Child-Care-Guidance-QA Guidance for Child Care Providers and Programs: Questions & Answers

Guidance for Child Care Providers and Programs: Questions & Answers

Updates as of July 22, 2022:

Table of Contents

  • Exposure
  • Isolation and Quarantine
  • Testing
  • Testing Resources
  • Face Coverings/Masks
  • PPE Resources
  • Requirements and Recommendations 

Exposure

Who is an "exposed person" in child care?

For children or adults not covered by Cal/OSHA COVID-19 Prevention Emergency Temporary Standards (ETS), an exposure is described in the CDPH Guidance for Local Health Jurisdictions on Isolation and Quarantine of the General Public as occurring when someone shares the same indoor airspace with an infectious person for at least 15 minutes in a 24-hour period.  For example, if someone has three individual 5-minute exposures to an infectious person for a total of 15 minutes, they are considered exposed.

Can a child who has been exposed to COVID-19 remain in child care?

As long as the local health department does not have more restrictive requirements, child care licensees can permit exposed children without symptoms to remain in child care, regardless of COVID-19 vaccination status. Additional details are available at the Child Care Decision Tree for Exposed Child.  

Any child with symptoms should not attend and licensed providers must exclude or isolate any child with symptoms of a contagious disease or illness in accordance with licensing regulations in Title 22 of the California Code of Regulations.

Providers should follow the CDSS/CDPH Child Care Guidance and the Child Care Decision Tree for Sick Child or Positive COVID Test in order to determine when the child can return to child care.

When is a person with COVID-19 infectious?

The COVID-19 infectious period used to determine exposure of other people starts 2 days before symptoms began and goes through day 5 after symptoms began. If a person with COVID-19 never has symptoms, the start of the infectious period is 2 days before a positive test and goes through day 5 after a positive test, if remaining with no symptoms. 

However, an infected person may be infectious longer than 5 days, which is why antigen testing is recommended before ending isolation. See below (Question 4) and the COVID-19 Isolation and Quarantine Q&As for more information on the infectious period and isolation.

Who does NOT need to quarantine after exposure?

In the workplace, employers are subject to the Cal/OSHA COVID-19 Prevention Emergency Temporary Standards (ETS) and should consult those regulations for any applicable requirements for covered workers.

Persons in a child care setting, regardless of vaccination status, do NOT need to quarantine after an exposure. All exposed persons 2 years of age and older are strongly encouraged to wear a well-fitting mask for 10 days after exposure. Anyone who develops symptoms, even if they previously had COVID-19 or are vaccinated, should isolate and get tested.

Is testing necessary after exposure?

People 2 years of age and older should get tested 3-5 days after exposure to someone with COVID-19 (Day 0 is the day of exposure, and Day 1 is the first full day after exposure).
They may also consider getting tested earlier, when notified of the exposure, but if negative, should re-test 3-5 days after. People who have recovered from COVID-19 within the last 90 days and have no symptoms should not test. Every person who develops new symptoms should test immediately. For additional information, please see CDPH Guidance for Local Health Jurisdictions on Isolation and Quarantine of the General Public.

Additional details for exposed children are available in CDSS/CDPH Child Care Guidance and in the Child Care Decision Tree for Exposed Child.

In the workplace, employers are subject to the Cal/OSHA COVID-19 Prevention Emergency Temporary Standards (ETS) and should consult those regulations for any applicable requirements for covered workers.

What should a Family Child Care Home provider do if they test positive?

Infected providers should follow isolation guidelines in the CDPH Guidance for Local Health Jurisdictions on Isolation and Quarantine of the General Public

If a family child care provider is infected, the provider should close the child care during their isolation period unless they can isolate from child care attendees and other staff and follow the isolation recommendations for infected household members in question #8 below. Uninfected, asymptomatic staff can provide care for the children while the family child care provider is isolating.

What should a Family Child Care Home provider do if they are exposed?

Exposed providers without symptoms do not need to quarantine, but should follow recommendations in CDPH Guidance for Local Health Jurisdictions on Isolation and Quarantine of the General Public, and any applicable requirements in the Cal/OSHA ETS, including testing and wearing a well-fitting mask around others for a total of 10 days.

What if someone in the home of a family child care home provider is infected with COVID-19?

If the infected household member can be isolated from child care attendees and staff, the provider can continue to provide child care as long as the provider is not infected and has no symptoms.

  • The infected household member should stay in a specific "sick room" or area away from child care attendees and staff and out of any shared spaces with attendees and staff, even if they are not in those spaces at the same time. 

  • The infected household member should wear a well-fitting mask when child care attendees and staff are present in home and avoid any contact or shared airspace with attendees or others in the home.

  • When possible, the infected household member should use a separate bathroom. If a bathroom must be shared, it must be cleaned and disinfected after each use by the infected person, with an exhaust fan, portable air cleaner/purifier, or window open to outside air (if safe to do so), to improve ventilation.

  • Ventilation, especially in areas where attendees are located, should be maximized by opening windows, when possible and safe to do so, and/or using portable air cleaners and exhaust fans.

If the infected household member cannot be isolated from child care attendees and staff, the provider should suspend child care services until the household member completes isolation. Licensed providers must avoid exposing children in care to someone showing symptoms of an infectious illness or disease, as per Title 22 licensing regulations.

How many cases or exposures would cause a child care facility to close? How long is the required closure?

There is not a specific number of cases that would result in a closure or a specific length of closure required by the state. Any necessary closures and re-openings are determined on a case-by-case basis in accordance with local public health guidance and Title 22 licensing regulations. Child care providers should confer with their local health department and local licensing office to determine if closure is necessary.  

What are the recommendations for isolation in child care?

Child care facilities should follow CDPH Guidance for Local Health Jurisdictions on Isolation and Quarantine of the General Public with the following exceptions, as noted in the CDSS/CDPH Child Care Guidance:

  • Children less than 2 years of age are permitted to discontinue isolation after Day 5.

    • Such children do not need to be tested before discontinuation of isolation and should not mask at any time.

  • Children 2 years of age and older are also permitted to discontinue isolation after Day 5.

    • Testing is recommended at Day 5.

    • Mask-wearing (except while eating or napping) is strongly recommended through Day 10.

    • See the Decision Tree for when a child is feeling sick or tests positive on the California Safe Schools for All Hubs page for additional information on isolation.

  • Employees should follow the recommendations for isolation and quarantine and any other requirements by Cal/OSHA and local public health.

  • To determine number of isolation days, Day 0 is the day of symptom onset or the day of specimen collection for the positive test in persons without symptoms.

Testing

What is the difference between an antigen test and a molecular (PCR, LAMP, NAAT) test?

Both tests can detect infection with COVID-19.

An antigen test takes 15-30 minutes for results and identifies higher levels of virus (when people are more likely to give COVID-19 to others). Antigen testing is usually done with a nose swab, can be done at home, and may be less accurate in people without symptoms. Because antigen tests provide results quickly, they are generally helpful for child care facilities.  Persons who are currently infected with COVID-19 or those within 90 days of being infected are encouraged to use antigen tests (instead of molecular tests) because molecular tests may stay positive for weeks or months after infection. 

A molecular test (PCR, LAMP, NAAT) typically takes 1-3 days for results and can identify even very small levels of virus that may no longer be infectious. Samples can be collected at home but must be sent to a laboratory.

More information is available on Updated Testing Guidance.

Testing Resources

 What resources are available to families to get at-home COVID-19 antigen tests to help with home testing?

  • Order free tests through the mail from the United States Post Office website. 

  • Medi-Cal or Medicare?  Bring your card to the window of any pharmacy to ask for 8 free tests per person per month.

  • Private insurance? Ask your insurance company how to get 8 free tests per person per month.

What resources are available to assist child care providers in establishing a COVID-19 testing program?

The California Testing Task Force (TTF) currently supports three testing programs:

  • At-home antigen testing (aka over-the-counter tests): good for any size child care facility, ages 2 and up, results in 15-30 minutes, child's swab and test is done by their family, staff may only test themselves.

  • On-site antigen tests: performed by child care staff who have been trained to administer a COVID-19 antigen test, good for larger child care facilities (at least 30 children), results in 15 minutes. 

    • Please note: a credentialed professional is required to perform testing on children younger than 5 years of age. Acceptable credentials include: Physician Assistant, Registered Nurse, Licensed Vocational Nurse, supervised Medical Assistant, Psychiatric Technician

  • Molecular tests: do not typically provide rapid results.  Results usually are available in 1-3 days, NO credentialed professional required, and parent/guardian can swab child.

How do I know if Antigen at-home tests are available from my local Resource and Referral (R&R) Agency?

Contact your local Child Care Resource and Referral Agency (R&R) to request COVID-19 tests, along with other Personal Protective Equipment (PPE) supplies that the R&R are distributing. In some areas, if R&Rs are not distributing, they may ask you to contact your local health department or the Testing Task Force.

Who can help children swab their nose for an at-home antigen test?

Parents or guardians may assist children with swabbing. Providers and child care staff cannot assist in the testing process, but they may ask to observe the swabbing, the test process, or a time-stamped photo of results.  At-home antigen tests currently do not have FDA authorization for children under 2 years of age, and most have instructions for a parent or guardian to assist children under 16 years of age.  

Face Coverings/Masks

How can children 2 years of age and older use masks properly?

Please see these resources:

Personal Protective Equipment

What State resources are available for PPE (Personal Protective Equipment) for child care providers?

Community Care Licensing Division (CCLD), Child Care Program (CCP) is partnering with R&R Agencies throughout the State of California to assist in distribution of COVID-19 PPE to child care providers.

Providers may contact their local Child Care Resource and Referral Agencies or local First 5 offices for information about obtaining PPE and supplies.

Requirements and Recommendations

What are the requirements that child care licensees must follow?

CDPH has requirements applicable to child care providers and programs in Orders of the State Public Health Officer. Cal/OSHA requirements are set forth in the COVID-19 Prevention Emergency Temporary Standards (ETS). 

CDSS requirements for licensed providers are set forth in Title 22 licensing regulations and the Health and Safety Code and include a requirement to report COVID-19 positive cases to the CCLD Child Care Program.

Local health departments may have additional requirements. Therefore, child care providers should always check with their local health department due to variation in requirements across the state. Implementation of this guidance should be adapted for the setting in which care is provided and may require training and support for staff, with adequate consideration of the needs of children and their families.

What are recommended practices for addressing COVID-19 in child care?

Guidance from CDPH, including current CDPH Guidance for Local Health Jurisdictions on Isolation and Quarantine of the General Public and additional materials referenced in response to the questions in this FAQ document, are recommendations. CDPH Guidance for the Use of Face Masks has updated mask information.

If a local health department has stricter child care guidance than the state, which takes precedence and should be followed?

The stricter guidance should be followed. Child care licensees must comply with any local public health orders or required guidelines.