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SAN FRANCISCO. CAMPUS FOR JEWISH LIVING G Jewish Senior Living Group April 29, 2020 Dear Residents, Patients and Families: We hosted our first Virtual Town Hall meeting on Thursday, April 24 as announced in the previous letter dated, April 17", 2020. The panel of speakers were Daniel Ruth, CEO & President of SFCJL, and Peggy Cmiel, Director of Nursing and Clinical Operations. Mark Friedlander, Executive Director, fielded the incoming questions through the online Q&A. The Town Hall began with an overview and a detailed update from both panelists on COVID patient admissions, positive cases, and Personal Protective Equipment (PPE), followed by Questions & Answers through the end of the session. The Town Hall was virtually joined by 110 attendees that included our District Supervisor, Ahsha Safai, and Dr. Janice Louie from San Francisco Department of Public Health. Due to the limited time, we made the effort to respond to as many people as possible by limiting the Q&A to one question per person. While we were able to answer more questions by combining some whose content overlapped, we received a total of 93 questions during this session, so we were unfortunately unable to speak to all of them in the allotted time. We truly appreciate the overwhelming responses from you and other families, and fully recognize the concerns for your loved ones, and we are grateful for the thanks and support many of you conveyed. Every unanswered question will receive the well-deserved attention from our COVID response team. Please allow some time and have patience with us as we follow up on the large volume of questions. To date, we do not have any known positive-tested residents or patients. The two staff members that tested positive were as follows: ‘* The first employee did not work in the COVID unit and had no contact with COVID patients. The virus was most likely community-acquired as this employee had another job at the time, The employee has been in quarantine for more than 14 days and there has been no sign of possible symptoms from staff or residents/patients within the areas where the employee worked. + The second employee has been working from home for more than 3 weeks, and has not been on campus during that time. It may have been community-acquired ‘+ Both employees are in stable condition. For your information, please see the enclosed Top 10 Frequently Asked Questions that were selected from the Virtual Town Hall. Some of the questions were addressed during the opening overview and report by the panelists, and some were also answered during the Q&A session Once again, we thank you for your patience on the individual follow-up for the additional questions, and please continue to visit our website,, for daily updates. Lastly, please direct any additional questions to covidinfo@sfcil org or 415.562.2521. We wish ‘everyone good health and safety as we continue to shelter-in-place, and thank you for your support and understanding in this challenging time. ‘San Francisco Campus for Jewish Living Management Team 302 Silver Aventie. San Francisco, CA 94112. 415.334.2500. — A baneficiary of Jewish Home & Senior Living Foundation and the San Francisco-based Jewish Community Federation SAN FRANCISCO CAMPUS FOR JEWISH LIVING G Jewish Senior Ling roup ‘Top 10 Frequent! 1. Why are we taking COVID patients when others are not? The mandates from California Department of Public Health (CDPH) required skilled nursing facilities to prepare to accept COVID-19 patients. As a healthcare organization, we also have ongoing partnerships with local hospitals, and as a skilled nursing facility, we cannot refuse admission to someone purely based on a COVID specific diagnosis. Our campus is uniquely designed to accommodate this critical need because we have 4 physically separate buildings spread out across 9 acres, and the building designated for COVID patients can be separated by floor and further by pod/section on each floor. Unlike some skilled nursing facilities, most of our rooms are private with private bathrooms to accommodate patient isolation. 2. Dowe have COVID patients? To date, we do not have any known COVID-positive residents or patients that acquired COVID within SFCJL. We began to accept COVID patients who were discharged from the hospitals that are in need of rehab or skilled nursing. The COVID patients in need of rehab are on the 3% floor of the Friedman building, separate from the majority of our long-term care residents. For information on COVID updates, please visit our website, https:/sfeil ora/COVI tm 3. How are you safely isolating COVID patients on daily service and care such as clinical, housekeeping, laundry and food delivery? Clinical (including physical therapy) and environmental services (Including housekeeping) only work in the COVID unit and do not cross over with services to non-COVID patients/residents. Meals for the patients and staff are delivered with disposable dishes, utensils and trays for single use. Laundry is handled separately, and the patients arrive through the separate, designated entrance through an elevator which is disinfected after every use. 4. What are we doing to ensure safety of our residents, patients and staff? We have dedicated clinical and housekeeping staff for COVID patients, and they do not provide services for non-COVID patients or residents. The COVID unit staff have access to their own breakroom, restroom and shower. They are able to shower before they go home and leave all of their garments so that we can launder them onsite. Every person entering the campus is screened daily with a temperature check and relevant questions covering possible symptoms and travel. We have hand sanitizers at every comer of the hallways and require staff to use them when they re-enter through the entrance. Everyone is required to wear a mask currently, and the mask policy is as follows: ‘* N95 mask: for staff who are in contact with COVID patients * Surgical mask: for staff who work with non-COVID residents and patients * Cloth mask: for non-clinical staff who do not come in contact with residents or patients 302 Silver Avenue. San Francisco, CA 94112. 415.334.2500. _sf¢ A beneficiary of Jewish Hame & Seniof Living Foundation and the San Francisco sunity edi Jewish Com 10. SAN FRANCISCO CAMPUS FOR JEWISH LIVING ‘G Jewish Senior Uving Group COVID patients have dedicated physicians who are in direct contact with them. Other Physicians may be involved in their care via telehealth. No physicians caring for COVID Patients are in contact with non-COVID patients. Do we have enough personal protective equipment (PPE)? We have adequate supply of PPE and continue to make the effort to acquire more for future use. Our supply of PPE includes but is not limited to, masks (N96, surgical), gloves, goggles andlor shields, and disposable gowns. What is your contact tracing plan and when/how are they conducted? When a positive COVID test is reported, we notify San Francisco Department of Public Health (SFDPH) and they guide the process by asking us to look back 48 hours and determine the internal contacts the COVID positive person had while at our facility. Patients/residents that had contact with a positive person are notified and placed on increased monitoring; staff are asked to self-monitor. The resident's physician and responsible person are also notified. If a resident exhibits symptoms, the resident is immediately masked, isolated and tested for COVID. A staff member who develops symptoms while at work (they would already be masked) is immediately sent home and told to contact their physician. Human Resources follows up with the employee and the employee notifies us of the results of the COVID test. Employee must have clearance from thelr physician prior to returning to work. What is your testing availability, current policy and plan moving forward? We are testing patients and residents who are symptomatic, and testing is done through ‘SFDPH. We have testing kits given to us by SFDPH. if a patient/resident is symptomatic, we notify SFDPH and obtain the specimen. SFDPH picks up the specimen and runs the test in thoir lab. The resident's physician and responsible person are notified. If guidance changes on testing, we will adjust accordingly. What is your plan on the visitor restriction as the Shelter-In-Place phases out? We continue to respect the Sholter-in-Place order, and when this order changes, we will review the restrictions put in place by SFOPH, CDPH and CMS to ensure we remain in compliance. CDPH and SFDPH will provide new guidance on when and how to phase out the restrictions Js SFCUL financially incentivized by taking COVID patients? SFC4L Is projecting a significant reduction in revenue during this time for two reasons. Fitst hospitals’ temporary pause on elective surgeries also results in no post-acute rehab patients {or our campus which creates a precipitous drop in revenue. Second, we are experiencing a significant increase in COVID-19 specific expenses, due to the extra staffing and preparation for the COVID units. While nursing homes may potentially receive a slightly higher per diem rate for caring for COVID-diagnosed patients (which is not yet confirmed in any legislation), the Costs associated with accepting these patients will almost certainly far exceed any revenue we might receive, Where can one express concerns for this mandate for SFCJL and other skilled nursing facilities? You may contact SFDPH or CDPH to express your concems.