Archive – Reference Only
These archived documents are for reference only! Newer versions of these documents are available at the appropriate sections of the site.
- Covid-19 Archive
- Dietary Corner – Forms
- Dietary Corner – Sanitation Policies
- Illinois Licensure Violations
- OLD General Pharmacy Policies
- OLD IV Therapy Policy & Procedures – Archived 10/2016
- Dietary Corner – Additional Policies
- COVID-19 – Resource Book (Archived)
Facility and Consultant List 11/1/2023 / archived 2/13/24
Isolation, Discontinuing (old) – archived 02/2024
Governing Body Managment Policy 2019
High Risk Event Communication 11/23
COVID Screening Entering Facility (1/5/2023) archived 1/8/24
Non-Communal Dining & Infection Control Tips (NutritionCare) archived 1/8/24
CPR Guidance During the COVID-19 Pandemic 4/8/2020 archived 1/8/24
COVID Posting if you have positives in house 4/23/2020 archived 1/8/24
COVID Indoor and Outdoor Visitations – Indiana & Illinois 11/19/2021 archived 1/8/24
High Risk Event Communication 9/11/23 archived 11/28/23
Indiana POST Form 2017
Indiana Declination -3.31.21
POLST FORM (ILLINOIS)-May, 2016
Ethics and Compliance Manual archived 11/23
Indiana – Influenza like Illness Outbreak Toolkit archived 10/30/2023
CDC Information Statement: Influenza (Flu) Vaccine August 2021 archived 10/30/2023
Pneumococcal Conjugate Vaccine February 2022 archived 10/30/2023
Pneumococcal Polysaccharide Vaccine October 2019 archived 10/30/2023
Authorized Legal Representative Immunization Program Notification Letter Aug 2012 archived 10/30/2023
Flu Symptoms Educational Handout (Poster) archived 10/30/2023
Flu Prevention Methods Handout (Poster) archived 10/30/2023
Informed Consent for Vaccinations (Influenza and Pneumococcal)-Revised, September, 2015 archived 10/30/2023
QAPI Minutes 9/12/23
archived 9/28/23
Contents of Investigation File 2/14/2023 – archived 9/27
Side Effects of COVID Vaccine archived 9/20
Benefits of COVID Vaccine archived 9/20
Illinois Abuse Prevention Policy 10-24-22 archived 9/23
Indiana Abuse Prevention Policy 10-24-22 archived 9/23
Informed Consent archived 7/31/23
Policy Coronavirus Disease 2019 (1/5/2023) – archived 7/23
Facility Testing IN and IL 1/5/2023 – archived 7/23
COVID Vaccination Mandate Policy 12/29/21 – archived 7/23
COVID Vaccination Mandate Policy INDIANA Revised – archived 7/23
COVID Medical Exception – archived 7/23
COVID Religion Exception revised 11/30/21 – archived 7/23
COVID Unvaccinated Staff Plans revised 3-15-2022 – archived 7/23
Admission Readmit Covid Testing Tracker 1/5/2023 – archived 7/23
COVID-19 New-Admission/Re-Admission 1/5/2023 – archived 7/23
Medicare Meeting Agenda Dialogue archived 5/23
Medicare Meeting Agenda Attendance archived 5/23
Reporting Form Revised July 1, 2010 – archived 4/12/23
Matrix Directions for Surveys – to give to surveyors Entrance Conference Worksheet archived 3/2023
Procedure for MDS 3.0 – CAA and Care Plan, Part 1 of 2 updated October, 2016, archived 2/24/23
Procedure for MDS 3.0 – CAA and Care Plan, Part 2 of 2 updated October, 2016, archived 2/24/23
Morning Meeting Template archived 2/21/23
HR and Credential Cheatsheet archived 2/20/23
Indiana Abuse Prevention Policy June, 2018-arch 10/24/22
Illinois Abuse Prevention Policy – February, 2017 arch 10/24/22
Routine Resident Checks and Safety Room Checks (contraband) Archived 10/2022
Smoking Archived 10/2022
Routine Resident Checks and Safety Room Checks (contraband) archived 10/2022
ITD Process Overview – archived 10/2022
ECC Policy Care Plans Comprehensive (updated April, 2015) arc 10/22
Answering Call Light 10/31/2022
Visitation Rights of Resident – Updated 11/2016 arch 10/2022
CDC Information: Pneumococcal Polysaccharide Vaccine April 2015 Arch 8/22
CDC Information Statement: Pneumococcal Conjugate Vaccine 8/21 Arch 8/22
Weighing and Measuring the Resident archived 12/2020
Sexual Harassment Policy SMHRF – archived 6/21/22
Pandemic Part 1 of 8 archived 1/20/2022
COVID Unvaccinated Staff Plans archived 3/15/2022
COVID Vaccination Mandate Policy archived 12/29/21
COVID Medical Exceptionarchived 12/29/21
COVID Religion Exception 11/30/21 archived 12/29/21
Clinical Record Content March 2014
COVID Religion Exception 11/30/21
E041 Fuel Monitoring Archived 3/2020
CDC Information Statement: Inactivated Influenza Vaccine August 2019 archived 9/10/21
CDC Information Statement: Live, Intranasal Influenza Vaccine August 2019 archived 9/10/21
Advance Directives archived 6/8/2021
Cardiopulmonary Resuscitation – CPR
Licensed Agency Nurse Orientation Checklist archived 4/8/2021
Agency Certified Nursing Assistant Orientation Checklist archived 4/8/2021
Weight Assessment and Intervention 1/21/21
Isolation – Categories of Transmission-Based Precautions 3/3/2020
HIM Privacy Protection archived 9/9/2020
Isolation – Categories of Transmission-Based Precautions archived 9/30/20
Isolation – Categories of Transmission-Based Precautions archived 6/4/2020
COVID-19
COVID Essential Caregiver Policy 12/14/2020 archived 7/14/21
Facility Testing – Illinois 8/28/2020 | Part 2 archived 5/12/2021
Facility Testing – Indiana 8/28/2020 | Part 2 archived 5/12/2021
EMPLOYEE & RESIDENT POINT OF CARE TESTING RESULT SHEET 10/7/2020 arxhived 3/25/21
Outdoor Visitation Guidance for Long-Term Care Facilities 6/19/2020 archived 3/23/21
Outdoor Visitation Policy 6/19/2020 archived 3/23/21
COVID Indoor and Outdoor Visitations – Indiana 3/18/2021 archived 3/23/21
COVID Indoor and Outdoor Visitations – Illinois 9/30/2020 archived 3/23/21
Facility Testing – Illinois 8/28/2020 | Part 2 Archived 10/15/20
Facility Testing – Indiana 8/28/2020 | Part 2 Archived 10/15/20
BD Veritor Plus Testing Machine Requisition Form – Resident archived 10/14/20
BD Veritor Plus Testing Machine Requisition Form – Employee archived 10/14/20
COVID-19 Isloation room tracking form archived 10/8/2020
COVID Indoor and Outdoor Visitations – Indiana & Illinois archived 11/19/21
Facility Testing – Indiana 8/28/2020 | Part 2 archived 10/7/2020
Fire Drill Report Form Oct 2015 archived 9/21/21
Facility Testing – Illinois 7/27/2020 – archived 8/31/2020
Facility Testing – Indiana 6/11/2020 – archived 8/31/2020
Policy – Coronavirus Disease 5/28/2020 – archived 7/29/2020
Facility Testing – Illinois 6/11/2020 archived 7/27/2020
Outdoor Visitor Sign In Sheet 7/17/2020
New Admission Policy During COVID 6/11/2020 archived 7/1/2020
COVID Outdoor Visitation Policy – Indiana 6/11/2020 – archived 6/19/2020
Social Distancing Policy archived 6/4/2020
COVID-19 Policy on Testing 5/28/2020 – archived 6/12/2020
New Admission Policy During COVID 5/29/2020 – archived 6/12/2020
Policy – Coronavirus Disease 5/29/2020 – archived 6/4/2020
Policy – Coronavirus Disease 5/20/2020 archived 5/29/2020
Policy – Coronavirus Disease 4/8/2020 – archived 5/20/2020
CMS REF QSO-20-14-NH archived 3/26/20
Coronavirus (COVID-19) Policy and Procedure 3/27/2020
Long-Term Care (LTC) Respiratory Surveillance Line List 3/12/2020
Respiratory Surveillance Line List 3/12/2020
Hand Washing/Hand Hygiene Policy archived 4/14/2020
Hand Washing Policy revised Nov 2013
Employee Monitoring Tool archived 5/8/2020
Staffing archived 5/2020
Facility and Consultant List Mar 2019
IDPH Form: Notice of Transfer and Discharge Archived 2/2020
E22 Shelter in Place Policy-Archived 2/2020
Loss of Air Conditioning During Hot Weather Policy archived 2/2020
Loss of Heat During Cold Weather Policy Archived 2/2020
Primary and Alternative Means of Communication E032 Archived Jan 2020
E-018 Tracking of Residents and Staff archived Jan 2020
Resident Declined POST-POLST form archived 11/19
CDC Information Statement: Inactivated Influenza Vaccine September, 2015
CDC Information Statement: Live, Intranasal Influenza Vaccine September, 2015
CDC Information Statement: Pneumococcal Conjugate Vaccine Revised 2013
Pain Managment Program – revised 1/2019 archived July 2019
IE1 – Controlled Substance Disposal archived 6/2019
IE5 – Medication Destruction archived 6/2019
QAPI Plan -FINAL 2017 archived 6/2019
Infection Verification Form archived April 19
Discharge Against Medical Advice (AMA) archived March 2019
Governing Body Management Policy – archived March, 2019
Refrigerator in a Resident’s Room August 2015
Acceptance/Declination Form for Influenza Vaccine 9/2010- Archived September 2020
Facility and Consultant List Jan 2016
Pressure Ulcers/Skin Breakdown – Clinical Protocol
Downstaging for MDS Coding
Dressing, Non-Sterile
Dressing, Sterile
Pressure Ulcer Treatment
Prevention of Pressure Ulcers
Staple and Suture Removal
Support Surface Guidelines
Tissue Tolerance Policy January 2014
Dietary Interventions
Wound Audit Tool
Treatment Nurse Training Orientation Program
Glossary
Braden Scale Competency Test
Appendix A
Appendix B
Appendix C
Matrix Audit Tool
Appendix D
Wound Care Formulary archived 3/2019
Pain Management Program revised 01/2019
Survey: New Survey Preparation List (Illinois) REVISED 1/2018
Survey: New Survey Preparation List (Indiana)REVISED 1/2018
Investigation of Acquired Pressure Ulcers archived oct 2018
ECC Use and Storage of Outside Food Brought to Residents Final Revision – with reheating (archived Sep 2018)
Abbreviations Oct 2013 (archived Sep 2018)
Performance Improvement Plan Monthly Tracking (revised 2018)
29. Storage of Medication – Expiration Dates (revised 2018)
Indiana Abuse Prevention Policy – (revised June 2018)
E-026 Emergency Prep Plan Archived June 2018
Discharging Resident AMA (2014)
Smoking Policy – Residents Archived April 2018
Illinois Comptroller Copying Fees Adjustments Archived February 2018
Contract Approval Lead Sheet – archived 05/2018
Shower Sheet-Back Page – archived 12/2017
Shower Sheet Jan 2017 – archived 12/2017
Shower Sheet Back Page – archived 12/2017
Code of Conduct 8-29-14 archived 10/2017
CCP Summary Final 8-29-14 archived 10/2017
Fire Watch Policy – Updated July, 2017 – archived 9/2017
Documentation Guidelines – Resident Discharge archived 2014
POST FORM (INDIANA) – April, 2016
Governing Body Management Policy clarified on 4/2017
Illinois Abuse Prevention Program – archived 2/2017
Post-Dialysis Monitoring archived 2/2017
Employee Accident Reporting Policy 2014 archived 8/2017
Shower Sheet Front Page (Revised 06/2016)- archived 8/2017
ACA Section 1557 Grievance Policy and Procedure -archived 8/2017
Resident Personal Trust Funds Policy & Procedure archived 1/2017
Notification of Resident Change in Condition Policy archived 11/2016
Bed Hold and Readmission Policy archived 12/2016
Fire Watch Policy, archived July, 2017
Fire Policy Procedure archived 1/2017
Fire-Disaster-Preparedness 7/2015 – archived 1/2017
Resident Grievance Form archived 1/2017
Grievance Investigation Form archived 1/2017
Fire Watch Policy archived 12/2016
Resident Advance Directives Policy archived 11/2016
Room to Room Transfers (policy) archived 11/2016
Immunization Policy: Resident Immunization Process archived 11/2016
Admission Policy archived Nov 2016
Admission Policy Oct 2013
Filing Grievance archived 11/2016
Lab Diagnostic Test Results Notification Feb 2014-archived 11/2016
Visitation-archived 11/2016
Infection Verification Form archived 11/2016
Resident Rights archived November, 2016
ECC – Policy – Resident Assessment Instrument MDS 3 0 – updated June 2015 archived 10/2016
Procedures for MDS 3.0, CAA and Care Plan – Part 1 of 2 (updated April, 2015) archived 10/2016
Procedure for MDS 3.0, CAA and Care Plan Part 2 of 2 (updated April, 2015) archived 10/2016
Transfer & Discharge Policy March 2014 Archived September, 2016
Fire Watch Policy updated Dec 2014
POLST FORM (ILLINOIS) – April, 2016 – Archived May, 2016
Indiana Reporting Requirements Revised 7/1/10 – Archived 9/2015
Guidelines for Reporting Abnormal Test Results for Physicians
Policy on Policies archived 10/9/2015
Reasonable Suspicion of a Crime Poster archived 10/20/15
Fire Watch Policy
ECC Facility and Consultant List
CNA Transfer/Ambulation Observation Archived 11/2015
2014 Admission Packet May 2014
Shower Sheet Front Page (Revised 04212015)
Angel Rounds May, 2016
Indiana Fee Schedule Nov 2005 (Archived 8/2016)
HITECH Policy and Procedures (archived september 2016)
Abuse Policies
Abuse and Neglect, archived November, 2016
Abuse/Neglect Investigations archived November, 2016
Abuse Policy Sept 2011- Dec 2012
Preventing Resident Abuse archived November, 2016
Reporting Abuse to Facility Management archived November, 2016
Resident-to-Resident Abuse archived November, 2016
Illinois Abuse Prevention and Investigation Policy – Archived 10/2016
Illinois Abuse Prevention and Investigation Procedures rev 11/2016-archived 11/2016
Illinois Abuse Prevention and Investigation Policy – October, 2016 archived, November 2016
Indiana Abuse Prevention and Investigation Policy – Nov 2013 archived, November 2016
Indiana Abuse Prevention and Investigation Procedures rev 11/2016-archived 11/2016
Elopements
Elopements
Nursing Policies and Procedures
Procedure: Resident Immunization Program Aug 2012
Abbreviation List through Oct 2013
Abuse/Neglect Observation
CDC Information Statement: Inactivated Influenza Vaccine 2014-2015 season
CDC Information Statement: Live, Intranasal Influenza Vaccine 2014-2015 2014-2015 season
Resident Assessment Protocol: Falls
Lab, Diagnostic Test Results and Change in Residents 2/2014
Physical Restraint Application 2/2014
Antipsychotic Medication Use 2/2014
Emergency Use of Restraints 2/2014
Death of a Resident 1/2016
OSHA Forms 300, 300A, 301 before 4/2014
Medication Administration Policy before 3/2014
Videotaping, Photographing, and other Imaging of Residents before 8/2016
Post Dialysis Monitoring rev 2/2017
Guardian Angel Program
Guardian Angel Program Overview before 4/23/2013
Guardian Angel Rounds Form before 4/23/2013
Room Inspection Report before 4/23/2013
Post Fall Management Team Form 2/2014
Isolation Culture Guidelines archived November 2014
Bed Mobility System Assessment archived 5/1/15
ECC – Policy – Resident Assessment Instrument (MDS 3 0) archived 6/2015
Old Administrator Manual Policies archived on 6/26/2015
Accident-Incident And Unusual Occurrence Reporting
Discharge Planning
Housekeeping Services Policy
Environmental Services
Ethics Committee
Fire and Disaster PreparednessFlame Retardant Materials Policy
Flame Retardant Materials Policy
Hazard Communication Program
Hazard Communication Quality Assurance
Hazard Communication Standard Policy
Hazardous Chemical Inventory Listing
Hazardous Chemical Purchasing
Informed Consent
Management of Actual- Potential Liability Claims Data Policy
Safety
Root Cause Analysis
Sentinel Event
Smoking Policy
Social Services
Smoking Cessation Policy
Spiritual Care Services
Transfer and Discharge Policy
Fire Disaster Preparedness
Appendix A