​Guidance for Limiting the Transmission of Coronavirus Disease 2019 (COVID-19) in Adult Day Health Centers

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AFL 20-27.1 From the California Department of Public Health

March 23, 2020

TO: Adult Day Health Centers

SUBJECT: Guidance for Limiting the Transmission of Coronavirus Disease 2019 (COVID-19) in Adult Day Health Centers
(This AFL supersedes AFL 20-27)

All Facilities Letter (AFL) Summary

  • This AFL provides guidance for adult day health centers (ADHCs) to mitigate and prevent the transmission of COVID-19.
  • This AFL supersedes AFL 20-27 to update gathering and visitation guidance.

On March 15, 2020, Governor Gavin Newsom advised that individuals at high risk for serious illness due to COVID-19, including persons over 65 years of age, or have serious chronic medical conditions, such as heart disease, diabetes, lung disease, or compromised immune systems, should practice home isolation. At this time, ADHCs are not mandated to close; however, the CDC’s Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission (PDF) provides mitigation strategies ADHCs can implement to reduce the transmission of COVID-19, with additional recommendations based on the level of local community transmission.

Community transmission of COVID-19 is occurring in California. The California Department of Public Health recommends all ADHCs use mitigation strategies for substantial level of community transmission – specifically, ADHCs should:

  • Stay updated with information from your local health department about COVID-19 transmission in the communities where your center is located and where your ADHC participants live.
  • Know the signs and symptoms of COVID-19 and recommended actions if participants or staff become symptomatic.
  • Review and update emergency operations plan (including implementing social distancing measures); develop plan if one is not available.
  • Use telephone and other distant communication methods to provide services to participants.
  • Consider temporary closure or quarantine of facility (based on local health department’s recommendations).

For centers electing to provide in-person services, ADHCs should:

  • Encourage personal protective measures among staff and participants (such as staying home when sick, handwashing, respiratory etiquette, etc.).
  • Clean frequently touched surfaces daily.
  • Ensure hand hygiene supplies are readily available in all buildings.
  • Implement social distancing measures.
    • Eliminate group gatherings of participants.
    • Alter schedules to reduce mixing.
    • Limit programs with external staff.
  • Screen participants and staff for fever and respiratory symptoms.
  • Enact no-visitor policy in the ADHC. 

ADHCs should also monitor the CDC’s Coronavirus Disease 2019 (COVID-19) webpage for additional community guidance as it becomes available.

 The State of California, and specifically the regulatory entities within Health and Human Services Agency, stand ready to assist and partner with health care facilities in this effort.

If you have any questions about infection prevention and control of COVID-19, please contact the CDPH Healthcare-Associated Infections Program via email at HAIProgram@cdph.ca.gov or novelvirus@cdph.ca.gov.

Please remember to immediately report suspected and confirmed cases of COVID-19 to your local public health department and your district office.


Original signed by Heidi W. Steinecker

Heidi W. Steinecker
Deputy Director