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Mandatory Directive for Long-Term Care Facilities

* Please confirm that your gathering is allowed under the State Order.
Where there is a difference between the local County Order and the State Order,
the more restrictive order must be followed. The State also has specific guidance for certain facilities that must be followed in addition to this mandatory directive. *

Information on the State’s Order and State guidance is available at

Issued: November 20, 2020

On August 28, 2020, the State issued a Statewide Public Health Officer Order (“State Order,” available here) and the Blueprint for a Safer Economy (“Blueprint,” available here). The State Order and Blueprint establish statewide restrictions applicable to each “tier” to which counties are assigned.   

Long-term care facilities must follow the mandatory requirements in this Directive and any other applicable County Health Officer Directive, the County Health Officer’s Revised Risk Reduction Order issued on October 5, 2020, the applicable restrictions under the State Order and Blueprint, the State’s COVID-19 Industry Guidance documents, and any applicable health and safety requirements.  When there is a difference between these rules, the most restrictive rule must be followed.

This Directive establishes the County Health Officer’s requirements for long-term care facilities in Santa Clara County.

This Directive is mandatory, and failure to follow it is a violation of the Health Officer’s Order issued October 5, 2020 (“Order”).

The Order Issued October 5, 2020

The Order imposes several restrictions on all businesses and activities to ensure that the County stays as safe as possible.  All businesses (including nonprofits, educational entities, and any other business entity, regardless of its corporate structure) that organize or host gatherings—such as religious institutions, wedding venues, wedding planners/coordinators, convention centers, and conference/meeting room rental facilities—must comply with the following requirements:

  • Social Distancing Protocol: All businesses and governmental entities that have not already done so must fill out and submit an updated Social Distancing Protocol under the October 5, 2020 Health Officer Order. Social Distancing Protocols submitted prior to October 11, 2020 are no longer valid.  The Revised Social Distancing Protocol must be filled out using an updated template, which is available here.  The Protocol is submitted under penalty of perjury, meaning that everything written on the form must be truthful and accurate to the best of the signer’s knowledge, and submitting false information is a crime.  The Protocol must be distributed to all workers, and it must be accessible to all officials who are enforcing the Order.
  • Signage: All businesses and governmental entities must print (1) an updated COVID-19 PREPARED Sign and (2) a Social Distancing Protocol Visitor Information Sheet, and both must be posted prominently at all facility entrances. These are available for printing after submission of the Revised Social Distancing Protocol online.  The Revised Social Distancing Protocol specifies additional signage requirements.
  • Face Coverings: Everyone must wear face coverings at all times specified in the California Department of Public Health’s mandatory Guidance for the Use of Face Coverings (“Face Covering Guidance”) and in any specific directives issued by the County Health Officer. Further, even where not required under State or local guidance and orders, face coverings should be worn to the maximum extent possible (1) when indoors and not in one’s own residence and (2) whenever outdoors and within six feet of anyone outside one’s own household.  

Mandatory Requirements for Long-Term Care Facilities

The danger of COVID-19 transmission in long-term care facilities is particularly high due to facility residents generally being at higher risk of severe illness or death from COVID-19.  Visitors to long-term care facility residents and residents returning to long-term care facilities after visits to friends or family in the community increase the risk of introducing and transmitting COVID-19 among residents and staff in the facility.  The Health Officer therefore issues the following directives for visitation of, and by, residents of long-term care facilities.  These directives supplement the guidance in the California Department of Public Health’s Guidance for Limiting the Transmission of COVID-19 in Long-Term Care Facilities (All Facilities Letter (AFL) 20-22.5) and Coronavirus Disease 2019 (COVID-19) Infection Control Recommendations during Holiday Celebrations (AFL 20-86):

  1. Prioritization of Visitation Options
    • Consistent with AFL 20-22.5, long-term care facilities shall, whenever practicable, conduct visits in outdoor areas that allow for 6 feet or more of physical distancing. If outdoor visitation is not possible (including, but not limited to, inclement weather, poor air quality, or resident inability to be moved outside), long-term care facilities shall conduct visits in large, well-ventilated communal indoor spaces where 6 feet or more of physical distancing.  In-room visitation shall only occur only if outdoor visitation and visitation in large, communal indoor spaces are not possible.
  1. Visitation Safety Procedures
    • Long-term care facilities shall follow the safety procedures identified in AFL 20-22.5 for all indoor visitation.
    • For all outdoor and indoor visits, long-term care facility staff shall ensure that residents and visitors are wearing required face coverings and observing infection control guidelines, including maintaining at least 6 feet of distance at all times.
  1. Testing Required for Indoor Visitors at Long-Term Care Facilities
    • All visitors must obtain a PCR diagnostic test for COVID-19 within 72 hours of their scheduled visit to a long-term care facility. Any visitor who tests positive for COVID-19 shall not be allowed to visit a long-term care facility during the time that they are supposed to be in isolation.
    • Visitors must provide the long-term care facility with a copy of their negative test result for COVID-19 prior to or upon arrival at the facility for their visit.
    • To document compliance with this Directive, long-term care facilities must maintain a log of all visitors, along with copies of their COVID-19 test results, for the prior 30 days.
    • Visitors with a negative COVID-19 PCR test result can conduct additional visits to a long-term care facility without getting re-tested for COVID-19 if no more than 7 days have passed since the date that the visitor was tested for COVID-19 (i.e., the date the specimen was collected).
    • The testing requirements in this Directive shall only apply to visitors conducting indoor visits at long-term care facilities and shall not apply to any of the categories of individuals exempt from the visitation restrictions in CDPH’s AFL 20-22.5.
  1. Quarantine Required for Long-Term Care Facility Residents Returning to the Facility After Visits to Family or Friends in the Community
    • On October 9, 2020, the State issued rules that limit private gatherings to no more than three households. Those rules also prohibit gatherings from occurring indoors if the county is in the Purple Tier under the State’s Blueprint for a Safer Economy.  For more information, please see the Mandatory Directive for Gatherings.
    • Long-term care facilities shall only allow residents to visit family or friends in the community in compliance with State rules and Mandatory Directive for Gatherings.
    • Long-term care facilities that allow residents to visit family or friends in the community shall screen returning residents for signs and symptoms of COVID-19, immediately test and isolate returning residents who are symptomatic in a single room pending results, isolate returning residents who test positive, quarantine all other returning residents for 10 days, and test quarantined residents at the end of the 10-day period before returning them to the general population.

Stay Informed

For answers to frequently asked questions about this industry and other topics, please see the FAQ page.  Please note that this Directive may be updated.  For up-to-date information on the Health Officer Order, please visit the County Public Health Department’s website at​​​​​​​​

Last updated: 11/23/2020 4:31 PM