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SENTARAS September 30, 2020 Dear Families and Friends of Sentara Nursing Center- Virginia Beach We have appreciated your support and compassion as we navigate the impact of the Coronavirus pandemic at Sentara Nursing Center. We are writing to provide an update on the facility. As you know, we have implemented changes in our regular operations as part of our response plan, including enhanced infection control and prevention measures, ‘monitoring residents and staff for symptoms, and restricting visitors except in end-of-life situations on a case-by-case basis. We are committed to respectful, open, and transparent communication. If we have additional positive cases, we will notify the residents, families, and our staff, and follow all privacy requirements. Our Medical Director, other providers, and local and state health departments will guide our efforts, as well as our own preparedness plans. We will continue to provide updates to all residents, families, and staff as we learn more. The test results from the Point Prevalence Testing on 9/25/2020 for employees is complete. A total of 19 employees were positive for COVID. Each of them are in quarantine for 10 days. * Today, we begun sanitizing the COVID Unit with High Ultraviolet Beams to detect and destroy spores and bacteria in the rooms, and common areas ‘on the COVID unit and plan to complete for entire facility. © The Sentara Infection Control Team has submitted a proposal to create negative pressure rooms in the facility. ‘+ We also increase our surveillance of putting on and taking off PPE properly, as well as hand washing observations. The Virginia Beach Department of Health will be onsite 10/2/2020. Point Prevalence Testing was conducted today 9/29/2020 for residents and ‘employees. You will be notified individually of any positive test of your loved one. Iwill continue to update you weekly and as needed. Thank you in advance for your consent to give the flu vaccinations. Just a reminder that | have suspended all non-emergent appointments, until further notice. We have also suspended Booth Visits. Please continue to contact the Activities department to schedule virtual visits. As always, | will keep you Informed on any changes at the facillty. We continue to work around-the-clock to protect our community and the broader community. Key components of the action plan are: * Quarantining residents and implementing enhanced infection control measures. We have identified a designated area in the building for any residents with a positive COVID-19 diagnosis and would quarantine the residents in their rooms. We have designated staff to support and care for them, and continue to follow alt infection control protocols as outlined by the CDC, CMS, and local and state health officials. The resident would remain in quarantine until well and cleared by medical professionals to return to normal activity. * Continuing to monitor and screen residents and staff for symptoms. We continue to actively screen residents and staff for fever and respiratory symptoms. Residents and staff are asked to wash their hands offen, avoid touching their face, cover their coughs and sneezes with a tissue, and to wear a mask Residents know to notify the staff immediately if they feel il. Staff know to notify their supervisor immediately if symptoms develop. Medical providers are consulted as appropriate for residents and Occupational Health for our employees. Residents and staff have been reminded that social distancing remains extremely important, We've shared that they should take everyday precautions to keep space between themselves and others (i.e., stay 6 feet away, which is about two arm lengths). We have shared the CDC's strategies for managing stress and anxiety with residents and staff. It is common to feel increased stress during this pandemic. Fear and anxiety can be overwhelming and cause strong emotions. We have let the residents know to contact our staff if there is anything we can do to better support them. ‘We encourage you to review the CDC website for information about COVID-19, including its symptoms, how it spreads, actions that you and your loved ones can take to protect your health, and how to manage stress and anxiety. See the following {inks for additional information: hitps:/www.cdc. gov/coronavirus/2019-ncsviindex.htmi and hitps //www.cde. gov/coronavirus/2019-ncov/daily-life-copina/manaaing-stress- anxiety html. Continuing to screen staff prior to beginning work. Staff are not allowed in the building if they are ill. Upon arriving at the building, a detailed health screening is completed including taking their temperature to check for a fever. Any staff who exhibit symptoms are instructed to put on a mask, isolate at home, call our employee health services, and notify their supervisor. Additionally, our staff is following CDC guidelines for hand and other related hygiene requirements. Advising affected staff to take all appropriate measures. For their health and well- being, staff members with a COVID-19 diagnosis are asked to quarantine at home, and contact our employee health services to guide their care. We will follow all CDC guidance on the retum to work criteria for health care professionals with confirmed COVID-19. Continuing to implement environmental safety precautions. Housekeeping staff continue to take extra measures to clean and disinfect all high-touch areas throughout the building. This includes countertops and tables, faucet handles, toilet flush handies, door knobs, crash bars, door handles, bathroom and kitchen areas, elevator call buttons, and hand rails. Continuing to restrict visitors in our building for everyone's safety. We encourage loved ones to communicate with residents by phone, letters, video chat, and/or social media, and are happy to facilitate this communication. We understand that itis hard to not have visitors, especially family. If you need assistance, please contact our Sentara Life Care Advocate Team via email advocatesic@sentara.com or by calling (757) 736-4677. Visitors who need to enter the building for end-of-life care situations are evaluated on a case-by-case basis to assure safety for all, Visitors who are permitted to enter the building for end-of life situations are first screened for fever and respiratory symptoms, They are also required to frequently clean their hands, limit their visit to a designated area within the building, and wear a facemask, Continuing to restrict congregate dining and have canceled any group activities. We have cancelled congregate dining, all community outings, and any group activities. We continue to help residents to practice social distancing and to frequently clean their hands. + Utilizing personal protective equipment (PPE) when interacting with residents, as directed by CMS quidelines. We are monitoring new information from the CDC, CMS, and state and local health officials to ensure we are taking the appropriate steps. We want to take this opportunity to share our ongoing gratitude to our dedicated staff, and for their commitment to the care of and service to our residents. Their courage is nothing short of inspiring—they are our heroes! It is moments like these that we remember our true calling and what brought us to senior health care. We care deeply about our residents and staff and consider them to be members of our own extended families. We are all in this together and again, thank you for support and understanding, Sincerely, Alverta Robinson Licensed Administrator Sentara Nursing Center - Virginia Beach

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