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Reporting LAHAN Alerts

Community Care Facilities

B73 COVID-19 - Procedural Guidance for DPH Staff



Community Care Facilities - Where People Reside Overnight AND Receive Care, also including Non-residential Adult Day Programs (ADP) and Community Based Adult Services (CBAS) Centers (excluding: Jails, Settings Associated with People Experiencing Homelessness, Housing Facilities Not Providing Care, Acute Care Facilities, and Skilled Nursing Facilities)

REPORTING PROCEDURES

Outbreak Definitions:

Under Title 17, Section 2500, California Code of Regulations all suspected outbreaks are reportable.

Community Care Facility (See below for facility definition)

Five or more lab confirmed (antigen or PCR) cases (symptomatic or asymptomatic) of COVID-19 have been identified in residents within a 7-day period.

NOTE: If newly admitted residents (e.g., within 7 days of admission) test positive for COVID-19, this is not considered an outbreak as it could have been acquired outside the facility.

NOTE: If a facility has cases in residents but does not meet one of the above thresholds, the outbreak should NOT be opened.

DCFS-affiliated congregate care facilities (see below for definition)

Five or more lab confirmed (antigen or PCR) cases (symptomatic or asymptomatic) of COVID-19 have been identified in residents within a 7-day period.
NOTE: If newly admitted residents (e.g. within 7 days of admission) test positive for COVID-19, this is not considered an outbreak as it could have been acquired outside the facility.

NOTE: If a facility has cases in residents but does not meet the above threshold, the outbreak should NOT be opened.

Emergency shelters for isolation/quarantine of DCFS-affiliated youth diagnosed or suspected of COVID-19 or contacts of confirmed COVID-19 cases

Five or more lab confirmed cases (antigen or PCR) of symptomatic or asymptomatic COVID-19 in staff within a 7-day period. NOTE: Residents are not included in the outbreak definition because they are there specifically for isolation or quarantine due to COVID-19.

Congregate Living Health Facilities (CLHFs) and Intermediate Care Facilities (ICFs)

Two or more lab confirmed (antigen or PCR) cases (symptomatic or asymptomatic) of COVID-19 have been identified in residents, epidemiologically linked to the facility, within a 7-day period.

NOTE: If newly admitted residents (e.g., within 7 days of admission) test positive for COVID-19, this is not considered an outbreak as it could have been acquired outside the facility.

NOTE: If a facility has cases in residents but does not meet the above threshold, the outbreak should NOT be opened.

Adult Day Programs (ADPs) licensed by CCLD and Community Based Adult Services (CBAS) Centers Ten

Five or more confirmed COVID-19 cases in participants who attend the ADP or CBAS for in-person activities within a 7-day period. These cases must be part of a group* where members do not share a household and are not a close contact of each other outside of the facility. Epidemiological links require cases to be present in the same setting during the same time period while infectious.

*Groups include persons that share a common membership, e.g., adult day care centers, same classroom, school event, school-based extracurricular activity, academic cohort, athletic teams, clubs.

For ADPs and CBASs where activities are conducted virtually and staff do not have any contact with participants, general guidance for quarantine, isolation, cleaning, mask wearing, distancing, and hand hygiene should be given for preventing further spread of infection to other staff, but no outbreak investigation needs to be done.

 

Epidemiologic Data for Outbreaks

  1. Confirm etiology of outbreak using laboratory-testing data. All symptomatic residents or staff are recommended to be tested for COVID-19. Antigen tests are acceptable.
  2. Complete the line lists appropriate for the setting (see Forms/Quick Links section).
  3. Conduct response testing: see Community Care Facilities guidance.
  4. Obtain site floor plan, if appropriate.
  5. Create an epi-curve, by date of onset (see CDC Quick Learn Lesson: Create an Epi Curve for guidance). Only put those that have suspected or confirmed COVID-19 on the epi-curve. (Optional)

CONTROL OF CASES & CONTACTS

Investigation can be conducted over the phone. The frequency of follow-up with the facility for outbreak updates can be determined by Outbreak Management Branch (OMB) MD.

Inform the facility that they will be included on a public outbreak notification list posted on the LAC Public Health website until the outbreak is resolved.

Note: All staff in all CCFs should receive their recommended COVID-19 vaccine and booster doses. Being up to date with COVID-19 vaccines is the best defense against the currently circulating strains of COVID-19. If a staff member has received the primary series and subsequently been infected with COVID-19, they may defer receiving the booster dose up to 90 days after clinical diagnosis or first positive test

Additional Guidance and Resources:

Cases

See detailed instructions below for case management of residents, as well as cases in facility staff.

Contacts

A close contact is a person with exposure to a confirmed or suspected case of COVID-19 during the period from 2 days before symptom onset until the case meets criteria for discontinuing isolation (see detailed instructions below for staff and residents). For asymptomatic cases, the date of collection of the specimen positive for SARS-CoV-2 can be used in place of onset date to determine period of isolation.

Exposures are defined as follows:

    1. Anyone who shared the same indoor space with the positive individual for a cumulative total of 15 minutes or more over a 24-hour period during the positive individual’s infectious period.
    2. Having unprotected (without PPE) direct contact with infectious secretions or excretions of a person with confirmed or suspected COVID-19 (e.g., being coughed on, touching used tissues with a bare hand, clinical care).
  • Caregivers: All direct care-giving staff, whether licensed or unlicensed, should follow the  Community Care Facilities guidance. This includes nurses (RNs/LVNs/CNAs), health aids and unlicensed caregivers.
  • Visitors: Contact any visitors that may have been exposed to a suspected or confirmed case and instruct them to self-quarantine for the appropriate number of days after last exposure (see Home Quarantine Instructions for Close Contacts to COVID-19). Visitors should call their primary care provider to discuss testing options.

Note: CDC does not recommend testing, symptom monitoring or special management for people exposed to asymptomatic people with potential exposures to SARS-CoV-2 (i.e., “contacts of contacts;” these people are not considered exposed to SARS-CoV-2).

COMMUNITY CARE FACILITY DEFINITIONS

Community Care Facilities:

These are short- or long-term residential facilities that meet any one of the following descriptors:

  • Residential facilities for adults licensed by the California Community Care Licensing Division (CCLD) including Residential Care Facilities for the Elderly (RCFEs) and Adult Residential Facilities (ARFs). For facility types see: www.cdss.ca.gov/inforesources/community-care/ascp-centralized-application-units. See below for separate definition of DCFS-affiliated congregate care facilities.
  • Residential behavioral health treatment facilities, such as substance use or mental health treatment facilities.
  • Group homes for adults not licensed by the State, which provide housing and assistance with activities of daily living or other need.
  • Adult Day Programs (ADPs) licensed by CCLD and Community Based Adult Services (CBAS) centers licensed by DHCS.
  • Congregate Living Health Facilities (CLHFs) licensed by the Health Facilities Inspection Division (HFID) and Intermediate Care Facilities (ICFs) licensed by California Department of Public Health (CDPH)

DCFS-affiliated congregate care facilities

  • CCLD-licensed residential facilities caring for minors age 6 through 17 and non-minor dependents age 18 through 21 in out-of-home care, including Short-Term Residential Therapeutic Programs, Community Treatment Facilities and Transitional Shelter Care Program Facilities.

Emergency shelters for isolation for DCFS-affiliated youth diagnosed or suspected of COVID-19 and for quarantine of youth contacts of confirmed COVID-19 cases

  • Small apartments where individual youth or youth from the same household are housed for short term stays due to isolation or quarantine needs.
  • Supervision is provided 24 hours daily onsite by disaster service workers in 8 to 12 hour shifts with staff sleeping onsite and providing assistance with meals, bathing, recreation, etc.

ADMINISTRATIVE CONTROL MEASURES IN COMMUNITY CARE FACILITIES DURING AN OUTBREAK

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

  1. Always encourage all staff and residents to follow physical distancing and adhere to hand hygiene guidance as much as possible.
    1. Signage should be posted to reinforce frequent hand washing and cover your cough.
    2. 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).
    1. Source control should be worn by all staff and visitors in all indoor resident care areas, common or shared areas, walkways, or where residents and/or staff congregate, with exceptions listed for visitation and group activities/communal dining. This can be required by the OMB team in an outbreak situation.
    2. 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 residents.
    3. Well-fitting surgical masks should be worn around others by any resident that is confirmed or suspected to have COVID-19 who is around others.
    4. All residents should be encouraged to wear masks when outside their room. This includes residents who regularly leave the facility for care (e.g. hemodialysis patients). This can be required by the OMB team in an outbreak situation.
    5. Residents who, due to age or underlying cognitive or medical conditions, cannot wear masks, outside their room should not be forcibly required to wear masks and should not be forcibly kept in their rooms. However, masks should be encouraged as much as possible. Children under 2 should not be required to wear masks.
    6. When staff are in resident rooms, residents should cover their noses and mouths as much as possible. Residents can use tissues for this or masks.
  3. Increase environmental cleaning throughout the facility. See CDC When and How To Clean and Disinfect a Facility. Use EPA-registered cleaning agents and follow the label directions.
  4. Identify a mechanism for the facility to obtain SARS CoV-2 samples and to send these specimens from the facility to a laboratory with quick turnaround for results.
  5. Response testing should be initiated following the detection of a positive case. Refer to Community Care Facilities guidance.
  6. Plan for ways to continue essential services if on-site operations are reduced temporarily.
    1. Restrict group activities, field trips, and communal dining as OMB team deems appropriate for the outbreak. For youth in DCFS-affiliated congregate care facilities, communal dining can be maintained as long as youth are assigned to cohorts appropriately by COVID status/exposure status and groups are small and stable.
    2. 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, residents.
    1. Every individual entering the community care facility (including residents, 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.
    2. Records are to be kept of screening.
    3. Facilities should limit access points and ensure that all accessible entrances have a screening station.
    4. 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:
    1. Those with fever symptoms, or close contact with a COVID positive person should not be permitted to enter the facility at any time (even in end-of-life situations. The OMB team can restrict visitation more if deemed necessary in an outbreak situation.
    2. Post signs explaining visitor restrictions.
    3. Set-up alternative methods of visitation such as through videoconferencing through Skype or FaceTime.
    4. 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 the resident’s room or other location designated by the facility. They should also be reminded to frequently perform hand hygiene and to avoid others while in the facility.
  12. For youth in DCFS-affiliated congregate care facilities, there are several important considerations concerning visitors and visitation:
    1. Court mandated visits may involve visits to youth onsite at the facilities or visits offsite. Legally these visits supersede HOO mandates for isolation and quarantine.
      • For youth who are COVID positive and finishing their isolation period, the facility needs to request that the DCFS social worker assigned to the youth request postponement of the court mandated visit until the isolation period is over.
      • For youth residing in a facility with an open outbreak but who are not under isolation or quarantine, visitations should be allowed to proceed.
    2. Onsite and off-site family visits that are not court-mandated should also be allowed or postponed according to the distinctions above. Youth in isolation should postpone visits until after their isolation term has been completed. Youth not in isolation can continue to have visits if approved by the facility staff and the assigned DCFS case-worker.
  13. Provide education and job-specific training to staff regarding COVID-19, including:
    1. Signs and symptoms.
    2. Modes of transmission of infection.
    3. Correct infection control practices and personnel protective equipment (PPE) use.
    4. Staff sick leave policies and recommended actions for unprotected exposures (e.g., not using recommended PPE, an unrecognized infectious patient contact).
    5. How and to whom COVID-19 cases should be reported.
  14. Ensure that your facility has the capacity to isolate residents with COVID-19 and quarantine residents who are close contacts of a COVID-19 case.
  15. Establish a COVID-19 area within the facility, if possible:
    1. The COVID-19 area is for residents who have confirmed COVID-19 and should have a designated bathroom. The area should ideally be physically separated from the area for those who do not have COVID-19. If not possible to separate physically because the facility is structured to have individual resident apartments or rooms with their own bathrooms, all that is needed is appropriate signage (see Transmission Based Precautions Signs, Novel Respiratory Precautions) outside the apartment or room designating the status of the resident and the appropriate PPE needed to care for that resident, along with a PPE cart for that room.
    2. All staff, equipment, and common areas should be kept separate as much as possible.
    3. LAC DPH does not recommend transferring patients to hospitals unless they require higher level of care and does not recommend transfer between facilities unless the facility is unable to isolate cases adequately.
  16. Facility should accept back COVID+ patients ready to be discharged from acute care hospitals.
  17. The facility should consult with the District Public Health Nurse (DPHN)/Outbreak Investigator (OI) assigned to the facility regarding closure of the facility to new/returning admissions.
  18. Have a resident and family notification process for when a case of COVID-19 is identified.
  19. Have the ability to identify residents who could be discharged to home in the event of COVID-19 introduction to the building.
  20. As much as possible, have employees work at only one facility in order to reduce interfacility spread of COVID-19.
  21. For any transfers out of the building, notify EMS and the receiving facility of possible exposures.
  22. Cancel and re-schedule all upcoming non-essential medical appointments or consider telemedicine routine care appointments when available.
  23. All staff should wear a well-fitting surgical mask in walkways and common or shared areas where residents and/or staff may congregate. For all resident encounters, caregivers should at minimum wear a mask (well-fitting surgical mask, or higher). If resident is unable to cover nose/mouth (i.e. practice source control), caregivers should also use eye protection for that encounter.
  24. Full PPE (N-95 respirator, gloves, gown, and eye protection) is recommended while providing care to a resident with suspected or confirmed COVID-19. For conservation of PPE, please refer to CDC guidance (www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html).

    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.

  25. If unsafe for residents to eat unsupervised (e.g., prone to aspiration) or cannot feed themselves, or if staffing is insufficient to support one to one feeding, residents may eat outside their rooms as long as physical distancing guidelines can be followed.
  26. Designate caregivers who will be responsible for caring for suspected or known COVID-19 residents. Ensure they are trained on the infection prevention and control recommendations for COVID-19 and the proper use of PPE.
  27. All staff should be careful to change required PPE between patients, and adhere to donning and doffing recommendations (www.publichealth.lacounty.gov/acd/docs/CoVPPEPoster.pdf), though N95 and face shields may be worn throughout the day consistent with CDC PPE conservation contingency strategies (www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html). If staff must care for residents not in isolation, as well as those in isolation, they should visit the residents in isolation last and should doff PPE and perform hand hygiene before and after each resident’s care.
  28. In an outbreak situation, admission of new residents (new admissions) and returning residents (readmissions) should be permitted unless closure is approved by the Area Medical Director (AMD). This rule applies to DCFS-affiliated congregate care facilities as well as other CCFs.
  29. For ADPs and CBASs: 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.
  30. The decision to close residential CCFs to admissions should be recommended only after a number of factors have been considered. Consider closing the facility to admissions if some or all of the following are concerns:
    1. Inadequate infection prevention & control concerns from licensing
    2. Concerning rates of adverse outcomes including hospitalizations and deaths
    3. Evidence of concerning viral transmission based on response testing of residents
    4. Inability to cohort residents per protocol:
      • Inability to effectively quarantine new admissions and readmissions
      • Inability to effectively dedicate COVID and non-COVID areas and staff in the facility
    5. Lack of effective infection control practices as evidenced by a virtual or on-site infection control visit
    6. Inadequate supply of PPE.
    7. Staffing shortages or inability of current staff to properly care for COVID-19 positive residents are reported.

OUTBREAK RESPONSE RECOMMENDATIONS FOR SUSPECTED OR CONFIRMED CASES

All ill persons (residents 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 residents, immediately mask and initiate quarantine/isolation.
  2. Symptomatic/confirmed 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.

Facilities should initiate contact investigation around each confirmed case (staff or resident) to identify all close contacts (staff and residents) during the infectious period of the case(s).

  • NOTE: Resident cases are NOT considered outbreak-associated if:
    • They were admitted as a known case.
    • Their specimen collection date was within 90 days of a prior positive result.
    • Their symptom onset or specimen collection date was on or prior to their 7th day of residency in the facility. Symptom onset or specimen collection date (whichever is earlier) is considered day 0.
    • Their symptom onset or specimen collection date was 3 or more days after being discharged from the facility. Symptom onset or specimen collection date (whichever is earlier) is considered day 0.
    • Their only positive test is not considered confirmatory (e.g., an unsupervised antigen test).
  • NOTE: Staff cases are NOT considered outbreak-associated if: 
    • They did not work for 5 or more days before their symptom onset or specimen collection date. Symptom onset or specimen collection date (whichever is earlier) is considered day 0.
    • They did not work for 10 or more days after their symptom onset or specimen collection date. Symptom onset or specimen collection date (whichever is earlier) is considered day 0.
    • Their specimen collection date was within 90 days of a prior positive result.
    • Their specimen collection date or symptom onset date occurred prior to the first resident case or after the outbreak was considered over per DPH guidance.
    • Their only positive test is not considered confirmatory (e.g., an unsupervised antigen test).

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. See the Community Care Facilities Guidance for more details.

Document all staff and resident or participant cases and contacts on the appropriate line lists (see Forms/Quick Links section). 

Designate areas in the facility for the placement of suspected and confirmed residents or participants. Refer to the Community Care Facilities Guidance. In ADPs and CBASs, have a room designated for placement of suspected or confirmed positive participants while they wait to be transported home or to a hospital.

Note: The actual isolation area will depend on each building but define the area by the local workflow (e.g., the unit the resident is located would be a logical decision).

    1. Case(s) should be isolated in single-person room(s). Move roommates into other rooms within the isolation area, if possible. Otherwise, cohort case(s) together in a separate room with the door closed and a dedicated restroom.
    2. Cohort staff (keep the same, limited number of staff caring for the residents in isolation and ensure they do not interact with residents/staff in other areas, as much as possible).
    3. Move suspected residents into quarantine if needed.

 

Designate a quarantine area, if needed, for residents who have been identified as close contacts to case(s) at your facility. Follow guidance in the LAC DPH Instructions for Close Contacts.

Residents in the quarantine and isolation should:

  1. Have visitors only as deemed appropriate by the investigating team and should have limited contact with staff and other residents. See above for special considerations for court-mandated visitation for youth in DCFS-affiliated congregate care facilities.
  2. Stay in a separate room as much as possible and away from residents 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.
  3. Use a separate bathroom.
  4. Continue to monitor all residents for fever and respiratory symptoms (i.e. cough, sore throat, shortness of breath).
  5. 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.
  6. Any resident 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.
  7. Notify DPHN immediately if any caregivers or resident contact tests positive for COVID-19.
  8. Special situations for facilities to consider:
    1. For residents receiving dialysis outside of the facility, notify their dialysis center and request that they be dialyzed in “isolation.”
    2. Consider substituting nebulizers for metered dose inhalers.

Management of Staff Member Exposure and Cases in Community Care Facilities

  1. Staff who provide care to residents should follow Community Care Facilities guidance to determine when they should return to work after an exposure to a person confirmed to have COVID-19.
    1. Instruct exposed staff to notify all other employers of the type and nature of their exposure.
  2. Document all close contacts on the COVID-19 Line List for Congregate Residential Settings (Excel) (See Report Forms 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.
  4. For confirmed staff cases, ensure the staff self-isolates for the time period described in the Community Care Facilities guidance.
    1. If possible, identify facility staff who can monitor sick staff with daily “check-ins” using telephone calls, emails, and/or texts.

TESTING RECOMMENDATIONS

  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.
    1. For testing at DCFS-affiliated congregate care facilities, response testing is also recommended if one COVID-19 positive individual (youth or staff) is identified. If consent cannot be obtained for testing of the youth, youth should be monitored for signs and symptoms of COVID-19.
    2. For DCFS Emergency shelter facilities, response testing should be initiated if one COVID-19 positive staff is identified.
  2. Response testing: If one or more COVID-19 positive individuals (resident or staff) are identified  (excluding independent Continuing Care Retirement Communities unless they have been in communal settings with other residents), response testing should take place, as outlined in the Community Care Facilities guidance. This does not apply to individuals who have been positive for COVID-19 in the previous 90 days. Testing may be discontinued after 14 consecutive days without positive residents.
  3. Exposure testing: Individuals who have been exposed should be tested.
  4. Symptomatic testing: Individuals who are symptomatic for COVID-19 should be tested. Any resident/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.
  5. 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.
  6. For symptomatic staff, ensure they are not working and recommend the following:
    1. Testing is recommended through their Primary Care Provider or through Los Angeles County https://covid19.lacounty.gov/testing/.
  7. If the facility is unable to find a lab to do testing within 1 week, despite attempting to do so, facilities can be referred to DPH community testing (strike) team. Requests for DPH strike team testing can be made if facilities are unable to conduct testing on their own. However, requests will be prioritized by ACDC in communication with OMB based on risk and scope of outbreak, and consensus that testing will change management, as well as DPH capacity and resources for testing supplies and staff. Decisions for testing through DPH will be made on a case-by-case basis with the OMB MD
    1. For an urgent need for testing outside of the priority, the request must come from the OMB Area Medical Director (AMD).

DISCONTINUATION OF TRANSMISSION-BASED PRECAUTIONS AND DISPOSITION OF PATIENTS WITH COVID-19

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

  1. If transmission-based precautions have been discontinued, but the resident has persistent symptoms from COVID-19 (e.g., persistent cough), they should wear a well-fitting surgical mask (if tolerated) during care activities until all symptoms are completely resolved or at baseline.

Transfers to and from Community Care Facilities

Interfacility transfers should be limited as much as possible, while still maintaining appropriate levels of care for all patients.

Residents/participants should not be sent to the Emergency Department (ED) to obtain SARS CoV-2 testing.

  1. Residents who developed symptoms of COVID-19 in the facility and are transferred to acute care hospital may return to the facility of origin once clinically stable if staffing levels in the facility are adequate to have dedicated staff to care for COVID-19 positive individuals.
  2. New COVID-negative admissions to the facility during an outbreak should be restricted based on:
    1. The assessment of the AMD or AMD delegated physician.
    2. Depending upon the layout of the facility and the capacity for the facility to separate COVID-positive residents from negative residents.
    3. Whether there is evidence of ongoing transmission (i.e., new symptomatic cases) in the facility
  3. Participants in ADPs and CBASs may return to their usual activities after day 5, provided that are wearing their well-fitting mask around others through day 10 (see LAC DPH Isolation Guidance).

Transfers between Community Care Facilities

LAC DPH does not recommend transferring residents to hospitals unless they require higher level of care and does not recommend transfers between community care facilities unless the facility is unable to isolate the resident adequately.

Outbreak Closure Criteria

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

At least 14 days have passed since the last confirmed COVID-19 case in a resident.

  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.

Outbreak can be closed for an ADP or 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 At least 10 days have passed since the last confirmed COVID-19 case in a participant.
  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.

 

Death Reporting

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



Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.

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