The findings of the infection control onsite survey conducted 11/16/2020, are documented in this report. The survey was conducted to determine compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities and OARs 411 Division 57 for Memory Care Communities.
Tag numbers beginning with the letter C refer to the Residential Care and Assisted Living rules. Tag numbers beginning with the letter Z refer to the Memory Care Community rules.
Abbreviations possibly used in this document:
ADL: activities of daily living
bid: twice a day
CBG: capillary blood glucose or
blood sugar
cc: cubic centimeter
CG: caregiver
cm: centimeter
F: Fahrenheit
HH: Home Health
HS or hs: hour of sleep
LPN: Licensed Practical Nurse
MA: Medication Aide
MAR: Medication Administration
Record
MCC Memory Care Community
mg: milligram
ml: milliliter
O2 sats: oxygen saturation in the
blood
OT: Occupational Therapist
PT: Physical Therapist
PRN: as needed
qd: every day or daily
qid: four times a day
RN: Registered Nurse
SP: service plan
TAR: Treatment Administration
Record
tid: three times a day
The findings of the first re-visit to the infection control survey of 11/16/20, conducted 1/26/20 through 1/27/20, are documented in this report. It was determined the facility was in substantial compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities, OARs 411 Division 57 for Memory Care Communities and Home and Community Based Services Regulations OARs 411 Division 004.
Based on observations and interviews, it was determined the facility failed to exercise reasonable precautions against any condition that could threaten the health, safety or welfare of residents. Failure to implement recommendations continued to place residents at risk for Covid-19. Findings include, but are not limited to:
Between the dates of 10/23/20 and 11/17/20, Safety and Oversight Quality Unit made multiple recommendations for the facility to implement reasonable infection control precautions during the Covid-19 pandemic. Such precautions included, but were not limited to:
*Increase staffing levels to meet resident needs;
*Physical distancing measures (furniture placement, reminders for staff and residents);
*Cohorting of Health Care Provider (HCP) (i.e., dedicated HCP);
*Identify an onsite Covid-19 positive wing or unit for cohorting Covid-19 suspected or positive residents; and
*Designate HCP to cover these isolation areas on an ongoing basis.
On 10/23/20 at 2:37 pm the following technical assistance was provided to Staff 1 (Administrator) and Staff 2 (RN):
* Educate and train staff on tools to redirect residents to ensure 6-foot physical distancing whenever possible;
* Remove and rearrange furniture to promote 6-foot physical distancing;
* Ensure dedicated staff were only working with suspected or confirmed Covid-19 positive residents; and
* Create detailed plans for isolation and/or quarantine as indicated for immediate response to a COVID-19 positive resident or exposure.
On 10/23/20 Staff 1 responded, "Thank you for your suggestions. We have started to implement these things."
On 10/29/20 the following technical assistance was provided onsite during an interview with Staff 1 and Staff 2:
* Establish a dedicated staffing plan for onsite isolation/cohorting area;
* The facility was running lean on staffing: Continue working with your staffing agencies and prioritize hiring;
* Rearrange furniture to promote physical distancing; and
* Establish a plan to address residents who may wander.
On 11/2/20 at 11:07 am the following recommendation was given to Staff 1:
* Follow up with assigned policy analyst to discuss the following:
* Overall staffing plan;
* Establish a dedicated staffing plan for Covid-19 positive and suspected residents; and
* Establish isolation/cohorting plan for Covid-19 suspected and confirmed positive residents.
On 11/5/20 Staff 1 was asked, "have you been able to establish an isolation/cohorting plan with dedicated staffing for Covid-19 positive residents? "Later that same day, Staff 1 reported, "I am working with my divisional team to get this plan in place. I will send you a copy when it is complete. "
On 11/16/20, during a Covid-19 infection control onsite tour of the facility with Staff 1, approximately 12 Residents were observed seated in dining room style chairs that were placed side by side in a single row, not practicing the recommended 6 foot distancing, were not wearing face masks and were left unattended in a TV lounge area. Meanwhile four staff members were observed congregating, not practicing physical distancing in a hallway around the corner from the TV lounge area. Staff 1 did not provide coaching for staff or residents and failed to correct and take reasonable precautions to ensure the health and safety of the residents during the Covid-19 pandemic.
During an interview on 11/16/20, Staff 1 acknowledged the facility had not completed the following Covid-19 infection control recommendations:
* Follow up with Policy Analyst to discuss Covid-19 cohorting and staffing plan;
* Increase staffing to meet resident needs;
* Establishing a dedicated staffing plan for Covid-19 residents;
* Establish an onsite isolation/cohorting plan for Covid-19 suspected or confirmed residents;
*Establish a plan to manage residents who may wander or otherwise be unable to quarantine;
* Educate and provide ongoing training and monitoring for staff, including staff tools to redirect residents, promoting 6-foot physical distancing whenever possible; and
* Remove and/or rearrange furniture to promote physical distancing.
The facilities failure to follow infection control recommendations/guidance to help minimize resident's exposure to COVID-19 continued to put residents at risk and threaten the health and safety of residents. Staff 1 acknowledged the findings.
Currently staffing 2-3 caregivers and 1 med tech on each side (Clare and Bridge) for day and swing shift. Currently staffing 1 caregiver on each side (Clare and Bridge) and 1 med tech for both sides on the night shift. A second med tech has been recruited for the night shift which will change the night shift staffing to 1 caregiver and 1 med tech for each side.
Contracts with 4 staffing agencies through out the area are in place. If the staffing agency is not able to assist the community, staffing hours for commuity associates will change to 12 hour shifts to meet the needs of our residents.
Additional infection control staff has been hired. This person will provide continuous sanitation to all high touch areas in the community.
In the case of a positive or suspected positive resident(s) designated staff of 1 caregiver and 1 med tech for each shift will be assigned to provide care to only these residents.
Staffing recruitement efforts continue. All positions are posted on major job boards and on the Brookdale Senior Living website. These will be monitored weekly by the Business Office Coordinator and Executive Director.
Furniture (couches) were removed from the community common areas. Remaining furniture has been rearranged to ensure 6' physical distancing whenever possible. The number of chairs available to the
residents have been reduced to encouage 6' distancing. The residents are offered cloth face masks and are encouraged to wear them if unable to maintain a 6' distance from other residents.
The staff has received training on Social Distancing between residents and staff members. The staff will frequently encourage the residents to sit 6' apart and will practice the 6' distancing unless providing resident care.
The Executive Director or designee will conduct a walk through the common areas of the communty frequently through out the day to encourage the residents to follow 6' social distancing, wearing masks and to assist with moving furniture to accomplish this.
In the case of a positive or presumed positive COVID 19 resident(s) designated staff of 1 caregive and 1 med tech for each shift will be assigned to provide care to these residents. When a resident is identified as COVID 19 positive, Brookdale has provided a guidance plan that identifies a Special Isolation Unit location which is largely determined on location of positive residents to limit movement within the community, designated entrance/exit spaces.
Based on interview and observation, it was determined the facility failed to have a sufficient number of caregiving staff to meet the 24-hour scheduled and unscheduled needs of residents to provide care for all residents during the Covid-19 pandemic. Findings include, but are not limited to:
The Memory Care facility was home to 56 residents at the time of the Covid-19 infection control onsite visit. The facility was separated into two neighborhoods, Claire and Bridge neighborhoods.
On multiple dates between 10/23/20- 11/16/20, the facility reported nine suspected Covid-19 residents, technical assistance for overall staffing and increasing staffing to create dedicated Covid-19 Health Care Professionals (HCP) to aid in reducing the risk of Covid-19 transmission was provided.
During a Covid-19 infection control visit on 11/16/20, approximately 12 Residents were seated in dining room style chairs, side by side in a row, not practicing the recommended six foot distancing, were not wearing face masks and were left unattended in a TV lounge area.
During interviews with Staff 1 (Administrator) on 10/29/20 and 11/16/20 she reported the following information:
* Day and Swing shift, two CG's and one MT in Claire Neighborhood;
* Day and Swing shift, two CG's and one MT in Bridge Neighborhood;
* NOC shift had one CG in Claire Neighborhood and a float MT that covered both Bridge and Claire neighborhoods; and
* NOC shift had one CG in Bridge Neighborhood.
During an interview on 11/16/20, Staff 1 agreed the acuity in the MCC was high and there was resident(s) with two person ADL needs. She agreed the facility was using the same staff to provide care and services to both Covid-19 negative and Covid-19 suspected residents and had not established a dedicated staffing plan that would effectively cohort Health Care Professionals (HCP) to provide care and services to Covid-19 suspected residents. She added, she was continuing to interview for new staff and had contracts with several staffing agencies but was unable to secure additional staff.
The need to ensure sufficient staffing to meet the scheduled and unscheduled needs of the residents and establish a dedicated Covid-19 isolation area with a dedicated Covid-19 staffing plan was discussed with Staff 1 (Administrator) on 11/16/20. She acknowledged the findings.
In the case of a positive or presumed positive COVID 19 resident(s) designated staff of 1 caregive and 1 med tech for each shift will be assigned to provide care to these residents. When a resident is identified at COVID 19 positive, Brookdale has provided a guidance plan that identifies a Special Isolation Unit location which is largely determined on location of positive residents to limit movement within the community, designated entrance/exit spaces.
Designated laundry rooms have been identified on each side of the community (Clare and Bridge). COVID positive or presumed positive resident laundry will be transported to the laundry room after being placed and sealed in garbage bag by a caregiver not assigned to the Special Isolation Unit. This caregiver will donn the proper PPE while transporting the laundry and while preparing it to be washed. The laundry room has one entrance and one exit door.
