Information for Long-Term Care Facilities

Last content update: 6/10/22

Welcome Long-Term Care Facilities (LTCFs) partners. The resources listed here are for LTCF Administrators, Directors of Nursing (DONs), Infection Prevention (IP) Nurses/IP team members, Directors of Staff Development (DSD), and other LTCF team members that play a role in the prevention and control of COVID-19 infections in LTCFs. 

    NOTE: Skilled nursing facilities (SNFs, 1) and long-term care facilities (LTCFs, 2) are required to adhere to different isolation, testing, and work restriction guidance. Please consult the information below for which guidelines are applicable to each setting.

    When there is a difference between local, state, and federal guidelines or health orders, or difference with other regulatory agency guidelines, including guidelines for testing, quarantine, and isolation, the most restrictive guideline or order must be followed.

      In general, healthcare workers in hospitals or skilled nursing facilities (SNFs)1  should follow CDPH AFLs. See AFL 21-08 for specific guidance on isolation, testing, and work restriction. For more information, please see the County’s COVID-19 Resources for Providers webpage and What Guidance Should I Follow. See below for the State of California’s definition for SNFs.

      1Skilled Nursing Facilities (SNFs): SNFs provide 24-hour care to residents whose primary need is for availability of skilled nursing care on an extended basis. A number of different terms, including "convalescent hospitals," "nursing homes," "rehabilitation centers" or "skilled nursing facilities" are used to describe facilities that are formally referred to in California as SNFs. For more information, refer to the California Department of Aging.

      Staff and residents in high-risk settings not covered by AFL 21-08, including congregate settings such as long-term care settings and adult/senior care facilities2, should follow the isolation, testing, and work restriction guidance in CDPH’s updated recommendations. For guidelines in these settings see COVID-19 Guidelines for Staff and Residents in High-Risk Settings and What Guidance Should I Follow. In addition to this guidance, facilities should also consult CDPH and CDSS (California Department of Social Services) recommendations for their specific facility type. Find the latest guidance from CDPH by setting type here and CDSS here. See below the State of California’s definition for LTCFs.

      2Long-term Care Setting and Adult/Senior Care Facility: These terms are used to describe a variety of facilities that provide both housing and personal care. They include "board and care homes," which are often six bed facilities in residential housing as well as much larger facilities. Some facilities primarily serve adults under age 60 (Adult Residential Care Facilities) and others primarily serve adults age 60 and over (Residential Care Facilities for the Elderly—RCFEs). For more information, refer to the California Department of Aging.

      What are my Reporting Requirements?

      Facilities must report to PHD in compliance with the chart below.

      Reporting COVID-19 Cases

      Who Must be Reported

      How to Report

      Call the Public Health Department (408-885-4214, ext. 3; ask for Provider Response Branch) by the next business day to report any confirmed case in any Long-Term Care Facility (LTCF), including a skilled nursing facility (SNF).

      1. Call PHD (Required for All Cases): Call the Public Health Department (408-885-4214, ext. 3; ask for Provider Response Branch) by the next business day to report any confirmed case in any Long-Term Care Facility (LTCF), including a skilled nursing facility (SNF).

      Long-Term Care Facilities (LTCFs) are required to submit to the County a report submission via the Shared Portal for Outbreak Tracking2 of any newly positive (antigen or PCR positive) staff or resident, including staff or residents with a history of previous COVID-19 positive results.

      1. Shared Portal for Outbreak Tracking (Required for All Cases): Report via the Shared Portal for Outbreak Tracking. Long-term care facilities should report all staff, resident, and visitor COVID-19 cases and contacts exposed at your healthcare facility or believed to be part of a healthcare facility outbreak. Consult AFL 20-75 (ca.gov) for threshold for reporting to PHD (>1 probable or confirmed COVID-19 case in staff or resident).

        Note: Shared Portal for Outbreak Tracking Video provides an overview and demonstration of the Shared Portal for Outbreak Tracking process for healthcare facilities. 

      Providers must report any suspected congregate setting outbreak. In LTCFs, >1 probable or confirmed COVID-19 case in staff or resident constitutes an outbreak.

      1. Congregate Setting Outbreaks (Required for All Outbreaks): Providers must report any suspected congregate setting outbreak (in LTCFs, this is >1 probable or confirmed COVID-19 case in staff or resident). Report by calling PHD at 408-885-4214, ext. 3 (8:00 a.m. – 5:00 p.m. M-F; please leave voicemail if calling after hours).

        For more instructions on reporting COVID-19 cases and contacts, please go here

      In addition to above, providers including LTCFs are required to submit a Case Report Form for cases that meet the criteria. As of 1/14/2022, Case Report Form submission is only required for COVID-19 cases who are (1) hospitalized or (2) deceased. Case report form submission is no longer required for post-vaccination cases OR cases that occur in congregate settings, unless case meets one or more of the criteria above.

      1. Case Report Form (Required for Cases Meeting Criteria): In addition to the required Shared Portal for Outbreak Tracking and Congregate Setting Outbreak reporting (1 and 2 above) California Health and Safety Code Title 17 requires ordering healthcare providers to report diagnosed COVID-19 cases to the County via the Case Report Form. Providers including LTCFs are required to submit a Case Report Form for all hospitalized and deceased patients. Case Report Form (CRF) requirement must be met within 1 business day instead of within 24 hours. In addition, a required question is included on this form to ascertain if the patient was hospitalized for  COVID-19 illness. All required questions must be completed for CRF submission to be considered compliant with Title 17 requirements. For more information, see the COVID-19 Resources for Providers webpage.

      What Guidance Should I Follow?

      Note: When there is a difference between local, state, and federal guidelines or health orders; or difference with other regulatory agency guidelines, including guidelines for testing, quarantine, and isolation, the most restrictive guideline or order must be followed.

      Table of Guidance for Facilities

      Testing for COVID-19

      Topic of Interest

      Notes

      Relevant Guidance (AFL, PIN, Health Order, etc.)

      Testing of Healthcare Personnel

      The California Department of Public Health released a Public Health Order on July 26, 2021, Health Care Worker Protections in High-Risk Settings. This order outlines testing and other public health requirements. 

      • CDPH - AFL 21-28:  COVID-19 Testing, Vaccination Verification and Personal Protective Equipment for Health Care Personnel (HCP) at Skilled Nursing Facilities (SNF) (1/26/22)
      • CDPH - AFL 21-29: COVID-19 Testing, Vaccination Verification and Personal Protective Equipment for Health Care Personnel (HCP) at Health Care Facilities (1/26/22)
      • CDPH: Updated Testing Guidance (10/29/21)
      • CDPH - AFL 20-53: COVID-19 Mitigation Plan Recommendations for Testing of Health Care Personnel (HCP) and Residents at Skilled Nursing Facilities (SNF) (12/27/21)
      • PIN 21-32-ASC: Updated Facility Staff Testing and Masking Guidance for COVID-19 (8/11/21)
      • PIN 22-05-ASC: Adult and Senior Care Facility Worker Coronavirus Disease 2019 (COVID-10) Vaccination and Booster Requirements (2/2/22)
      • QSO-20-38-NH: Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements

      Testing of Residents

      The California Department of Public Health released recommendations for SNFs on conducting diagnostic screening testing of SNF HCP and response-driven testing of SNF residents and HCP. See Coronavirus Disease 2019 (COVID-19) Mitigation Plan Recommendations for Testing of Health Care Personnel (HCP) and Residents at Skilled Nursing Facilities (SNF) for more information.

      • CDPH - AFL 20-53: COVID-19 Mitigation Plan Recommendations for Testing of Health Care Personnel (HCP) and Residents at Skilled Nursing Facilities (SNF) (12/27/21)
      • CDPH: Updated Testing Guidance (10/29/21)
      • Order of the State Public Health Officer: Revision of Mandatory Reporting of COVID-19 Results by Health Care Providers (2/10/22)
      • QSO-20-38-NH: Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements

      Testing of Visitors

      The California Department of Public Health released a Public Health Order on August 26, 2021 (amended 2/7/22) pertaining to Requirements for Visitors in Acute Health Care and Long-Term Care Settings. The Order applies only to indoor visitation in facilities identified in this Order. Visitors to hospitals and nursing homes must show proof of vaccination for COVID-19 or a negative COVID test (taken within the last 48 hours). This applies to anyone more than two years old (including those who cannot be vaccinated due to age or other reasons). 

      Visitors need to wear face covering at all times. 

      • Order of the State Public Health Officer: Requirements for Visitors in Acute Health Care and Long-Term Care Settings (2/7/22)
      • CDPH - AFL 22-07: Guidance for Limiting the Transmission of COVID-19 in Skilled Nursing Facilities (SNFs) (2/7/22)
      • PIN 22-07-ASC: Updated Statewide Visitation Waiver, and Testing and Vaccination Verification Guidance for Visitors Related to COVID-19 (2/7/22)
      • QSO-20-29-NH: Nursing Home Visitation – COVID-19 (REVISED)

      Testing of New Admissions or Re-admissions

      See CDPH - AFL 20-87 and CDPH - AFL-20-53 for information on  testing of new resident admissions or re-admissions.

      • CDPH - AFL 20-87: Movement of Patients/Residents in the Healthcare Continuum During Seasonal Surges and the COVID-19 Pandemic (11/15/21)
      • CDPH - AFL-20-53: COVID-19 Mitigation Plan Recommendations for Testing of Health Care Personnel (HCP) and Residents at Skilled Nursing Facilities (SNF) (12/27/21)

       

      Isolation and Quarantine in LTCFs

      Topic of Interest

      Notes

      Relevant Guidance (AFL, PIN, Health Order, etc.) 

      Isolation and Quarantine Guidelines for HCP

      Healthcare workers in hospitals or skilled nursing facilities (SNFs) should follow the isolation, testing, and work restriction guidance in AFL 21-08.

      Staff and residents in Long Term Care Facilities (LTCFs), which are not covered by AFL 21-08, should follow the latest guidelines from CDPH dated April 6, 2022.

      NEW 5/27/22: All Adult and Senior Care Program Residential Licensees should also follow guidance in PIN 22-15 ASC.

      NOTE: In addition to the guidance in this section, high-risk settings should also look at the CDPH recommendations for their specific facility type. Find the latest guidance from CDPH by setting type here.

       

      Personal Protective Equipment (PPE)

      Topic of Interest

      Notes

      Relevant Guidance (AFL, PIN, Health Order, etc.) 

      PPE (Including Eye Protection), Resident Placement, and Staffing Considerations

      Use of N95 or Other Respirator:

      CDC recommends HCP wear N95 or higher level respirator while caring for residents undergoing aerosol generating procedures, in counties with substantial or high levels of community COVID-19 transmission (per the CDC COVID-19 Data Tracker).

      CDPH recommends HCP wear N95 or higher level respirator while caring for residents undergoing aerosol generating procedures in counties with moderate to higher levels of community COVID-19 transmission (per the CDC COVID-19 Data Tracker).

       

      Use of Eye Protection:

      • CDPH and CDC recommends HCP wear eye protection for all direct patient/resident care.
      • Eye protection and N95 respirators for aerosol generating procedures should always be worn in the “red zone” or “yellow zone” and should also be worn in the “green zone” during a COVID-19 outbreak.

       

      • CDPH - AFL 20-74: COVID-19 Recommendations for Personal Protective Equipment (PPE), Resident Placement/Movement, and Staffing in Skilled Nursing Facilities (7/22/21)
      • CDPH: COVID-19 PPE, Resident Placement/Movement, and Staffing Considerations by Resident Category (7/22/21)
      • CDPH: Respiratory Protection – Resources for Health Care (3/24/21)
      • CDC: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic (2/2/22)
      • Healthcare Facility Resources Requests - 213 RR Forms
      • NEW 5/27/22: For All Adult and Senior Care Program Residential Licensees: PIN 22-15 ASC: Guidance on resident cohorting, isolation and quarantine, staffing and use of PPE

       

      Vaccination Information and Resources

      Topic of Interest

      Notes

      Relevant Guidance (AFL, PIN, Health Order, etc.) 

      General Info

      Visit the County’s COVID-19 Vaccine Information website for COVID-19 vaccine information for the general public.  

      The County of Santa Clara COVID-19 Vaccine Information for Healthcare Providers has information on how to become a COVID-19 vaccine provider, managing and administering COVID-19 vaccines,  and more. 

      CDPH recommends that GACHs and APHs offer COVID-19 vaccinations to eligible patients prior to discharge, especially to those at highest risk to morbidity and mortality. See AFL-21-20 (ca.gov) for more information.

      Eligibility

      Visit the County’s COVID-19 Vaccine Information website for information about COVID-19 vaccines including booster eligibility.

       

      Vaccination Requirements

      Topic of Interest

      Notes

      Relevant Guidance (AFL, PIN, Health Order, etc.) 

      Vaccine Requirements for Healthcare Personnel

      The following Health Orders outline the vaccination requirements for healthcare workers:

      • Health Care Workers (including SNF workers) must adhere to the requirements for vaccination of the December 22, 2021 Health Order (amended 2/22/22),
      • Workers in Adult Care Facilities and Home Health Care Providers must adhere to the requirements for vaccination of the December 22, 2021 Health Order (amended 2/22/22),
      • Workers in higher-risk settings must adhere to the requirements for vaccination of the December 28, 2021 County of Santa Clara Health Order (amended 3/7/22).
      • “Higher-Risk Settings” include the following facilities where there is shared air, space or proximity to patients, clients, or vulnerable populations:
        • skilled nursing facilities, long term care facilities, adult day care facilities, and memory care facilities;
        • healthcare delivery facilities (such as hospitals, clinics, medical offices, dialysis centers, etc.) where patient care is provided, as well as medical first responders;
        • jails and other correctional facilities; and
        • congregate shelters

      Additional information on these requirements can be found at AFL 21-34 (ca.gov)Adult Care Facilities and Direct Care Worker Vaccine Requirement, and the Health Care Worker Vaccine Requirement.

       

      Visitation in Long Term Care Settings

      Topic of Interest

      Notes

      Relevant Guidance (AFL, PIN, Health Order, etc.) 

      Visitor Guidance Including Vaccine Requirements

       

       

      Consult the State Public Health Officer Order of August 26, 2021 (amended 2/7/22) to review requirements for visitors in acute health care and long-term care settings.

       

       

       

      Infection Prevention

      Topic of Interest

      Subtopic

      Relevant Guidance (AFL, PIN, Health Order, etc.) 

      Infection Control (IP)

       

      SNF Infection Preventionist Requirements

      • CDPH - AFL 21-51: Assembly Bill (AB) 1585 – Expansion of SNF Infection Preventionist (IP) Minimum Qualifications (12/13/21)
       

      IP Resources

      How Can I Submit Requests for Resources?

      Request Submittal Steps

      How to Submit Request(s) for Staffing

      Topic of Interest

      Notes

      Relevant Guidance (AFL, PIN, Health Order, etc.) 

      Facility Staffing

       

      Staffing

       

      The State now requires those seeking staffing to go into direct contract with a vendor to provide these services. The State has provided the attached POC list for vendors that have been used successfully in the past to work with. The facility should exhaust the attached list before submitting a resource request to the Op Area. To clarify, the facility cannot seek staffing from the County, Region or State solely because they do not like the associated costs with filling their staffing need.

       

      1. Prior to submission, the facility should exhaust the Staffing Agency POC Information List before submitting a resource request to the Op Area.
      2. Complete the 213 Resource Request (213RR) form​:
      3. Save and send as an attachment to: [email protected].

       

      How to Submit Request(s) for PPE and Other Resources

      Topic of Interest

      Notes

      Relevant Guidance (AFL, PIN, Health Order, etc.) 

      Non-Staffing Resources (Including PPE, Testing, etc)

       

      PPE

      Healthcare providers who need PPE, antigen tests, or other resources to continue delivering healthcare services during this time can make a request through the County Emergency Operations Center (EOC).

       

      1. Complete the 213 Resource Request (213RR) form​:
      2. Save and send as an attachment to: [email protected].

       

       

      Useful Phone Numbers

      The Provider Response Group (PRG) oversees COVID-19 response and surveillance among LTCFs. They are available Monday through Friday 8am-5pm for general questions related to COVID-19. Call 408-885-4214, select Option 3, and ask for the Provider Branch. 

      Contact the County about COVID-19, including questions about shelter in place, essential businesses, and more using the Secure Messaging System

      For more resources, please consult the Public Health Department Directory.

      Additional Resources

      For LTCFs, the California Department of Public Health (CDPH) and California Department of Social Services (CDSS) are the licensing bodies for the majority of the LTCFs in Santa Clara County. Below are resources for LTCFs published by these licensing bodies in addition to others published by the CDC and County.

      Resources

      Topic of Interest

      Relevant Resource(s)

      General/Misc.

      State Resources

       

      County Resources

      COVID-19 Vaccinations

      CDC Resources

      • CDC: COVID-19 Vaccine Booster Shots (2/2/22)

       

      State Resources

       

      County Resources

       

      Testing

      CDC Resources

      • CDC: COVID-19 Testing Resources for Nursing Homes (11/9/21)
      • CDC: Antigen Testing in LTCFs (2/17/22)
      • CDC: Considerations for Interpretation of Antigen Tests in Long-Term Care Facilities (1/15/21)

       

      State Resources

       

      Reporting

      County Resources

       

      IP &

      IP Training

      State Resources

       

      County Resources

       

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