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The status of California’s policies on Cleaning and Disinfection are as follows:

  • Two Palms Nursing Center created an outside screening and infection prevention station for all health care workers (HCW) and visitors to utilize prior to allowing entry into the facility. All HCWs and visitors entering the facility are screened one at a time for signs and symptoms of COVID-19.
  • Following the screening, they proceed to an outside “washing station” where they sanitize their hands and don personal protective equipment, including gowns, N95s, and face shields. Prior to entering the nursing home, they step on a bleaching mat to ensure they do not track in contaminants from the outside into the facility.

Notable Groups: Two Palm Nursing Center, Inc.

The status of California’s policies on reporting, guidance, and mandated reporting are as follows:

  • Provides resources for skilled nursing facilities (SNFs) on preventing, detecting, and preparing for COVID-19 in a toolkit titled “Preparing for COVID-19 in California Skilled Nursing Facilities” (Relevant link: https://www.cdph.ca.gov/Programs/CHCQ/LCP/CDPH%20Document%20Library/AFL-20-25-Attachment-01-SNF-Checklist.pdf)
  • CDPH released an All Facilities Letter (AFL 20-43) on May 13, 2020, requiring all skilled nursing facilities (SNFs) to report daily updates regarding current staffing levels, the number of COVID19 patients, and equipment availability to CDPH via an online survey. This reporting is to ensure that California has the information necessary to respond to the COVID-19 outbreak and to provide resources and support to SNFs. To meet the Centers for Disease Control and Prevention (CDC) reporting requirements, CDPH modified its daily online survey to include the questions required by CDC via the National Healthcare Safety Network (NHSN). (Relevant link: https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-43.aspx)
  • CDPH will report this data to the CDC on behalf of facilities via the online SNF COVID-19 Survey (Relevant link: https://survey123.arcgis.com/share/f4050e65e5304c7d8b00760e7718fcc4)
  • Due to the higher risk of severe illness and death from COVID-19 among nursing home residents, CDPH required all nursing homes to submit a mitigation plan by June 1, 2020 that must include six elements, including:
    • Testing and cohorting
    • Infection prevention and control
    • Personal protective equipment (PPE)
    • Staffing shortages
    • Designation of space
    • Communication
  • To assist nursing homes in developing their plan and expanding their infection control policies, CDPH provided a mitigation plan template and local public health departments provided technical assistance to assist nursing homes in developing their plans (Relevant link: https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-52.aspx)
  • To ensure California has the information necessary to respond to COVID-19 outbreaks in nursing homes, CDPH requires all nursing homes to report daily updates regarding current staffing levels, the number of COVID-19 patients, and equipment availability via an online survey. Nursing homes are also required to report weekly data to Centers for Medicare & Medicaid Services via the National Healthcare Safety Network (NHSN), so to reduce the reporting burden, CDPH modified their daily online survey to include the questions required by CMS in NHSN.
  • CDPH is now reporting data to CMS via NHSN on behalf of all nursing homes that conferred rights to CDPH (Relevant link: https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-43.aspx)

Notable Groups: California Department of Public Health (CDPH), Centers for Medicare & Medicaid Services (CMS), National Healthcare Safety Network (NHSN)

California’s testing policies are described below:

  • California Association of Long Term Care Medicine (CALTCM), Health Services Advisory Group (HSAG) convened a Delphi panel of long term care clinicians that published “Diagnostic Testing for SARS-Coronavirus in the Nursing Facility: Recommendations of a Delphi Panel of Long-Term Care Clinicians” on May 30, 2020 in the Journal of Nutrition, Health and Aging. The article supports facility-wide testing of all staff and residents and provides recommendations to nursing homes in hopes of providing value to the long term care industry and to policymakers. (Relevant link: https://link.springer.com/article/10.1007/s12603-020-1401-9)
  • Governor Newsom launched the COVID-19 Testing Task Force, a public-private working group with stakeholders across the state, to quickly boost California’s testing capacity. The Testing Task Force ensures California has enough capacity and supplies to administer a significantly greater number of tests statewide. The task force maintains and publishes a list of approved labs that have met all criteria for readiness, and disseminates information to nursing homes throughout the state to ensure facilities have access to testing (Relevant link: https://testing.covid19.ca.gov)
  • On September 12, 2020, the CDPH released new recommendations for baseline screening and response-driven testing of nursing home residents and staff. The recommendations also provide guidance on the use of point of care antigen testing instruments. CDPH is requiring all nursing homes, including those without positive COVID-19 cases, to implement weekly testing for all nursing home staff. Facilities with a positive COVID-19 case must conduct weekly response-driven testing for all residents and staff. Weekly response-driven testing will continue until no new positive cases are identified among residents after two sequential rounds of testing (Relevant link: https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-53.aspx)
  • Cedar Crest Nursing and Rehabilitation Center was declared COVID-19 free on May 13, 2020 after battling the virus for seven weeks, which infected 55 percent (44) of their residents and 13 percent (19) of their staff. One-third of their residents that tested positive were asymptomatic, and half of their staff that tested positive were asymptomatic. The solutions to mitigate the spread of COVID-19 included:
    • Mass testing and cohorting to determine who is positive in the facility
    • Get permission from local public health department to allow asymptomatic staff to care for COVID-19 positive residents
    • Appoint a dedicated liaison to handle communication with staff and families.
    • Establish a tracking system, such as a binder with tabs for every day of the month to file all communication, occurrences, and activities.
  • With increased community spread of COVID-19 and heightened demand for testing, Los Angeles County has committed $400,000 in one-time bridge funding to support staffing-related costs at COVID-19 testing sites operated by Community Organized Relief Effort (CORE), a nonprofit, within the City of Los Angeles. In addition, the County will continue to fully fund its nine operated sites and is also preparing to add additional testing sites in coming weeks to areas identified as “hot spots” where data illustrates high test positivity, low testing access, and high mortality. Nursing Home employees can potentially introduce COVID-19 into the facilities. To avert this from occurring, the County of Los Angeles committed additional funding to support 25 State Actions for COVID-19 Management and Response testing site operation and is preparing to add additional sites to widen access to testing in highrisk communities. That effort will include partnerships with community-based organizations to target high-risk communities through street outreach teams delivering COVID-19 prevention messages door-to-door (Relevant link: https://covid19.lacounty.gov/covid19-news/la-county-commitment-testing-site-funding)

Notable Groups: California Department of Public Health (CDPH), California Covid-19 Testing Task Force, Cedar Crest Nursing and Rehabilitation Center, California Association of Long Term Care Medicine (CALTCM), County of Los Angeles

The status of California’s workforce and staffing are explained beneath:

Notable Groups: County of Santa Clara Emergency Operations Center, LeadingAge California, State Actions for COVID-19 Management and Response, Los Angeles County Emergency Operations Center

California’s cohorting practices are as follows:

Notable Groups: San Mateo County Health, County of San Luis Obispo, Cal Poly San Luis Obispo, Dignity Health and Tenet Healthcare, California Department of Public Health

California has established infection controlStrike Teams”, which are described in-depth beneath:

Notable Groups: California Department of Public Health, Health Services Advisory Group (HSAG), Centers for Medicare & Medicaid Services (CMS)

California has established a number of infection control surveys and other state survey activities within their state’s boundaries:

  • California Department of Public Health (CDPH):
    • CDPH required all nursing homes to expand their infection control policies by submitting a mitigation plan by June 1, 2020, that included these six elements:
      • Testing and cohorting
      • Infection prevention and control
      • Personal protective equipment (PPE)
      • Staffing shortages
      • Designation of space
      • Communication
    • To assist nursing homes in strengthening and effectively implementing their plans, CDPH partnered with the California Association of Long Term Care Medicine and Health Services Advisory Group, the California Quality Improvement Organization (QIO), to host calls every Wednesday and Thursday to provide infection prevention education and field questions from providers (Relevant link: https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-52.aspx)

Notable Groups: California Department of Public Health

The status of California’s nursing home (NH) communications during the Covid-19 pandemic:

  • California Association of Long Term Care Medicine (CALTCM) has hosted weekly webinars since March 9, 2020, featuring state actions to help nursing homes understand infection prevention state actions. In addition, CALTCM actively appears in the media and writes white papers and guidelines to assist public health officials and providers to ensure the safety of nursing home residents and staff.
  • CALTCM developed the Long term Care Quadruple Aim, which includes stellar infection control, including a full-time infection preventionist in every nursing home:
    • access to sufficient personal protective equipment (PPE)
    • readily available testing for symptomatic and asymptomatic staff and residents
    • incident command mode

Notable Groups: California Association of Long Term Care Medicine (CALTCM)

California’s ongoing actions to improve access to personal protective equipment (PPE):

  • CAHF developed the “Just-In-Time Respiratory Protection Program” to assist nursing homes in responding to events or situations, such as COVID-19, that will require them to implement a program for the respiratory protection of their employees. The nine-page guide contains a step-by-step process to get nursing homes prepared to set up and implement a plan to protect their employees, including a Fit-Test video to help prepare staff to use personal protective equipment (PPE) (Relevant link: https://www.cahf.org/Portals/29/DisasterPreparedness/pandemic/JustInTimeRespProtProgram.pdf)

Notable Groups: California Association of Health Facilities (CAHF)

California’s current actions to improving the utilization of personal protective equipment (PPE):

  • California Department of Public Health All Facilities Letters (AFL) provides resources for skilled nursing facilities (SNFs) on preparing for COVID-19 and a toolkit for management of exposures and recognized cases in SNFs.
  • The Assessment of California SNFs to Receive Patients with Confirmed COVID-19 provides guidance for SNFs planning to designate a specific wing/unit to care for residents with suspected or confirmed COVID-19 (Relevant link: https://www.cdph.ca.gov/Programs/CHCQ/LCP/CDPH%20Document%20Library/AFL-20-25-Attachment-05-SNF-Assessment-Checklist.pdf)
  • In early May 2020, Grancell Village of the Jewish Homes for the Aging, Los Angeles County implemented the use of universal face shields accompanied by face masks for all visitors and staff interacting within six feet of residents. The implementation resulted in no resident cases and no evidence of staff-to-staff transmission in the facility. Overall, 14 staff and one resident have tested positive for COVID-19 in this facility, with no deaths.
  • In August 2020, the Los Angeles County Department of Public Health made the recommendation for health care workers to wear face shields to prevent the spread of COVID-19/
  • Face shields have proven to be an effective mitigation strategy and the facility highly recommends this strategy to other nursing homes

Notable Groups: California Department of Public Health All Facilities Letters (AFL), Grancell Village of the Jewish Homes for the Aging, Los Angeles County

California’s actions to house and shelter at-risk populations and infected patients:

  • The County of San Luis Obispo, in partnership with Cal Poly San Luis Obispo, Dignity Health, and Tenet Healthcare opened its Alternate Care Site located at Cal Poly San Luis Obispo’s Recreation Center. This site will help relieve local hospitals and nursing homes by housing patients with needs between home care and hospitalization (Relevant link: https://www.emergencyslo.org/en/alternate-care-site.aspx)

Notable Groups: County of San Luis Obispo, Cal Poly San Luis Obispo, Dignity Health, Tenet Healthcare

California’s attempts to solve the transportation needs of its citizenry are as follows:

  • California partnered with United Airlines in April 2020 to provide free, round-trip flights for volunteer medical professionals from across California and the country who join the state’s health care workforce.

Notable Groups: United Airlines

The state of California’s patient transfer routines below:

  • The County of Los Angeles:
    • The Department of Public Health provides guidance to skilled nursing facilities (SNFs) on clinical care related to COVID-19 under the direction of the dedicated Hospital Acquired InfectionAntimicrobial Resistance Committee (HAI-ARC) to include directives on interfacility transfer, discharge rules, preventing and managing COVID-19 in long term care facilities and return to facility rules (Relevant link: http://publichealth.lacounty.gov/media)
  • San Mateo County Health, Health Plan of San Mateo:
  • County of San Luis Obispo, Cal Poly San Luis Obispo, Dignity Health, Tenet Healthcare:
    • The County of San Luis Obispo, in partnership with Cal Poly San Luis Obispo, Dignity Health, and Tenet Healthcare opened its Alternate Care Site located at Cal Poly San Luis Obispo’s Recreation Center. This site will help relieve local hospitals and nursing homes by housing patients with needs between home care and hospitalization (Relevant link: https://www.emergencyslo.org/en/alternate-care-site.aspx)

Notable Groups: The County of Los Angeles, San Mateo County Health, Health Plan of San Mateo, County of San Luis Obispo, Cal Poly San Luis Obispo, Dignity Health, Tenet Healthcare

California’s current resources during the Covid-19 pandemic:

  • California Health Care Foundation:
    • Provides COVID-19 resources to support nursing home providers, patients, and families to have conversations about serious illness and end of life care

Notable Groups: California Health Care Foundation:

California’s Actions for COVID-19 Management and Response:

Notable Groups: California Partnership to Improve Dementia Care, Coalition for Compassionate Care of California, County of Santa Clara Emergency Operations Center, YMCA of Orange County

California’s ongoing actions to better check visitors for potential Covid-19 and other methods of screening said visitors for family meetings:

Notable Groups: California Department of Health AFL

California’s Telehealth Inclusion:

  • Los Angeles Jewish Home:
    • Student pharmacists are conducting Zoom meetings with residents to review medication regimens and to provide education to residents about their medications. The student pharmacists are also providing medication regimen review to prescribers to potentially deprescribe medications. This best practice is a win-win, including active learning for the student pharmacists and social interaction for the residents.

Notable Groups: Los Angeles Jewish Home

California’s notable organizations that are confirmed nursing home assistance for the pandemic:

Notable Groups: Los Angeles County Emergency Operations Center

Category

California: Nursing Home Tool Kit

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