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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Suspension of Professional Certification Requirements for Certified Nurse Assistants (CNAs)

AFL 20-35.2 From the California Department of Public Health October 15, 2020 TO: All Facilities SUBJECT: Suspension of Professional Certification Requirements for Certified Nurse Assistants (CNAs) (This AFL supersedes AFL 20-35.1) ​AUTHORITY:      Proclamation of a State of Emergency (PDF) and Executive Orders N-27-20 (PDF) and N-39-20 (PDF) All Facilities Letter (AFL) Summary This AFL notifies all facilities of a temporary waiver of specified statutory and regulatory requirements for CNAs due to the state of emergency related to the COVID-19 outbreak.AFL 20-35.1 has been updated to allow a CNA who remains in an “employable during state of emergency” status to complete in-service or continuing education units and count them towards certificate renewal.

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GACH Coronavirus Disease 2019 (COVID-19) Vaccination Survey

AFL 20-81 From the California Department of Public Health October 12, 2020 TO: General Acute Care Hospitals (GACHs) SUBJECT: GACH Coronavirus Disease 2019 (COVID-19) Vaccination Survey All Facilities Letter (AFL) Summary This AFL requests all hospitals complete a survey to assist with COVID-19 vaccination planning. The California Department of Public Health (CDPH) is requesting that all hospitals complete the survey by October 16, 2020.

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Recommendations for the Prevention and Control of Influenza during the Coronavirus Disease 2019 (COVID-19) Pandemic

AFL 20-80 From the California Department of Public Health October 12, 2020 TO: Skilled Nursing Facilities SUBJECT: Recommendations for the Prevention and Control of Influenza during the Coronavirus Disease 2019 (COVID-19) Pandemic All Facilities Letter (AFL) Summary This AFL provides recommendations to prevent and manage influenza outbreaks in skilled nursing facilities (SNFs) during the COVID-19 pandemic.

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Access to Salesforce for Resource Requests

AFL 20-79 From the California Department of Public Health October 9, 2020 TO: General Acute Care Hospitals SUBJECT: Access to Salesforce for Resource Requests All Facilities Letter (AFL) Summary This AFL informs general acute care hospitals (GACHs) of the ability to access Salesforce to create and coordinate resource requests to their Medical Health Operational Area Coordinator (MHOAC).

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November 3, 2020 Election: Voting During the COVID-19 Pandemic

AFL 20-78 From the California Department of Public Health  October 5, 2020 TO: Skilled Nursing Facilities SUBJECT: November 3, 2020 Election: Voting During the COVID-19 Pandemic AUTHORITY:   Title 42 Code of Federal Regulations section 483.10(b) Title 22 California Code of Regulations section 72527(a)(7) Election Code section 3021 All Facilities Letter (AFL) Summary This AFL reminds skilled nursing facilities (SNFs) to ensure that residents can exercise their right to vote safely in the November 3, 2020 election during the Coronavirus Disease 2019 (COVID-19) pandemic.

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Notice of Grant Opportunity to Benefit Nursing Facility Residents to Support In-Person Visitation

AFL 20-77 From the California Department of Public Health  October 2, 2020 TO: Skilled Nursing Facilities Nursing Facilities SUBJECT: Notice of Grant Opportunity to Benefit Nursing Facility Residents to Support In-Person Visitation ​AUTHORITY:      Title 42 Code of Federal Regulations Section 488.433 All Facilities Letter (AFL) Summary This AFL notifies skilled nursing facilities (SNFs) and nursing facilities (NFs) about the availability of a new federal civil money penalty (CMP) grant opportunity for facilities to purchase materials that aid with in-person visitation.

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Changes on the Minimum Data Set (MDS) 3.0 v1.17.2

AFL 20-76 From the California Department of Public Health September 29, 2020 TO: Skilled Nursing Facilities (SNF) Nursing Facilities (NF) Intermediate Care Facilities Swing Bed Hospitals SUBJECT: Changes on the Minimum Data Set (MDS) 3.0 v1.17.2 All Facilities Letter (AFL) Summary This AFL informs all Medicare and/or Medicaid certified nursing facilities to use the revised MDS 3.0 v1.17.2, effective October 1, 2020.

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Coronavirus Disease 2019 (COVID-19) Outbreak Investigation and Reporting Thresholds

AFL 20-75 From the California Department of Public Health September 22, 2020 TO: All Facilities SUBJECT: Coronavirus Disease 2019 (COVID-19) Outbreak Investigation and Reporting Thresholds ​AUTHORITY:     Title 17 California Code of Regulations (CCR) sections 2500, 2501, and 2502; Title 22 CCR sections 70737, 70739, 72523, 72539, and 72541 All Facilities Letter (AFL) Summary This AFL reminds licensed health facilities of requirements to report outbreaks and unusual infectious disease occurrences to their local health department (LHD) and Licensing and Certification District Office and provides investigation and reporting thresholds for reporting for COVID-19.

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