Overview

The State of California remains committed to taking actions that protect the health, safety, and welfare of the people in California. As businesses and activities reopen, guidance has been updated for Coronavirus Disease 2019 (COVID-19) infection control practices. Every child care program is expected to continue to minimize the spread of COVID-19 and to ensure the safety of children, providers, and families. All providers should apply new and updated policies and requirements that address the need for continued infection control and should update their emergency preparedness plan.

This guidance informs child care providers and the families they serve about infection control practices that prevent and mitigate the spread of COVID-19 infection in facilities. It is important for providers to maintain frequent communication with families and staff about implemented policies and practices to keep everyone safe.

This guidance supersedes prior COVID-19 guidance in the COVID-19 Update Guidance: Child Care Program and Providers dated July 17, 2020.

Licensees and other child care providers should continue to follow COVID-19 requirements and guidance in all applicable California Department of Social Services (CDSS) and Community Care Licensing (CCL) Provider Information Notices (PIN), in addition to guidance or requirements from California Department of Public Health (CDPH), California Department of Industrial Relations Division of Occupational Safety & Health (Cal/OSHA), and local public health departments, as applicable to the particular facility.

If there are differing requirements between the most current CDPH, CCL, Cal/OSHA, and local health department guidance or health orders, licensees and providers should follow the strictest requirements. Implementation of this guidance should be adapted for the setting in which you provide care and may require training and support for staff and adequate consideration of children and family needs.

Workplace safety and health regulations in California require employers to take steps to protect workers exposed to infectious diseases. Licensees and providers who fall under the scope of the Cal/OSHA COVID-19 Prevention Emergency Temporary Standards (ETS) must remain in compliance with these Standards.

Planning

• Licensees and providers must continue to mitigate the spread of COVID-19. Review Cal/OSHA COVID-19 Guidance and Resources to implement steps to protect staff and minimize exposure to the COVID-19 virus.
• The Cal/OSHA COVID-19 Prevention Program (CPP) is a written plan required under the Cal/OSHA COVID-19 Emergency Temporary Standards. For more details and to access a template, refer to the California Department of Industrial Relation's COVID-19 Prevention Emergency Temporary Standards.
  
• Facilities should have a written plan for when a child or staff member has been exposed to someone with COVID-19, has symptoms of COVID-19 or tests positive for COVID-19.
• Developing a written communication plan with parents, guardians, and caregivers to share information and guidelines in their preferred language is recommended.
  

COVID-19 Vaccines

• The CDC has strongly encouraged vaccination as one of the most important tools to end the COVID-19 pandemic. Licensees and providers are eligible to receive vaccinations at no expense. There are several ways to obtain vaccination. Please see PIN 21-06-CCP (PDF) for more information on vaccine safety, benefits, and how to get the vaccine.
• Please share information about vaccines with staff and families, and reference the California COVID-19 Vaccine Website Homepage.
• If a licensee or provider requests confirmation that a staff or child has received the COVID-19 vaccine, it is recommended the confirmation should be documented in the same way immunizations are documented and maintained in the facility file. Those confirming may review and accept a hard copy or digital record of vaccine receipt.

Testing

• Testing is one layer in a multi-layered approach to COVID-19 prevention. For more information about testing, please see: Updated COVID-19 Testing Guidance.

Face Coverings

• Child care providers must ensure compliance with the current CDPH Guidance for the Use of Masks. As of June 15, 2021, the use of face coverings is required by the California Department of Public Health (CDPH) and the Division of Occupational Safety and Health (Cal/OSHA) in child care indoor settings regardless of vaccination status.
• Never place face coverings on babies or children under 2 years of age because it poses a danger and risk for suffocation.
• Children should not wear face coverings while sleeping.
• Child care providers and licensees must ensure the use of face coverings does not cause children to overheat in hot weather.

Essential Protective Equipment and Supplies

Use the chart below for a quick reference to protective equipment and supplies to use in child care environments. Further information about face coverings, hand hygiene and disinfecting and cleaning is provided within this document.

Note: Child care providers and licensees may contact their local Child Care Resource and Referral Agencies or local First 5 offices for information about obtaining Personal Protective Equipment (PPE) and supplies.

Physical Distancing and Stable Groups

• Physical distancing is an infection control best practice that may be implemented as an additional safety layer between groups of children and staff to reduce the spread of COVID-19.
• Child care settings typically have a stable group model with the same groups of staff and children each day, and licensees and providers should consider continuing to implement stable groups as a best practice.
• Staff should follow Cal/OSHA ETS for physical distancing requirements.

Ventilation

Ventilation is one component of maintaining healthy environments, and is an important COVID-19 prevention strategy for child care programs. Good ventilation is another step that can reduce the number of virus particles in the air. Along with other preventive actions, ventilation can reduce the likelihood of spreading disease and assists in ensuring a safe and healthy environment for children in care. (See for example, ventilation Title 22 requirements, California Code of Regulations (CCR) sections 101216(e)(2), 101223(a)(2), 101238(a), 102416(c), 102417(b), and 102423.)

• All businesses permitted to operate indoors should follow the recommended CDPH interim guidance for ventilation, filtration, and air quality. This guidance includes practical steps to promote better ventilation, filtration, and air quality indoors to reduce the spread of COVID-19 and ensure the buildings and grounds are safe.
• Consider how to safely bring fresh air into the child care facility.
• Consider using child safe fans to increase the effectiveness of open windows. Point fans to blow air outwards. May also consider other approaches for reducing the amount of virus particles in the air, such as using an air filtration and exhaust fans.
• Ventilation considerations are also important to have inside your transport vehicles, such as buses or vans. It is recommended to open windows to increase airflow from outside when safe to do so.
• Additional information for child care facilities can be found on the CDC Ventilation in Schools and Child Care Programs page.

Cleaning and Disinfection

Cleaning and disinfecting surfaces can reduce the risk of infection. Train and monitor staff to follow infection control practices below related to requirements for cleaning and disinfection, housekeeping and sanitation principles, and universal health precautions. (See cleaning and disinfection requirements pursuant to CCR sections 101216(e)(2), 102416(c), 101238(a) and 102417(b).) These practices also help ensure buildings and grounds are clean, safe and sanitary, and the personal right to safe and healthful accommodations. (See for example, of cleaning and healthful accommodations requirements pursuant to Title 22 CCR sections 101216(e)(2), 101223(a)(2), 101238(a), 102417(b), and 102423.)

• It is important to know the difference between cleaning, sanitizing, and disinfecting and when to do each in order to maintain a healthy child care environment and the well-being of children in care. See CDC guidance on Cleaning and Disinfecting Your Facility for detailed information on infection control practices related to cleaning and disinfection.
• Laundry, such as clothing and bedding, should be washed using the appropriate hot water setting and allow items to dry completely. If handling dirty laundry from a person who is sick, wear gloves and a mask. See PIN 20-11-CCLD (PDF) for more information.
• When choosing cleaning products, consider using those approved for use against COVID-19 on the Environmental Protection Agency (EPA)-approved list "N" and follow product instructions.
• Always follow the directions on the label to ensure safe and effective use of the product.
• The Healthy Schools Act requires that anyone using disinfectants at child care centers complete annual California Department of Pesticide Regulation-approved training. Online training can be found by going to the California School & Child Care Integrated Pest Management website. Note: This does not apply to family child care homes.

Hand Washing and Hygiene

Using the personal hygiene practices below can reduce the risk of infection. Train and monitor staff to follow these strongly recommended universal health precautions and preventative health practices. (See handwashing and hygiene requirements in, Title 22 CCR sections 101216(e)(2) and 102416(c).)

• Learn from the CDC about How to Select, Wear, and Clean Your Mask. Masks should be washed frequently.

Isolation for Illness

Child care programs must exclude or isolate any child, parent, caregiver, or staff showing symptoms of a contagious disease or illness as required pursuant to Title 22 in CCR sections 101216(h), 101226.1(a)(1) and 102417(e).

• Take action to isolate children who begin to have COVID-19 symptoms while in care, from other children and staff.
• Ensure that isolated children continue to receive adequate care supervision and that the health of the child is continually observed throughout the day according to licensing requirements.
• If an individual who resides in a family child care home is exhibiting symptoms of COVID-19, the facility should follow public health guidelines for quarantine or isolation.
• Notify local health officials, staff, and families immediately of any confirmed case of COVID-19.

Food Service and Meal Times

Changes may be made during meal times to help mitigate the spread of COVID-19.

• Moving tables to spread children out or the use of name cards to provide adequate spacing of children is recommended.
• Licensees and providers should follow proper handwashing, cleaning, and disinfection practices before and after eating. Follow CDC and CACFP COVID-19 food handling guidelines.
• Implement outdoor meal times if space and weather allow.

How to Respond to Exposure or Outbreaks

Licensees and providers should have a plan in place for responding to COVID-19 exposures or outbreaks.

• Actively encourage staff and families to notify the facility if they test positive for COVID-19 or have been exposed to someone with COVID-19 symptoms or a confirmed or suspected case.
  
• Employers are required to report positive COVID-19 cases in a workplace to the local health department. Follow Cal/OSHA emergency temporary standards on COVID-19 for reporting.
• Child care centers are required to report epidemic outbreaks to the CDSS Community Care Licensing Division (CCLD) through their local Regional Office (PDF) as required pursuant to Title 22, CCR section 101212(d). Family child care homes must report a communicable disease outbreak, when determined by the local health authority, to CCLD through their local Regional Office pursuant to Title 22, CCR section 102416.2(c)(3).
  

Resilience Tips During the Pandemic

The COVID-19 pandemic has had a major effect on our lives. Many are facing challenges that can be stressful, overwhelming, and cause strong emotions in adults and children. It is natural to feel stress, anxiety, grief, and worry during the COVID-19 pandemic. Below are a few recommendations to help yourself, staff, children, and families manage stress:

• California's playbook on Stress Relief during COVID-19 (PDF) provides guidance on how to notice stress in kids and outlines tools and strategies on how to reduce stress for children and adults.
• Promote healthy nutrition, sleep, and physical activity habits and self-care.
• Discuss and share stress reduction strategies.
• Encourage staff and children to talk with people they trust about their concerns and feelings.
• Communicate openly and often with staff, children, and families about mental health support services available in the community, including if mental health consultation is available to the program.
• Consider posting signage for CalHOPE and the national distress hotline: 1-800-985-5990, or text TalkWithUs to 66746.
• Encourage staff to call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255), 1-888-628-9454 for Spanish, or Lifeline Crisis Chat if they are feeling overwhelmed with emotions such as sadness, depression, or anxiety; or call 911 if they feel like they want to harm themselves or others.