1. Annual In-Service

2. The commitment of The Care Group / Reach Therapy is to provide high quality, state of the art, outcome-oriented health care to patients requiring specialized nursing, adult and pediatric rehabilitation services, adult nursing services, durable medical equipment, or respiratory therapy services in the home or other alternative sites. The commitment shared by every employee of The Care Group / Reach Therapy is to strive daily for performance improvement, clinical superiority, the highest standards of patient care, and customer service excellence. Mission Statement

3. Purpose of In-Service Ensure ongoing training and development for all personnel to maintain competence. This also includes annual continuing education and training for all personnel. Policy Number: HHA 8-001.1 Policy Number: HHA 9-001.4

4. Topics Environmental Safety Equipment Management Utilities Management Security Infection Control Hazardous Materials/Wastes Emergency Preparedness Fire Safety

5. Environmental Safety Back Safety Preventing Slips, Trips, and Falls Unsafe Practices All personnel will be responsible for recognizing and avoiding unsafe conditions, as well as controlling or eliminating any hazards or exposure to injury. Policy Number: HHA 8-002.1

6. Back Safety There is one important rule:THINK BEFORE YOU LIFT In lifting, you are the major cause of your injuries; therefore, you have the major responsibility for preventing them.

7. Back Safety - Moving Materials To pick up a low load: Drop to one knee and lift the load to balance it on your other knee. Pause, adjust your grip and lift to standing, holding the load as close to your body as possible. As you rise, lift your head and your back will maintain its neutral curves.

8. Slips, Trips, and Falls

9. Watch where you walk Do not allow cabling to create a tripping hazard Clean up spills quickly Do not block passageways Keep office areas clean Keep stacking and storage areas safe Pick up objects that fall Preventing Slips, Trips, and Falls

10. Unsafe Practices Stacking and Storage Boxes, files, and other articles must NOT be stacked on top of cabinets, cupboards, or window sills Keep passages clear and fire fighting equipment unobstructed Light objects are stored in top drawers and heavy objects in the bottom – also in filing cabinets Filing Cabinets Close the drawers Do not open all drawers at the same time Use the handle to close the drawer

11. Equipment Management Office Machines All personnel will be knowledgeable regarding equipment management and safety. Policy Number: HHA 8-005.1

12. Office Machines If you see smoke or sparks, unplug it immediately and report it Place a sign on the machine indicating to others that it is out of order Learn how to operate them safely before you use them

13. Utilities Management Electrical Safeguarding All personnel will be knowledgeable of the principles of electrical safety and utilities management. Policy Number: HHA 8-004.1

14. Electrical Safeguarding Cables Loose lying cables can cause tripping hazards, electrocution, and damage to expensive equipment Do not overload sockets Turn equipment off before unplugging It is your responsibility to report cable problems to your supervisor to have them fixed

15. Security Personal Safety Self protection to enhance personal safety is the responsibility of all personnel. Policy Number: HHA 8-012.1

16. Personal Safety Know exactly where you are going before you leave Always keep car doors locked Carry your keys in your hand You can use them as a method of self-defense Quick access into your car Stay near groups of people Be aware of your surroundings

17. Infection Control The Care Group of Texas / Reach Therapy is committed to reducing and minimizing employee exposure to infections in the workplace…Employees of The Care Group of Texas / Reach Therapy must assume responsibility to avail themselves of required personal protective equipment and to implement appropriate workplace controls. Policy Number: HHA 9-001.1 Bloodborne Pathogens Hepatitis B Vaccination Universal Precautions Personal Protective Equipment Hand Washing

18. Bloodborne Pathogen Diseases Malaria Brucellosis Syphilis Hepatitis B(HBV) Hepatitis C(HCV) Human Immunodeficiency Virus (HIV)

19. Hepatitis B Vaccination Strongly endorsed by medical communities The Care Group / Reach Therapy offers the Hepatitis B Vaccine to all employees who have patient contact at no cost If you have patient contact and would like to receive the Hepatitis B Vaccine, make the HR Department or supervisor aware of your request

20. Universal Precautions Isolate- separate yourself from contamination with a barrier Remove- dispose of potentially contaminated waste Decontaminate- apply disinfectant to stop contamination from going further Safety Awareness- watch for potential hazards and source of contamination Immunizations Immunizations prevent infection. The CDC recommends that you be immunized against hepatitis B, influenza, measles, mumps, rubella, and chicken pox.

21. Personal Protective Equipment Anything that is used to protect a person from exposure Latex or Nitrile gloves, goggles, CPR mouth barriers, aprons, and respirators TCG / Reach Therapy will supply and make accessible appropriate personal protective equipment consistent with the tasks being performed…Employees of TCG / Reach Therapy must assume responsibility to avail themselves of required personal equipment. Policy Number: HHA 9-006.1

22. Hand Washing Hand washing is the single most important precaution against the spread of infection. Use antibacterial soap (if possible) Scrub hands for 10 – 15 seconds, washing all surfaces thoroughly Rinse using warm water and dry hands with a clean towel If no hand washing facilities are available, come prepared with a waterless hand washing agent. Always wash hands… Immediately before and after patient contact Every time you remove gloves After using the restroom Before you eat Immediately following any obvious contaminations

23. Infection Control Plan Follow your agencys Infection Control Program. This battle plan includes the Occupational Safety and Health Administrations (OSHAs) bloodborne pathogen standards, OSHAs tuberculosis control guidelines, and isolation precautions recommended by the Centers for Disease Control (CDC). The Care Group / Reach Therapy Infection Control Program includes: surveillance of infection trends; identification of types and sources of infections; prevention of infections; control measures to discourage the spread of infection; and reporting of any infections to the appropriate agencies.

24. Hazardous Materials/Wastes Occupational Safety and Health Administration Hazardous Waste Disposal Accident/Incident Reporting To ensure the protection of agency personnel, patients, families/caregivers, and the community through proper handling of contaminated waste. Policy Number: HHA 8-011.1

25. OSHA OSHAs Hazardous Communication To ensure that employers and employees know about work hazards and how to protect themselves so that the incidence of illnesses and injuries due to hazardous chemicals is reduced. Hazardous Chemicals Must Include Labels which Indicate: The identity of the chemical Appropriate hazard warning Name and address of the responsible party Policy Number: HHA 9-013.1

26. Hazardous Waste Disposal Always where gloves when handling hazardous wastes Contaminated Paper Wastes: Place and secure in a plastic bag. Double bag and, if possible, place in a plastic trash container which is labeled appropriately. Sharps: Needles, syringes, and razor blades should be placed in a puncture proof container and labeled as contaminated waste. The container should be bagged, secured, and returned to the office for appropriate disposal. NEVER recap, break, or bend needles. Blood and Bodily Fluids: Pour down the toilet and immediately flush. Care should be taken to avoid splashing. Policy Number: HHA 9-011.1

27. Accident/Incident Reporting Employees are required to immediately report all work related injuries to their supervisor. State law and TCG/Reach Policy requires that injuries be reported in writing within twenty-four hours. Use the Accident/ Incident form to report all injuries. During orientation employees signed acknowledgment of TCG/Reach Therapy Workers Compensation Network. If you did not receive this information, please contact the HR department.

28. Emergency Preparedness Emergency Preparedness Plan On-Call To establish a plan which will allow for the continuation of services in the event of a major disaster. Policy Number: HHA 8-016.1

29. The agency has developed the following emergency preparedness plan for providing continuing patient care and support at a safe and therapeutic level in the event of a natural disaster... Policy Number: HHA 8-016.1 Emergency Preparedness Plan An alternate site will be designated in the event the office must be evacuated or is not accessible due to an emergency. Clinical supervisors will be responsible for triaging all patient care. In all emergency situations, the Administrator or designee will maintain communications and act as the spokesperson between other facilities, media, and safety authorities.

30. On-Call On call personnel are on a twenty-four hour paging system through the answering service. A current patient list with telephone numbers, addresses, and discipline types will be maintained by the Administrator on-call. In the event that a disaster or emergency takes place, the Administrator on-call will attempt to contact all clinical supervisors, who will in turn attempt to contact all patients that are involved in the potential disaster areas. When a patient is contacted, the patients immediate needs will be identified and documented. Policy Number: HHA 8-016.A

31. Fire Safety Types of Fires Types of Fire Extinguishers Extinguisher Use Fire Escapes To delineate the fire response process for the agency office. Policy Number: HHA 8-003.1

32. Types of Fires Class A - Wood, paper, cloth, trash Class B - Flammable liquids, oil, gas, grease Class C - Electrical, energized electrical equipment

33. Types of Extinguishers All Purpose Water Extinguisher Use on CLASS A fires Wood, paper, cloth, and trash Carbon Dioxide Extinguisher Use on CLASS B and CLASS C fires – Flammable liquids, oil, gas, grease – Electrical, energized electrical equipment Dry Chemical Extinguisher Use on CLASS A, CLASS B, and CLASS C fires – Wood, paper, cloth, and trash – Flammable liquids, oil, gas, grease – Electrical, energized electrical equipment

34. PASS – Use of Fire Extinguisher Always remember PASS when using a fire extinguisher. The following are guidelines for using a fire extinguisher on a small fire: P – Pull the pin from the handle A – Aim the nozzle at the base of the fire S - Squeeze the handle to activate the extinguisher S – Sweep the nozzle on the base of the fire until the fire is out, stop.

35. Fire Escape Guidelines for reacting to the discovery of fire; remember RACE in case of fire: R – Rescue – Rescue people in immediate danger if you can do so without putting your life in fear. A – Alarm – Activate the alarm from a pull station near you and call 911 or other emergency rescue team. C – Confine – Close windows, doors, and other openings, if you can do so safely. E – Evacuate – Evacuate the building as soon as you can by going to the closest exit.

36. All employees are responsible for understanding and complying with The Care Group / Reach Therapy policies and procedures. These policies and procedures are found in Forms on Augusta (J)/Archive/Policy/Home Health Policies and Procedures Current. Once you have reviewed the Annual In-Service PowerPoint, complete the Annual In-Service Quiz and submit it to Jessica Coleman via e-mail jcoleman@caregrp.com or fax 713-383-2113. All employees are required to take the Annual In-Service Quiz and send it no later than June 15, 2012. jcoleman@caregrp.com Disclaimer Quiz