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DHS COVID-19 PROVIDER GUIDANCE // OCDEL

Announcement 20-12: Interim Guidance for Certified Child Care Facilities operating during the Novel Coronavirus Pandemic

Issued: September 29, 2020; Effective: Immediately

Audience

Certified Child Care Facilities, Early Learning Resource Centers, Office of Child Development and Early Learning Staff

Purpose

This announcement replaces in its entirety, C-20-06-Revised.

To provide certified child care facilities with interim guidance for operating a facility during the Novel Coronavirus (COVID-19) pandemic. This guidance covers policies and procedures providers should implement during the COVID-19 pandemic. It also provides certified child care facilities with guidance on how to handle a positive COVID-19 case or exposure to a positive COVID-19 case in child care facilities. This announcement replaces C-20-06R and includes updated guidance from the Centers for Disease Control and Prevention (CDC).

Background

Following the Proclamation of Disaster Emergency issued on March 6, 2020, by Governor Tom Wolf, statewide mitigation efforts were put in place to slow the spread of COVID-19. As the pandemic situation evolves, the Office of Child Development and Early Learning (OCDEL) acknowledges the need to provide up to date operational guidance for child care based on new information and guidelines from the Pennsylvania Department of Health (DOH) and the CDC.

Discussion

Child care facilities that continue to remain open or that are preparing to reopen should follow the guidance issued by the CDC and the DOH. The guidance details the steps providers are recommended to follow in order to mitigate the impact of COVID-19 on child care facilities. OCDEL developed this guidance based on recommendations from the CDC and DOH and it is subject to change. Health and safety guidance for child care facilities operating during COVID-19 is outlined in this document. In cases where local health department guidance is not fully aligned with OCDEL guidance, programs should adhere to the most stringent guidance. Please visit DOH and CDC for the most up to date information on COVID-19.

Topics addressed in this guidance include:

      1. Reopening
      2. Transmission
      3. Symptoms of COVID-19
      4. Practices, Policies, and Procedures for Consideration
      5. Social Distancing in the Child Care Setting
      6. Face Coverings
      7. Dealing with confirmed positive COVID-19 cases and exposure to COVID-19
      8. Reporting
      9. Additional Resources

Re-opening

Child care providers should understand the aspects of reopening or continuing to operate during COVID-19. Additional policies and procedures must be put in place to protect the health and safety of children in care while maintaining a safe environment for child care employees and families. The CDC has developed a decision tool to assist in operating and reopening decisions during these unique circumstances. Child care providers should review and plan for the implementation of the CDC and DOH guidelines before reopening. It is suggested that child care providers develop and publicly post their implementation strategies to mitigate the further spread of COVID-19 and to inform parents of new procedures and expectations.

Transmission

COVID-19 is mostly spread by respiratory droplets released when people talk, cough, or sneeze. It is thought that the virus may spread to hands from a contaminated surface and then to the nose or mouth, causing infection. Therefore, prevention practices and environmental cleaning and disinfection are important principles that are covered below.

Symptoms of COVID-19

People with COVID-19 have had a wide range of symptoms reported. Symptoms may appear 2-14 days after exposure to the virus. The chart below defines the criteria for a COVID-19 like illness:

A COVID-like illness is defined as:​
​At least ONE of these symptoms:
​OR
​At least TWO of these symptoms
  • ​New or persistent cough
  • Shortness of breath
  • New loss of sense of smell
  • New loss of sense of taste
  • ​Fever over 100.4 degrees Fahrenheit
  • Chills
  • Muscle pain
  • headache
  • Sore thoat
  • Nausea/vomitting
  • Diarrhea
  • Fatigue
  • Congestion/runny Nose

Please continue to follow normal exclusion protocols for infectious diseases outside of COVID-19. When applicable, children suspected of an infectious illness shall be excluded pursuant to 55 Pa. Code §3270.137, §3280.137, and §3290.137 relating to children with symptoms of disease.

Practices, Policies, and Procedures for Consideration

All guidance below is strongly recommended in order to adhere to guidelines published by the CDC and DOH.

Drop-off/Arrival Procedures

Child care programs are strongly recommended to:

      • Post signage in drop-off/arrival area to remind all facility persons and children to keep six feet of distance whenever feasible. Parents should wear a face covering during drop-off and pick-up unless one of the exemptions in Section 3 of the Order of the Secretary of the Pennsylvania Department of Health Order for Universal Face Coverings applies.
      • Ideally, the same parent or designated person should drop off and pick up the child every day. If possible, individuals with serious underlying medical conditions should not pick up children because they are more at risk.
      • Set up hand hygiene stations at the entrance of the facility, so that children, facility persons, and parents can clean their hands before they enter. If a sink with soap and water is not available, provide hand sanitizer with at least 60 percent alcohol next to parent sign-in sheets.
      • Keep hand sanitizer out of children’s reach and supervise use. If possible, place sign-in stations outside, and provide sanitary wipes for cleaning pens between each use.
      • Consider staggering arrival and drop off times and plan to limit direct contact with parents as much as possible.
      • Consider greeting children outside as they arrive.
      • Consider designating a child care staff person to be the drop off/pick up volunteer to walk all children to their classroom, and at the end of the day, walk all children back to their cars.
      • Transport Infants in their car seats.

Screening Procedures

The best way to prevent the spread of COVID-19 is to prevent it from getting inside the facility.

Child care providers must:

      • Conduct a daily health screening of any person entering the building, including children, facility persons, family members, and other visitors to identify symptoms, diagnosis, or exposure to COVID-19.
      • Not allow facility persons, children, family members, or visitors to enter the child care facility if:
            • They have tested positive for or are showing COVID-19 symptoms as outlined in the above chart; or
            • They have recently had potential exposure with a person with COVID-19.
                • A potential exposure means being in a household or having close contact within six feet of an individual with a confirmed or suspected COVID-19 case for at least 15 minutes during the case’s infectious period.
                • Persons with COVID-19 are considered infectious from two days before onset of symptom until the end of isolation (discussed below in “Discontinuing at home isolation”).
      • Continue to monitor all facility persons and child health throughout the day.
      • Immediately isolate a child or facility person that develops COVID-19 symptoms as outlined in the above chart and send them and any family members home as soon as possible.
      • While waiting for a sick child to be picked up, if the child has symptoms of COVID-19, the caregiver should remain as far away as safely possible from the child (preferably six feet) while maintaining supervision. The caregiver must wear a cloth face covering. If the child is over the age of 2 and can tolerate a face covering, the child should also wear a cloth face covering.
See Return to Care section below for guidance for readmission to child care 

Examples of Screening Methods

There are several methods that facilities can use to protect their workers while conducting temperature screenings. The most protective methods incorporate social distancing (maintaining a distance of six feet from others) or physical barriers to eliminate or minimize exposures due to close contact to a child who has symptoms during screening.

Reliance on Social Distancing (Example 1)

      • Ask parents/guardians to take their child’s temperature either before coming to the facility or upon arrival at the facility. Upon their arrival, stand at least six feet away from the parent/guardian and child. Parents should wear a face covering during drop-off and pick-up unless one of the exemptions in Section 3 of the Order of the Secretary of the Pennsylvania Department of Health Order for Universal Face Coverings applies.
      • Ask the parent/guardian to confirm that the child does not meet the symptom criteria as outlined above.
      • Make a visual inspection of the child for signs of illness as outlined in the above chart

Reliance on Barrier/Partition Controls (Example 2)

      • Stand behind a physical barrier, such as a glass or plastic window or partition that can serve to protect the facility persons mouth, nose and eyes from respiratory droplets that may be produced if the child being screened sneezes, coughs, or talks.
      • Make a visual inspection of the child for signs of illness as outlined in the above chart.
            • Conduct temperature screening (follow steps below)
            • Perform hand hygiene.
            • Wash your hands with soap and water for 20 seconds. If soap and water are not available, use a hand sanitizer with at least 60 percent alcohol.
      • Put on disposable gloves.
      • Check the child’s temperature, reaching around the partition or through the window.
      • Make sure your face stays behind the barrier at all times during the screening.
      • If performing a temperature check on multiple individuals, ensure that you use a clean pair of gloves for each child and that the thermometer has been thoroughly cleaned in between each check.
      • If you use disposable or non-contact (temporal) thermometers and you did not have physical contact with the child, you do not need to change gloves before the next check.
      • If you use non-contact thermometers, clean them with an alcohol wipe (or isopropyl alcohol on a cotton swab) between each client. You can reuse the same wipe as long as it remains wet.

If social distancing or barrier/partition controls cannot be implemented during screening, personal protective equipment (PPE) can be used when within six feet of a child. However, reliance on PPE alone is a less effective control and more difficult to implement, given PPE shortages and training requirements.

      • Upon arrival, wash your hands and put on a facemask, eye protection (goggles or disposable face shield that fully covers the front and sides of the face), and a single pair of disposable gloves. A gown or an oversized long-sleeved shirt could be considered if extensive contact with a child is anticipated.
      • Make a visual inspection of the child for signs of illness as outlined in the above chart.
      • Take the child’s temperature.
            • If performing a temperature check on multiple individuals, ensure that you use a clean pair of gloves for each child and that the thermometer has been thoroughly cleaned in between each check.
            • If you use disposable or non-contact (temporal) thermometers and did not have physical contact with an individual, you do not need to change gloves before the next check.
            • If you use non-contact thermometers, clean them with an alcohol wipe (or isopropyl alcohol on a cotton swab) between each client. You can reuse the same wipe as long as it remains wet.
      • After each screening, remove and discard gloves. Use an alcohol-based hand sanitizer that contains at least 60% alcohol or wash hands with soap and water for at least 20 seconds
      • If hands are visibly soiled, soap and water should be used before using alcohol-based hand sanitizer.
      • If your staff does not have experience in using PPE:
            • Check to see if your facility has guidance on how to put on and take off PPE. The procedure to put on and take off should be tailored to the specific type of PPE that you have available at your facility.
            • If your facility does not have specific guidance, the CDC has recommended steps for putting on and taking off PPE.

Routine disinfecting/sanitization procedures: 

Child care facilities should post signs in highly visible locations (e.g., facility doors, lobby, restrooms) that promote everyday protective measures and describe how to stop the spread of COVID-19 such as by properly washing hands and properly wearing a cloth face covering. Resources for signage for handwashing can be found here. Signage for face coverings can be found here

Caring for Our Children (CFOC) provides national standards for cleaning, sanitizing and disinfection of educational facilities for children. Toys that can be put in the mouth must be cleaned and sanitized (see “Intensify cleaning and disinfection efforts” below). Other hard surfaces, including diaper changing stations, doorknobs, and floors can be disinfected.

Intensify cleaning and disinfection efforts

      • Facilities must develop a schedule for cleaning and disinfecting. An example can be found here.
      • Routinely clean, sanitize, and disinfect surfaces and objects that are frequently touched, especially toys and games. This may also include cleaning objects/surfaces not ordinarily cleaned daily such as doorknobs, light switches, classroom sink handles, countertops, nap pads, toilet training potties, desks, chairs, cubbies, and playground structures. Use the cleaners typically used at your facility. Guidance is available for the selection of appropriate sanitizers or disinfectants for child care settings.
      • Use all cleaning products according to the directions on the label. For disinfection, most common EPA-registered, fragrance-free household disinfectants should be effective. A list of products that are EPA-registered for use against the virus that causes COVID-19 is available here. If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
      • All cleaning materials must be kept secure and out of reach of children per regulations.
      • Cleaning products must not be used near children, and child care staff should ensure that there is adequate ventilation when using these products to prevent children from inhaling toxic fumes.

Clean and Sanitize Toys

      • Toys that cannot be cleaned and sanitized should not be used.
      • Toys that children have placed in their mouths or that are otherwise contaminated by body secretions or excretions should be set aside until they are cleaned by hand by a person wearing gloves. Clean with water and detergent, rinse thoroughly, sanitize with an EPA-registered disinfectant, rinse thoroughly again, and air-dry. You may also clean in a mechanical dishwasher.
      • Machine washable cloth toys should be used by one individual at a time or should not be used at all. These toys should be laundered before being used by another child.
      • Do not share toys with other groups of infants or toddlers, unless they are washed and sanitized before being moved from one group to the other.
      • When setting aside toys that need to be cleaned, place in a dish pan with soapy water or put in a separate container marked for “soiled toys.” Keep dish pan and water out of reach from children. Washing with soapy water is the ideal method for cleaning. Try to have enough toys so that the toys can be rotated through cleanings.
      • Use bedding that can be washed. Keep each child’s bedding separate, and consider storing in individually labeled bins, cubbies, or bags. Cots and mats must be labeled for each child. Bedding that touches a child’s skin should be cleaned weekly or before use by another child.
      • When possible, bedding should be laundered by the facility to reduce the back and forth transportation between the child’s home and the facility.

Social Distancing in the Child Care Setting

If possible, child care classes should include the same group each day, and the same child care providers should remain with the same group each day. If your child care program remains open, consider creating a separate classroom or group for the children of healthcare workers and other first responders. Cancel or postpone special events such as festivals, holiday events, and special performances.

      • Consider whether to alter or halt daily group activities that may promote transmission. Keep each group of children in a separate room.
      • Limit the mixing of children, such as staggering playground times and keeping groups separate for special activities such as art, music, and exercising.
      • If possible, at nap time, ensure that children’s naptime mats (or cribs) are spaced out as much as possible, ideally six feet apart. Consider placing children head to toe in order to further reduce the potential for viral spread.

Face Coverings

With the exception of children 2 years old and younger, all persons in a childcare facility are required to wear a face covering pursuant to the Order of the Secretary of the Pennsylvania Department of Health Order for Universal Face Coverings, unless one of the exceptions included in Section 3 of the Order applies.

If a child is outdoors and able to consistently maintain a social distance of at least six feet from individuals who are not a part of their household, they do not need to wear a face covering.

If a parent, guardian, or responsible person has been unable to place a face covering safely on the child's face, they should not do so.

If a child 2 years old or older is unable to remove a face covering without assistance, the child is not required to wear one.

The Department of Health recognizes that getting younger children to be comfortable wearing face coverings and to keep them on may create some difficulties. Under these circumstances, parents, guardians, licensed child care providers in community-based and school settings or responsible persons may consider prioritizing the wearing of face coverings to times when it is difficult for the child to maintain a social distance of at least six feet from others who are not a part of their household (e.g., during carpool drop off or pick up, or when standing in line at school). Ensuring proper face covering size and fit and providing children with frequent reminders and education on the importance and proper wearing of cloth face coverings may help address these issues. 

Dealing with Confirmed or Probable COVID-19 CAses and Exposure to COVID-19 

The following pertains to all facility persons, household members residing in a group child care home or family child care home, and children at a child care facility who either test positive for COVID-19 (confirmed case) or who have been exposed to someone with COVID-19 and have developed symptoms (probable case). 

For COVID-19 cases:

      • If the child is in care when the test results are confirmed positive, the child must be isolated until the appropriate party arrives to pick them up.
      • Follow the “Discontinuing at home isolation” guidance below for timelines on returning to the child care setting.
      • If a facility person or child tests positive for COVID-19, areas used by the person who tested positive must be closed for a period of 24 hours following the confirmed positive COVID-19 case of child or facility person in attendance so that the facility can be cleaned and disinfected properly. Close contacts as defined below, must self-quarantine.
      • If a facility person or child becomes ill with COVID-19 like symptoms as defined above, close off areas used by the person who is sick and clean and disinfected properly.
            • The individual should be evaluated by their healthcare provider immediately.
            • If the individual tests positive upon further evaluation by a healthcare provider, follow guidance under Exposure to a person who tests positive for COVID-19.
      • The operator shall inform parents of enrolled children when there is a suspected outbreak of a communicable disease or an outbreak of an unusual illness that represents a public health emergency in the opinion of the Department of Health as per 55 Pa. Code §3270.136(b), §3280.136(b), and §3290.136(b).
            • An outbreak is defined as a single positive COVID-19 case.
      • The facility must report positive COVID-19 cases to the Department of Health (DOH) as per 55 Pa. Code §3270.136(d), §3280.136(d), and §3290.136(d), EXCEPT in the counties listed below on page 13. Facilities within the counties listed on page 13 must report positive COVID-19 cases to their local health department, who will in turn report this information to DOH. 
      • The facility must report positive COVID-19 cases and positive COVID-19 cases that result in death to their Department of Human Services (DHS) Certification Representative.
      • The facility must utilize the DHS Licensed Facility COVID Data Collection Tool. Facilities who do not have access to the DHS Licensed Facility COVID Data Collection Tool will inform their DHS Certification Representative to ensure the information is entered into the COVID Data Collection Tool by DHS personnel.
      • The facility must develop a process to inform facility persons of positive COVID-19 cases within the facility.

Exposure to a person who tests positive for COVID-19:

Exposure is defined as being within six feet of the individual who tests positive for COVID-19 for a period of 15 minutes or more. It also means coming into direct contact with droplets from a COVID-19 positive individual. Persons who test positive are considered infectious 48 hours before the onset of symptoms. Persons testing positive but who do not have symptoms are considered infectious 2 days after exposure (if known) or starting 2 days before test date (if exposure is unknown).

If a facility person, household member, or a child is exposed to an individual who tests positive for COVID-19:

      • They shall self-quarantine for a period of 14 days based on the CDC guidance.
      • If a child becomes ill at the facility, the operator shall notify the child’s parent as soon as possible.
      • The operator shall inform parents of enrolled children when there is a suspected outbreak of a communicable disease or an outbreak of an unusual illness that represents a public health emergency in the opinion of the Department of Health as per 55 Pa. Code §3270.136(b), §3280.136(b), and §3290.136(b).
      • The facility must report to their DHS Certification Representative when a facility person, child, or household member is exposed to a positive COVID-19 case.
      • The facility must utilize the DHS Licensed Facility COVID Data Collection Tool. Facilities who do not have access to the DHS Licensed Facility COVID Data Collection Tool will inform their DHS Certification Representative to ensure the information is entered into the COVID Data Collection Tool by DHS personnel.
      • If a facility person/child is a potential exposure AND has COVID-19 like symptoms as defined above, please report to DOH or your local health department.
      • The facility must develop a process to inform facility persons of possible exposure to a positive COVID-19 case.

Return to Care

Children and facility persons identified as ill on screening or who are sent home for being symptomatic

Children or facility persons who meet criteria for illness on screening or who become ill while at the facility and are sent home should be referred to their healthcare provider for evaluation.

For facility persons and children, who are not currently a close contact or quarantined, presenting with symptoms that may be associated with COVID-19 may return to a facility when:

      • Symptomatic child/facility persons who is not tested: exclude for 10 days from symptom onset AND at least 24 hours after fever resolution (if present) without the use of fever reducing medication AND improved respiratory symptoms.
      • Symptomatic child/facility persons determined by a health care provider to have an illness other than COVID-19: exclude until without a fever for 24 hours (if fever present) without the use of fever reducing medication and symptoms improving.
      • Symptomatic child/facility persons with test negative: exclude until without a fever for 24 hours (if fever present) without the use of fever reducing medication AND improved respiratory symptoms.

Discontinuing at home isolation:

A symptom-based strategy (i.e., time-since-illness-onset and time-since-recovery strategy) is the only recommended strategy in discontinuing at home isolation. A test-based strategy is no longer recommended to determine when to discontinue home isolation, except in certain circumstances as determined by a healthcare provider.

Symptom-Based Strategy

Individuals with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:

      • At least 1 day (24 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in symptoms; and,
      • At least 10 days have passed AFTER symptoms first appeared.

For Persons Who Tested Positive for COVID-19 but have NOT had COVID-19 Symptoms in Home Isolation:

Persons with laboratory-confirmed COVID-19 who have not had any symptoms and were directed to care for themselves at home may discontinue isolation after no less than 10 days have passed since the date of their first positive COVID-19 diagnostic test, provided no symptoms have developed during that 10-day period.

Reporting

On August 28, 2020, OCDEL launched the Licensed Facility COVID Data Collection Tool. Although this tool has been launched, continue to notify your certification representative of exposure and/or new positive cases of COVID-19. Utilize the link above for the most recent information relating to this tool. Facilities who do not have access to the DHS Licensed Facility COVID Data Collection Tool will inform their DHS Certification Representative to ensure the information is entered into the COVID Data Collection Tool by DHS personnel

In all instances when reporting to DHS, please provide:

      • The name of the facility;
      • The address of the facility including the county;
      • The number of cases; and
      • Identify if the positive case is a facility person, household member (of a GCCH or FCCH), child, or family member.

This information must immediately be reported to your Certification Representative or the appropriate Regional Office which can be found here.

In addition, programs located in any of the following 6 counties or 4 municipalities with local health departments must report to their respective local health department listed below. All other programs must report to the PA Department of Health, 1-877-PA-HEALTH or 1-877-724-3258.

If a child care provider is aware of a retailer selling personal protective equipment for well above the manufactures suggested retail price The Office of Attorney General handles these issues. Visit their website to file a complaint.

Additional Resources


Next Steps

Child care providers must:

  1. Read this Announcement and share the revisions and updates with appropriate staff.
  2. Develop, communicate and implement policies and procedures to prevent the spread of COVID-19 in child care facilities.
  3. Develop a process and procedures for timely reporting to DOH, DHS, and local health departments.
  4. Develop a procedure for notifying staff and parents of positive COVID-19 cases in your facility.
  5. Make sure staff become familiar with CDC guidance.1


Comments and Questions Regarding this Announcement Should be Directed to the Provider’s Regional Office of Child Development and Early Learning: Central Region 800-222-2117; Northeast Region 800-222-2108; Southeast North and Southeast South Region 800-346-2929; Western Region 800-222-2149.