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Date of Order: April 16, 2020
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Attachment A – Patient Care Facilities this Order applies to
- Psychiatric Health Facilities
- Acute Psychiatric Hospitals
- Crisis Stabilization Units
- Federally Qualified Health Centers
- Skilled Nursing Facilities
- Urgent Care Centers
- Ambulatory surgical centers
- Intermediate care facilities (all license types)
- Hospice Facilities
- Chronic Dialysis Centers
- Community Clinics
Attachment B – Other Congregate Living Settings this order applies to
- Residential Care Facilities for the Elderly
- Social Rehabilitation Facilities
- Adult Residential Facilities (ARF) (all license types)
- Continuing Care Retirement Facilities (Assisted Living)
- Juvenile Probation Camp
- Residential Facilities for the Developmentally Disabled
- Residential Facilities for Substance Use Disorder Treatment and Detox
- Community Crisis Home
Please read this Order carefully. Violation of or failure to comply with this Order is a crime punishable by fine, imprisonment, or both. (Health and Safety Code § 120295, et seq.)
UNDER THE AUTHORITY OF CALIFORNIA HEALTH AND SAFETY CODE SECTIONS 101040, 101085, AND 120175, THE HEALTHOFFICER OF THE COUNTY OF SONOMA (“HEALTH OFFICER”) ORDERS:
- This Order becomes effective as of 12:01 a.m. on April 17, 2020 and continues in effect until rescinded, superseded, or amended in writing by the Health Officer or by the State Public Health Officer.
- This Order is issued in accordance with, and incorporates by reference: the March 2, 2020 Proclamation of a Local Emergency by the Director of Emergency Services of the County of Sonoma, ratified by the Sonoma County Board of Supervisors on March 10, 2020; the March 2, 2020 Declaration of Local Health Emergency Regarding the Novel Coronavirus 2019 (COVID-19) issued by the Health Officer and ratified by the Sonoma County Board of Supervisors on March 10, 2020; the declaration of a state of emergency by California Governor Gavin Newsom on March 4, 2020; the March 11, 2020 declaration of a global pandemic by the World Health Organization; the March 13, 2020, Health Officer Order Restricting Visitation at Residential Care Facilities; the March 31, 2020 Health Officer Extending the Shelter in Place Order; the April 13, 2020 Health Officer Order Requiring the Public to Wear Facial Coverings; add County’s SIP order, County’s facilities visitor order, County’s facial masking order; the April 6, 2020 Health Officer Guidance on Surgical Masking for Health Care Workers and First Responders; the March 19, 2020 Governor’s Executive Order regarding Shelter in Place; and the March 13, 2020 Presidential Declaration of a National Emergency.
- The Sonoma County Health Officer has determined that there is an increased risk of the Coronavirus 2019 Disease (“COVID-19”) among persons living or working in licensed healthcare facilities, residential care facilities, shelters, group homes and other congregate living facilities. Social distancing alone in these facilities is not effective due to the concentration of individuals and the nature of the services provided. To help slow the spread of COVID-19 and protect vulnerable individuals and critical workers, and prevent the healthcare system in the County of Sonoma from being overwhelmed, it is necessary for the Health Officer to direct the implementation of additional preventative measures.
- This Order is issued based on scientific evidence and best practices as currently known and available to prevent the spread of the virus that causes “COVID-19 to the residents and workers in congregate living facilities. The age, condition, and health of a significant majority of adult residents living in certain congregate settings and care facilities place those residents at particularly high risk of experiencing serious health complications from COVID-19, including death.
- COVID-19 can easily spread between people who are in close contact with one another. There is growing evidence of transmission risk from infected persons before the onset of symptoms. Thus, all individuals who contract COVID-19, regardless of their level of symptoms (none, mild or severe), may place other vulnerable members of the public and critical health care workers and first responders at significant risk.
- Because COVID-19 is spread through respiratory droplets that are produced when an infected person coughs, sneezes or talks, covering the nose and mouth of an infected person can slow or prevent the spread of the virus. Even a small reduction in community transmission could make a major difference to the demand on the healthcare system.
- This Order is based on substantial guidance from the Centers for Disease Control and Prevention (“CDC”), the California Department of Public Health and other public health officials throughout the United States and around the world about the symptoms that may be related to COVID-19.
- This Order is issued in light of the existence of 163 cases of COVID-19 in the County as well as 2 fatalities, as of April 16, 2020. The County has confirmed through testing that every section of the County suffers from infection.
- This Order is necessary because COVID-19 is highly contagious and has a propensity to spread person to person and by attaching to surfaces or remaining in the air, resulting in property loss or damage.
Residents/Patients Not Covered By This Order:
- The preventative measures required by this Order do not apply to patients or existing or new residents of congregate care facilities, but only to persons entering such facilities who are not patients, or existing or new residents.
- Self-Evaluation. Immediately prior to entering a facility in Sonoma County described in Attachment A or Attachment B, all individuals shall self-evaluate for mild to moderate symptoms related to COVID-19, or other respiratory illness. The symptoms that must be included in this self-evaluation are sore throat, coughing, shortness of breath, runny nose in the absence of known allergies, unusual headaches, severe fatigue, fever, chills, gastro-intestinal symptoms such as diarrhea or stomach cramps, or loss of sense of smell or taste. Upon entry to the facility, the individual shall immediately report the results of the symptom self-evaluation to the Facility or Agency Operator or designee.
- Temperature screening. All individuals entering a facility in Sonoma County listed in Attachment A or Attachment B shall submit to a temperature screening immediately prior to entering the facility. The temperature screenings shall be conducted by the operator of the facility or agency or his or her designee utilizing the least intrusive means possible.
- Prohibition of Entry. No individual who is not a patient or existing or new resident at a facility shall enter the facility listed in Attachment A or Attachment B if: 1) through self-evaluation the individual identifies he/she has symptoms or 2) a temperature screening of the individual results in a temperature of 100.0 F or 37.8 C or greater, or the person feels like they are running a fever.
- Masking Patient Care Facilities. Each staff member or authorized visitor of a facility listed in Attachment A shall cover his or her nose and mouth with a medical-grade isolation or surgical mask at all times while in the facility. To preserve limited medical-grade mask supplies, the Facility or Agency Operator or designee may exempt certain staff members from this requirement who work in areas with no contact with patients or patient care staff. Exempt staff must wear fabric or cloth facial covering and must launder the covering after each shift before use. The Facility Operator or designee shall post the list of exempted staff at the entrance to the facility and shall provide the list to the Health Officer upon request.
- Masking Non-Patient Care Congregate Settings. Each staff member or authorized visitor of a facility listed in Attachment B shall cover his or her nose and mouth with a facial covering made from fabric or cloth. If medical-grade masks are available, those may be used in lieu of a cloth or fabric facial covering. If a cloth covering is used, it must be laundered after each shift before reuse.
Other Preventative Measures Applicable To Patient Care Facilities:
- Physical Distancing. Residential group activities and communal dining shall be discontinued at facilities listed in Attachment A.. Staff members of and visitors to a facility shall practice physical distancing by remaining at least six feet apart from other persons unless caring for a resident. This includes while on breaks or at meals. Facilities may need to stagger break and meal times for staff to accommodate this order. The facility operator shall direct staff members to provide instruction to residents about physical distancing. All residents of a facility shall practice physical distancing by remaining at least 6 feet apart from other persons when out of their rooms.
- Multiple Facilities. Facilities listed in Attachment A should avoid by any means possible utilizing employees or staff who have worked at another facility within the past 14 days. If this is not feasible, the facility operator shall keep a daily log that shows, for each employee, all of the facilities where the employee has worked in the past 14 days. The log shall be produced immediately upon demand by any authorized representative of the Health Officer.
- Multiple Facilities Protective Measures. If an individual works at or provides services for more than one facility listed in Attachment A, the individual must shower and change clothes and shoes prior to starting a shift at a second facility. The facility or agency must identify those individuals who work at or provide services for more than one facility and make available a shower and changing area that can be accessed before the individual enters any common area where staff and patients congregate. A staff locker room with a shower can meet this obligation, if staff can pass through the facility quickly without contacting other individuals on the way to the locker room.
EMS Providers/First Responders
- Emergency Medical Services (“EMS”) and First Responders On Site: If emergency or other medical transport of a patient or resident is required, the facilities listed in Attachment A and Attachment B shall endeavor to move the patient or resident requiring transport to the nearest ambulance-accessible entry way, to the extent consistent with medically appropriate patient care.
- EMS/First Responder Masking. Staff and volunteers for EMS providers and any individual who is a “first responder” must wear medical-grade masks while responding to a call or engaging in activities that involve interaction with the public or patients. Staff and volunteers for EMS providers and any individual who is a “first responder” may wear a fabric or cloth facial covering instead of a medical grade mask when they are engaging in activities that only involve interaction or close proximity to a co-worker, such as riding in a vehicle. “First responders” includes persons who provide 24/7 emergency response, first aid care, or other related assistance either in the course of the person’s occupational duties or as a volunteer, such as peace officers, emergency medical technicians, firefighters, rescue workers, certain social workers, and certain animal control officers.
- EMS/First Responder Self-Evaluation and Screening. Before commencing duty, all staff and volunteers for EMS providers and all first responders as defined in Paragraph 20, shall conduct both a self-evaluation screening in accordance with Paragraph 11, and shall submit to a temperature screening in accordance with Paragraph 12. No individual shall be on duty if through self-evaluation the individual identifies he/she has symptoms or a temperature screening of the individual results in a temperature of 100.0 F or 37.8 C or greater, or the person feels like they are running a fever. Nothing in this Order prevents an EMS provider or an employer of a “first responder” from requiring more frequent temperature or symptom checks.
- Masking at Fire Stations. While on duty at a fire station, staff and volunteers for EMS providers and any “first responder” as defined in Paragraph 20, need not wear a facial covering while within the footprint of the fire station, provided that: 1) the fire station is closed to the public and no person who is not on duty at the station enters the station; 2) the individuals on duty at the station comply with the Social Distancing and Hygiene Requirements set forth in Order No. C19-05; 3) duty boots are disinfected prior to entry or are left outside of the fire station; and 4) a schedule is established and enforced to stagger workouts, meals, computer access, and bathroom use to minimize interactions between individuals on duty. Nothing in this Order prevents an individual on duty at a fire station from voluntarily wearing a facial covering.
- Medical-grade masks do not need to be changed on a daily basis. They can be used for up to one week, unless soiled, torn, unable to cover mouth/nose, or otherwise compromised.
- A copy of this Order shall be posted at all entrances to each facility listed in Attachment A or Attachment B immediately upon receipt.
- Pursuant to Government Code sections 26602 and 41601 and Health and Safety Code section 101029, the Health Officer requests that the Sheriff and all chiefs of police in the County ensure compliance with and enforce this Order. The violation of any provision of this Order constitutes an imminent threat and menace to public health, constitutes a public nuisance, and is punishable by fine, imprisonment, or both.
- Copies of this Order shall promptly be 1) made available at the County Administration Center at 575 Administration Drive, Santa Rosa, CA 95403; 2) posted on the Sonoma County Public Health Department website and SoCoEmergency website; and 3) provided to any member of the public requesting a copy.
- If any provision of this Order or its application to any person or circumstance is held to be invalid, the remainder of the Order, including the application of such part or provision to other persons or circumstances, shall not be affected and shall continue in full force and effect. To this end, the provisions of this Order are severable.
IT IS SO ORDERED:
Dr. Sundari R. Mase, MD, MPH
Health Officer, County of Sonoma