Reopening Process

Please find below the plan for our reopening process.

Symptomatic Covid-19 Testing

     Any resident found to have symptoms consistent with the symptoms of COVID-19 shall be tested at the onset of symptoms. There is a standing PRN order in all residents’ charts that permits testing as needed for symptoms. All testing can be completed through either Washington Hospital or Quest Diagnostics.

Outbreak Testing for Staff and Residents

     In the event of a Covid-19 outbreak in the facility, we have secured the resources for resident and staff testing through Quest Diagnostics as well as additional testing through Washington Hospital Lab.

Covid-19 testing of non-essential staff

    At this time all Therapy staff from Genesis have been baseline tested. Prior to volunteer services beginning, baseline testing will be made available, and negative results must be obtained in order to participate in volunteer activities.

Refusal of Covid-19 testing by staff

     All staff will be STRONGLY encouraged to participate in mandatory testing and will be educated on the importance of testing for the wellbeing of our residents and our reopening plan.  Any employee of Transitions Healthcare LLC. Washington has the right to refuse Covid-19 testing. After an employee refusal has been signed, the employee will be required to wear an N-95 mask at all times when in the building. If at some point there is not an ample surplus of N-95 masks in the building, the employee may be placed on administrative leave without pay until either masks become available or testing is completed.

Refusal of Covid-19 testing by residents

     All residents will be STRONGLY encouraged to participate in mandatory testing and will be educated on the importance of testing for the wellbeing of our residents and our reopening plan.  Any resident at Transitions Healthcare LLC. Washington has the right to refuse Covid-19 testing. Any patient refusing testing will be placed in the yellow zone isolation for 14 days. If at any time they become symptomatic and still refuse Covid -19 testing, they will be presumed positive and placed in red zone isolation for a duration of 10 days from the onset of symptoms. The resident must remain symptom free for 72 hours before isolation can be discontinued.

Isolation and cohorting of residents with confirmed Covid-19

     Upon discovery of an active case of COVID 19 case, the patient will be moved to a RED zone isolation and will remain under isolation until the patient is symptom free for 3 days and has 2 negative COVID-19 not collected less than 24 hours apart. Patients that are found to be Covid-19 positive may be cohorted with other positive patients in the Red Zone. Cohorted patients should not be more than 72 hours apart from the onset of symptoms or diagnosis. In addition, when at all possible, a non-symptomatic positive patient will not be cohorted with a symptomatic patient

Screening of Staff

     All employees are being screened prior to getting to patient care areas. The temperature logs will be maintained by the ICP. Any employee who hits the temperature threshold will be released from duty until they are asymptomatic for 72 hours. A new survey should be completed if there have been any changes outlined in the survey.

Daily screening of residents

     All residents are to be screened once daily for temperature and pulse oximetry. If values are found to be out of the normal range, an immediate nursing assessment will be completed to determine if Covid-19 testing is indicated.

Visitor screening

     All visitors will be screened at the front lobby window. Visitors will be instructed to use the provided alcohol based hand sanitizer, will have their temperature screened and will be asked the survey questions found on the AHCA / NCAL Covid-19 Screening Checklist. This checklist will assist in assessing the visitors’ potential risk prior to being given permission to enter the facility.

PPE supply management

     Facility will monitor use of and procurement of PPE supplies. A list of PPE is available from the ICP. Facility will make every attempt to ensure adequate supplies are available and will continue to monitor availability and proper use. Completed inventory of essential PPE is reviewed weekly. Burn rates are used to calculate estimated usage to project future needs and avoid PPE shortages.

Staffing review daily

     Staffing meetings are held daily between the scheduler and DON to ensure that staffing is adequate to meet the needs of the patients. At the present time this facility is not operating under its emergency staffing contingency plan.

Resumption of limited communal dining

     Limited resumption of communal dining will resume as long as the building remains COVID-19 free. 10 residents will attend lunch daily and 10 residents will attend dinner daily. There will be one patient at each table, and tables will be spaced at least six feet apart. The patients will be rotated daily through the dining schedule to assure that all residents have equal opportunity to participate in communal dining. Communal dining will be supervised by appropriate staffing. In the case of a COVID-19 outbreak in the facility, communal dining will be suspended until which time the outbreak is resolved.

Resumption of Volunteer Services

Resumption of Volunteer Services will resume in step 2 of the reopening phase.  In step 2, volunteers will be used exclusively for the purpose of assisting with visitation protocols.  Volunteer duties with visitation will only be with residents that are unexposed to COVID-19 and not under any isolation precautions.  All volunteers will be baseline tested for COVID-19, perform frequent hand hygiene and universal masking will be required. 

Resident Activities

     Under step one of the reopening process, communal activities can resume in groups of 5 or less.  Group activities must be held in the dining room or Courtyard Cafe and each resident must maintain social distancing, frequent hand hygiene and universal masking is required.  Residents should be provided with ABHR at the completion of the activities.   Under step 2, the group can contain 10 or less participants with the same requirements.   Step 3 will not limit the number of participants, but all social distancing guidelines and universal masking are required.  All residents in all steps of reopening must not be patients that have potential COVID-19 exposure or in any isolation status.

Visitation Guidelines in Step 2 of Reopening

• Established visiting hours will be from 1 PM to 4 PM Monday through Friday and any holidays if staffing can safely accommodate.
• Visitation will not be permitted for residents that are in either RED or YELLOW isolation.
• Outdoor visitations can occur in two locations during step 2 of the reopening process. The first location being the gazebo located just behind the dining room. The gazebo will house one patient and 2 guests.  A second outdoor area will be in the central courtyard nearest the dining room.  This area of the courtyard will be restricted into 2 visitation areas.  The areas will be clearly marked to provide adequate social distancing.   All outdoor visitation will be dependent on weather conditions and staffing.  Not all residents will be able to tolerate humid conditions.  The ultimate decision on this will be made by nursing staff, and will be made on a case by case basis according to the residents’ health conditions and needs.                                                                                                                     
• Indoor visitation in step 2 will be permitted only due to inclimate weather or when a patient is unable to be safely taken out of doors. A visitation neutral zone will be established and mapped out within the dining room and in the Dining Room.  Each area in the dining room will be marked using 12′ x 12′ visitation zones. Each zone will accommodate the patient and 2 visitors. Each visitation zone will be no closer than six feet apart and will be separated by a divider if possible.                                                                                                
• Each visit will be no more than 45 minutes long to allow for 15 minutes to decontaminate the zone for the next potential visitation.
• All surfaces in the visitation zones will be decontaminated with facility approved cleaner that meets CDC guidelines for killing the Covid-19 virus.
• All visitors must access the facility through the main entrance and immediately wash their hands with ABHR and apply a face mask. The visitors’ temperature will be taken and the screening checklist must be completed by the screener. Once the screening process is completed, the visitors will be escorted to the appropriate visitation zone. Visitation will be denied for any visitor that does not meet the requirements of the screening checklist or has a fever.
• A six foot boundary will be clearly marked to separate the resident and the visitors. It is vital that all visitors maintain a social distance of 6 feet from all residents and wear the provided PPE at all times during the visit.                                                                                                   
• Children under the age of 10 will not yet be permitted to visit at this time.
• All visits must be scheduled at least 48 hours in advance and will be granted on availability and the residents’ condition.

Halting reopening

     If at any point there is a positive COVID-19 outbreak within the facility, the reopening status will halt, communal dining will be discontinued, volunteers and all non-essential personnel will no longer be permitted within the building. The reopening process will resume at the beginning of the recommended incremental steps by the Pennsylvania Department of Health.