Community Based Adult Services

More strict criteria can be instituted per the investigating team if deemed necessary.

1. Always encourage all staff and participants to follow physical distancing and adhere to hand hygiene guidance as much as possible.
   • Signage should be posted to reinforce frequent hand washing and cover your cough.
   • Provide accurate and updated Public Health materials to facility including posters, handouts, etc.: http://publichealth.lacounty.gov/acd/ncorona2019/printmaterials.htm.
2. Ensure indoor masking at the facility for staff and visitors (well-fitting surgical masks for visitors and the same or higher for staff).
   • Source control should be worn by all staff and visitors in all indoor participant care areas, common or shared areas, walkways, or where participants and/or staff congregate. This can be required by the OMB team in an outbreak situation.
   • Staff working alone in closed areas do not need source control unless they are moving through common spaces where they may interact with other staff or participants.
   • Well-fitting surgical masks should be worn around others by any participant that is confirmed or suspected to have COVID-19 who is around others.
   • All participants should be encouraged to wear masks when outside their room. This can be required by the OMB team in an outbreak situation.
   • Participants who, due to age or underlying cognitive or medical conditions, cannot wear masks should not be forcibly required to wear masks. However, masks should be encouraged as much as possible. Children under 2 should not be required to wear masks.
3. Increase environmental cleaning throughout the facility. Use EPA-registered cleaning agents and follow the label instructions.
4. Ensure the CBAS has sufficient and unexpired testing supplies.
5. Response testing for exposed individuals should be initiated following the detection of a positive case.
6. Plan for ways to continue essential services if on-site operations are reduced temporarily.
   • Restrict group activities, field trips, and communal dining as OMB team deems appropriate for the outbreak.
   • Staff may eat together in staff breakrooms or a separate designated area but should be wearing medical grade (surgical masks) unless actively eating or drinking. Wipes should be provided for staff to clean up after finishing their breaks.
7. Plan for employee absences and create a back-up/on-call system.
8. Immediately implement symptom screening for all staff, visitors, and, if feasible, participants.
   • Every individual entering the community care facility (including participants, staff, visitors, outside healthcare workers, vendors, etc.) regardless of reason, should be asked about COVID-19 symptoms and exposure to a COVID-19 positive person. An exception to this is Emergency Medical Service (EMS) workers responding to an urgent medical need. They do not have to be screened, as they are typically screened separately.
   • Records are to be kept of screening.
   • Facilities should limit access points and ensure that all accessible entrances have a screening station.
   • Anyone with a fever (100.4° F or 38° C) or COVID-19 symptoms (fever, chills, cough, shortness of breath, new loss of taste or smell, muscle or body aches, headache, sore throat, congestion or runny nose, nausea or vomiting, diarrhea) should not be admitted entry.
9. Restrict all volunteers and non-essential personnel (e.g., barbers) during an outbreak.
10. Post a notification letter at the entrance of the facility and community area.
11. Visitors are allowed to visit with the following restrictions:
    • Those with fever symptoms, or close contact with a COVID positive person should not be permitted to enter the facility at any time. The OMB team can restrict visitation more if deemed necessary in an outbreak situation.
    • Post signs explaining visitor restrictions.
    • Set-up alternative methods of visitation such as through videoconferencing through Skype or FaceTime.
    • Those visitors that are permitted should be screened for fever and respiratory symptoms, should wear a mask while in the building, and should restrict their visit to a location designated by the facility. They should also be reminded to frequently perform hand hygiene and to avoid others while in the facility.
12. Provide education and job-specific training to staff regarding COVID-19, including:
    • Signs and symptoms.
    • Modes of transmission of infection.
    • Correct infection control practices and personnel protective equipment (PPE) use.
    • Staff sick leave policies and recommended actions for unprotected exposures (e.g., not using recommended PPE, an unrecognized infectious patient contact).
    • How and to whom COVID-19 cases should be reported.
13. Have a family notification process when a case of COVID-19 is identified.
14. For any transfers out of the building, notify EMS and the receiving facility of possible exposures.
15. All staff should wear a well-fitting surgical mask in walkways and common or shared areas where participants and/or staff may congregate. For all participant encounters, staff should at minimum wear a mask (well-fitting surgical mask, or higher). If participant is unable to cover nose/mouth (i.e. practice source control), staff should also use eye protection for that encounter.
16. Full PPE (N-95 respirator, gloves, gown, and eye protection) is recommended while providing care to a participant with suspected or confirmed COVID-19. Note: The rationale for mask and eye protection is to try to prevent caregiver exposure. Well-fitting surgical masks can be worn for an extended period but should be discarded after they become saturated with moisture.
17. All staff should be careful to change required PPE between caring for participants and adhere to donning and doffing recommendations (www.publichealth.lacounty.gov/acd/docs/CoVPPEPoster.pdf).
18. In an outbreak situation, new participants and returning participants should be permitted unless closure is approved by the Area Medical Director (AMD).
19. Facilities should work with their OMB team to determine if short-term closure is needed to contain the spread of transmission during an outbreak. The facility can be reopened after changes have been instituted that follow Public Health guidelines for infection prevention.

All ill individuals (participants or staff) with symptoms suggestive of respiratory illness should be presumed to have COVID-19 and SARS-CoV2 testing should be done. More strict criteria can be instituted per the investigating team if deemed necessary.

1. For suspected or confirmed participants, immediately mask and initiate quarantine/isolation.
2. Symptomatic/confirmed positive staff should be asked to go home immediately and seek care as appropriate. Immediately mask the staff and isolate in room with door closed if need to remain on premises.
3. In the case of two or more unknown respiratory cases in 72 hours at facility, encourage testing of routine respiratory pathogens including influenza testing if appropriate to establish alternative diagnosis.
4. Facilities should initiate response testing around each confirmed case (staff and participants) to identify all close contacts during the infectious period of the case(s).
5. Facilities need to report all COVID-19 positive cases within 24 hours to LAC DPH using REDCap: https://redcap.link/lac-covid, or by phone at (213) 240-7941, or by fax at (213) 482-4856. After being assigned an Outbreak Investigator, the Facility should report additional cases and deaths to that person.
6. Document all staff and resident or participant cases and contacts on the appropriate line lists (see Forms/Quick Links section).
7. Designate an area with its own restroom, if possible, for placement of suspected and confirmed positive participants while they wait to be transported home or to a hospital.
8. Designate an area with its own restroom, if possible, for placement of participants who have been identified as close contacts to case(s) at your facility. Follow guidance in the LAC DPH Instructions for Close Contacts.
9. Participants in quarantine or isolation should:
   • Have visitors only as deemed appropriate by the investigating team and should have limited contact with staff and other participants.
   • Stay in a separate room as much as possible and away from participants who are vulnerable to severe illness related to COVID-19. Individuals vulnerable to severe illness related to COVID-19 include those who are age 65 and above, or with underlying medical conditions such as chronic lung disease or moderate to severe asthma, chronic heart disease, diabetes, end stage kidney or liver disease or weakened immune systems such as cancer patients, those on immunosuppressive therapy and HIV/AIDS.
   • Use a separate restroom.
   • Should be monitored for concerning fever and respiratory symptoms (i.e., worsening cough, shortness of breath).
   • Instruct the facility to notify District Public Health Nurse (DPHN) assigned to the facility immediately if any resident or staff report fever or respiratory symptoms.
   • Any participant that develops symptoms of respiratory illness (fever and cough or shortness of breath) should be tested for SARS-CoV2 and isolated if positive. If negative, they should wear a well-fitting surgical mask around others until symptoms are improved.
   • Notify DPHN immediately if any close contact tests positive for COVID-19.
   • Special situations for facilities to consider:
     • For COVID-19 positive participants receiving dialysis outside of the facility, notify their dialysis center and request that they be dialyzed in “isolation.”
     • Consider substituting nebulizers for metered dose inhalers.

1. Staff who provide direct care to participants should follow any applicable guidance from Cal/OSHA (Non-Emergency Regulations and Aerosol Transmissible Diseases Standard) to determine when they should return to work after an exposure to a person confirmed to have COVID-19, or after being positive for COVID-19.
2. Document all close contacts on the line list (See Forms/Quick Links section).
3. Monitor and follow-up close contacts for symptoms during, or at the end of monitoring period, to check-in and respond to concerns, if possible.

1. DPH testing recommendations should be communicated to the facility administrator/manager or medical director. More strict criteria can be instituted per the investigating team if deemed necessary.
2. Response testing: Individuals who have been close contacts or exposed to a COVID-19 positive individual should be tested. This does not apply to individuals who have been positive for COVID-19 in the previous 90 days.
3. Symptomatic testing: Individuals who are symptomatic for COVID-19 should be tested. Any participant that develops symptoms of respiratory illness (fever and cough or shortness of breath) should be tested for SARS-CoV2 and isolated if positive. If negative, they should wear a well-fitting surgical mask around others until symptoms are improved.
4. Testing can be done with antigen or PCR tests. A positive test is generally confirmatory for COVID-19. A negative antigen test in a symptomatic person should be followed with a laboratory-based PCR test within 24 hours to confirm the negative result.
5. For symptomatic staff, ensure they are not working and recommend the following:
   • Testing is recommended through their Primary Care Provider or through Los Angeles County https://covid19.lacounty.gov/testing/.

Follow LAC DPH instructions for discontinuing isolation. More strict criteria can be instituted per the investigating team if deemed necessary.

1. New COVID-negative participants in a facility during an outbreak should be restricted based on:
   • The assessment of the AMD or AMD delegated physician.
   • Whether there is evidence of ongoing transmission (i.e., new symptomatic cases) in the facility.
2. Participants may return to their usual activities when they have not had a fever for 24 hours without using fever reducing medications and other symptoms are improving. They should wear a well-fitting mask around others through day 10 (see LAC DPH Isolation Guidance).

Outbreak can be closed for a CBAS once closure criteria is met:

At least 10 days have passed since the last confirmed COVID-19 case in a participant.

1. PHN/OI uploads all documents into IRIS and documents in IRIS per protocol.
2. PHN/OI or PHNS can close COVID-19 outbreak in IRIS after approval by AMD or AMD delegated physician. Closure letter will be signed by AMD or AMD delegate and placed in IRIS under the filing cabinet.

DPHN/OI must be notified of a death and the facilities will need to complete and submit a death report form to ACDC.