PRINCETON HEALTH CARE CENTER

SAFETY AND DISASTER MANUAL

POLICY AND PROCEDURES

Revision 2/1/2018

TABLE OF CONTENTSPURPOSE / EXPLANATION / TRAINING ………………...…..…………………………..2

RESPONSIBILITES…………………………………………………………………………3-5SPECIFIC PROCEDURES…………………………………………………………………….5

ACTIVE SHOOTER / VIOLENT INCIDENT (CODE BLACK)…….…………………6-7ARMED ROBBERY………………………………………………………………………….8-9BOMB THREAT……………………………………………………………………………10-12CHEMICAL SPILLS…………………………………………………………………………..13CIVIL DISTURBANCE………………………………………………………………………..14EARTHQUAKE………………………………………………………………………………...15

ELECTRICAL OUTAGE / GENERATOR FAILURE………………..…………………….16ELOPEMENT (CODE SILVER)………………………..……………………………….17-23EMERGENCY EXPLANSION OF SERVICES……………………………………………..24

EVACUATION OF RESIDENTS / RESIDENT TRACKING TOOL.………………….25-28EXPLOSION……………………………………………………………………………………29

FIRE (RACE & PASS) (CODE RED)……………………........………….…………………30

SPECIFIC DUTIES…………………………………………………………….…..31-33FIRE ALARM PROCEDURES……………………………………..……………..34-35FIRE WATCH PROCEDURES / LOG…………....…………………….………..36-38

FLOOD PLAN………………………………………………………………….……………….39INCLEMENT WEATHER…………………………………………………………………40-42INTERNAL SECURITY……………………………………………………………………….43MASS CASUALITIES………………………………………………………………………....44

TORNADOE / HIGH WINDS………...……………………………………………………45-46WATER OUTAGE……………………………………………………………………………..47WILDFIRES…………………………………………………………………………………….48

LOCATION OF MASTER UTILITY CONTROLS…………………………………………49PHONE OUTAGE……………………………………………………………………………...49

EMERGENCY EYE/BODY WASH STATIONS…………………………………………….49TOBACCO FREE ENVIRONMENT…………………………………………………………49

TRANSFER AGREEMENT…………………………………………………….......……...50-52DRAWING OF FACILITY…………………………………..……………….…….………….53MANUAL APPROVAL PAGE…………………….…………………………………………..54

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DISASTER PREPAREDNESSSTANDARD PROCEDURES FOR

PRINCETON HEALTH CARE CENTER

I. Purpose To set forth basic responsibilities and outline actions to be taken to protect life, property, and continue to provide resident care in this facility during natural or other disaster situations.

II. Explanation

A disaster is defined as a serious disruption, occurring over a relatively short time, of the functioning of a community or society involving widespread human, material, economic or environmental loss and impacts, which exceeds the ability of the affected community or society to cope using its own resources.

III. Education and Training All employees on the premises during a drill are to immediately report to assigned work stations. This

includes employees on breaks and lunches. Fire Drills will be conducted quarterly for each shift, under the supervision of the Administrator and

with the cooperation of the alarm company. All drills are reviewed by the safety committee and reported to QAPI quarterly.

Periodic training sessions are practiced in fire exercise drills and reviewed annually in the walk thru. Copies of the Fire Plan are posted throughout this facility. Extra copies are available at the Administrator's office and a copy is included in this Disaster Plan. Study the Fire Plan, learn what your duties are and memorize the location of all the exits and fire extinguishers.

Residents and/or the responsible party will be provided information regarding the facility’s emergency plan. A fact sheet on the emergency plan will be provided in writing during the admission process, upon request, and whenever there are revisions. The emergency plan is available upon request and on the facility’s website.

All employees will know the location and operation of the main controls for shutting off the electricity, gas and water leading into this facility. It’s reviewed in orientation and annually in the walk thru. In the event of a disaster affecting any or all of these utilities, you may be the only person on duty to alleviate the danger.

IV. Receipt of Disaster Warning for All Employees All employees that are on the premises during a drill are to immediately report to assigned work stations.

This includes employees on breaks or lunches. All emergency actions will be coordinated at the Control Center (Administrator’s Office) or another

location as announced. If there is a Civil Defense "alert or attack warning", the facility will be notified via telephone from a

local or state law enforcement agency or the Mercer County LEPC (Local Emergency Preparedness Committee)

Any employee receiving notification of a potential disaster situation or an actual disaster that could affect this facility, will immediately inform the Nursing Supervisor on duty. Depending upon the extent and nature of the situation, and if in the opinion of that supervisor the situation warrants, the following personnel will be notified in the order listed:

Administrator Office Phone: 304-431-4226 Cell: 304-961-0717Director of Nursing: Office Phone: 304- 431-4206 Cell: 304- 888-4428

Maintenance Office Phone: 304-487-3458

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John Walker: Cell: 304-809-1962V. Disaster and Fire Control Committee:

The following personnel constitute the Disaster Control Committee within this facility. In the event of notification or an awareness of an actual or impending disaster affecting this facility, they are to report immediately to the Control Center unless their services are required to provide on-the-scene assistance in their area or responsibility:

AdministratorDirector of Nursing

Case Managers Nursing Supervisor

Maintenance DirectorMedical RecordsMedical DirectorOffice ManagerDietary ManagerHousekeeping/Laundry SupervisorSafety Chair PersonAll other personnel remain in your assigned working area, provide assistance as needed and await for further instructions.

VI. Responsibilities: The Administrator will assume responsibility for coordinating emergency actions uponarrival at the facility. In his/her absence the Director of Nursing (DON) or Nursing Supervisor on duty will assume this responsibility in the order listed:

A. Administrator: The Administrator or designee will assume responsibility for notifying other staff members. Employees may be called to return to the facility only upon the order of the Administrator. The purpose of recall is to form a personnel pool for use in emergency situations.

Verifies nature and extent of disaster. Assumes control of all emergency actions within the facility. Assigns tasks to committee members. Augments departmental staff with any available personnel. Directs and initiates recall of off-duty personnel. Authorizes issuance of emergency supplies and equipment as needed. Orders evacuation, if necessary. Releases public information to the news media and the public, or delegates this.

B. Director of Nursing

In the absence of the Administrator, assumes control of all emergency actions and performsduties listed above.

Assigns nursing personnel to effect best utilization. Initiates recall of nursing unit personnel as necessary. Supervises relocation of residents.

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C. Case Managers

In the absence of the DON assumes the above responsibilities. Assist DON/Supervisor as assigned

D. Nursing Supervisor

In the absence of the Administrator, DON and Case Managers, assumes control of all emergency actions and performs duties listed above.

Notify Administrator and DON. Accounts for all residents and staff

E. Maintenance Director

Aides in verifying the nature and extent of the disaster. Assist Administrator/Director of Nursing as instructed.

F. Medical Records

Responsible for ensuring a complete accurate record accompanies the resident to the best extent possible.

G. Office Manager

Assists Administrator as required. Keeps Administrator informed. Secures resident’s records/files and any other information designated by the Administrator.

H. Dietary Manager

Maintain food service for all residents and modify as necessary Maintain contact with suppliers. Maintain adequate supply of food on hand to serve residents and staff as needed. Keep Administrator informed.

I. Housekeeping\Laundry Supervisor

Provide housekeeping duties as necessary. Prepare/direct to issue linens and blankets as directed. Assign housekeeping personnel as directed. Assist other departments as needed.

J. Social Services/Activities Directors

Will assist in maintaining location of residents. Assist with notifying responsible parties. Perform other duties as assigned.

K. Medical Director

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Responsible for triage of injured/trauma victims Assist Administrator/Director of Nursing as instructed.

VII. Public Information

Information to the news media or the public concerning emergency activities at this facility will be released only by the Administrator or designee. This is necessary to prevent the release of misinformation regarding the exact nature and extent of the disaster.

Appointed public person will be directed to the Administrator's office.

VIII. Care of Disaster Caused Fatalities

After a resident has been declared dead by a physician, the Administrator or Director of Nursing will be responsible to perform or delegate:

a. Preparing death certificate(s), b. Notifying next of kin.c. Completing all necessary documentation in the residents’ record.d. Making mortuary arrangements with the listed mortuary providere. Supervising removal of the deceased.

XI. Specific Procedures

The remainder of this plan consists of separate sections. In each section is a list of actions (and supporting data) that it is expected you will need to take in each of the following situations:

Active Shooter/Violent Incidents Armed Robbery Bomb Threat Chemical Spills Civil Disturbances Earthquake Electrical Outage/Generator Failure Elopement Emergency Expansion of Services Evacuation of Residents Explosions Fire Flood Plan Inclement Weather Internal Security Mass Casualties Tornado/High Winds Water Outage Wild Fires

Active Shooter/Violent IncidentsCODE BLACK

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Our facility is committed to maintaining a safe environment, including safety from violence. The intent of PHCC is to minimize the potential and actual impact to residents, employees, visitors, and property resulting from individual(s) brandishing a firearm or other weapon, or claiming to possess a firearm/weapon with the expressed intention of causing harm.

A. Response Plan:

Any employee who becomes aware of any individual(s) on facility property threatening/acting to cause harm with a deadly weapon will perform the following:

Call 911 for law enforcement assistance. This can be done by anyone when it is safe to do so. If possible, use a facility phone. This will allow the 911 operator to positively identify the address you are calling from without you having to give it. If using a cell phone, the 911 operator may not be able to identify your location unless you give them the address.

Report facility name and location (if using a cell phone), your name, what is happening, where you and the assailant are located, description of the subject or shooter (if known), type of weapon(s), number and extent of persons injured.

If you are unable to speak, leave the line open and allow the dispatcher to listen. If possible, page overhead “Code Black” with location of threat. If after hours, notify Administrator/Director of Nursing as soon as possible.

B. Code Black Action Plan: Do Not respond to location of Code Black. Do Not pull the fire alarm. This will bring others into harm’s way that are unaware of the

dangerous situation. Do Not approach, confront, or provoke the assailant. Assess the threat in your immediate area to determine ability to safeguard self and others. If you must flee the immediate area of gunfire, run in a zigzag pattern utilizing obstructions. If possible, secure residents/visitors/employees in a single room on unit with door closed and

locked/barricaded. If possible, close all doors, including security and fire doors, to unit or between shooter and

populated areas. Lock doors or barricade with any available heavy object. Close windows and/or blinds. Turn off lights. Silence pagers, cell phones, and any other source

of noise, and remain quiet. Hide under objects or in closets. Be out of shooter’s view. You should make a choice to attempt to negotiate with or overpower the assailant ONLY if there

is no possibility of escaping, and as a LAST resort when your life is in imminent danger.

C. Incident Command Procedure: When the situation allows, the highest ranking employee will initiate an Incident Command”.

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Incident Command is the approach to control and coordinate personnel and emergency services via telephone, cell phone, etc.

Work with law enforcement once they are in position on site. Restrict access of general public into the facility.

D. Interaction with Law Enforcement: Follow officers’ instructions. They are in charge. Put down any items in your hands, including bags and jackets. Keep hands visible at ALL times. Avoid making quick, unexpected movements toward officers such as attempting to hold on to

them for safety.

E. Post Incident Response (after law enforcement has determined the threat has ceased to exist): Obtain a list of all employees and residents known to be in the facility at the time of the incident,

and account for them. Provide first aid or arrange for transport to hospital as needed. Licensed staff may utilize

professional judgment when deciding to transport at the time of immediate post-incident assessment.

Determine need/method for notification of family members of employees/residents. Obtain a list of visitors present in the facility at the time of the incident, including contact

information. Perform walk through of building to determine if there is property damage. Restrict access to

damaged areas. Work with Social Services and outside agencies on securing counselors as needed.

ARMED ROBBERY

In the event an armed robbery affects the facility, the following actions will be taken:7 | P a g e

A. Response Plan:

Remain calm and make no necessary movements that may cause the robber to harm you.

Cooperate with the robber. Do not try to become a hero. Follow the robber’s commands including demand for drugs / narcotics. Do not use or encourage the use of weapons against the robber. Introducing

another weapon into the situation increases the chances of someone becoming injured during the robbery.

If the robber displays a firearm or claims to have one, consider it loaded and that they would use it.

Try to alert other employees of the situation by using signals. If the robber uses a written note, try to place it out of sight to retain it as

evidence. Be observant. Plan to be a good witness. Mentally note as many

characteristics of the robber as possible. Make mental notes of the following: Race, sex, age, height, weight, color of eyes/hair, speech patterns

(accents), scars, marks and/or deformities, right or left handed The number of robbers Clothing description Any names used by the robbers Weapons used Try to remember all that was taken by the robber. Do not chase or follow the robber. The robber may shoot at any

pursuers.

B. Post Robbery Procedure:

Secure the doors so the robber cannot reenter the facility. Call 911 immediately. Notify if anyone is injured so they can dispatch

medical personnel. Notify the Shift Supervisor as soon as you are no longer in danger from the

robber. Notify Administrator and Director of Nursing as soon as possible. If it can be safely accomplished as the robber leaves, try to note method of

escape along with the direction of travel. If a vehicle is used, try to find out the make, color, type, license number and state of registration.

Protect the scene of the crime and do not touch anything the robber may have touched. Keep people out of the area.

Write down description of the robber. Complete Description Checklist. Assist law enforcement personnel in every way possible. All persons involved

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should remain available to talk to the law enforcement agency

ARMED ROBBERY DESCRIPTION CHECKLIST

PHYSICAL DESCRIPTION

Color ____________________ Sex ______ Nationality _______________ Age _______ Height __________

Weight ______ Hair Color ________ Speech (accent, impediment) ________________

Mannerisms (twitch, unusual walk, nervous) / Other distinguishing characteristics _______________________

_________________________________________________________________________________________

Build (thin, stocky, etc.) _______________________ Complexion (dark, ruddy, acne, etc.) ________________

Nose (large, broad, etc.) _______________________ Ears (prominent, small, etc.) _____________________

Glasses (frame) ___________________

Facial Hair (moustache, beard, long sideburns, etc.) Right or Left-handed__________________________________________ _________________________________________

Scars, marks, tattoos, piercings or deformities (describe) Other distinguishing physical characteristics

_____________________________________________ __________________________________________

CLOTHING (Describe color, type of material, style, etc.) MISCELLANEOUS

Weapon exhibited ( ) yes ( ) no

Describe weapon ___________________________________________________

Mask or other disguise (type, color, etc.) ______________________________________________________

Hat / Coat / Shirt / Pants / Shoes / etc. ____________________________________________________________________________________________________________________________________________________

Other clothing (tie, scarf, headband, jewelry, etc.) ___________

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List any names used by robber _________________________________________________________________ _________________________________________________________________

FOR ADDITIONAL SPACE, CONTINUE ON REVERSE SIDE

BOMB THREAT

Any bomb threat, either verbal or written, should be taken seriously and be reported immediately to the appropriate local authorities. A bomb threat should cause the initiation of the facility’s comprehensive emergency management plan. All personnel should familiarize themselves with the facility’s plan and act accordingly in a bomb threat situation. In the event of a Bomb Threat, the following actions will be taken:

A. Response Plan Dial 911 and notify of bomb threat situation. Notify Administrator and Director of Nursing immediately upon awareness of bomb threat. Notify Shift Supervisor. Upon notification of a bomb threat, or that a suspicious object has been

found, the Nursing Supervisor will take the actions listed in the response plan. Receive resident accountability from other nurses.

Be familiar with the layout of the building. Building diagrams showing evacuation routes are posted throughout the facility.

Provide layout of the building to local law enforcement upon arrival. This is located in this manual.

Visitors should be requested to leave the premises. Do not allow any re-entry into the building unless cleared by local law enforcement. Employees must remain alert to any unfamiliar, unauthorized or suspicious persons and

immediately report their presence to the supervisor. Employees must be alert for any suspicious looking, suspicious sounding or unusual items found

in their work area and immediately report such items when found to their supervisor. DO NOT MOVE OR TOUCH THE OBJECT IN QUESTION.

Evacuate residents and staff personnel from facility only with administrative and local law authoritative advice.

B. Written Bomb Threat that does not accompany a package Follow Response Plan. Do not handle the letter any more than necessary. Search the premises. Have personnel objectively search their respective areas for any unusual or

unfamiliar items, such as boxes, packages, or bags. Residents should not be involved in the search. The search should be conducted very quietly, but quickly and thoroughly. If any unusual food item is found, do not disturb it.

Discreet communication should be used to avoid upsetting the residents. Place facility on lockdown.

C. If the written bomb threat/delivery medium accompanies a package, immediately evacuate the area.

Follow Response Plan. Report exact location and description of the object.

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Follow fire plan for checking, evacuating, and securing rooms. Attempt to isolate the area, removing residents and staff by working out away from the area with

the object.D. Leave as many windows and doors open to minimize blast and fragmentation damage if explosion

occurs. Telephoned (Verbal) Bomb Threat If a telephone call is received, the person answering the phone should try to talk with the

individual as long as possible. Follow Bomb Threat Checklist to note any distinguishing characteristics of the caller and

background noises. Keep caller talking if agreeable to further conversation. Ask the caller questions such as:

Where is the bomb (or bombs) right now? When is the bomb going to explode/time remaining? What does it look like? What kind of bomb is it? Did you place the bomb? Why? Where are you now? What is your name? Where do you live?

While bomb threat caller is on the telephone talking with another employee, dial 911 and report: Your name and facility A bomb threat is being received Telephone number the caller is using Request emergency trace of the call Have the person receiving the bomb threat complete the bomb threat checklist as soon as

possible and remain available to talk with law enforcement personnel when they arrive. Entire conversation needs written and any other comments on a separate sheet of paper and attached to checklist.

Continue to follow Bomb Threat Response Plan

E. Things to Remember

Remain calm. Conduct your search efficiently, but do not create any more activity than absolutely necessary. Cooperate fully with local fire and police departments. Total evacuation of the facility is not recommended unless directed by the authorities.

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TELEPHONE PROCEDURESBOMB THREAT CHECKLIST

Instructions: BE CALM! BE COURTEOUS! LISTEN, DO NOT INTERRUPT THE CALLER. NOTIFY SUPERVISOR OR OTHER STAFF MEMBER WHILE CALLER IS ON LINE.

NAME OF OPERATOR: ________________________________ DATE: _____________ TIME: _________

CALLERS IDENTITY:

SEX: _____________ MALE_______________ FEMALE__________ ADULT______ JUVENILE ________

APPROXIMATE AGE: ____________ CALLER APPEAR FAMILIAR WITH BUILDING ___________

ORIGIN OF CALL:

PHONE NUMBER DISPLAYED: _______________________________

LOCAL______ LONG DISTANCE______ INTERNAL (Within Building)

VOICE CHARACTERISTICS SPEECH

LOUD____________ SOFT________ FAST_______ SLOW______HIGH PITCH______ DEEP________ DISTINCT___ DISTORTED________RASPY___________ PLEASANT___ STUTTER___ NASAL______INTOXICATED____ SLURRED___ LISP_______ OTHER _________________________ OTHER________________________________

LANGUAGE ACCENT

EXCELLENT______ GOOD ________ LOCAL________ NOT LOCAL_______FAIR_____________ POOR ________ FOREIGN______ REGION___________FOUL____________ OTHER _______ RACE _________

MANNER BACKGROUND NOISES

CALM___________ ANGRY_______ MACHINES____ TRAINS____RATIONAL_______ IRRATIONAL_____ ANIMALS____ VEHICLES ____COHERENT_______ INCOHERENT____ MUSIC____ ROAD NOISE ____DELIBERATE_____ EMOTIONAL_____ VOICES____ QUIET____RIGHTEOUS______ LAUGHING______ AIRPLANES____ PARTY ____

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CHEMICAL SPILLS

Internal:

Block off and remove residents/staff from affected area.

Refer to SDS for appropriate precautions and actions to take.

Notify Administrator, Director of Nursing, and Maintenance.

Turn off air handling units to curtail spread of any hazardous fumes.

Utilize cloth pads, blankets, towels as needed to contain spill.

Determine if resident evacuation is necessary; if so, institute evacuation procedures as determined by Administrator or Director of Nursing.

Call Princeton Fire Department (Hazmat) at 911 if necessary.

External:

Notify Administrator, Director of Nursing, and Maintenance.

Conduct fire drill to institute closing windows, doors, cutting off air handling units to curtail passage of hazardous fumes into facility.

Utilize wet cloths, wet blankets, towels to impede fume penetration.

Determine if evacuation is necessary; institute evacuation procedures as determined by Administrator or Director of Nursing.

Call Princeton Fire Department (Hazmat) at 911 if necessary.

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CIVIL DISTURBANCE

Civil disturbance means acts of violence and disorder prejudicial to the public law and order. It includes acts such as riots, acts of violence, insurrections, unlawful obstructions or assemblages, or other disorders prejudicial to public law and order.

In the event a civil disturbance affects this facility, the following procedures apply:

1. Ensure that all residents and staff personnel on duty are inside the facility.

2. Each department manager will be responsible to see that all exterior doors and windows in their department are closed and locked as soon as all residents and staff personnel are inside.

3. Each department manager will have all Fire Doors located in their department closed.

4. The Nursing Supervisor will immediately establish internal security within the facility.

5. Call Police at 911.

6. If off-duty hours, notify the Administrator.

7. The Nursing Supervisor, Director of Nursing or designee will have all residents moved away from exterior doors and windows. Staff personnel will be reminded to remain clear as well.

10. Maintenance or designee will insure that a constant patrol is maintained within the facility to detect any unusual situations.

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EARTHQUAKE

An earthquake will occur without warning and undoubtedly cover a large area. Do not expect instant response from outside assistance.

A. Active-Earthquake: All personnel attempt to get as many residents into doorways, under tables, and other safe

places. Drop, cover, and hold on when earth shakes Lock equipment (beds, wheelchairs, etc.) Protect head and neck with your arms, pillows, or blankets Do not move anyone outside

B. Post-Earthquake: Restore calm to the residents. Check all residents for injuries and other ill effects. Set-up command station and triage area for any injured Check / observe for gas odors / leaks Check / observe for water ruptures / leaks Check / observe the facility grounds for ruptures and/or liquefied soils Check for fires throughout the facility.

C. Procedure: Maintenance is responsible for assessing utilities and shutting off all gas, electricity, and water at main controls if necessary

The main water valve, main sprinkler valve and main electrical power shut off is located in the Mechanical/Electrical room through the employee lounge across from the women’s bathroom.

The main gas valve is located in water heater room. Take east exit door in service hallway, turn right, door to left marked Main Gas Valve (left of door entrance).

Maintenance will immediately inspect the facility for damage and report to the person in charge of the facility at that time.

Inform Administrator, Director of Nursing and the Nursing supervisor of the situation if after hours.

If no structural or minimal structural damage has occurred, maintenance will turn on utilities one at a time and check building to see if each utility is operating properly.

Inform the Mercer County LEPC (Local Emergency Preparedness Committee) If major structural damage has occurred, the Shift Supervisor will order the evacuation of

residents from the damaged area. See section entitled "Evacuation of Residents". Establish additional security for the facility. If structural damage, Maintenance will have the building inspected as soon as possible. Monitor media for hazard updates For water outage, call Water Company, telephone number 1-800-685-8660. For low

water pressure and there is not a leak call the ADA plant at 304-327-8913 or 1-304-466-5085. If outage is to be more than 4 hours you must call OHFLAC at 1-304-558-0050.

For electrical outage, call Electric Company, telephone number 1-800-956-4237ELECTRICAL OUTAGE

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A power outage (also called a power cut, a power blackout, power failure, or a black out) is a short-term or a long-term loss of the electric power to a particular area.

Identify oxygen dependent residents and convert to a portable oxygen cylinder in an approved transport carrier until electricity is restored.

Observe all residents to ensure their safety.

Utilize Emergency Supply Kits located in Central Supply and the Therapy department. Supply kits will include flashlights, portable radio scanner, batteries, etc.

Access the facility cell phones located in Medical Records for emergency use.

Call Electric Company (emergency services), telephone number 1-800-956-4237.

The Administrator, Director of Nursing or Nursing Supervisor as directed by Maintenance will ensure all electrical switches are off before electricity is restored

All areas of this facility will be supplied by alternate power supply system.

GENERATOR FAILURE

Call Cummins Crosspoint, LLC for generator failure/emergency service 304-769-1012.

Cummins service personnel can talk through manual starting procedure. Instructions are also located in the door of generator.

If needed, Cummins can have assistance to facility in 2-2 ½ hours unless unexpected delay.

Facility generator tank hold 3,000 gallons/ 71.77 hours at maximum load.

Rumley Oil Co. will deliver additional diesel for generator if needed. Call 304-898-5871

ELOPEMENT OF RESIDENTS (CODE SILVER)

CODE SILVER16 | P a g e

A missing resident is called “Resident Elopement”. It occurs when a resident leaves the premises or a safe area without authorization and/or necessary supervision to do so. It is the mission of PHCC to provide a safe and secure environment for all residents. Staff who have residents under their care are responsible for knowing the location of those residents at all times. In the event of resident elopement, it is the policy of the facility to immediately implement procedures to locate the resident in a timely manner.

A. Resident Elopement Response Plan

Any staff member becoming aware of a missing resident will immediately alert the Nursing Supervisor.

Nursing Supervisor will announce overhead “Code Silver” times three. If off-duty hours, notify Administrator and Director of Nursing. Assemble all available department managers. Nursing Supervisor to organize and institute a thorough search of the facility, facility grounds and

surrounding areas as listed. Follow the Elopement Incident Search Assignment. When designated area checked, staff to report back to nursing station with findings and await further instructions.

If the resident is not located in the facility or facility grounds, the Administrator or designee will notify the local police department via 911. Administrator or designee will serve as the designated liaison between the facility and the police department.

Nursing Supervisor or designee to notify the attending physician and responsible party. Police will be given a description and information about the resident, including any available photos

and face sheet. See Resident Description. Recall off-duty personnel as needed. Notify volunteers listed by the Activities department for additional search personnel as needed. When resident is located, notify police department, search personnel, relatives, physician, and any

others who were alerted resident was missing. Nursing Supervisor to announce overhead “Code Silver” all clear times three after resident is found. Appropriate reporting requirements to the State Survey agency shall be conducted.

B. Post-Elopement Procedure:

Assess resident for harm. A nurse will perform a full body assessment, document, and report findings to physician. Any new physician orders will be implemented and communicated to the responsible party. Monitor resident with a frequency of 15 to 30 minute intervals. Case manager to review existing care plan for facility compliance with resident plan of care

investigating what transpired and record. The resident and responsible party will be included in the care plan meeting.

Administration, Director of Nursing, and Case Managers to revisit policies and protocols related to the occurrence and evaluate for effectiveness and need for modification.

Evaluate resident for placement of RoamAlert Securaband Staff education will be conducted on elopement and possible strategies for avoiding such behavior.

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Documentation in the medical record will include: findings from nursing and social service assessments, physician/family/responsible party notification, care plan discussions, and consultant notes as applicable.

Safety committee to review and evaluate what happened, what went wrong, and how to prevent reoccurrence.

C. Resident Description:

1. Name:____________________________

2. Sex:______________________________

3. Age:______________________________

4. Time Discovered Missing:_____________

5. Where resident last seen:_________________________

6. Physical Description:

a. Height:______________________

b. Weight:______________________

c. Race:________________________

d. Hair color:____________________

e. Eye color:_____________________

7. Physical impairments, if any:________________________________

________________________________________________________

8. Mental condition:__________________________________________

9. Language spoken:____________________________

10. Color and type of clothing worn, if known:_______________________

__________________________________________________________

11. Is resident harmful to him/herself, or others? ______________________

12. Home address:______________________________________________

13. Address of any known friends or relatives:________________________

___________________________________________________________

14. Favorite haunts of resident, if known:_________________________

ELOPEMENT INCIDENT SEARCH ASSIGNMENTHighest ranking on-site staff member coordinating search:

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ZONE ONE (Facility Premises)

Staff Assigned Post-Search Report & Time

Entire Outdoor area

All Offices

Entire North Unit

Entire South Unit

Maintenance area

Dietary area

Housekeeping area

Laundry area

Main Lobby/Employee Lounge

All Outside Buildings

Entire Parking Lot & Cars

Entire Training Center

** If search of facility and grounds fails to locate missing resident, notify law enforcement @ 911**

ZONE TWO(Off Premises)

Staff Assigned Post-Search Report & Time

Over hill beyond wooden fence in front of facility to Bluefield/Princeton Rd.

Cheers parking lot/Everlasting Monument.

Morning Side

Hill Crest

City View Heights

ZONE THREE(Off Premises)

Staff Assigned Post-Search Report & Time

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Wendy’s

Fire Department / Hospital

Princeton Park

Hunnicutt Stadium

Roselawn Cemetery including Mausoleum

Lees MHP

Ramey Ford

SEARCH WILL END AT RAMEY FORD, PRINCETON HOSPITAL, COURTHOUSE, AND BB&T BANK LOCATED ON STAFFORD DRIVE.

Employees who can drive Facility Vehicles: Activities Department, Maintenance, Restorative Department, Stefanie Compton, Keith Buchanan, Christie Bailey, Robert Bailey, Vanessa Davis, and Crystal Dunn.

SUBJECT: CODE SILVER (MISSING RESIDENT / ELOPEMENT) EFFECTIVE: 3/25/2013

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DEPARTMENT: ALL

FORMULATED BY: CHRISTIE BAILEY, BSN, RN, DONPAGE: 1OF: 1

APPROVED BY: REVISED: 12/08/2015

POLICY:

It is the policy of Princeton Health Care Center to provide a safe and secure environment for all residents. In the event of resident elopement it is the policy of the facility to implement its policies/procedures immediately to locate the resident in a timely manner.

PURPOSE:

1. To assure the safety and security of all residents.

2. To establish policies and procedures in the event of a missing resident.

3. To train and maintain staff awareness of the importance of resident safety and security.

4. To provide a detailed guidance to follow during resident elopement.

ELOPEMENT RESPONSE TEAM:

The members of the Search Team include the following:

During normal business hours: All Department Heads, Supervisors, Maintenance personal are to report to Nurses Station after Code Silver is announced. Notify Administrators/ DON.

Off hours: All nursing personnel are to report to the Nursing Station except for one CNA from each side and one nurse from each side and other available staff, i.e., Housekeeping, Maintenance, and Dietary. Notify Administrators/ DON.

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PROCESS:

Responsibility Action

All Staff Will notify highest ranking nursing personnel of missing resident.

Highest Ranking Nursing Personnel

Will direct unit staff to begin search of each side immediatelyWill announce from any telephone, Code Silver and repeat three (3) times.

Response Team Upon hearing Code Silver announcement, report to designated Nurses Station.

Highest Ranking Onsite Staff Member

Assigns a search sector to each team member and records on the attached Elopement Incident Search Assignment form.Notifies DON/Administrator if needed and provides copies of residents face sheet to police, if needed.

Staff Assigned to Sector When sector search completed report back to nurse station for further instructions from.

Highest Ranking Onsite Staff Member

When resident is found, announce “Code Silver cancelled” and repeat three (3) times over PA system.

Administrator/Designee Notifies Princeton Police Department Emergency 911 that a resident is missing.

Nurse in Charge Completes appropriate documentation including condition of resident when last seen.

Administrator/Director of Nursing/Designee Notifies OHFLAC as per requirements.

Nurse in Charge Once resident is found follow successful 22 | P a g e

Escape/Elopement Algorithm. Elopement Attempts & Nursing Facility Actions

SITUATION I

Key FactorsAbility to Think, Make Decisions, and Understand is Intact.

WANTS TO LEAVE

Able to Think, Make Decisions and Understand.Staff believe resident will be at risk.

DISCUSS IMPLICATIONS OF LEAVING

Facts about weather, traffic, etc.Alternatives that would insure safety.

PERSIST IN LEAVING

Be sure they carry identification.Notify family, Attending Physician, and Administrative Person.

Document circumstance, interventions and outcomes.

\

LEAVES AND DOES NOT RETURN

Initiate Code Silver per Disaster policy.

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PLAN FOR EMERGENCY EXPANSION OF SERVICES

Should a mass casualty disaster occur in the vicinity of this facility, it may be necessary to utilize this facility as an emergency medical center. To provide this service, the following procedures will apply:

1. Notify the Administrator and Director of Nursing.

2. The Shift Supervisor will immediately notify 911.

3. The Director of Nursing or designee will call the Medical Director / Nurse Practitioner as necessary.

4. The Director of Nursing, with the advice and consent of a physician, will determine which of our residents may be released home, moved to a less private room or section of this facility, or temporarily placed in another nursing home, motel, hotel, school, etc.

5. The Director of Nursing or designee will arrange to have these residents moved.

6. Additional beds can be placed in hallways, North Unit Solarium and/or South Unit Lounge.

7. Director of Admissions \ Social Services will be responsible for registration of incoming residents.

8. Family members of incoming residents will be assembled in the North Unit Solarium.

9. Director of Nursing or designee will be responsible for advising families of resident's condition.

10. Administrator will be responsible for issuing press releases to the news media.

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EVACUATION OF RESIDENTS

It is the policy of PHCC to evacuate the building when deemed necessary to protect the life and safety of residents, employees, and visitors. Evacuation decisions will be made by the Administrator or local/state authorities.

There are several types of evacuation depending upon the particular disaster situation:

A. Complete evacuation of all residents to another facility. Princeton Recreation Center 304-487-5040 (See Transfer Agreement located in this manual)Princeton Rescue Squad complex 304-425-3914 (See Transfer Agreement located in this manual)Princeton Community Hospital, Parkview Complex 304-487-7000 (See Transfer Agreement in manual)

B. Complete temporary evacuation of all residents to an area adjacent to, but outside the facility.

C. Evacuation of residents from one section or wing of the facility to another section or wing.

D. Evacuation of certain rooms to other areas of the facility.

Complete Evacuation to another Facility

The Administrator will notify the Mercer County LEPC (Local Emergency Preparedness Committee) at 911

Only the Administrator / designee or local / state authorities may order an evacuation Move any resident or visitor from immediate danger. Do not wait for instruction. All available staff will report to their designated area of responsibility if possible. The Administrator will determine where residents will be evacuated. Evacuation priority will be:

Ambulatory Residents Non-ambulatory Residents Visitors Faculty and Staff members

The Director of Nursing or designee will notify these facilities when the residents will be arriving, their condition, how many and their mode of transportation.

The Director of Nursing or designee will call physicians as needed. Nursing Secretary or designee will call off-duty personnel as needed. The Director of Nursing or designee will arrange for ambulances to move non-ambulatory residents.

Call 911 for Rescue Squad assistance The Director of Nursing or designee will arrange for transportation for ambulatory residents. Activity Director will call volunteer assistance groups for additional help. The Director of Nursing or designee will determine area of immediate danger and direct evacuation of

this area first. Housekeeping and Maintenance departments will provide available personnel to assist in the movement

of non-ambulatory and ambulatory residents. The Charge Nurse or designee will be responsible to see that medical records and medications

accompany each resident. Director of Nursing has large zip-lock bags to use for medication transfer.25 | P a g e

The Charge Nurse will insure that each resident has the proper identification before being evacuated. Plastic identification bands are in the Director of Nursing’s office and are to be placed on each resident before transfer.

The Director of Nursing or designee will record where and when each resident is evacuated. Tracking tool is located in this manual.

The Director of Housekeeping will be responsible to see that the necessary personal effects of each resident are at their new location as soon as available.

The Administrator or designee will notify responsible party of any fatalities should they occur. Staff will remain with residents in the relocated area until residents have been reassigned or transferred

or the building is safe to reenter. Contact resident’s responsible party once everyone is safe and accounted for. Must “Shelter in Place” when: the external environment would pose a greater danger to residents or

when adequate and timely facility and/or mutual aid resources are not available.

Temporary Evacuation to an Area outside the Facility

Under certain circumstances (smoke, toxic fumes, uncertain or unknown structural damage, etc.) it may be necessary to temporarily evacuate all residents to an outside area adjacent to the facility. The emergency actions to accomplish this are as follows:

The Administrator and/or the Director of Nursing will determine where to assemble the evacuated residents depending upon the wind, weather, etc.

The Director of Nursing or designee will determine area of immediate danger and direct evacuation of this area first and in case of injuries setup triage area.

The Director of Nursing or designee will call the physician as needed. Nursing Secretary or designee will recall off-duty personnel as directed. All available personnel will assemble as directed for instructions. Activities Director will call volunteer assistance groups for additional help. The Housekeeper Supervisor and Maintenance Supervisor will provide all available personnel to assist

in the movement of non-ambulatory and ambulatory residents. Medical Records will be responsible to see that all personal and medical records are moved, or

otherwise safeguarded from possible damage. Refer to FDA U.S. FOOD & DRUG ADMINISTRATION handout for Safe Drug Use After a Natural

Disaster. This is included in this manual.

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Emergency Preparedness Resident Tracking ToolPAGE: 1

DEPARTMENT: SKILLED NURSING OF: 2

EFFECTIVE: 7/7/17

APPROVED BY: Revised:

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EXPLOSION

In the event of an explosion, the following procedures apply:

After hours notify Administrator and Director of Nursing. The nurse supervisor is to start procedures until they arrive.

Call 911. This call also dispatches City Police. Also contact the State Fire Marshall’s office at 1-304-558-2191 ext. 218. After hours, weekends, and holidays call 911 and see if they will contact the Fire Marshall’s Office.

Call administration and physician.

The Nursing Department will render first aid as necessary.

The Director of Nursing or designee will set up Disaster Control Center to coordinate activities.

Nursing Secretary or designee will recall off-duty personnel as needed.

Establish security of area until police arrives.

Have all areas of the facility inspected for damage.

Have electricity and water systems checked for damage.

Have damaged or potentially damaged utilities shut off at main controls.

The main water valve, main sprinkler valve and main electrical power shut off is located in the Mechanical/Electrical room through the employee lounge across from the women’s bathroom.

The main gas valve is located in water heater room. Take east exit door in service hallway, turn right, door to left marked Main Gas Valve (left of door entrance).

Mechanical room door must stay unlocked and lights on at all times.

The Director of Nursing or designee will evacuate residents as necessary. See section entitled "Evacuation of Residents".

The Director of Nursing or designee will arrange for transportation of fatalities (if needed).

The Director of Nursing or designee will identify injured and fatalities.

The Case Manager or designee will notify the resident’s responsible party.

The Administrator will prepare public information/news for media release.

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SPECIFIC DUTIES IN CASE OF FIRE

Remain Calm!!

At the sound of the fire alarm, the specific duties assigned below should provide for a safe and orderly accounting for and, if necessary, safe evacuation of residents and employees.

Remember, your role is important for the safety of our residents. The key to ensuring the safety of our residents in the event of a fire is to be thoroughly familiar with the following procedures. You must also be familiar with the location of the fire alarms and fire extinguishers, and evacuation route s po s ted in your immed iate work area.

If you should discover a fire be prepared to take appropriate action. Remember RACE and PASS.

FIRE PROCEDURE PLANPRINCETON HEALTH CARE CENTER

IN THE EVENT OF A FIRE

R emove all persons from the area of smoke or fire. Only personnel in the fire zone must evacuate. Advise residents who are not in immediate danger to remain in their rooms. Tell residents if asked, "an emergency alarm is on'', REMAIN CALM!

Activate fire alarm system by pulling CALL FIRE DEPARTMENTthe nearest fire alarm pul l station & DIAL 911 Tell them to respond to:page overhead “CODE RED” and the location 3 times, by dialing *12. Princeton Health Care CenterAnnounce the exact location of the 315 Courthouse Road. fire in the building. Tell them where exactly the fire is in the building.

Confine smoke and fire by closing all doors and windows. Be sure all doors remain closed.

Extinguish fire. If possible, put out fire with fire extinguisher. Fire extinguishers are effective fire fighting tools; However, to use them against a very intense fire may place you indanger. In these cases, the safest action is to leave the area and wait for assistance.When necessary, Evacuate residents as directed by the Nurse Supervisor .

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During required fire drills a red tinted five gallon bucket with a blue lid containing red flashing lights will be considered a fire situation and RACE will be initiated immediately by the employee locating it. At the sound of the fire alarm, the following procedures will be followed by all employees on duty:

All Employees : Return immediately to assigned work area if alarm sounds while on break or lunch and begin performing your listed specific duty. Lights always remain ON at ALL TIMES to ensure optimum visibility.Be aware of the location of all fire alarm pull stations, fire extinguishers and emergency exits. Be prepared to obtain and use a fire extinguisher. Remember PASS.

Administrator : Report to the scene of the fire and be prepared to direct activities as necessary.

Director of Nursing (DON): Report to the nursing station and assist the nursing supervisor in directing activities.

Case Managers : Report to your wing and help charge nurse direct activities. Assist DON as above or act on her behalf in her absence.

Shift Nursing Supervisor : Report to nursing station and have the daily census readily available. Look for the fire location on the fire panel display (press the down arrow to ensure correct location). Press Page All button and announce CODE RED and location of fire 3 times.

(press talk and dial 9600 to announce on all cordless phones). Utilize any available personnel for assistance. Await for details of assessed situation by the department(s) with this assigned duty. In the absence of

these departments, be prepared to delegate to available personnel. Once the supervisor has determined the alarm to be a drill, the alarm can be silenced. If determined to be a fire, be prepared to give orders to evacuate residents or other actions as necessary. If off-duty hours, notify Administrator, Associate Administrator and Director of Nursing. Assemble all

other available department heads. Account for all staff in the building through department heads verifying their department is accounted

for. Also be prepared to evacuate vital resident records and information in the absence of Medical Records. When local fire department arrives, the fire chief assumes responsibility. If a drill, an ALL CLEAR will be announced 3 times. Follow alarm reset procedure in manual. Once reset and doors lock, nursing aides will visibly account for the assigned residents and report to

their nurse to ensure resident safety. After 4:30 p.m. an aide from North unit will be assigned to monitor exit doors in North dining

room and solarium. After 11 p.m. one nurse must remain at each nursing station. One nurse will also remain at the

North hub (outside of clean linen room) to monitor therapy exit, main entrance, south unit entrance and employee service hallway entrance.

After 11 p.m. an aide will be assigned to monitor the South lounge and dining room exit doors.

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Charge Nurse : Immediately return to nursing station. Make sure medication carts and treatment carts are locked and out of reach of residents. After the alarm is reset including locking of doors, direct nursing aides in accounting for all residents in their work areas and other areas as necessary. Report resident count to nursing supervisor. Under supervisor’s direction, be prepared to direct evacuation and/or other appropriate actions in your area of responsibility.After 11 p.m. one nurse must remain at nursing station. One nurse will also remain at the North hub (outside of clean linen room) to monitor therapy exit, main entrance, south unit entrance and employee service hallway entrance.

Nursing Aides : Immediately report to your assigned work area. Turn off heating/air conditioning units, bathroom heaters, etc. Close windows and doors. Do not disconnect oxygen unless orders given by Nursing Supervisor or charge nurse. Remove all objects (wheelchairs, lifts, linen carts, isolation carts, etc.) out of hallways into nearest resident room (unoccupied if available). Assure resident doors remain closed and assist in keeping residents calm. One Aide is to ALWAYS remain inside fire doors to monitor the exit doors at the end of each wing to ensure resident safety. When the alarm is reset including doors locked, VISIBLY account for each assigned resident on your worksheet. Report to nurse with correct count of your residents. Check all forms to see if your resident is signed off the unit.After 4:30 p.m. an aide from North unit will be assigned to monitor exit doors in North dining room and solarium. After 11 p.m. an aide will be assigned to monitor the South lounge and dining room exit doors.

Bed maker : Immediately move cart and/or supplies to the nearest resident room (unoccupied if available) without blocking exit. Report to nearest nursing station and await for further instructions.

Other : Bath Teams, Restorative aides, Dining room aides, trainees, students, and any other employee that are not mentioned above: Report to the nearest nursing station and await for further instructions.

Medical Records : Report to nursing station and be prepared to evacuate vital resident records and information. Await for further instructions.

Business Office Personnel : Ensure doors are closed to the administrator's office, business office and main lobby. Be prepared to evacuate vital records and information. Report to main entrance hallway and be prepared to instruct entering visitors to remain in main lobby until alarm has been cleared. Monitor South unit entrance doors to ensure resident safety.

Social Services : Each Social worker will report to opposite nursing stations and stand by for further instructions.

Activities Department : Report to nearest resident lounge or solarium and assist in keeping residents, volunteers and visitors calm. Monitor all exit doors to ensure resident safety. In the absence of residents in the lounge or solarium, only one staff member is to remain and others report to nearest nurses’ station and await for further instructions. Shall be required to perform CNA duties as needed. If returning from an outing, remain outside the facility until the alarm is announced all clear.

Environmental Manager : Report to south dining room to monitor exit doors to ensure resident safety. Assigned supervisor will act on her behalf in her absence until 11:00 p.m.

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Housekeeping Department : Report to assigned location. Turn off hallway ventilation fan. Assist in clearing hallways and closing doors. Report to nursing station and await for further instructions.

Laundry Department : Shut off all equipment including exhaust fans and heating /air conditioning units. Close doors to laundry room. Check mechanical room, employee lounge including restrooms to ensure resident safety. Report to South Wing Nursing Station and await for further instructions.

Dietary Manager : Check entire kitchen area and assist personnel in shutting off equipment. Report to north dining room monitor residents and exit doors to ensure resident safety. Head cook or designee will act on manager’s behalf in her absence.

Dietary Department : Shut off all equipment and close all windows and doors. This includes exhaust fans and heating/air conditioning units. Report to north wing nursing station and await for further instructions.

Maintenance Department : Report to scene of fire with a fire extinguisher, assess the situation and assist with extinguishing the fire. Secure area until fire department arrives. Supervisor or designee will report to the main lobby to meet and coordinate with local fire department upon arrival.

Therapy Department: If assisting residents when the fire alarm is sounding, ensure the resident is assisted to the nearest safest place. Report to the nearest nurses’ station and await for further instructions. Supervisor or designee will remain in therapy to monitor exit door and ensure resident safety.

Training Center Personnel : Monitor 300 wing exit door, 400 wing exit door and South lounge exit door to ensure resident safety. Perform duty only after the fire location is announced.

Training Center Nursing Personnel: Report to the affected location and assist as directed. Report ONLY after the fire location is announced.

All department heads are to account for staff and report to Nursing supervisor.

RESET CODE: #4358

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ABORT CODE WORD: GENESIS

FIRE ALARM PROCEDURES FOR PRINCETON HEALTH CARE

There are 4 annunciator stations. Locations: Main lobby, North and South Nurses’ Stations, on the front of the Fire Alarm Control Panel. Any one of them may be used to control the system and/or view conditions.

RESETTING AN ALARM

When an alarm occurs, the annunciator will display the alarm condition along with an audible tone. Follow these steps to reset alarm:

Press the ↓ arrow key once to display the location of the device (i.e. pull station or smoke detector) that has initiated the alarm.

After checking the device/area indicated, return to the annunciator and silence the alarm by pressing the “silence” button

Enter the 4 digit user code 4358 Once the condition has been corrected (i.e. resetting the pull station or clearing the area of smoke),

return to the annunciator and press the “reset” button Enter the 4-digit user code 4358. The panel will take a few seconds to reset. If the reset is successful, the

annunciator will display the message “all systems normal”. If the reset is unsuccessful, the alarm will re-sound and the procedure must be repeated.

Upon alarm activation, the MONITORING SERVICE (Alarm Central) will dispatch the Fire Department, then call the premises to verify the signal. If there is no need for the Fire Department to respond, the dispatch may be canceled by providing the monitoring operator with a valid abort code “GENESIS”.

TROUBLE CONDITIONS

Any one of several system events (i.e., low battery, device failure, phone line trouble, a break in wiring circuits, etc.) may generate a trouble condition. The system trouble indicator will light on all annunciators. Troubles may be silenced in the same manner as “resetting an alarm”. The specific trouble condition may be displayed by pressing the ↓ arrow button.

The MONITORING SERVICE will call the premises to advise of any trouble signals received. The Fire Department will not be dispatched in the event of a trouble signal.

SUPERVISORY ALARM

The annunciator will display a “supervisory” alarm condition when a sprinkler system shutoff valve is closed or tampered with. The fire horns and strobe lights will not be activated. This type of alarm may also be silenced and reset as described above.

The MONITORING SERVICE will respond in the same manner as with a trouble condition.

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TESTING YOUR SYSTEM

Before performing a fire drill, system test, or any maintenance, you must put your system on “test”. Call the MONITORING SERVICE (Alarm Central) at 1-800-434-4000, and ask the operator to put your system on test. You will need to provide them with your system account number and the time that you will be finished testing. The system will automatically be removed from test status once the test time has expired. Once all testing is completed, call the MONITORING SERVICE to verify that the appropriate signals have been received and terminate test status, if desired.

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FIRE WATCH PROCEDURES

Policy:Fire watch procedures will be implemented should our fire alarm system or sprinkler system be out of working order. The purpose of the fire watch is to watch for fires, which would ordinarily be detected by the fire alarm or sprinkler system.

Policy Explanation and Compliance Guidelines:1. “Fire watch” is the assignment of a person or persons to an area for the express

purpose of notifying the fire department, the building occupants, or both of an emergency; preventing a fire from occurring; extinguishing small fires; or protecting persons from fire or life safety dangers (LSC 2012 3.3.104).

2. The Safety Chairperson or designee by management will inform the following persons that our fire watch procedures have been implemented:

a. Local Fire Department (via telephone at 911)b. State Survey Agency (OHFLAC) via telephone at (304) 558-0050)

The state agency should only be notified in the event that the system will be out longer than 4 hours in a 24 hour period.

c. Facility Management, Staff, and Visitors.3. Fire watch personnel may not leave their assigned watch areas except in an

emergency. Fire watch personnel may not be assigned any other duties while on fire watch.

4. The Fire Watch will be continuous until the affected system has been repaired, tested, and placed back into service.

5. A written log of the fire watch will be maintained. The log includes the date, time, name and signature of person(s) conducting the round (inspection), violations or unusual events, and other data as may be necessary to ensure the safety of our residents, staff, and visitors. (See attached “Fire Watch Log.”)

6. Fire watch rounds (inspections) will be made at one-half hour intervals. During the rounds, fire watch personnel will make a thorough inspection of the building, resident rooms, storage areas, kitchen, laundry room/areas, mechanical/electrical rooms, exit ways, office areas, etc.

7. Upon completion of each round, fire watch personnel must sign the Fire Watch Log. At the end of each shift, fire watch personnel must complete the shift report portion of the Fire Watch Log.

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8. Completed fire watch logs will be submitted to the assigned unit within the administrator.

9. Fire watch personnel are trained in fire prevention and are familiar with our site-specific emergency plans relative to fires and other emergencies.

10. Fire watch personnel are trained in and knowledgeable of our facility’s:a. Building and premises;b. Fire protection system;c. Manual and/or automatic fire detection and alarm systems;d. Portable fire extinguishers;e. Emergency shutdown procedures and equipment;f. Occupancy of the building.g. When and how to use radio equipment, telephone, and alarm pull stations;h. How to notify the local fire and police departments;i. Personnel to be contacted should an emergency event occur.

11. Smoke and fire doors, including those normally held open with magnets, shall remain closed until the fire alarm or sprinkler system has been made operational.

12. The Administrator, or other person designated by management, will notify persons and agencies outlined in this policy when our fire alarm system or sprinkler system has been placed back into service.

13. Inquiries concerning this policy should be directed to the Administrator.

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Fire Watch Log

Individual Shift Report

Date: ________________________ Area Assigned: _____________________________

Time Shift Began: ______________ [ ] am [ ] pm Time Shift Ended: _____________ [ ] am [ ] pm

Signature and time each round began and ended must be recorded below. Complete the bottom portion of this form. Sign form and provide completed copy to supervisor at the end your shift.

Record of Fire Watch Rounds

Signature of Person Making Round Time Started AM PM Time Ended AM PM

Events Encountered YES NO REMARKS

Areas UnsecuredCorridors ObstructedExits Obstructed / BlockedFire Doors Not ClosedFire Extinguishers Missing / InoperativeImproper Storage of Combustible MaterialsSmoking ViolationsOpen WindowsSprinkler Valves Closed

Printed Name: _______________________________ Signature: ________________________________Use the reverse side of this form for additional comments or other

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FLOOD PLAN

1. Floods can be placed into three general categories:

Internal Flood-A flood confined to the internal areas of the facility. These are usually caused by a broken water main or sprinkler head.

External Flash Flood-A flood that occurs with little or no warning and usually results from a torrential downpour, cloudburst, broken dam or similar occurrence.

External General Area Flood-A flood that usually has a slow rise in water depth which allows for a warning time. They can result from a variety of reasons ranging from a rapid snow-melt to a steady heavy rain in the same general geographical area for an extended period of time.

Internal Flood

Shut off electricity (if possible) at the closest breaker switches to the affected area.

The main water valve, main sprinkler valve and main electrical power shut off is located in the Mechanical/Electrical room through the employee lounge across from the women’s bathroom.

The main gas valve is located in water heater room. Take east exit door in service hallway, turn right, door to left marked Main Gas Valve (left of door entrance). This shut off switch must not be used if mechanical/electrical room is flooded.

Inform Emergency Services at 911 if conditions warrants.

Evacuate residents from affected area of the building. See section titled "Evacuation of Resident”.

Notify Administrator, Director of Nursing, and Maintenance if after hours.

Move equipment, supplies, property and food from affected area.

Call off-duty personnel if necessary.

Call water company telephone number 1-800-685-8660 if needed.

Call Electric Company at 1-800-956-4237 if needed.

If internal flooding due to sprinkler system failure/rupture, the facility must remain on fire watch until sprinkler system is restored.

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INCLEMENT WEATHER

Inclement weather terms:40 | P a g e

Winter Weather Advisory: Winter weather conditions are expected to cause significant inconveniences and may be hazardous. When caution is used, these situations should not be life threatening.

Winter Storm Watch: A winter storm is possible in your area. Tune in to NOAA Weather radio, commercial radio, or television for more information.

Winter Storm Warning: A winter storm is occurring or may soon occur in your area.

Blizzard Warning: Sustained winds or frequent gusts up to 35 miles per hour or greater and considerable amounts of falling or blowing snow reducing visibility to less than a quarter mile are expected to prevail for a period of three hours or longer.

Sleet: Rain that turns to ice pellets before reaching the ground. Sleet also causes moisture on roads to freeze and become slippery.

Frost/Freeze Warning: Below freezing temperatures are expected.

Freezing Rain: Rain that freezes when it hits the ground, creating a coating of ice on the roads, walkways, trees and power lines.

Guidelines to follow during blizzards, heavy snow, freezing rain, ice storms, or sleet:

Keep posted on all area weather bulletins and relay to others. Have portable radios/scanners available. Make sure extra batteries are available. Utilize Emergency Supply Kits located in Central Supply and the Therapy department. Supply kits will

include flashlights, portable radio scanner, batteries, etc. Make sure emergency food supplies, supply of water, and equipment are on hand.

See contract with US Food Roanoke for disaster plan agreement. PHCC maintains an on-site 5 day supply of food and water which includes residents and staff.

Make sure emergency power supply is operable. Have extra blankets available and keep residents as warm as possible. Make sure adequate staff is available. Do not panic; remain calm In the event of a “state of emergency” each department will be required to call their supervisor to

determine if they should come to work. Staff must refer to Inclement Weather section in Personnel Manual for guidelines during periods of

extreme weather and similar emergencies. Be prepared to evacuate residents if necessary.

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INTERNAL SECURITY

Under certain circumstances, it may be necessary to increase the internal security of the facility restricting entry into the facility to only specified persons. Those whom it is necessary to deny entry into the facility at certain times could range from unwieldy number of well-meaning relatives of casualty victims to unruly participants involved in civil disturbances. The circumstances will dictate the type and degree of internal security required. In this case, the general procedures that will apply are:

Notify 911

Administrator, Director of Nursing, Nursing Supervisor or designee will act as security supervisor.

If off-duty hours, notify the Administrator and Director of Nursing.

Designate personnel who will constitute internal security force.

Determine which doors shall be authorized entries.

Determine who will be permitted to enter the facility.

Determine what identification will constitute authorization to enter the facility.

Brief the security supervisor who will in turn brief the internal security personnel.

If additional personnel are needed, Nursing Secretary or designee will recall off-duty personnel as required.

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MASS CASUALTIES

To provide first-aid services for a mass-casualty situation, the following procedures apply:

Notify 911

If off-duty hours, notify the Administrator and Director of Nursing.

Initiate a recall of off-duty personnel, as necessary.

The Director of Nursing to call in physician/nurse practitioner and other medical personnel as necessary.

Set up triage in an available room.

Have emergency first-aid supplies brought to treatment room. Additional first-aid supplies are available at Princeton Community Hospital, telephone number 487-7000.

In the absence of a physician, a licensed nurse will provide and administer first-aid treatment.

Social Services or designee will be responsible for registration of incoming residents.

The attending physician will classify residents into three categories:

Those who will be treated and released.

Those to be transported to a hospital for further treatment.

Those who cannot be moved and will remain at the facility for treatment.

Transporting Casualties to Hospital :

Notify Princeton Community Hospital, telephone number 487-7000 of the number of residents, type of injury, and condition of each, the mode of transportation being used and the estimated time of arrival.

Arrange for ambulances; Notify Sheriff; Fire Department; City and State Police all at 911.

Notify Bluefield Regional 327-1100 if needed for overflow if PCH unable to manage number of casualties.

The Administrator or Director of Nursing will provide personnel to assist in the movement and handling of residents. Utilize facility vehicles if necessary.

Charge Nurse will be responsible to see that each resident has proper Resident I.D. Band before being evacuated.

Charge Nurse/Medical Records department will be responsible to see that the proper medical/treatment records accompany each resident (Emergency Discharge Packet)

Housekeeping department will be responsible to see that the personal effects of each resident are sent to the same facility as the resident.

Family members of incoming residents will be assembled in the North Unit Solarium.

The Administrator or designee will be responsible to advise families of resident’s condition and other pertinent information.

The Administrator will be responsible for issuing press releases to the news media, if necessary.TORNADO / HIGH WINDS

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Tornado alerts are of two classes:

1. A Tornado Watch means that local weather conditions are favorable for severe high winds or tornadoes to develop. Review and discuss emergency plans and check supplies. Be prepared.

2. A Tornado Warning is an alert issued by the National Weather Service to warn the public that severe thunderstorms with tornadoes are imminent or indicated by weather radar. The issuance of a warning indicates that residents should take immediate safety precautions. Take action.

High Winds:

1. A very strong wind or current of air moving with considerable force from an area of high pressure to an area of low pressure.

Preparation:

During off duty hours the Nursing Supervisor is responsible for starting preparations until Administrator or Director of Nursing arrives.

Keep radios and/or television turned on and listen for the latest weather advisories.

Clear all large rooms (dining room, activities room, etc.) of all residents and staff personnel.

Move all residents into interior hallways away from windows, close all resident room doors, and ensure that adequate staff are with the residents to ensure resident safety.

Open some windows to equalize pressure, but keep everyone away from them.

Take all fire precautions.

Place as many records as possible in a safe place.

During and After Tornado/High Wind Passes:

Reassure and calm the residents.

Check all residents for injuries and other ill effects.

Call 911

Maintenance will immediately inspect the facility for damage and report to the person in charge of the

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facility at the time. Other responsibilities include:

Shutting off all gas, electricity and water at main controls until the building is inspected for damage. Follow fire watch procedures

Prepare and check auxiliary power and gas units should electric or gas utilities be lost If water service is cut off, provide portable gallons of water on hand. Utilize Emergency Supply Kits located in Central Supply and the Therapy department.

Supply kits will include flashlights, portable radio scanner, batteries, etc.

If major structural damage has occurred, evacuate residents from the damaged area. See Section entitled "Evacuation of Residents".

Establish additional security for the facility, if needed.

For electrical outage, call Electric Company at 1-800-956-4237.

For water outage, call Water Company at 1-800-685-8660 or 304-425-9631 or 1-304-466-5085.

Mountaineer Gas number is 1-800-834-2070.

WATER OUTAGE

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If there is low water pressure and there is not a leak call the water company and notify the maintenance director or maintenance on call.

Immediately notify staff to restrict use of water in facility (baths, toilet flushing to be curtailed).

Nursing and Dietary supplies for residents during outage should be utilized.

If outage is to be lengthy, notify Director of Emergency Services-Mercer County @ 425-8911 and inform them of situation.

Water company for water buffalo use 304-327-8913 or 304-466-5085

PHCC to provide water hose and pump to transfer water into PHCC's system.

They will notify either the WVDOH for tanker truck use

Bottled Water:

Pet Dairy 1-276-326-2015 or 1-276-326-2695 or 1-800-438-0460 for gallon jugs

Portable water is available in gallon jugs on hand in facility.

If water outage for extended duration, evaluate for resident evacuation. If outage lasts for more than 4 hours notify OHFLAC.

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WILDFIRES

A wildfire is an unplanned, unwanted fire burning in a natural area. Wildfires can cause death or injury, damage or destroy structures, and disrupt community services including transportation, gas, power, communications, and other services. Wildfires can occur anywhere and at any time throughout the year, but the potential is always higher during periods with little or no rainfall.

A. Wildfire Response Plan:

Turn on TV or radio for latest weather updates and emergency instructions.

If you see wildfire call 911. Do not assume someone else has called.

Turn off the main gas valve is located in water heater room. Take east exit door in service hallway,

turn right, door to left marked Main Gas Valve (left of door entrance).

Make sure all windows and doors are closed.

Keep all lights on for visibility in heavy smoke.

Reassure and calm residents.

For electrical outage, refer to section in manual.

Be prepared to evacuate as necessary. See evacuation plan.

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LOCATION OF MASTER UTILITY CONTROLS

The location of the main (master) controls for electricity, gas and water are as below:

The main water valve, main sprinkler valve and main electrical power shut off is located in the Mechanical/Electrical room through the employee lounge across from the women’s bathroom.

The main gas valve is located in water heater room. Take east exit door in service hallway, turn right, door to left marked Main Gas Valve (left of door entrance). This shut off switch must not be used if mechanical/electrical room is flooded.

PHONE OUTAGES INCLUDING PAY PHONES

There are three facility cell phones. They all are located in the Medical Records office. Payphone is located in therapy department.

EMERGENCY EYE AND BODY WASH STATIONS

In addition to Princeton Health Care Center’s hazard chemical communication program, the facility also provides emergency eye and body wash stations for employees use in the event of an accident with a substance that would need to be rinsed out of the eyes or off of the body.

The emergency eye wash stations are located in the clean utility rooms on North and South Units. The following areas have accessible wall mounted bottle type eye wash stations:

Maintenance department Laundry department Housekeeping department Dietary department

The emergency body wash stations are located in 300 central bath on the South Unit and 201 Central Bath on North Unit.

TOBACCO FREE ENVIRONMENT

In compliance with the Mercer County Clean Indoor Air Regulation and in further considerationof other health and environmental issues, tobacco use shall be prohibited at any PHCC location.No smoking signs will be maintained on the gate or door where oxygen is used or stored. Family member(s) will be informed prior to and during the admission process, and as needed of the policy prohibiting smoking.

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DRAWING OF FACILITY

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THE SAFETY AND DISASTER MANUAL WAS REVISED AND APPROVED:

________________________________ ADMINISTRATOR DATE

__________________________________________ __________________________A.N.H.A / C.F.O DATE

__________________________________________ __________________________MEDICAL DIRECTOR DATE

__________________________________________ ___________________________DIRECTOR OF NURSING DATE

__________________________________________ ___________________________MAINTENANCE SUPERVISOR DATE

___________________________________________ ___________________________SAFETY COMMITTEE CHAIRPERSON DATE

___________________________________________ ___________________________INFECTION PREVENTIONIST DATE

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