Interdisciplinary Team (IDT) Authorized Medical Interventions for Residents Unable to Provide Informed Consent and Without a Health Care Decision Maker

AFL 20-83 From the California Department of Public Health October 30, 2020 TO: Skilled Nursing Facilities (SNFs) Intermediate Care Facilities (ICFs) SUBJECT: Interdisciplinary Team (IDT) Authorized Medical Interventions for Residents Unable to Provide Informed Consent and Without a Health Care Decision Maker ​AUTHORITY:      Health and Safety Code (HSC) section 1418.8   All Facilities Letter (AFL) Summary This AFL notifies SNFs and ICFs of the appellate court’s decision in California Advocates for Nursing Home Reform (CANHR), et al.

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Visitor Limitations Guidance

AFL 20-38.5 From the California Department of Public Health October 23, 2020 TO: All Facilities SUBJECT: Visitor Limitations Guidance (This AFL supersedes AFL 20-38.4) All Facilities Letter (AFL) Summary AFL 20-38.5 updates the California Department of Public Health’s (CDPH’s) visitation guidance, permitting facilities with medium or low Coronavirus Disease 2019 (COVID-19) county positivity rate to allow one visitor per patient at a time.This AFL also provides visitor guidelines for certain individuals, regardless of the COVID-19 county positivity rate:Pediatric patientsPatients in labor and deliveryNeonatal intensive care unit (NICU) patientsPediatric intensive care unit (PICU) patientsPatients at end-of-lifePatients with physical, intellectual, and/or developmental disabilities and patients with cognitive impairmentsStudents obtaining clinical experienceLong-term care (LTC) facilities should refer to AFL 20-22.5 for updated LTC visitation guidance.

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Guidance for Limiting the Transmission of COVID-19 in Long-Term Care Facilities

AFL 20-22.5 From the California Department of Public Health October 23, 2020 TO: Long-Term Care Facilities SUBJECT: Guidance for Limiting the Transmission of COVID-19 in Long-Term Care Facilities (This AFL supersedes guidance provided in AFL 20-22.4) All Facilities Letter (AFL) Summary This AFL notifies long-term care (LTC) facilities of the Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) guidance for improving their infection control and prevention practices to prevent the transmission of COVID-19, including guidance for visitation.This AFL authorizes LTC facilities to temporarily modify their facility’s visitation policies in accordance with CMS and CDC COVID-19 guidance when necessary to protect the health and safety of residents, staff, and the public.AFL 20-22.5 updates the California Department of Public Health’s (CDPH’s) visitation guidance to align with CMS QSO-20-39-NH (PDF), including:Required visitation; failure to facilitate visitation without adequate reason related to clinical necessity or resident safety may constitute violation of Title 42 Code of Federal Regulations (CFR) section 483.10(f)(4) and subject to citation and enforcement actionsUpdates previously issued indoor and outdoor visitation guidelinesAllows visitation for residents in the green zone in a facility with an ongoing COVID-19 outbreak that has not yet achieved two sequential negative rounds of response testing over 14 daysExceptions to visitation restrictions, which include representatives of protection and advocacy (P&A) programs, individuals authorized by federal disability rights laws, and compassionate care visitsUse of civil money penalty (CMP) funds to help facilitate visitationCOVID-19 infection prevention core principles and best practices Background On March 11, 2020, CDPH issued AFL 20-22, authorizing LTC facilities to temporarily modify their visitation policies in accordance with CMS and CDC COVID-19 guidance when necessary to protect the health and safety of residents, staff, and the public.

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Suspension of Professional Certification Requirements for Certified Nurse Assistants (CNAs)

AFL 20-35.2 From the California Department of Public Health October 15, 2020 TO: All Facilities SUBJECT: Suspension of Professional Certification Requirements for Certified Nurse Assistants (CNAs) (This AFL supersedes AFL 20-35.1) ​AUTHORITY:      Proclamation of a State of Emergency (PDF) and Executive Orders N-27-20 (PDF) and N-39-20 (PDF) All Facilities Letter (AFL) Summary This AFL notifies all facilities of a temporary waiver of specified statutory and regulatory requirements for CNAs due to the state of emergency related to the COVID-19 outbreak.AFL 20-35.1 has been updated to allow a CNA who remains in an “employable during state of emergency” status to complete in-service or continuing education units and count them towards certificate renewal.

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UPDATED GUIDANCE ON CORONAVIRUS DISEASE 2019 (COVID-19) AND STATEWIDE WAIVER RELATED TO VISITATION

California Department of Social Services PIN 20-38-ASC October 6, 2020 PIN TO: ALL ADULT AND SENIOR CARE PROGRAM RESIDENTIAL LICENSEES Original signed by Pamela Dickfoss FROM: PAMELA DICKFOSS Deputy Director Community Care Licensing Division SUBJECT: UPDATED GUIDANCE ON CORONAVIRUS DISEASE 2019 (COVID-19) AND STATEWIDE WAIVER RELATED TO VISITATION Provider Information Notice (PIN) Summary IN 20-38-ASC provides updated guidance to Adult and Senior Care (ASC) residential licensees on testing, infection control protocols, communal gatherings, statewide and county guidance and closures for residential facilities; and the statewide waiver related to visitation.

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Coronavirus Disease 2019 (COVID-19) Outbreak Investigation and Reporting Thresholds

AFL 20-75 From the California Department of Public Health September 22, 2020 TO: All Facilities SUBJECT: Coronavirus Disease 2019 (COVID-19) Outbreak Investigation and Reporting Thresholds ​AUTHORITY:     Title 17 California Code of Regulations (CCR) sections 2500, 2501, and 2502; Title 22 CCR sections 70737, 70739, 72523, 72539, and 72541 All Facilities Letter (AFL) Summary This AFL reminds licensed health facilities of requirements to report outbreaks and unusual infectious disease occurrences to their local health department (LHD) and Licensing and Certification District Office and provides investigation and reporting thresholds for reporting for COVID-19.

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Coronavirus Disease 2019 (COVID-19) Recommendations for Personal Protective Equipment (PPE), Resident Placement/Movement, and Staffing in Skilled Nursing Facilities

AFL 20-74 From the California Department of Public Health September 22, 2020 TO: Skilled Nursing Facilities SUBJECT: Coronavirus Disease 2019 (COVID-19) Recommendations for Personal Protective Equipment (PPE), Resident Placement/Movement, and Staffing in Skilled Nursing Facilities ​All Facilities Letter (AFL) Summary This AFL provides recommendations for PPE, resident placement/movement, and staffing based on the residents’ COVID-19 status.

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Suspension of Regulatory Enforcement of Home Health Agency Requirements

AFL 20-72 From the California Department of Public Health  September 17, 2020 TO: Home Health Agencies SUBJECT: Suspension of Regulatory Enforcement of Home Health Agency Requirements ​AUTHORITY:     Executive Order N-75-20 (PDF) ​All Facilities Letter (AFL) Summary This AFL notifies home health agencies of a temporary waiver of specified regulatory requirements due to the state of emergency related to the Coronavirus Disease 2019 (COVID-19) outbreak.

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Coronavirus Disease 2019 (COVID-19) Mitigation Plan Recommendations for Testing of Health Care Personnel (HCP) and Residents at Skilled Nursing Facilities (SNF)

AFL 20-53.3 From the California Department of Public Health September 12, 2020 TO: Skilled Nursing Facilities SUBJECT: Coronavirus Disease 2019 (COVID-19) Mitigation Plan Recommendations for Testing of Health Care Personnel (HCP) and Residents at Skilled Nursing Facilities (SNF) (This AFL supersedes AFL 20-53.2) All Facilities Letter (AFL) Summary This AFL provides recommendations from the California Department of Public Health (CDPH) for SNFs developing COVID-19 Mitigation Plans.

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Survey Priorities during the Coronavirus Disease 2019 (COVID-19) Pandemic

AFL 20-69 From the California Department of Public Health September 11, 2020 TO: All Facilities SUBJECT: Survey Priorities during the Coronavirus Disease 2019 (COVID-19) Pandemic ​AUTHORITY:Health and Safety Code section 1278 ​All Facilities Letter (AFL) Summary This AFL describes the surveys that the California Department of Public Health (CDPH) will conduct during the COVID-19 pandemic.

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