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: (1^st Floor) – Starting Monday, November 9^th.

            Monday’s will accommodate C1 (rooms 120 – 131) and A1 units (rooms 101-104) 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: (2^nd Floor) – Starting Monday, November 16^th.

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.

Respectfully,

 

 

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.

 

FACILITY INFORMATION
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
3.        CITY   Hanover	4.        ZIP CODE   17331
5.        NAME OF FACILITY CONTACT PERSON   Daniel S. Pyle, NHA	717-633-4520

 

 

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   11/9/2020
7.        SELECT THE STEP AT WHICH THE FACILITY WILL ENTER REOPENING – EITHER STEP 1 OR STEP 2 (CHECK ONLY ONE)   ☐  Step 1         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)   ☒  Step 2         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)         AND         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)   Yes, 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   6/12/2020

 

 

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   6/15/2020                           to                6/16/2020
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 commercial lab.
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 commercial lab.
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 testing.
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.   The 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 staffing needs.
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 respective supervisors.

 

 

SCREENING PROTOCOLS
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.
20.     RESIDENTS   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.
21.     STAFF   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 testing.
24.     VISITORS   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.
25.     VOLUNTEERS   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 FOR 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   See #26
28.     DESCRIBE INFECTION CONTROL MEASURES, INCLUDING USE OF PPE BY STAFF   See #26
29.     DESCRIBE ANY OTHER ASPECTS OF COMMUNAL DINING DURING REOPENING   See #26

 

 

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 all participants.

 

 

NON-ESSENTIAL PERSONNEL
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.

 

 

VISITATION PLAN
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 visit.
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.                                                                             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.
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 distancing.
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.
STEP 2	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 Acknowledgement Form
STEP 3	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.

 

 

VOLUNTEERS
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   Volunteers will 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 transmission-based precautions.
55.     DESCRIBE THE DUTIES TO BE PERFORMED BY VOLUNTEERS DURING STEP 2   Volunteers will be used to assist/supplement the activity department and may perform one to one visits, outdoor activities, small group activities, and assist with indoor/outdoor visitation.

 

 

ATTESTATION
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
57.     ATTESTATION   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
58.

 

 

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  Symptoms

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

 

 

 

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                            (Visitor signature)                                                            (Date)