departments of behavioral health ---- - - and...

DEPARTMENTS OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES &

HEAL TH AND WELLNESS 99 Jesse Hill Jr. Drive S.E. Atlanta, Georgia 30303

Telephone (404) 613-1202 - Fax (404) 730-1294

---- - -_ - ,.._ ::"'_.;; .~ r-'" ... ~ '/ --;w ...., .. ~ - FUlJON COUNTY

Date: July 24, 2015

Anita Beaty Metro Atlanta Task Force for the Homeless, Inc, 477 Peachtree Street Atlanta, Georgia 30308

To - Anita Beaty,

Find attached a summary of the findings of the Fulton County Health Department following our visit to the AGENCY on July 8,2015 to assess the implementation of CDC recommended administrative controls provided in the "Guidelines for Preventing and Controlling Tuberculosis" and checklist of administrative controls.

The Health Department is pleaseq that your shelter facility has been able to fully implement14 / 14 of the CDC recommended administrative controls.

Properly implemented, administrative controls can prevent the transmission of tuberculosis. The consequence of not implementing these recommendations is continued transmission of TB,

The Health Department is committed to provide ongoing technical assistance and support to your facility.

Sincerely,

Dr. Daniel VanderEnde Medical Program Administrator

"To Promote, Protect and Assure the Health and Wellness of the People of Fulton County"

01: Shelter/Agency Name

02: Date

Date and Time 07/08/2015 12:00 PM

03: Team Members Team Member 1

Team Member 2

Team Member 3

Team Member 4

Team Member 5

Q4: Shelter/Agency Points of Contacts Health Care Liaison

Shelter Administrator

Other StafflTitle

Other StafflTitle ----~--

PAGE 2

1 110

Peachtree and Pines

Shawnese Blount

Bridget Dunlap

Janika Robinson

Randall Merriott

Emma Konan

Anita Beaty

Anita Beaty

Troy Harris

Valarie Dawson

TB TECHNICAL ASSTSTANCE TOOL 2015 v2

Q5: Administrative Control - Ensure Client Has TB Test I Clearance Exam

Shelter determines that all clients have a current (at minimum yearly) TB test / clearance exam each time a client presents to the shelter

Shelter ensures that clients who do not have a current TB test receive a TB test within 7 days.

Comments/Observations

Q6: Administrative Control - Client ID

Client presents valid 10 upon entry to the facility

Shelter refers clients without IDs to obtain valid, perferable government issued ID's,in a reasonable period of time.


Yes

Yes

On 7/8/2015 Fulton County staff observed case manager Paul Bellew performing the intake process. Case manager Paul Bellew asked the client to provide him with his name, social security number emergency contact and TB card. After obtaining the information a database search was conducted to locate the, client According to case manager Anthony Murphy, if a client does not have a TB card they are given a referral to Fulton County Department of Health and Well ness. The client is encouraged to take a TB test immediately and bring the documentation to the intake office, within one day from the date 'of the referral. Anthony Murphy showed FCDHW staff members where they place expiration dates in their database, after receiving medical documentation.

Yes

Yes

On 7/8/2015 Fulton County staff observed staff member Paul Bellew asking client for identification and birth certificate during the intake process. Case manager, Anthony Murphy explained that if a client does not have identification they are referred to "Cross Roads" for assistance. Currently, all forms of identification are being accepted at the facility,

2/10

TB TECHNICAL ASSISTANCE TOOL 2015 v2

Q7: Administrative Control- Use of Symptom Screen for TB

Shelter screens all clients for TB symptoms using the symptom screening checklist found in the "Guidelines for Preventing and Controlling Tuberculosis in Atlanta Homeless Housing Facilities"

Shelter staff administering symptom screen demonstrate proficiency and knowledge in the use of the symptom screen.

Results of the symptom screen are documented and stored for future reference


Yes

Yes

Yes

Fulton County staff spoke with case manager Anthony Murphy and Troy Harris about their implementation of the new symptom screening questionnaire. Mr. Murphy stated that all questions have been updated after receiving the recommendation from Fulton County Department of Health and Wellness. The symptom screening is located within the facility electronic database and was observed by FCDHW staff members during our site visit. Results of the screening are stored electronically and a copy is made in place in client's folder. All clients are screened during the intake process, and FCDHW staff observed staff member Paul Bellew conducting the symptom screening on a newly admitted client. Mr. Anthony Murphy was asked if he could tell FCOHW staff members any of the question that he ask clients from the symptom screening? He successfully repeated several question verbatim out of the "2015 Guidelines for Preventing and Controlling Tuberculosis in Atlanta Homeless Housing Facilities."

3/10

l


08: Administrative Control - Cough Alert Log

Log records all individuals who are coughing in the shelter during the day

Log records all individuals who are coughing in the shelter at night

Log records all individuals who are coughing for more than 3 weeks without improvement

Log records record all individuals who cough is accompanied with weight loss, night sweats and fever

Log records all individuals who are coughing up blood

Log records the date, client name, clients date of birth, date referred to a medical facility/name of facility


Yes

Yes

Yes

Yes

Yes

Yes

At approximately 12:40pm on 7/8/2015, we observed a copy of the cough alert log located in the check in area at Metro Task Force. The cough log was observed in different areas around the facility. According to Ms. Beaty, the appointed Healthcare Liaison, the cough log is in use during the day and night. Mr. Murphy was asked, "At what point do you place a name on the cough log? He answered, "If a client continuously coughs." He was also asked "what is some information that needs to be recorded on the cough log and he answered "Clients area, name, and symptoms." The cough log that is being used is the exact form from the "Guidelines for Preventing and Controlling Tuberculosis in Atlanta Homeless Housing Facilities." The cough log that we provide does not have an area to put the results of the symptom screening. The cough log only asks that you state if the screening was positive or negative, revising it to include details is recommended. The cough log records date, client name, date referred to care, and outcome of referral. Ms. Beaty stated that staff leaders have been trained on the use of the cough alert log.

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TB TECHNICAL ASS1ST ANCE TOOL 2015 v2

09: Administrative Control· Separate Clients with symptoms of TB and refer to care.

Interviews with clients that have a postive symptom Yes screen occur in a well-ventilated room.

Staff Instructs tells clients to cover nose and mouth Yes when coughing and offer a mask or tissue to use.

Staff notifies the coughing client confidentially that a Yes medical evaluation is needed within 48 hours

Staff assist the client in arranging an evaluation witha Yes primary care provider, community clinic, or emergency room.

Staff provides a referral letter to clients referred to the health department

Yes

Shelter provides routine health screening opportunities or refers clients to health screenings that include a HIV test

Yes

Comments/Observations We observed cough posters located throughout the entire facility. We also observed clients wearing mask and being instructed to cover their coughs by staff member Ms. Valerie Dawson. Coughing clients are given homeless verification letters with written services to be obtained for a medical evaluation and are referred to Crawford-Long, Grady or Fulton County Health department within 48 hours stated per Ms. Anita Beaty. The staff at Metro task force are in daily communication with FCDHW for the purpose of assisting with arrangements for evaluations. Mr Harris stated that a TB and Syphilis test is mandatory to stay at the facility and HIV is strongly suggested and encouraged.

5/10


Q10: Administrative Control - Provision of Masks, Tissues, or other Protection.

Masks, Tissues or other protection is readily available to staff and clients.

Staff inform clients who have a cough and are seeking shelter will not be turned away.

Staff offer a mask, tissue or other type of protection to a client who is coughing

Clients who are coughing wear masks, cover thier cough and if not are encouraged to do so by staff.

Plastic-lined waste baskets are placed in convenient locations

Staff separate clients and staff with symptoms of TB from others until they have been medically evaluated

Clients referred to the Health Department are given a referral letter.


6/10

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Tissues and masks were observed by the Fulton County staff in the garage area and by the sign-in desk at 12:50pm We then observed masks being worn by clients at the Task Force at 1 :01 pm . There were also tissue and masks available at each intake desk in the offices where the clients are interviewed. Plastic lined waste baskets were observed around the building in various locations. Ms. Anita Beaty stated that it is not the policy of the Task Force to turn away any coughing client seeking shelter: they would rather link them to care. The facility appointed Mrs. Valerie Dawson as a health care liaison to send coughing clients to get a symptom screening, mask, and further evaluation. Mr. Harris stated that due to limited space there isn't an area to separate persons with symptoms of TB , instead they provide them with a mask and send them for evaluation within 24 hours. Mrs. Dawson stated that the policy for having a client with TB symptoms is to get them evaluated immediately by Emory located across the street from the facility. We observed Mrs. Dawson providing clients with referral! homeless verification letters to be evaluated by the Health Department.

Shelter has Standard Operating Procedures whereby all shelter staff and volunteers who have face to face contact with clients will be informed that they need a yearly TB screening with either a PPD Skin test, blood test for TB, or Chest X-Ray.

Yes


011: Administrative Control - Screening of Staff and Volunteers for T8

Shelter inform staff prior to the first day of work about the increased risk of exposure to TB when providing services to homeless clients

Yes

Shelter keeps a record of staff TB tests Yes

Shelter keeps a record of volunteer TB tests Yes

Shelter has a policy that staff with suspected pulmonary TB will be excluded from work until a written physician clearance is obtained.

Yes

Shelter has a policy/liability form signed by volunteers and parents of minors indicating they are aware of risk of TB at the shelter and need for a TB test if they have face to face contract with homeless clients.

Yes

Comments/Observations We observed that the facility has a written TB policy that states that staff and volunteers who have face to face contact with clients are informed that a yearly TB screening is required. We observed that the facility keeps a record of staff/volunteer TB tests in their electronic database, as well as in their personal files. Per Mrs.Beaty, if staff is absent from work for medical reasons more than three consecutive days, they must provide a written physician's clearance letter to return. Per Mrs. Beaty, the facility does not utilize minors.

Q12: Administrative Control - Provision of Educational Materials

Shelter has identified a Health Care Liaison Yes

The Health Care Liaison has received in service Yes training on TB by staff of the Department of Health and Well ness and/or the State DPH and is knowledgable about the information contained in othe "Guidelines for Preventing and Controlling Tuberculosis in Atlanta Homeless Housing Facilities"

Cough posters are placed in prominent locations Yes throughout the facility where clients can see them

All staff and volunteers with face to face contact with Yes clients are informed of and provided access to TB educational materials.

7/10

TB TECHNICAL ASSISTANCE-TOOL 2015 v2

Clients at the shelter have access to TB educational Yes materials

TB educational materials are available to clients, staff and volunteers in different languages

Yes

Comments/Observations From the last visit, the Shelter now has two (2) Health Care Liaisons instead of three (3) Health Care Liaisons, They are Mrs.Anita Beaty and Mrs. Valerie Dawson. Mr.Troy Harris has been removed to perform other duties as assigned, but per Mrs. Beaty he may be called upon to assist FCDHW staff at any point, Trainings are conducted by the State DPH twice a month and we observed an education/training log book that indicates the date of the trainings, the names of the staff/volunteers that attended and the last four digits of their social security number. Mrs. Beaty received an updated version of the "Guidelines for Preventing and Controlling Tuberculosis in Atlanta Homeless Housinq Facilities", In addition, Troy Harris usually attends the TB Task Force monthly meetings. FCDHW staff observed Cough posters placed in prominent locations throughout the facility where clients can see them. Laminated posters in the garage area, in the cafeteria, the breaking rooms, the waiting upstairs, in hallways, in women bath rooms as well as in personnel bathroom, in the conference room. In addition we observed large TB posters and information board that was located in the intake waiting area. All inside volunteers/staff at the shelter receive TB educational materials and outside volunteers are now given a volunteer package. The outside volunteers also receive TB awareness and sign a liability form prior to working in the shelter. It contains a referral letter for volunteer, Outside volunteers who are seasonal helpers do not receive a copy of the Guidelines for Preventing and Controlling Tuberculosis in Atlanta Homeless Housing Facilities" TB educational materials are available to clients, staff and volunteers in English and Spanish. Additional material are provided to clients by case managers upon request. Mrs. Beaty was given additional TB literature, masks and HALT TB posters and information cards.

8/10


Q13: Administrative Control - Maintain an Accurate Daily Electronic Log.

Shelter utilizes a daily electronic registry to store client information.

Electronic registry is used for ali clients who enter the shelter

Electronic registry contains an accurate record that includes a clients name, date of birth, results of tests that identify persons with a history of TB infection (i.e. Tuberculosis Skin Test (TST) or Quantiferon© (QFT)), Chest x-ray date (for residents with positive screening tests for latent TB infection), and basic medical history and responses to questions about TB symptoms.


9/10

Yes

Yes

Yes

We observed that the shelter has an electronic Log. Clients who enter the facility are placed into this electronic database daily. The electronic Log captures client name, date of birth, TST or QFT results, TB history and other demographics. FCDHW staff was given a copy of the daily electronic database.


014: Administrative Control - Bed Maps used to record where clients sleep

All clients entering shelters are assigned a location to sleep for the night.

The shelter has a reliable system for identifying bed numbers or locations (bed map) for all clients at the shelter facility.

The client's first name, last name, and date of birth are clearly printed/recorded on bed maps

It is evident on the bed maps what date(s) the client stayed at the shelter facility

Clients are positioned head-to-foot when sleeping where possible

Records of the bed maps are kept for at least 24 months.


10/10

Yes

Yes

Yes

Yes

Yes

Yes

We observed the client signs in daily upon arrival then clients are entered into the database. We observed that the shelter has clients identified by bed numbers that are recorded into the database. We observed and received a copy/sample of the bed map that identifies the clients by name last four their of social security number, dates of service and bed location. Per Mrs. Beaty, encouraging clients to sleep positioned head-to-foot is carried out but does not always happen. There are 416 bunked beds and FCDHW staff observed the entire layout of bed locations and a blueprint of bed mappings.

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