Dear Families and Friends,

As we are continuously receiving more information and guidelines from various governmental agencies, our COVID-19 policies will continue to evolve. Last night, we received an order from the Ohio Department of Health (ODH) regarding limiting access to Ohio Nursing Homes. This order adds a few requirements to the original visitation policy that we sent out (via email and USPS) Wednesday afternoon, which was based on federal guidance from Medicare & Medicaid Services. We have highlighted the changes in the visitation policy in red below.

REVISED VISITATION POLICY – Updated 3/12/2020; Effective Friday, 3/13/2020
Anna Maria (nursing facility & assisted living) and Kensington are continuing to limit visitation. This is defined as the visitor should not be allowed to come into the facility, except for certain situations, such as end-of-life situations or when the visitor is essential for the resident’s emotional well-being and care.

Additional Requirements for Visitation Established by the ODH Order on 3/11/2020:

• All non-staff visitors (other health care providers, contractors, governmental agency personnel, and vendors) will be required to produce a state or federal ID and provide their business address and phone number.
• The screening will include the questions below, with the addition of a body temperature check (we will be taking temperatures)
• The facility will be restricted to one point of entry. For the Anna Maria building (including all of assisted living), the point of entry will be the main entrance of the nursing facility. For Kensington, the point of entry will also be the building’s main entrance.
• Allow resident to discharge from facility at any time (return home with family).

No visitation, even under the limited definition, will be allowed by those who meet the following criteria:
1. Signs or symptoms of a respiratory infection, such as fever (specifically, body temperature of 100.4 degrees or higher), cough, shortness of breath, or sore throat.
2. In the last 14 days, has had contact with someone with a confirmed diagnosis of COVID-19, or under investigation for COVID-19, or are ill with respiratory illness.
3. International travel within the last 14 days to countries with sustained community transmission. For updated information on affected countries visit: https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
4. Residing in a community where community-based spread of COVID-19 is occurring.

NOT PART OF THE VISITATION POLICY, BUT ALSO INCLUDED IN THE ODH ORDER: Everyone allowed to enter the facility aside from visitors (all facility staff, other health care providers, contractors, governmental agency personnel, and vendors) also be screened for signs and symptoms of COVID-19.

3/11/2020
SURVEILLANCE of the Corona Virus Outbreak
We have a dedicated nurse position, the Infection Preventionist, who will be in charge of daily surveillance of the COVID-19. Their duties include:

• Monitor the presence in Ohio and locally in Portage County
• Monitor new information from CDC or ODH or the Portage County Dept. of Health
• Communicate information on facility illness with Portage County Dept. of Health
• Communicate information on facility illness with medical director
• Oversee monitoring process of respiratory illness in residents and follow-up

The same procedures that apply to visitors will apply to staff. Staff members who have signs and symptoms of respiratory infection have been directed not to come to work and seek guidance from their healthcare provider. Any staff member who develops signs and symptoms while on the job will immediately stop work and be sent home for self-isolation and seek guidance from their healthcare provider.
A major risk to all nursing facilities and other providers is a severe staffing shortage in the event of an outbreak. We have contracted with a staffing agency as an added precaution in the event of a staffing shortage.

TRANSFER TO THE HOSPITAL
If Anna Maria or Kensington begins to have residents suspected of having COVID-19 infection, the local health department will be contacted. Symptoms of COVID-19 may vary in severity from lack of symptoms to mild or severe, and possibly even death. Initially, symptoms may be mild and not require transfer to a hospital as long as we can follow the infection prevention and control practices recommended by CDC. The recommendation is that the facility not transfer the resident to the hospital if the resident does not require a higher level of care and the facility can adhere to the rest of the infection prevention and control practices recommended for caring for a resident with COVID-19.

PERSONAL PROTECTIVE EQUIPMENT (PPE)
PPE consists of supplies such as masks, gowns, gloves, face shields, etc. Nursing facilities and other providers across the country are experiencing a widespread shortage of PPE, and medical suppliers report either that they have limited inventory and are restricting deliveries or that they have no inventory. The shortage stems from a sharp decline in production of these items in China. While federal officials are trying to stimulate domestic production of PPE, providers are left with conflicting directions: to make PPE easily available to staff, patients, and visitors but also to conserve PPE as much as possible and to make do when it is not available. Anna Maria and Kensington are working with our medical supply provider to purchase as much PPE as possible. We do have a supply of PPE from our general emergency preparedness program. However, we will be conserving as much PPE as we can should an outbreak occur.
The facility uses EPA registered antimicrobial cleaning products for use against Novel Coronavirus SARS-CoV-2, the cause of COVID-19. The Supply Coordinator will monitor usage of supplies and communicate level of need with vendors.

ADMISSIONS TO THE CAMPUS
We will be screening new admissions into the facility for possible COVID-19 infection, and based on their condition and our capacity to meet isolation/care standards, we will make decisions for admission on a case by case basis. Our local county health department, as well as CMS, are emphasizing the critical need for healthcare facilities to continue to provide care for all patients, irrespective of COVID-19 infection status, at the appropriate level (e.g., nursing home, home-based care, outpatient, urgent care, emergency room, or hospitalization). We may need to respond to a surge in residents requiring care.

CARE OF RESIDENTS/ISOLATION
Nursing staff will be continuously monitoring residents for signs/symptons of COVID-19. If COVID-19 is suspected, facility will initiate isolation protocol.
The facility will order tests as directed by the resident’s physician and the Medical Director. Decisions such as moving or not moving residents will be made by the Director of Nursing and Administration with input from the Medical Director and the Infection Preventionist. It is not our intent to disrupt the residents from their existing rooms and living arrangements, but an outbreak could require these temporary changes.

EDUCATION TO STAFF AND FAMILIES
Flyers have been placed at the entrances and throughout the buildings with information about the virus and prevention as new information becomes available. We are also providing educational sessions to staff on our procedures and on COVID-19 in general.
In addition to this email, letters will be sent to all resident families/responsible parties.

BASIC INFORMATION—HOW COVID-19 SPREADS

Person-to-person spread
The virus is thought to spread mainly from person-to-person.

• Between people who are in close contact with one another (within about 6 feet).
• Through respiratory droplets produced when an infected person coughs or sneezes.

These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Can someone spread the virus without being sick?

• People are thought to be most contagious when they are most symptomatic (the sickest).
• Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.

Spread from contact with contaminated surfaces or objects
It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

Precautions that everyone should observe:

• Do hand hygiene frequently, preferably with soap/water but also alcohol handrub acceptable
• Use Cough Etiquette, to cover cough or sneeze with tissue and discard, then do hand hygiene or cough into elbow if no tissue
• Use the antiseptic wipes in stores for shopping cart or baskets; wash hands frequently at home
• Clean surfaces and doorknobs and other frequent touch surfaces frequently at home

For more information on COVID-19, go to the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/index.html

Again, it is our intent to place the health and well-being of the residents first, and we appreciate your cooperation and understanding in advance in dealing with this health crisis. We can be reached at (330) 562-6171.

Sincerely,
Aaron Baker & Chris Norton, Administrators/Owners