As the virus causing COVID-19 continues to spread, including the more infectious Delta variant, the risk is greatest for those who are not fully vaccinated. Vaccination remains the most effective strategy to prevent outbreaks and serious illness and is strongly recommended for all eligible people. Because many of the people in childcare settings are not yet eligible for vaccination (children younger than 12 years), the California Department of Public Health (CDPH) has made masking indoors a requirement in childcare settings for everyone regardless of vaccination status.
Multiple layers of COVID-19 risk mitigation must be implemented by Early Care and Education (ECE) sites to protect staff, children and their families, and to prevent outbreaks and interruptions in service. Layers of risk mitigation include vaccination, wearing masks, testing, physical distancing/cohorting, screening and responding to cases of COVID-19, maximizing ventilation, practicing good hand hygiene, and cleaning and disinfecting. An Exposure Management Plan is provided to assist ECE sites in understanding the requirements for reporting and managing COVID-19 cases. Reference US Centers for Disease Control and Prevention (CDC) guidance for Early Care and Education/Child Care Programs.
ECE providers must comply with applicable Cal/OSHA COVID-19 Prevention Emergency Temporary Standards (ETS), CDSS Community Care Licensing Division regulations, and any Pasadena Public Health Department orders if they are stricter.
COVID-19 vaccines are safe and effective and are the best way to prevent COVID-19 outbreaks in ECE sites and in the community. COVID-19 vaccines are widely available in every community.
- Adopt policies and provide communication that clearly explain CDC recommendations for COVID-19 vaccination and outlines opportunities to access vaccine.
- Create partnerships with PPHD, commercial pharmacies, or other vaccine providers to connect staff or students’ families to COVID-19 vaccination opportunities.
- Promote accurate vaccine information through formal and informal channels, such as educating and training staff to understand vaccine science and how to identify misinformation and counter and dispel myths.
- Employers with 26 or more employees must provide covered employees paid time off to attend vaccine appointments or if they are unable to work or telework due to vaccine-related symptoms. For more information, see the 2021 COVID-19 Supplemental Paid Sick Leave
- Consider offering a vaccination clinic at your workplace to make it more convenient for you employees to get vaccinated. Consider opportunities to incentivize your employees to get vaccinated or to make it easier to get vaccinated.
Everyone children 2 years and older, including children, employees, staff, volunteers, parents and all visitors to a childcare site, are required by state health officer order to wear a mask indoors at childcare sites. Some exceptions to the masking requirement still apply per the state order.
ECE providers and sites must require all:
- Visitors, including parents and caregivers, regardless of vaccination status, to bring and wear masks when they are indoors at their facility. Make masks available to those who arrive without them.
- Children ages 24 months and older to wear a face mask. Masks may be removed during nap time or when children are eating and drinking.
- Employees*, regardless of vaccination status, to wear masks when working indoors and in shared vehicles. Masks are not required when the employee is alone in a room or actively eating or drinking at a seated or stationary location. Public Health recommends that all employees eat outdoors and be spaced at least 6 feet from other persons, if possible.
- Employees that are in a setting where they are in close contact with other people who may not be fully vaccinated, for example children younger than 12, should be offered and should consider wearing higher level of protection, such as wearing a cloth mask over a medical grade disposable mask (“double masking”), a KN95, or a respirator (e.g., N95). This is particularly important if the employee is not fully vaccinated and is working in an indoor or crowded outdoor area.
- Consider also offering gloves for tasks such as serving food, diapering, handling trash, or using cleaning and disinfectant products.
* The terms “employees” and “staff” refer to individuals who work in an ECE site in any capacity associated with teaching, student support, site cleaning or maintenance, administration, or any other activity required for the ECE to function. “Employees” or “staff” may include individuals who are: paid directly by the ECE, paid by entities acting as contractors to the ECE, paid by outside entities acting in collaboration with the ECE to serve students, or unpaid volunteers acting under ECE direction to carry out essential functions. The term “parents” refers to any persons serving as caregivers or guardians to students.
Develop a plan or protocol for incorporating COVID-19 testing into regular ECE operations.
- At a minimum, the plan should describe the strategy for ensuring access to testing for students and employees, regardless of vaccination status, who are symptomatic or have known or suspected exposure to an individual infected with SARS-CoV-2. Note that the current Cal/OSHA Emergency Temporary Standards (Cal/OSHA ETS) require employers to offer testing at no cost to employees during paid time for:
- Symptomatic unvaccinated employees, regardless of whether there is a known exposure
- Unvaccinated employees after an exposure
- Vaccinated employees after an exposure if they develop symptoms. However, the CDC and PPHD now recommends individuals who are fully vaccinated to be tested 3-5 days after an exposure, regardless of whether or not they have symptoms
- Unvaccinated employees in an outbreak (3 or more employee cases)
- All employees in a major outbreak (20 or more cases)
- The ECE may consider a strategy for periodic testing for asymptomatic individuals with no known exposure, particularly in the setting of moderate, substantial, or high transmission.
- When the community is experiencing higher rates of COVID-19 transmission, in light of evolving data on virus variants, PPHD recommends periodic testing include fully vaccinated individuals, if resources allow.
- The plan must include that all testing results will be reported to the Pasadena Public Health Department.
- Please note: Screening testing is not recommended for persons who have recovered from laboratory confirmed COVID-19 within the past 90 days and are asymptomatic.
Symptom Screening and Responding to Cases
Post signage to remind everyone who enters your establishment that they should NOT enter if they have symptoms of COVID-19 or if they are under isolation or quarantine orders.
Exclude any person or isolate any child or staff showing symptoms of a contagious disease or illness until they can be transported home, as required by CDSS Community Care Licensing Division (CCLD) and pursuant to Title 22 in CCR sections 101216(h), 101226.1(a)(1) and 102417(e).
- 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 supervision and that the health of the child is continually observed throughout the day according to licensing requirements.
Daily symptom screenings are required, and it is highly recommended they are conducted before students, visitors and staff enter the ECE. Screenings should include a check-in concerning symptoms consistent with possible COVID-19 and any other symptoms the individual may be experiencing. These checks can be done remotely (using a digital app or other form) or in-person upon arrival. A temperature check with a no-touch thermometer at entry should be included as part of the screening, if feasible, especially for visitors who may not be part of a systematic at-home screening process.
Initiate the COVID-19 Exposure Management Plan consistent with PPHD guidance that outlines procedures for:
- Isolation of the person (case) with confirmed or suspected COVID-19
- Identification of individuals exposed to the case while at the ECE;
- Quarantine of exposed unvaccinated employees and students; and
- Assurance of access to testing for all exposed individuals within the ECE, regardless of vaccination status, as the basis for further control measures.
- Notification to PPHD of all confirmed cases of COVID-19 among employees and students who were at the ECE at any point 14 days prior to the illness onset date.
- The illness onset date is the symptom onset date of the infected person, or for an asymptomatic person, the COVID-19 test date.
- Cases should be reported within 1 business day of the school learning of the case.
- This can be completed by downloading and completing the Exposure Investigation Worksheet and sending it by secure email to email@example.com or FAX (626) 744-6115.
- Family childcare 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).
- Verify the ECE site’s HVAC system is in good, working order. Consider having the HVAC system evaluated by an appropriate engineer familiar with the CDPH Ventilation Guidance for Reopening Schools and the American Society of Heating, Refrigerating, and Air-conditioning Engineers (ASHRAE) Guidance for HVAC Systems. Upgrade HVAC filters to a higher efficiency (MERV-13 or higher rating is preferred).
- Consider installing portable high-efficiency air cleaners, upgrading the building’s air filters to the highest efficiency possible, and making other modifications to increase the quantity of outside air and ventilation in all working areas.
- Consider how to safely bring fresh air into the facility. When conditions allow, increase fresh outdoor air by opening windows and doors, adhering to fire and other safety standards. Consider using child-safe fans to increase the effectiveness of open windows; always position window fans to blow air outward, not inward. Existing fire codes requiring closure of fire-rated doors must be respected.
- Decrease occupancy in areas where outdoor airflow cannot be increased.
- If your business utilizes transport vehicles, such as buses or vans, it is recommended to open windows to increase outdoor airflow when it is safe to do so and weather permitting.
Implement measures to promote frequent hand washing by staff, students, and visitors. These may include:
- Give students and staff frequent opportunities to wash their hands for 20 seconds. Wash hands with soap, rubbing thoroughly after application, and use paper towels (or single-use cloth towels) to dry hands thoroughly.
- Schedule students for frequent handwashing breaks, including before and after eating, after toileting, after outdoor play, and before and after any group activity.
- Instruct staff to model frequent handwashing to reinforce students’ healthy habits and monitor proper hand washing.
- Place handwashing stations or ethyl alcohol-based (contains at least 60% ethanol) hand sanitizer at entry and other convenient locations with signage promoting use. Be sure that hand sanitizer is out of the reach of children. Supervise children under the age of 6 when they use hand sanitizer to prevent swallowing alcohol or contact with eyes.
- Swallowing alcohol-based hand sanitizers can cause alcohol poisoning. Hand sanitizer should not be out in the open and should only be used with adult supervision for children under age 9. Inform faculty and staff of the risk of ingestion and that they should call Poison Control at 1-800-222-1222 if there is reason to believe that a student has consumed hand sanitizer.
- Provide hand sanitizer, soap and water, tissues and trash cans at or near the entrances, the main office reception area, other office spaces, and anywhere else inside the workplace or immediately outside where people have direct interactions.
Cleaning and Disinfection
Cleaning and disinfecting surfaces can reduce the risk of infection. Train and monitor staff to follow the infection control practices related to requirements for cleaning and disinfection, housekeeping and sanitation principles listed below:
- Follow cleaning and disinfection requirements as laid out in CCR sections 101216(e)(2), 102416(c), 101238(a) and 102417(b).
- 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.
- Use cleaning products that are effective against COVID-19 (listed on the Environmental Protection Agency (EPA) List N), and follow product instructions.
- 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. Note: This does not apply to family child care homes.
For more information about cleaning and disinfection, see CDC guidance on Cleaning and Disinfecting Your Facility.
Post signage so that visitors who are entering your building are aware of policies, including the requirement for all visitors, employees and children over 24 months to wear a face mask while indoors.
Update your parent manual and online platforms to share ECE site’s COVID-19 safety policies with parents, particularly information concerning policies related to:
- Any requirements or recommendations pertaining to vaccination
- Isolation and quarantine policies as they apply to students who have symptoms or may have been exposed to COVID-19
- Options for COVID-19 testing if the student or a family member has symptoms or has been exposed to COVID-19
- Who to contact at the school if student has symptoms or may have been exposed
- How to conduct a symptom check before student leaves home
- Required use of high quality face masks
- Importance of providing the ECE site with up-to-date emergency contact information including multiple parent contact options
COVID-19 Mental Health Resource Guide
As the world continues to combat COVID-19, many children and their families continue to face challenges that can be stressful and overwhelming. It is natural to feel stress, anxiety, grief, and worry during the COVID-19 pandemic. If a child, family member or employee are having a hard time coping, help is available 24/7. For information about accessing local mental health services, refer to PPHD’s COVID-19 Mental Health Resource Guide, which includes listing of services that can help children, youth, and families cope during the pandemic.
Below are additional resources and recommendations to help in dealing with stress:
- California's playbook on Stress Relief during COVID-19 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 with colleagues and families.
- 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.
- 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.