Information for Long-Term Care Facilities
Last content update: 9/15/22
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 21-08.8 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 21-08.8, 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.
Provider COVID-19 Reporting and General Assistance
Providers can report COVID-19 cases, outbreaks, and/or deaths to the Shared Portal for Outbreak Tracking (SPOT). For technical assistance with SPOT, please contact the SPOT Help Desk at [email protected] or call (916) 520-1619.
For questions, the Provider Response Group (PRG) is available through email at [email protected].
Shared Portal for Outbreak Tracking (SPOT)
Reporting COVID-19 Cases
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Who Must be Reported |
How to Report |
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Long-Term Care Facilities (LTCFs), including Skilled Nursing Facilities, are required to report to the County via the Shared Portal for Outbreak Tracking (SPOT) any newly positive (antigen or PCR positive) staff or resident, including staff or residents with a history of previous COVID-19 positive results. |
Shared Portal for Outbreak Tracking (Required for All Cases): Report via the Shared Portal for Outbreak Tracking (SPOT) within 1 business day. Long-Term Care Facilities, including Skilled Nursing 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). For more instructions on reporting COVID-19 cases and contacts, please click here. For more information on SPOT, see SPOT Reporting Overview and SPOT Help and Training Material. |
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Providers must report any suspected congregate setting outbreak. In LTCFs, >1 probable or confirmed COVID-19 case in staff or resident constitutes an outbreak. |
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 through the Shared Portal for Outbreak Tracking (SPOT) within 1 business day. For more instructions on reporting COVID-19 cases and contacts, please click here. For more information on SPOT, see SPOT Reporting Overview and SPOT Help and Training Material. |
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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. |
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
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Topic of Interest |
Notes |
Relevant Guidance (AFL, PIN, Health Order, etc.) |
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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. |
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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 AFL 22-13 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. |
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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. |
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Testing of New Admissions or Re-admissions |
See CDPH - AFL 20-87.1 and CDPH - AFL 22-13 for information on testing of new resident admissions or re-admissions. |
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Isolation and Quarantine in LTCFs
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Topic of Interest |
Notes |
Relevant Guidance (AFL, PIN, Health Order, etc.) |
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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 21-08.8. Staff and residents in Long Term Care Facilities (LTCFs), which are not covered by AFL 21-08.8, should follow the latest guidelines from CDPH dated June 9, 2022. NEW 09/01/22: For All Adult and Senior Care Program Residential Licensees: PIN 22-15.1 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. |
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Personal Protective Equipment (PPE)
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Topic of Interest |
Notes |
Relevant Guidance (AFL, PIN, Health Order, etc.) |
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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:
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Vaccination Information and Resources
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Topic of Interest |
Notes |
Relevant Guidance (AFL, PIN, Health Order, etc.) |
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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-21-20.1 for more information. |
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Eligibility |
Visit the County’s COVID-19 Vaccine Information website for information about COVID-19 vaccines including booster eligibility. |
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Vaccination Requirements
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Topic of Interest |
Notes |
Relevant Guidance (AFL, PIN, Health Order, etc.) |
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Vaccine Requirements for Healthcare Personnel |
The following Health Orders outline the vaccination requirements for healthcare workers:
Additional information on these requirements can be found at AFL 21-34.3, Adult Care Facilities and Direct Care Worker Vaccine Requirement, and the Health Care Worker Vaccine Requirement. |
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Visitation in Long Term Care Settings
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Topic of Interest |
Notes |
Relevant Guidance (AFL, PIN, Health Order, etc.) |
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Visitor Guidance Including Vaccine Requirements
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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.
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Infection Prevention
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Topic of Interest |
Subtopic |
Relevant Guidance (AFL, PIN, Health Order, etc.) |
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Infection Control (IP)
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SNF Infection Preventionist Requirements |
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IP Resources |
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How Can I Submit Requests for Resources?
Request Submittal Steps
How to Submit Request(s) for Staffing
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Topic of Interest |
Notes |
Relevant Guidance (AFL, PIN, Health Order, etc.) |
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Facility Staffing
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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.
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How to Submit Request(s) for PPE and Other Resources
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Topic of Interest |
Notes |
Relevant Guidance (AFL, PIN, Health Order, etc.) |
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Non-Staffing Resources (Including PPE, Testing, etc)
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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).
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Useful Phone Numbers
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