Information for Long-Term Care Facilities

Last content update: 12/14/22

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.

      1. Skilled Nursing Facilities (SNFs)
      In general, healthcare workers in hospitals or skilled nursing facilities (SNFs)1  should follow CDPH AFLs. See AFL 21-08.9 for specific guidance on isolation, testing, and work restriction for healthcare personnel. 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 21-08.9 or AFL 22-13.1, including congregate settings such as long-term care settings and adult/senior care facilities2, may follow the isolation, testing, and work restriction guidance in AFL 21-08.9. For more information,  see  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

      What to Report

      How to Report

      Long-Term Care Facilities (LTCFs), including Skilled Nursing Facilities, should 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 CDPH AFL 20-75.1 (ca.gov) for threshold for reporting to PHD (>1 probable or confirmed COVID-19 case in staff or resident).

      Additionally, facilities licensed by the California Department of Social Services (CDSS) should follow the reporting guidance set forth in PIN 21-46-ASC Section D: Reporting Requirements.

      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.

      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.

      Providers should report all hospitalizations and deaths to the Shared Portal for Outbreak Tracking (SPOT)

      Hospitalization and Death Reporting:

      As of 9/19/2022, the Case Report Form submission is no longer required for cases and/or hospitalizations. Please find information about the rescission of this requirement in this letter

      As of 11/10/2022, submission of the Death Report Form is no longer required for deaths. Please find information about the rescission of this requirement in this letter.

      Please continue to report all hospitalizations and deaths to the Shared Portal for Outbreak Tracking (SPOT).

       

      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 September 12, 2022, Health Care Worker Protections in High-Risk SettingsThis order rescinds previous orders regarding testing and other public health requirements. 

      • CDPH: Updated Testing Guidance (9/15/22)
      • CDPH - AFL 22-13.1: COVID-19 Mitigation Plan Recommendations for Testing of Health Care Personnel (HCP) and Residents at Skilled Nursing Facilities (SNF) (10/05/22)
      • PIN 21-32.1-ASC: Updated Facility Staff Testing and Masking Guidance for COVID-19 (8/11/21)
      • PIN 22-05.1-ASC: Adult and Senior Care Facility Worker Coronavirus Disease 2019 (COVID-10) Vaccination and Booster Requirements (3/18/22)
      • 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 (Revised 9/23/22)

      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 22-13.1 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 22-13.1: COVID-19 Mitigation Plan Recommendations for Testing of Health Care Personnel (HCP) and Residents at Skilled Nursing Facilities (SNF) (10/5/22)
      • CDPH: Updated Testing Guidance (9/15/22)
      • 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 (Revised 9/23/22)

      Testing of Visitors

      The California Department of Public Health released a Public Health Order on September 12, 2022  pertaining to Requirements for Visitors in Acute Health Care and Long-Term Care Settings. The Order rescinds previous orders that required visitors to show proof of vaccination or a negative COVID-19 test (taken within the last 48 hours).  

      • CDPH - AFL 22-07.1: Guidance for Limiting the Transmission of COVID-19 in Skilled Nursing Facilities (SNFs) (10/06/2022)
      • PIN 22-08-ASC: Best Practices for Visitation Related to Coronavirus Disease 2019 (COVID-) and the Rescission of the Statewide Visitation Waiver19 (9/26/22)
      • QSO-20-39-NH: Nursing Home Visitation – COVID-19 (Revised 3/10/22)

      Testing of New Admissions or Re-admissions

      See CDPH - AFL 20-87.1 and CDPH - AFL 22-13.1 for information on  testing of new resident admissions or re-admissions.

      • CDPH - AFL 20-87.1: Movement of Patients/Residents in the Healthcare Continuum During Seasonal Surges and the COVID-19 Pandemic (11/15/21)
      • CDPH - AFL 22-13.1: COVID-19 Mitigation Plan Recommendations for Testing of Health Care Personnel (HCP) and Residents at Skilled Nursing Facilities (SNF) (10/5/2022)

       

      Isolation and Quarantine in LTCFs

      Topic of Interest

      Notes

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

      Isolation and Quarantine Guidelines for HCP and Residents

      NEW 10/26/22: On 10/26/22, the County of Santa Clara Public Health Department released Local Quarantine Guidance recommendations for all Long-Term Care Settings. Please refer to this letter for recommendations. 

      Healthcare workers in hospitals or skilled nursing facilities (SNFs) should follow the isolation, testing, and work restriction guidance in AFL 21-08.9.

      Staff and residents in Long Term Care Facilities (LTCFs), which are not covered by AFL 21-08.9, should follow the latest guidelines from CDPH dated June 9, 2022.

      NEW 9/1/22: 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.

       

      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. 
       
      Use of Eye Protection:

      • CDPH 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.

       

       

      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-21-20.1 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:

      Additional information on these requirements can be found at AFL 21-34.3Adult 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

       

       

      The State Public Health Officer Order of September 15, 2022 rescinds previous orders regarding 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

      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

       

      State Resources

       

      County Resources

       

      Testing

      CDC Resources

       

      State Resources

       

      Reporting

      County Resources

       

      IP &

      IP Training

      State Resources

       

      County Resources

       

      ©2023 County of Santa Clara. All rights reserved.