Valor EOC — Environment of Care

Form 1 — Health & Safety Assessment

Place "yes" if conditions are satisfactory, "no" if unsatisfactory

Inspector

Date & Time

Waste Disposal

Smoking Areas

Electrical Equipment & Appliances

Flammable Liquids & Gases

Fire Equipment

Heating Appliances

Aisles / Exiting

Smoking (Inside / Outside)

General Satisfaction of Assessment

Comments / Recommendations

Inspector Signature (type name)

Form 2 — Facility Inspection Checklist (7 sections)

Inspector: Date:

Review of Prior Corrections

Emergency Lighting

Emergency Preparedness

Fire Extinguishers

Kitchen

Housekeeping

Electrical

Smoke Alarms

Personal Protective Equipment (PPE)

Medical Supplies

Legal & Other Requirements

Security

Other Equipment Maintenance

Corrective Actions Summary

Items below auto-populated from "No" answers. These will be logged as findings. Return to Safety/QA Officer within 30 days.

#	Unsafe Condition / Work Practice	Person Assigned	Corrective Actions	Due Date
1
2
3

Management Reviewer

Date of Review

Form 3 — Temperature Logs

Valor uses Bluetooth/WiFi connected thermometers in each refrigerator. Monthly tracking is available upon request. Log readings below.

Form 4 — Hand Hygiene: Infection Control Compliance Observation

Staff Member Observed

Observed By

Date of Observation

I. Hand Hygiene — Patient Care Areas Have Readily Accessible (A)

Staff Perform Hand Hygiene (B)

Regarding Gloves, Staff (C)

Form 5 — Emergency Drill

Person Conducting Drill

Facility

Date & Time

Shifts Present

Numbers of Clients Present

Number of Staff Present

Plan Tested (select all that apply)

🔥 Fire (Facility) ⚡ Utility Failure 💣 Bomb Threat 🏥 Medical Emergency 🌪 Natural Disaster ⚠️ Threats of Violence ❄️ Snow/Ice Storm

Drill Results

Duration

Evacuation Time (if applicable)

Blocked Routes (if any)

Drill Result

Comments / Recommendations

Corrective Actions

#	Description	Date
1
2
3

Received and Approved By

Approval Date

Form 6 — Health & Safety / Infection Control Committee Meeting

Type of Meeting

Location

Date

Start Time

End Time

Facilitator's Name

Facilitator's Title

Members Present (one per line)

Members Absent

Agenda & Minutes

Agenda Item 1

Items Discussed & Inspected

Findings & Actions Needed

Person Responsible & Due Date

Agenda Item 2

Items Discussed & Inspected

Findings & Actions Needed

Person Responsible & Due Date

Agenda Item 3 — Emergency Procedures / Fire Drills

Items Discussed & Inspected

Findings & Actions Needed

Person Responsible & Due Date

Agenda Item 4 — Illness & Infection Control

Items Discussed & Inspected

Findings & Actions Needed

Person Responsible & Due Date

Next Meeting

Next Meeting Date

Next Meeting Time

Next Meeting Location

Next Meeting Facilitator

Form 7 — Emergency Procedures Reference

Reference document — these procedures are included in each monthly binder tab. No data entry required.

🔥 Fire Drill Response

▼

On Duty Staff:

Staff call 911 (for drill, simulate)
Notify management (for drill, simulate)
One staff member is responsible for gathering the medication, MAR book, and emergency contacts binder
One staff member is responsible for making a facility run and checking ALL rooms, including bathrooms
Ensure that all doors are closed as you leave a room
Staff member who makes the facility run is responsible for conducting a head count and directing all clients and staff to safely evacuate the building to the "evacuation safe place" in the front parking lot
Clients are not permitted to re-enter the facility until staff instructs them to

If and when able:

Shut off emergency valves for gas and electrical panel

🏥 Medical Emergency

▼

Clear the clients from the area immediately and instruct them to remain in their rooms until notified the situation is clear
Assess the situation to determine if an ambulance and the Client Physician needs to be called
If an ambulance needs to be called, call 911 and follow instructions as given. If CPR needs to be given, please follow proper protocol
If basic 1st aid needs to be rendered, please follow proper protocol in rendering 1st aid
Notify management as soon as possible

🌪 Natural Disaster

▼

In the event of a natural disaster cease all outdoor activities. Avoid open areas; places near trees, metal fences, overhead wires or power lines. Most external disasters will be general in nature, impacting not only this facility but also the general area around the facility.

Safety Response: In the event of an external disaster the most senior staff on duty shall assume charge, make assignments, monitor status and instruct other staff.

🌍 Earthquake

▼

If indoors, remain indoors:

Take cover under a heavy desk, table or well supported object and hold on
Select a location that will allow you to breathe should the building collapse. Stay away from glass, heavy doors, windows, and mirrors
Protect your head. Watch out for falling objects
DO NOT leave the building until the staff on duty, senior counselor, the Director of Residential Services, or COO instructs you to do otherwise
Use flashlight! DO NOT use patches, electrical switches, or appliances because gas leaks may exist

NO STAFF SHALL LEAVE THE FACILITY DURING A DISASTER AND WITHOUT AUTHORIZATION FROM THE DIRECTOR OF RESIDENTIAL SERVICES, THE COO, OR SENIOR STAFF.

⚡ Utility Failures

▼

In case of electrical power shutdown:

Call So Cal Edison at 1-800-655-4555
Get the flashlights from the copy room
Distribute flashlights to staff and clients as needed
Call management
Keep a close eye on all clients and keep them in the same general area

In case of major plumbing emergency:

Locate the main water shut off valve on the north side of the building, behind the locked gate. The key for the gate is kept in the AO desk drawer
Call the Operations Manager who will contact maintenance
Contact the Water Department at 310-458-8531 after hours 310-434-2672

In case of a gas leak:

Notify the So Cal Gas Co IMMEDIATELY: 1-800-427-2200
Notify management immediately

⚠️ Workplace Threats & Violence

▼

Internal Violence — Threats of Violence:

Clear the floor and surrounding area of other clients; announce that the authorities are being called
Call 911 and notify the Director of Residential Services, who will contact the COO
If a client is threatening to harm staff and other clients and is becoming violent, do not try to handle the situation by yourself — get another staff member to assist and notify Director of Residential Services and Clinical Director

External Violence:

In case of a fight or major disturbance out of the facility do not try to get in the middle of it
Get clients back to the facility or to a safe location
Call 911 and notify Director of Residential Services, who will contact the COO

💣 Bomb Threat

▼

All threats should be taken seriously — there will always need to be a response by emergency personnel: Police, Fire Dept., Medical
Call 911 and report the threat
Initiate an evacuation of the building
STAFF — MAKES RUN OF ENTIRE HOUSE
Clients are to line up in the designated safety zone, across the street from the front entrance of the facility, single file until the head count has been confirmed and all clients have been safely evacuated
Staff on duty will notify all upper management
NO ONE IS TO REENTER BUILDING OR OUTSIDE AREA UNTIL CLEARED BY AUTHORIZED PERSONNEL