CV Readiness Checklist

• Conducted on

  Date

• Prepared by

• Location

  LionsGate

  Gorge

  Britannia

  AspenWoods

  WhiteRock

• Physical distancing maintained during break times

  Yes

  No

  N/A

• Satellite break rooms are established

  Yes

  No

  N/A

• Time clock is sanitized after each use with appropriate signage to encourage physical distancing (Visibly verified and account for a best practice)

  Yes

  No

  N/A

• Leadership and team meetings are coordinated with physical distancing practices

  Yes

  No

  N/A

• Shift exchange and cross over with proper physical distancing in place (can articulate the location of discussion)

  Yes

  No

  N/A

• Physical distancing in common spaces, activities, and dining room observed

  Yes

  No

  N/A

Screening and Declaration

• Proper use of PPE at all times

  Yes

  No

  N/A

• Screener asks visitors role (ex. ECP, designated caregiver, other) and has an updated list of designated caregivers/ visitors

  Yes

  No

  N/A

• Screener is verbally asking the questions

  Yes

  No

  N/A

• Temperature checks are completed (entry and exit)

  Yes

  No

  N/A

• One primary entry point with a dedicated screener during peak hours

  Yes

  No

  N/A

Resident Temperature and Symptoms Checks

• Teams can provide evidence that ALL residents temperature and symptoms checks done according to provincial directives (ON - min 2X daily; AB - with care - min 1x daily done by TM, without care - self check for symptoms at least daily, isolation - min 1x daily; BC - min 1x daily unless suspected COVID then 2x daily)

  Yes

  No

  N/A

Amica Directives PPE Universal Protocols

• Teams are able to articulate their practice

  Yes

  No

  N/A

• Daily education to LL and TMs

  Yes

  No

  N/A

• Leaders are monitoring proper use and informing where gaps exist, progressive discipline measures are documented

  Yes

  No

  N/A

• Proper PPE use is maintained outside the residence (on breaks, carpooling, waiting for screener, etc) following Amica PPE guide by role

  Yes

  No

  N/A

• Proper use of PPE has been communicated and signed off by all TMs (can produce evidence of such)

  Yes

  No

  N/A

• PPE signage throughout building; all TM break rooms, time clock, washrooms, etc.

  Yes

  No

  N/A

• Through contact mapping exercises, no impact to Team or residents identified due to inappropriate PPE use

  Yes

  No

  N/A

• PPE education and audits provided to ECPs (including private companions, designated caregivers) to support proper PPE usage across all shifts across all neighborhoods

  Yes

  No

  N/A

• TMs list pulled to audit all TMs over time

  Yes

  No

  N/A

PPE and Hand Hygiene

• PPE and HH audits submitted monthly via outbreak preparedness form in collaboration with DOW

  Yes

  No

  N/A

• Evidence at a minimum of 1 audit/ week per shift of days, evenings, nights in each dept completed with outcomes identified; including weekends

  Yes

  No

  N/A

• TM list pulled to audit all TMs over time. Team able to demonstrate audits on different TMs.

  Yes

  No

  N/A

• ECPs, visiting health professionals, LE vendors, salon operators, designated caregivers, etc included in hand hygiene and PPE audits

  Yes

  No

  N/A

Hand Hygiene

• Hand sanitizers available at all entry points to common spaces and care areas including but not limited to - front entry, screening station, concierge, bistro, entry and exit to dining room, entry to care floors, elevators, break areas, time clock, and spaced throughout care areas

  Yes

  No

  N/A

• *MC - if inappropriate for ABHR to be left out, process to ensure ABHR is available to all TMs and residents (ex. Personal ABHR on all TMs)

  Yes

  No

  N/A

• Residents are being cued to complete hand hygiene prior to dining, activities, and on entry/exit

  Yes

  No

  N/A

• Education on proper hang hygiene is completed regularly noting the 4 moments for hand hygiene across all depts and each shift including weekends

  Yes

  No

  N/A

• Hand washing is completed when ABHR is not available or when appropriate

  Yes

  No

  N/A

• Hand washing observed to be completed properly (at least 20 seconds, washing using warm water and soap, using paper towel to dry and turn off taps, etc)

  Yes

  No

  N/A

• Signage noted at all ABHR stations providing visual cues to complete hand hygiene; visible to both TMs and residents

  Yes

  No

  N/A

Daily PPE inventory and secure management system

• PPE tracker submitted by residence every Thursday end of day via connect form. If COM is not submitter, reviews and approves for accuracy and submits

  Yes

  No

  N/A

• Each week, GM/COM reviews submission for accuracy and validity with regional team

  Yes

  No

  N/A

• Minimum inventory level at least = to 3 days (as outlined by dashboard)

  Yes

  No

  N/A

• Usage within 10% of average use

  Yes

  No

  N/A

• Level 1 masks within 5% of expected use

  Yes

  No

  N/A

• Locked storage with no more than 2 people (non-wellness) managing inventory

  Yes

  No

  N/A

• Dedicated wellness TM 24/7 has access and is accounting for inventory with process owner

  Yes

  No

  N/A

Contact mapping exercise

• Each LL has proficiency in contact mapping exercise and demonstrated ability to coordinate and lead contact mapping exercises

  Yes

  No

  N/A

• Contact mapping exercise completed minimum of 2/month; lead by a different leader in each dept.

  Yes

  No

  N/A

• Effective contact mapping tool is followed which outlines all of the tools one can pull and interview techniques

  Yes

  No

  N/A

• Regional teams review finalized contact mapping, probing deep for commonalities and fulsome contact mapping and confirms they are using most up to date version of the effective contact mapping tool

  Yes

  No

  N/A

• Teams can articulated learnings, impact, and opportunities and have seminar action items on opportunities

  Yes

  No

  N/A

• Contact mapping results show no impact to TM and Residents due to weakness in 5 lines of defence (inappropriate PPE, lack of physical distancing, inadequate screening)

  Yes

  No

  N/A

Enhanced Cleaning

• Documentation of infection control cleaning (can provide evidence of)

  Yes

  No

  N/A

• 7 days a week schedule in place

  Yes

  No

  N/A

• Can articulate ‘outbreak’ cleaning procedures and are executing for line listed residents

  Yes

  No

  N/A

• Common area 3x minimum per day

  Yes

  No

  N/A

• LE, bus, dining room, and bistro enhanced cleaning completed prior to/after programs and/or dining services

  Yes

  No

  N/A

• Shared equipment disinfected between individual use

  Yes

  No

  N/A

• Proper use of chemical (disinfecting solution for all surface cleaning, exception being food prep areas)

  Yes

  No

  N/A

Programming/Outings

• Attendance being tracked and logged for 100% of activities/ outings in provided template

  Yes

  No

  N/A

• Evidence of enhanced cleaning prior to programs and between programs

  Yes

  No

  N/A

• LE outing checklist completed including evidence of enhanced cleaning

  Yes

  No

  N/A

• Limit of 5 participants per outing OR as directed by bus capacity to ensure proper physical distancing guidelines

  Yes

  No

  N/A

• Program limits do not exceed space limits or government guidelines and ensure proper physical distancing

  Yes

  No

  N/A

• Process in place to disinfect equipment that may be shared outside of programming times (ex. Cards, games, library books, etc)

  Yes

  No

  N/A

• Resident cohort plan completed in the event we move to a high risk scenario

  Yes

  No

  N/A

Common Spaces

• Each common space capacity is identified and signage posted at the door

  Yes

  No

  N/A

• Physical distancing reminders/ signage visible for residents

  Yes

  No

  N/A

• Furniture is arranged to promote physical distancing

  Yes

  No

  N/A

• Enhanced cleaning evident 3x/day or after common space has been used (schedule for use of common areas)

  Yes

  No

  N/A

• Signage at elevators indicating max capacity

  Yes

  No

  N/A

Dining Room/Bistro

• Residents dine with the same dining partner selected. Only 2 people per table

  Yes

  No

  N/A

• Tables set up to support physical distancing

  Yes

  No

  N/A

• No communal items in dining rooms and on tables

  Yes

  No

  N/A

• Proper use of PPE by entire team

  Yes

  No

  N/A

• Enhanced cleaning of all surfaces occurring prior and after each services

  Yes

  No

  N/A

• Bistro staffed by TM while open

  Yes

  No

  N/A

• No Self Serve items available in Bistro

  Yes

  No

  N/A

• All bistro items individually wrapped

  Yes

  No

  N/A

• Physical distancing is observed in bistro with signage/reminders or decals for residents with only 1 chair per table

  Yes

  No

  N/A

• Evidence of enhanced sanitization

  Yes

  No

  N/A

• All kitchen deliveries are 'tailgate drops'. No delivery person permitted inside the building

  Yes

  No

  N/A

Resident Coming and Going

• Education provided to residents for coming and going - at minimum, monthly ongoing education provided to residents on physical distancing and actions to take to keep themselves safe

  Yes

  No

  N/A

• Mask provided to residents at frequency directed by Amica. Any additional are made available at cost

  Yes

  No

  N/A

• Resident Interaction Journal provided to Residents

  Yes

  No

  N/A

Visitors

• Visitor education provided to all visitors on onsite protocols, PPE, and hand hygiene

  Yes

  No

  N/A

• Visitors wear PPE, physical distancing, and follow onsite protocol

  Yes

  No

  N/A

• Screener provides visitor education toolkit, if visit indicates. If visitor does not understand protocols at point of declaration, able to articulate the protocols

  Yes

  No

  N/A

• Screener able to instruct visitor on proper use of PPE

  Yes

  No

  N/A

• TM instructs visitors on proper donning/doffing of PPE as necessary

  Yes

  No

  N/A

TM Case Management & Testing

• LL contacts any isolated TMs every other day to see if their condition has changed and how they are doing

  Yes

  No

  N/A

• Updates TM Case Mgmt Form within shift

  Yes

  No

  N/A

• TMs returning to work on anticipated RTW dates

  Yes

  No

  N/A

• Regional Team always consulted on RTW protocol discussions and decisions

  Yes

  No

  N/A

• 100% of symptomatic TMs immediately tested and placed in isolation

  Yes

  No

  N/A

• Hard copies of ALL positive TM test results are collected and place in TM medical files

  Yes

  No

  N/A

• Interval testing completed per regional guidelines

  Yes

  No

  N/A

Saliva and Panbio Study consent for TMs

• Panbio pilot and saliva based study are voluntary alternatives to the PH NP swab for routine asymptomatic surveillance testing. Consent forms are available at residence (Saliva based study)

  Yes

  No

  N/A

• Team is able to describe the process of obtaining consent and ensuring the consent forms are submitted with samples

  Yes

  No

  N/A

• Team is able to describe the process for managing testing refusal

  Yes

  No

  N/A

Staffing

• DS recruitment: postings closed within 20 days; # of new hires in month > or = # of terms in month

  Yes

  No

  N/A

• Maintaining relationship with COVID contract TMs that have left; keeping them warm in case we need to recall them

  Yes

  No

  N/A

• Building plan on how to incrementally reduce surge labour hours, overtime; sensible, logical and able to maintain dedicated staffing within the parameters

  Yes

  No

  N/A

• TMs available to work hrs & hrs being scheduled as per surge labour dashboard results

  Yes

  No

  N/A

• Have all TMs identified in Commitment Tracker and know who can extend shifts if necessary; schedule template prepared in case of need

  Yes

  No

  N/A

ECP Management

• Contingency plan in place to staff for ECP hours if needed

  Yes

  No

  N/A

• Conversations had up front with Agencies, private companions, etc in event of outbreak

  Yes

  No

  N/A

• Meet at minimum monthly with Agency provider to work through staffing, troubleshoot issues, and discuss payment in case of missed care. ECP missed visit incident connect form completed. Contingency planning conversations had with resident/POA

  Yes

  No

  N/A

• A list of ECPs/Private companions are kept at the residence for easy contact mapping

  Yes

  No

  N/A

• ECPs have been trained on all COVID protocols; offered/ encouraged to participate in interval testing when available

  Yes

  No

  N/A

• ECP Dashboard is reviewed with Wellness Team, GM, and LL monthly

  Yes

  No

  N/A

WAA

• 100% enrollment - all Dept schedules are published in WAA for 4 weeks upcoming

  Yes

  No

  N/A

Cohorting Plans

• Cohorting plan prepared in the event of outbreak

  Yes

  No

  N/A

• This should include a schedule/TM assignment where primary TMs are assigned to care for ill residents and well residents separately

  Yes

  No

  N/A

• In outbreak scenario, to the best of ability, we reduce movement of TMs between neighborhoods/floors in collaboration with PH

  Yes

  No

  N/A

New Hire/LOAs Return to Work

• 100% of new hires and TMs returning to work have been fully trained on COVID directive and any changes to protocols

  Yes

  No

  N/A

50% reduction in staffing plan

• 3+ agency agreements in place

  Yes

  No

  N/A

• Continually recruiting and receiving referrals from TMs

  Yes

  No

  N/A

• Received commitments from TMs of max availability if we were to suffer reduction in staffing

  Yes

  No

  N/A

• Schedule is prepared in event of Outbreak and/or reduction of staffing occurs

  Yes

  No

  N/A

• Essential tasking duties list prepared in case of non-care related duties need to be stripped away from Wellness positions and given to UTMs

  Yes

  No

  N/A

TM Culture and Communication

• Physically distancing daily stnd up occurring using stand up tool and being disseminated to TMs to review during crossover

  Yes

  No

  N/A

• Communicating updates to FAQs and TM letters, showing videos

  Yes

  No

  N/A

• Weekly acts of recognition/appreciation

  Yes

  No

  N/A

Physician/ Medical Director Collaboration

• Physician and Medical Director proactively communicated with regarding approach and treatment in the event of CV positive residents to ensure up to date treatment given as appropriate

  Yes

  No

  N/A

• Communication regarding our swabbing efforts and expectations around ordering physycian (all swabs must have submitter information completed)

  Yes

  No

  N/A

• Expectations are set up front with our physicians and the availability of emergency calls to support CV positive resident

  Yes

  No

  N/A

Line List Review with Wellness/LL and CV scenario form completed

• 2x daily review and CV scenario connect form completed

  Yes

  No

  N/A

PN review/symptom search report review

• Reviewed 7 days a week by wellness team leaders for aggressive case finding (more often in case of outbreak)

  Yes

  No

  N/A

PH Management and CV Testing Readiness

• 100% of symptomatic residents swabbed (if POA - consent received)

  Yes

  No

  N/A

• Swabs available onsite (max amount of swabs allowed onsite as determined by PH)

  Yes

  No

  N/A

• Administration prepared in advance and includes pertinent information including submitter information

  Yes

  No

  N/A

• Pending swabs reviews (able to articulate resident and date of swab) regularly with PH.

  Yes

  No

  N/A

Daily Assessment of Isolated Residents

• Symptomatic residents assessed at each shift (3x/day)

  Yes

  No

  N/A

• Asymptomatic - Process in place to communicate to Wellness any changes in status noted and 2x symptoms check

  Yes

  No

  N/A

• Health status updated to LL daily 7 days a week

  Yes

  No

  N/A

Residents on Droplet Precautions

• All residents as per Amica scenarios or government directives (contact mapping, exposure risk, return from hospital, move in or any atypical symptoms)

  Yes

  No

  N/A

• PPE signage outlining PPE requirements on the door and caddie prepared and placed in approved area

  Yes

  No

  N/A

• Line list is updated and all TMs made aware (communication, crossover, and daily stand up)

  Yes

  No

  N/A

• Yes

  No

  N/A