NEW: Clearpol's Opinion of this Guidance
Supersedes AFL 22-07, notifying SNFs of updated CDPH, CMS and CDC guidance for improving infection prevention and control practices to prevent COVID-19 transmission, including guidance for visitation. This AFL:
· provides CDPH guidance for group activities and communal dining
· announces that, effective September 17, 2022, the visitation requirements outlined in the August 26, 2021 PHO are rescinded. Visitors are no longer required to show proof of vaccination or a negative test to have indoor visitation. Visitors must continue to comply with CDPH Masking Guidance while visiting in these indoor healthcare settings and should continue to maintain all current infection prevention practices to continue protecting these most vulnerable populations.
General Visitation Guidance
Facilities may conduct visitation through different mean, however, facilities must adhere to the core principles of COVID-19 infection prevention, at all times. Visitation should be person-centered, consider the residents' physical, mental, and psychosocial well-being, and support their quality of life. SNFs must also enable visits to be conducted with an adequate degree of privacy and should be scheduled at times convenient to visitors (e.g. outside of regular work hours).
SNF residents and HCP must continue to follow current CDPH Masking guidance to protect themselves and others, including wearing a mask, avoiding crowds and poorly ventilated spaces, covering coughs and sneezes, washing hands often, and following guidance for personal protective equipment use and SARS-CoV-2 testing.
Any visitor entering the facility, regardless of their vaccination status, must adhere to the following:
· must be screened for fever and COVID-19 symptoms and/or exposure within the prior 14 days to another person with COVID-19; if a visitor has COVID-19 symptoms or has been in close contact with a confirmed positive case, they must reschedule their visit, regardless of their vaccination status.
· must wear a well-fitting face mask with good filtration (N95, KF94, KN95, or surgical masks are preferred over cloth face coverings) and perform hand hygiene upon entry and in all common areas in the facility;
· If PPE is required for contact with the resident, due to COVID positive isolation status (including fully vaccinated visitors), it must be donned and doffed according to instruction by HCP.
· Facilities should limit visitor movement in the facility, regardless of the visitor's vaccination status; for example, visitors should not walk around the hallways of the facility and should go directly to and from the resident's room or designated visitation area.
Visitors have tested positive for COVID-19 should not be permitted to visit or should be asked to leave if they are still in their isolation period (within 10 days of their positive test). Under such circumstances, facilities must offer alternatives for remote (Skype, etc.) or telephone visitation. Staff should provide monitoring for those who may have difficulty adhering to core principles, such as children.
If a SNF resident is not able to leave their room or otherwise meet with visitors outdoors, the visitation may take place indoors even for visitors who cannot provide vaccine verification or a negative test; however, these visits cannot take place in common areas, or in the resident's room if the roommate is present, and the visitor must wear a well-fitted mask with good filtration (N95, KF94, KN95, or surgical masks are preferred over cloth face coverings) and the resident must wear a well-fitting face mask at all times and physically distance.
Indoor In-Room, and Large Communal Space Visitation Requirements
Facilities shall allow indoor in-room visitation for:
· All residents, regardless of vaccination or COVID-19 status
Indoor in-room visitation shall meet the following conditions:
· Indoor visits must be conducted with both the resident and visitor wearing a well-fitting face mask. Regardless of the vaccination status, the resident and visitor do not need to physically distance and can include physical contact (e.g., hugs, holding hands), but must wear a well-fitting face mask while in the resident's room unless eating or drinking;
· Visits for residents who share a room should be conducted in a separate indoor space or with the roommate not present in the room (if possible), regardless of the roommate's vaccination status.
· Visitors should be provided PPE (gloves, gown, eye protection and N95 respirator) and instructed in a N95 respirator seal check for visitation of residents in isolation areas
Facilities shall accommodate visitation in large communal indoor spaces for residents who are not in isolation:
Indoor spaces used for visitation such as a lobby, cafeteria, activity room, physical therapy rooms, etc. should be arranged to accommodate physical distancing between visitor-resident groups.
Facilities should assess the maximum number of resident-visitor groups that can be accommodated while maintaining physical distancing between groups in communal indoor spaces designated for visitation; when the maximum is reached, visits will need to be conducted in the resident's room (if appropriate) or outdoors (preferably).
During Indoor large communal space visits between residents and visitors, regardless of vaccination status, both the resident and visitor must always wear a well-fitting face mask unless eating or drinking while in designated spaces for visitation. These visits may be conducted without physical distancing and include physical contact (e.g., hugs, holding hands)
Continuing Outdoor Visitation Requirements
All facilities must continue to allow outdoor visitation options for all residents, regardless of vaccination status.
Outdoor visits pose a lower risk of transmission due to increased space and airflow; therefore, outdoor visitation should offered unless the resident cannot leave the facility or outdoor visitation is not possible due to precipitation, outdoor temperatures or poor air quality. When providing outdoor visitation facilities should facilitate visits on the facility premises (e.g., visits on lawns, patios, and other outdoor areas, drive-by visits, or visit through a window) with physical distancing between visitor-resident groups and staff monitoring infection control guidelines.
Outdoor visits between residents and all visitors do not need to be conducted with face masks and may include physical contact (e.g., hugs, holding hands) Visits between residents or visitors that are unvaccinated or incompletely vaccinated should be conducted with well-fitting face masks during the visit.
Other Visitation Options in Addition to Outdoor and Communal Spaces
In addition, to maximize visitation opportunities and keep residents and families connected, facilities are encouraged to:
· Offer alternative means of communication for people who would otherwise visit, such as virtual communications (phone, video-communication, etc.).
· Assign staff as primary contact to families for inbound calls and conduct regular outbound calls to keep families up to date.
· Offer a phone line with a voice recording updated at set times (i.e. daily) with the facility's general operating status, such as when it is safe to resume visits.
· Create/increase listserv communication to update families, such as the status and impact of COVID-19 in the facility.
Communal Dining and Group Activities:
Communal activities and dining may occur in the following manner:
· Residents who are not in isolation may eat in the same room without physical distancing regardless of vaccination status
Residents who are not in isolation may participate in group/social activities together without face masks or physical distancing regardless of vaccination status
Facilities should consider, in consultation with their local health department, reimplementing limitations on communal activities and dining based on the status of COVID-19 infections in the facility, e.g., when one or more cases has been identified in facility staff or residents.
Residents Who Leave and Return to the Facility
Residents taking social excursions outside the facility should be educated about potential risks of public settings, and reminded to avoid crowds and poorly ventilated spaces. They should be encouraged and assisted with adherence to all recommended infection prevention and control measures, including source control, physical distancing, and hand hygiene. If they are visiting friends or family in their homes, they should follow the source control and physical distancing recommendations for visiting with others in private settings as described in the CDC’s Guidance on Minimizing the Impact of COVID-19 on Communities
Non-essential personnel/contractors (e.g., barbers, manicurists/pedicurists) who comply with universal face mask requirements of the facility may enter the facility and provide services to residents in appropriate spaces (outdoors, if feasible, or indoors in a well-ventilated area where physical distancing can be maintained between residents)
All facilities must comply with state and federal resident’s rights requirements pertaining to
visitation. Follow CDPH and local public health department guidance when implementing visitation policies. Failure to facilitate visitation, without adequate reason related to clinical necessity or resident safety, would constitute a violation of resident's rights and the facility would be subject to citation and enforcement actions.
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