Guidance on Quarantine for Health Care Personnel (HCP) Exposed to SARS-CoV-2

AFL 21-08.1 From the California Department of Public Health March 5, 2021 TO: General Acute Care Hospitals (GACHs) Acute Psychiatric Hospitals (APHs) Skilled Nursing Facilities (SNFs) SUBJECT: Guidance on Quarantine for Health Care Personnel (HCP) Exposed to SARS-CoV-2 (This AFL supersedes AFL 21-08) All Facilities Letter (AFL) Summary The purpose of this AFL is to provide health care facilities with updated guidance on exposure risk assessment and the duration of quarantine for SARS-CoV-2 exposed HCP working in hospitals and SNFs and SNF residents.This revision includes updated risk assessment and quarantine guidance from the Centers for Disease Control and Prevention (CDC) for HCP working in hospitals and SNFs and SNF residents who have been fully vaccinated against SARS-CoV-2.

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Suspension of Regulatory Enforcement of Specified PCC and MHCU Requirements

AFL 20-30.2 From the California Department of Public Health  February 26, 2021 TO: Primary Care Clinics (PCCs)Mobile Health Care Units (MHCUs) SUBJECT: Suspension of Regulatory Enforcement of Specified PCC and MHCU Requirements (This AFL supersedes AFL 20-30.1) ​AUTHORITY: Executive Order N-35-20 All Facilities Letter (AFL) Summary This AFL notifies PCCs and MHCUs of a temporary waiver of specified regulatory requirements due to the state of emergency related to the Coronavirus Disease 2019 (COVID-19) outbreak.This revision extends the waiver for any clinics conducting COVID-19 vaccinations until June 1, 2021.

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Guidance on Quarantine for Health Care Personnel (HCP) Exposed to SARS-CoV-2

AFL 21-08 From the California Department of Public Health January 29, 2021 TO: General Acute Care Hospitals (GACHs) Acute Psychiatric Hospitals (APHs) Skilled Nursing Facilities (SNFs) SUBJECT: Guidance on Quarantine for Health Care Personnel (HCP) Exposed to SARS-CoV-2 ​All Facilities Letter (AFL) Summary The purpose of this AFL is to provide health care facilities with updated guidance on exposure risk assessment and the duration of quarantine for SARS-CoV-2 exposed HCP working in hospitals and SNFs and SNF residents.

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Suspension of Regulatory Enforcement of Hospital Requirements

AFL 20-26.5 From the California Department of Public Health January 24, 2021 TO: General Acute Care Hospitals SUBJECT: Suspension of Regulatory Enforcement of Hospital Requirements (This AFL supersedes AFL 20-26.4) ​AUTHORITY:     Proclamation of Emergency, Executive Order N-27-20 and Executive Order N-39-20 All Facilities Letter (AFL) Summary This AFL notifies hospitals of a temporary waiver of specified regulatory requirements due to the state of emergency related to the Coronavirus Disease 2019 (COVID-19) outbreak.

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Suspension of Regulatory Enforcement of Hospital Requirements

AFL 20-26.4 From the California Department of Public Health December 11, 2020 TO: General Acute Care Hospitals SUBJECT: Suspension of Regulatory Enforcement of Hospital Requirements (This AFL supersedes AFL 20-26.3) ​AUTHORITY:     Proclamation of Emergency, Executive Order N-27-20 and Executive Order N-39-20 All Facilities Letter (AFL) Summary This AFL notifies hospitals of a temporary waiver of specified regulatory requirements due to the state of emergency related to the Coronavirus Disease 2019 (COVID-19) outbreak.

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Transfers to Low Acuity Alternate Care Sites During Coronavirus Disease 2019 (COVID-19) Pandemic

AFL 20-48.2 From the California Department of Public Health December 7, 2020 TO: All Facilities SUBJECT: Transfers to Low Acuity Alternate Care Sites During Coronavirus Disease 2019 (COVID-19) Pandemic (This AFL supersedes AFL 20-48.1) All Facilities Letter (AFL) Summary This AFL provides information on state-run alternate care sites and guidance for the transfer of COVID-19 positive patients to alleviate strain on hospitals and skilled nursing facilities (SNFs) and ensure patient safety.This AFL also addresses transfers to congregate living health facilities licensed by the California Department of Social Services (CDSS).This guidance has been updated to revise the admission criteria and to provide additional information regarding effectuating a transfer between the alternate care site and health facility.

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CORONAVIRUS DISEASE 2019 (COVID-19) INFECTION CONTROL GUIDANCE FOR CELEBRATIONS AND OUTINGS

California Department of Social Services PIN 20-43-ASC-CCR December 1, 2020 TO: ALL RESIDENTIAL CARE FACILITIES FOR THE ELDERLY-CONTINUING CARE CONTRACTS Original signed by Ley Arquisola FROM: LEY ARQUISOLA, M.S.N, R.N. Acting Deputy DirectorCommunity Care Licensing Division SUBJECT: CORONAVIRUS DISEASE 2019 (COVID-19) INFECTION CONTROL GUIDANCE FOR CELEBRATIONS AND OUTINGS Provider Information Notice (PIN) Summary PIN 20-43-ASC-CCR shares the recent Adult and Senior Care PIN 20-42-ASC which provides guidance on COVID-19 infection control recommendations for celebrations and outings for licensees and staff, residents, friends, and families.

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Interdisciplinary Team (IDT) Authorized Medical Interventions for Residents Unable to Provide Informed Consent and Without a Health Care Decision Maker

AFL 20-83 From the California Department of Public Health October 30, 2020 TO: Skilled Nursing Facilities (SNFs) Intermediate Care Facilities (ICFs) SUBJECT: Interdisciplinary Team (IDT) Authorized Medical Interventions for Residents Unable to Provide Informed Consent and Without a Health Care Decision Maker ​AUTHORITY:      Health and Safety Code (HSC) section 1418.8   All Facilities Letter (AFL) Summary This AFL notifies SNFs and ICFs of the appellate court’s decision in California Advocates for Nursing Home Reform (CANHR), et al.

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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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