IPAC+ Self-Assessment for Long-Term Care Homes (LTCHs) and Retirement Homes (RHs)

1.1.1 Health care workers (HCWs), other staff, essential visitors, and general visitors STOP at the entrance, maintain physical distancing (2 metres [6 feet]) and perform their passive screening.

1.2.1 There is alcohol based hand rub (ABHR), with 70-90% alcohol concentration, and instructions to clean hands at the entrance.

1.3.1 Anyone who enters the home (e.g., HCWs, other staff, essential visitors, general visitors and residents returning to the home) with the exception of emergency first responders, are actively screened by a screener for signs and symptoms of and exposure to COVID-19as they enter the building.

1.4 Surveillance Testing (routine testing of asymptomatic HCWs, other staff andvisitors who have not been exposed to COVID-19) is performed inaccordance to the requirements in the Minister‘s Directive COVID-19:Long-Term Care Homes Surveillance Testing and Access to Homes or as amended.

1.5.1 Screener performs a Personal Risk Assessment (PRA) for personal protective equipment (PPE) for each interaction.

1.6.1 All HCWs, other staff, and essential visitors are actively screened at the beginning of their shift or visit.

1.7 HCWs, other staff or visitors who fail active screening are prevented from entering the LTCH and are advised to go home immediately, to self-isolate, and are encouraged to be tested.

1.8 Visitors of imminently palliative residents who fail screening are permitted entry. The LTCH ensures they wear a medical mask and maintain physical distance from other residents, HCWs and other staff.

1.9 HCWS, and other staff with post-vaccination related symptoms are exempt from exclusion from work where expressly permitted under and in accordance with the Guidance for Employers Managing Workers with Symptoms within 48 Hours of COVID-19 Immunization guidance.

1.10 Residents returning to the LTCH following an absence who fail active screening are permitted entry to the home

Residents who fail active screening are placed on Droplet and Contact Precautions and tested for COVID-19 as per the COVID-19: Provincial Testing Requirements Update.

1.11 There is a process to record contact information and visit details for any visitor who has entered and exited the home (full name, contact information, the resident they are visiting, and the in/out time).

1.12 All essential visitors and general visitors don a mask for the duration of their time inside the home. Essential visitors and general visitors receive donning and doffing mask support and appropriate hand hygiene instructions from staff. Support for other personal protective equipment (PPE) is provided as required.

2.1 There are written polices and procedures with respect to visits in accordance to the requirements described in COVID-19 Directive #3 for Long-Term Care Homes under the Long-Term Care Homes Act, 2007. and the COVID-19 Guidance for Long-term Care Homes in Ontario.

3.1 Personal care services (e.g., hairdressing and barber services) are operating in accordance with all applicable laws including Regulations under the Reopening Ontario (A Flexible Response to COVID-19) Act, 2020.

3.2 Personal care service providers are managed as general visitors.

4.1 HCWs, other staff, and essential visitors receive education and training with respect to universal masking.

4.2 HCWs, other staff and visitors (essential and general) are compliant with universal masking and residents (if tolerated) when in common areas and when receiving a guest.

5.1 A contingency plan with respect to human resources has been developed that identifies minimum staffing needs and prioritizes critical and non-essential services based on residents‘ health status, functional limitations, disabilities, and essential facility operations, and considers staffing needs in outbreak and non-outbreak scenarios, and the expectation of increased staff absenteeism during outbreaks.

5.2 Home is aware of the Ministry of Health‘s Workforce Matching Portal or other available supports (e.g., Ontario Health-region) that can be accessed if the home would like to request help from available resources.

6.1 Home has an immunization policy and process in place.

6.2 Immunization rates for COVID-19 vaccines and other vaccines such as influenza are documented and maintained for all residents and staff.

6.3 Support from local Public Health Unit with immunization programs is available.

6.4 All individuals, regardess of COVID-19 vaccine status, continue to practice the recommended public health measures for the prevention and control of COVID-19 infection and transmission.

7.1 HCWs, other staff and essential visitors who provide health care receive education/training on how to perform a PRA, selecting PPE, Routine Practices and Additional Precautions upon hire (orientation), annually and just-in-time for specific cases or outbreaks.

7.2 HCWs, other staff and essential visitors receive education and training on how to safely don and doff (put on and take off) PPE.

7.3 There are posters/visuals to help staff with donning and doffing of PPE.

7.4 HCWs receive education on what is an aerosol generating medical procedure and what is not an aerosol generating medical procedure.

7.5 Eye protection (e.g., goggles or face shield) is worn by all HCWs, other staff and essential visitors within 2 metres of a resident(s) as directed by Ministries‘ directives and guidance.

7.6 Home has a plan in place for estimating the number of days of supplies (PPE Burn Rate Calculator) and for maintaining an adequate supply of PPE for resident care for both usual care requirements and outbreak scenarios, including:

7.6.1 Medical masks (adequate is based on projected COVID-19 cases and numbers of masks expected to be used for providing care and universal masking).

8.1 HCWs, other staff and essential visitors receive education and training on how and when to perform hand hygiene.

8.2 Alcohol based hand rub (ABHR) (70-90% alcohol concentration) is available at point-of-care and in other resident and common areas.

9.1 A plan with key contacts (e.g., Ontario Health region) has been put in place to monitor consumable supplies including but not limited to gloves, gowns, masks, eye protection, N95 respirators, thermometer tip covers, ABHR, tissues, and critical medications.

10.1 HCWs, other staff, essential visitors and general visitors receive education and training on physical distancing (maintaining a minimum 2 metre [6 foot] distance apart, as much as possible).

10.2 Breaks and lunches are staggered to help ensure physical distancing of HCWs and staff:

10.2.1 Outdoor spaces are considered for breaks as weather permits

10.3 Physical distancing of residents is supported by:

10.3.1 Educating residents on physical distancing

10.4 The following exceptions to physical distancing are permitted:

10.4.1 Brief physical contact with their essential caregiver(s) and/or general visitor(s) (e.g., hugs).

10.5 Residents‘ medication administration schedules are reviewed to minimize the number of times HCWs need to enter residents‘ rooms.

11.1 A multidisciplinary planning committee or team has been created to specifically address COVID-19 and respiratory virus season preparedness planning.

11.2 Home has identified a person(s) who is responsible (24 hours per day, seven days per week) for leading a timely COVID-19 response/outbreak management team.

11.3 Home has identified a person(s) responsible (24 hours per day, seven days per week) to liaise with the local Public Health Unit person(s).

11.4 Home has the name(s) and contact information of their local Public Health Unit person(s).

11.5 Home has the name(s) and contact information of other resources that may support/be involved during an outbreak.

11.6 Contact information for family members or guardians of home residents is up-to-date and the power-of-attorney (POA) is clearly identified.

11.7 Resident(s)‘ care goals/advanced directives are known and updated.

11.8 There are processes in place for communication with HCWs, staff, essential visitors, residents and families and the media (external and internal communications).

11.9 There is a process for inter-facility transfers that includes notifying transport personnel and receiving facilities about a resident‘s suspected or confirmed diagnosis (e.g., presence of respiratory symptoms or known COVID-19) and or the facilities outbreak status prior to transfer.

11.10.1 Test kits/requisitions/specimen collection:

11.10.1 Home has a process in place for ordering tests kits/requisitions/specimen collection

11.11 There is a process for transporting COVID-19 and other respiratory viruses specimens to laboratory for testing.

11.12 Alternative accommodation plans have been considered to support resident physical separation for isolation and or cohorting:

11.12.1 Isolation — Single rooms are identified and set aside for individuals requiring Droplet and Contact Precautions.

11.13 General accommodations: After completing all testing and isolation requirements under Admissions and Transfers as applicable, all new residents are placed in a single or semi-private room.

11.14 General accommodations: Where semi-private rooms are used, there is adequate space (minimum 2 metres) between beds.

11.15 Ward rooms: Where placement into single or semi-private rooms is not possible, new admissions are placed in a ward room (a room that has 3 or 4 beds) with no more than one (1) other resident.

11.16 Ward Rooms: There are no more than two (2) residents in a ward room and every effort is made to ensure there is adequate space (minimum 2 metres) between beds.

11.17 Ward Rooms: Beds in a ward rooms are left vacant if a resident who occupied a bed in the ward room is discharged from the LTCH and there are two or more residents who continue to occupy a bed in the ward room.

11.18 Plans have been considered in preparing for alternative meal delivery and services should communal dining need to be stopped (e.g., in-room tray service).

11.19 Plans have been considered in preparing for alternative resident activities should small cohort activities no longer be permitted.

12.1 Residents are assessed for signs and symptoms of COVID-19 in accordance to Directive #3.

12.2 Residents with symptoms or signs of COVID-19 or potential exposure to a suspect or confirmed case are immediately placed on Droplet/Contact Precautions in a single room, where feasible.

12.3 The symptomatic resident is tested immediately in accordance with ministry guidance for testing for residents, HCWs, and other staff.

12.4 The local Public Health Unit is notified.

12.5 Identification of a resident(s) OR HCW(s), other staff member(s) or essential visitor(s) presenting with symptoms compatible with COVID-19 immediately triggers an outbreak assessment by the local Public Health Unit.

12.6 A line-listing of suspected or known cases is kept updated as new cases develop and shared with the local Public Health Unit.

12.7 Contacts of the suspected or known case(s) are identified.

12.8 Residents who were in close contact (i.e., shared room) with a symptomatic resident, HCW, other staff or essential visitor are tested.

12.9 During an outbreak, residents do not leave the home for short-stay absences to visit family and friends.

12.10 During an outbreak, residents who wish to go outside of the home are told to remain on the home‘s property and maintain safe physical distancing.

12.11 When there is a suspect or known case, provide in-room tray service to avoid communal dining, to those residing in the affected area.

12.12 When there is a suspect or known case, all group activities are stopped.

12.13 Alternative activities to support residents‘ well-being are in place.

12.14 The home has a process to ensure that any external agency, engaged to assist the home, follows the directions of the local public health unit when providing services at the home.

12.15 Those employed by the external agency have received appropriate IPAC training by either the agency or the home with whom they are engaged.

13.1 PPE (gloves, gowns, medical masks, eye protection) required for caring for resident is readily accessible (e.g., store just outside the resident room in a manner that will keep the PPE clean and dry).

13.2 All suspected and know COVID-19 cases are cared for on Droplet/Contact Precautions

13.2.1 Hand hygiene is performed and PPE is donned prior to entering the resident‘s room.

13.3 Home has a plan for cohorting or grouping residents, in consulation with the Outbreak Management Team, following the guidance in COVID-19: Cohorting in Outbreaks in Congregate Living Settings:
For small homes – determine the need for the home to be considered a single unit, where all residents are managed as infected/potentially infected and HCWs use Droplet/Contact Precautions for all residents and while in the affected area.

13.3.1 HCWs are assigned to care for only a specific cohort of residents

13.4 Wherever possible, PPE is removed and hand hygiene performed, just at the exit of the resident room, following the process described in Recommended Steps: Putting on and Taking Off Personal Protective Equipment (PPE).

13.5 Garbage and/or laundry bins are positioned near the exit inside of the resident room to make it easy for staff to discard PPE after removal, and prior to exiting the room.

13.6 Signage is clear indicating the resident is on Droplet/Contact Precautions.

13.7 There is signage indicating the correct sequence of donning and doffing PPE.

13.8 Droplet/Contact Precautions remain in place as indicated in the most current guidance document

14.1 There are written polices and procedures with respect to accepting new admissions, as well as transfers of residents from other health care facilities back to the home (re-admission), in accordance to the requirements described in COVID-19 Directive #3 for Long-Term Care Homes under the Long-Term Care Homes Act, 2007 and COVID-19 Guidance for Long-term Care Homes in Ontario.

14.2 There are no new admissions or re-admissions while home is in an outbreak unless otherwise directed or permitted by the public health unit.

14.3 There is a written policy and procedure with respect to permitting residents to go on absences in accordance with the requirements described in COVID-19 Directive #3 for Long-Term Care Homes under the Long-Term Care Homes Act, 2007.

14.4 Residents are provided a medical mask (worn as tolerated) and residents are reminded follow public health measures, such as physical distancing and hand hygiene, while they are away from the home.

14.5 All residents on an absence, regardless of type or duration of the absence, are actively screened upon their return to the home.

15.1 HCWs receive education and training on care of a deceased COVID-19 patient (i.e., Droplet/Contract Precautions continue after the person has died).

15.2 The LTCH follows directives from the Bereavement Authority of Ontario and the Chief Coroner for Ontario regarding the management of deceased residents.

15.3 The home contacts the local public health unit immediately following the death of any person from confirmed or suspected COVID-19.

16.1 The outbreak is declared over by the local Medical Officer of Health or designate in collaboration with the Outbreak Management Team when there are no new cases in residents or staff after 14 days from the latest of:

16.1.1 Date of isolation of the last resident case; OR

17.1 Environmental cleaning is performed using a health care grade cleaner/disinfectant with a drug identification number (DIN).

17.2 Aerosol or trigger spray bottles are not used to apply cleaner/disinfectants.

17.3 Contact time, as indicated in the disinfectant‘s manufacturer‘s instructions for use, is adhered to.

17.4 High touch surfaces are cleaned at least once per day. A list of the high touch surfaces to be cleaned is maintained. Who is responsible for cleaning the high touch surfaces and when they were cleaned is recorded daily.

17.5 Equipment that cannot be dedicated to a single resident is cleaned and disinfected between residents.

17.6 There are policies and procedures regarding staffing in Environmental Services to allow for surge capacity (e.g., additional staff, supervision, supplies, and equipment).

17.7 There is a policy for cleaning rooms of residents who are on Droplet/Contact Precautions (suspect and confirmed cases).

17.8 Environmental Services staff receive education and training on hand hygiene and the correct way to clean (e.g., use the correct dilution, correct contact time, clean from clean to contaminated and from top to bottom, do not double dip).

18.1 There is a process for auditing compliance to hand hygiene, Routine Practices, Additional Precautions, PPE use (e.g., how one dons and doffs), and Environmental Cleaning.