Community Services/Quality Assurance Update
During this COVID-19 pandemic, the goal of VMRC is to promote the health and safety of all
the consumers, especially the vulnerable ones with underlying medical conditions and living
in group settings with or without roommates.
When a consumer, living in licensed care or group living arrangements, is going to travel or
go out in outings individually or groups, and care home staff are able to ensure that the
consumer is able to follow all the precautions, the consumer does not have to do the 14-
day isolation. During this time, the following conditions must be met:
• the care home staff will always wear mask per CA State mandate and CDC guidelines
• the care home staff was able to ensure that the consumer had mask on at all times,
covering the nose and mouth, and all precautions were adhered to
• optional to use a face shield or eye goggles as added protection
• practiced more than 6 feet physical distancing
• avoided touching face
• washed hands frequently or used hand sanitizer
• showered immediately and changed clothes upon return to care home
• clothes washed immediately and separately
During this COVID-19 pandemic, the goal of VMRC is to promote the health and safety of all the consumers, especially the vulnerable ones with underlying medical conditions and living in congregate settings.
When a consumer, living in congregate setting, is visiting friends or family members in their homes or other places for a few hours to days, VMRC is highly recommending that consumers will do 14-day isolation upon return to the care home. Please refer to isolation guide with title “DDS Expectations for Consumers Coming back from Hospital or ER or Other placements.”
Similar will be expected when a consumer is working as an essential employee, and lives in congregate setting. The consumer may go to the living area provided that a mask is worn at all times, and he/she is more than 6 feet away from other consumers.
When a consumer, living in congregate setting, is going to an office visit to a primary care provider, doctor visit, dentist visit or laboratory visit, there is a different expectation. Because these settings are controlled environment in such as there is temperature check prior to entry, individuals are required to wear mask at all times inside the building, and chairs are arranged physically distanced with easy access to soap and water or hand sanitizer. If the consumer is able to abide by those safety precautions at all times, and consumer is able to shower and change clothes immediately when he/she returns to care home, the consumer does not have to do 14-day isolation. Clothes should be washed immediately and separately.
Similarly, when a consumer goes out to the community for example, grocery shopping, the consumer does not have to do 14-day isolation when the following conditions are met:
• the care home staff will always wear mask per CA State mandate
• the care home staff was able to ensure that the consumer had mask on at all times, covering the nose and mouth
• practiced more than 6 feet physical distancing
• washed hands frequently or used hand sanitizer, and avoided touching face
• showered immediately and changed clothes upon return to care home
• clothes washed immediately and separately
Further guidance on the document title “In-person Meeting Outdoors / Outside the Home During COVID-19."
When a consumer is discharged from a skilled-nursing facility (SNF), or being discharged from Hospital admission, or from an Emergency Room visit, or from a psychiatric hold, or from behavioral facility, or from home going to a care home, or going to a new care home, please practice the following guidelines from DDS and CDC:
1. Isolate the consumer for 14 days. We will call this Consumer A.
2. Ideally, consumer A will stay isolated in a private room with private bathroom that only this consumer will access.
3. Please separate everything, clothes, eating utensils and others.
4. Please have a dedicated staff to care for this consumer only, if possible.
5. If consumer A is sharing a room with consumer B, please move consumer B to a different room, if possible.
6. The care home may also identify a specific area of the home to consumer A, if that is more feasible.
7. If a private bathroom for consumer A is not possible, please do your best to clean it very well, and disinfect the bathroom every after use of consumer A, including every after shower or bath.
8. An option of providing a bedside commode for consumer A is okay if he/she is comfortable with that.
9. Consumer A may come out of his room to the living area as long as there is no one else out there and wearing mask. If there is another person in the living area, Consumer A should be more than 6 feet away from other individuals and still wearing mask.
10. If all the above conditions are not feasible at the care home, the regional center may look into other options such as surge capacity homes, or hotel with SLS or staff as an example.
11. Regional center should ensure that isolation protocols are in place at each of the care homes.
12. Care home staff are trained to check temperature of Consumer A, at least twice daily, and document this. Care home staff should also monitor for other symptoms of COVID-19 such as fever, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle aches or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, or diarrhea.
13. Care home staff are asked to monitor oxygen saturation, if available, and to seek medical attention if it is 92% or less.1 This is best practice.
14. If any of the above symptoms are recognized, care home staff should contact the primary care provider (PCP) and seek medical attention.
15. Per CA State mandate, care home staff/direct support professionals will wear masks/face coverings while in the care home, whether they are in direct care of a consumer or not. The care home is their work environment.
16. If someone is positive with COVID-19, care home administrator will submit a SIR to VMRC, and isolate the consumer. Testing of other consumers and staff in the care home is highly recommended. The care home staff should monitor the individual with positive result for any symptoms of COVID-19, as well as any other individuals that were exposed. The exposed individual should self-quarantine per CDC guidelines.
Update on the Isolation Plan
1. When discharged from ER/hospital or from parent visit, isolate consumer for 14 days. The reason is we are not sure what type of exposure the consumer had. And continue 14 days because of the incubation period of COVID-19 which is 2-14 days.
2. Based on new CDC guidelines for those with positive COVID-19 result: isolate for 10 days from date of first positive RT-PCR testing if the individual never develop symptoms. If symptomatic, discontinue isolation and precautions 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms.
3. Example 1: Consumer A exposed to ER/hospital/family visit, will have 14-days isolation. On Day 11, Consumer A develops diarrhea (covid-19 symptom) seek medical attention and isolate 10 more days based on CDC guidelines from onset of symptoms.2
4. Example 2: Consumer B has positive test result but has no symptoms 10 days isolation. On Day 9 of isolation, develops headache and body ache (covid-19 symptoms), seek medical attention and additional 10 days of isolation based on CDC guidelines.
5. For persons with severe illness or severely immunocompromised, isolation will last up to 20 days after symptoms onset; consider consultation with infection control experts.3
6. Severe illness will be classified as those who has been hospitalized due to COVID-19 or COVID-19 related-symptoms.4
7. Examples of severely immunocompromised would be individuals who have weak immune system due to solid organ transplant, blood or bone marrow transplant; has immune deficiencies; or use immune weakening medicines.5
Additional examples are those on chemotherapy for cancer; has untreated HIV infection with CD4 T lymphocyte count of <200; combined primary immunodeficiency disorder; and individuals on long-term steroid use such as prednisone of >20 mg/day for more than 14 days.
COVID-19 Hospital Discharges & other Placement
Revised: 04/02/2020, 04/09/2020, 07/16/2020, 07/20/2020, 08/05/2020, 08/07/2020
1 Academic Emergency Medicine. July 23, 2020. https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.14053
2 CDC. July 22, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
3 CDC. July 22, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
4 CDC. June 30, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
5 CDC. July 17, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fgroups-at-higher-risk.html
6 Stanislaus County Public Health Officer. July 20, 2020. http://schsa.org/PublicHealth/pages/corona-virus/pdf/return-to-work-en.pdf
The Community Services Department and
Quality Assurance Team
