AFL 22-07 Guidance for Limiting the Transmission of COVID-19

This supersedes AFL 20-22.9, 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 guidance for group activities and communal dining based upon vaccination status of residents. It requires SNFs to develop and implement processes for verifying the vaccination status of all visitors, and for obtaining and tracking documentation of SARS-CoV-2 diagnostic test of all visitors. It updates restrictions on visitation and also removes outdated exemptions to visitation restrictions.

Facilities must verify vaccination status OR documentation of a negative SARS-CoV-2 test where the specimen collection occurred within two days if using PCR or one day if using antigen testing before each visit and for which the test results are available at the time of entry to the facility. For visitors who visit for multiple consecutive days proof of negative test is only required every third day. Unvaccinated or incompletely vaccinated visitors with history of COVID-19 within the prior 90 days may provide documentation of recovery from COVID-19 in lieu of testing.

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 and the resident must wear a well-fitting face mask at all times and physically distance. Visitors who are visiting a resident in critical condition, when death may be imminent, are exempt from the vaccination and testing requirements, however, must comply with all infection control and prevention requirements applicable for indoor visits.

Ombudsmen and CDPH surveyors are not visitors and are subject to vaccination verification and testing requirements established by the state. Facilities do not need to verify the vaccination or testing status of surveyors and ombudsmen when they are on site conducting state business.

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The California Department of Health has issued an All Facilities Letter updating guidance for skilled nursing facilities (SNFs) to limit the transmission of COVID-19. The letter outlines updated visitation guidelines, group activities, and communal dining based on residents' vaccination status. SNFs are now required to develop and implement processes for verifying the vaccination status of all visitors and tracking documentation of SARS-CoV-2 diagnostic tests. The letter also updates restrictions on visitation and removes outdated exemptions. Facilities must adhere to the core principles of COVID-19 infection prevention and ensure that visits do not increase risk to other residents. SNFs must comply with state and federal residents' rights requirements pertaining to visitation, and failure to do so may result in citation and enforcement actions. The department will continuously review scientific literature and CDC guidance for updates on vaccine effectiveness and adjust the guidelines accordingly.

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