Module 1: Infection Control in the Home Setting
Thorough handwashing is the single most important way to stop the spread of infection. Treat every client's blood and body fluids as if they are infectious.

Hand hygiene

• Clean your hands before, during and after every client contact, and right after removing gloves.
• Wash with soap and running water for at least 20 seconds, then dry with a paper towel.
• Alcohol-based hand rub is acceptable only when hands are not visibly dirty. Visibly soiled hands need soap and water.

Universal Precautions and PPE

• Universal Precautions means treating all human blood and certain body fluids as if they are known to be infectious. When you cannot tell body fluids apart, treat all of them as infectious.
• The bloodborne pathogens of greatest concern are HIV, Hepatitis B (HBV) and Hepatitis C (HCV).
• Personal protective equipment (PPE) includes gloves, masks, gowns, goggles and face shields. Wear clean disposable gloves for any contact with blood, body fluids, mucous membranes or non-intact skin. Discard gloves at the point of use.

How infection spreads

• Pathogens can be bloodborne, airborne or foodborne. COVID-19 and flu spread mainly through droplets from coughing, sneezing and talking.
• Fomites are contaminated objects and surfaces that carry infection from one person to another. Microbes can survive on surfaces from minutes to months.
• Never share personal items such as razors, nail clippers, towels or toothbrushes between people.
• Cough or sneeze into your sleeve or elbow, not your hands.

Protect yourself and your clients

• Stay current on vaccinations, and follow current agency policy and county health orders on vaccination and masking during respiratory virus season.
• If you are sick or test positive for COVID-19, stay home and call the office before your shift.
• When preparing food, use separate cutting boards for raw meat and vegetables, wash produce, and refrigerate food within two hours.

Module 2: Emergency Operations Plan

The emergency call-in number is 415-898-4278. The plan covers fires, earthquakes, severe weather, power outages, disease outbreaks, hazardous spills and terrorist attacks, and its goal is continuity of care for every patient.

Chain of command

• The Executive Director, Breann Van Slooten, is the Incident Commander and activates or deactivates the plan. In her absence, the Director of Development or the Director of Professional Services has that authority.
• The Incident Command Center is the agency office unless staff are told otherwise.
• The Incident Commander activates a phone tree to reach all staff and patients.

The three Cs

• Communication: keep contact lists current and use more than one way to reach people.
• Continuity: make sure necessary services continue. Every patient has an emergency plan, ideally created at the initial assessment.
• Collaboration: coordinate resources and services with the team and local health authorities.

Patient priority levels

Every patient has a priority code on the care plan and in AlayaCare.

Level - Priority - What it means
1 - High - Must have uninterrupted care. Life-sustaining equipment, treatments or medications; condition highly unstable.
2 - Moderate - Visit may be postponed with telephone contact. A caregiver can provide basic care until the situation improves.
3 - Low - Stable, with informal support. Can safely miss a scheduled visit.
4 - Lowest - Visit may be postponed 72 hours or more. Willing and able caregiver present, or patient independent in most ADLs.

Your role

• Know the emergency number, your patients' priority codes, and where the plan is kept: the bulletin board in the HR application room and the new hire manual.
• Review each patient's emergency plan with them, and tell the office if a priority code should change.
• Wear your name tag so other emergency agencies can identify you.
• If cell towers and phone lines are down, listen to radio station 810 KGO.
• During an emergency, check in with the office once a day at 10 am or 2 pm for updates and assignments.
• Expect to be called for the mock emergency drill held once a year.

Specific emergencies

• Fire in a patient's home: call 911, give the address and what is burning, and begin evacuating. Stay low in heavy smoke. Do not stop to save belongings.
• Earthquake: stay calm and get under a desk or table, away from glass and windows. Do not leave the building during the shaking. Afterward, do not smoke, light fires, use electrical equipment or drink the building's water.
• Medical emergency: call 911, state the problem and the address, then call the office as soon as possible.
• Pandemic: wear the PPE the agency provides, wash hands after every contact, and report any symptoms in yourself or your patient to the office.

Module 3: Workplace Violence and Sexual Harassment

Workplace violence is violence or the threat of violence against a worker, from verbal abuse to physical assault. Heart of Humanity does not tolerate violence, bullying or harassment from anyone: clients, family members, coworkers or supervisors.

What bullying looks like

• Repeated hurtful remarks, or making fun of a person or their work
• Swearing, yelling, name calling or hanging up on someone
• Intimidation, mind games or creating a negative work environment
• Pushing, shoving, grabbing, attacking or threatening
• Refusing to cooperate, or deliberately holding back information needed to do the job

Risk factors in home care

• Working alone
• Client or family frustration, and unstable or volatile persons in the home
• High-crime areas, weapons in the home, and exposure to drugs in the community
• Using your car for work, and the perception that you carry syringes or drugs

How to protect yourself

• Learn to recognize escalating agitation. Do not try to reason with an agitated or angry person. Walk away, leave the home if you feel unsafe, and call the office. Call 911 if you are in danger.
• Do not engage in confrontation or abusive language with any client or employee.
• Report every incident promptly and accurately, and put it in writing.

Sexual harassment

Sexual harassment is unwelcome verbal, visual or physical conduct of a sexual nature, or conduct directed at someone because of their sex. It is illegal under federal and California law.

• Verbal or written: comments about clothing or a person's body, sexual jokes, repeatedly asking someone out, spreading rumors about someone's personal life
• Physical: inappropriate touching, blocking movement, unwanted hugging or kissing
• Nonverbal and visual: leering, sexual gestures, following a person, sexual posters, pictures or emails

Harassment based on race, color, religion, sex, gender identity, sexual orientation, national origin, age or disability is also prohibited. A supervisor may not date an employee who reports to them. Counseling or an investigation conducted by a supervisor is not harassment.

If it happens to you

1. Say "no" clearly. Tell the person the behavior offends you.
2. Write down what happened right away: dates, times, places and witnesses.
3. Report it in writing to your supervisor, Human Resources or the Executive Director, and keep a copy.
4. Use the agency grievance procedure. You may also file a complaint with a government agency.

Every complaint is investigated. You cannot be fired, demoted or have your hours cut for reporting in good faith. Retaliation is prohibited.

Module 4: HIPAA and Confidentiality

Protected Health Information (PHI) may be used or shared only for treatment, payment and routine operations unless the patient authorizes it in writing. PHI is protected in every form: spoken, written, on paper and electronic.

What counts as PHI

Health records, and anything that identifies the patient alongside them: name, date of birth, Social Security number, address, phone number, email address.

Patient rights

• See and receive copies of their medical records
• Ask for corrections to their records
• Choose how they are contacted and who may receive their information
• Restrict information, including from family members
• Receive a Notice of Privacy Practices
• File a complaint with the Department of Health and Human Services

When PHI may be shared without written authorization

• Treatment, payment and day-to-day health care operations. Doctors, nurses, labs and pharmacies may discuss the patient's care.
• Public health purposes, including disease control and FDA monitoring
• A HIPAA investigation, or cooperation with law enforcement
• Life-threatening emergencies

Avoiding common violations

• Speak privately and keep your voice down, especially in waiting rooms and public places.
• Do not assume family members may be told. The patient may have restricted that information.
• Never post about a client on social media, with or without their name.
• Do not discuss a client's or coworker's health with coworkers, friends or family. If asked, be polite but firm: you are not allowed to talk about it.
• Keep paper records out of sight in a desk or file cabinet. Shred what is no longer needed. Never put it in the trash.

Violations carry civil penalties that can reach tens of thousands of dollars per violation, and may lead to termination. Report any suspected privacy violation or suspicious activity to the Heart of Humanity office right away.

Module 5: Elder, Dependent Adult and Child Abuse Reporting

Every nurse at Heart of Humanity is a mandated reporter under California law. If you reasonably suspect abuse or neglect of a child, an elder or a dependent adult, you must report it yourself. You do not need proof.

Who is protected

• Child: anyone under 18
• Elder: anyone 65 or older
• Dependent adult: anyone 18 to 64 with physical or mental limitations that restrict their ability to carry out normal activities or protect their rights. This includes most of our Regional Center clients.

Types of abuse

• Physical abuse, including inappropriate restraint and unlawful corporal punishment
• Sexual abuse or exploitation
• Neglect, including failure to provide food, hygiene, medical care or a safe home. For elders and dependent adults this includes self-neglect.
• Financial abuse: taking or misusing an elder's or dependent adult's money or property
• Abandonment, isolation and abduction
• Emotional or mental abuse: threats, humiliation, intimidation

Warning signs

• Unexplained bruises, burns, fractures, or injuries in different stages of healing
• An explanation that does not match the injury
• Weight loss, dehydration, poor hygiene, untreated pressure injuries, missing medications
• Fear, withdrawal or flinching around a particular person
• A caregiver who will not let you see the client alone
• Missing money or belongings, or sudden changes to accounts
• In children: frequent absences, sexual knowledge beyond their age, being left alone

When you must report

Report when you observe abuse, have knowledge of an incident that reasonably appears to be abuse, are told by the client that it happened, or reasonably suspect it. Do not investigate or confront the suspected abuser. If anyone is in immediate danger, call 911 first.

Who	Call	Phone report	Written report
Elder or dependent adult living at home	County Adult Protective Services (APS) or local law enforcement	Immediately, or as soon as practicably possible	Form SOC 341 within 2 working days
Child	County child welfare (CPS), police or sheriff	Immediately, or as soon as practicably possible	Form BCIA 8572 within 36 hours

 

Abuse that occurs in a long-term care facility is reported to the Long-Term Care Ombudsman or law enforcement on shorter deadlines. Ask your supervisor for help if this applies.

What else you need to know

• The duty is personal. Telling your supervisor does not satisfy it, and no supervisor may stop you or penalize you for reporting.
• After you report, notify the office the same day. For Regional Center clients the agency must also file a Special Incident Report with the Regional Center within 24 hours.
• You are protected from civil and criminal liability for a required report, and your identity is kept confidential.
• Failure to report is a misdemeanor punishable by up to six months in jail, a fine of up to $1,000, or both. Penalties increase if an elder or dependent adult dies or suffers great bodily injury.
• Document only facts: what you saw, what you heard, and the client's own words.

Domestic violence

Domestic violence is abuse by a spouse, partner, former partner or household member. It can be physical, sexual, emotional or financial, and it affects patients of every age and background.

• Warning signs: injuries that do not match the explanation, injuries in different stages of healing, a partner who answers for the patient or will not leave the room, missed appointments, fear, anxiety or depression.
• Talk with the patient alone and in private. Listen, do not judge, and do not confront the suspected abuser.
• If anyone is in immediate danger, leave the home if you need to and call 911.
• California law (Penal Code 11160) requires health practitioners who treat a physical injury they know or reasonably suspect was caused by assaultive or abusive conduct to report it to local law enforcement: by phone immediately, and in writing within two working days. Call your supervisor right away and the agency will help you make the report.
• If the patient is a child, an elder or a dependent adult, the abuse reporting rules above also apply.
• Offer the National Domestic Violence Hotline, 1-800-799-7233, which is open 24 hours.
• Document facts and the patient's own words.

Legal references: Welfare and Institutions Code 15630 (elder and dependent adult abuse reporting), Penal Code 11164 to 11174.3 (Child Abuse and Neglect Reporting Act) and Penal Code 11160 (injuries from assaultive or abusive conduct).

Module 6: OSHA and Workplace Safety

OSHA, and Cal/OSHA in California, require your employer to provide a safe workplace, and the client's home is your workplace. Report every hazard, injury and exposure to your supervisor right away.

Your rights

• Safety training, PPE and the Hepatitis B vaccine at no cost to you
• Access to the agency's Injury and Illness Prevention Program and Exposure Control Plan
• The right to report a hazard or injury, or to file a complaint with Cal/OSHA, without retaliation

Bloodborne pathogens and sharps

• Follow Universal Precautions with every client (see Module 1).
• Never recap, bend or break a used needle. Use safety devices when provided.
• Place used sharps immediately into a puncture-resistant sharps container. Do not overfill it, and never put sharps in the household trash.
• Bag linens and waste soiled with blood or body fluids before disposal, and wear gloves.

If you have a needlestick or exposure

• Wash the area with soap and water. Flush eyes, nose or mouth with water.
• Report to your supervisor immediately. Do not wait until the end of the shift.
• Get the confidential medical evaluation and follow-up the agency provides at no cost.
• Complete an incident report.

Tuberculosis and respirator protection

• TB spreads through the air when a person with active TB of the lungs coughs, speaks or sneezes.
• Symptoms of active TB: a cough lasting three weeks or more, coughing up blood, fever, night sweats, unexplained weight loss and fatigue. Report a patient with these symptoms to your supervisor the same day.
• Keep your TB screening current: at hire and every year after.
• A surgical mask does not protect you from TB. You need a fit-tested N95 respirator to care for a patient with suspected or confirmed active TB.
• Before you use an N95 you must have a medical evaluation, a fit test and training. Fit testing is repeated every year and whenever you change respirator model or your face shape changes.
• Do a seal check every time you put the respirator on. Facial hair under the seal prevents a proper fit.
• Report any unprotected TB exposure to your supervisor right away. The agency provides follow-up testing at no cost.

Hazardous materials and your right to know

• You have the right to know about every hazardous substance you may be exposed to at work. The agency keeps a written Hazard Communication program and provides training.
• Read the label before using any product. Safety Data Sheets (SDS) list a chemical's hazards, first aid and safe handling, and you may ask the office for one at any time.
• Never mix bleach with ammonia or other cleaners. Use products in a ventilated area and wear gloves.
• Keep products in their original labeled containers, out of reach of children and confused adults.
• Handle medical waste, soiled dressings and hazardous medications as the plan of care directs. Never put sharps or blood-soaked waste in an open trash can.
• Secure oxygen cylinders upright or flat so they cannot fall, and keep them away from heat.
  For a spill you cannot safely clean up, keep people away and call the office. For a chemical in the eyes or on the skin, flush with water for 15 minutes and call Poison Control at 1-800-222-1222, or 911 for serious symptoms.

Proposition 65

• Proposition 65 is California's Safe Drinking Water and Toxic Enforcement Act of 1986.
• It requires businesses to give a clear warning before knowingly exposing anyone to a chemical known to the state to cause cancer, birth defects or other reproductive harm.
• The state publishes and updates the list of these chemicals. Warnings appear on product labels and on posted signs.
• If you see a Proposition 65 warning on a product you use at work, follow the label directions and ask the office if you have questions.

Lifting and body mechanics

• Back injuries are the most common injury in home care. Assess the client and the space before every transfer.
• Use gait belts, slide sheets and mechanical lifts as ordered. Get help when the plan of care calls for two people.
• Keep the load close, bend your knees, and pivot your feet. Do not twist.

Hazards in the home

• Slips, trips and falls: clear clutter and cords, wipe up spills, wear closed-toe non-slip shoes.
• Oxygen: no smoking or open flame in the room.
• Animals, weapons, pests and unsafe conditions: report them to the office before the next visit.
• Driving: wear a seat belt and do not use a handheld phone.
• Respiratory illness: keep your TB screening current and wear the mask or respirator the situation requires.

If you are injured at work

Report the injury to your supervisor the same day, however minor. The agency will give you a workers' compensation claim form and direct you to medical care. Call 911 for any serious injury.

Module 7: Patient Rights, Advance Directives, Ethics and No Solicitation

Every patient has the right to make decisions about their own care, and every nurse is expected to protect that right and to act honestly.

Patient rights

Patients receive a written notice of their rights before care begins. Every patient has the right to:

• Be treated with dignity and respect, and have their home and property respected
• Receive care without discrimination
• Be told about their care in a language and manner they understand, and take part in planning it
• Be told in advance about changes to their care and about charges
• Refuse care or treatment and be told the consequences
• Have their information kept confidential
• Be free from abuse, neglect and exploitation
• Voice a grievance to the agency or the state without fear of retaliation

If a patient raises a complaint, listen, do not argue, and report it to the office the same day.

Advance directives

• An Advance Health Care Directive lets an adult name a health care agent and write down their wishes for care if they cannot speak for themselves.
• A POLST (Physician Orders for Life-Sustaining Treatment) is a signed medical order for seriously ill patients. It covers CPR and other life-sustaining treatment and should stay with the patient.
• Patients are asked at admission whether they have an advance directive, and the answer is documented. Care never depends on having one.
• Know whether your patient has an advance directive, POLST or DNR, and where it is kept.
• In an emergency, call 911 and show the POLST or DNR to the responders. If there is no valid DNR or POLST, begin CPR if you are trained and call 911.
• Do not advise a patient on what to choose, and do not sign as a witness. Agency staff may not witness a patient's advance directive. Refer questions to your supervisor or the patient's physician.
• Patients can change or cancel an advance directive at any time. Report any change to the office.

Ethics

• Respect each patient's choices, act in their best interest, do no harm, and treat all patients fairly.
• Document honestly and on time. Never chart care that was not given, and never alter visit times or records.
• Practice only within your license and the plan of care.
• Report your own errors promptly. Reporting protects the patient.
• Keep professional boundaries. Do not share personal problems, give out your personal finances, or enter a personal or financial relationship with a patient or family.
• Avoid conflicts of interest, and report suspected fraud, waste or abuse to the office. You will not be penalized for reporting in good faith.

No patient solicitation

• Do not ask for or accept money, tips, loans or gifts from patients or their families. Politely decline and tell the office.
• Do not sell products or services to patients, or promote a business, religious or political cause.
• Do not recruit patients to another agency or to private work with you, and do not encourage a patient to change their health plan or provider.
• Do not accept or offer anything of value in exchange for a referral.
• Do not borrow from a patient, handle their finances, or agree to be named in a will or power of attorney.

I have read and understood the seven modules of this in-service.