Applewood expects to stay safe, but is prepared for anything
View the latest updates on Applewood’s precautionary measures and protocols to address Coronavirus (COVID-19) below or learn more about the latest information on COVID-19 from CentraState Healthcare System here.
A. COVID-19 PLAN
The CDC has issued new guidelines which state that masks are no longer needed when outside (if you are fully vaccinated and 2 weeks beyond your last shot). However, if you are outdoors with a group, you must continue to wear a mask. And, masks must be worn at all times when you are indoors.
If you have a confirmed positive exposure (if you have been in direct contact with someone who has tested positive for COVID-19), please stay in your residence and contact the Wellness Center immediately as we now have access to the rapid test.
Indoor Dining
Indoor dining tables have been spaced out to provide more room for residents and their guests.
Card Room
The Card Room capacity is limited to twelve people (3 tables of four).
Craft Room
Capacity in the Craft Room has been increased to eight.
Packages
We have resumed the pre-COVIDpackage delivery processes. Shoprite, InstaCart, Peapod, and UPS will deliver directly to your apartments. The Concierge accepts packages from FedEx, Amazon and the US Postal Service. If a package is delivered for you, the Concierge will call you and you may pick it up at the front desk. If it is too cumbersome to carry, it will be delivered to you by the end of the day.
Resident Computer Center
The computer center is open.
Changes to Protocols for Applewood Independent Living Residents Based on CDC Protocols
• Fitness Center now open 7 days/week
• Masks required
• Indoor and outdoor dining are now open
• Masks must be worn except while eating
• Limited to 38 diners by reservation only
• Indoor visitation: expanded to 10am-6pm – 7 days per week
• Screening questionnaire and temperature taking continues
• Continue to make advance reservations
• Visitors not permitted in common areas
• Masks are required while walking though the community.
• Masks must be worn by the resident in the apartment if vaccination requirements have not been met
• Common areas, meeting rooms, game and craft rooms, library and all public spaces throughout Applewood require the wearing of masks and maintaining social distancing
• Leaving the community and gathering in family members’ homes
•You can gather indoors with unvaccinated people from one other household (for example, visiting with relatives who all live together) without masks, unless any of those people or anyone they live with has an increased risk for severe illness from Covid-19 or the resident has not met the vaccine criteria
• Vaccinated residents visiting in other vaccinated residents’ apartments: may remove masks
• Shopping continues
• Limited to 50% capacity on the bus at one time
• Reservations are required
B. INFLUENZA PLAN
The primary purpose of Applewood Pandemic Influenza Plans and Procedures is to outline a course of action to follow if a pandemic influenza outbreak occurs in Assisted Living, Memory Care or Healthcare areas.
The Administrator or designee shall be responsible for monitoring federal and state public health advisories and updating the Director of Nursing serving as the pandemic response coordinator.
In the event of influenza outbreak at Applewood the Administrator or designee will be responsible for notifying Hospital Administration and the State and Freehold Departments of Health. The Pandemic response coordinator will be responsible for completing the line list on a daily basis and submitting to the Freehold Department of health. A timeline will immediately be created marking initial illness and spread which will be used for the line list creation.
The Director of Nursing serving as the pandemic response coordinator or designee shall be responsible for weekly or daily as needed monitoring of seasonal influenza-like illness among residents and staff. If the DON should become ill the Administrator will assume the reporting role.
Director of Nursing or designee will communicate and educate residents, staff and family members on implication of and prevention of pandemic influenza utilizing handouts upon admission and or employment as well as seasonally during influenza season.
Education and training will include information on infection control measures to prevent the spread of influenza.
Supplies such as alcohol-based sanitizers, masks, gloves and disinfectant will be available to all staff and rationed based on need by the Director of Nursing or designee.
If quarantine cannot be managed on B Wing Healthcare, the area known as the Healthcare Dining room will be utilized as the quarantine area should it become necessary to designate such an area to control the spread of infection.
The Director of Nursing serving as the pandemic response coordinator or designee will ensure information materials such as brochures and posters developed to communicate policies and procedures during infectious outbreak are posted. Communication will include visitation suspensions or restrictions, instructions on obtaining further information on facility as well as state and federal information will be posted on our website.
The Administrator will be responsible for disseminating information to staff regarding the implementation of these policies and procedures in the face of an influenza outbreak.
The internet will be continually monitored by the Administrator at http://www.cdc.gov/flu/weekly/fluactivity.htm for updates and nationwide influenza activity, reporting updates as necessary to the Director of Nursing.
Areas for equipment storage shall be designated for use when pandemic influenza alerts occur within our area.
Vaccines and antibiotics will be secured based on public demand.
Safety concerns regarding public demand of antibiotics could result in increased security measures depending on intensity of outbreak (internally and public), symptoms and public demand.
Should a pandemic influenza outbreak occur that results in needed hospitalizations, local hospitals shall be notified of such, with estimate of number being transported to their facility.
a. Any ambulance, transportation, or medical personnel shall be requested when such service is necessary.
During a pandemic influenza outbreak, VISITATION shall be RESTRICTED based on severity of outbreak and ability to contain infectious persons. ONLY those persons authorized visitation rights shall be permitted in the area, UNLESS written authorization has been executed by the person in charge.
When a Pandemic Influenza outbreak is identified for this area, staff shall implement the following procedures.
Nursing Service:
Isolate contaminated residents to minimize spread of virus.
Ensure masks, gloves and gowns are available for staff use and protection.
Ensure staff has alcohol based cleansers to use in conjunction with appropriate hand washing techniques.
Dining Service:
Check and disseminate necessary food supplies (liquid diet).
Ensure supply of water is adequate.
Maintenance Service:
Have plastic sheeting, tape, plywood, lumber, etc., ready and available for immediate use in creating quarantined areas.
Laundry Service:
Have extra supply of linen and blankets available.
Ensure supplies are maintained for increased loads due to infectious materials.
Housekeeping Services:
Ensure all disinfectants and protective equipment is accessible to staff
Be prepared to disinfect all equipment and furnishings.
Assist where needed or assigned.
Administration:
Ensure staff communication and any additional coverage as needed.
Make sure needed supplies and equipment are maintained.
C. PANDEMIC OTHER
The primary purpose of Applewood Pandemic Plans and Procedures is to outline a course of action to follow if a pandemic outbreak occurs either naturally or with intention as in a biological (CBRN) emergency in Assisted Living, Memory Care and/or Healthcare.
From April of 2020 to June of 2020 Applewood responded to residents diagnosed as COVID-19 positive. A multidisciplinary team was established to provide care to keep both our residents and staff safe. This team included Executive Director, Director of Healthcare Services, Director of Facilities, Director of Nursing, Director of Social Service, Medical Director and supportive services from CentraState Healthcare System such as Infectious Disease. As a result of COVID-19 Applewood created a cohorted area to handle positive residents as well as residents with symptoms on the Hallway B located on the Healthcare Unit.
The Administrator or designee shall be responsible for monitoring federal and state public health advisories and updating the Director of Nursing serving as the pandemic response coordinator.
The Administrator will be responsible for notifying Hospital Administration, The State Department of Health, the Monmouth County OEM, Freehold Department of Health and the CDC if mandated. The Pandemic response coordinator will be responsible for completing the line list on a daily basis and submitting to the Freehold Department of health. A timeline will immediately be created marking initial illness and spread which will be used for the line list creation.
The Director of Nursing serving as the pandemic response coordinator or designee should the DON be unable shall be responsible for:
The Director of Nursing or designee will communicate and educate residents, staff and family members on implication weekly or daily as needed monitoring of illness among residents and staff.
All staff will be educated if they present with symptoms to not come to work until tested. Visitation will be curbed or stopped depending on situation.
The Director of Nursing or designee will communicate and educate residents, staff and family members on implication of and prevention of pandemic outbreak utilizing handouts and other forms of communication.
Education and training will include information on infection control measures to prevent the spread of illness.
The Director of Nursing serving as the pandemic response coordinator or designee will ensure information materials such as brochures and posters are developed to communicate policies and procedures during the infectious outbreak are posted. Communication will include visitation suspensions or restrictions, instructions on obtaining further information on facility as well as state and federal information will be communicated to family and representatives through email. Social Worker or designee will be responsible for ensuring communication and updates to family members and resident representatives by 5 p.m. the next calendar day following the subsequent occurrence of either: each time a single confirmed infection of COVID-19 is identified, or whenever three or more residents or staff with new-onset of respiratory symptoms occur within 72 hours of each other, in accordance with CMS rule 42 CFR 483.80 (g).
When a Pandemic outbreak is identified for this area, departments shall implement the following procedures.
Nursing Service:
Isolate contaminated residents to minimize spread of outbreak.
Ensure any supplies including masks, gloves and gowns are available for staff use and protection.
Ensure staff has alcohol based cleansers and disinfectants to use in conjunction with appropriate hand washing techniques.
Ensure staff who can work remotely do so and that ALL staff are aware that they should NOT come to work if they are sick.
Dining Service:
Check and disseminate necessary food supplies (liquid diet, isolation tray supplies).
Ensure supply of water is adequate.
Maintenance Service:
Have plastic sheeting, tape, plywood, lumber, etc., ready and available for immediate use in creating additional quarantined areas.
Laundry Service:
Have extra supply of linen and blankets available.
Ensure supplies are maintained for increased loads due to infectious materials.
Housekeeping Services:
Ensure all disinfectants and protective equipment is accessible to staff.
Be prepared to disinfect all equipment and furnishings.
Assist where needed or assigned.
Administration:
Ensure staff communication and any additional coverage as needed. Ensure any staff able to work remotely is given the opportunity and that all staff is aware NOT to come to work if they are sick.
Make sure needed supplies and equipment are maintained.
1. At the point in which the outbreak hits the state of New Jersey certain precautions and procedures will immediately be put into place.
Educate Residents, family and staff on pandemic and facilities plans to move forward.
Restrict visitors and non-essential healthcare personnel, except in end of life situations which will be dealt with on a case by case basis. Skype, face time and window and drive by visits will take place to help family and residents stay connected.
All communal dining is STOPPED and all group activities which includes internal and external group activities. Social distancing at least 6 feet will be managed with all residents and staff.
Active screening of all residents for fever and symptoms including questions related to the specific pandemic (out of country travel, exposure). Resident symptoms will be assessed at each shift but at a minimum, daily. Vital signs should include heart rate, blood pressure, temperature, and pain and pulse oximetry. The staff should have a heightened awareness for any change in baseline of their residents, and should be reeducated to ensure reporting of all changes. Any residents showing signs or symptoms of the pandemic will be treated as a person under investigation (PUI) as will the roommate if there is one. Isolation precautions will be put in place accordingly.
Staff screening will be done for all staff entering the building. All entrances will be closed to staff except for the employee entrance where the staff will have their temperature taken and respond to questions relating to symptoms or exposure. Any staff found to have a temperature or symptoms associated with the pandemic will be immediately sent home.
Staff, physicians, essential healthcare personnel should begin wearing masks (surgical) while in the building to prevent source contamination to residents. If PPE is limited follow reuse and conservation guidelines.
If taking new admissions create cohort area and treat as persons under investigation (PUI) until allotted period as designated by CDC without showing any signs or symptoms. Designated staff should be in that area only each shift. Staff should wear appropriate infection control PPE as needed based on precautions.
Create cohorted areas to handle positive residents and residents with symptoms and healthy. Hallway B on the Healthcare Unit is the best place to cohort infections as the area has a separate HVAC to help control cross contamination. The area known as the Dining room can also be utilized as a quarantine area.
All cohorted areas should have designated staff unless staffing does not allow in which case the facility will close to new admissions, and staffing will be managed as best as it can, always working from clean to dirty.
Encourage all residents to remain in their room. Activity staff can utilize “hallway” games or electronic equipment games.
Increase internal environmental cleaning protocols to ensure appropriate measures are being taken to clean and disinfect where appropriate including high-touch surfaces and all shared medical equipment (e.g., lifts, blood pressure cuffs, medication carts).
Provide education to all environment staff to ensure knowledge of what products to use effective for the specific germ and how to use the products. Ensure staff is trained on appropriate PPE to be worn in contaminated rooms including doffing and donning. Create checklists to outline all areas that are to be cleaned and how often.
Provide education to all direct care staff and therapy to ensure knowledge of PPE and donning and doffing as well as infection protection protocols.
Depending on the type of global outbreak supplies such as alcohol based sanitizers, masks, gloves, gowns and disinfectant will be available to all staff and rationed based on need and stored in a secure area by the Director of Nursing or designee.
2. If there comes a point in which an outbreak occurs in the facility certain precautions and procedures will immediately be put into place. An outbreak is defined as having more than two residents and or staff members become infected.
All residents will be tested and cohorted as identified; if testing is not available all residents will be assessed as persons under investigation (PUI), except for symptomatic residents who will be cohorted as positive. If testing is available:
Test all residents if possible, if not those exposed and with symptoms should be tested to establish cohorts and infection control strategies for room planning, those not able to be tested would be cohorted as a PUI and monitored for symptoms for the incubation period.
All residents who test positive will be cohorted as such.
All residents who test negative will be treated and cohorted as a PUI until retested again within 7 days and if still negative will follow CDC guidance with weekly testing until the testing no longer reveals any new cases. If there are enough rooms to keep these residents in their own room then private rooms will be the preference, otherwise a separate area for PUI’s will be created.
If an asymptomatic resident declines to be tested it will be documented in the chart and the resident will be treated as a PUI. If a resident has symptoms or an asymptomatic resident should begin to present with symptoms the resident will be cohorted as positive.
Maintain dedicated staff for each cohort area. If staffing does not allow prioritize rounding from well to ill.
All staff should be tested if testing is available. If it is not track staff calling out and create exposure lists for resident’s cared for, work with employee health. Continue required masking of all staff while in the building. Continue to take all staff temps before starting work and continue screening questions regarding symptoms or exposures. If testing is available:
Plan and schedule all staff for testing while managing shift coverage.
Ensure authorizations for release of information are signed by staff to inform facility of status for prevention strategies.
If staff refuses to be tested or refuses to authorize release of the test results, they may not work until such time that they are tested or authorize release.
If staff test positive and do not have symptoms they may return to work 10 days after their test if they have not had subsequent symptoms. If symptoms develop they cannot return until at least 10 days after symptoms developed and 3 days after fever resolved without fever reducing medication and significant improvement in respiratory symptoms, whichever period is longer. If using testing method must have 2 negative tests at least 24 hours apart and resolution of fever (without medications) and improvement in respiratory symptoms.
When staff return to work they should be restricted from taking their mask off even to eat around others and should be restricted from caring for residents who are severely immunocompromised until at least 14 days from the illness onset or positive test, whichever is longer.
If staffing issues occur due to positive testing results, the following strategies may help:
Stop all PTO during the period of outbreak.
Utilize all state waivers for staffing allowances and call lists to fill in gaps where needed.
Schedule nurses to work as aides if needed, look at agency help as well.
Consider a CNA training program to cross train other staff after the outbreak where they can fill in as CNA’s in an emergency.
Utilize all staff to fill in for environmental and or laundry needs, train accordingly.
Utilize all administrative positions to fill in where needed.
Business Manager of Nursing Services at CentraState to utilize Senior Services Float Pool
AYA Nursing Agency
Implement infection control precautions for all residents assuming those not tested have all been exposed. Re-educate all staff on infection control practices and PPE needs including proper donning and doffing; this includes environmental staff, laundry, maintenance, therapy, activities and kitchen.
Residents who are positive can be managed in facility if able to cohort, if not send to hospital. Any residents on an aerosol based procedure such as bipap or nebulizer will be stopped and physician called and requested to switch to a puffer so as not to create infectious particles in the air without negative pressure.
Admissions should be stopped especially with staffing constraints.
Social Worker or designee will notify patients/residents, their families or guardians and staff about any infectious disease outbreaks. This communication will occur via, phone, email or virtual communication at a minimum on a weekly basis. Applewood website for public view will be updated to reflect above on a weekly basis. Visit our website and click on tab to learn the latest information on Coronavirus (COVID-19).
Social Worker or designee will communicate to all residents, resident representatives and staff regarding the outbreak by 5 p.m. the next calendar day following the subsequent occurrence of either: each time a single confirmed infection of COVID-19 is identified, or whenever three or more residents or staff with new-onset of respiratory symptoms occur within 72 hours of each other, in accordance with CMS rule 42 CRF 483.80 (g). This communication will occur via, phone, email or virtual communication. Applewood website for public view will be updated to reflect above on a weekly basis. Visit our website and click on tab to learn the latest information on Coronavirus (COVID-19).
Social Worker of designee will schedule and offer alternative means of visitation such as virtual communications (phone, video-communications, Facetime) via laptops or tablets with residents, families, and resident representatives, in the event of visitation restrictions due to an outbreak of infectious disease or in the event of an emergency.
Social Worker or designee is primary contact to the resident’s visitors for both incoming and outgoing calls.
Applewood Security phone 732-410-2192, is available for urgent calls or concerns.
Mask all residents (who can tolerate masks) with or without symptoms when providing direct care; if masks are limited or not tolerated using a tissue to cover the nose and mouth is appropriate.
Should a pandemic outbreak occur that results in needed hospitalizations, local hospitals shall be notified of such, with estimate of number being transported to their facility.
Any resident’s needing hospitalization will be masked and both transport and hospital notified of positive patient.
Nurses must notify mortician of any positive resident deaths utilizing.
3. Recovery
An individual is considered recovered if it has been at least 1 week since symptoms started and at least 3 days since significant resolution of symptoms, including being fever free without fever reducing medicines. If testing can be used then two negative tests at least 24 hours apart would consider a resident recovered.
A recovered resident can be moved off Hallway B but kept in a separate area from healthy residents. Hallway A can be used as the “step down” cohort for residents considered recovered.
After two incubation periods control measures can be stopped. Masks will continue to protect the residents from any staff exposure until County and State numbers are in safe zones and Health departments feel it is safe to stop all measures.
Visitation will remain banned until County, State and Federal health departments allow.
Admissions can be continued, if taking infected admissions the unit will remain open and control measures will remain for that area. If admission is asymptomatic with no test or negative, the resident should be kept in a private room on unit with recovered and monitored for signs or symptoms for at least 10 days. The resident could be transferred back into a semi-private accommodation in the main facility if they remain afebrile and without symptoms for 10 days after their exposure (or admission).
All normal operations such as visitation, group activities and communal dining will continue to cease until County, State and Federal health departments direct otherwise. Skype, face time and window and drive by visits will continue.
If a vaccine or antibiotics should come out Applewood and its sister facilities will be covered under the Hospital agreement as a CLOSED POD able to distribute medication to our staff and resident’s. Safety concerns regarding public demand of antibiotics could result in increased security measures depending on intensity of outbreak (internally and public), symptoms and public demand.
The Administrator will be responsible for disseminating information to staff regarding the implementation of these policies and procedures in the face of a pandemic outbreak.
The internet will be continually monitored by the Administrator at http://www.cdc.gov/for updates and nationwide outbreak activity, reporting updates as necessary to the Director of Nursing.
Protected areas for equipment storage shall be designated for use when pandemic outbreak alerts occur within our area so as to manage and maintain needed PPE supplies. The emergency trailer has nursing supplies stored should there be backorders or lack of PPE. If you have additional questions about Applewood and the Pandemic Outbreak Plan, please call 732-303-7416.