COVID-19 Preparedness Plan

Purpose: To implement measures to prevent and control disease spread and to collect data that will help track respiratory illness and COVID-19 in residents and staff.

When to Report Symptoms or Cases of COVID-19

“Any pattern of cases, suspected cases, or increased incidence of any illness beyond the expected number of cases in a given period…” shall be reported immediately to MDH. This includes suspected outbreaks or unusual disease activity at your facility. Notify MDH immediately (within 24 hours) about any of the following:

  • Severe respiratory infection associated with hospitalization or sudden death of a resident.

Individual residents or staff are identified with confirmed COVID-19.

  • Increase in the number of residents transferred to acute care hospitals for any cause over baseline.
  • An increase of EMS transfers has sometimes been the first indication of a COVID-19outbreak in a facility.

COVID-19 will be reported using one of the following means:

Using the form: (https://www.health.state.mn.us/diseases/coronavirus/hcp/covidreportform.pdf).

By phone at 651-201-5414 or 877-676-5414.

Reporting online: (https://redcap-c19.web.health.state.mn.us/redcap/surveys/?s=H8MT9TTNCD)

Administration Concepts

Being ready for and responding to a COVID-19 case takes leadership, organization, plans, supplies, and policy. In NOCA, plans are laid out in this policy if anyone in management team becomes ill or requires quarantine. Back-up plan is to have someone else in leadership position take over managerial/administrative roles.

Incident commander and the back-up person are on-call 24 hours a day and 7 hours a week. Both can be reached at any time. A back-up agency is also provided in the event of emergency that involve the incident commander and the back-up person.

Means of contact include phone calls, texting and e-mailing.

If any staff is ill or requires quarantine, the incident commander should be contacted.

If any client has a symptom of Covid-19, the incident commander should be contacted.

In any case, if the incident commander cannot be reached, the back-up person should be called immediately.

COVID-19 cases have been reported in all 50 states and Washington, D.C., with widespread

community transmission in many areas. Given the high likelihood of spread once COVID-19 enters an LTC facility, facilities, including NOCA must act immediately to protect residents, families, and staff from serious illness, complications, and death.

NOCA is committed to providing a safe and healthy workplace for all our employees and clients. To ensure we have as safe and healthy workplace, we have developed the following COVID-19 Preparedness Plan in response to the COVID-19 pandemic. Management and employees are responsible for implementing and complying with all aspects of this COVID-19 Preparedness Plan. Our goal is to mitigate the potential for transmission of COVID-19 in our workplaces and communities, and that requires full cooperation among our employees and clients. Only through this cooperative effort can we establish and maintain the safety and health of our employees and clients.

Roles/ContactsIncident Commander  Backup Incident Commander  Alternate Agency  
Name   
Email Addressnoblecaresllc@gmail.comfavourfaith2002@gmail.comLivinggrace2015@gmail.com
Phone Number612-978-0574763-354-0015

Space: 3240 Sprague Avenue Anoka MN 55303 is currently a home to 2 clients but has the capacity to accommodate 4 clients. Staffing plan is 2:1. Three rooms in the main level are adjacent and opposite to one another.Clients have been educated about the need to stay 6 feet apart from each other when they are out of the rooms. Only two chairs are placed around the dining table to avoid close contact if two clients plan to eat at the same time. Each client has TV with cable services in their rooms. There will be no need for clients to congregate in the living/family room to watch television.

Staff can assist client in the kitchen to prepare meals. If the client wants to help with meal preparation, staff must ensure 6 feet is always between the client and the staff. In addition to this, staff must ensure facemask/shield is worn.

Given the limited space in the bathroom, and the required proximity if the client were to be assisted, facemask, shield, gown, and gloves must be worn when client is being assisted in shower or bathroom. Personal protective equipment (PPE) must also be worn if the client requires feeding assistance.

Quarantine measures will be instituted for clients with Covid-19 with symptoms that do not require hospitalization. Unused PPE will be kept at the entrance to the room. Staff member will doff PPE at the entrance before going to the room. Used PPE will be removed while still in the room and be bagged.

Staff/Staffing:  Staffing need is anticipated. Provision for on-call individuals is in place. If staff become ill on shift or receive a positive test result (particularly when multiple staff are tested and could be pulled off shift on short notice), contingencies are in place. NOCA will need minimum of one staff per shift.  Whenever staff report any sign and symptoms of COVID-19 or are confirmed COVID-19 positive, the staff will be sent home immediately. The staff will be replaced by another trained staff to cover the shift. On-call staff will be utilized as much as possible during this period of COVD-19. Stay home from work and school when you are sick. To avoid contacting Covid, staff have been told to do the following:

  • Stay away from others as much as possible when they are sick.
  • Wash hands frequently. Use soap and water or an alcohol-based hand sanitizer, such as Purell or
  • store-brand.
  • Cover mouth and nose when coughing and sneezing. Try using the crook of your elbow or
  • your shoulder for cover, instead of hands.
  • Throw away used tissues right away. If you use tissues to cover your cough or blow your nose, dispose of them in the nearest waste bin immediately after use, then wash hands

MN COVID-Sitters Resource: Students from the University of Minnesota have banned together to offer support to healthcare workers during COVID-19. They are serving both the metro area and central Minnesota, with a toolkit provided to teach students in other areas of the state to start a similar program.

Support can be accessed via their website: www.mncovidsitters.org. Volunteer support services include childcare, pet-sitting, and errands. Simply fill out an application to check out availability of volunteers. All staff in long term care organizations are considered healthcare workers who qualify for this free service.

Supplies: Covid 19 is an airborne virus. Thus, an airborne precaution is required. Usually, personal protective equipment (PPE) including gloves of various sizes, gowns, face shields and mask is required. Part of infection precaution training is how to use PPE appropriately. Staff are trained on how to wear mask, gloves, face shield and gowns. PPE are in many areas of the house known to staff persons.

Special considerations: Given their congregate nature and population served, NOCA does not relax any approach necessary to combat Covid-19. COVID-19 has had a disproportionate impact on the lives of people living in long-term care facilities. The pandemic impacts the health of those who have COVID-19 and affects all other residents through visitation restrictions that decrease valuable time spent with family and friends.

Each year, some residents wish to leave the nursing home or assisted living facility temporarily to visit family and friends for the holidays. Unfortunately, this year the winter holidays coincide with significant increases in community spread of COVID-19. The Centers for Disease Control and Prevention (CDC) recently reported that an important driver of the recent case increases is small family gatherings. The CDC and the Minnesota Department of Health (MDH) recommend that people at increased risk of severe illness from COVID-19 avoid in-person gatherings with anyone they do not live with.

Before taking a loved one out of a facility, you should contact the facility administration to review quarantine plans and, if applicable, to make sure that an observation room will be available on their return. If one is not available, you may be required to care for your loved one at home until a room is available.

Instead of gathering in family homes, MDH recommends visiting with loved ones at their long-term care communities outdoors, or indoors if the organization meets criteria for safe indoor visitation. For residents who desire to exercise their right to leave their long-term care facilities to visit their homes or other destinations over the holidays, we recommend taking the following steps to lower the risk of COVID-19 transmission. This guidance will be updated as more information becomes available.

Keeping COVID-19 from entering the facility

The greatest COVID-19 risk comes from the movement of persons into and out of the facility. Anyone who leaves and then returns to the facility can potentially bring COVID-19 into the facility.

Visitors Restriction

Visitors are restricted from entering NOCA’s facility at this time. This includes spouses, immediate family, and nonessential health care workers. The only exception is for compassionate care situations (e.g., end of life).

  • If a resident spends time with a visitor for a compassionate visit, even if outdoors on facility grounds, they must remain at least six feet apart.
  • All volunteers and nonessential health care Worker (HCW), including consultant services (e.g., barber) are restricted during Covid-19
  • Processes to help residents and family members remain connected, including facilitating resident access to virtual visits by phone and other electronic devices are in place.
  • Families who request electronic monitoring devices will be assisted.
  • Regular communication using telephone and other digital devices with family members will be unrestricted.

Employee Screening

NOCA will engage in active and daily screening of all staff for fever and symptoms of illness before starting each shift. In addition to facility staff, health screening will be conducted for other essential health care personnel including therapy personnel, hospice, home care, dialysis, ombudsman, state surveyors, chaplain at end of life, mortician, etc.

[Active screening means that a trained person will physically monitor temperature of staff entering the building and ask questions regarding other COVID-related symptoms].

The following screening will be conducted prior to start of shift:

  • Active assessment for fever (measured temperature >100.0oF) or subjective fever (chill, feeling feverish).
  • Screening for symptoms of illness (e.g., measured or subjective fever, cough, shortness of breath, chills, headache, muscle pain, sore throat, or new loss of taste or smell).
  • Evaluation for fever <100.0°F, or other symptoms not attributable to another diagnosis, including, nausea, vomiting, diarrhea, abdominal pain, runny nose, and fatigue.
  • Referral will be made for testing symptomatic staff should as soon as possible.
  • Staff will not be allowed to work while sick. If illness develops while at work, staff must immediately separate themselves from others, alert RN, and leave the workplace.
  • All staff of NOCA to wear a mask when in the facility and practice strict hand hygiene.
  • Eye protection will be used (e.g., face shield, goggles, safety glasses with side shields) during all resident care encounters.
  • NOCA understands that use of appropriate PPE can reduce staff exposures that might occur before detection of a COVID-19 case (e.g., when working with infected but asymptomatic resident or co-worker) that might lead to exclusion from work.
  • All staff will practice social distancing (≥6 feet from others) when in break rooms or common areas. There have been clusters of staff illness in health care settings associated with lack of social distancing in nonresident care areas.

Limiting and Monitoring Resident Transport Out of Facility

  • Non-essential trips to locations outside of the facility will be cancelled. However, special considerations will be given to residents who must leave the facility for medically necessary purposes (e.g., hemodialysis).
  • Residents should wear an alternative (cloth) mask when they leave their room and when traveling via resident transport services.
  • Suspected or confirmed cases of Covid-19 will be communicated prior to inter-facility transfer (including EMS) of residents.
  • Residents will be screened for fever and new respiratory symptoms (cough, shortness of breath) when going offsite for dialysis or other medical appointments and within one hour of returning to the facility.
  • Receiving facility will be alerted ahead of time if there is COVID-19 in the facility.
  • If a resident with respiratory symptoms, or who is COVID-19 positive, needs dialysis, NOCA will work with the dialysis center to develop a plan.
  • The goal is to put in place infection control measures, and to adjust the resident’s dialysis schedule to accommodate the dialysis center’s protocol of treating residents with respiratory symptoms or COVID-positive status.
  • If a resident leaves the facility to stay with a family member, exposures to persons with COVID-19 cannot be ruled out. Upon the resident’s return, the resident will be quarantined in a private room with a private (not shared) bathroom.
  • The CDC defines quarantine as the separation of people who may have been exposed to a contagious disease. With coronavirus, the recommended period to self-quarantine is 14 days.
  • Because of the quarantine implications, NOCA recommends that residents do not leave the facility campus during this time of COVID-19 community transmission (e.g., when the source of COVID-19 infection cannot be traced). This does not mean residents cannot go outside for fresh air. Residents should wear a cloth mask as tolerated when they go outside and should maintain social distancing.

 Criteria for Discontinuing Transmission-Based Precautions

Except for rare situations, a test-based strategy is no longer recommended to determine when to discontinue Transmission-Based Precautions because, in a majority of cases, it results in prolonged isolation of Clients who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious. The decision to discontinue Transmission-Based Precautions for Clients with confirmed SARS-CoV-2 infection will be made using a symptom-based strategy.

Symptom- and time-based strategies

Clients with mild to moderate illness who are not severely immunocompromised:

  • At least 10 days have passed since symptoms first appeared, AND
  • At least 24 hours have passed since last fever without the use of fever-reducing medications, AND
  • Symptoms (e.g., cough, shortness of breath) have improved
  • For Clients who are not severely immunocompromised and who were asymptomatic throughout their infection, Transmission-Based Precautions may be discontinued when at least 10 days have passed since the date of their first positive viral diagnostic test.

Clients with severe to critical illness or who are severely immunocompromised:

  • At least 20 days have passed since symptoms first appeared, AND
  • At least 24 hours have passed since last fever without the use of fever-reducing medications, AND
  • Symptoms (e.g., cough, shortness of breath) have improved

For severely immunocompromised Clients who were asymptomatic throughout their infection: Transmission-Based Precautions may be discontinued when at least 20 days have passed since the date of their first positive viral diagnostic test.

Test-based Strategy

In some instances, a test-based strategy could be considered for discontinuing Transmission-Based Precautions earlier than if the symptom-based strategy were used. However, many individuals will have prolonged viral shedding, limiting the utility of this approach. A test-based strategy could also be considered for some Clients (e.g., those who are severely immunocompromised) in consultation with local infectious disease experts if concerns exist for the Client being infectious for more than 20 days.

The criteria for the test-based strategy are:

Clients who are symptomatic:

  • Resolution of fever without the use of fever-reducing medications, AND
  • Symptoms (e.g., cough, shortness of breath) have improved, AND
  • Results are negative from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens) tested using an FDA-authorized molecular viral assay to detect SARS-CoV-2 RNA.

Clients who are not symptomatic:

  • Results are negative from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens) tested using an FDA-authorized molecular viral assay to detect SARS-CoV-2 RNA.

More information can be found from MDH: Interim Guidance for Discharge to Home or New/Re-Admission to Congregate Living Settings and Discontinuing Transmission-Based Precautions (https://www.health.state.mn.us/diseases/coronavirus/hcp/hospdischarge.pdf).

Staff Risk Assessment and Monitoring

MDH and health care facilities are cooperating to identify and manage staff with workplace exposure to people with confirmed COVID-19 disease. This approach calls for timely identification of these persons who have contact with a co-worker, Client, or long-term care Client beginning 48 hours before onset of symptoms. Then, a structured risk assessment is conducted, with individual employees receiving recommendations for health monitoring, voluntary quarantine, and social distancing, as relevant. In addition to the information below, more information can be obtained from MDH: Responding to and Monitoring COVID-19 Exposures in Health Care Settings (https://www.health.state.mn.us/diseases/coronavirus/hcp/response.pdf).

Identifying at-risk staff

A list of staff that had an exposure with a person (Client or co-worker) that tested positive for COVID-19. The list will include people involved in direct care, food service, house cleaning, and other activities.

  • The list will include all staff that interacted with the positive person from 48 hours before symptoms started until one of the following conditions is met:
  • Positive Client: All necessary PPE (i.e., Transmission-Based Precautions) is put in place for the positive Client, OR the Client was transferred out of the facility
  • Positive co-worker: The last day that the COVID-19 positive staff member came to work
  • In other words, the exposure risk period starts 48 hours before the Client or staff member developed symptoms and ends on the date that risk of COVID-19 transmission was eliminated.
  • For persons tested when asymptomatic, the exposure risk period starts 48 hours before the Client or staff member was tested and ends on the date that risk of COVID-19 transmission was eliminated.

Staff risk assessment

After getting a list of potentially exposed staff, NOCA will work with MDH to complete the following steps:

  • Conduct an initial risk assessment for everyone on the list of staff members who interacted with the positive Client or co-worker.
  • Send to MDH (by encrypted email) the names and phone numbers of employees (HCW and other staff members) identified to have had low- or higher-level risk. Include the name of the person (staff or Client) with confirmed COVID-19 and the facility name on the employee list.
  • Tell staff that MDH will contact those with higher-risk exposures with recommendations to stay out of work and for health monitoring.

Management of Monitoring Health Care Personnel

Public Health Management

Once the risk assessment has been completed and a risk level has been established for HCW who had contact with the client, MDH will perform the following actions.

For low risk exposures, MDH will provide the facility with a low risk factsheet that they can share with these HCW. Information in the fact sheet includes information about self-monitoring for symptoms for 14 days and what to do if symptoms develop.

For high risk exposures, MDH will inform HCW of restrictions on their activities (voluntary quarantine), including exclusions from work, explain the active monitoring process, and provide a phone number to reach MDH 24/7. MDH will conduct daily symptom monitoring and follow up by email or phone call. With HCW permission, daily symptom monitoring information can be shared with NOCA staff responsible for overseeing occupational/employee health.

MDH recommends that all HCW who have been exposed and assigned a high-risk exposure be excluded from work for 14 days. Employees classified as high risk are given a letter explaining their employment protections under Minnesota state law (Minnesota Statutes, section 144.4196).

High risk employees have the right to stay in home isolation/quarantine for 14 days and exclude themselves from work. CDC allows for employers who have exhausted other staffing options to ask asymptomatic employees if they would agree to continue working; however, it is the high-risk employee’s right to make that choice.

Facility Management

Each facility is expected to ensure that HCW undergoing monitoring have the capability to monitor their health status (e.g., access to a thermometer). If COVID-19 testing is necessary, NOCA will assist in coordinating specimen collection, unless the HCW chooses to seek care elsewhere.

For low-risk exposures, NOCA will provide the affected HCW with the MDH low risk fact sheet by email and explain self-monitoring of their health. If an employee having a low risk exposure develops symptoms consistent with COVID-19, NOCA will exclude the employee from work immediately, and notify MDH within 24 hours.

For all high-risk exposures, NOCA will maintain awareness of HCW symptom and health status and assist in coordination of testing, if necessary. If an employee with a high-risk exposure develops symptoms consistent with COVID-19, NOCA will exclude the employee from work immediately, and notify MDH within 24 hours.

Alerting Staff About Work-Related Recommendations

MDH will contact staff with high-risk exposures to provide recommendations to stay out of work and for health monitoring. Based on NOCA’s risk assessment, work-related recommendations may also be communicated to the employee by NOCA’s infection control personnel.

Low-risk exposure: These employees should continue working and should conduct twice daily self-monitoring of health, including temperature checks.

Higher-risk exposure: These employees should undergo voluntary quarantine and stay out of work for 14 days after the last exposure to a person with COVID-19 while not wearing all necessary protective equipment. They will receive daily emails from MDH for active health monitoring and will receive an email when voluntary quarantine is released (i.e., 14 days after the last unprotected exposure). These employees can be asked to return to work if they are not sick (no fever or symptoms of illness) and the facility has exhausted all other staffing options, but the State of Minnesota provides worker protections for this group of people during the voluntary quarantine period (Minnesota Statutes section 144.4196).

If an employee chooses to work during the 14-day voluntary quarantine period, they must always wear a medical-grade face mask when providing client care.

Planning for Care Coordination, Discharge, or Transfer for Confirmed COVID-19 Clients

Before a confirmed COVID-19 Client is discharged or transferred, NOCA will inform MDH of the plan for care transition. MDH needs to be informed if plans include transfer to another health care facility, orders for home or hospice care services, or medical transport. During care transitions, NOCA will communicate with the receiving facility, agency, or medical transport service to plan appropriate precautions to reduce disease transmission.

Post-Mortem Testing Facilitation

If a client dies in the facility, MDH recommends testing for COVID-19 if there are any confirmed cases in your facility or if the death is not clearly associated with another cause(s).

A nasal pharyngeal (NP) swab will be collected from the deceased individual for testing prior to sending the body to the funeral home or medical examiner’s office.

Management of Clients with Prior Cases of COVID-19

If the deceased client was not diagnosed with COVID-19 from a laboratory confirmed test at the time of death, a NP swab should be collected post-mortem.

If the deceased client has a known laboratory-confirmed COVID-19 positive test at the time of death or a swab is pending test results, no additional steps need be taken.

Management of Clients with No known Cases of COVID-19 Situation

If the client had signs or symptoms of illness prior to death, an NP swab will be collected for COVID-19 testing prior to sending the body to the funeral home or medical examiner’s office.

If the deceased client did not have signs or symptoms of illness prior to death, an NP swab may be collected for COVID-19 testing but is not necessary.

NOCA may choose to conduct testing of deceased clients to identify unknown presence of SARS-CoV-2

The specimen will be sent to MDH for COVID-19 testing

COVID-19 Case Summary

Cases in Residents

Date first resident case detected:

Total number of resident cases:

Number of resident cases in the last 14 days:

Cases in Staff

Date first staff case detected:

Total number of staff cases:

Number of staff cases in the last 14 days:

COVID 19 STAFF DAILY ASSESSMENT

STAFF NAMETEMPERATURESHORTNESS OF BREATH (Y/N)COUGH (NEW DEVELOPMENT) (Y/N)SORE THROAT (Y/N)COMMENT
EX: TROY LINDSEY97.1NNNN/A
AUGUST 10, 2020