Guidance for Long Term Care Settings 

Guidance for Responding to an Exposure in a Skilled Nursing Facility 


When one or more COVID-19 positive individual (healthcare personnel (HCP) or resident) is identified, notify Nevada County Public Health using the SPOT Intake Form. After you submit the SPOT Intake Form, Nevada County Public Health will review your information and contact you if additional information is required. Start the investigation immediately. 


  • Initiate contact tracing to identify exposed staff and/or residents
  • All exposed HCP/Staff and residents, regardless of vaccination status, should be tested promptly (but not earlier than 24 hours after exposure) and, if negative, at 3 days and 5 days 
    • Testing is not generally recommended for those who had infection in the last 30 days if they remain asymptomatic 
  • Residents who test positive and are asymptomatic throughout their infection should be isolated for 10 days following the date of their positive test
  • Residents who test positive and are symptomatic with mild to moderate illness should be isolated (regardless of their vaccination status)until the following conditions are met:
    • At least 10 day have passed since symptom onset; AND
    • At least 24 hours have passed since resolution of fever without the use of fever reducing medications; AND
    • Any other symptoms have improved
      • NOTE: The duration of isolation could be extended to up to 20 days for individuals who had critical illness (e.g., required intensive care) and beyond 20 days for individuals who are moderately to severely immunocompromised (e.g., currently receiving chemotherapy, or recent organ transplant); use of a test-based strategy and (if available) consultation with an infectious disease specialist is recommended to determine when Transmission-based precautions could be discontinued for these individuals
  • Exposed residents who test negative should wear source control when outside their room, but do not need to be quarantined, restricted to their room, or cared for by HCP/Staff using the full PPE recommended for the care of a resident with COVID-19
  • Refer to AFL 21-08 for guidance about work restrictions for exposed healthcare personnel
  • If there is a large outbreak and contact tracing cannot be successfully implemented, the facility in partnership with Nevada County Public Health may need to implement a facility-wide or group-level testing approach

CDC Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic 

CDPH Coronavirus Disease 2019 (COVID-19) Outbreak Investigation and Reporting Thresholds

CDPH Guidance on Quarantine and Isolation for Health Care Personnel (HCP) Exposed to SARS-CoV-2 and Return to work for HCP with COVID-19


When three or more COVID-19 positive individuals (staff or resident) are identified, notify Nevada County Public Health using the SPOT Intake Form. After you submit the SPOT Intake Form, Nevada County Public Health will review your information and contact you if any additional information is required. Start the investigation immediately.  

  • Initiate contact tracing to identify exposed staff and/or residents 
  • Residents and staff who are identified as close contacts should be tested following CDPH COVID-19 Isolation Guidance
  • Residents  staff who test positive for COVID-19 should promptly isolate following CDC Isolation and Precautions for People with COVID-19
  • Residents who are close contacts, asymptomatic, and test negative for COVID-19 do not need to be quarantined, excluded from activities, restricted to their room, or cared for by facility staff using the PPE required for the care of a person in care with COVID-19. Close contacts should wear masks when outside of their room according to the CDPH COVID-19 Isolation Guidance