GENERAL GUIDELINE RECOMMENDATIONS

Recommend taking additional precautions with high-risk individuals

• If a setting cares for a high-risk individual as defined by the CDC and Utah Department of Health, the setting must follow guidance for high-risk individual procedures, including taking appropriate precautions for visitation and interaction outside their place of residence. Individuals caring for or living with a high-risk individual should conduct themselves as if they are a significant risk to the high-risk individual. 
• Recommended that Providers take extra precaution on behalf of individuals in high-risk populations by limiting their close contact with multiple people, including having the same caretakers whenever possible.

• High risk individuals are discouraged from leaving their places of residence for non-essential purposes, which may include day programs or outpatient treatment. This determination should be made by the individual and their team. 

• In addition, while disability alone may not be related to a higher risk for getting COVID-19 or having severe illness, individuals with limited mobility or who cannot avoid coming into close contact with others, those who have trouble practicing preventative measures such as hand washing, physical distancing, and wearing face coverings, and those who may not be able to communicate symptoms of illness may be at higher risk of becoming infected or having unrecognized illness.

• Please review Protecting High Risk Individuals carefully, including the workplace safety checklist to learn more about how you should be protecting your high-risk staff and clients.
• Vaccination Guidelines

Strongly encourage the use of face coverings to protect clients and staff

• Employees are strongly encouraged to wear face coverings (e.g. cloth or surgical mask if available) indoors at all times, unless they are alone in an office or other room with the door closed, or are unable to due to a medical condition, in which case continuous physical distancing of 6 feet or more is encouraged; clients are encouraged to wear face coverings whenever possible

• Face coverings are strongly encouraged to be worn outdoors when physical distancing cannot be maintained

• Change or launder cloth face coverings routinely
• Cloth face coverings should not be placed on young children under the age of 2, anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove the mask without assistance
• Personal Protection Equipment (PPE) should not be shared and should be utilized and disposed of properly, or properly cleaned

• Follow additional CDC guidance for using face coverings here

Create a safe environment for clients and staff through enhanced hygiene and disinfecting

• Follow strict hygiene standards including:

• Individuals must wash hands upon arrival; frequent hand washing for clients and staff with soap and water for at least 20 seconds, or hand sanitizer use if soap and water are unavailable
• Make hand sanitizer, soap and water, or effective disinfectant readily available.
• Establish a procedure, appropriate to the population served, to prompt and support individuals throughout the day to wash their hands
• Promote etiquette for coughing, sneezing, and handwashing; avoid touching face, especially eyes, nose, and mouth; place posters that encourage hand and respiratory hygiene.
• Follow CDC guidance for cleaning and disinfecting community facilities; clean and disinfect high-touch surfaces (e.g. workstations, countertops, handrails, doorknobs, breakrooms, bathrooms, common areas), using an EPA-registered cleaner either twice a day or after each use; keep a logbook of cleaning regimen
• Don’t use toys or items that can’t be washed and disinfected; items used should be disinfected after each use
• Before and after using gloves, employees should wash their hands

• Display posters for reducing risk, physical distancing, handwashing, and mask wearing

• Increase circulation of outdoor air as much as possible by opening windows and doors, using fans, and other methods; do not open windows and doors if doing so poses a safety or health risk, or risk of violating client privacy
• Follow any other standards communicated by the Centers for Disease Control and Prevention (CDC), the Utah Department of Health, and local health department

Recommend maintaining small group sizes and physical distancing between staff and clients. Provide services via telehealth to high-risk individuals wherever possible.

• Services should continue to be provided via telehealth or other virtual meeting service as much as possible if individuals are high-risk, in accordance with individual needs and preferences
• Groups must be restricted to a maximum of 10 individuals including staff; high-risk individuals should remain in smaller groups

• A program may serve more than one group if a wall or separate space can physically divide each group
• Groups may be increased to 20 including staff if every individual in the group can consistently wear face coverings, physical distance, adhere to hygiene standards
• The decision related to an individual’s participation in a group setting must be assessed on a case-by-case basis, based on an individual’s needs, choice, and personal risk, with their team and in consultation with their healthcare provider if needed

• Limit contact between the groups of individuals including staff (keep in separate rooms, alternate groups in play areas or other group areas; sanitize areas between groups)
• Avoid handshaking or any unnecessary physical contact
• Maintain signage and ensure that staff direct and support individuals to stand at least 6 feet apart and avoid congregating in common areas
• If your business involves a waiting area, clients should wait outside or in their cars

Maintain physical distance and wear face coverings when transporting clients; do not transport high-risk clients in groups

• Strongly encouraged that individuals are screened, including temperature taking before entering vehicle
• Employees and clients wash hands or use hand sanitizer before entering and after exiting the vehicle
• Strongly encourage employees and clients who are able to wear face coverings do so
• Avoid using the recirculated air option for the car’s ventilation during passenger transport; use the car’s vents to bring in fresh outside air and/or lower the vehicle windows, unless open windows pose a safety risk to passengers or employees
• If possible, have only one individual per row; maintain small groups and physical distancing within the vehicle
• Individuals who cannot wear face coverings and not of the same household/residence should be on a row by themselves, or provider should consider alternative transportation options, including public transportation or use of informal supports
• Consider multiple trips or staggering arrival and departure times for clients
• Clients should be dropped off and picked up curbside
• High-touch areas of the vehicle should be sanitized before and after use, including the steering wheel, handles inside and outside, and seat belt buckles

Practice safety when taking clients into the community

• Strongly encourage staff and clients wear face coverings when in public; providers are responsible for ensuring that the client has a face covering
• Avoid large, dense crowds and stay at least 6 feet away from others when outside the home - refer to community guidelines for group sizes, families are encouraged to stay in their household groups with, members of your household
• Follow the state of Utah guidelines for individuals including “Social Guidelines,” “Use of Face Coverings,” “Family Gatherings (e.g. Funeral, Wedding, Religious Ceremonies),” “Children, including Playgrounds,” “Outdoor Recreation, Youth Outdoor Sports, including Parks, Playgrounds, Pavilions,” “Pools, Water Parks, Spas,” and “Religious Services.”

• The decision related to an individual’s participation in a group setting, such as a Day Service, must be assessed on a case-by-case basis, based on an individual’s needs, choice, and personal risk, with their team and in consultation with their healthcare provider if needed

• Avoid handshaking or any unnecessary physical contact
• If use of public transportation (train or bus) cannot be avoided, strongly encourage taking additional precautions:

• Wear a face covering
• Maintain a 6-foot distance from other passengers as much as possible
• Avoid touching high-touch surfaces such as handrails, and wash hands or use hand sanitizers as soon as possible after leaving

• Limit riding in cars with members of different households. If that’s not possible, strongly encourage:

• Wear a face covering
• Limit close contact and create space between others in the vehicle
• Avoid using the recirculated air option for the car’s ventilation; use the car’s vents to bring in fresh outside air and/or lower the vehicle windows, unless open windows pose a safety risk to passengers or employees

Recommend monitoring employees, visitors, and clients for symptoms.^[1] No symptomatic individuals allowed on site

• Strongly encourage employees, clients, and visitors to go through screening and symptom checking before every shift, or visit, including temperature. A log is recommended to be kept and available for review if needed. The log should include the employee or visitor name, date, time, symptoms checked, and whether or not their temperature is at or above 100.4 degrees Fahrenheit. The log does not need to include actual temperature, and should be treated as Protected Health Information (PHI). For visitors, include the reason for the visit on the log.
• Ensure staff are aware of sick leave policies and are encouraged to stay home if they are sick; advise staff to check for any symptoms before reporting to work each day and notify their supervisor if they become ill when at work
• Train managers/leadership to spot symptoms of COVID-19 and to be clear on relevant protocols
• Employees or clients exhibiting symptoms of illness should be sent home immediately and should contact their healthcare provider for testing; even if an individual has not been tested or confirmed to have COVID-19, those with symptoms should be considered contagious
• Employees returning from travel from areas with high rates of transmission follow exposure guidelines and quarantine if symptomatic

Review and update emergency, continuity of operations, and infectious disease protocols

• Designate an infection control lead responsible for implementing all COVID-19 protocols
• Work with your licensing entity and (for DHS contracted providers) the Office of Quality and Design to address background screening, variance, and adaptations to this guidance if needed by emailing dhsinfo@utah.gov 
• Consider what reserve supplies may be necessary to obtain (e.g., cleaning supplies, gloves or other protective equipment); visit this link for assistance accessing personal protective equipment
• Develop/Update plans and procedures for management of clients with COVID-19 symptoms* upon admission to the facility, including admission to a dedicated location within the facility for management of illness or to a pre-identified facility where clients with COVID-19 will be managed during the course of their illness

Work with your local health department to address suspected or confirmed cases of COVID-19

• Immediately contact your local health department if COVID-19 is suspected among clients or staff and follow all health department guidance on testing, quarantining, protective equipment and mitigation strategies; notify DHS by submitting an incident report
• Providers must also inform parents or guardians of affected individuals; for individuals receiving services under a contract with DHS, work with the individual’s team to determine what family members need to be contacted and by whom
• Follow this Health Department guidance for isolating and quarantining individuals who are exposed to COVID-19 and contact your local health department for further instructions