October 21, 2020
Dear Residents, Responsible Parties, and Family Members,
The purpose of this letter is to communicate updates regarding our efforts to accommodate visitation, within the facility, as weather is becoming less conducive to outside visits.
Effective Monday, November 9, we will begin our new structured in-house facility visits.
Attached to this letter are two documents.
The first document is the Implementation Plan for Reopening In Accordance with the Pennsylvania Department of Health’s Interim Guidance for Skilled Nursing Facilities During Covid-19. This document is required by the Department of Health and describes how we intend to accommodate in-house visitation. We are also required to share this document with our families.
The second document is the Visitor Acknowledgement and Consent Form. Please review this form and share this form with your family members. You will be asked to sign this acknowledgement when you enter the facility to visit. Please understand, you are responsible for the safety and well-being of the resident with whom you are visiting, during the visit. We are not going to police visitations. The precautions identified in this document are for the resident’s and staff safety in this unprecedented time.
Below is the structured in-house visitation schedule, which is also identified in the first document attached.
Week A: (1st Floor) – Starting Monday, November 9th.
Tuesday’s will accommodate B1 (rooms 109, 111, 114, 115, 117, 119) in the C1 or C2 lounge.
Wednesday’s will accommodate B1 (rooms 108, 110, 112, 116, 118) in the C1 or C2 lounge
Week B: (2nd Floor) – Starting Monday, November 16th.
Monday’s will accommodate C2 (rooms 221, 223, 225, 227, 229, and 231) in C1 or C2 lounge.
Tuesday’s will accommodate D2 (rooms 233, 235, 237, 239, 241, 243,245) in C1 or C2 lounge.
Wednesday’s will accommodate C2 (rooms 220, 222, 224, 226, 228, 230) in C1 or C2 lounge
Thursday’s will accommodate D2 (rooms 234, 236, 238, 240, 242, 244) in C1 or C2 lounge.
Friday’s will accommodate all of B2 unit in the C1 or C2 lounge.
- · Visitors will choose one of two time options to visit on unit/room corresponding day.
- · RSVP no more than 24 hours in advance by calling into the receptionist.
- · Visiting hours will be either 9:30am to 11:15am or 1:00pm to 4:00pm.
- · Visitation will be limited to 30 minutes.
- · One visitor permitted per resident per day.
- · No one under the age of 18 years of age permitted visitation within the facility.
- · Accommodations will be made to the best of the facility’s ability based on available space.
While I appreciate that this new schedule may limit some families, I am hopeful that the majority will benefit more than the few.
While unfortunate, the restrictions are necessary. Just in these last few weeks, we have seen an increase within the acute care hospitals as well as in the surrounding skilled nursing facilities within York County. Covid -19 continues to have a negative impact on the residents and staff of these institutions.
We appreciate your continued prayers and trust in the care and services we provide and for your understanding and support of any necessary adjustments as this situation evolves.
Please feel free to contact me at 717-633-4520 with any questions or concerns.
May God bless us all.
Daniel Pyle, NHA
Administrator, Hanover Hall
Implementation Plan for Reopening
In Accordance with the Pennsylvania Department of Health’s
Interim Guidance for Skilled Nursing Facilities During COVID-19
This template is provided as a suggested tool for skilled nursing facilities to use in developing their Implementation Plan for reopening. This (or another version of an Implementation Plan) is to be posted on the facility’s website (if the facility has a website) or available to all residents, families, advocates such as the Ombudsman and the Department upon request. This is NOT to be submitted to the Department.
This section contains the name and location of the facility along with contact information for an individual designated by the facility. That individual does not have to be the Nursing Home Administrator but should be someone available to respond to questions regarding the Implementation Plan.
1. FACILITY NAME
Hanover Hall Nursing and Rehabilitation Center
2. STREET ADDRESS
267 Frederick Street
4. ZIP CODE
5. NAME OF FACILITY CONTACT PERSON
Daniel S. Pyle, NHA
DATE AND STEP OF REOPENING
The facility will identify the date upon which all prerequisites will be met for reopening and the Step at which the facility will enter reopening. Those facilities that experienced a significant COVID-19 outbreak will identify the date the Department of Health survey was conducted (that is required prior to reopening).
6. DATE THE FACILITY WILL ENTER REOPENING
7. SELECT THE STEP AT WHICH THE FACILITY WILL ENTER REOPENING – EITHER STEP 1 OR STEP 2 (CHECK ONLY ONE)
The facility must meet all the Prerequisites, including the baseline universal test for COVID-19 administered to staff and residents (in accordance with the June 8, 2020, Order of the Secretary of Health)
The facility must meet all the Prerequisites, including the baseline universal test for COVID-19 administered to staff and residents (in accordance with the June 8, 2020, Order of the Secretary of Health)
Have the absence of any new facility onset of COVID-19 cases for 14 consecutive days since baseline COVID-19 testing
8. HAS THE FACILITY EXPERIENCED A SIGNIFICANT COVID-19 OUTBREAK? (IF NO, SKIP TO #11)
in April and May of 2020
9. DATE THE FACILITY WAS SURVEYED BY THE DEPARTMENT OF HEALTH TO ENSURE THE FACILITY IS ADEQUATELY PREVENTING TRANSMISSION OF COVID-19
STRATEGY FOR TESTING, COHORTING, PERSONAL PROTECTIVE EQUIPMENT, AND STAFFING
To ensure the facility has taken appropriate measures to protect residents and staff, descriptions of those strategies are required in this section (prerequisites to reopening).
10. DATE RANGE FOR THE BASELINE UNIVERSAL TEST ADMINISTERED TO STAFF AND RESIDENTS (BETWEEN MAY 24, 2020 AND JULY 24, 2020) IN ACCORDANCE WITH THE JUNE 8, 2020, ORDER OF THE SECRETARY OF HEALTH
11. DESCRIBE THE CAPACITY TO ADMINISTER COVID-19 DIAGNOSTIC TESTS TO ALL RESIDENTS SHOWING SYMPTOMS OF COVID-19 AND TO DO SO WITH 24 HOURS
Through the Department of
Health, Point of Care testing, and through a contractual relationship with a
12. DESCRIBE THE CAPACITY TO ADMINISTER COVID-19 DIAGNOSTIC TESTS TO ALL RESIDENTS AND STAFF IF THE FACILITY EXPERIENCES AN OUTBREAK
Through the department of
Health, Point of Care testing, and through a contractual relationship with a
13. DESCRIBE THE CAPACITY TO ADMINISTER COVID-19 DIAGNOSTIC TESTS TO ALL STAFF, INCLUDING ASYMPTOMATIC STAFF
Any new on-set of symptoms
amongst the staff will be tested through their PCP referral process. All
asymptomatic staff will be tested through facility’s private contract lab or
Point of Care testing.
14. DESCRIBE THE PROCEDURE FOR ADDRESSING NEEDED TESTING OF NON-ESSENTIAL STAFF AND VOLUNTEERS
Before facility considers
opening to any non-essential staff, including volunteers, facility will test
non-essential staff through our private contract lab or Point of Care
15. DESCRIBE THE PROCEDURE FOR ADDRESSING RESIDENTS OR STAFF THAT DECLINE OR ARE UNABLE TO BE TESTED
Residents who decline testing
are monitored, daily, for signs/symptoms, as will their roommate if
applicable. This procedure occurs for all residents regardless of testing.
Staff who decline testing will be removed from the schedule. Any staff
unable to be tested will be removed from the schedule until staff member is
available for testing and results are obtained.
16. DESCRIBE THE PLAN TO COHORT OR ISOLATE RESIDENTS DIAGNOSED WITH COVID-19 IN ACCORDANCE WITH PA-HAN-509 PURSUANT TO SECITON 1 OF THE INTERIM GUIDANCE FOR SKILLED NURSING FACILITIES DURING COVID-19.
facility follows and adheres to PA-HAN-509 regarding cohorting related to
Green/Yellow/Red zones within the facility.
Staff are instructed to follow transmission-based precautions, which
includes full use of PPE. Only essential staff are permitted on the unit. No
visitation, communal dinning, or group activities. Families schedule virtual
visits through the activities department. If/when, the facility acquires a
positive Covid result, following the 14-day of no new cases; facility will
close again to visitation and begin weekly testing until no new cases are
identified in a 14-day span.
17. DESCRIBE THE CURRENT CACHE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) AND THE PLAN TO ENSURE AN ADEQUATE SUPPLY OF PPE FOR STAFF (BASED ON THE TYPE OF CARE EXPECTED TO BE PROVIDED)
Facility is currently well
supplied with the necessary PPE. The designated central supply person
maintains a daily/weekly list of available PPE, which ensures adequate
supply, is maintained. Conservation strategies for use of PPE are still in
place regarding N95 masks. Facility will continue to order the maximum
allotted PPE, per month, and build upon our existing supply for a potential
resurgence this year and 2021. Facility has replaced disposable isolation
gowns with washable/reusable isolation gowns as our first choice when
Transmission-Based Precautions (TBP) are implemented. Facility has adequate
supplies of face shields, eye googles, gloves, hand sanitizer, and
disinfectants to meet our existing needs and the potential for a second
resurgence this year and in 2021.
18. DESCRIBE THE CURRENT STAFFING STATUS AND THE PLAN TO ENSURE NO STAFFING SHORTAGES
The facility’s current
staffing status is abundant and has been since the start of the pandemic.
The facility has better than 40% of the employees’ tenure at 15 years of
service or greater. The facility also experiences a much lower turnover rate
compared to state and national averages. The facility management also
assures that the facility census does not exceed the ability to meet the
19. DESCRIBE THE PLAN TO HALT ALL REOPENING FACILITIES IF THE COUNTY IN WHICH THE FACILITY IS LOCATED IS REVERTED TO A RED PHASE OF THE GOVERNOR’S REOPENING PLAN
Facility would notify all
families and residents that the facility was closing to visitation, group
activities, communal dining, non-essential and volunteer staff by means of
phone calls, facility website notification, and room-to-room visits with
residents. Staff would be notified by On-Shift message notification,
facility sign postings, emails, and one to one notification by their
In each block below, describe the screening protocol to be used including where screening occurs, method of determining symptoms and possible exposure, and action taken if screening reveals possible virus.
All resident’s vitals are assessed daily including
pulse-ox, temperature, and any new on-set signs and symptoms, at bedside.
When new on-set of signs and symptoms determine possible covid, facility
calls the Department of Health to obtain approval for covid testing. When a
resident is suspect for covid and asymptomatic, facility will obtain physician
and responsible party approval to test through facility’s private contract
lab. Any resident under suspicion of covid is immediately placed on
Transmission-Based Precautions along with their roommate, if applicable. If
the test results reveal a positive covid case, the facility assess current
location of positive resident in relation to the unit and other resident
rooms. Following PA-HAN-509, facility will either isolate in place or move
resident to an already existing RED ZONE. All decisions made are in the best
interest of all the residents, staff, and the containment of the infection.
All staff are screened prior to their shift and at the
end of their shift. The screening involves temperature readings and
completion of a questionnaire. There are three entry points for employees to
screen before start of shift. All three locations are separate from resident
living areas. Each nurse’s station maintains an outgoing screening log for
staff to utilize prior to leaving facility. If/when, any staff member is ill
and/or presenting signs/symptoms related to covid, they are encouraged to
call into facility and speak with a supervisor before reporting to work. Any
staff member with signs/symptoms related to Covid are required to leave the
facility and seek medical attention. Medical clearance is required before
said employee may return to work.
22. HEALTHCARE PERSONNEL WHO ARE NOT STAFF
Healthcare Personnel who are not staff are screened at
our reception area/main entrance to the facility. The screening involves
temperature readings and completion of a questionnaire. Masks are provided,
upon request, if the healthcare professional does not have a mask or their
mask is in visible need of replacement.
23. NON-ESSENTIAL PERSONNEL
Most non-essential employees have been excluded from
entering the building, IE: volunteers and paid entertainment. If/when, the
facility invites these non-essential personnel back to the facility, they
will be required to provide proof of a negative test result within one week
of return and in-service on the screening protocols at start of service and
at the end of their service. Moving forward, if any non-essential personnel
works a weekly routine, they will be included in the facility wide staff
All visitors will enter through the main entrance and
complete the screening process. Visitors will be provided a facemask, if
needed, at this time. Any visitor who refuses screening will be denied
entry. Any visitor, who presents with signs/symptoms, has knowingly been
exposed in the community, and/or traveled internationally, traveled to any
of the current states that requires quarantine upon return, has flown, or
taken a cruise within the last 14 days, will be denied entry. Indoor visitation
will occur in designated neutral zones. Currently, these neutral zones are
C1 and C2 Lounges. Outdoor visitation, weather permitting, is preferred and
will be encouraged by facility with family’s advance notice. All visitation
will be limited to residents unexposed to Covid-19. Visiting in a resident’s
room will be permitted only if the resident is unable to be transported to a
designated neutral zone. There will be no crossover visitation permitted
until further notice.
The facility, currently, does not have any volunteers due
to the pandemic. When the facility is comfortable inviting volunteers back
into the facility, the screening process will follow established facility
staff protocols. Any volunteer willing/able to assist weekly will be
included in the scheduled weekly staff testing. Volunteers will be limited
to only those residents unexposed to Covid-19.
Communal dining is the same for all steps of reopening so there is no need to differentiate among the three steps.
26. DESCRIBE COMMUNAL DINING MEAL SCHEDULE, INCLUDING STAGGERED HOURS (IF ANY)
Due to the
limited common area/neutral zones within the facility and the need to
utilize certain areas within the facility to accommodate indoor visitation,
communal dining remains on hold. When the facility is ready to
consider/accommodate communal dinning, steps 26 through 29 will be addressed
prior to initiating communal dinning.
27. DESCRIBE ARRANGEMENT OF TABLES AND CHAIRS TO ALLOW FOR SOCIAL DISTANCING
28. DESCRIBE INFECTION CONTROL MEASURES, INCLUDING USE OF PPE BY STAFF
29. DESCRIBE ANY OTHER ASPECTS OF COMMUNAL DINING DURING REOPENING
ACTIVITIES AND OUTINGS
In each block below, describe the types of activities that will be planned at each step and the outings that will be planned at Step 3 (an all-inclusive list is not necessary). Include where they will be held and approximately how many residents will be involved. Describe how social distancing, hand hygiene, and universal masking will be ensured. Also include precautions that will be taken to prevent multiple touching of items such as game pieces.
30. DESCRIBE ACTIVITIES PLANNED FOR STEP 1 (FIVE OR LESS RESIDENTS UNEXPOSED TO COVID-19)
Limited activities with social distancing with five or
less residents will occur when inside or outside. Outside group activities
are preferred, weather permitting. Facility has ample space outside to
accommodate social distancing. Canopies are used, if needed, to protect the
residents from the sun. Universal masking is required at all times including
outside activities. Staff will avoid using items, which require multiple
residents to touch in a single activity. When single use items are used for
activities, these items will be cleaned/sanitized at the end of the
activity. All surfaces involved will also be cleaned/sanitized.
31. DESCRIBE ACTIVITIES PLANNED FOR STEP 2 (TEN OR LESS RESIDENT UNEXPOSED TO COVID-19)
See item #30.
32. DESCRIBE ACTIVITIES PLANNED FOR STEP 3
Group activities may only be conducted with residents
unexposed to Covid-19. Staff will ensure social distancing, hand hygiene,
and universal masking are followed. Staff will avoid using items that
require multiple residents to touch in a single activity. When single use
items are used for activities, these items will be cleaned/sanitized at the
end of the activity. All surfaces involved will be cleaned/sanitized.
33. DESCRIBE OUTINGS PLANNED FOR STEP 3
Community outings are allowed only for residents unexposed
to Covid-19. Outings will be limited to no more than the number of people
where social distancing between residents can be maintained. Hand hygiene
and universal masking will be required. Assigned staff involved with the
community outing will be responsible for the supervision and compliance for
In Step 2, non-essential personnel deemed necessary by the facility are allowed (in addition to those already permitted in Section 4 of Interim Guidance for Skilled Nursing Facilities During COVID-19). In Step 3, all non-essential personnel are allowed. Screening and additional precautions including social distancing, hand hygiene, and universal masking are required for non-essential personnel.
34. DESCRIBE THE LIMITED NUMBER AND TYPES OF NON-ESSENTIAL PERSONNEL THAT HAVE BEEN DETERMINED NECESSARY AT STEP 2
Contractors who are required to maintain the safety and
integrity of the facility and cannot otherwise be accomplished with existing
essential staff are determined necessary at Step 2. These non-essential
staff are limited to no more than 3, for any one-job task, at one time.
These non-essential staff are screened, following facility protocols, prior
to entering resident care areas. Masks and hand hygiene are required before
entering resident care areas.
35. DESCRIBE HOW SOCIAL DISTANCING, HAND HYGIENE, AND UNIVERSAL MASKING WILL BE ENSURED FOR NON-ESSENTIAL PERSONNEL AT STEPS 2 AND 3
All non-essential personnel are screened, following
facility protocols, prior to entering resident care areas. Masks and hand
hygiene are required before entering resident care areas. Facility will
provide weekly testing for any non-essential personnel who will be working
in the facility three or more days per week.
36. DESCRIBE MEASURES PLANNED TO ENSURE NON-ESSENTIAL PERSONNEL DO NOT COME INTO CONTACT WITH RESIDENTS EXPOSED TO COVID-19
Any resident exposed and/or who test positive for
Covid-19 are cohorted and placed on transmission-based precautions.
Non-essential personnel are not permitted within the designated cohorted
areas or room of said resident. Exception would be end-of-life visit by
clergy and/or family. Under such circumstances, non-essential personnel and
family member would be provided the necessary PPE and instruction under
transmission-based precaution protocols to safely visit with an exposed or
positive Covid-19 resident, for a pre-determined limited amount of time.
Staff supervision is maintained during the duration of visit.
For visitation to be permitted in Steps 2 and 3 of reopening (as described in Section 6 of Interim Guidance for Skilled Nursing Facilities During COVID-19), the following requirements are established. Screening and additional precautions including social distancing, hand hygiene, and universal masking are required for visitors.
37. DESCRIBE THE SCHEDULE OF VISITATION HOURS AND THE LENGTH OF EACH VISIT
Indoor visits will be scheduled every other week, by floor,
by unit, and resident rooms,Monday through Friday. Visitors will choose one
of two options to visit on unit’s corresponding day and will be asked to
RSVP 24 hours in advance. Visiting hours will be either 9:30am to 11:15am or
1:00pm to 4:00pm. Visitors will be limited to 30 minutes. One visitor
permitted per resident per day. No one under the age of 18 years of age will
be permitted visitation within the facility. Weather permitting, if family
wish to visit outside, family will be asked to notify facility prior to
visit. Outside visitation, weather permitting, is preferred. Any resident
unable to be transferred to the designated neutral zone for visitation will
receive their visitor at bedside. Current neutral zones identified within
the facility are C1 and C2 lounges. Each interior neutral zone will have
tables and chairs providing ample social distancing for all parties
participating. One resident/visitor per table. Tables will be dressed with
tablecloths and the tablecloths will be changed between visits. Visitors
will be provided a water droplet mask if visitor does not have their own
mask. Visitors will be screened and temped per facility protocol prior to
38. DESCRIBE HOW SCHEDULING VISITORS WILL OCCUR
Week A: (1st Floor) Monday’s will accommodate C1 and A1 units in the C1 or C2 lounge. Tuesday’s will accommodate B1 (rooms 109, 111, 114, 115, 117, 119) in the C1 or C2 lounge. Wednesday’s will accommodate B1 (rooms 108, 110, 112, 116, 118) in the C1 or C2 lounge.
Week B: (2nd Floor) Monday’s will accommodate C2 (rooms 221, 223, 225, 227, 229, and 231) in C1 or C2 lounge. Tuesday’s will accommodate D2 (rooms 233, 235, 237, 239, 241, 243,245) in C1 or C2 lounge. Wednesday’s will accommodate C2 (rooms 220, 222, 224, 226, 228, 230) in C1 or C2 lounge. Thursday’s will accommodate D2 (rooms 234, 236, 238, 240, 242, 244) in C1 or C2 lounge. Friday’s will accommodate all of B2 unit in the C1 or C2 lounge.
will choose one of two options to visit on unit’s corresponding day and will
be asked to RSVP 24 hours in advance. Visiting hours will be either 9:30am
to 11:15am or 1:00pm to 4:00pm. Visitors will be limited to 30 minutes. One
visitor permitted per resident per day. No one under the age of 18 years of
age will be permitted visitation within the facility.
39. DESCRIBE HOW VISITATION AREA(S) WILL BE SANITIZED BETWEEN EACH VISIT
Tablecloths will be changed between visits and chair/s
wiped down with EPA approved disinfectant.
40. WHAT IS THE ALLOWABLE NUMBER OF VISITORS PER RESIDENT BASED ON THE CAPABILITY TO MAINTAIN SOCIAL DISTANCING AND INFECTION CONTROL?
One visitor per resident per assigned day will be
permitted for each resident based on available space to maintain social
41. DESCRIBE THE ORDER IN WHICH SCHEDULED VISITS WILL BE PRIORITIZED
Please see #37 & # 38. Nursing units and designated
rooms within the nursing units are assigned a specific day of the week and
one of two time options to visit resident. Visitors will RSVP 24 hours prior
to scheduled day. If/when there presents a critical need/emergency; facility
management will work directly with the individual/s involved to accommodate
family needs to the best of our ability.
42. DESCRIBE HOW THE FACILITY WILL DETERMINE THOSE RESIDENTS WHO CAN SAFELY ACCEPT VISITORS AT STEP 2 (CONSIDERING SUCH SAFETY FACTORS AS EXPOSURE TO OUTDOOR WEATHER AND TRANSPORTING RESIDENT TO VISITOR LOCATION)
Only residents residing in the green zones may receive
visitors within the facility or outside. Residents in yellow and red zones
will not be able to receive visitors until quarantine is discontinued and
resident is moved to a green zone. Residents who are in a yellow/red zone
may participate in virtual/zoom calls, window visits, and phone calls.
43. DESCRIBE THE OUTDOOR VISITATION SPACE FOR STEP 2 TO INCLUDE THE COVERAGE FOR SEVERE WEATHER, THE ENTRANCE, AND THE ROUTE TO ACCESS THE SPACE
Outside main entrance of facility exists a large patio as
well as small tables/chairs along one exterior wall along the building.
Facility does not currently have any outdoor space under roof. Requests for
outside visits will be granted/denied by facility management based on
weather conditions, heat index, and air quality, and resident’s preference.
44. DESCRIBE HOW A CLEARLY DEFINED SIX-FOOT DISTANCE WILL BE MAINTAINED BETWEEN THE RESIDENT AND THE VISITOR(S) DURING OUTDOOR VISITS
Families and visitors will be provided, in writing, with
a Visit Compliance Acknowledgement and Consent Form. This acknowledgement
form identifies the infection prevention precautions each visitor is
accountable for and agrees to follow. Visitor signature is obtained as a
condition of participation. Included within the acknowledgement form the
family/visitor is informed that they must refrain from physical contact and
always maintain a physical distance of six feet between self and
others. Staff, when available, will
be present to supervise.
45. DESCRIBE THE INDOOR VISITATION SPACE THAT WILL BE USED IN THE EVENT OF EXCESSIVELY SEVERE WEATHER TO INCLUDE THE ENTRANCE AND THE ROUTE TO ACCESS THE SPACE
Refer to #37 & #38.
46. DESCRIBE HOW A CLEARLY DEFINED SIX-FOOT DISTANCE WILL BE MAINTAINED BETWEEN THE RESIDENT AND THE VISITOR(S) DURING INDOOR VISITS
Refer to #37 and #44 regarding Visit Compliance and
47. DESCRIBE HOW THE FACILITY WILL DETERMINE THOSE RESIDENTS WHO CAN SAFELY ACCEPT VISITORS AT STEP 3 (CONSIDERING SUCH SAFETY FACTORS AS TRANSPORTING RESIDENT TO VISITOR LOCATION)
Refer to #42.
48. WILL OUTDOOR VISITATION BE UTILIZED AT STEP 3? IF NO, SKIP TO QUESTION #52
Yes, weather permitting and family / resident preference.
49. DESCRIBE THE OUTDOOR VISITATION SPACE FOR STEP 3 TO INCLUDE THE COVERAGE FOR SEVERE WEATHER, THE ENTRANCE, AND THE ROUTE TO ACCESS THE SPACE (IF THE SAME AS STEP 2, ENTER “SAME”)
Same. Refer to #43
50. DESCRIBE HOW A CLEARLY DEFINED SIX-FOOT DISTANCE WILL BE MAINTAINED BETWEEN THE RESIDENT AND THE VISITOR(S) DURING OUTDOOR VISITS (IF THE SAME AS STEP 2, ENTER “SAME”)
Same. Refer to #43
51. DESCRIBE THE INDOOR VISITATION SPACE THAT WILL BE USED TO INCLUDE THE ENTRANCE AND THE ROUTE TO ACCESS THE SPACE (IF THE SAME AS STEP 2, ENTER “SAME”)
Same as #37 and Families/visitors will enter facility
through main entrance and be greeted by the receptionist. At the
receptionist desk, visitors will be screened per facility protocol. Visitor
will be provided a water droplet mask if visitor is not masked. Visitors can
access C1 lounge located inside front entrance, behind C1 nurse’s
station. For visitors accessing the
second floor, visitor will be shown the elevator to the second floor. C2/D2
lounge is located to the immediate left off the elevator.
52. DESCRIBE HOW A CLEARLY DEFINED SIX-FOOT DISTANCE WILL BE MAINTAINED BETWEEN THE RESIDENT AND THE VISITOR(S) DURING INDOOR VISITS (IF THE SAME AS STEP 2, ENTER “SAME”)
Tables are spaced to accommodate adequate social
distancing. Only one resident/visitor per table.
53. FOR THOSE RESIDENTS UNABLE TO BE TRANSPORTED TO THE DESIGNATED VISITATION AREA, DESCRIBE THE INFECTION CONTROL PRECAUTIONS THAT WILL BE PUT IN PLACE TO ALLOW VISITATION IN THE RESIDENT’S ROOM
Facility has identified residents who are not able or may
not be able to safely transport to a neutral zone for visitation. In these
specific cases, facility management and/or designee will contact family to
discuss infection control protocols prior to visitation. Any visitor
requiring resident access in resident room will be shown how to don PPE and
provided full PPE before entering room. This will include an isolation gown,
gloves, and mask. Visitor will be permitted to visit for 30 minutes, same as
all other visits. Upon completion of visit, visitor will remain in room
until staff arrive to assist visitor with proper doffing of PPE. Visitor
will exit facility the same way they entered.
In Step 2, volunteers are allowed only for the purpose of assisting with outdoor visitation protocols and may only conduct volunteer duties with residents unexposed to COVID-19. In Step 3, all volunteer duties may be conducted, but only with residents unexposed to COVID-19. Screening, social distancing, and additional precautions including hand hygiene and universal masking are required for volunteers.
54. DESCRIBE INFECTION CONTROL PRECAUTIONS ESTABLISHED FOR VOLUNTEERS, INCLUDING MEASURES PLANNED TO ENSURE VOLUNTEERS DO NOT COME INTO CONTACT WITH RESIDENTS EXPOSED TO COVID-19
follow the same protocols as staff regarding infection control such as PPE
utilization, screening at start and end of shift, and weekly covid testing.
Volunteers will not be permitted in any resident room that is under
55. DESCRIBE THE DUTIES TO BE PERFORMED BY VOLUNTEERS DURING STEP 2
will be used to assist/supplement the activity department and may perform one
to one visits, outdoor activities, small group activities, and assist with
The Nursing Home Administrator (NHA) is responsible for the accuracy of the Implementation Plan and the facility’s adherence to it. Upon completion of blocks 1-57, the Implementation Plan should be printed and the signature and date affixed by the NHA in block 58.
56. NAME OF NURSING HOME ADMINISTRATOR
Daniel S. Pyle
I attest that the information provided in this Implementation Plan is an accurate representation of the facts and that this facility will adhere to the Implementation Plan as written. I further attest that the county in which this facility is located is in a Yellow or Green phase per the Governor’s Reopening Plan. This Implementation Plan will be posted on our website and made available to all residents, families, advocates such as the Ombudsman and the Department upon request. This facility will progress to the next step of reopening only when the criteria is met as described in the Interim Guidance for Skilled Nursing Facilities During COVID-19. If at any point during reopening the facility fails to meet the criteria for reopening, I will ensure the facility ceases reopening immediately. Further, if at any point during reopening this facility is operating under a contingency staffing plan, I will ensure the facility ceases reopening immediately.
_____Daniel S. Pyle _____________________ October 20, 2020_
SIGNATURE OF NURSING HOME ADMINISTRATOR DATE
Visitor Acknowledgement and Consent Form
I, ________________________________________ visitor of ____________________________
(Visitor printed name) (Resident name)
I understand that WILMAC Corporation, d.b.a. Hanover Hall is putting forth its greatest efforts to ensure that the health of the residents is our highest priority.
During my visit, I understand and agree to the following infection prevention precautions:
· Hand hygiene will be performed upon entering the facility and frequently during the visit as needed.
· Submission to screening for signs and symptoms of COVID-19, travel history, and report any contact with person(s) known or suspected to be COVID-19 positive.
· Wearing a mask and/or other appropriate PPE throughout the entire time of my visitation.
· Refrain from physical contact with the resident or others during the visit and maintain to the best of your ability physical distance of six (6) feet between others and myself.
· I agree to limit my visitation to the assigned designated area.
· If I develop signs or symptoms of a respiratory infection or other COVID-19 symptoms up to 14 days after this visit, I will:
o Immediately notify the facility of:
Ø Date of my visit
Ø Individuals I was in contact with
Ø Location within the facility where visit occurred
o Contact my health care provider, and
o Self-isolate at home
(Visitor signature) (Date)