Community Care Facilities - Where People Reside Overnight AND Receive Care, also including Non-residential Adult Day Programs (ADP) and Community Based Adult Services (CBAS) Centers (excluding: Jails, Settings Associated with People Experiencing Homelessness, Housing Facilities Not Providing Care, Acute Care Facilities, and Skilled Nursing Facilities)
Under Title 17, Section 2500, California Code of Regulations all suspected outbreaks are reportable.
Community Care Facility (See below for facility definition)
Five or more lab confirmed (antigen or PCR) cases
(symptomatic or asymptomatic) of COVID-19 have been
identified in residents within a 7-day period.
NOTE: If newly admitted residents (e.g., within 7 days of admission) test positive for COVID-19, this is not considered an outbreak as it could have been acquired outside the facility.
NOTE: If a facility has cases in residents but does not meet one of the above thresholds, the outbreak should NOT be opened.
DCFS-affiliated congregate care facilities (see below for definition)
Five or more lab confirmed (antigen or PCR) cases
(symptomatic or asymptomatic) of COVID-19
have been identified in residents within a 7-day period.
NOTE: If newly admitted residents (e.g. within 7 days of admission) test positive for COVID-19, this is not considered an outbreak as it
could have been acquired outside the facility.
NOTE: If a facility has cases in residents but does not meet the above threshold, the outbreak should NOT be opened.
Emergency shelters for isolation/quarantine of DCFS-affiliated youth diagnosed or suspected of COVID-19 or contacts of confirmed COVID-19 cases
Five or more lab confirmed cases (antigen or PCR) of symptomatic or asymptomatic COVID-19 in staff within a 7-day period. NOTE: Residents are not included in the outbreak definition because they are there specifically for isolation or quarantine due to COVID-19.
Congregate Living Health Facilities (CLHFs) and Intermediate Care Facilities (ICFs)
Two or more lab confirmed (antigen or PCR) cases (symptomatic or asymptomatic) of COVID-19 have been identified in residents, epidemiologically linked to the facility, within a 7-day period.
NOTE: If newly admitted residents (e.g., within 7 days of admission) test positive for COVID-19, this is not considered an outbreak as it could have been acquired outside the facility.
NOTE: If a facility has cases in residents but does not meet the above threshold, the outbreak should NOT be opened.
Adult Day Programs (ADPs) licensed by CCLD and Community Based Adult Services (CBAS) Centers Ten
Five or more confirmed COVID-19 cases in participants who attend the ADP or CBAS for in-person activities within a 7-day period. These cases must be part of a group* where members do not share a household and are not a close contact of each other outside of the facility. Epidemiological links require cases to be present in the same setting during the same time period while infectious.
*Groups include persons that share a common membership, e.g., adult day care centers, same classroom, school event, school-based extracurricular activity, academic cohort, athletic teams, clubs.
For ADPs and CBASs where activities are conducted virtually and staff do not have any contact with participants, general guidance for quarantine, isolation, cleaning, mask wearing, distancing, and hand hygiene should be given for preventing further spread of infection to other staff, but no outbreak investigation needs to be done.
Investigation can be conducted over the phone. The frequency of follow-up with the facility for outbreak updates can be determined by Outbreak Management Branch (OMB) MD.
Inform the facility that they will be included on a public outbreak notification list posted on the LAC Public Health website until the outbreak is resolved.
Note: All staff in all CCFs should receive their recommended COVID-19 vaccine and booster doses. Being up to date with COVID-19 vaccines is the best defense against the currently circulating strains of COVID-19. If a staff member has received the primary series and subsequently been infected with COVID-19, they may defer receiving the booster dose up to 90 days after clinical diagnosis or first positive test
Additional Guidance and Resources:
See detailed instructions below for case management of residents, as well as cases in facility staff.
A close contact is a person with exposure to a confirmed or suspected case of COVID-19 during the period from 2 days before symptom onset until the case meets criteria for discontinuing isolation (see detailed instructions below for staff and residents). For asymptomatic cases, the date of collection of the specimen positive for SARS-CoV-2 can be used in place of onset date to determine period of isolation.
Exposures are defined as follows:
Note: CDC does not recommend testing, symptom monitoring or special management for people exposed to asymptomatic people with potential exposures to SARS-CoV-2 (i.e., “contacts of contacts;” these people are not considered exposed to SARS-CoV-2).
Community Care Facilities:
These are short- or long-term residential facilities that meet any one of the following descriptors:
DCFS-affiliated congregate care facilities
Emergency shelters for isolation for DCFS-affiliated youth diagnosed or suspected of COVID-19 and for quarantine of youth contacts of confirmed COVID-19 cases
More strict criteria can be instituted per the investigating team if deemed necessary.
Note: The rationale for mask and eye protection is to try to prevent caregiver exposure. Well-fitting surgical masks can be worn for an extended period but should be discarded after they become saturated with moisture.
All ill persons (residents or staff) with symptoms suggestive of respiratory illness should be presumed to have COVID-19 and SARS-CoV2 testing should be done. More strict criteria can be instituted per the investigating team if deemed necessary.
Facilities should initiate contact investigation around each confirmed case (staff or resident) to identify all close contacts (staff and residents) during the infectious period of the case(s).
Facilities need to report all COVID-19 positive cases within 24 hours to LAC DPH using REDCap: https://redcap.link/lac-covid, or by phone at (213) 240-7941, or by fax at (213) 482-4856. After being assigned an Outbreak Investigator, the Facility should report additional cases and deaths to that person. See the Community Care Facilities Guidance for more details.
Document all staff and resident or participant cases and contacts on the appropriate line lists (see Forms/Quick Links section).
Designate areas in the facility for the placement of
suspected and confirmed residents or participants. Refer to
the
Community Care Facilities Guidance.
In ADPs and CBASs, have a room designated for placement of
suspected or confirmed positive participants while they wait to
be transported home or to a hospital.
Note: The actual isolation area will depend on each building but define the area by the local workflow (e.g., the unit the resident is located would be a logical decision).
Designate a quarantine area, if needed, for residents who have been identified as close contacts to case(s) at your facility. Follow guidance in the LAC DPH Instructions for Close Contacts.
Residents in the quarantine and isolation should:
Follow LAC DPH instructions for discontinuing isolation. More strict criteria can be instituted per the investigating team if deemed necessary.
Interfacility transfers should be limited as much as possible, while still maintaining appropriate levels of care for all patients.
Residents/participants should not be sent to the Emergency Department (ED) to obtain SARS CoV-2 testing.
Outbreak can be closed for a residential CCF once closure criteria is met:
At least 14 days have passed since the last confirmed COVID-19 case in a resident.
Outbreak can be closed for an ADP or CBAS once closure criteria is met:
At least 10 days have passed since the last confirmed COVID-19 case in a participant.