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Heartland Senior Living Policy for Testing and Response PlanPolicy Number: 19Policy Name: COVID -19 Testing and Response PlanEffective Date:Revision Date:6/12/2020Approved by: Ellen Strohl, RNApproved Date: 6/12/2020Heartland Senior Living LLC COVID-19 Testing and Response PlanPolicy, Purpose, and BackgroundIt shall be the policy of the Facility to guard against the introduction and spread of SARS-CoV-2 within itscommunity of residents and staff. The Facility uses available and current guidance from the Centers forDisease Control and Prevention (CDC), Center for Medicare and Medicaid Services (CMS), the IllinoisDepartment of Public Health (IDPH), and Local Health Department (LHD) officials to instruct thedevelopment and implementation of policies and procedures that comprise its strategy to prevent,respond to, and mitigate the presence of SARS-CoV-2. This policy will provide the administrativeframework for the development and implementation of specific subordinate policies, procedures, andprotocols for the prevention, monitoring, testing, and responding to any incidence of SARS-CoV-2 withinthe Facility.The Facility’s global response strategies are articulated in part in the Testing and Response Plan and arealso included in the Infection Control Policy (ICP) and other related policies. The Facility’s Testing andResponse Plan is intended to be fluid and responsive to local conditions related to SARS-CoV-2 infectionin the Facility and the surrounding region as defined in the Restore Illinois Public Health Plan to SafelyReopen Illinois.I.Facility Information & Situation AwarenessThe Facility will monitor specified characteristics of the local SARS-CoV-2 situation as defined inthe Restore Illinois Public Health Plan to Safely Reopen Illinois as well as relevant local, state,and federal information in order to inform infection prevention and control actions, resourceplanning, and coordination of appropriate responses as changes occur.A. Name of the Facility: Heartland Senior Living LLC IDPH No: 146030/ 0056010B. Facility Address: 101 Trowbridge Road, Neoga IL 62447C. County: CumberlandRestore Illinois Region: 6 EMS Region in IllinoisD. Individual preparing Facility Testing & Response Plan: The Facility’s Testing & ResponsePlan was prepared by: Ellen Strohl, RN and John Letizia, AdministratorE. Date of initial Facility Testing & Response Plan: The Facility’s initial Testing & ResponsePlan was prepared on June 11, 2020F. The Facility will review and update its Facility Testing and Response Plan on a periodicbasis to ensure it is up to date with current CDC, IDPH, CMS, and LDH guidelines.Communication - The Facility communicates its testing plans and results to the LHD,residents, families, legally authorized representatives, and Healthcare Personnel(HCP)Communication is through written and verbal.H. SARS-CoV-2 Local Incidence: The Facility’s Infection Preventionist or designee monitorslocal SARS-CoV-2 incidence and regional designation in IDPH’s Restore Illinois Reopeningplan and reports this information to the Administrator and Director of Nursing Servicesto inform infection prevention activities. The infection preventionist logs any positive1
Heartland Senior Living Policy for Testing and Response PlanPolicy Number: 19Policy Name: COVID -19 Testing and Response PlanEffective Date:Revision Date:6/12/2020Approved by: Ellen Strohl, RNApproved Date: 6/12/2020cases and reports to LHD and will continue to monitor the regional area of ustics t (LHD) Contact: The Facility’s Infection Preventionist/designee will maintainregular communication with its Local Health Department contact Michelle Black usingthe following contact information: 217-849-3211, mbrn@cumberlandhealth.orgCommunication is documented in the Facility’s COVID-19 Facility Response Log.J. IDPH Regional Infection Control Consultant: The Facility’s InfectionPreventionist/designee or Administrator will maintain regular communication with itsIDPH Regional Infection Control Consultant using the following contact Information: Thefacility will contact LHD and the LHD contacts IDPH. Communication is documented inthe Facility’s COVID-19 Facility Response Log.K. CDC Social Vulnerability Index for County: CDC’s SVI uses U.S. Census data to determinethe social vulnerability of every census tract. Census tracts are subdivisions of countiesfor which the Census collects statistical data. The SVI ranks each tract on 15 socialfactors, including poverty, lack of vehicle access, and crowded housing, and groups theminto four related themes. As noted by IPDH, the CDC SVI may influence IDPH indetermining testing assistance priority. 2016 overal SCI score: 0.3015. Possible scoresrange from 0 to 1 highest. To aid IDPH, the Facility notes that the CDC SVI is 0.3015 asdetermined on June 12, 2020.II.Infection Control Capacity: The Testing and Response Plan is part of the Facility’s overarchingInfection Control Policy.A. Infection Preventionist or designee: The Testing and Response Plan is executed underthe guidance of the Facility’s Infection Preventionist or designee.B. The Testing and Response Plan is executed by the necessary Healthcare Personnel(HCP) with appropriate training and experience. The Facility ensures that trainingincludes: COVID-19 (e.g., symptoms, how it is transmitted); Hand hygiene (how to usealcohol-based hand rub (ABHR) and properly wash hands with soap and water);Donning and doffing of personal protective equipment (PPE) including Gloves, Faceprotection (goggles or face shield), Face mask (surgical or procedure mask), N95respirator (if applicable), and Gowns (disposable, reusable, or alternative sources ofprotection). It also includes cleaning and disinfection and Specimen collectionprocedure. Training includes return demonstration competencies for PPE donning anddoffing. 16 RN’s, 17 LPN’s, 42 C.N.A.’s and 31 other staff.C. The Testing and Response Plan is executed by the Facility’s additional HCP in thefollowing role(s): DON and Nurse Managers will conduct testing. Training provided bythe LHD and SBL Lab.D. Appropriate Personal Protective Equipment (PPE) is a critical component of the Facility’sInfection Control Policy. PPE is necessary to both protect staff and reduce transmission2
Heartland Senior Living Policy for Testing and Response PlanPolicy Number: 19Policy Name: COVID -19 Testing and Response PlanEffective Date:Revision Date:6/12/2020Approved by: Ellen Strohl, RNApproved Date: 6/12/2020within the Facility. Reference back to facility policy. See map of unit designation forPositive COVID-19. Constraints on PPE resulting in changes to the Testing and ResponsePlan are documented in the COVID-19 Facility Response Log .E. Infection Prevention & Control interventions – The Facility has policies addressing thefollowing:1. Visitor restrictions – The Facility restricts visitation to essential individuals. Allvisitors are informed of risk and instructed on proper PPE use prior to enteringany unit. Appropriate signage is posted.2. Cessation of communal dining and large group activities – The Facilitydiscontinued communal dining and large group congregate activities such asbingo, beauty shop, church, etc. and provided alternatives that maintains socialdistancing such as arranging in room dining.3. Universal source control – The Facility implements universal source control forresidents, HCP, and any persons entering the building including compassionatecare.4. Social distancing – The Facility implements social distancing maintaining 6 feetbetween individuals except during direct care activities.5. Residents leaving the facility – Residents are asked to wear a face mask whenleaving the building for appointments. Their COVID-19 status is shared withtransportation services and whomever the resident has the appointment. Note:In the event any resident asked to wear a mask is unable to do so due to amedical condition, a physician order is used to document this information inthe medical chart. The Facility works to explore alternative measures to keepthe resident and others safe.6. Cleaning and disinfection - The Facility has policies addressing cleaning anddisinfection surfaces including product selection based on EAP-approveddisinfectants against COVID-19.7. Facility design – The Facility designates appropriate space for cohorting andmanaging care for residents with COVID-19 and for cohorting and managingnew/ readmissions with unknown COVID-19 status. It may transfer recoveredCOVID-19 residents to a transitional or observational area for 14 days beforeadmitting directly back to the regular unit or may transfer back to the regularunit if unable to designate a transitional or observational area.III.Testing Capacity and ProtocolA. Medical Director or Ordering Physician for Testing: The Facility’s health care providerresponsible for ordering SARS-CoV-2 tests for the Facility’s residents and HCP is: Dr.Gregory Deters, Medical Director. 217-246-0134.B. Method for Obtaining Consent: The Facility ensures informed consent is obtained bytesting staff prior to collecting specimens from residents and HCP. Testing staff informsresidents or their legally authorized representatives and HCP of their right to authorize3
Heartland Senior Living Policy for Testing and Response PlanPolicy Number: 19Policy Name: COVID -19 Testing and Response PlanEffective Date:Revision Date:6/12/2020Approved by: Ellen Strohl, RNApproved Date: 6/12/2020C.D.E.F.or refuse testing, how the test will be conducted, that the test will be performed by a 3rdparty laboratory, how result information will be handled, the potential need forisolation to prevent the spread of infection and that there is the potential for falsepositive or negative test results. Additionally, if positive, the Facility notes that testingdoes not replace treatment by their medical provider, and they have the responsibilityto obtain appropriate medical treatment.1. Signed consents are retained in the appropriate resident medical record or staffmember employee health record. In the event where it is not possible to obtaina signed consent at the time of specimen collection, a verbal informed consentwill be obtained prior to testing and documented in the resident’s chart.2. The Facility acknowledges that residents or their legally authorizedrepresentatives have a legal right to refuse testing. The Facility uses targetededucation and motivational interviewing techniques to inform residents of therisks and benefits, including community benefits, of testing. If the residentrefusal persists, the Facility takes the following measures to protect otherresidents from risk of exposure to a resident with undetermined SARS-CoV-2status, the infection preventionist will consult with the resident/family memberto educate regarding the testing. The resident that refuses testing will beisolated for 14 days.3. The Facility acknowledges that healthcare personnel have a legal right to refusetesting and have alerted staff that testing is a condition for continuedemployment.Method for Funding Testing: The Facility will properly bill the Cares Act forreimbursement for tests conducted.Contracted/Engaged Lab: The Facility’s Administrator has engaged SBL Lab to provideSARS-CoV-2 clinical testing services according to the volume and frequency identified inthe Testing and Response Plan. SBL Lab reports they have current capacity to meet theFacility’s testing needs as of June 11, 2020. The Facility’s Infection Preventionist ordesignee monitors the Laboratory’s capacity and result turn-around time on a regularbasis. The Facility promptly responds to any delays in turn-around times or evidence ofdecreased capacity by identifying additional laboratory partners and contacting IDPH toreceive assistance in identifying laboratories with available capacity. The Facility’sAdministrator will then pursue an appropriate arrangement for testing and billing.Viral Testing Type and Specimen Source – The Facility determined that it will utilize thefollowing type of Emergency Use Authorization or Food and Drug Administrationapproved viral test. SBL lab will provide the nasal swab test and results will be indicatedin a 48 hour turn around time.Test Kit Supply (Current and Pipeline): The Facility calculates the total number of testkits necessary to have in inventory and on order to complete testing according to theperiodicity schedule as determined by the current testing requirements and documents4
Heartland Senior Living Policy for Testing and Response PlanPolicy Number: 19Policy Name: COVID -19 Testing and Response PlanEffective Date:Revision Date:6/12/2020Approved by: Ellen Strohl, RNApproved Date: 6/12/2020this information in the Facility’s COVID-19 Response Log, taking into consideration thefollowing:1. Current inventory of test kits2. Lab result turnaround time in days with the acknowledgement that if this takeslonger than 1 week, testing frequency may be modified to correlate3. Current SARS-CoV-2 test kit order-to-delivery time in weeks4. On-site inventory neededG. Process for Specimen Collection and Transportation: The Facility’s InfectionPreventionist or designee oversees the process for specimen collection andtransportation to the laboratory ensuring that the instructions provided with the testkits and laboratory protocols are followed to prevent contamination or alteredspecimen that can interfere with diagnosis.H. Staff Designated to Conduct Testing: The specimen collection process is conducted bythe Facility’s Nurse Manager’s. Ellen Strohl, RN DON, Amy Fritcher, RN, Margie Gaugh,LPN and Becca Turner, LPN.I. Training of Personnel for Testing: The Facility’s Infection Preventionist or designee isresponsible to assure testers receive training for safe and correct testing of residentsand HCP and the safety of those professionals who will be administering the tests.Training includes identification of who should be tested, appropriate locations forspecimen collection, informed consent including explanation of the procedure to theindividual, standard precautions, appropriate use and removal of PPE, contents ofdiagnostic test kit, proper individual and specimen identification, procedure for nasaland throat swabs, guidelines for storing specimens for shipment, and appropriatedocumentation.J. Test Result Communication, Documentation and Reporting Protocol - The Facility’sInfection Preventionist or designee oversees the process for receiving and acting onresults of testing to identify asymptomatic cases, confirm infection in symptomaticcases, evaluate quality indicators, follow-up on infection control programs, and tosupport decision-making. Once results are obtained, HR designee will record staff resultsand Nurses will be responsible to record the result and date in the resident’s medicalrecord or HCP’s employee health record, communicate the result to the individual orlegally authorized representative on a timely basis, and ensure the appropriategovernment entities are informed via designated processes including NationalHealthcare Safety Network (NHSN) COVID-19 Module for LTCF weekly and IDPH or LHDdaily or as directed.1. The Facility maintains documentation or line listing of aggregated testingresults for both residents and HCP, including such fields as: test typeconducted, date of tests, date of results, results, unit of residence or of staffassignment, and any barrier preventing testing.2. The Facility informs residents/legally authorized representatives, HCP, andfamilies of the number of cases in the facility by 5 p.m. the next calendar dayfollowing the occurrence of either a single confirmed infection of COVID-19, or5
Heartland Senior Living Policy for Testing and Response PlanPolicy Number: 19Policy Name: COVID -19 Testing and Response PlanEffective Date:Revision Date:6/12/2020Approved by: Ellen Strohl, RNApproved Date: 6/12/2020three or more residents or staff with new-onset of respiratory symptomsoccurring within 72 hours of each other as follows: Residents and familymembers and staff will be notified by the management team via phone call.Communications are recorded by date and type in the Facility’s centraldocument in the facility Response Log.3. All identified SARS-CoV-2 tests, results, and documentation are maintainedunder strict compliance with HIPAA requirements.IV.Testing Periodicity regardless of Outbreak status:A. Resident Symptom Screening and Testing: Consistent with the Facility Infection ControlPolicy and IDPH guidance, all residents are screened for symptoms consistent with SARSCoV-2 infection and temperature, heart rate, respirations and pulse oximetry once pershift and blood pressure once daily in accordance with IDPH guidance. SARS-CoV-2-likeillness is described by IDPH as new onset of subjective or measured ( 100.4oF or38.0oC) fever OR cough OR shortness of breath OR sore throat that cannot be attributedto an underlying or previously recognized condition. The DON or designee isimmediately notified of any resident who screens positive for symptoms or change invital signs and appropriate infection control measures are initiated according to FacilityIC Policy or other policy regarding clinically ill residents. Resident receives immediateSARS-CoV-2 testing via testing process as described in Section III. Residents withsymptoms or change in vital signs are tested regardless of previous SARS-CoV-2 testingstatus.B. Staff Symptom Screening and Testing: Consistent with the Facility’s Infection Controlpolicies, and IDPH guidance, all HCP (including non-staff visiting HCP, vendors,volunteers, and visitors) are screened for temperature and symptoms of SARS-CoV-2 inaccordance with IDPH guidance prior to shift and at mid-shift. HCPs who have fever orsymptoms receive SARS-CoV-2 testing as described in Section III and are excluded fromwork pending results of the test. HCPs who test positive for SARS-CoV-2 are excludedfrom work until they meet return to work criteria as defined in current IDPH guidance.Visiting HCPs who screen positive for symptoms or fever while onsite at the Facility areimmediately removed from the Facility and must either be tested according toprocedures outlined in Section III for staff HCP or provide documentation of negativetesting or clinical statement from a qualified professional that fever and/or symptomscan be reliably ascribed to another condition prior to resuming visiting work.C. Testing for readmission after hospitalization for COVID: Whenever possible the Facilityrequests hospitals to verify negative SARS-CoV-2 status through testing prior todischarge back to the Facility. When testing is not available, the Facility employs asymptom-based strategy to determine length of infection control precautions. Residentswith verified SARS-CoV-2 infection are excluded from Point Prevalence Surveys andbaseline surveys in the future.6
Heartland Senior Living Policy for Testing and Response PlanPolicy Number: 19Policy Name: COVID -19 Testing and Response PlanEffective Date:Revision Date:6/12/2020Approved by: Ellen Strohl, RNApproved Date: 6/12/2020D. Testing for readmission after hospitalization or other prolonged or multiple encountersoutside of the Facility for non-COVID related condition: In consultation with theresident’s healthcare providers and LHD, the Facility may periodically test asymptomaticresidents who are at elevated risk for transmission of SARS-CoV-2 based on theirexposure outside of the Facility. This includes residents who are hospitalized with a nonCOVID condition or residents with frequent visits outside of the Facility such as residentsundergoing dialysis, cancer treatments, and other services. Conditions impacting testingfrequency are documented in the COVID-19 Facility Response Log. When the rate ofcommunity transmission is high as defined by the facility region in Phase 1 or 2 of theRestore Illinois Plan, these residents w
Heartland Senior Living LLC COVID-19 Testing and Response Plan . Policy, Purpose, and Background . It shall be the policy of the F acility to guard against the introduction and spread of SARS-CoV-2 within its community of residents and staff. The Facility
