BAPTIST HOME OF SOUTH JERSEY/RIVERVIEW ESTATES COVID-19 OUTBREAK RESPONSE PLAN

 

Baptist Home of South Jersey/Riverview Estates

  COVID-19

Outbreak Plan

 

Baptist Home of South Jersey/Riverview Estates Outbreak Plan is in accordance with the amended New Jersey Department of Health Executive Order 20-026 issued August 10, 2020.  Long Term Care and Assisted Living Facilities are required to have an Outbreak Response Plan that outlines specific items as we abide by the Level of Phases designated by the New Jersey Department of Health and as our state moves through various Phases of Re-opening. The Facility can only advance stages once criteria is met and cannot advance past the level which the State of New Jersey advances their re-opening Phases.

The Executive Order 20-026 outlines The Road to Recovery. Long Term Care Facilities must meet certain criteria to obtain the next Phase of reopening.

 

Lessons learned from the response to and experience with COVID-19

Effectiveness of Screening and monitoring of residents each shift for signs and symptoms of COVID-19 as new symptoms were identified.  Importance of including vital signs and pulse oximetry to this process each shift. 

Surveillance monitoring of staff and visitors prior to entering the facility for symptoms and pertinent       history related to potential exposures to mitigate spread of infection in the facility.

Need for extended supplies of PPE available for Emergency Usage

Developing and Implementing Policies and Processes for Isolation and Cohorting of Residents with like phases of infection to mitigate the spread of COVID-19 Virus. Attempts to keep staff in specific assignments and phases through shift as possible, to keep infection from spreading (mitigating

movement through facility) to the best of our ability. (copy of cohorting plan was shared with Residents, Families and Resident Representatives via weekly email communication and Staff has been educated to this plan and continued to be in-service ongoing)

Revising Infection Control policies to include extended education and training of staff on Infection Control, proper use of PPE and donning and doffing techniques, cleaning and disinfecting, proper use of facemasks and various types, proper use of face shields or eye protection.

The need for new ways of Communication between Residents, Families and Resident Representatives for notice of positive cases, updates to changes and general wellbeing of the facility.

Developing ways of Communication with staff, residents, families and resident representatives on notification of a positive COVID-19 test result.  Staff receives notification either verbal, written, text or email. Families and responsible parties/POAs are notified via email with “Urgent Notification of Positive COVID-19 test Result”. This letter explains actions taken by the facility without disclosure of personal information or identities.  This communication also includes guidelines for window and outdoor visits, and ways to obtain an appointment for a Duo, Facetime or Skype visit with loved ones.  Letters are distributed as per NJ Department of Health and CMS Guidance, before 5pm the following calendar day. Residents receive written “Urgent Notice of Positive COVID-19” letter and also receive verbal notice by staff. The email of our Executive Director/Administrator, Director of Nursing, Director of Assisted Living and Infection Prevention Nurse, Social Worker and Resident Life Director are included on these emails to ensure anyone who has questions or concerns may reach out to any of the Team. Our Residents, Families and Resident Representatives have embraced this communication well through the pandemic and offer responses of appreciation for keeping them current with Riverview Estates.

 

Communication and Visitation

Processes for virtual ways of communications for Residents, Families and Representatives during visitation restrictions are communicated through weekly letters to Residents, Families and Representatives.  We have asked that Families and Friends call our receptionist or email our Social Worker or Resident Life Director to make an appointment for virtual visits. Also, a monthly copy of the Beacon is forwarded for updates from the Ombudsman.

Policies and Processes for Visitation are communicated via our weekly letters to Residents, Families/Resident Representatives.

   Alternative visitation includes:  Window visits, Duo, Facetime, Skype visits, Outdoor visits, Essential Caregiver and End of Life/Compassionate Care Visits. Guidelines and Policies and restrictions have been sent to our Residents, Families and Resident Representatives. We encourage anyone with questions or requests for these visits to contact our Resident Life or Social Services Director (email addresses and phone numbers are attached in this plan)

   

 

Strategy for Securing Staffing during an Outbreak

  • Encouraging Safe Infection Control Practice to keep workers healthy and safe to enable them to continue their assigned duties. Ensure proper PPE is worn at all times. Riverview Estates Staff have been wearing a facemask and face shield since March 2020 (even during no outbreak) to mitigate the spread of virus.
  • Identify through surveillance each shift and testing employees weekly or with signs and symptoms of COVID-19 to decrease spread of illness.
  • Encourage staff who are sick and isolating at home to communicate daily for continued surveillance and progression of any signs or symptoms.
  • Continuous assessment of current staffing needs with current census and care needs
  • Hiring of additional staff.
  • Providing education opportunities for employee in good standing for c.n.a class
  • Riverview Estates has contracts to procure additional staff through three agencies. They are able to provide nurses and certified nursing assistants.
  • Incentive bonuses to encourage coverage of shortages to staffing needs
  • Utilize Hero Bonus and incentive bonuses
  • Cross training staff to other duties and assignments
  • Discouraging vacations/time off requests during staffing crisis with consideration to need for rest and mental health of staff.
  • Utilizing Waivers for C.N.A/Nurses out of state if needed
  • Utilizing job board postings to assist with recruiting new staff (LinkedIn, NJUE job posts, Leading Age job posts, Schools of Nursing and C.N.A Certification Graduates)
  • Strategize appointments for window and outside visits to free up staff during crisis or other activities
  • Encourage Team Approach and All Hands-on Deck

 

Testing of Residents and Staff for COVID-19

Testing requirements for Staff remains weekly until the further notice from the CMS and NJ Department of Health guidance to testing. 

Staff exhibiting and signs or symptoms of the virus are also tested with new onset of symptoms regardless of last test date.

Staff is immediately notified of Positive test results and encouraged to call their physician and remain on isolation at home. They are also sent an isolation surveillance tracking form to write their symptoms such as temperature, body aches, cough, diarrhea, nausea, vomiting, shortness of breath. Information on this tracking form is communicated with the Infection Control Nurse or Director of Nursing to help determine a safe return to work. Staff with min/mod symptoms may return in 10 days if symptom free and no fever for 72 hrs. Returning staff will re-continue with surveillance and monitoring before entering the facility and wearing proper face mask and face shield at entry.

Residents are not tested weekly unless they are symptomatic. If there is a positive result in one staff or in the event of a COVID-19 Outbreak, all residents will be tested weekly until there are no positive results for 14 days and two rounds of testing are met in that 14-day period and all are resulted negative.           

                                           Reporting Requirements

Riverview Estates reports all new positive test results to the Burlington County Local Department of Health and New Jersey Department of Health. Surveillance Line Lists are utilized for maintaining and reported as appropriate with guidance and instruction of these Departments.

 Reporting to through the NJHA PPE portal is done daily, 7 days per week. This portal asks for case counts, census, suspect and positive cases for both residents and staff. Testing numbers are submitted daily as well as positive, negative and pending results. PPE counts are submitted daily to track supply. We also use a Burn Rate Calculator to track consumption of PPE and how much is on hand. Testing materials are reported to ensure there is sufficient supply for weekly testing and prn testing.

CDC/CMS portal is through NHSN. We report 5 times per week in this portal. This portal also asks for census, positive cases in residents and staff, suspect cases in resident and staff, availability of PPE and staffing shortages.

Positive results are also reported to our Staff, Residents, Families and Resident Representatives’ no later than 5pm next calendar day of positive result. A positive in a Resident would be reported to Family/Resident Representatives and physician via telephone as soon as possible.

 

                                                Daily Monitoring and Screening:

Riverview Estates actively screens everyone entering the facility. The only exception is for EMS personnel who must move quickly to assist in an emergent situation. Staff is monitored at the Employee entrance with oncoming shifts. Visitors or other HCP entering the facility are monitored at the lobby entrance. Both staff and visitors have temperature checked fever greater than 99.4 are suspect and asked not to enter. This Questionnaire includes symptoms, any potential exposures, travel to countries or states in high risk areas as per guidelines of State of New Jersey, and confirmed diagnosis of COVID-19 or recovering from COVID-19.

                Symptoms of COVID-19 Virus Might Include:

Temperature, chills, cold like symptoms, runny nose, congestion, recent loss of smell or taste, body aches, headache, cough, shortness of breath, sore throat, fatigue, confusion, nausea, vomiting, diarrhea.

Not meeting this Surveillance Screening and Monitoring Criteria would deem the person at risk and therefore will not be permitted to enter the facility. 

When a visitor is able to enter the facility, the following will be implemented prior to entry:

Screening and monitoring process

Signage of informed consent by the visitor and resident, stating the visitor and resident are aware of risks to both visitor and resident and rules for safe visitation. Resident Representative would have to sign for resident that is not able. This also gives the Resident’s consent to have the visitor.  Rules of all visits are defined for each type of visit including window, outdoor visits, essential caregiver visits, end of life/compassionate visits. The type of visit is guided by the Phase of the facility to re-opening guidelines.

Proper hand hygiene and donning of PPE required for the type of visit.

Maintain social distancing of at least 6ft from residents and staff (avoid touching, hugging, handshakes, kissing.) Avoiding contact with any resident other than the one you are visiting. And also do not wander through the facility or to any other area of the facility during your visit. Visits will be limited to Resident’s room if a private room or another area designated.

Residents are assessed and monitored for signs and symptoms of respiratory infection and COVID-19 symptoms 3 times per day. Residents with symptoms are put in surveillance isolation and physician and family are notified.

Residents and Staff will be tested for COVID-19 at onset of new symptoms.

 

Cohorting, PPE and Training Requirements in Every Phase:

 

  1. Facilities shall train and provide staff with all recommended COVID-19 PPE, to the extent PPE is available, and consistent with CDC guidance on optimization of PPE (https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html), if applicable. All staff must wear all appropriate PPE when indicated. Staff may wear cloth face coverings if facemask is not indicated, such as for administrative staff or while in non-patient care areas (e.g. breakroom).
  2. Facilities shall implement universal source control for everyone in the facility. All residents, whether they have COVID-19 symptoms or not, must practice source control when around others (surgical mask if supply is available) in accordance with CDC guidance at :https://www.cdc.gov/coronavirus/2019-ncov/prevent-gettingsick/cloth-face-cover-guidance.html. A face covering must NOT be worn by children under the age of two (2) or anyone who has trouble breathing, is unconscious, incapacitated, or otherwise unable to remove the mask without assistance. Source control may be provided with cloth face coverings or facemasks.

iii. Facilities shall separate COVID-19 positive and negative residents in accordance with NJDOH guidance at: https://www.nj.gov/health/cd/topics/covid2019_healthcare.shtml. A resident is considered recovered from COVID-19 only after they have met the criteria for discontinuation of isolation as defined by the NJDOH at: https://www.state.nj.us/health/cd/topics/ncov.shtml, and CDC guidance at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalizedpatients.html.

 

Facilities must continue to follow current NJDOH orders, guidance and directives on admissions and readmissions.  Facilities may receive residents who were tested prior to admission transfer or shortly thereafter, in accordance with NJDOH Guidance: https://www.nj.gov/health/cd/documents/topics/NCOV/COVID_Cohorting_PAC.pdf, Orders: https://www.state.nj.us/health/legal/covid19/4-1320_EmergencyCurtailmentOfAdmissions.pdf and Directives.  Facilities shall take appropriate action on the results including, but not limited to, the guidance below: 

  1. Sending Facility: COVID-19 diagnostic test results must be provided (in addition to other pertinent clinical information) to the receiving facilities for any transferred residents upon receipt of lab results.

 

  1. Receiving Facility: Upon identification of a case of COVID-19 in a resident who was recently admitted (within 14 days), the receiving facility must provide these results back to the sending facility to allow for the appropriate response and investigation.

 

 Communication, Calls or Concerns

                                            Baptist Home of South Jersey/Riverview Estates 

We are here to assist. Email Addresses for the Executive Director, Director Nursing, Director of Assisted Living, Social Services Director are included in the emails weekly to our Residents, Families and Representatives.  The are also included in every “Urgent Notice of Positive COVID-19 result” Letter. 

We have encouraged communication regarding any questions or concerns to these key Directors

Email contact list:

                            Executive Director,  jpastore@riverviewestates.org

                            Director of Assisted Living:  kleypoldt@riverviewestates.org

                            Director of Nursing, Long term care: wdobovich@riverviewestates.org

                            Director of Social Services:  jesseg@riverviewestates.org

                            Director of Resident Life:  maryellen@riverviewestates.org

                            Resident Life Dept: residentlife@riverviewestates.org

                            Assistant Administrator/HR,  cathym@riverviewestates.org

               

 

Facility telephone number: 856-829-2274 

Compliance and Privacy Hotline: 1-800-211-2713

 

 

How the Phases of the Executive Order Guide our Re-opening at

         Riverview Estates as stated in Executive Order

 

Phase 0

Phase 0:  Any facility with an active outbreak of COVID-19, as defined by the Communicable Disease Service (CDS), per the COVID-19 Communicable Disease Manual Chapter, any facility that cannot attest to criteria to advance phases, and all facilities if New Jersey is in maximum restrictions per the Road Back to Recovery: https://covid19.nj.gov/faqs/nj-information/reopening-guidance/when-and-how-is-newjersey-lifting-restrictions-what-does-a-responsible-and-strategic-restart-of-new-jerseyseconomy-look-like

A facility with a COVID-19 outbreak will remain in Phase 0 (maximum restrictions) until their outbreak of COVID-19 has concluded. The detection of a NEW COVID-19 outbreak returns the facility to Phase 0 regardless of the facility’s current Phase. In order to leave phase 0, facilities must re-submit an attestation upon conclusion as directed within this directive.

 An outbreak of COVID-19 is defined by the Communicable Disease Service, COVID19 Communicable Disease Manual Chapter available at: https://www.nj.gov/health/cd/documents/topics/NCOV/NCOV_chapter.pdf.  

Outbreaks are considered concluded when there are no symptomatic/asymptomatic probable or confirmed COVID-19 cases among employees or residents after 28 days (two incubation periods) have passed since the last case’s onset date or specimen collection date (whichever is later), as defined and updated per the COVID-19 Communicable Disease Manual Chapter. For CMS certified facilities, the facility must receive a survey by the NJDOH.  The determination of an outbreak’s conclusion will be made by either NJDOH or local health officers, pursuant to N.J.A.C. 8:57-1.10. 

 Upon conclusion of an outbreak, the facility may directly advance to the applicable Phase based on the criteria in this Directive. For example, if a facility was at Phase 3 but has a new outbreak of COVID-19, they would return to Phase 0. If the facility can still attest to the criteria for Phase 3 and the State is still in Stage 3 of reopening when the outbreak is concluded, it could directly return to Phase 3. 

 For the purposes of this Directive, management of a COVID-19 outbreak, infection prevention and control recommendations for COVID-19, or laboratory testing guidance issued by a local health department (LHD) or NJDOH should be followed in addition to the requirements set herein.  

 In order for the facility to meet the requirements of this Directive and before advancing from Phase 0 or to any other phase, the facility must submit to the Department an End of Outbreak attestation following the end of a COVID-19 outbreak or, if the facility never experienced a COVID-19 outbreak, a No Outbreak Experienced attestation on facility.

Phase 1:  Facilities that never had an outbreak or that concluded an outbreak per section (II)(5) below, and 14 days have passed since New Jersey moved to Stage 1 (May 2, 2020) of the Road Back to Recovery and the facility has submitted all the attestations required in this Directive. 

Phase 2:  Facilities that never had an outbreak or that concluded an outbreak per section (II)(5) below, and 14 days have passed since New Jersey moved to Stage 2 (June 15, 2020) of the Road Back to Recovery and the facility has submitted all the attestations required in this Directive. 

Phase 3: Facilities that never had an outbreak or that concluded an outbreak per section (II)(5) below, and 14 days have passed since New Jersey moved to Stage 3 (DATE TBD) of the Road Back to Recovery, and the facility has submitted all the attestations required in this Directive.

 

 All Facilities start at Phase 0 on August 10, 2020.

 

PHASE DESCRIPTIONS PROVIDED AS DIRECTLY FROM THE EXECUTIVE ORDER

Phase 0  

  1. Screen and log all persons entering the facility and all staff at the beginning of each shift in accordance with section (III)(2)(i) to (ix) of this Directive.
  2. Entry of non-essential personnel is prohibited. Those providing elective consultations, personnel providing non-essential services (e.g., barber, hair stylist), and volunteers, are prohibited from entering the building.

iii. Facilities shall screen all residents, at minimum during every shift, with questions and observations for signs or symptoms of COVID-19 and by monitoring vital signs. Vital signs recorded shall include heart rate, blood pressure, temperature, and pulse oximetry.

  1. When facilities are experiencing an outbreak, communal dining and all group activities should be limited. Residents shall stay in their rooms as much as possible and cohort in accordance with CDS: https://www.nj.gov/health/cd/documents/topics/NCOV/COVID_Cohorting_PAC.pdf and CDC guidance: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-controlrecommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoron avirus%2F2019-ncov%2Finfection-control%2Fcontrol-recommendations.html
  2. Avoid non-medically necessary trips outside the building. For medically necessary trips away from the facility the resident must wear a cloth face covering or facemask (surgical mask if supply is available) in accordance with CDC guidance: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-coverguidance.html. A face covering must NOT be worn by children under the age of two (2) or anyone who has trouble breathing, is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.
  3. Perform ongoing weekly testing of all staff until guidance from the NJDOH changes based on epidemiology and data about the circulation of virus in the community. Staff who have previously tested positive must be re-tested according to CDC and CDS guidance at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/testinghealthcare-personnel.html

 

 Phase 1   

  1. Screen and log all persons entering the facility and all staff at the beginning of each shift in accordance with section (III)(2)(i) to (ix) of this Directive.
  2. Entry of non-essential personnel is prohibited. Those providing elective consultations, personnel providing non-essential services (e.g., barber, hair stylist), and volunteers, are prohibited from entering the building.

iii. Restrict communal dining to COVID-19 negative and asymptomatic or COVID-19 recovered residents only.  

  1. Residents may eat in the same room while practicing infection prevention and control precautions including social distancing measures. This includes limiting the number of people at tables and using barriers and/or maintaining separation of space by at least 6 feet, as deemed appropriate based on facility risk assessment
  2. When feasible, seat the same small group of residents together each day, so that each resident is in contact with the same small group. There should be no mixing of residents across these groups.
  3. When feasible, staff should be assigned to specific tables in order to minimize the number of residents they interact with and remain with that group each day, whenever possible.
  4. The sharing of condiments and serving utensils is prohibited. Sanitize/clean high touch surfaces (e.g. chairs, tables) between seating/meals. The facility should use disposable utensils and cups when possible.
  5. The facility must ensure that processes are in place to maintain infection control protocols such as preventing staff from cleaning used tableware (e.g. plates and cups) and immediately serving food without proper handwashing. When feasible disposable cups and utensils are preferred.
  6. Restrict group activities in general. Limited activities may be conducted for COVID19 negative and asymptomatic or COVID-19 recovered residents only in their small groups. Facilities that permit group activities shall:
  7. Maintain infection prevention and control precautions including social distancing and source control measures, and limit the numbers of residents who participate, as deemed appropriate based on facility risk assessment and as permissible pursuant to statewide indoor and outdoor gatherings limitations.
  8. As much as possible, keep the same residents in the same group each day so that each resident is in contact with the same group, including the same staff, in order to minimize multiple interactions and remain with that group daily. Group size should not exceed more than 10 individuals.
  9. Activity items that cannot be appropriately cleaned and disinfected should not be shared between residents. For example, residents should be given their own personal bingo cards and tiles.
  10. Avoid non-medically necessary trips outside the building. For medically necessary trips away from the facility, the resident must wear a cloth face covering or facemask

(surgical mask if supply is available) in accordance with CDC guidance at: .  A face covering Screen all residents, at a minimum daily, with temperature checks, questions and observations for other signs or symptoms of COVID-19.  

vii. Continue to perform ongoing weekly testing of all staff until guidance from the NJDOH changes based on epidemiology and data about the circulation of virus in the community.  Staff who have previously tested positive should be re-tested according to CDC and CDS guidance at: https://www.cdc.gov/coronavirus/2019ncov/hcp/testing-healthcare-personnel.html

 

 Phase 2

  1. Screen and log all persons entering the facility and all staff at the beginning of each shift in accordance with section (III)(2)(i) to (ix) of this Directive.
  2. Indoor visitation by appointment is allowed. Visitation in this section is based on CMS guidance at: https://www.cms.gov/files/document/covid-visitation-nursing-homeresidents.pdf. Visitors must be screened and logged in accordance with section (III)(2)(i) to (ix) of this Directive.

iii. For medically necessary trips away from the facility the resident must wear a cloth face covering or facemask (surgical mask if supply is available) in accordance with CDC guidance: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-facecover-guidance.html.  A face covering must NOT be worn by children under the age of two (2) or anyone who has trouble breathing, is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.

  1. In order for the facility to meet the requirements of this Directive and at least 48 hours before commencing indoor visitation, the facility must submit to the Department a Phase 2 Indoor Visitation attestation on facility letterhead from the facility administrator.

As with the requirements set forth in Executive Directive 20-026, the facility has a mechanism to collect informed consent from the residents and visitors, has a location designated for indoor visitation, sufficient staff, a mechanism for appointments and sufficient PPE to permit visitation.

  1. Entry of non-essential personnel/contractors into the building is permitted. Personnel /contractors must be logged and screened in accordance with section (III)(2)(i) to (ix) of this Directive. This includes personnel providing elective consultations and nonessential services (e.g., barber, hair stylist) as determined necessary by the facility.  Such personnel are permitted access only to COVID-19 negative and asymptomatic or COVID-19 recovered residents. Entry of Volunteers is not permitted in Phase 2.
  2. Requirements for infection prevention and control precautions, including social distancing, cloth face coverings or facemasks continue to apply for indoor visitation/entry of non-essential personnel/contractors in Phase 2. When possible, facilities should restrict movement of person entering the facility to a designated area (e.g., medical consults provided in designated treatment room).

 vii. Limit communal dining to COVID-19 negative and asymptomatic or COVID-19 recovered residents only. 

  1. Residents may eat in the same room while practicing infection prevention and control precautions including social distancing measures whenever possible. This includes limiting the number of people at tables and using barriers and/or maintaining separation of space by at least 6 feet, as deemed appropriate based on facility risk assessment.
  2. When feasible, a small group of residents should be seated together each day, so that each resident is in contact with the same small group. There should be no mixing of residents across these groups. 
  3. When feasible, staff should be assigned to specific tables in order to minimize the number of residents they interact with and remain with that group each day, whenever possible.
  4. The sharing of condiments and serving utensils is prohibited. Sanitize/clean high touch surfaces (e.g. chairs, tables) between seating/meals.

 

  1. The facility must ensure that processes are in place to maintain infection control protocols such as preventing staff from cleaning used tableware (e.g. plates and cups) and immediately serving food without proper handwashing. When feasible disposable cups and utensils are preferred.

1) Consider the following steps: refrain from removing used plates and tableware from the table until all residents have finished eating or utilize specific staff to serve residents and refill drinks during the meal and a separate group of staff to clear plates and tableware of those who are finished.

viii. Limit group activities to no more than 10 people, including outings, for COVID-19 negative and asymptomatic or COVID-19 recovered residents only, as deemed appropriate based on facility risk assessment. 

  1. Maintain infection prevention and control measures including social distancing and source control measures.
  2. Continue to perform ongoing weekly testing of all staff until guidance from the NJDOH changes based on epidemiology and data about the circulation of virus in the community. Staff who have previously tested positive should be re-tested according to CDC and CDS guidance at: https://www.cdc.gov/coronavirus/2019ncov/hcp/testing-healthcare-personnel.html
  3. Screen all residents, at minimum daily, with temperature checks, questions and observations for other signs or symptoms of COVID-19.

 

 Phase 3

  1. Resume indoor visitation. Screen and log all persons entering the facility and all staff at the beginning of each shift in accordance with section (III)(2)(i) to (ix) of this Directive.
  2. Allow entry of non-essential healthcare personnel/contractors as determined necessary by the facility, based on screening and including infection prevention and control precautions, social distancing, hand hygiene, and cloth face coverings or facemasks.

iii. Allow entry of volunteers, based on screening and including infection prevention and control precautions, social distancing, hand hygiene, and cloth face coverings or facemasks.

  1. Screen all residents, at minimum daily, with temperature checks, questions and observations for other signs or symptoms of COVID-19 and test if symptomatic.
  2. Limit communal dining to COVID-19 negative and asymptomatic or COVID-19 recovered residents only.
  3. Residents may eat in the same room while practicing infection prevention and control precautions including social distancing measures whenever possible. This includes limiting the number of people at tables and using barriers and/or maintaining separation of space by at least six (6) feet, as deemed appropriate based on facility risk assessment.
  4. When feasible, a small group of residents should be seated together each day, so that each resident is in contact with the same small group. There should be no mixing of residents across these groups.
  5. When feasible, staff should be assigned to specific tables in order to minimize the number of residents they interact with and remain with that group each day, whenever possible.
  6. The sharing of condiments and serving utensils is prohibited. Sanitize/clean hightouch surfaces (e.g. chairs, tables) between seating/meals.
  7. The facility must ensure that processes are in place to maintain infection control protocols such as preventing staff from cleaning used tableware (e.g. plates and cups) and immediately serving food without proper handwashing. When feasible disposable cups and utensils are preferred.

1) Consider the following steps: refrain from removing used plates and tableware from the table until all residents have finished eating or utilize specific staff to serve residents and refill drinks during the meal and a separate group of staff to clear plates and tableware of those who are finished. 

  1. Resume Group activities, including outings, for COVID-19 negative and asymptomatic or COVID-19 recovered residents only, as deemed appropriate based on facility risk assessment.

vii. Maintain infection prevention and control measures including social distancing and source control measures. 

viii. For medically necessary trips away from the facility the resident must wear a cloth face covering or facemask (surgical mask if supply is available) in accordance with CDC guidance, available at https://www.cdc.gov/coronavirus/2019-ncov/preventgetting-sick/cloth-face-cover-guidance.html.  A face covering must NOT be worn by children under the age of two (2) or anyone who has trouble breathing, is unconscious, incapacitated, or otherwise unable to remove the mask without assistance

  1. Continue to perform ongoing weekly testing of all staff until guidance from the NJDOH changes based on epidemiology and data about the circulation of virus in the community. Staff who have previously tested positive must be re-tested according to CDC and CDS guidance at https://www.cdc.gov/coronavirus/2019ncov/hcp/testing-healthcare-personnel.html.