HomeMy WebLinkAboutsteps-to-preventing-controlling-outbreaks-unlicensed-congregate-living-facilities-2022-10-05Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 1 ver: 10-5-22
Contact Name: Date:
Phone: Name of Location:
Fax/Email: Complete Address:
This checklist should be used by managers and operators of unlicensed group and transitional
housing facilities. It lists the steps necessary to either prevent or control a COVID-19 outbreak.
Please also see the Alameda County Public Health Department (ACPHD) COVID-19 Recovery
Webpage here for more resources.
When you have an outbreak, an outbreak investigator (OI) from ACPHD will be
assigned to your facility.
Best ways to work with your OI:
1. Pick one person to communicate with your OI
2. Your OI will be in touch at least weekly while the outbreak is active
3. Report to your OI right away:
• New cases and people with new symptoms
• Info about close contacts
• Questions or problems with your OI’s recommendations
4. Security
• Any emails that include confidential information (PHI) should be sent securely to COVIDOB@acgov.org.
• Your OI can send you an encrypted email. You will need to create a password, but then the email thread will be safe.
5. Questions and guidance
• Your OI is available to support you.
• Your OI will also help you prevent future outbreaks.
• Be prepared to ask your OI questions so that you can get the help you need.
STEP 1: Identify COVID-19 cases
COVID-19 Outbreak in group living: 3 or more residents and/or staff who test positive or have symptoms (if no test) in a 14-day period and are linked in the setting (that is, they may have had some contact that could cause spread).
COVID-19 (+) DEFINITIONS:
Confirmed COVID-19: When a person has a positive molecular COVID-19 test (such as a PCR test) in a person with or
without symptoms.
Suspected COVID-19: When a person has a positive at-home test (antigen) OR a specific type of positive antibody test
with no history of previous COVID-19 infection.
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 2 ver: 10-5-22
Probable COVID-19: When a person has at least one of the following: new or worsening cough, shortness of breath or difficulty breathing; OR at least two of the following: fever, chills, aches, headache, sore throat, new or worsening stuffy or runny nose, loss of smell or taste, nausea, vomiting or diarrhea AND is linked
to other cases in the setting.
OR When a person has a positive antigen test done by a certified laboratory (such as at a COVID-19 testing site).
Go here for Case Definitions. If you have questions about COVID-19 case definitions, please ask your OI.
Monitor for COVID-19 symptoms and screen staff and residents daily.
Tell all staff and residents to report immediately if they start feeling any of these symptoms, even if they are mild.
Make sure that all staff or residents who have tested positive or are suspected of
having COVID-19 are following the rules for isolation, stay out of work, and know when it is OK to stop isolation.
Any staff or resident who has tested positive for COVID-19 should be given the
Alameda County Health Officer Order for isolation and instructions for isolation which is available in multiple languages.
If cases (including people with symptoms but no positive test) are not able to safely isolate where they are, make a referral IMMEDIATELY to the isolation & quarantine hotel (Operation Comfort) by using this link: https://docs.google.com/forms/d/e/1FAIpQLSdxrTwn8FUux4xbV_uHcPoSG8nzK
xzVlQgOPTd_-Zo1ldqRrQ/viewform. If you need assistance with the referral,
contact (510) 891-8950 or achch@acgov.org. If you have questions email: covidhousing@acgov.org
o Staff and residents who test COVID-19 (+) and have certain high-risk conditions may qualify for treatment to prevent serious illness.
o Staff and residents who are close contacts of a COVID-19 case and have a high-risk condition may qualify for post-exposure therapy.
Share the ACPHD’s Treatment and Prevention flyer and CDPH’s COVID-19 Treatments Facts page with your staff and residents so that they can learn more about available COVID-19 treatments. Test to Treat locations are also now available in Alameda County. Staff and residents should contact their healthcare
providers to find out more about eligibility and access to these treatments.
See Resources and Links at the end of this document for resources to help residents and staff find a healthcare provider in Alameda County.
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 3 ver: 10-5-22
STEP 2: Identify and Manage Close Contacts
CLOSE CONTACT DEFINITION: Close contacts are people who spent a total of at least 15 minutes over a 24-hour period within the
same indoor space (such as a home, clinic waiting room, airplane etc.) as a COVID-19 case when the case was contagious even if both people were wearing masks.
WHEN IS A PERSON WITH COVID-19 CONTAGIOUS?
COVID-19 (+) cases are contagious 2 days before the start of COVID symptoms through 10 days after symptoms began (or through the end of Day 5 if testing negative on Day 5 or later). If the COVID-19 (+) case has no symptoms, they are treated as contagious from 2 days before the date that the test was collected through 10 days after (or through the end of Day 5 if testing negative on
Day 5 or later).
It is very important to understand who to count as a close contact because that person may have become infected with COVID-19 and could infect other people in the home or facility.
Sometimes group housing should be treated as one household, and everyone should be considered an exposed close contact. In these cases, all residents and staff who are not up to date on their vaccinations should quarantine (see Quarantine & Work Exclusion Guidance below). The facility is
one household if:
Meals, kitchen, and/or bathrooms are shared
Rooms are small
Residents and/or staff do not wear masks consistently
There is a family feel with many shared activities
If you are unsure, ask your OI.
Identify and manage close contacts who are RESIDENTS:
Sometimes you will be able to tell who a close contact is because you work onsite and
observe those who spend time around each other. But sometimes you will have to interview the person with COVID-19 to find out. Ask about time spent within the same airspace as others for 15 or more minutes over a 24-hour period. Think about:
o Roommates
o People who eat together, smoke together, are sex partners or couples
o People who have shared close spaces to watch TV or socialize
o People who work or do chores together
o Someone who is a caregiver for others.
Identify and manage close contacts who are STAFF: Again, ask about time spent within the same airspace as others for 15 or more minutes over a 24-hour period. Ask about time spent while working AND while doing activities
not related to work such as:
o Carpooling
o Social gatherings outside of work
o Break times and eating together
Ask your OI for help figuring out who is a close contact and what to do.
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 4 ver: 10-5-22
Your OI may ask for extra information about staff cases. Be ready to send a list of staff with job titles, work areas, close contacts in the workplace, dates of symptom onset, and shifts worked while contagious.
ISOLATION GUIDANCE is for people with COVID-19 infection and for people with symptoms of COVID-19 (even if they have not tested).
ALL staff and residents are recommended to isolate for 10 days.
• Day 0 is the first day of symptoms. If no symptoms, Day 0 is the positive test date. Day 1 is the
first full day after symptoms started OR test date.
• If symptoms start after testing positive, the isolation period should start over with Day 0 as the first day of symptoms.
Staff &
Residents
Staff and residents are required to isolate for at least 5 days. They can leave isolation after Day 5 IF:
• They test negative on Day 5 or later AND
• Their symptoms are getting better AND
• Have no fever for >24 hours without use of fever-lowering medicines
The earliest staff and residents should leave isolation is Day 6.
Day 0 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6
Date of
positive
test OR
start of
symptoms
Take a test
(antigen
preferred)
Only leave
isolation if
above
conditions
met.
If a STAFF or RESIDENT has a positive test on Day 5, they may choose to test daily after Day 5 and
may leave isolation once they receive a negative test. People may leave isolation on Day 11 if their symptoms are better and they have had no fever for >24 hours, even if they are still testing positive.
Alameda County Health Care for the Homeless (ACHCH) and ACPHD have agreed upon
separate isolation guidance below for residents of homeless service provider sites: All positive resident cases should isolate away from others for at least 10 days.
• These residents can leave isolation on Day 11 if their symptoms are getting better AND
they have no fever for >24 hours.
Start
isolation
here
End
isolation
here
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 5 ver: 10-5-22
QUARANTINE & WORK EXCLUSION GUIDANCE (all congregate living facilities) is for people who
were in close contact with a person while they were contagious with COVID-19. Quarantine (for
residents) & work exclusion (for staff) helps to stop the spread by making sure that close contacts
who have been infected do not expose anyone else. The guidance below depends on vaccination
status. Again, read carefully and contact your ACPHD OI if you have questions.
Vax status Up to Date
o Definition: Fully
vaccinated AND either:
a) Not yet eligible for a vaccine booster dose
OR
b) Boosted with all eligible vaccine booster doses
NOT Up to Date
o Definition: Unvaccinated, partially
vaccinated, or fully vaccinated & booster-
eligible but not boosted
o Unvaccinated & partially
vaccinated: Has not completed a primary vaccine series
Residents
Up-to-Date NOT Up to Date
No quarantine needed but these
residents must:
o Test negative on Day 5
AND
o Have no symptoms
These residents should quarantine for at least 5
days.
TEST OPTION:
Quarantine can end on Day 6 IF:
o Negative test on Day 5 AND
o No symptoms
NO TEST OPTION Quarantine can end after
Day 10 if they have no symptoms
If residents have jobs, they must be allowed to continue to work through quarantine.
Staff
No work exclusion needed but
these staff must:
o Test negative on Day 5
AND
o Have no symptoms
These staff should be excluded from work for at
least 5 days.
TEST OPTION:
Work exclusion can end on Day 6 IF:
o Negative test on Day 5 AND
o No symptoms
NO TEST OPTION
Work exclusion can end after Day 10 if they
have no symptoms
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 6 ver: 10-5-22
STAFF and RESIDENT close contacts who have had test-confirmed COVID-19 infection in the
past 90 days do not have to quarantine or be restricted from work as long as they remain without symptoms, but they should monitor for symptoms and must continue to wear a face covering. STAFF and RESIDENTS who develop symptoms must isolate immediately and follow the isolation guidance above.
STAFF and RESIDENTS who are severely ill or have weakened immune systems may need to isolate for up to 20 days. These people should talk to their healthcare providers to find out when to end isolation. A person is considered to be fully vaccinated against COVID-19 if it has been ≥2 weeks following the second dose in a 2-dose series, or ≥2 weeks following one dose of a single-dose vaccine authorized by FDA or WHO. See CDC's Interim Public Health Recommendations for Fully Vaccinated People.
• It is very important for residents and staff to stay up-to-date with COVID-19 vaccination. In addition to being fully vaccinated, residents and staff should be referred for booster doses when eligible. Staying up-to-date with vaccination is the best way to protect against COVID-19 infection and severe illness. See CDC's COVID-19 Vaccine Booster Shots.
For settings where there are larger shared indoor spaces, it may not be possible to quarantine all
residents & staff within these spaces. In these situations, you may need to think about high-risk
contacts when identifying close contacts who should quarantine or be excluded from work.
High-risk contacts are people who may experience severe illness or death if they become infected
with COVID-19 OR people who are more likely to get COVID-19 due to their closeness to the positive
case in the setting and/or the duration or intensity of their exposure.
o Examples of high-risk contacts may include roommates, friends, sex partners/couples, or
immunocompromised people.
ACHCH and ACPHD have agreed upon separate quarantine guidance below for residents of
homeless service provider sites:
Within homeless shelter settings, ALL residents who are considered high-risk contacts to a positive
case should quarantine for 10 days, regardless of their vaccination status.
Recommendations and referrals to the isolation & quarantine hotel for quarantine will be based on risk by considering the following for close contacts: 1. Individual health risks and medical needs 2. Level of exposure to a positive case
3. Vaccination status If residents have jobs, they must be allowed to continue to work through quarantine.
If you have questions about who should quarantine, ask your ACHCH contact or ACPHD OI for help.
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 7 ver: 10-5-22
ISOLATION & QUARANTINE HOTEL (OPERATION COMFORT): If cases or contacts are not able safely isolate or quarantine where they are, make a referral IMMEDIATELY to the isolation & quarantine hotel (Operation Comfort) by using this link:
https://docs.google.com/forms/d/e/1FAIpQLSdxrTwn8FUux4xbV_uHcPoSG8nzK
xzVlQgOPTd_-Zo1ldqRrQ/viewform. If you need assistance with the referral, contact (510) 891-8950 or achch@acgov.org. If you have questions email: covidhousing@acgov.org
For all residents who are transferred to the isolation and quarantine hotel, release dates will be determined by the hotel staff. This has been approved by ACPHD’s Health Officer.
Both vaccinated and unvaccinated staff members must still follow all Cal/OSHA ETS requirements.
Tell all close contacts (regardless of vaccination status) to monitor themselves closely for symptoms of COVID-19 for 14 days after their last exposure. They should report immediately if they start having symptoms of COVID-19. Staff members (especially those who are off work, quarantining at home) should be
instructed to contact their health care provider.
• IF close contacts start having symptoms, they should isolate away from others until they can take a test for COVID-19. If they use an antigen test
and the result is negative, they should stay in isolation and repeat testing
after 24 to 48 hours. If they get a PCR test and the result is negative, a second test is not needed. If they have TWO negative antigen tests or ONE negative PCR test and their symptoms are improving (and no fever for 24 hours), they no longer need to isolate but must continue to follow
the quarantine guidance above.
• IF close contacts test positive, they should follow the isolation guidance above. If close contacts with symptoms do not test, they should isolate
away from others for at least 10 days. See CDPH’s isolation & quarantine
guidance page for more info.
If any close contacts test COVID-19 (+), they must isolate. Give them instructions
for isolation and let them know the date when they can end isolation/return to work.
Ask your OI when it is okay for residents/staff to release from isolation/quarantine
and/or return to work.
If the cases and contacts are able to isolate/quarantine where they are staying
but need help with food and other items, please check ACPHD’s Food, Housing, & Financial Resources page.
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 8 ver: 10-5-22
STEP 3: Closing your facility
While the outbreak is active, do not accept new residents. Your OI will let you
know when it is okay to reopen.
ACPHD has the authority to suspend operations while an outbreak is being investigated.
If residents transfer out to a different facility, tell the new facility that there is COVID-19 in your facility.
Do your best to keep residents with COVID-19 and close contacts at your facility
until they have finished their isolation or quarantine periods. If they insist on moving out, make sure to give them written isolation and quarantine instructions.
Stop indoor group activities. If there are therapy or treatment groups, try to move them outdoors or use online platforms like Zoom.
STEP 4: Masks, Distancing, Handwashing
Follow CDPH instructions Infection Control Guidance for Clients in Congregate Shelters, Including Shelters for People Experiencing Homelessness or CDC’s COVID-19 Guidance for Shared or Congregate Housing depending on your setting type. Guidance for Congregate Housing is an archived version. Some information may not be current, but general recommendations for preparation of
your facility still apply.
If you run a homeless shelter or other homeless service provider facility, check
with the Alameda County Health Care for the Homeless (HCH) program at (510)
891-8950 for additional guidance and resources.
If you run a residential program for behavioral/mental health clients, check with
Alameda County Behavioral Health at aaron.chapman@acgov.org for additional health guidance.
Staff and residents should:
o Social distance by staying 6+ feet apart.
o Wash hands and/or use hand sanitizer often.
o Cover mouth when coughing.
o Per CDPH’s Guidance for the Use of Face Masks, masks are required to be worn by residents & staff in homeless shelters during outbreaks and/or when the COVID-19 Community Level is medium or high.
o The risk of spreading COVID-19 within a congregate living facility is reduced when all residents & staff wear masks. Residents & staff within homeless shelters and other congregate living settings are still recommended to mask at all times within indoor communal areas (except while eating or sleeping),
regardless of the current COVID-19 Community Level or outbreak status.
o Residents & staff should also consider their individual risk when determining whether they should wear a mask. It is especially important for vulnerable people to consider masking within indoor communal areas of the facility and
within indoor public spaces.
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 9 ver: 10-5-22
o Vulnerable people include those who: are NOT up to date with recommended vaccine doses, are immunocompromised, and/or have disabilities or health conditions that put them at higher risk for severe illness or death from COVID-19 infection.
o Residents & staff should make sure that their masks provide the best fit and filtration. See CDPH’s ‘Get the Most Out of Masking’ page for more information.
o Cal/OSHA ETS also has strict requirements for face coverings for staff.
o You are REQUIRED to provide and ensure use of face coverings at all times in certain settings AND in all settings during outbreaks and major outbreaks.
o You are also REQUIRED to provide N95 respirators to any staff
who requests one.
o You should evaluate the need for personal protective equipment (PPE) to prevent exposure to COVID-19 hazards, such as gloves, goggles, and face shields, and provide this PPE as needed.
o You must allow staff to wear face coverings if they wish to unless wearing a
face covering would create a safety hazard
Put hand sanitizer in multiple locations around the facility especially:
• Near entrances
• Dining and kitchen areas
• Each bedroom
• All bathrooms
Teach your staff and residents how to prevent COVID-19. Plan to check and remind them often. Encourage attention to cleaning and personal hygiene.
Put up signs in key locations to remind staff and residents about prevention
measures.
STEP 5: Set up
Space furniture to avoid crowding.
Increase airflow inside the house or facility:
Open windows and doors to the outside
Use portable high-efficiency particulate air (HEPA) filters or properly
placed fans in high use common areas. For proper use of fans see CDC’s FAQ “Can fans be used to decrease the use of COVID-19 transmission indoors?”
Make sure exhaust fans in restrooms work at full capacity.
Per the ETS, implement ventilation changes to mechanical ventilation
systems including increasing filtration efficiency to at least MERV-13, or the highest efficiency compatible with the ventilation system. Evaluate whether HEPA air filtration units are needed. See CDPH Interim Guidance For Ventilation, Filtration, and Air Quality in Indoor Environments.
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 10 ver: 10-5-22
Shared Bedrooms:
Beds should be set up in opposite directions (head-to-toe) and at least 6 feet apart. If this is not possible, then set up beds head to toe and at least 3 feet apart.
People in bunkbeds should also sleep head-to-toe.
Put up temporary barriers like curtains between beds.
Shared kitchen and dining rooms:
Best to make bagged meals or have residents eat meals on trays in their rooms or outside.
Set places at the table a minimum of 6 feet apart and make sure diners keep 6 feet apart at all times.
Don’t crowd. Have residents eat in shifts to limit the number eating
together.
Do not share dishes, drinking glasses, cups, or eating utensils. Non-disposable food service items should be handled with gloves and washed with dish soap and hot water or in a dishwasher.
Make sure there is a person watching and making sure rules are followed.
Shared bathrooms:
Make sure bathrooms are continuously stocked with soap and paper towels or automated hand dryers. Hand sanitizer could also be made available.
Make sure trash cans are emptied regularly.
Provide information on how to wash hands properly. Hang signs in
bathrooms.
Residents should be instructed that sinks could be an infection source and
should avoid placing toothbrushes directly on counter surfaces. Totes could also be used for personal items to limit their contact with other surfaces in the bathroom.
Shared laundry rooms:
Maintain access and adequate supplies to laundry facilities to help prevent
spread of COVID-19.
Restrict the number of people allowed in laundry rooms at one time to
ensure everyone can stay at least 6 feet (2 meters) apart.
Provide disposable gloves, soap for washing hands, and household
cleaners and products from EPA’s List N: Disinfectants for Coronavirus
(COVID-19) for residents and staff to clean and disinfect buttons, knobs,
and handles of laundry machines, laundry baskets, and shared laundry
items.
Post guidelines for doing laundry such as washing instructions and
handling of dirty laundry.
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 11 ver: 10-5-22
Shared living areas:
During an outbreak consider closing TV rooms and other shared spaces.
Post signs where people get together to talk, smoke, or eat. These activities are high risk especially if they involve mask removal.
Put visual markers on the ground that are 6 feet apart.
Unless it is necessary, staff should not enter residents’ living quarters. Instead try using phone or video chat to check in.
Limit the presence of non-essential volunteers and visitors in shared areas, when possible.
Step 6: Cleaning and disinfecting
See CDC Guidance on Cleaning and Disinfection for Community Facilities.
When a resident or staff tests positive for COVID-19, carefully clean and disinfect
all areas they touched using EPA approved cleaning agents.
See List of EPA approved cleaning agents.
Pay close attention to dilution instructions and contact time on the product label.
Make sure that staff who are doing the cleaning wear the proper PPE and
follow safety instructions.
Close off areas visited by the ill persons until carefully disinfected.
Open outside doors and windows and use fans in the area to increase circulation while cleaning.
Wait 24 hours, or as long as possible, before cleaning or reopening for
use.
High-touch surfaces and shared bathrooms should be cleaned at least once per
day. If you want to use cleaning products with disinfectants, choose products
from approved EPA list above.
STEP 7 Protect Staff
Employers are required to do what they can to keep staff safe from COVID-19 in the workplace. Please see Cal/OSHA's COVID-19 Emergency Temporary
Standards
Cal/OSHA’s COVID-19 Emergency Temporary Standards FAQ includes a helpful
summary and link to a model Prevention Program.
To keep staff safe:
If there is a shared office, try to stagger use or set up workstations at least 6 feet apart.
Staff should avoid sharing equipment; if equipment must be shared, clean it between use. Staff should never share objects (like phones) that may come into contact with their face, mouth, or nose.
Try to arrange stable work groups (by shifts, locations, and/or work duties) so that the same staff stay together without mixing across groups.
Pay careful attention to staff break times and locations! When staff remove
their masks to eat, drink, or smoke, they are at higher risk for spread of
COVID-19.
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 12 ver: 10-5-22
Stagger break times
Use outside space for breaks if weather is good.
Ask staff to use their own cars when removing their masks to eat/drink.
Indoor breaks should only happen in a space where people can safely
stay at least 6-feet apart. Limit the number of people in any space at one
time and arrange seating of chairs and tables to be 6 feet apart.
Put EPA approved disinfectant wipes and hand sanitizers in break rooms and shared offices so that staff can clean between uses.
Post signs to remind staff to follow prevention practices.
Cal/OSHA ETS requires that employers provide thorough staff training that includes the below topics and much more:
• Your facility’s COVID-19 policies and procedures
• Worker benefits
• COVID-19 transmission
• Face coverings and respirators
• Hand hygiene See Cal/OSHA ETS training requirements for more information.
STAFF RESOURCES
ACPHD has a list of staff resources and website that should be shared with staff.
See Equal Employment Opportunities Commission’s (EEOC) info on staff protection laws.
Step 8. TESTING
View CDC’s Testing Strategies for SARS-CoV-2.
Follow CDC testing guidance:
o All close contacts should get tested on day 5 after their last exposure.
o All close contacts who develop symptoms, whether vaccinated or unvaccinated, should isolate, test immediately, and follow-up with a healthcare provider.
If a staff member or resident tests positive, you will need to do facility-wide testing. Test all residents and staff (except recent positive cases) at least weekly (more frequent testing is better) until there are no new positive cases, and it has been at least 14 days since the last positive case. Talk to your OI about who
should be included.
Screening testing involves testing people without symptoms and without known exposure. When screening testing is done for residents and staff in congregate
living settings, it helps to identify positive cases quickly and prevent outbreaks.
• It is recommended that screening testing is done on a regular basis (such as weekly) in congregate living facilities when the COVID-19 Community Level is medium or high.
• If your facility is partnered with HCH, please review the HCH Shelter Health and COVID-19 page OR reach out to the HCH team at achch@acgov.org for additional testing guidance.
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 13 ver: 10-5-22
People can get tested through their own healthcare provider, at a community testing site, or you could set up on-site testing. Talk to your OI about mobile testing options. Your OI can help you make a plan and find local testing resources.
As an employer, you are required to inform staff, even those with no known exposure, of how to get tested. You are also required to follow all testing requirements for workplaces outlined in Cal/OSHA’s ETS. View Cal/OSHA ETS
FAQ under testing requirements for more information.
Keep a record of test results, if possible, to give to your OI.
See ACPHD Criteria for Release from Home Isolation and/or How Long Should I stay in Quarantine?
Per Cal/OSHA ETS, staff close contacts are required to test by Day 5 in order to continue to work (regardless of their vaccination status). See Cal/OSHA's ETS
page for more information.
Anyone who has tested positive should not be re-tested for 3 months unless they
have symptoms of COVID-19. If this happens, they should get a medical exam.
Unless a health care provider determines that they do not have COVID-19, they
will have to isolate again.
Step 9. Vaccine Status Verification
Staff within residential substance use treatment and mental health treatment
facilities must get vaccinated & receive eligible boosters unless they have a qualifying exemption. These facilities must also maintain vaccine status records of all staff per the State Public Health Officer Order: Health Care Worker Vaccine Requirement.
• Staff with vaccine exemptions must wear an approved respirator or surgical mask at all times while in the facility. All facilities are strongly encouraged to verify vaccine status of all staff and
residents. Check the Vaccine Record Guidelines & Standards for preferred proof.
Ongoing: MONITORING FOR ILLNESS & EXPOSURE
Put signs at all entrances that tell people not to enter if they have signs and symptoms of COVID-19 or have been in close contact with a person who tested positive or who have experienced symptoms of COVID-19 in the past 14 days.
Screen all residents, staff, and essential visitors for signs and symptoms of COVID-19 each day. If symptoms develop, the person should immediately isolate and test as soon as possible.
Symptom review
Ask about anything NEW
● Fever or chills ● Short of breath ● Muscle or body aches ● Cough ● Tired ● Headache
● Sore throat ● Runny nose ● Stuffy nose
● Nausea ● Vomiting ● Diarrhea
● Loss of taste or smell
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 14 ver: 10-5-22
Visual check Observe for illness (even if not reported) Temperature check Fever of ≥ 100° F (37.8° C)
Encourage residents and staff to get vaccinated against COVID-19. See info about how to get vaccinated.
Ongoing: COMMUNICATION with ACPHD
Please see CDPH REPORTING requirements for Non-Healthcare Congregate Facilities.
Congregate living facilities in Alameda County are required to report >1 COVID-19 cases within a 14-day period in residents and/or staff. See Reporting Threshold for Shelters and Congregate Living Facilities for more information.
Keep a list of all cases and contacts. Add to the list if new cases are reported and email it to your OI and copy COVIDOB@acgov.org. Only send securely. Talk to
your OI about how to make sure your email is secure.
Send your OI a map/floor plan of your facility as soon as possible.
If you have a COVID Safety Prevention Plan in place, please send it to your OI.
Send a list of all staff members to your OI with:
Job description
Work location
Work schedule
Contact information
REOPENING to new residents
When you do take new residents, consider requesting a negative COVID-19 test taken within 48 hours of move-in. While waiting for results, the new resident
should isolate away from others.
Do not accept COVID-19 (+) residents until they have completed their isolation
period (at least 10 days, no fever, and improvement in symptoms for 24 hours)
unless approved by your OI.
Do not accept residents with a recent close contact until they have completed
their quarantine period of 10 days from last exposure unless approved by your OI.
Be especially careful to monitor new residents for symptoms of COVID-19 for 14
days. Tell them to report any new symptoms even if they are mild.
If a new resident develops symptoms of COVID-19, they should isolate and test as soon as possible.
New residents without symptoms should be encouraged to retest 5 days after move-in but don’t have to isolate while waiting for results.
Talk to your OI about safely reopening to admissions or to group activities.
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 15 ver: 10-5-22
RESOURCES and LINKS
Please review and bookmark these important links. They include national, state, and local
guidance on COVID-19.
Work closely with your assigned ACPHD outbreak investigator (OI) who will help you prevent and/or control an outbreak as quickly as possible. Regular and open communication with your OI is essential.
Alameda County
Alameda County Public Health Department (ACPHD) MAIN COVID-19 website
https://covid-19.acgov.org/index.page
ACPHD Masking Resources https://covid-19.acgov.org/face-masks
ACPHD Isolation and Quarantine Resources
https://covid-19.acgov.org/isolation-quarantine.page Alameda County Resources for Help Finding a Healthcare Provider
• Family Health Line Toll Free Number: 1-888-604-4636
• Use this number if you currently have or recently applied for Medi-Cal.
• Health Insurance Enrollment Assistance Toll Free Number: 1-800-422-9495
• HealthPAC: 1-877-879-9633; http://www.acgov.org/health/indigent/pac-all.htm
• Use this number for help applying for free or low-cost health insurance including Medi-Cal and Covered CA. Visit the page linked above to learn more about
HealthPAC.
• Alameda County Child Health and Disability Prevention (CHDP) program’s Find-a-Doctor web page: https://acphd.org/chdp/find-a-doctor/medical/
• CHDP Information Line: 1.510.567.2070
• CHDP Family Help Line: 1.888.604.4636
• Resource locator for low-cost healthcare services in Alameda County:
http://achealthcare.org/ Alameda County Health Care for the Homeless Shelter Health Guidance: https://www.achch.org/shelter-health-guidance.html
ACBH COVID-19 Web Page: https://www.acbhcs.org/providers/COVID-19/index.htm
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 16 ver: 10-5-22
Alameda County COVID-19 Recovery Resources for the Workplace
https://covid-19.acgov.org/recovery
• COVID-19 Worksite-Specific Protection Plan Guidance & Template for Developing
Your Own Plan: https://covid-19.acgov.org/covid19-assets/docs/shelter-in-place/20-
21-appendix-a-protection-plan-guidance-and-template-eng-2021.03.01.pdf
• Staff Resources: https://covid-19.acgov.org/recovery
ACPHD Vaccination Information webpage
https://covid-19.acgov.org/vaccines
California
Infection Control Guidance for Clients in Congregate Shelters, Including Shelters for People Experiencing Homelessness
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/infection-control-guidance-
clients-congregate-shelter-including-homelessness.aspx
CDPH The California SMARTER Plan https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/California-Response.aspx CDPH Guidance for The Use of Face Masks
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/guidance-for-face-coverings.aspx
CDPH AB 685 COVID-19 Workplace Outbreak Reporting Requirements:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/ab685.aspx
Cal/OSHA Emergency Temporary Standards https://www.dir.ca.gov/dosh/coronavirus/ETS.html
• FAQ: https://www.dir.ca.gov/dosh/coronavirus/COVID19FAQs.html
United States
CDC COVID-19 Guidance https://www.cdc.gov/coronavirus/2019-ncov/communication/guidance.html CDC Interim Guidance for Homeless Service Providers to Plan and Respond to Coronavirus Disease
2019 (COVID-19) https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/plan-prepare-respond.html
Alameda County Public Health Department
Steps to Preventing & Controlling Outbreaks in Unlicensed
Congregate Living Facilities
OUTBREAKS IN CONGREGATE LIVING FACILITIES 17 ver: 10-5-22
CDC COVID-19 Guidance for Shared or Congregate Housing
https://www.cdc.gov/coronavirus/2019-ncov/community/shared-congregate-house/guidance-shared-congregate-housing.html CDC Guidance for Retirement Communities and Independent Living
https://www.cdc.gov/coronavirus/2019-ncov/community/retirement/index.html