Visitor Limitations Guidance

AFL 20-38.5 From the California Department of Public Health October 23, 2020 TO: All Facilities SUBJECT: Visitor Limitations Guidance (This AFL supersedes AFL 20-38.4) All Facilities Letter (AFL) Summary AFL 20-38.5 updates the California Department of Public Health’s (CDPH’s) visitation guidance, permitting facilities with medium or low Coronavirus Disease 2019 (COVID-19) county positivity rate to allow one visitor per patient at a time.This AFL also provides visitor guidelines for certain individuals, regardless of the COVID-19 county positivity rate:Pediatric patientsPatients in labor and deliveryNeonatal intensive care unit (NICU) patientsPediatric intensive care unit (PICU) patientsPatients at end-of-lifePatients with physical, intellectual, and/or developmental disabilities and patients with cognitive impairmentsStudents obtaining clinical experienceLong-term care (LTC) facilities should refer to AFL 20-22.5 for updated LTC visitation guidance.

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Guidance for Limiting the Transmission of COVID-19 in Long-Term Care Facilities

AFL 20-22.5 From the California Department of Public Health October 23, 2020 TO: Long-Term Care Facilities SUBJECT: Guidance for Limiting the Transmission of COVID-19 in Long-Term Care Facilities (This AFL supersedes guidance provided in AFL 20-22.4) All Facilities Letter (AFL) Summary This AFL notifies long-term care (LTC) facilities of the Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) guidance for improving their infection control and prevention practices to prevent the transmission of COVID-19, including guidance for visitation.This AFL authorizes LTC facilities to temporarily modify their facility’s visitation policies in accordance with CMS and CDC COVID-19 guidance when necessary to protect the health and safety of residents, staff, and the public.AFL 20-22.5 updates the California Department of Public Health’s (CDPH’s) visitation guidance to align with CMS QSO-20-39-NH (PDF), including:Required visitation; failure to facilitate visitation without adequate reason related to clinical necessity or resident safety may constitute violation of Title 42 Code of Federal Regulations (CFR) section 483.10(f)(4) and subject to citation and enforcement actionsUpdates previously issued indoor and outdoor visitation guidelinesAllows visitation for residents in the green zone in a facility with an ongoing COVID-19 outbreak that has not yet achieved two sequential negative rounds of response testing over 14 daysExceptions to visitation restrictions, which include representatives of protection and advocacy (P&A) programs, individuals authorized by federal disability rights laws, and compassionate care visitsUse of civil money penalty (CMP) funds to help facilitate visitationCOVID-19 infection prevention core principles and best practices Background On March 11, 2020, CDPH issued AFL 20-22, authorizing LTC facilities to temporarily modify their visitation policies in accordance with CMS and CDC COVID-19 guidance when necessary to protect the health and safety of residents, staff, and the public.

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