommended personal protective equipment (at a minimum, gloves and facemask) and are capable of adhering to precautions recommended as part of home care or isolation (e.g., respiratory hygiene and cough etiquette, hand hygiene);
• There are household members who may be at increased risk of complications from COVID-19 infection e.g., older people and people with severe chronic health conditions, such as heart disease, lung disease, and diabetics.

 

PROCESS:

1. Discharge planning should begin upon admission. Considerations to successful discharge planning should be based upon above recommended guidelines.
2. Licensed nurse should perform resident’s assessment including vital signs, oximeter check upon discharge and document in clinical record.
3. Residents with sudden onset or worsening of these symptoms
   1. Fever,
   2. Cough
   3. Shortness of breath or difficulty breathing
   4. Chills, Repeated shaking with chills,
   5. Muscle pain,
   6. Headache,
   7. Sore throat,
   8. New loss of taste or smell,
   9. Eye drainage

Physician should be notified immediately, and decision to hold discharge should be considered.

4. If discharging a resident with a recovering COVID-19 or a resident with COVID-19 symptomatic resident that is not of life-threatening in nature to the community, the facility should ensure that appropriate community home health agency is available for follow-up, and notify the local DOH for contact tracing.
   1. If physician determines that the resident’s symptoms is ‘stable’ and can be managed in the community, documentation supporting such decision must be available in the medical record.
   2. The facility must notify the local health department of the pending discharge for appropriate directives.
5. Isolation should be maintained at home if patient is discharged before discontinuation of Transmission-Based Precautions
   1. The decision to discharge resident should be made in consultation with patient’s clinical care team and local board of health
   2. Notify the local Health Department of resident plan to discharge home
   3. Facility should make determination, through assessment and family meetings, of home’s suitability for patient and family to adhere to home isolation recommendations
6. COVID-19 laboratory tests:
   1. Facility should take into consideration the length of time required to obtain COVID-19 results. Measures should be taken to obtain COVID-19 laboratory tests, and allowing sufficient time for physician to review and make decision if discharge to community is safe.
   2. All pending laboratory reports should be received prior to discharge to community, as feasible.
   3. A repeat COVID-19 test is not required to clear a resident previously diagnosed with COVID-19 positive for discharge. Presenting clinical symptoms is sufficient to determine if resident is stable for discharge.
   4. If laboratory test result for COVID-19 is positive, however, the resident is asymptomatic, discharge to community should be discussed with MD and notify the DOH for additional directive.

 

7. Patient Education:
   19. Licensed nurse should provide COVID-19 education to the resident / legal representative (via telephone, or other social media) including preventive measures at home relating to steps to prevent exposure to COVID-19.
   20. Include any education on isolation precautions if resident is being discharged prior to discontinuing isolation precautions
   21. Licensed nurses should provide patient education related to resident’s underlying condition that predispose resident to at risk for COVID-19.
8. Patient handout may be given from CDC ‘Prevent the spread of COVID-19 if you are sick “ Accessible version: https://www.cdc.gov/coronavirus12019-ncov/if-you-are-sick/steps-when-sick.htm
   1. Patient education related to COVID-19 prevention, and treatment plan should appear in the medical record.
   2. Local health department number should be provided to the resident upon discharge.

 

8. Discharge medication: Facility should make all necessary arrangements for discharge medications to be available upon discharge.
   1. Resident should have at least a 2-week supply of prescription and non-prescription medications. Assist resident in obtaining required supplies and medications as applicable prior to discharge.
      1. Current dispensed narcotics from pharmacy may be sent with resident upon discharge. Licensed nurses should:
         1. Obtain order from physician relating to narcotics medications to be sent upon discharge.
         2. Physician order should state “…send ——(medication)…amount (….) with resident upon discharge. Sample order ‘Send Oxycodone 5mg/325mg I tab. Po every 6 hours, (total # 20 tabs) with resident upon discharge.”
         3. Obtain additional narcotic script (as applicable). Send on-hand dispensed medication and script with resident.
         4. Send medication as prescribed and dispensed from pharmacy (blister pack) with resident.
         5. Complete narcotic book with 2 nurses validating medication sent with resident
         6. Complete medical record including directions related to the medication.
      2. Notify resident’s physician insurer, and pharmacist about getting an extra supply (i.e., more than two weeks) of prescription medications, if possible, to reduce trips to the pharmacy.

 

9. Leaving Against Medical Advice (AMA): Resident diagnosed with COVID-19 or suspected COVID-19 leaving the facility against medical advice. The facility should notify the local health department for contact tracing. Documentation of such notification should appear in medical record.

 

POLICY:	Pandemic – lab – obtaining OROPHARYNGEAL swab			POLICY NO:	IC- 11 – COVID – 19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:
				Prev. Date Revised:
				Creation Date:	5/2020
RELATED FORMS:

 

Policy:                    

Oropharyngeal swabs are used for the detection of respiratory viruses such as RV, Influenza A & B, COVID-19 or parainfluenza virus

PROCEDURE:

1. Obtain oropharyngeal swab per physician order
2. Resident should be provided privacy for testing/sample collection
3. Use only synthetic fiber swabs with plastic or wire shafts. Do not use calcium alginate swabs or swabs with wooden shafts, as they may contain substances that inactivate some viruses and inhibit PCR testing

SWABBING:

1. Assemble supplies
2. If bulk packaging, remove only the number swabs needed for one resident at a time
3. If individual packets take full packet to residents’ room
4. Explain procedure to resident
5. Wash hands. Put on appropriate personal protective equipment (PPE)
6. At a minimum, gloves and facemask to protect yourself in case the resident coughs or sneezes while you are collecting the specimen
7. If collecting sample for infectious disease (i.e. COVID-19) staff should wear:
8. N95 mask if available note: (wear 2 surgical masks in lieu of N95 mask)
9. Gown

• Goggles/Shield

1. Gloves
2. Seat resident in a comfortable bed/chair. It may be necessary to have a second person available to assist with the collection.
3. Swab Collection:
4. Ask the person to tilt their head back to straighten out nasal passage – 70° angle
5. If unable to assist in procedure have an assistant to assist in positioning head back
6. Depress the persons tongue and ask them to say “Ahh”,
7. Collect the throat culture by rubbing the sterile swab tip on the surface of one or both tonsils, the tonsillar pillars, or the posterior pharyngeal wall
8. Other areas of the oral pharynx and mouth are not acceptable sites, and could lead to false negative results
9. Try not to touch the tongue
10. Gently move the swab without touching the teeth, gums or tongue
11. Break off top of swab (it will snap off or follow the manufacturer’s label)
12. Place in transport medium
13. Place in transport medium
14. Remove personal protective equipment, wash hands
15. Ensure the specimen is labeled and transport to the laboratory with completed requisition.

 

POLICY:	Pandemic -lab – obtaining nasal swab			POLICY NO:	IC- 12 – COVID – 19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:
				Prev. Date Revised:
				Creation Date:	5/2020
RELATED FORMS:

 

Policy:                    

Nasal swabs are used for the detection of respiratory viruses such as RSV, Influenza virus A & B, COVID-19 or parainfluenza virus.

PROCEDURE:

4. Obtain nasal swab per physician order
5. Resident should be provided privacy for testing/sample collection
6. Use only synthetic fiber swabs with plastic or wire shafts. Do not use calcium alginate swabs or swabs with wooden shafts, as they may contain substances that inactivate some viruses and inhibit PCR testing

SWABBING:

11. Assemble supplies
12. If bulk packaging, remove only the number swabs needed for one resident at a time
13. If individual packets take full packet to residents’ room
14. Explain procedure to resident
15. Wash hands.
16. Put on appropriate personal protective equipment (PPE)
17. At a minimum, gloves and facemask to protect yourself in case the resident coughs or sneezes while you are collecting the specimen
18. If collecting sample for infectious disease (i.e. COVID-19) staff should wear:
19. N95 mask if available note: (wear 2 surgical masks in lieu of N95 mask)
20. Gown

• Goggles/Shield
• Gloves

15. Seat resident in a comfortable bed/chair. It may be necessary to have a second person available to assist with the collection.
16. Swab Collection:
17. Ask the person to tilt their head back to straighten out nasal passage – 70° angle
18. If unable to assist in procedure have an assistant to assist in positioning head back
19. Gently insert swab into one nostril – into the anterior nares.
20. Gently rotate the swab
21. Withdraw slowly
22. Break off top of swab (it will snap off or follow the instructions provided by the lab)
23. Place in transport medium
24. Remove personal protective equipment, wash hands
25. Ensure the specimen is labeled and transport to the laboratory with completed requisition.

 

POLICY:	Pandemic -COVID-19 – EMPLOYEE TESTING			POLICY NO:	IC- 13 – COVID – 19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:
				Prev. Date Revised:
				Creation Date:	5/2020
RELATED FORMS:

 

Policy:                    

Executive Order No. 202.30 requires twice per week testing of all personnel of all nursing homes. All staff includes but is not limited to employees, contract staff, per diem staff, medical staff, operators, administrators, and volunteers.  Staff who are working from home, on leave, or otherwise not at the same site as residents do not need to be tested as long as they remain offsite.  Staff who work at a facility on three days per week or less only need to be tested one time per week.  The facility will maintain appropriate documentation of the test results.

The facility has adapted and implemented various policies to endure the safety of our residents and staff. This includes but is not limited the routine testing of staff for COVID-19.

PROCEDURE:

7. The facility will test all staff for COVID-19 via Nasopharyngeal swab, or oropharyngeal swab, twice per week during a 7 day period for fulltime employees and at least once weekly for part time employees
8. If test is negative, staff member will be tested two times a week during the testing program
9. If test is positive, staff member will be removed from the schedule and follow the 14-day quarantine guidelines to return to work (personnel must be furloughed until 14 days from the onset of illness (and at least 3 days have passed since resolution of fever without use of fever-reducing medication and respiratory symptoms are improving) for symptomatic staff and for 14 days from the first positive test for asymptomatic staff.

 

8. The facility will track testing dated, testing method and testing results of each employee by the Director of Human Resources and will notify staff of results
9. If a staff member tests positive for COVID-19 a PCR test, facility will contact NYSDOH by 5pm the following day of known result
10. Staff member who refuse testing will be removed from the schedule until a result can be obtained. Failure to comply will result in the employee being out of medical compliance and will be under suspension without pay effective immediately.
11. The facility will obtain an agreement with testing sites for ongoing testing. This may include:
12. Utilizing contracted lab services to process samples obtained in-house
13. Using public drive thru testing sites
14. Employee’s physician
15. Identified clinics
16. State testing site

 

IN-HOUSE TESTING

1. Human Resources Director or designee should contact staff to schedule testing
2. Facility will have a designated location within facility to perform testing/sample retrieval
3. Area should:
4. Provide privacy
5. Have the ability to close door
6. Have easy to table for supplies and documentation
7. Have ample PPE required
8. Off residents unit
9. Have a sink or readily supply of Alcohol gel available
10. Should remained lock when not being used
11. Should be thoroughly cleaned at least twice a day

 

4. Staff performing testing should wear appropriate PPE
5. N95 mask (note: may wear surgical mask over N95 during procedure)
6. Gown/overalls
7. Goggles or face shield
8. Gloves

 

5. Facility will designate at least one or two persons to perform test for consistency and accuracy
6. Facility will tract testing date, testing method and testing results of each employee
7. Records of personnel testing and results are kept for the period of one year.

 

POLICY:	Pandemic –  COMMUNICABLE dISEASE PREPAREDNESS			POLICY NO:	IC- 14- COVID-19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:
				Prev. Date Revised:
				Creation Date:	5/2020
RELATED FORMS:

 

Policy:                    

This guidance is based on the currently limited information available about 2019-nCov related to disease severity, transmission efficiency, and shedding duration. The facility’s policy is to promptly prevent, detect and respond to dangerous and transmissible pathogens. The facility will engage a rapid institution of infection control measures to minimize potential transmission of communicable disease to staff, residents and visitors.

PURPOSE:

• To enhance early recognition of a resident who may have a communicable disease of public health concern
• To institute effective methods and best practices in screening, isolation and infection control
• To control the spread of disease and provide necessary information to all who may be affected, in compliance with all state/county/city regulations related to communicable disease.

GUIDELINES:

• Guidelines for Communicable Disease Preparedness are to be initiated and followed for a specified amount of time upon directive from the Medical Director.
• Perform initial resident identification.
• Screen resident for potentially infectious risk for airborne, droplet, or contact transmission of infectious agents to others and initiate isolation
• Screening/Triage staff will use a reminder sys

POLICY:	Pandemic – covid-19 – RESIDENT USE OF OUTSIDE GROUNDS OF THE FACILITY			POLICY NO:	IC-15-covid-19
Dept:  Nsg	clinical operations		☒  New ☐  Revised	Last Date Revised:
				Prev. Date  Revised:
				Creation Date:	6/11/2020
RELATED FORMS:

 

Policy:                    

This guidance is based on the currently limited information available about 2019-nCoV related to disease severity, transmission efficiency, and shedding duration. Providence Rest promotes a Culture of Safety to ensure optimal safety for both residents and staff during the COVID-19 Pandemic.

The virus is thought to spread mainly from person-to-person.

• Between people who are in close contact with one another (within about 6 feet).
• Through respiratory droplets produced when an infected person coughs or sneezes.

Spread from contact with infected surfaces or objects

 

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

 

PROCEDURE:

• Residents that exhibits respiratory symptoms consistent with COVID-19, shall not be permitted to enter the balcony or the courtyard patio. COVID-19, Persons Under Investigation, and “Unknown”, 2C residents, shall not be permitted to engage in this process.
• Staff will monitor residents’ whereabouts
• Upon request, Residents whom are alert, oriented and able to make their needs known; that are requesting to go outside on the balcony shall be escorted by staff to enjoy fresh air for at least 15 minutes during the COVID – 19 Pandemic.
• Residents shall wear masks when participating in the use of outside grounds of the facility
• Staff and Residents shall maintain social distancing of six (6) feet at all times while in the designated area.
• Staff and residents will be assigned by the Licensed Nurse on a day by day basis, weather permitting.
• Residents that are exhibiting mental health issues i.e. depression, crying, etc., shall be seen by Psychiatry services and the Social Service Department. Social Worker may escort the resident outside in the designated areas in attempt to re-direct the residents’ mental psyche.
• A maximum of 2 residents shall be permitted at one time during the use of outside grounds

 

 

[1] Based on the California Association of Health Facilities COOP Plan Template

[2] The Priority Program and Service Areas are an expanded version of the Joint Commission’s Six Critical Areas.  They are provided as a suggestion; user should modify and adapt the Priority Program and Service Areas to match those of their facility.

[3] Source:  http://www.bt.cdc.gov/disasters/reopen_healthfacilities_checklist.asp.  Content source: National Center for Environmental Health (NCEH)/Agency for Toxic Substances and Disease Registry (ATSDR), Coordinating Center for Environmental Health and Injury Prevention (CCEHIP)  Page last updated October 18, 2005.  Viewed April 28, 2009.