The Connecticut Department of Public Health (DPH) ordered the evacuation of 69 residents from a nursing home in Waterford. Three of the units in the facility had flooring removed which was not tested for asbestos prior to removal. DPH, in consultation with the Centers for Medicare & Medicaid Services (CMS), issued a finding of Immediate Jeopardy. CMS defines an Immediate Jeopardy as a situation “that is clearly identifiable due to the severity of its harm and the immediate need for it to be corrected to avoid further or future serious harm.”
DPH Commissioner Manisha Juthani, MD, said, “On Thursday [March 9, 2023], we learned that the facility began renovations to its South Center and North Center Nursing Units without notifying DPH in advance as required by state regulation. DPH has determined that the condition of both units poses an imminent danger to the health, safety, and welfare of the residents there, and all work has been halted.”
In addition to evacuating the residents from the facility, Commissioner Juthani issued an order for the facility to complete the following:
- Immediately cover the entire concrete floor on the South Center Nursing Unit
- Immediately close the corridor doors between the North Center Nursing Unit and North Star Nursing Unit and post the following notice on the doors: “Do Not Open, Emergency Use Only”
- Require staff to enter the building using the exterior door at the North Star Nursing Unit at all times during this renovation project, including to report to their assignment, and to bring all dietary carts through the exterior doors
- Immediately set up a temporary satellite nurse station in the North Star Nursing Unit
- Immediately provide notice of the Order to all residents, residents’ families, and caregivers
- Conduct asbestos testing of all flooring materials throughout the building and in the dumpster
- Install negative air scrubbing machines in all units and ensure that such machines are turned on 24/7 throughout the duration of this project
- Immediately stop new admissions
- Provide to DPH within 24 hours the full renovation plan for the facility
- Facility shall not resume work until a work plan is submitted to DPH for review and received DPH’s approval
Compliance Perspective
Issue
CMS regulations state that facilities must be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel, and the public. Asbestos is well recognized as a health hazard and its use is now highly regulated by both the Environmental Protection Agency (EPA) and the US Department of Labor’s Occupational Safety and Health Administration (OSHA). The EPA requires facility owners or operators to inspect facilities for asbestos in advance of renovations. Contractors must not start any renovations where asbestos is present and may be disturbed by the renovation without providing an asbestos abatement notification to the appropriate state agency. There are specific OSHA standards which address worker exposure to asbestos hazards. These standards reduce the risk to workers by requiring that employers provide personal exposure monitoring to assess the risk and hazard awareness training for operations where there is any potential exposure to asbestos.
Discussion Points
- Review your policies and procedures on construction and remodeling of the facility and environment. Ensure that OSHA’s standards and guidelines for removal of asbestos are incorporated into your policies, and also the requirement to notify the appropriate state agency if asbestos is found. Update as necessary.
- Train staff, including your maintenance director and infection control preventionist, on your policies and procedures for construction and remodeling of the facility or the environment before the initiation of any work. Document that the trainings occurred, and place the signed document in each employee’s education file.
- Periodically audit to ensure facility leadership is aware of the requirement to inspect for asbestos before beginning any renovations, and that they are also aware of OSHA’s standards and guidelines. During remodeling and construction efforts, ensure that all requirements related to the handling of materials, posting of precautionary signage, controlled access by those entering the work area, and work processes are followed at all times. Provide periodic reports to the state agency as may be required.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
