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Gino J.Merli Veterans' Center

Implementation Plan for Reopening

In Accordance with the Pennsylvania Department of Health’s

Interim Guidance for Skilled Nursing Facilities During COVID-19



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


Gino Merli Veterans’ Center

2. STREET ADDRESS


401 Penn Avenue

3. CITY


Scranton

4. ZIP CODE


18503

5. NAME OF FACILITY CONTACT PERSON


James Miller, Commandant

6. PHONE NUMBER OF CONTACT PERSON


570-961-4304



DATE AND STEP OF REOPENING

The facility will identify the date upon which all prerequisites will be met for reopening and the Phase 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).

7. DATE THE FACILITY WILL ENTER REOPENING


9/1/2020

8. SELECT THE PHASE AT WHICH THE FACILITY WILL ENTER REOPENING – EITHER PHASE ALPHA OR PHASE BRAVO (CHECK ONLY ONE) (All PVHs WILL BEGIN THE REOPENING IN PHASE ALPHA)


  Phase Alpha  

    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)


  Phase Bravo

    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

9. HAS THE FACILITY EXPERIENCED A SIGNIFICANT COVID-19 OUTBREAK? (IF NO, SKIP TO #11)


NO

10. DATE THE FACILITY WAS SURVEYED BY THE DEPARTMENT OF HEALTH TO ENSURE THE FACILITY IS ADEQUATELY PREVENTING TRANSMISSION OF COVID-19


6/30/2020



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).

11. 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 


7/21/2020 to 7/23/2020

12. DESCRIBE THE CAPACITY TO ADMINISTER COVID-19 DIAGNOSTIC TESTS TO ALL RESIDENTS SHOWING SYMPTOMS OF COVID-19 AND TO DO SO WITH 24 HOURS


If a resident has signs or symptoms, they will be transferred to the 1 South Nursing Unit which has been established as a yellow isolation unit, placed on transmission-based precautions and tested for Covid-19. GMVC has the clinical staff to conduct COVID-19 testing. GMVC obtains supplies for COVID-19 testing supplies through their contract with Quest Diagnostic. Additionally, GMVC will work with Geisinger Labratories for additional support and testing capacity.Finally, if needed, GMVC would utilize the Pennsylvania Department of Health (DOH) emergency assistance via the DOH testing program by contacting the resource account at: ra-dhcovidtesting@pa.gov 

GMVC maintains testing supplies to administer COVID-19 tests to any resident that would show signs/symptoms of the virus.  


13. DESCRIBE THE CAPACITY TO ADMINISTER COVID-19 DIAGNOSTIC TESTS TO ALL RESIDENTS AND STAFF IF THE FACILITY EXPERIENCES AN OUTBREAK


If a resident has signs or symptoms, they will be transferred to the 1 South Nursing Unit which has been established as a yellow isolation unit, placed on transmission-based precautions and tested for Covid-19. GMVC has the clinical staff to conduct COVID-19 testing. GMVC obtains supplies for COVID-19 testing supplies through their contract with Quest Diagnostic. Additionally, GMVC will work with Geisinger Labratories for additional support and testing capacity.Finally, if needed, GMVC would utilize the Pennsylvania Department of Health (DOH) emergency assistance via the DOH testing program by contacting the resource account at: ra-dhcovidtesting@pa.gov 

GMVC maintains testing supplies to administer COVID-19 tests to any resident that would show signs/symptoms of the virus.  


14. DESCRIBE THE CAPACITY TO ADMINISTER COVID-19 DIAGNOSTIC TESTS TO ALL STAFF, INCLUDING ASYMPTOMATIC STAFF


GMVC will test staff as indicated  pending supply and lab availability.   Testing will also be completed on any staff member with signs or symptoms or staff returning to work after being out of the facility for an extended period of time, or had travled to a high risk exposure area.  GMVC has the clinical staff to conduct COVID-19 testing. GMVC obtains supplies for COVID-19 testing supplies through their contract with Quest Diagnostic. Additionally, GMVC will work with Geisinger Labratories for additional support and testing capacity.Finally, if needed, GMVC would utilize the Pennsylvania Department of Health (DOH) emergency assistance via the DOH testing program by contacting the resource account at: ra-dhcovidtesting@pa.gov 


15. DESCRIBE THE PROCEDURE FOR ADDRESSING NEEDED TESTING OF NON-ESSENTIAL STAFF AND VOLUNTEERS


All GMVC staff are designated essential and were tested during the baseline testing. The capacity to test volunteers and contractors can be met through the contract with Quest Diagnostic, when volunteers are permitted to resume volunteer work on campus as per the Bureau of Veterans Homes (BVH) Reopening Plan. Contractors are screened and assessed on an “as needed” basis for required testing.


16. DESCRIBE THE PROCEDURE FOR ADDRESSING RESIDENTS OR STAFF THAT DECLINE OR ARE UNABLE TO BE TESTED


Residents who decline testing will be asked frequently and highly encouraged; the risks vs benefits will be explained.  Residents will be made aware they may be required to move to the yellow zone if they refuse to be tested.  Employees are required to be tested and will not work until testing is completed.  


17. 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.


If a resident has a positive test they will be moved to red isolation zone. The resident will stay in the red zone for 14 days and/or has 2 negative Covid-19 test results or will pass the time-based strategy of isolating for 10 or 20 days as outlined in PAHAN-517.  If a resident is undergoing testing or upon hospital return, they are moved to a yellow isolation zone until test results are received.  The resident may need to stay in the yellow zone for 14 days.  Signs and symptoms will be monitored.  Residents that are frequently going out of the facility to appointments (i.e. dialysis) are to remain in the yellow zone due to being at higher risk of exposure. 


18. 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)


PPE is inventoried and counted daily, burn rates for each type of PPE is calculated and monitored within the facility and at the Bureau level.  GMVC continues to purchase and secure PPE in order to maintain the required par levels.  GMVC goal is to have a 6 month of supply on hand with our current burnrate.  GMVC as needed will reach out to outside sources to procure PPE supplies, sources include, County Agencies, PEMA, DOH, and donations from other organizations.  

19. DESCRIBE THE CURRENT STAFFING STATUS AND THE PLAN TO ENSURE NO STAFFING SHORTAGES 


GMVC budget for staff is 3.4 nursing hours PPD.  If nursing manpower becomes critical (nearing less than 2.7 hours PPD) nursing staff will adjust to 12-hour shifts. Contracted agency staff will be utilized depending upon availability.  At the discretion of the Department of Military and Veterans Affairs, the National Guard will be utilized.  The Wilkes Barre VA Medical Center will be contacted for the potential utilization of nursing staff through a mission assignment.  Management nursing staff will be utilized on the units and schedules will be altered to work every other weekend.  Ancillary Staff will be assigned to duties on the units.  All hands-on deck will be utilized at the discretion of Administration.  Dual employees will be assigned a nursing schedule.


20. 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


If the county is reverted to a red phase the opening plan will cease. GMVC will notify all residents, POA’s and staff, signs will be posted at each entrance and all appropriate agencies will be notified. 



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.


21. RESIDENTS

 

1. Resident Screening: Each resident will have their temperature obtained and documented at least daily for the duration of the COVID-19 pandemic, or until directed otherwise per BVH and DOH guidelines. Should a resident present with signs or symptoms of COVID-19, the following protocol will be followed: The RNS will be notified by the charge nurse & report to the unit to ensure all equipment is on hand and proper utilization of PPE protocol is reviewed with the staff. The Medical Provider will be notified and informed of the resident’s signs and symptoms, to include current temperature, oxygen saturation levels, lung sounds, any known disease processes that may be attributing to their current status, etc. (The Respiratory SBAR is available as a guide.) The Medical Provider will also be made aware of any resident roommates. Provider will order a COVID-19 swab if warranted. The resident and any roommates will be moved to a Yellow Zone or if private room/bath will be isolated in their room, their room becoming a Yellow Zone.  Resident/s, Responsible Party/s as well as any new roommate/s will be notifed of the room move/s.  Each resident moving to the Yellow Zone will be provided their own room when available. Residents will be cohorted with other residents in the YELLOW ZONES or RED ZONES only if necessary, due to room availability.  Licensed Nurse or other properly trained personnel will obtain a specimen utilizing a QUEST/other contracted lab PCR culturette via nasopharyngeal swab in the resident’s room, donning full PPE, including N-95 mask. A nursing staff member will retrieve a PPE cart and biohazard waste & linen bins for outside the resident’s room or anteroom. Proper signage for Contact Isolation and Droplet Precautions, as well as donning and doffing signage will be hung. All residents on YELLOW or RED ZONES will be monitored for s/sx of COVID-19 and have a respiratory observation, temperature, and pulse ox documented each shift. Documentation regarding s/sx, procedures initiated, orders obtained, responsible party notification, will be completed in the Medical Record.  Appropriate notifications will be completed of positive or negative results, including Provider/s, Responsible Party/s and Resident/s.  Unless otherwise necessary for the health, welfare, safety and security of other residents, consistent staffing will be maintained within YELLOW and RED ZONES. Residents will be maintained in RED or YELLOW ZONES until symptom free for at least 14 days from onset of symptoms or positive test.  All facility staff, responsible parties and residents will be routinely updated regarding facility test results.  Staff Screening:  All staff, vendors, essential personnel, visitors will be screened prior to entry into the facility.  If any present with signs and symptoms of COVID-19 during their shift/visit, the following will occur:  Visitors and non-Commonwealth employees will be escorted from the facility and not be permitted to return until at least 14 days have past since symptoms occurred.  For Commmonwealth employees - if testing supplies are available, they will be tested in a designated testing area and sent home to await results. The residents residing on unit(s) that they worked/visited on will have their respiratory status, including lung sounds, oxygen saturation levels and temperature monitored and documented each shift for 14 days. The facility will proceed accordingly based on the test results.

22. STAFF


1. Employees will drive up to the screening booth at the far end of the parking lot and have their temperatures taken.  2. The screening booth guard will don mask and gloves and take the employees temperatures.  The booth guard will not make any contact with the person having their temperatures taken, if they do have contact, they will don new gloves. The thermometer will be wiped down with and alcohol wipes between use. 3. The booth guard will instruct the person to fill out the screen form in their car and bring the form to the security tent in front of the building entrance. 4. If the person being screened shows up to the security tent without the form filled out the guard will ask them the questions and fill out the form.  They will write their name and date on the form and give the form back to the employee for signature. The employee will then have to return the form to security.  5. The security tent guard will collect the form, make sure there are seven (7) “NO” answers and permit the person to enter the Facility.  6. If there is a “YES” to any question the employee will be detained in the lobby area and nursing will be called to assess if the persons can report to work or not. 7. Employees sent out of work will follow the return to work procedure.  8. If staff shows an elevated temperature on the first reading, guard will take temperature a second time. If staff shows a temperature on the second reading, guard will contact the security desk to request a nurse take the staff’s temperature with a different thermometer, at the main entrance to the facility. If the temperature reading by the nurse is elevated, the staff will be instructed to leave and get tested.   Staff are directed to leave due to: elevated temperature and/or any screening form questions that have “YES” answered and/or COVID signs and symptoms.  h the person having their temperatures taken, if they do have contact, they will don new gloves. The thermometer will be wiped down with and alcohol wipes between use.  

23. HEALTHCARE PERSONNEL WHO ARE NOT STAFF


1.  Healthcare personnel will drive to the screening booth at the far end of the parking lot and have their temperature taken.  2.  The screening booth guard will take temperatures while donning mask and gloves. The booth guard will not make any contact with the person having their temperature taken, if they do have contact they will don new gloves.  The thermometer will be wiped down with alcohol wipes between use.  3.  The booth guard will instruct the person to fill out the screen form in their car and bring the form to the tent.  4.  If the person being screened shows up to the security tent without the form filled out the guard will ask them the questions and fill out the form.  They will write their name and date on the form and give the form back to the Healthcare personnel for their signature. The Healthcare Personnel will then have to return the form to security.  5. The tent guard will collect the form, make sure there are seven (7) “NO” answers and permit the person to enter the Facility.  6. If there is a “YES” to any question the Healthcare personnel will not enter the facility.

24. NON-ESSENTIAL PERSONNEL


1. Non-essential personnel will drive up to the screening booth and have their temperatures taken.  2. The screening booth guard will take non-essential personnel’s temperatures while donning mask and gloves. The booth guard will not make any contact with the person having their temperatures taken, if they do have contact, they will don new gloves. The thermometer will be wiped down with and alcohol wipes between use. 3. The booth guard will instruct the person to fill out the screening form in their car and bring the form to the tent. 4. If the person being screened shows up to the security tent without the form filled out the guard will ask them the questions and fill out the form.  They will write their name and date on the form and give the form back to the non-essential personnel for their signature. The non-essential personnel will then have to return the form to security.  5. The tent guard will collect the form, make sure there are seven (7) “NO” answers and permit the person to enter the Facility.  6. If there is a “YES” to any question the non-essential personnel will not enter the facility.  

25. VISITORS


1. Visitors will drive up to the screening booth and have their temperatures taken.  2. The screening booth guard will take visitors temperatures while donning mask and gloves. The booth guard will not make any contact with the person having their tempetures taken, if they do have contact, they will don new gloves. The thermometer will be wiped down with and alcohol wipes between use. 3. The booth guard will instruct the person to fill out the screen form in their car and bring the form to the tent. 4. If the person being screened shows up to the security tent without the form filled out the guard will ask them the questions and fill out the form.  They will write their name and date on the form and give the form back to the visitor for signature. The visitor will then have to return the form to security.  5. The tent guard will collect the form, make sure there are seven (7) “NO” answers and permit the person to enter the Facility.  6. If there is a “YES” to any question the visitor will be detained in the lobby area and nursing will be called to assess the person to determine if they are allowed to visit. 7. If the visitor shows an elevated temperature on the first reading, the guard will take temperature a second time.  If a temperature shows on the second reading, the guard will contact the security desk to request a nurse take the visitor’s temperature using a different thermometer at the main entrance to the facility.  If the temperature reading by the nurse is elevated, the visitor will be asked not to visit and encouraged to get a Covid 19 test.  

26. VOLUNTEERS


1. Volunteers will drive up to the screening booth and have their temperatures taken.  2. The screening booth guard will take employee temperatures while donning mask and gloves. The booth guard will not make any contact with the person having their temperatures taken, if they do have contact, they will don new gloves. The thermometer will be wiped down with and alcohol wipes between use. 3. The booth guard will instruct the person to fill out the screen form in their car and bring the form to the tent. 4. If the person being screened shows up to the security tent without the form filled out the guard will ask them the questions and fill out the form.  They will write their name and date on the form and give the form back to the volunteer for signature. The volunteer will then have to return the form to security.  5. The tent guard will collect the form, make sure there are seven (7) “NO” answers and permit the person to enter the Facility.  6. If there is a “YES” to any question the volunteer will be detained in the lobby area and nursing will be called to assess if the person can report to volunteer. 7. Volunteers sent out of the facility will follow the staff return to work procedure.  8. If the volunteer shows an elevated temperature on the first reading, guard will take temperature a second time.  If the volunteers shows a temperature on the second reading, guard will contact the security desk to request a nurse take the volunteers temperature using a different thermometer, at the main entrance to the facility. If the temperature reading by the nurse is elevated, the volunteers will be directed to leave and get tested.   Volunteers are directed to leave due to: elevated temperature and/or any screening form questions that have “YES” answered and/or COVID signs and symptoms.



COMMUNAL DINING FOR RESIDENTS UNEXPOSED TO COVID-19

Communal dining is the same for all phases of reopening so there is no need to differentiate among the three steps.

27. DESCRIBE COMMUNAL DINING MEAL SCHEDULE, INCLUDING STAGGERED HOURS (IF ANY) 


The BVH Phased Reopening Plan guidance on communal dining will be followed. Modified Communal dining is permitted on the units for residents recovered from or unexposed to COVID-19. Continue with disposable dishware as appropriate for yellow & red zones. Maintain social distancing by limiting the number of residents at each table, stagger arrival times, and maintain two service times  as possible per meal to allow for fewer residents in common areas at a time.Residents independent with dining will be encouraged to eat in their rooms.

28. DESCRIBE ARRANGEMENT OF TABLES AND CHAIRS TO ALLOW FOR SOCIAL DISTANCING


There are 10 tables in each dining room.  There will be no more than two (2) residents per table.  Residents not requiring assistance with feeding will be encouraged to eat in their room.  If a resident does not wish to eat in their room one of the 3 lounge areas will be offered to the resident to dine in.  Social distance will be maintained.  

29. DESCRIBE INFECTION CONTROL MEASURES, INCLUDING USE OF PPE BY STAFF


Staff feeding residents that are at high risk for choking/aspiration will wear a gown and goggles/faceshield. When assisting more than one resident to eat at the same time, staff must perform hand hygiene with hand sanitizer each time when switching between residents. 

30. DESCRIBE ANY OTHER ASPECTS OF COMMUNAL DINING DURING REOPENING


When GMVC reaches Delta phase communal dining will resume.  Staff will wear masks, sanitize between servings and wash resident hands.  Residents with dysphagia (difficulty swallowing) will be social distanced with others in the dining room.  If Resident prefers to eat in their room a tray will be delivered.



ACTIVITIES AND OUTINGS

In each block below, describe the types of activities that will be planned at each phase and the outings that will be planned at Phae Charlie (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.

31. DESCRIBE ACTIVITIES PLANNED FOR ALPHA (FIVE OR LESS RESIDENTS UNEXPOSED TO COVID-19)


GMVC will have 1:1 visits on all units with all residents.  Residents will participate in hallway socials; hallway games; hallway trivia; hallway exercise; hallway arts & crafts; hallway birthday bash monthly; dine-in lunches per unit weekly; hallway hydration program.  A supply cart is available for resident’s leisure interests. Social distancing and proper hygiene will be maintained at each program; the activity staff will disinfect all items used during activities if residents use the items to participate in a program (golf, bowling, fishing, ball toss, etc.)

32. DESCRIBE ACTIVITIES PLANNED FOR BRAVO (TEN OR LESS RESIDENT UNEXPOSED TO COVID-19)


GMVC will have 1:1 visits on all units with all residents.  Residents will participate in hallway socials; hallway games; hallway trivia; hallway exercise; hallway arts & crafts; hallway birthday bash monthly; dine-in lunches per unit weekly; hallway hydration program. A supply cart is available for resident’s leisure interests. Social distancing and proper hygiene will be maintained at each program; the activity staff will disinfect all items used during activities if residents use the items to participate in a program (golf, bowling, fishing, ball toss, etc.)

33. DESCRIBE ACTIVITIES PLANNED FOR PHASE CHARLIE


GMVC will have 1:1 visits on all units with all residents.  Residents will participate in hallway socials; hallway games; hallway trivia; hallway exercise; hallway arts & crafts; hallway birthday bash monthly; dine-in lunches per unit weekly; hallway hydration program. A supply cart is available for resident’s leisure interests. Social distancing and proper hygiene will be maintained at each program; the activity staff will disinfect all items used during activities if residents use the items to participate in a program (golf, bowling, fishing, ball toss, etc.)

34. DESCRIBE OUTINGS PLANNED FOR PHASE DELTA


Residents will participate in fresh air activities.  Fresh air activities will be scheduled by unit daily.  During fresh air activity residents can participate in programs such as ball toss, trivia, ice cream sundae’s, root beer floats, conversation and gardening.   Masks will be worn at all times, social distancing and proper hygiene will be maintained at each program.



NON-ESSENTIAL PERSONNEL

In Phase Bravo, 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 Phase Charlie, all non-essential personnel are allowed. Screening and additional precautions including social distancing, hand hygiene, and universal masking are required for non-essential personnel.

35. DESCRIBE THE LIMITED NUMBER AND TYPES OF NON-ESSENTIAL PERSONNEL THAT HAVE BEEN DETERMINED NECESSARY AT BRAVO


Podiatry, Hospice, Dental and Psychological professionals will be determined necessary in Phase Bravo

36. DESCRIBE HOW SOCIAL DISTANCING, HAND HYGIENE, AND UNIVERSAL MASKING WILL BE ENSURED FOR NON-ESSENTIAL PERSONNEL AT PHASE CHARLIE AND DELTA


Non-essential staff will be screened upon entrance, they will be required to wear a mask and sanitize hands.  The non-essential personnel will be educated and sign off on the facility’s expectations on screening, hand hygiene, social distancing, mask adherence and making attempts to minimize or eliminate their presence in resident areas unless absolutely necessary.

37. DESCRIBE MEASURES PLANNED TO ENSURE NON-ESSENTIAL PERSONNEL DO NOT COME INTO CONTACT WITH RESIDENTS EXPOSED TO COVID-19


Non-essential staff will not visit red or yellow zones in the facility.   If there is an emergent need, non-essential staff will wear PPE according to transmission-based precautions.  



VISITATION PLAN

For visitation to be permitted in Bravo and Charlie 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.

38. DESCRIBE THE SCHEDULE OF VISITATION HOURS AND THE LENGTH OF EACH VISIT


Visitation will be scheduled Monday thru Friday, 1 (one) unit will be scheduled each day.   POA/Responsible Party will receive a letter with visitation dates and times and information on how to preschedule a visit.  Prescheduled visits will be ½ hour per visit,  limit 2 visitors per resident (visitors must be cleared to enter facility through the screening process).  Resident and visitor must wear a mask at all times, hand sanitizer will be provided for all visitors, proper social distancing will be maintained, no touching, hugging etc.  There will be no weekend visits and no one under 18 allowed to visit the facility at this time.

39. DESCRIBE HOW SCHEDULING VISITORS WILL OCCUR


Once the visitation plan is finalized a letter will be sent to families detailing exact steps for safe visitation.  The letter outlining visitiation procedures will be sent out the first week of August 2020.  Visits must be scheduled 24 hours in advancethru the Activity Director.  The phone number and contact hours for visitation will be listed in the letter that will be sent out by the Commandant.  If you have not received the visitation procedure, contact the facility and we will send you the information (570-961-4300).  The Activity Director and/or assistant will notify the units and residents of scheduled visits.  When GMVC enters the 2nd phase of reopening (tentatively 8/13/20) visits will occur in an outside courtyard.  If there is inclement weather and it is not safe for the Resident to participate the visit will be cancelled until the next week.  Visition is scheduled to begin outdoors on August 13, 2020.  

40. DESCRIBE HOW VISITATION AREA(S) WILL BE SANITIZED BETWEEN EACH VISIT


Housekeeping staff will clean and sanitize the visiting area once visit is completed and staff member takes resident back to their unit.  Upon arrival back to their unit from the visit, nursing will take the residents temperature.

41. WHAT IS THE ALLOWABLE NUMBER OF VISITORS PER RESIDENT BASED ON THE CAPABILITY TO MAINTAIN SOCIAL DISTANCING AND INFECTION CONTROL?


Two (2) visitors will be allowed per resident.

42. DESCRIBE THE ORDER IN WHICH SCHEDULED VISITS WILL BE PRIORITIZED 


To start a letter will go out to POA/Responsible Parties explaining our scheduled visits.  POA/RP will need to email or call Activities Director to set up a scheduled visit.  Visits will be scheduled in the order in which the responses are received.   Activity department will keep a log of visits and provide to security, nursing, Commandant etc.  

STEP 2 (Phase Bravo)

43. 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)


Any residents who are not experiencing health conditions that require them to be on isolation or otherwise maintained in their rooms will be eligible for off-unit visitation. All residents will be allowed to accept visitors. GMVC has canopy tents and a large pavilion covering our activity courtyardAny residents who are not experiencing health conditions that require them to be on isolation or otherwise maintained in their rooms will be eligible for off-unit visitation. GMVC has canopy tents and a large pavilion covering our activity courtyard.  

44. DESCRIBE THE OUTDOOR VISITATION SPACE FOR STEP 2 TO INCLUDE THE COVERAGE FOR SEVERE WEATHER, THE ENTRANCE, AND THE ROUTE TO ACCESS THE SPACE


GMVC will utilize the Multi-Purpose Room during visiting hours.  Housekeeping will clean and sanitize the room prior to and after visits when we have severe weather.  Visitors will enter through the Franklin Street entrance.GMVC will utilize the Multi-Purpose Room (MPR) during visiting hours.  Housekeeping will clean and sanitize the room prior to and after visits when we have severe weather.  Visitors will enter through the Franklin Street.

45. DESCRIBE HOW A CLEARLY DEFINED SIX-FOOT DISTANCE WILL BE MAINTAINED BETWEEN THE RESIDENT AND THE VISITOR(S) DURING OUTDOOR VISITS


GMVC will have areas marked with tape, seating will be set up prior to visits and staff will be monitoring at all times.

46. 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


The MPR is spacious enough to accommodate visitation.  Visitation areas will be set up with ten (10) 6-foot tables and seating will be set up prior to visits. The number of visitors may be altered to ensure social distancing is maintained.  Access to the MPR will be through the Franklin street entrance.

47. DESCRIBE HOW A CLEARLY DEFINED SIX-FOOT DISTANCE WILL BE MAINTAINED BETWEEN THE RESIDENT AND THE VISITOR(S) DURING INDOOR VISITS


GMVC will utilize 6-foot tables with resident on one side of the table and visitor on opposite side of table, seating will be set up prior to visits and staff will be monitoring at all times. Floor signage will be utilized.

STEP 3 (Phase Charlie)

48. DESCRIBE HOW THE FACILITY WILL DETERMINE THOSE RESIDENTS WHO CAN SAFELY ACCEPT VISITORS AT PHASE CHARLIE (CONSIDERING SUCH SAFETY FACTORS AS TRANSPORTING RESIDENT TO VISITOR LOCATION)


Any residents who are not experiencing health conditions that require them to be on isolation or otherwise maintained in their rooms will be eligible for off-unit visitation.All residents will be allowed to accept visitors. Staff will transport residents safely to the designated visiting area with a mask on at all times.  If visitation is cancelled because of severe weather the visits cancelled for that day will have first chance at next weeks visitation.  

49. WILL OUTDOOR VISITATION BE UTILIZED AT STEP 3? IF NO, SKIP TO QUESTION #52


Yes

50. DESCRIBE THE OUTDOOR VISITATION SPACE FOR PHASE CHARLIE TO INCLUDE THE COVERAGE FOR SEVERE WEATHER, THE ENTRANCE, AND THE ROUTE TO ACCESS THE SPACE (IF THE SAME AS PHASE BRAVO, ENTER “SAME”)


Same process however Phase Charlie allows for inside visits in designated area.  A designated area will be provided during bad weather.

51. 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 PHASE BRAVO, ENTER “SAME”)


Same

52. DESCRIBE THE INDOOR VISITATION SPACE THAT WILL BE USED TO INCLUDE THE ENTRANCE AND THE ROUTE TO ACCESS THE SPACE (IF THE SAME AS PHASE BRAVO, ENTER “SAME”)


Designated areas in neutral zones away from other residents will be utilized. Compassionate care situations will be addressed with GMVC leadership, and visitation will take place in a designated area, likely resident’s room. 

53. 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 PHASE BRAVO, ENTER “SAME”)


Same

54. 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


In an emergent situation, family visits in the isolation units must wear PPE according to transmission-based precautions.  Visits will have time limits (30 minutes) established by GMVC. Visitors will follow CDC and DOH universal source control guidelines; screening must occur, social distancing of at least 6 feet must be maintained, hand hygiene must be performed and masks must be worn Visitation for residents without a roommate will be limited to 3 family members/2 family members if the visit is to take place in the resident’s room. It can be different individuals on subsequent visits. If a resident has a roommate, then only one family member may visit at a time.  If roommate present, inquire of resident if he/she would like to enjoy the lounge or other common area away from visitors & socially distant from other residents.





VOLUNTEERS

In Phase BRAVO, 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 Phase Charlie, 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.

55. 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 be tested by the Gino J. Merli Veterans’ Center for COVID prior to entering the facility. They will follow the same protocols as staff in having their temperatures tested upon entering and leaving the facility, COVID questionnaire will be required to be filled out, and masks are mandatory when volunteering inside the facility.  Every volunteer will be educated on universal precautions and the building zones Green, Yellow, and Red.

56. DESCRIBE THE DUTIES TO BE PERFORMED BY VOLUNTEERS DURING Phase Bravo 


Volunteers will be allowed into the facility until Phase Charlie, and then will only be allowed to assist the Activities Department with Non-Covid residents in Green Zones during visitations.





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.

57. NAME OF NURSING HOME ADMINISTRATOR


James Miller - NHA

58. 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 (if one exists) or 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.



             James Miller – Commandant       


                                                                                                 July 27, 2020

SIGNATURE OF NURSING HOME ADMINISTRATOR DATE