10. Prevention, Containment, and Mitigation in Residential and Child Care Facilities

Hours:    None

 
CDC Mitigation Protocols
CDC recommends the following measures to mitigate the spread of the virus and to protect people at increased risk of severe illness: social distancing, wearing a mask when social distancing is not possible, avoiding crowds, avoiding indoor crowded spaces, and washing or sanitizing hands frequently.

Preliminary Guidance for Prevention and Management of COVID-19 in Residential Care Facilities for the Elderly (RCFE)
March 12, 2020

COVID-19 may be introduced into residential care facilities by newly admitted residents, staff, or visitors. Spread can occur between and among residents, staff, and visitors.

General Measures to Be Implemented Now
Restrict ill visitors. Post signs at the entrance instructing visitors not to visit if they have symptoms of respiratory infection.

Restrict employees from working while ill. Staff with respiratory or influenza-like illness should not work until their symptoms have subsided for 48 hours consecutively. Ensure that sick leave policies allow employees to stay home if they have symptoms of infection.

Staff developing symptoms while at work should immediately don a face mask, notify management, and leave work.

Encourage hand hygiene and respiratory etiquette by all residents, visitors, and employees. Employees should review and follow recommendations for hand hygiene before and after contact with residents, and after contact with contaminated surfaces or equipment. Encourage hand washing and/or use of alcohol-based hand sanitizer. Place hand sanitizer inside and outside residents’ rooms. Have sinks available with soap and paper towels for hand washing. If you do not have a supply of alcohol-based hand sanitizer, revert to hand washing as frequently as possible. Post signs encouraging hand hygiene and respiratory etiquette.

The Household Cleaners That Will Really Kill the Coronavirus
March 18, 2020
3.49 minutes

Enhanced cleaning of common areas. Make sure all surfaces are wiped with an EPA-approved disinfectant at least daily and as needed, especially “high-touch” surfaces such as doorknobs, handrails, etc.

Standard Contact and Respiratory Droplet Precautions

Use personal protective equipment (PPE) appropriately, including gloves and gown

  • Wear gown, gloves, N95 respirator, and eye protection for all interactions with a resident
  • Put on PPE when entering room and properly discard before exiting the resident’s room to contain spread of virus

Use disposable or dedicated care equipment (e.g., walkers)

  • If need to use common equipment used for multiple residents, clean and disinfect such equipment before using on another person

Move resident outside of room only when it is medically needed

  • When moving is necessary, put a mask on the resident
  • Remove and throw away contaminated PPE and perform hand hygiene prior to transporting patients
  • Put on clean PPE to handle the patient

Prioritize cleaning and disinfecting rooms of the resident, focusing on frequently touched surfaces and equipment in the immediate vicinity of the resident

Cleaning and Disinfection for Community Facilities
September 10, 2020

Current evidence suggests that SARS-CoV-2 may remain viable for hours to days on surfaces made from a variety of materials. Cleaning of visibly dirty surfaces followed by disinfection is a best practice measure for prevention of COVID-19 and other viral respiratory illnesses in community settings.

It is unknown how long the air inside a room occupied by someone with confirmed COVID-19 remains potentially infectious. Facilities will need to consider factors such as the size of the room and the ventilation system design (including flowrate [air changes per hour] and location of supply and exhaust vents) when deciding how long to close off rooms or areas used by ill persons before beginning disinfection. Taking measures to improve ventilation in an area or room where someone was ill or suspected to be ill with COVID-19 will help shorten the time it takes respiratory droplets to be removed from the air.

This guidance provides recommendations on the cleaning and disinfection of rooms or areas occupied by those with suspected or with confirmed COVID-19. It is aimed at limiting the survival of SARS-CoV-2 in key environments.

These guidelines are focused on community, non-healthcare facilities such as schools, institutions of higher education, offices, daycare centers, businesses, and community centers that do, and do not, house persons overnight. These guidelines are not meant for cleaning staff in healthcare facilities or repatriation sites, households, or for others for whom specific guidance already exists.

Cleaning refers to the removal of dirt and impurities, including germs, from surfaces. Cleaning alone does not kill germs. But by removing the germs, it decreases their number and therefore any risk of spreading infection.

Disinfecting works by using chemicals, for example EPA-registered disinfectants, to kill germs on surfaces. This process does not necessarily clean dirty surfaces or remove germs, but killing germs remaining on a surface after cleaning further reduces any risk of spreading infection.

Cleaning and Disinfecting

Hard (non-porous) surfaces

  • Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning. If reusable gloves are used, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes. Consult the manufacturer’s instructions for cleaning and disinfection products used. Clean hands immediately after gloves are removed.
  • If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
  • Always read and follow the directions on the label to ensure safe and effective use.
  • Wear skin protection and consider eye protection for potential splash hazards
  • Ensure adequate ventilation
  • Use no more than the amount recommended on the label
  • Use water at room temperature for dilution (unless stated otherwise on the label)
  • Avoid mixing chemical products
  • Label diluted cleaning solutions
  • Store and use chemicals out of the reach of children and pets
  • You should never eat, drink, breathe or inject these products into your body or apply directly to your skin as they can cause serious harm. Do not wipe or bathe pets with these products or any other products that are not approved for animal use.
  • Special considerations should be made for people with asthma, and they should not be present when cleaning and disinfecting is happening as this can trigger asthma exacerbations.
  • Disinfect with a household disinfectant on List N: Disinfectants for use against SARs-CoV-2external icon, the virus that causes COVID 19. Follow the manufacturer’s instructions for all cleaning and disinfection products. Read the product label for the correct concentration to use, application method, and contact time.
  • Diluted household bleach solutions can be used if appropriate for the surface. Unexpired household bleach will be effective against coronaviruses when properly diluted
  • Prepare a bleach solution by mixing: 5 tablespoons (1/3rd cup) of 5.25%–8.25% bleach per gallon of room temperature water or 4 teaspoons of 5.25%–8.25% bleach per quart of room temperature water
  • Bleach solutions will be effective for disinfection up to 24 hours.
  • Alcohol solutions with at least 70% alcohol may also be used.
  •  

    Soft (porous) surfaces
    For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces. After cleaning:

    • If the items can be laundered, launder items in accordance with the manufacturer’s instructions using the warmest appropriate water setting for the items and then dry items completely
    • Otherwise, use products that are EPA-approved for use against the virus that causes COVID-19 and that are suitable for porous surfaces

    Electronics
    For electronics such as tablets, touch screens, keyboards, remote controls, and ATM machines, remove visible contamination if present.

    Follow the manufacturer’s instructions for all cleaning and disinfection products.

    Consider use of wipeable covers for electronics.

    If no manufacturer guidance is available, consider the use of alcohol-based wipes or sprays containing at least 70% alcohol to disinfect touch screens. Dry surfaces thoroughly to avoid pooling of liquids.

    L​inens, clothing, and other items that go in the laundry​
    In order to minimize the possibility of dispersing virus through the air, do not shake dirty laundry.

    Wash items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry that has been in contact with an ill person can be washed with other people’s items.

    Clean and disinfect hampers or other carts for transporting laundry according to guidance above for hard or soft surfaces.


    Personal Protective Equipment (PPE)

    The risk of exposure to cleaning staff is inherently low. Cleaning staff should wear disposable gloves and gowns for all tasks in the cleaning process, including handling trash.

    Gloves and gowns should be compatible with the disinfectant products being used.

    Additional PPE might be required based on the cleaning/disinfectant products being used and whether there is a risk of splash.

    Gloves and gowns should be removed carefully to avoid contamination of the wearer and the surrounding area. Be sure to clean hands after removing gloves.

    If gowns are not available, coveralls, aprons or work uniforms can be worn during cleaning and disinfecting. Reusable (washable) clothing should be laundered afterwards. Clean hands after handling dirty laundry.

    Gloves should be removed after cleaning a room or area occupied by ill persons. Clean hands immediately after gloves are removed.

    Cleaning staff should immediately report breaches in PPE such as a tear in gloves or any other potential exposures to their supervisor.

    Cleaning staff and others should clean hands often, including immediately after removing gloves and after contact with an ill person.

    Follow normal preventive actions while at work and home, including cleaning hands and avoiding touching eyes, nose, or mouth with unwashed hands.

    Additional Considerations for Employers
    Employers should work with their local and state health departments to ensure appropriate local protocols and guidelines, such as updated/additional guidance for cleaning and disinfection, are followed, including for identification of new potential cases of COVID-19.

    Employers should educate staff and workers performing cleaning, laundry, and trash pick-up activities to recognize the symptoms of COVID-19 and provide instructions on what to do if they develop symptoms within 14 days after their last possible exposure to the virus. At a minimum, any staff should immediately notify their supervisor and the local health department if they develop symptoms of COVID-19. The health department will provide guidance on what actions need to be taken.

    Employers should develop policies for worker protection and provide training to all cleaning staff on site prior to providing cleaning tasks. Training should include when to use PPE, what PPE is necessary, how to properly don (put on), use, and doff (take off) PPE, and how to properly dispose of PPE.

    Employers must ensure workers are trained on the hazards of the cleaning chemicals used in the workplace in accordance with OSHA’s Hazard Communication standard.

    Employers must comply with OSHA’s standards on Bloodborne Pathogens, including proper disposal of regulated waste, and PPE.

    Further Steps Should COVID-19 Infection Be Confirmed
    Conduct further management to limit the likelihood of transmission to others in the facility. The following actions will be required in consultation with County Health:

    VISITATION

    Essential, Virtual, and Outdoor Visits
    Facilities must allow:

    • essential visits
    • virtual visits (e.g., video calls)
    • scheduled outdoor visits at all times

    ESSENTIAL VISITS INCLUDE:

    • medically or legally necessary visits
    • visits from social workers
    • government health and social services agency visits
    • visits by service contractors necessary to maintain facility operations
    • visits mandated by court order or federal law, such as visits by Adult Protective Services or the Long-Term Care Ombudsman

    Indoor Visits
    Facilities may also allow for scheduled indoor visits as long as the facility is not experiencing:

    • new transmission of COVID-19 for 14 days
    • staff shortages
    • shortages of Personal Protective Equipment and essential cleaning supplies

    As a best practice, it is recommended that licensees have a dedicated visitation area that allows for at least six feet of physical distance between residents and visitors. Licensees should also require the use of face coverings, and clean and disinfect visitation areas after each use.

    BEST PRACTICES FOR ALL VISITATIONS INCLUDE:

    • Daily symptom screenings and temperature checks of residents, staff, and visitors, including using a no-touch thermometer to check for fever and asking about COVID-19 symptoms and possible exposures
    • Following physical distancing guidelines
    • Requiring the use of face coverings (i.e. face masks or cloth face coverings)
    • Employing enhanced cleaning and disinfecting protocols
    • Designating one area to enter the facility and a different area to exit the facility
    • Limiting the number of visitors at any one time to avoid having large groups congregate
    • Making available and encouraging use of handwashing stations or hand sanitizer upon entry and while in the facility
    • Recording name and contact information for individuals entering the facility for possible contact tracing

    How to implement visitor policies
    NOTIFY all residents, family members, and their loved ones about the visiting policy

    • Send letter to family members and support systems with details on visitor policy and timing
    • Give a phone line with a voice recording updated at set times (e.g., daily) with the facility’s general status (e.g., when it is safe to resume visits)

    HELP set up processes for residents and their families/support systems to communicate with each other and keep up to date through remote means

    • Assign staff member as a primary contact to families for inbound calls and conduct regular outbound calls
    • Help residents use video chat, telephone, text, social media, etc.

    POST signs to remind visitors to check whether they are at risk for having COVID-19

      Note: CCLD prepared sample signage and a visitor poster template that you were previously offered. You may contact the CCLD Regional Office if you did not receive them or would like more.

    SET SPECIFIC HOURS AND LIMIT ENTRANCES TO CLOSELY MONITOR WHO COMES INTO THE FACILITY

    • Limit visitors to daytime hours (e.g., 9:00 a.m. to 7:00 p.m.). Consider having one central entry and exit location
    • Enforce the sign-in policy for visitors to check-in with staff before entering facility, and screen for COVID-19

    ACTIVITIES
    Activities are an important part of maintaining a person’s physical and mental health. Activities should be encouraged and modified to help prevent the transmission of COVID-19 in the facility.

    Examples of modified activities:

    • Allow for persons in care to socialize in common areas with social distancing
    • Book clubs, crafts, movies and bingo and other activities, that include 6 feet physical distancing and other infection control measures, such as face coverings
    • Encourage use of technology to video chat with family members, friends, or other persons in care
    • Disposable paper games, such as crossword puzzles or word searches, or art supplies to persons in care
    • Have staff visit persons in care from the hallway with a traveling ice cream sundae or happy hour cart
    • Set up a space outdoors for socially distanced games, crafts, or group exercise
    • Set up games that can be played by phone or the PA system, or from hallways, such as bingo
    • Set up video streaming from the in-house TV station for persons in care to enjoy daily exercise classes, concerts, movies, lectures, and religious ceremonies
    • Start a pen pal program

    COMMUNITY ACTIVITIES
    Which types of activities are encouraged vs. restricted?

    TYPES OF ACTIVITIES THAT SHOULD BE RESTRICTED
    Activities with potential for exposure, such as:

    • Group activities outside the facility that typically have large gatherings
    • Group activities that would crowd the common spaces inside the facility

    Group activities within facilities, if:

    • The facility has persons in care with respiratory symptoms (and should be in isolation per CDC guidance)
    • COVID-19 is prevalent or spreading in the surrounding community

    Communal Dining is allowed under certain requirements:

    • Set up tables so diners can remain at least six feet apart
    • Create dining shifts to reduce the number of persons dining at any one time
    • Wear face coverings before and after dining

    Residents in isolation or quarantine may not participate in communal dining until cleared.

    TYPES OF ACTIVITIES THAT ARE ENCOURAGED
    Just because you have to practice social distancing doesn’t mean you can’t have fun!

    Encouraged activities include:

    • Gardening
    • Crossword puzzles and games
    • Community walks
    • Outdoor games such as volleyball, bean bag toss, ping pong
    • Aromatherapy
    • Spontaneous events (e.g., ice cream sundae parties), as long as social distancing is maintained
    • Photography
    • Get Fit Program

    WHAT TO DO IF A STAFF MEMBER SHOWS SYMPTOMS

    BEFORE COMING INTO WORK
    Staff members should not come into the facility if they have COVID-19 symptoms including fever, cough, or shortness of breath – ensure sick leave policies allow staff to stay home.

    AT THE FACILITY
    Staff members should be monitored for COVID-19 symptoms before starting their shift as well as during their shifts.

    Any staff members who show symptoms should put on a mask immediately, return home to self-isolate for at least 14 days, and contact their healthcare provider.

    Staff should be implementing universal source control with a face mask or face covering while in the facility

    RETURNING TO WORK
    Staff members returning to work should follow the CDC and/or local health department guidelines and perform frequent hand hygiene.

    WHAT TO DO IF A STAFF MEMBER TESTS POSITIVE FOR COVID-19

    1. IMMEDIATELY NOTIFY THE FAMILIES OF ALL PERSONS IN CARE
    Do not provide any personally identifiable information or protected health information about the person(s) who tested positive

    2. OBTAIN MEDICAL CLEARANCE BEFORE RETURNING TO THE FACILITY
    If their health care provider or local health department directs them to isolate outside the facility (e.g., home, hospital, etc.)

    For staff who must isolate:
    They should isolate at home (not work at the facility) for 14 days. However, if a licensee has a critical shortage of essential workers, staff who have no symptoms may work at the facility during this time if they wear a mask and self-monitor for fever and symptoms every 12 hours, including while at work.

    They must isolate at home until:

    • At least 24 hours without a fever and without the use of fever reducing medications
    • Improvementinrespiratorysymptomsatleast10 days have passed since symptoms appeared

    What If the Staff Person Is No Longer at the Facility?
    You must still immediately notify all families of persons in care, but do not provide any personally identifiable information or protected health information about the person(s) who tested positive.

    ALL CALIFORNIA ADULT AND SENIOR CARE PROGRAM LICENSEES
    Community Care Licensing Division
    Provider Information Notice (PIN)
    March 13, 2020

    Access the complete California Department of Social Services document here:
    PIN 20-07-ASC

    Always follow any guidance or instructions from health care providers, the Federal Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), the California Department of Public Health (CDPH), and local health departments.

    Scenario 1: Implementation of Prevention Measures
    Licensees can take steps now to slow the spread of respiratory infectious diseases, including COVID-19, by implementing the following steps:

    1. Limit entry to only individuals who need entry, such as:

    • Facility staff, contractors, volunteers, consultants who need to keep the
      operations running and ensure the needs of persons in care are met
    • Government officials who in their capacity require entry (e.g., the CDC or
      public health staff)
    • Immediate families or friends

    Note: The Community Care Licensing Division (CCLD) does not recommend a complete restriction on all visitors. The circumstances for the reason for entry need to be taken into consideration. The rationale should be explained, and alternative methods of communications offered.

    Some best practices that may be possible in your facility include:

    • Post signage clearly in your facility. The CDC provides sample signage for use to ensure that all those entering or exiting a facility are aware of the risks associated with COVID-19 and the recommended precautions they should take. Signage should also remind people that anyone with symptoms of respiratory illness should not enter the facility.
    • Notify all persons in care, family members, and their loved ones. Ask the persons in care to strongly encourage their family members and friends not to visit for the time being and discuss alternative methods of communication.
    • Establish specific visiting hours. Specifically, consider limiting visitors to only daytime hours (e.g., 9:00 a.m. to 7:00 p.m.) when staff can more closely monitor a visitor entrance.
    • Close more than one entry point in accordance with life safety regulations. Consider having one central entry location (e.g., main entrance only).
    • Enact a sign-in policy to encourage all visitors to check-in with staff and conduct a possible screening for COVID-19. Screening may include checking for symptoms of respiratory infection, such as fever, cough, or shortness of breath.

    2. Restrict activities or individuals with potential for exposure, including:

    • Visitors, where there are COVID-19 confirmed cases in the surrounding community.
    • Other visitors for routine social visits, tours with prospective persons in care or their families, and outside group activities (e.g., school groups, bands, etc.) should be restricted.
    • Cancel activities that take persons in care to public places, particularly with large gatherings such as the mall, movies, etc. (See CDPH guidance about gatherings for more information).
      Note: This does NOT apply to persons in care who need to leave the facility for essential medical care such as dialysis, doctor visits, etc.
    • Internal group activities should be restricted, especially if:
      i. The facility has persons in care with respiratory symptoms (who should be in isolation per CDC guidance) and/or other underlying health conditions;
      ii. If COVID-19 is in the surrounding community; and/or
      iii. The ability to restrict visitors is challenging in the facility.
    • Movement within the facility outside the room of the person in care (e.g., reduce walking the halls, avoid congregate dining rooms, etc.)

    3. Restrict individuals who have respiratory symptoms or potential COVID-19 exposure out of an abundance of caution, including staff, contractors, volunteers, visitors, new admissions, government officials, and health care professionals. Post notices for individuals to assess their risk, which would include any individuals with:

    • Respiratory symptoms, including fever, cough, sore throat, and shortness of breath
    • Contact with someone with a confirmed diagnosis of COVID-19, or under investigation for COVID-19, or ill with respiratory illness within the last fourteen days
    • Domestic or international travel within the last fourteen days to areas where COVID-19 cases have been confirmed
    • Residence in a community where community spread of COVID-19 is occurring
    • Anyone who has worked in another care setting with confirmed COVID-19 cases

    Note: Extenuating circumstances may be taken into consideration, but those individuals who should be restricted according to the descriptions above must wear a face mask, gown, and gloves to reduce the risk of spreading any communicable disease. If the facility does not have personal protective equipment, the facility should restrict the visitor from entering and ask them to come back at a later date (e.g., after fourteen days with no respiratory symptoms).

    4. Remind staff to stay home if they are sick.

    • Ensure sick leave policies allow staff to stay home if they have symptoms of respiratory infection.
      i. Staff who are ill should be excluded from work for at least twenty-four hours after a flu-related fever is absent without the use of fever-reducing medicines. Follow the CDC and/or local health department guidelines for returning to work.
      ii. Once staff return to work, reinforce the importance of performing frequent hand hygiene.
    • Check staff for respiratory infection symptoms, including fever, cough, or
      shortness of breath, before they start their shift.

    Note: In general, if staff or persons in care are directed by their health care provider or local health department to quarantine or isolate outside the facility (i.e., home, hospital, etc.), they should obtain medical clearance before returning to the facility.

    5. Require all staff and visitors entering the facility to wash their hands upon entry.

    • If possible, set up hand washing and/or alcohol-based hand sanitizer stations immediately inside all entryways, with signage reminding people to wash before entering.
    • Ask each person who enters the facility to immediately wash their hands or use alcohol-based hand sanitizer before they do anything else.
    • Encourage them to wash their hands or use alcohol-based hand sanitizer throughout their time in the facility.
      Note: Frequently wash hands with soap and water for at least twenty seconds or use alcohol-based hand sanitizer containing at least 60 percent alcohol, especially after going to the bathroom, before eating, before and after providing care to persons in care, and after blowing your nose, coughing, or sneezing. Always wash hands with soap and water if hands are visibly dirty.
    • Clean and disinfect frequently touched objects and surfaces following the manufacturer’s guidance. Frequently touched surfaces include, but are not limited to, commodes, toilets, faucets, hand and/or bed railings, telephones, door handles and knobs, computer equipment, and kitchen food preparation surfaces.
    • Clean and disinfect rooms after each meeting between a visitor and person in care.
    • Use all cleaning products according to the directions on the label.
    • Management of laundry, food service utensils, and medical waste should be performed in accordance with routine procedures.
    • Remind people to not shake hands or hug each other, staff, or persons in care.
    • Remind people to use “cough etiquette.” Cover your mouth and nose with a flexed elbow or tissue when coughing and sneezing. Throw away the used tissue immediately and wash your hands or use alcohol-based hand sanitizer.
    • Remind people to maintain social distance. If possible, keep a distance of at least six feet between yourself and someone who is coughing, sneezing, or has a fever.

    6. Set up a process to allow remote communication for persons in care and others.

    • Ensure emergency contact information for family members and the person’s responsible party is up to date.
    • Develop alternative means of communication for persons in care to visit and talk with loved ones, such as video chat, telephone, texting, or social media.
    • Inform persons in care, or their responsible parties, of these changes using clear, concise, jargon-free messages that express empathy for their situation while simply explaining the policy.
    • Ensure proactive communication with persons in care, loved ones, contractors, volunteers, etc. to make them aware of these restrictions and to keep them up to date.
    • Assign staff as a primary contact to families for inbound calls and conduct regular outbound calls to keep families up to date.
    • Offer a phone line with a voice recording updated at set times (e.g., daily) with the facility’s general operating status, such as when it is safe to resume visits.
    • Develop a process for family members to communicate with the facility with questions.

    Scenario 2: Implementation of Containment Measures
    It is unknown how long prior to being symptomatic a person could spread COVID-19 to another person. Based on what is currently known about other communicable diseases, such as influenza, symptoms ranging from mild to severe may appear two to fourteen days after exposure.

    Possible Exposure to COVID-19
    Steps to take when there is a possible case of COVID-19 or if persons in care display symptoms of respiratory infection in the facility:

    1. Isolate the person from others in their room and limit contact as much as possible.

    2. Implement standard contact and respiratory droplet precautions. This includes the use of appropriate personal protective equipment, including gloves, disposable gown, face mask, and eye protection.

    Note: Licensees seeking face masks (or other resources) for persons in care and staff may contact their Medical Health Operational Area Coordinator (MHOAC). Email is recommended to log the request if phone lines are impacted. MHOAC offices, under the Emergency Medical Services Authority (EMSA), are an alternative place for licensees to request resources.

    3. Immediately contact the person’s health care provider for an evaluation and for guidance.

    4. Contact your local health department for directions.

    5. Advise visitors to inform the facility if they develop any signs or symptoms of COVID-19 within fourteen days after visiting the facility.

    Note: It is recommended to take additional preventative measures that may include serving meals to all persons in their rooms rather than in congregate dining rooms, canceling group activities, and limiting visitors.

    Possible COVID-19 Exposure by Person Who Is No Longer at the Facility
    Steps to take if a person is transferred from a facility due to COVID-19 and may have exposed others:

    1. Monitor other persons in care and staff for fever or respiratory symptoms.

    2. Isolate exposed or potentially exposed persons from others and limit contact as much as possible.

    3. Implement standard contact and respiratory droplet precautions. This includes the use of appropriate personal protective equipment, including gloves, disposable gown, face mask, and eye protection.

    4. Immediately contact the exposed or potentially exposed person’s health care provider for an evaluation and for guidance.

    5. Contact your local health department for directions.

    6. Advise visitors to inform the facility if they develop any signs or symptoms of COVID-19 within fourteen days after visiting the facility.

    Note: Take additional preventative measures that may include serving meals to all persons in care in their rooms rather than congregate dining rooms, canceling group activities, and limiting visitors.

    Please contact your local health department immediately if you have someone with a confirmed case of COVID-19 in your facility and/or suspect an outbreak in your facility.

    Scenario 3: Implementation of Mitigation Measures
    Steps to take if a person or persons have tested positive for COVID-19 and remain at
    the facility.

    Person or Persons Confirmed with COVID-19 and Remains in Facility

    1. Isolate person or persons in care until they are determined by state or local health authorities in coordination with the CDC to no longer be infectious.

    2. Immediately contact the person’s or persons’ health care provider(s) and your local health department for directions.

    3. Implement standard contact and respiratory droplet precautions. This includes the use of appropriate personal protective equipment, including gloves, disposable gown, face mask, and eye protection.

    4. Immediately contact your local Adult and Senior Care Regional Office and the person-in-care’s authorized representative, as required by applicable regulations (California Code of Regulations, Title 22, section 80061(b)(1)(H), Title 22, section 81061(b)(1)(G), Title 22, section 82061(a)(1)(F), and Title 22, section 87211(a)(2)).

    Note: A person who received a directive to isolate from their health care provider and/or the local health department should receive medical clearance before coming out of isolation.

    5. Serve meals to all persons in care in their rooms rather than congregate dining rooms.

    6. Cancel group activities, including those off the premises of the facility.

    7. Limit visitors to only medically necessary visits.

    Note: The licensee shall not restrict CDSS, CDPH, local health department officials, and healthcare providers, Ombudsman, and essential government authority from entering or conducting investigations at the facility. Additional exceptions to visitor restrictions include end-of-life situations.

    What is the difference between quarantine and isolation?

    QUARANTINE
    Required when someone has been exposed to the virus, does not currently have any symptoms, but could become symptomatic or test positive during the quarantine period.

    Actions needed:

    Separate resident from others for 14 days

    Watch for fever, cough, shortness of breath, or other COVID-19 symptoms

    If a person becomes symptomatic, contact their healthcare provider immediately.

    Check with the local Health Department about testing for exposure.

    For residents with memory impairment or cognitive issues:

    • Be direct and concrete when explaining why they are being quarantined
    • Emphasize and repeat, especially for residents with cognitive issues
    • Try to understand reasons for not wearing a mask

    ISOLATION
    Required when someone displays COVID-19 symptoms and/or positives

    Actions needed

    Check on residents with symptoms frequently – every 4 hours.

    Separate resident with symptoms from others who are not infected until resident no longer has fever for at least 24 hours without the use of fever-reducing medications, and:

    • Resident shows improvement in respiratory symptoms, and
    • At least 10 days have passed since symptoms first appeared, or from the date of the positive test, if the resident never developed any symptoms.

    If a resident has a positive COVID-19 test and remains without symptoms, separate resident from others in his/her own room for at least 10 days from the time the positive COVID-19 test was obtained.

    COHORTING
    Cohorting means moving residents to separate areas of the facility near others who have similar needs, such as residents who have tested positive, or residents who have COVID-19 symptoms, or residents who have been exposed to a COVID-19 positive person.

    Cohorting reduces risk of transmission and spreading COVID-19, and protects non-infected people from catching the virus from exposed individuals.

    Cohort formation suggestions:

    • Cohort 1: Residents who tested positive for COVID-19
    • Cohort 2: Residents who are not sick, but have been exposed to someone who is sick
    • Cohort 3: Residents who are not sick, do not have symptoms, and have not been exposed

    PREVENTION, CONTAINMENT, AND MITIGATION MEASURES FOR ALL CHILD CARE FACILITY LICENSEES AND PROVIDERS
    Community Care Licensing Division
    March 16, 2020

    Access the complete California Department of Social Services document here:
    PIN 20-04-CCP

    While the situation surrounding the Coronavirus Disease 2019 (COVID-19) continues to rapidly change, this PIN provides general recommendations for prevention, containment, and mitigation of COVID-19 for child care providers.

    The California Department of Social Services (CDSS) is recommending child care providers follow guidance in this PIN in addition to guidance or instructions from their CDSS Child Care Regional Office, including but not limited to all CDSS PINs, and from health care providers, the Federal Centers for Disease Control and Prevention (CDC), the California Department of Public Health (CDPH), and local health departments.

    Scenario 1: Implementation of Prevention Measures
    Licensed child care centers and family child care homes can take steps to slow the spread of respiratory infectious diseases, including COVID-19, by implementing the following steps:

    • Review and update disaster plans to include contingencies for providing care to children in the event that your child care facility is impacted by an outbreak of illness.

    • Develop and include a communications plan to use to keep families, staff, and the community informed.

    • Inform families, teachers, visitors, or staff who have traveled to an area identified by the CDC as Level 3 Travel Health Notice that they may not attend the facility for fourteen days from the day they returned to the United States. Additionally, exclude those who have been in close contact with someone diagnosed with COVID-19 for fourteen days from the day of their last exposure.

    • Send teachers, staff, or visitors home immediately who have a fever and/or respiratory infection symptoms. If a child appears to have respiratory infection symptoms notify their parent or authorized guardian to take the child home immediately.
    – Separate the individual or individuals from others until they go home. When feasible, identify a “sick room” through which others do not regularly pass.

    • Limit any non-essential visitors from coming into your child care. This could include volunteers.

    • Coordinate with all partner organizations serving children to ensure consistent practices.

    • If you, as the licensee, have a fever and/or respiratory infection symptoms, please notify parents immediately that care will not be available and follow reporting requirements.

    • Contact your local public health department immediately if you notice any concerning clusters of respiratory disease or spikes in absenteeism: You may find your local public health department at the link here.

    • Encourage all children, families, and staff to take everyday prevention actions:

    – Stay home when sick. Remain at home until fever has been gone for at least 24 hours without the use of fever-reducing medicines. Seek immediate medical care if symptoms become more severe; e.g., high fever or difficulty breathing. Use the Cleaning and Waste Management Considerations for Residences to help clean your home.

    – Use “respiratory etiquette.” Cover cough with a tissue or sleeve. See CDC’s Cover Your Cough page (https://www.cdc.gov/flu/prevent/actions-prevent-flu.htm) for multilingual posters and flyers, posted at the bottom of webpage. Provide adequate supplies within easy reach, including tissues and no-touch trash cans.

    – Wash hands frequently. Encourage hand washing by children, parents, and staff through education, scheduling time for hand washing, and the provision of adequate supplies. Provide alcohol-based hand sanitizers to supplement routine hand washing.

    – Enhance cleaning consistent with CDC guidance (see Environmental Cleaning and Disinfection Recommendations).Encourage flu vaccine for those persons over 6 months of age who have not had it this season to reduce illnesses.

    Scenario 2: Implementation of Containment Measures
    Measures to be taken if there are two or more community transmission cases of COVID-19, but no individuals within the facility test positive.

    If the local public health department has confirmed two or more community transmission cases, but no individuals at the child day care facility have tested positive for COVID-19, it is recommended, in addition to the items outlined in Scenario 1, child care facilities implement the following steps:

    • Teachers and staff with any fever and/or respiratory infection symptoms should not come to work. Screen teachers and staff for respiratory infection symptoms each morning before they interact with children. Teachers and staff with any respiratory infection symptoms should not be at work.

    • Limit visitors to the facility by not allowing those with symptoms of respiratory infection or who have a travel history to countries impacted by COVID-19 over the course of the last fourteen days.

    • Ensure sick leave policies for allowing teachers and staff to stay home if they have symptoms of respiratory infection, if applicable.

    • Cancel or postpone large gatherings within the facility including any large or communal activities.

    • Implement staggered outdoor or large group times to limit the number of children who are together as much as possible.

    Scenario 3: Implementation of Mitigation Measures
    Measures to be taken if one child, family member, visitor, licensee, or staff member tests positive for COVID-19 and exposed others at the facility.

    If one child, family member, licensee, visitor, or staff member tests positive for COVID-19, the licensee of a child day care facility should immediately implement the following measures:

    • In consultation with the local public health department, the licensee may consider if closure of the child care facility is warranted and what length of time is appropriate based on the risk level within the specific community, as determined by the local public health officer.

    • Immediately notify your Child Care Licensing Local Regional Office.

    • Implement communication plans for facility closure including outreach to parents, authorized guardians, staff, and the community.

    • Maintain regular communications with the local public health department.

    • Consult CDC guidelines (see Environmental Cleaning and Disinfection Recommendations and Reminders for Using Disinfectants at Schools and Child Cares) for facilities to determine what additional cleaning protocols, if any, should be used at the facility, prior to reopening.

    • Determine the timing of return for children, staff, and if any additional steps are needed for the child care facility to reopen, in consultation with the local public health department.

    • Closing facilities is a difficult decision as it has impacts on families and employers. The state will continue to assess the situation and provide information as needed.

    • Provide guidance to parents, teachers, and staff, reminding them of the importance of community social distancing measures while the facility is closed, including discouraging students or staff from gathering elsewhere. Community social distancing measures include canceling group activities or events.

     

    Sources

    “Cleaning and Disinfection for Community Facilities.” Centers for Disease Control and Prevention, 10 Sep. 2020, www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html.

    “The Household Cleaners That Will Really Kill the Coronavirus.” YouTube, uploaded by The List, 18 Mar. 2020, www.youtube.com/watch?v=3ptlpw1AHS4.

    “Overview of Testing for SARS-CoV-2 (COVID-19).” CDC, 21 Oct. 2020, www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html.

    “Playbook for COVID-19.” CDSS Community Care Licensing Divisions, www.cdss.ca.gov/Portals/9/CCLD/COVID/COVID19-Playbook.pdf.

    “Preliminary Guidance for Prevention and Management of COVID-19 in Residential Care Facilities for the Elderly (RCFE).” County of San Mateo, 12 Mar. 2020, www.smcgov.org/press-release/march-12-2020-preliminary-guidance-prevention-and-management-covid-19-residential-care.

    “Prevention, Containment, Mitigation Measures, and Statewide Waiver for Coronavirus Disease 2019 (COVID- 19).” California Department of Social Services, 13 Mar. 2020, www.cdss.ca.gov/Portals/9/CCLD/PINs/2020/ASC/PIN%2020-07-ASC%20COVID19%20Implementation%20with%20Statewide%20Waiver%20.pdf?ver=2020-03-13-175747-783.

    “Reminders for Using Disinfectants at Schools and Child Cares.” State of California, Mar. 2020, apps.cdpr.ca.gov/schoolipm/pubs/reminders_for_using_disinfectants.pdf.

    “Statewide Waivers for Licensing Requirements Due to Coronavirus Disease 2019 (COVID-19), and Prevention, Containment, and Mitigation Measures.” California Department of Social Services, 16 Mar. 2020, www.cdss.ca.gov/Portals/9/CCLD/PINs/2020/CCP/PIN_20-04-CCP.pdf.

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