Suspension of Regulatory Enforcement of Specified ADHC Requirements

Please note that this information has been superseded by a more recent item and is only retained here for reference.

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AFL 20-34.4 From the California Department of Public Health

June 2, 2021

TO: Adult Day Health Care Centers (ADHCs)

SUBJECT: Suspension of Regulatory Enforcement of Specified ADHC Requirements
(This AFL supersedes AFL 20-34.3)

AUTHORITY:     Executive Order N-35-20 (PDF)

All Facilities Letter (AFL) Summary

  • This AFL notifies ADHCs 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 notifies ADHCs that the waiver allowing ADHCs to provide services using alternate methods including remote services contained in this AFL is valid until the end of the public health emergency.

Pursuant to the Governor’s Executive Order N-35-20 related to COVID-19, the Director of the California Department of Public Health (CDPH) may waive any of the licensing and staffing requirements of Chapter 3.3 of Division 2 of the HSC and accompanying regulations with respect to any ADHC identified in HSC section 1575.

California has made significant progress in the response to COVID-19 as a result of the collective efforts taken by Californian’s and the widespread availability of COVID-19 vaccines. With decreasing case rates, stabilizing hospitalizations and increased availability of vaccines California is preparing to move Beyond the Blueprint for a Safer Economy.

As a result, the temporary waivers of expedited licensure approval will expire June 1, 2021. The remaining specified regulatory requirements contained in this AFL will remain valid until the end of the public health emergency.

CDPH is temporarily waiving specified licensing requirements and suspending regulatory enforcement for the following requirements:


Title 22 CCR sections 7830178305,78307,78309,78311,78313,78319,78337,78339,78341: ADHCs shall not be required to provide all services at the center and will have flexibility in how they provide basic services to participants. Basic services include: occupational therapy, physical therapy, speech therapy, medical services, nursing services, nutrition services, psychiatric or psychological services, social services, and recreation or planned social activities. Services may be provided via telehealth or other remote methods. This will allow for, but is not limited to, check-in calls, health screening calls, video conferencing, and meal delivery. ADHCs that provide in-person services should follow the mitigation guidance.

The flexibility to provide services using remote methods is being extended to allow ADHCs to continue to service as many participants as possible while maintaining physical distancing in the center. This waiver is valid until the end of the public health emergency.

This waiver is approved under the following conditions – ADHCs shall:

  • Report any substantial staffing or supply shortages that jeopardize patient care or disrupt operations.
  • Follow their disaster response plan.
  • Follow infection control guidelines from the Centers for Medicare and Medicaid Services (CMS) and from the Centers for Disease Control and Prevention (CDC) related to COVID-19.
  • Comply with directives from their local public health department, to the extent that there is no conflict with federal or state laws or directives or CDPH AFLs.

If you have any questions about this AFL, please contact your local district office.


Original signed by Cassie Dunham

Cassie Dunham

Acting Deputy Director