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State of California—Health and Human Services Agency
California Department of Public Health

AFL 21-52
December 13, 2021

Intermediate Care Facilities/Developmentally Disabled (ICF/DD)
Intermediate Care Facilities/Developmentally Disabled – Habilitative  (ICF/DD-H)
Intermediate Care Facilities/Developmentally Disabled – Nursing (ICF/DD-N)
Intermediate Care Facilities/Developmentally Disabled – Continuous Nursing (ICF/DD-CN)

Guidance for Residents/Clients to Safely Participate in Day Programs


All Facilities Letter (AFL) Summary

This AFL provides ICF/DD-H-N-CNs with recommendations for residents/clients that leave the facility to participate in day program services during the Coronavirus Disease 2019 (COVID-19) pandemic.

NOTE: This AFL is no longer in effect and is for historical purposes only​


On July 21, 2021, the Department of Developmental Services (DDS) issued Department Directive 01-072121 (PDF), rescinding its August 10, 2020 Directive (PDF) regarding day program services. Residents/clients may participate in day program services, the decision to participate should be determined by each individual and their planning team, taking into consideration overall health status and associated risks. Day program services must be provided in accordance with local county public health orders or recommendations and relevant guidelines issued by the California Department of Social Services and/or California Department of Public Health (CDPH).

This AFL provides recommendations to ICF/DD-H-N-CNs on promoting safe practices for residents/clients who participate in day program services. Due to increasing circulation of more transmissible variants of the SARS-CoV-2 virus and continuing COVID-19 incidence in California, CDPH recommends ICF/DD-H-N-CNs use the following infection control measures to mitigate the risk of COVID-19 transmission for residents/clients who leave the facility to participate in day programs.

Facility Safety Protocols

CDPH recommends ICF/DD-H-N-CNs use the following safety protocols:

  • Residents/clients should refrain from participating in day program services when any of the following occurs, regardless of vaccination status:
    • Tested positive for, have symptoms of, or are in quarantine for COVID-19 exposure
    • Recently had close contact (less than six feet for a cumulative total of 15 minutes or more over a period of 24 hours, or direct physical contact) with a person with COVID-19 during the prior 14 days
  • Facilities must conduct screening for COVID-19 for all residents/clients returning from day program services. Anyone entering the facility, regardless of their vaccination status, must be screened for fever and COVID-19 symptoms and/or exposure within the prior 14 days to another person with COVID-19.
  • Facilities should contact the day program and confirm that they have appropriate infection control protocols in place prior to having residents/clients participate in the day program.
  • Facilities should educate residents/clients leaving the facility about potential risks of public settings, particularly if they have not been fully vaccinated[i], and reminded to avoid crowds and poorly ventilated spaces. Residents/clients should be encouraged and assisted with adherence to all recommended infection prevention and control measures, including source control, physical distancing, and hand hygiene.
  • Residents/clients exposed to positive case: Residents/clients who have prolonged close contact (within six feet for a cumulative total of 15 minutes or more over a 24-hour period) with someone with SARS-CoV-2 infection while outside the facility should quarantine[ii] in a single room (preferably) or in their usual room with as much distance possible and curtains drawn between bed spaces for 14 days and be tested immediately, at five to seven days after exposure and again prior to return to their usual room in green-unexposed/recovered area, regardless of their vaccination status.
  • Facilities should consider periodically testing (e.g., once or twice weekly) asymptomatic unvaccinated and incompletely vaccinated residents/clients who leave and return to the facility regularly even when there is no known exposure.

Resident/Client Rights and COVID-19 Vaccinations

ICF/DD-H-N-CNs must keep in mind the importance of adhering to resident/client rights throughout the COVID-19 vaccination period, including the right to receive or reject medical care or health related services. Residents/clients who refuse to be vaccinated may not be denied participation in any activity or service available to any other resident/client solely based on the decision to not receive the vaccine. Residents/clients who are unvaccinated or incompletely vaccinated must always wear a mask unless they are eating or drinking and maintain six feet of physical distance from others.


ICF/DD-H-N-CNs should refer to the following guidance regarding resident/client transportation:

  • Schedule and stagger drop off or pick up times for resident to avoid crowding.
  • Encourage physical distancing among staff and residents/clients at the entrance and exit during these drop off and pick up times at the day program.
  • Fully vaccinated residents/clients may be seated together without physical distancing in transport vehicles; otherwise, unvaccinated and incompletely vaccinated residents/clients should be seated with as much distance possible and wear masks while in transport vehicles.
  • Create resident/client pods (keeping small groups together) to limit mixing and create distance between passengers (e.g., skip rows) when possible.
  • Require mask wearing and encourage physical distancing among staff and residents/clients at the entrance and exit during these drop off and pick up times at the day program.


If you have any questions about infection prevention and control of COVID-19, please contact the CDPH Healthcare-Associated Infections Program via email at



Original signed by Cassie Dunham

Cassie Dunham

Acting Deputy Director

[i] People are considered fully vaccinated for COVID-19: two weeks or more after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna or vaccine authorized by the World Health Organization), or two weeks or more after they have received a single-dose vaccine (Johnson and Johnson [J&J]/Janssen).

[ii] CDC Defines quarantine as separate and restrict the movement of people who were exposed to a contagious disease to see if they become sick. CDC Quarantine and Isolation

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