COVID-19 guidance for congregate living settings funded and licensed by the Ministry of Children, Community and Social Services
Learn about the COVID-19 guidelines for congregate care settings to protect the health and safety of residents, staff and visitors across the province.
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We recommend that you wear a mask in MCCSS-funded and/or licensed congregate living settings.
Until further notice, the extended measures described in the April 2022 Interim direction apply to all MCCSS-funded congregate living settings, with the exception of Youth Justice Open and Secure facilities.
These extended measures provide temporary direction that overrides theGuidance for MCCSS-funded and Licensed Congregate Living Settings as identified. Where interim direction has not been provided, existing Guidance for MCCSS-funded and Licensed Congregate Living settings continues to apply.
April 2022 Interim Direction
For Youth Justice operators please follow the Interim Direction for Youth Justice Open and Secure Facilities.
By April 15, 2022 and until further notice, all MCCSS-funded and licensed congregate living settings (CLSs) to which the applies (see section Scope), are required to implement additional precautions. Guidance for MCCSS-funded and Licensed Congregate Living Settings
Use of rapid antigen testing
Dependent on test kit availability, and until further notice, CLSs are to use rapid antigen tests to:
- Support test-to-work strategies to support early return to work when required for critical staffing (learn more in the MOH Interim Guidance: Omicron Surge Management of Critical Staffing Shortages in Highest Risk Settings).
- Screen all staff who enter a CLS regardless of vaccination status, at a frequency of 3 times per week (7-day period).
- CLSs that are currently using at-home antigen screening for staff may continue to do so.
- A staff member with a positive result on a rapid antigen test will be presumed positive for and must not be permitted entry to the CLS. Service providers will follow existing guidance for positive case management.
- While MCCSS CLSs have been identified by the MOH as a priority for PCR testing, where such testing is not available, any positive results from a rapid antigen test will no longer require a confirmed laboratory-based PCR or molecular point of care test (for example, ID NOW).
- Screen all visitors entering a CLS (regardless of the visitor’s vaccination status). Exception only if the visitor presented a negative rapid antigen test result at the same CLS the day before.
- A visitor with a positive result on a rapid antigen test must not be permitted entry and should be encouraged to follow public health direction for persons presumed positive for .
- Make rapid antigen screening available for residents who return to a CLS (regardless of vaccination status) from an overnight absence. For clarity, it is not a mandatory requirement that returning residents undertake the test. However, service providers are strongly encouraged to promote the use of rapid antigen screening by returning residents as a measure to help protect others in the CLS.
- For overnight absences of 2 nights or less: Rapid antigen screening should occur on day three and day seven from the day the resident left the setting.
- For overnight absences of 3 nights or more: Rapid antigen screening should occur on the day of return (as part of active screening upon entry) and day four following their return.
- If the resident leaves for a subsequent overnight absence within those 7 days, a new 7-day period should be started when they return to the CLS.
- A resident who receives a positive result on a rapid antigen test should be given a medical (surgical/procedure) mask to wear, unless they are subject to a masking exemption (learn more in the masking section) and directed to a designated space away from other residents where they can self-isolate and wait for arrangements to be made for a confirmatory PCR test. Learn more in the Guidance for MCCSS-funded and Licensed Congregate Living Settings January 2022 - Caring for Individuals Who Need to Self-Isolate.
- Test new admissions and transfers (regardless of vaccination status) where PCR testing is not available in a timely manner. Rapid antigen screening is to be used on the day of admission/transfer, as part of active screening upon entry, and on day four following admission/transfer.
- Test residents who are symptomatic where PCR testing is not available in a timely manner. Find additional guidance on the use of rapid antigen tests for individuals with symptoms of . Integrated Testing & Case, Contact and Outbreak Management Interim Guidance: Omicron Surge in the
While MCCSS funded and licensed CLSs have been identified by the MOH as a priority for PCR testing, in the event that such testing is not available, any positive results from a rapid antigen test will no longer require a confirmed, laboratory-based PCR or molecular point of care test (for example, ID NOW).
- Staff, residents, and visitors receiving a positive rapid antigen test result will be presumed to have
- Where a confirming PCR test is not available, service providers will follow existing guidance for positive case management for staff and residents including isolation requirements
In an outbreak, where the PHU directs the CLS to test a large number of individuals, the local PHU will be responsible for arranging PCR testing and/or making rapid antigen test kits available to the CLS.
Use of N95 respirators
Based on the Public Health Ontario interim technical brief, fit-tested N95 respirators are being recommended for use in congregate care settings when providing direct care to someone who is suspected or confirmed positive with . Service providers should be reviewing the PHO technical brief to determine if they fall within the scope of the interim recommendations on the usage of N95 respirators.
A fit-tested N95 respirator continues to be required when performing (or supporting a person during) an aerosol generating medical procedure and the person is suspected or confirmedpositive.
Service providers should determine the appropriate PPE for staff based on the organization’s risk assessment and factors specific to the staff role/function, including risk of infection.
In cases of providing direct care to someone who is suspected or confirmed positive witha fit-tested N95 respirator is recommended. If a fit tested respirator is not available when it is required, other appropriate PPE in the interim would include the use of a respirator that is not fit tested, until fit testing is undertaken for applicable staff.
As service providers consider the need for fit testing to support effective use of N95s, consideration should also be given to establishing internal fit testing capacity to support sustainable access to fit testing within the organization. As a reminder, service providers can also engage their local MCCSS IPAC Champion if support is needed for fit testing. If an organization is accessing private/third party fit testing through available services, this would be considered an eligible expense through the CRRF.
As previously communicated, based on the organization's PCRA MCCSS-funded and/or licensed service providers may identify situations not described in the guidance linked above where PPE including N95 respirators may be used as part of an individual's care plan. Service providers should ensure documentation of any such requirements within the individual's care plan.
- N95 respirators will be available to staff in CLSs based on an organization's risk assessment of the needs of individuals receiving service and the nature of the supports being provided by staff and documented in an individual's care plan.
- Service providers should ensure the appropriate and necessary policies and procedures are in place to support the access to and usage of N95 respirators as part of a respiratory protection program. For example, the process for staff to access to respirators outside of regular business hours. This may require engagement of an organization's Joint Health and Safety Committee (JHSC) in the development and review of measures and procedures.
- A service provider's respiratory protection program should incorporate the necessary training for staff to ensure that the PPE will be used safely and appropriately by staff and in accordance with any industry-based standards that may exist.
Mandatory positive case reporting
Service providers must continue to report COVID- 19 cases through the ministry's Serious Occurrence Reporting system. A positive case can now be based on a positive result on any PCR, molecular point of care, or rapid antigen test. Regardless of the test(s) conducted, each positive case should only be reported once (that is, where a positive rapid antigen test is reported, there is no need to report again if a subsequent positive PCR test is received).
Management of Staff in Highest-Risk Settings
The Ministry of Health (MOH) has issued Management of Cases and Contacts of COVID-19 in Ontario (replacing the COVID-19 Interim Guidance: Omicron Surge Management of Critical Staffing Shortages in Highest Risk Settings), which provides a framework for service providers of certain highest risk settings (including MCCSS funded and licensed congregate living settings) to use when considering early return to work of staff who are otherwise not eligible for early return to work as a mitigation to critical staffing shortages. This framework may be used and implemented by service providers without approval or review by the local Public Health Unit (PHU). Service providers also do not require the approval of the ministry.
All settings should fully utilize staffing strategies in their continuity of operations plan to avoid and mitigate situations of staffing shortages impacting care before utilizing early return to work for staff in isolation. Options with lower risk should be exhausted prior to progressing to options with more risk. The use of options with more risk should be commensurate to the risk of insufficient staffing to residents. As service providers are informing their program supervisor about critical staffing issues, they should also advise them that “high risk staffing options” are being implemented. This is for awareness (not approval) and to help your Program Supervisor identify additional supports that could be provided.
Rapid antigen tests have been prioritized to highest risk settings for use for test-to-work strategies to support early return to work when required for critical staffing.
Guidance for MCCSS-funded and Licensed Congregate Living Settings
In response, the Ministry of Children, Community and Social Services has updated thisguidance for MCCSS-funded and licensed congregate living settings to reflect the principles in MOH’s guidance for PHUs. While the guidance aligns closely, this document also includes some modified and/or additional requirements for MCCSS-funded and licensed CLSs that the ministry has deemed appropriate for our settings.
Please note that PHUs may continue to provide direction that may be different and/or in addition to those in this guidance to prevent and mitigate the spread ofand/or other infectious diseases to ensure a tailored response to each local outbreak scenario.
This guidance is intended to be followed in addition to other applicable legislation and/or health guidance including, but not limited to:
- Local public health unit direction to address local circumstances (for example, community spread)
- Public Health Ontario preparedness and prevention in congregate living settings
- Public Health Ontario Managing outbreaks in congregate living settings
- Resources to prevent in the workplace
- Occupational Health and Safety Act (OHSA)
This document is not legal advice. Therefore, service providers may wish to seek an independent legal opinion regarding the application of legislative and other requirements in the context of the services they provide.
As always, the health and safety of individuals served, including their mental and emotional well-being, remains our top priority.
This guidance document applies to the following MCCSS-funded and licensed congregate living settings:
- Adult developmental services residential services
- Intervenor residential services
- Violence against women shelters
- Anti-human trafficking (AHT) residences
- Children’s residential facilities
- Indigenous Healing and Wellness services (IHWS) facilities
Note for youth justice operators: the guidance in this document does not apply to youth justice open and secure custody/detention facilities. Please continue to follow the existing direction. Read the existing direction for justice open and secure custody/detention facilities.
MCCSS recognizes that CLSs in First Nations communities may need to collaborate with Chief and Council, and if applicable the federal government and/or local public health unit, in applying this guidance to their settings in a way that is culturally appropriate and in relation to applicable federal and First Nation laws and public health measures. Urban Indigenous service providers may also need to work with their leadership and their local public health unit, to apply the guidance in a way that is culturally appropriate.
Terms used in this document
Please refer to the Ministry of Health’s website for the definition of “Fully vaccinated”, where applicable in this document.
Staff refers to anyone conducting activities in the CLS regardless of their employer. This includes, but is not limited to:
- staff employed by the CLS
- temporary and/or staffing agency staff
- third-party staff who are performing job duties (for example, support services staff, Elders, contracted cleaning staff, tradespeople)
- students on placement (for example, nursing students)
Residents refers to individuals who reside in and receive ministry-funded or licensed services in a CLS.
Household refers to a group of individuals (that is, residents) who live together and are part of each other’s daily routine and therefore spend most of their time in close physical contact with one another.
- In general, household members do not include those living in separate residential units within a single CLS facility
- However, this term may be applied in select CLSs where a small number of residents live and spend most of their day-to-day activities together, often owing to shared medical, physical, mental, cognitive, and/or behavioural needs
- PHUs will use their discretion to determine whether a CLS is equivalent to a household, as this has implications for case and contact management due to the potential for high-risk exposure if were to be introduced in this setting
Visitors are defined broadly in two categories:
- Essential visitors provide essential support to the ongoing operation of a CLS and/or are considered necessary to maintain the health, wellness, and safety, or any applicable legal rights, of a congregate living resident. MCCSS recognizes a parent/guardian, or other family member as essential visitors. An essential visitor may also include social service workers and health care providers or other person(s) recognized as meeting the criteria above. Essential visitors are permitted to enter the CLS even when residents are in self-isolation and/or the CLS is in an outbreak.
- General visitors comprise all other types of visitors who are not considered essential visitors as per above. They are not permitted to visit resident(s) who are self-isolating and/or when the CLS is in an outbreak.
Point of care risk assessment (PCRA) (also known as personal risk assessment) is a dynamic risk assessment completed by a staff person before every resident care/interaction in order to determine whether there is a risk of being exposed to an infection. A PCRA will help determine the correct personal protective equipment (PPE) required to protect the staff in their interaction with the resident and resident environment
Absences are defined broadly in two categories:
- Short-stay absences occur the same day. This includes essential absences (for example, a resident leaving the CLS for work, school, medical appointment, physical exercise) and recreational outings (for example, activities for pleasure, visiting a friend’s home).
- Overnight absences may be short-term or extended absences. This includes residents’ essential overnight absences (necessary to maintain the health, wellness, and safety, or any applicable legal rights, of a resident), and general overnight absences (non-essential) from the CLS.
Prevention of disease transmission
The use of multiple layers of public health measures will help protect residents, staff, and visitors against and other respiratory infections. Many of these recommended measures should already be part of existing organizational plans developed for infectious disease outbreaks or other emergencies (for example, pandemic and/or business continuity plans). Factors such as the physical/infrastructure characteristics of the CLS, staffing availability, and the availability of personal protective equipment (PPE) should all be considered when developing CLS-specific policies.
vaccination is one of the most important public health measures to prevent infection and transmission, and it is the most effective way to prevent severe outcomes including hospitalizations and death due to . As such, all residents, staff, and visitors should be encouraged to get vaccinated against (including booster doses, when eligible) as soon as possible if they have not already done so.
- New resident admissions to the CLS who have not yet received a vaccine or are not up-to-date with booster dose(s) should be offered access to a complete series of vaccinations as soon as possible, and booster dose(s), when eligible.
- More information on webpage Vaccine-Relevant Information and Planning Resources vaccination can be found on the MOH’s
Find out how to book a . vaccine
All eligible staff, visitors, and residents of CLSs are also strongly encouraged to receive the annual influenza vaccine.
Active screening for anyone entering the CLS
All persons seeking entry to the CLS should be actively screened regardless of theirvaccination status. This includes all staff, visitors, and residents returning from an absence. Emergency first responders should be permitted entry without screening.
A formal process should be used to ensure a rigorous active screening process at all times, including after hours. CLSs may use mobile apps or other tools to assist in the screening process. However, the individual being screened should interact with the screener prior to being permitted entry.
As part of active screening, all residents, staff, and visitors should be advised that if they start to feel unwell while on-site, they should immediately notify a designated individual (either staff or a supervisor).
A CLS can choose to use or adapt the screening tools that have been developed by the Ministry of Health, such as:
- COVID-19 Screening Tool for Long-Term Care Homes and Retirement Homes (gov.on.ca)
- general self-assessment
- , for staff and essential visitors specifically worker and employee screening
During active screening, CLSs should continue to consider:
- limiting points of entry into the setting to help facilitate screening
- rearranging the layout at the entrance so that physical distancing can be maintained while staff conduct screening
- placing a physical barrier (for example, plexiglass) that staff can stand or sit behind while conducting screening at entrances
- providing access to alcohol-based hand rub (ABHR, 60-90% alcohol), tissue, and lined no-touch wastebasket or bin
- encouraging all residents, staff, and visitors to use alcohol-based hand rub (ABHR) before entering
People who don’t pass the screening
If a staff or a visitor has not passed active screening (for example, if they have symptoms of), they should not be allowed to enter the CLS. They should be instructed to self-isolate immediately and be encouraged to get tested for . Staff should also report their result to their immediate supervisor/manager or occupational health and safety representative in the CLS.
- Visitor policies should incorporate allowances for visitors that fail screening that consider the type of visitor and the resident's circumstances (i.e., there may be instances where CLSs may need to consider permitting the entry of an individual who has failed active screening for compassionate and/or palliative reasons). This should include consideration for additional precautions that may need to be put in place to facilitate a safe visit (e.g. PPE, other barriers).
CLSs should instruct all staff and visitors to self monitor forsymptoms at home and not come to work if feeling ill. Those who are experiencing symptoms should report this to their employer.
Staff with post-vaccination related symptoms may be exempt from exclusion from work as per the Guidance for employers managing workers with symptoms within 48 hours of . immunization
Staff responsible for occupational health and safety in the setting should follow up with all staff who have screened positive to provide advice on any work restrictions.
Staff who are close contacts or cases of early return to work.must follow the protocols and the return to work requirements as per the MOH's guidance for
Residents being admitted, transferred or returning from an overnight absence are to undergo active screening. The GeneralSelf Assessment can be used as a tool to guide screening activities and can be adapted as needed.
Residents who do not pass this screening should be given a medical (surgical/procedure) mask to wear, unless they are subject to a masking exemption (see masking section), and directed to a designated space away from other residents where they can self-isolate and wait for arrangements to be made for a clinical assessment, including getting tested foras appropriate.
For more information read:
- caring for individuals who need to self-isolate
- appendix 2 for additional detail on active screening requirements for staff, visitors and residents
Daily symptom assessment of residents
Residents should be assessed at least once daily to identify any new or worsening symptoms of . Where deemed appropriate, this could include temperature checks.
CLSs are strongly encouraged to conduct symptom assessment more frequently (for example, at every shift change), especially during an outbreak, to facilitate early identification and management of ill residents.
CLSs should be aware that some residents (for example, elderly, young children, non-verbal individuals) may present with subtle or atypical signs and symptoms of . As much as possible, it is important for the CLS to understand a resident’s baseline health and functioning and ensure routine monitoring of their status to facilitate early identification and management of ill residents.
In large CLS that primarily serve transient and/or large numbers of residents, it may be challenging to ascertain the resident's health status. As much as possible, staff should be encouraged to check in with the residents, inquire about how they are doing opportunistically while providing services, remind residents to self identify if they are feeling unwell through verbal reminders and passive signage, and ensure good IPAC practices on site.
Rapid antigen screening can quickly identify asymptomatic cases ofthat would have otherwise gone undetected and can help stop the spread of the virus. Service providers can use rapid antigen screening as a tool to enhance their existing Infection Prevention and Control (IPAC) measures for individuals living, visiting, participating, and working in congregate settings or receiving in-person services.
- Antigen Point of Care Testing (POCT) does not replace public health measures such as vaccination, symptom screening, physical distancing, masking and hand hygiene.
- Any positive results from antigen POCT must be confirmed with laboratory based polymerase chain reaction (PCR) testing or molecular POCT (for example, ID NOW) where the results can be reported into the Ontario Laboratory Information System (OLIS).
Service providers that are interested in participating in the Provincial Antigen Screening Program (PASP) may apply through the Ontario Together Portal.
Where signage is deemed, by the service provider, to be inappropriate for resident living spaces (for example, small settings that operate like a household), signage should be posted at the entrance(s) to the setting and in staff-only spaces, such as an office or break room.
Access to handwashing stations and/or alcohol-based hand rub (ABHR) should be available at multiple, prominent locations throughout the CLS, such as at entrances and in common areas, to promote frequent hand hygiene.
All staff, visitors, and residents should be reminded through training and signage to:
- clean hands frequently throughout the day by washing with soap and water or using ABHR (60-90% alcohol) when hands are not visibly soiled;
- perform hand hygiene before and after using any shared equipment or items
- If gloves are being used, perform hand hygiene prior to putting on gloves and immediately after removing them. After use, gloves should be placed in the garbage (i.e. non-touch, lined waste receptables, which should be placed throughout the CLS) . Gloves are not recommended for hand hygiene.
- Safe placement of alcohol-based hand sanitizer to avoid consumption is important, especially for young children.
Assistance should be provided to residents who may not be able to perform hand hygiene on their own.
Physical distancing remains one of the key public health measures to reduce the transmission of. In general, all individuals should be encouraged to practice physical distancing (maintaining a minimum of 2 metres from others) to reduce the risk of transmission of .
Physical distancing may be practiced in a number of different ways depending on the nature of the CLS. See the table below on when physical distancing should be practiced and when it may not be possible and/or necessary.
|Physical distancing may be necessary:||Physical distancing may not be possible or necessary:|
In emergency shelter settings, physical distancing may not always be possible due to demand. In such situations, rigorous compliance with all other measures, including active screening and masking, will be all the more important as part of the layered approach toprevention.
As much as possible, CLSs should continue to alter activities in the setting to optimize and support physical distancing. This will also enable CLSs to adapt to enhanced precautions (for example, in outbreak situations) as appropriate. This may include:
- limiting capacity in common areas, including staff break rooms
- posting signage in common areas re: maximum capacity
- moving furniture around and/or removing unnecessary furniture/equipment
- placing markers on the floor or walls to guide physical distancing and unidirectional flow of movement
- planning enhanced in-house/on the property recreation and structured activities that support physical distancing
- supporting and/or encouraging activities outdoors
In shared bedrooms, beds should be spaced at least 2 metres apart. If this is not possible, consider different strategies to keep residents apart (for example, place beds head to foot or foot to foot).
- Avoid using bunk beds
- Consider additional measures, such as private rooms or rooms with the fewest number of occupants
The Chief Medical Officer of Health and MCCSS continue to recommend masking in congregate living settings.
Where service providers choose to maintain masking requirements in their settings, they should take steps to ensure this does not become a barrier to entry for permitted visitors (a supply of masks should be available to individuals who may have been unaware of the provider’s requirement and would otherwise be refused entry without a mask).
Personal protective equipment (PPE) for staff and essential visitors
PPE is intended to protect the wearer by minimizing their risk of exposure to. The effectiveness of PPE depends on the person wearing it correctly and consistently. Recommendations for the use of PPE are based on risk assessments of specific environments and risk of exposure.
The employer must train workers on the care, use, and limitations of any PPE that they use.
A person should wear appropriate PPE that provides protection of the person’s eyes, nose, and mouth if, in the course of providing services, the person is required to come within two metres of another person who is who is isolating on Droplet and Contact Precautions (e.g. such as when providing care to a resident who is isolating) or during a Caring for Individuals who Need to Self-Isolate, below). The choice of PPE, including the use of fit-tested N95 respirators, should be based on a point of care risk assessment guided by the nature, type, and duration of the intended interaction.outbreak (see
- For more information, see PHO’s Interim IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed for more information on PPE use.
- Eye protection includes face shields, goggles, or certain safety glasses. Properly fitting eye protection should be close-fitting around the head and/or provide a barrier from the front, the sides, and the top.
- Non-medical masks are not considered PPE.
Use of N95 respirators
In CLSs the need for the use of N95 respirators will most often be indicated based on the medical needs (that is, aerosol-generating medical procedures) of an individual who is known or suspected to have .
Based on the organization's PCRA MCCSS-funded or licensed service providers may identify situations not described in the guidance linked above where PPE including N95 respirators may be used as part of an individual's care plan. Service providers should ensure documentation of any such requirements within the individual's care plan.
N95 respirators will be available to staff in CLSs based on an organization's risk assessment of the needs of individuals receiving service and the nature of the supports being provided by staff and documented in an individual's care plan.
Service providers should ensure the appropriate and necessary policies and procedures are in place to support the access to and usage of N95 respirators as part of a respiratory protection program. For example, the process for staff to access respirators outside of regular business hours. This may require the engagement of an organization's joint health and safety committee (JHSC) in the development and review of measures and procedures.
A service provider's respiratory protection program should incorporate the necessary training for staff to ensure that the PPE will be used safely and appropriately by staff and in accordance with any industry-based standards that may exist.
Fit testing for N95 respirators
Before N95s can be accessed and used, service providers must have identified staff fit tested to ensure a proper seal and trained on appropriate usage of the respirator.
Please contact your MCCSS IPAC Hub Champion for support in accessing fit testing.
The 3M 1870+ N95 is the most common model available through MCCSS. In the case that the 3M 1870+ N95 does not seal for an individual, staff may be fit tested to an alternative N95 provided by the ministry.
Environmental cleaning and disinfection
CLSs should ensure that the premises are cleaned regularly. Commonly used cleaners and disinfectants are effective against.
- All common areas (including bathrooms) and high-touch surfaces that are touched and used frequently should be cleaned and disinfected at regular intervals (for example, once daily) and when visibly dirty. These include door handles, kitchen surfaces, and small appliances, light switches, elevator buttons, television, remotes, phones, computers, tablets, medicine cabinets, sinks, and toilets.
- Cleaning and disinfection should be more frequent during an outbreak. See managing . outbreaks in congregate living settings
- Hand hygiene should be performed before and after use of shared items.
- Clean linen should be provided to all residents for individual use, with instructions not to share, and should be cleaned on a regular schedule.
- Lined no-touch garbage bins (such as garbage cans with a foot pedal) are preferred for disposal.
- For more information and guidance on environmental cleaning, please refer to PHO’s on cleaning and disinfection for public settings.
Ventilation and air filtration
In general, ventilation with fresh air and filtration can improve indoor air quality and are layers of protection in a comprehensivestrategy.
To reduce the risk oftransmission, outdoor activities are encouraged over indoor activities where possible.
Indoor spaces should be as well ventilated as possible, through a combination of strategies: natural ventilation (for example, by opening windows), local exhaust fans, or centrally by a heating, ventilation, and air conditioning (HVAC) system.
Where ventilation is inadequate or mechanical ventilation does not exist, the use of portable air cleaners can help filter out aerosols. Expert consultation may be needed to assess and identify priority areas for improvement and improve ventilation and filtration to the extent possible given HVAC system characteristics.
Ensure that HVAC systems are functioning properly through regular inspection and maintenance (for example, filter changes).
Service providers should consider, as part of regular HVAC maintenance, the type of filter used to support ongoing air quality improvements and should use the highest efficiency ventilation filters possible, without it having detrimental effects on overall HVAC system capacity performance.
Minimum efficiency reporting values, or MERV, report a filter's ability to capture particles. Filters with MERV-13 or higher ratings can trap smaller particles. Upgrading to a MERV-13 rated filter, or the highest-rated filter that your HVAC system fan and filter slot can accommodate could improve the system’s efficacy in removing particles from circulated air. Service providers should consult with an HVAC expert if they are considering making changes to the type of filter they are using to ensure it is compatible with the system that they have on-site.
For more information, see PHO’s heating, ventilation and air conditioning (HVAC) systems in buildings and .
Ventilation and filtration are important for overall indoor air quality as they help to dilute or reduce respiratory droplets and aerosols in a given space. However, they do not prevent transmission in close contact situations and need to be implemented as part of a comprehensive and layered strategy against.
HEPA filters in congregate living settings
In September 2021 MCCSS began distributing HEPA filters to congregate living settings to support increased air quality and reduce the chance of potential exposure to.
HEPA filters are air purification systems that capture a minimum of 99.97% of contaminants at 0.3 microns in size and will kill germs and viruses, remove airborne chemicals and odours, and filter dust and pollen. The HEPA filters are portable, meet Canadian standards, and can be used in areas where residents and staff congregate. Learn more about portable air cleaners.
Ontario’s Science Table has advised about use and placement including:
- The position of portable air cleaners in an indoor space should take into consideration the likelihood that aerosols/droplets are being captured by the intake and that the exhaust is not directed to occupants. Placement near the center of the room or near potential sources of SARS-CoV-2 droplets/aerosols (that is, common rooms, dining rooms) is helpful.
- It is also important that HVAC and supplemental ventilation/filtration systems are regularly maintained according to manufacturers’ instructions and that measures are checked with the goal of optimization (for example, air exchange rates, outdoor air intake, temperature, humidity).
Learn about achieving and maintaining adequate air quality through ventilation and filtration, by reading a science brief by the Ontario Science Advisory Table.
Use of CO2 Monitors in Congregate Living Settings
Carbon dioxide (CO2) sensors may be used to help identify areas with poor ventilation (they cannot identify the presence or absence of in the air). During pandemic conditions, it is beneficial to keep indoor air as close to “fresh” outdoor conditions as possible, where outdoor air generally has a CO2 concentration < 450 parts per million (ppm). When CO2 levels are consistently increasing over time, this is a strong signal that ventilation is inadequate for the number of occupants and/or their activities. However, because of the need to heat or cool air to keep the indoors comfortable, 100% fresh air is not always possible and some amount of CO2 buildup is unavoidable. Notably, the United States Centers for Disease Control and Prevention (CDC) and the Federation of European Heating, Ventilation and Air Conditioning Associations (REHVA) have reduced their recommended indoor CO2 levels to 800 ppm during pandemic conditions.
specific policies and procedures
All CLSs should continue to have
These policies should consider different levels ofrisk in the setting and in the community. CLSs should plan for contingencies when activities may need to be curtailed to ensure the health and safety of the residents, staff, and visitors in the setting. Activities should be modified, limited, postponed, or paused:
- if a resident is self-isolating for any reason
- if a resident resides in a outbreak area of the CLS
- to align with any provincial or regional restrictions
- as directed by the local PHU
Admissions and transfers
Pre-screening of new admissions/transfers
As much as possible, new residents should be screened over the phone for signs and symptoms of before admission (intake).
Regardless of whether pre-admission screening has taken place, CLS should also conduct active screening in-person upon the arrival of the resident to the setting. Read about active screening.
In general, admissions and transfers to a CLS in aoutbreak should be avoided. However, if the risks of not admitting a resident are determined to outweigh the risks of admitting the resident into a CLS in an outbreak, consultation with the local PHU should be considered. The following risk-based considerations may be taken into account:
- Residents without active infection may be admitted or transferred to an area of the CLS not in outbreak, with their informed consent.
- Residents with active infection, or who fail active screening, may be admitted/transferred to an outbreak area of the CLS, with their informed consent. Ideally, residents admitted into this situation should be admitted into a private room.
For individuals who are partially vaccinated, unvaccinated, or for whom theirvaccination status is unknown, they should:
- follow additional precautions until they receive a negative result on a
footnote 7or 10 days have passed PCR test
- monitor for symptoms
- avoid using common areas; however, if a common area cannot be avoided, the resident must use a medical (surgical/procedural) mask if tolerated
- limit contact with other residents
- only participate in group activities if physical distancing is maintained (that is 2 metres) and a medical (surgical/procedural) mask is used for the duration of the activity
- practice proper hand hygiene by washing hands often (using soap and water or using ABHR)
- adhere to respiratory etiquette
CLSs should consider whether it is necessary, safe, and operationally appropriate to proceed with or postpone the admission of those who fail their active screening and/or test positive. This decision should be made in consultation with the local PHU. If admission is postponed, individuals should be referred to other organizations or services in the community where they can be safely housed for their self-isolation period.
- Individuals who have previously tested positive for in the last 90 days (based on positive rapid antigen test or molecular test results) and have since been cleared are exempt from isolation and testing should they have a subsequent exposure, as long as they are currently asymptomatic
Absences (short-stay and overnight)
When a resident leaves the CLS on an absence for any reason, they should be provided with a medical (surgical/procedural) mask, unless they are subject to a masking exemption (find more information in the masking section), and should also be reminded to follow general public health guidance in the community such as physical distancing and hand hygiene while away from the CLS. In community spaces where masking is not mandated, residents may choose to wear a mask or not to.
- Depending on the nature of the CLS and the residents, when operationally feasible and appropriate (e.g., when there is an overnight or extended absence of a resident in a setting serving immunocompromised individuals or those at higher risk of severe disease due to ), residents should be actively screened upon their return to the CLS.
CLSs should have policies in place that enable the setting to flexibly adjust their absence policies where necessary. This includes limiting or restricting short-stay recreational outings and general overnight absences if the CLS is in an outbreak.
There may be circumstances in which absences must be permitted. CLSs should seek the advice of the local PHU on how to facilitate an absence safely in these circumstances, which may include absences to:
- seek medical care or for palliative/compassionate reasons, which must not be denied at any time
- mitigate any undue hardship for the resident, recognizing the specific needs and challenges that many residents of CLSs may face (for example, to access support persons or services which may include but are not limited to social workers, case supervisors, group sessions, and/or other paramedical care for mental health and/or substance use)
The following pre-requisites must be met before accepting visitors in a setting:
- Proactive and ongoing communication with residents, families/friends, and staff about on-site visit procedures, which should include, but not be limited to:
- visit scheduling protocols and any site-specific policies (for example, outbreak)
- PPE requirements for indoor/outdoor visitors (see sections on masking and PPE above)
- operational procedures such as limiting movement inside the CLS, if applicable, and ensuring visitors' agreement to comply with the procedures prior to each visit
- identification of dedicated indoor and outdoor visitation areas
- a list/log of visitors and their contact information, which is to be made available to relevant staff and for PHU case and contact management, as needed. Logs are to be kept for a minimum of one month
- an approach to dealing with non-adherence to these policies and procedures, including the discontinuation of visits where appropriate
- Protocols are in place to maintain IPAC standards prior to, during and after visits, which include:
- active screening of all visitors upon arrival, with policies and protocols in place to admit entry to only those who pass the screening
- proper respiratory etiquette and frequent hand hygiene
- education on all required protocols will be provided by the site
- adequate staffing to implement visitation protocols and continue ongoing operations within the setting
- environmental cleaning and disinfection of the visitation space(s) (including washrooms), following recommended IPAC standards
- where appropriate, the CLS is able to facilitate visits in a manner aligned with physical distancing protocols, including identifying a space(s) where visiting takes place and the areas that are off-limits to visitors (for example, common areas, etc.), and the maximum capacity limit based on ability to physically distance within a designated space
- scheduling of indoor non-essential visits to ensure physical distancing within a designated space can be maintained
- indoor and outdoor visits within the CLS are permitted in alignment with provincial/regional restrictions and/or direction from local PHU
- For each visit, all essential and non-essential visitors must:
- pass an active screening questionnaire that screens for signs andsymptoms
- read and agree to the parameters of the visit set out by the service provider in compliance with this document and public health direction
- share their contact information, which will be made available to relevant staff and for PHU contact tracing activity, as needed
- remain within designated spaces as identified by the service provider
- CLSs may choose to request a visitor attestation to the acceptance of the visitor protocols and the consequences of failure to adhere to them
Communal activities for residents
There are many cognitive, social and psychological benefits for residents to participate in communal dining and other forms of activities. CLSs are strongly encouraged to continue with programs and activities for their residents while ensuring that they align with the public health requirements in O. Reg. 364/20 and in consideration of the measures outlined in this document in order to reduce the risk oftransmission for residents while outside of the CLS.
This includes community-based programs and activities that are also open to residents (that is, day programs).
Some considerations for reducing the risk ofin group settings include:
- keeping the groups (cohorts) as consistent as possible to reduce the number of potential high-risk contacts in the event of exposure
- keeping the size of the groups small - recognizing that group sizes may need to be balanced to address the psychosocial needs of the residents, the CLS’s staffing capacity, and/or take into consideration any capacity limits for indoor areas
- ensuring same staffing assignment to each group where operationally feasible
- ensuring that residents wear medical (surgical/procedural) masks, unless they are subject to a masking exemption, and practicing physical distancing, particularly in settings that serve transient and/or a large number of residents (see sections on physical distancing and masking above)
- Using larger spaces and improving ventilation (e.g. opening windows and doors), and moving communal activities to outdoor areas, where feasible.
This section does not apply to CLSs that already function like a household.
Caring for individuals who need to self-isolate
Some residents of CLS may live with certain conditions and/or experience undue hardships when it comes to self-isolation and/or frequenttesting (for example, mental health, behavioural or cognitive conditions, substance use, trauma/violence, and/or other precarious factors). This should not result in refusal of services and CLSs should work with the resident and the PHU to identify resident-centered solutions that can reduce the potential risk of transmission and mitigate potential harms. Examples include permitting some degree of socialization or outdoor breaks during a self-isolation period. Layering as many public health measures possible, such as masking and physical distancing, will be extremely important.
- New admission/transfer residents who have not passed their active screening on arrival (read about active screening)
- residents who are unwell with symptoms of and/or other common respiratory infections, such as influenza
- residents awaiting test results for and/or other common respiratory infections
- residents who have tested positive for and/or other common respiratory infections
- residents who have been identified as close contacts of a known case of and/or instructed to self-isolate by the local PHU
Any resident who needs to self-isolate should be placed in a single room with a door that closes and, if feasible, have access to a private bathroom.
If this is not possible, at the direction of the local PHU, the resident may be grouped (cohorted) with others who are in the same situation as the resident (for example, group those who are unwell/symptomatic). In this case, each resident should wear a medical (surgical/procedural) mask, unless they are subject to a masking exemption (see masking section for more information), and maintain as much distance as possible from others. See PHO’s cohorting in outbreaks in congregate living settings document for further guidance on developing cohorts of residents in CLSs during an outbreak.
If a resident needs to leave self-isolation:
- They should maintain physical distance from others and wear a medical (surgical/procedural) mask, unless they are subject to a masking exemption, for the entire time they are outside of their room. This includes when accessing a shared bathroom or leaving the CLS to seek external care.
- Staff providing direct care should take appropriate precautions depending on the nature of the planned interaction and what is known about the health status of the resident. This includes ensuring that staff are wearing appropriate PPE (that is, medical (surgical/procedural) mask and eye protection) when providing care to a resident (within 2 metres). Gloves and gowns should also be worn if providing direct care where skin or clothing could become contaminated. See PHO’s Interim IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed for more information on PPE use.
- how and where the resident can be clinically assessed and/or tested for COVID-19 (for example, assessment centre, health care provider on site)
- how and where to self-isolate the resident for the duration of their required self-isolation period (wherever possible, private rooms are preferred.)
- how to support the resident remaining in their room, including the ability to receive meals in their room, and, if possible, not sharing a bathroom with others
- how to safely support the use of shared facilities by the resident in self-isolation where required, including maintaining physical distancing, staggering access, and undertaking thorough cleaning and disinfection of shared spaces
- who will monitor the resident’s symptoms and how often this will be done, what PPE is required and how to determine when additional medical care and intervention is required
- what to do if a resident develops severe symptoms
- how to access private transportation if there is a need to transfer the resident, including if they need to be transferred to an external location (public transportation should be avoided)
Responding to a symptomatic individual
When a resident(s) is symptomatic
When a staff or a visitor is symptomatic
All symptomatic staff or visitors should not be permitted to enter the CLS. If they become symptomatic during their shift or visit, they should be asked to leave immediately and/or isolated until they can safely leave the CLS. They should be instructed to continue to self-isolate, seek medical assessment as required, and be encouraged to get molecular testing for. Note that staff, volunteers and visitors in highest risk settings are eligible and prioritized for PCR testing.
Note: visitor policies are to incorporate allowances for visitors that fail screening in certain circumstances (i.e. compassionate and/or palliative reasons).
Mandatory positive case reporting
CLS must contact PHU when:
- there is a probable case of in the CLS
- there is a confirmed case of in the CLS
- an outbreak is suspected based on ill residents, staff and/or frequent visitors
CLS must also:
- continue to report serious occurrence reporting cases through the ministry's
- provide regular status updates to their primary ministry contact
Case and contact management
PHUs are responsible forcase and high-risk contact (HRC) management. CLSs should follow all advice and direction received from the PHU with respect to self-isolation (case management) and contact management when a resident, staff, or visitor of the setting is confirmed positive for .
Declaring an outbreak
PHUs have the discretion to declare a suspected or a confirmed outbreak based on the results of their investigation, including when the definitions below are not completely met.
- A suspect outbreak in a CLS is defined as one lab-confirmed case in a resident
- A confirmed outbreak in a CLS is defined as two or more lab-confirmed
cases in residents and/or staff (or other visitors) in a CLS with a positive PCR test or rapid molecular test OR rapid antigen test AND with an epidemiological link, within a 10-day period.
- Epidemiological link defined as: reasonable evidence of transmission between clients/staff/other visitors AND there is a risk of transmission of COVID-19 to other clients within the CLS.
Outbreak management is directed by the local PHU. CLSs should follow all directions received from the local PHU.
See Management of Cases and Contacts of . in Ontario
Also see PHO’s checklist for managing document to provide further guidance on managing outbreaks in congregate living settings outbreaks in congregate settings.
Outbreak testing in a CLS is directed by the local PHU. This should be guided by the Management of Cases and Contacts of COVID-19 in Ontario.
- PHUs will advise the CLS on the need and the frequency for repeat testing as part of an ongoing outbreak investigation to identify additional cases.
- If large numbers of individuals in a CLS require testing, the local PHUs and the CLS provider should consider making arrangements to either bring testing services to the setting or make arrangements with the local Assessment Centre.
- At this time, RATs are not intended for diagnostic purposes in highest risk settings given the limited sensitivity of RATs compared with PCR testing; however, they may be used to facilitate case, contact, and outbreak management. The results of a RAT may be used to declare a suspect or confirmed outbreak while awaiting PCR or rapid molecular diagnostic test results. If a RAT is used for a staff or client with symptoms or high-risk exposure, PCR or rapid molecular testing should be performed in parallel.
- Negative RAT results should not be used independently to rule out in an outbreak situation or for a symptomatic individual or a close contact who works or resides in a CLS due to the limited sensitivity of RATs.
Measures to prevent, eliminate or reduce transmission
Outbreak measures are any action or activity that can be used to help prevent, eliminate or reduce the ongoing transmission of. The CLS should consult with the PHU on:
- defining the outbreak area (that is, affected unit(s) versus the whole CLS) to which outbreak measures will be implemented
- limiting or restricting all communal activities and/or spaces within the CLS where residents, staff, and visitors can congregate
- establishing resident cohorts based on their exposure status (that is, exposed versus non-exposed): this is an important IPAC strategy to limit potential transmission throughout the facility
- where operationally feasible, establishing staff cohorts alongside the residents based on their exposure status and/or designating staff to work with only one group of cohorts on each shift
- limiting work locations for staff to prevent spread to other settings
- limiting or restricting new admissions and transfers: best practice is that no new residents are allowed into an outbreak area until the outbreak is declared over
- Note: where new admissions or transfers cannot be avoided, the CLS provider should consult the local PHU for guidance.
- limiting or restricting resident absences: residents who have left the CLS on an overnight absence prior to an outbreak being declared should, if possible, avoid returning to the setting until the outbreak is declared over
- limiting or restricting visitors into the CLS: only essential visitors are permitted in an outbreak and general visits must be restricted in an outbreak
- Note: CLSs should ensure that visitations are not unnecessarily discontinued and continue to safely facilitate essential visitors on-site during an outbreak. However, CLSs may wish to consider limiting the number of visitors at any one time to reduce crowding and ensure all outbreak measures can be followed.
As part of the outbreak management process, the CLS should notify all relevant individuals and/or agencies about the outbreak as listed in the setting’s procedures and policies.
Residents, staff, family members and visitors should be made aware of the outbreak measures being implemented at the CLS. As much as possible, efforts should be made to facilitate interactions between residents and their loved ones through technology (telephone and video).
Declaring the outbreak over
The outbreak may be declared over by the PHU when there are no new cases in residents or staff after 10 days (maximum incubation period) from the latest of the:
- date of isolation of the last resident case
- date of illness onset of the last resident case
- date of last shift at work for last staff case
For greater clarity, if staff continue to test positive for(i.e., a staff presumed or linked to an external exposure), the outbreak may be declared over at the discretion of the PHU, provided there is no evidence of transmission to clients. The CLS should continue to conduct enhanced symptom surveillance for clients.
Following the end of an outbreak, the CLS should follow directions from the PHU with respect to de-escalation ofoutbreak control measures as the cases are resolved.
Occupational health and safety
The Occupational Health and Safety Act (OHSA) requires employers to take every precaution reasonable in the circumstances for the protection of workers
More information on occupational health and safety requirements and workplace guidance for page and the and workplace health and safety webMinistry of Labour, Training and Skills Development (MLTSD) webpage.are available on the Ontario
Reporting occupational illness
Under OHSA, if an employer is advised that a worker has tested positive fordue to exposure at the workplace, or that a claim has been filed with the Workplace Safety and Insurance Board (WSIB), the employer must provide written notice within four days to:
- the workplace’s joint health and safety committee or a health and safety representative; and
- the worker’s trade union (if applicable)
Additionally, under the Workplace Safety and Insurance Act, 1997 (WSIA), an employer must report any occupationally acquired illnesses to the WSIB within 72 hours of receiving notification of said illness
Appendix 1: summary for active screening
The following table provides a summary of the suggested screening practices. Please refer to active screening for anyone entering the CLS, above, for more details as well as for considerations for implementation.
|Staff, visitors and anyone entering the CLS||Current residents of the CLS|
|Who does this include?|
|What are the screening practices?|
|What if someone does not pass active screening?||Staff, visitors and those attempting to enter the CLS who are experiencing symptoms of or had potential exposure to , and have not passed active screening should:|
Appendix 2: personal protective equipment (PPE) supply
Medical (surgical/procedure) masks, face shields, hand sanitizer, gloves, disinfectant wipes and isolation gowns are considered 'core' PPE types. By reporting your current inventory, daily consumption, and forecasted usage via the Critical Supplies and Equipment (CSE) survey portal, MCCSS can see when your survey results indicate less than a 2 week supply of core PPE, which will trigger an automatic 2-week top-up shipment to be sent within one week of the survey close.
Items such as eye goggles, larger-sized gowns and thermometers are considered a "niche" PPE type and can be obtained through the Ontario Association of Children's Aid Societies (OACAS) shared services PPE order page.
Service providers are asked to use discretion when ordering niche PPE and should default to using core PPE (that is, face shields as opposed to eye goggles) when operationally feasible as access and supply to these products is more stable.
Service providers should forecast their requirements in the CSE survey portal. In case of an emergency (that is, outbreak, having less than a 5-day supply of PPE) organizations requiring additional medical (surgical/procedure) masks, eye protection and isolation gowns can request additional supplies from the OACAS Shared Services PPE order page.
Please note that N95s are not currently shipped through automatic shipments. Orders for N95s must be placed through the MCCSS web portal. Place an order for N95s online using the portal.
As supply is limited, the ministry is making available a maximum of two HEPA filters per residential site. Large sites with more than 20 residents should have a discussion with their appropriate ministry contact to determine if additional HEPA filters may be required and orders may be adjusted for larger sites to go above the two HEPA filter maximum.
Please place an order for HEPA filters only, do not include PPE items in your cart.
Upon submitting an order, service providers will be required to complete an attestation confirming that they are providing services deemed eligible for filters at this time.
The HEPA filter unit model available on the web order portal can be used stand-alone or can be wall-mounted in accordance with manufacturer instructions.
Order deadline: Orders may be placed throughout November and December 2021 (while supplies last with delivery typically occurring within 3-5 business days).
Service providers will be required to accept HEPA filter deliveries by the end of the 2021 calendar year. When placing orders, service providers should also be mindful that service delivery standards may be impacted by the holiday season.
Appendix 3: public health Ontario resources
- Public resources
- resources for congregate living settings
- Congregate living setting resources toolkit
Infection prevention and control
- (course) IPAC Fundamentals Training
- checklist: preparedness and prevention in congregate living settings
- checklist: managing outbreaks in congregate living settings
- vaccine communication strategies for community congregate living settings
- : personal protective equipment and non-medical masks in congregate living settings
- Cleaning and disinfection for public settings
Respiratory Virus Outbreaks
- Planning for respiratory virus outbreaks in congregate living settings
- Key features of influenza, SARS-CoV-2 and other common respiratory viruses
- Antiviral use in congregate settings
Indoor air quality
- : heating, ventilation and air conditioning (HVAC) systems in buildings
- Use of portable air cleaners and transmission of
- footnote Back to paragraph Definition adapted from: Ontario Agency for Health Protection and Promotion (Public Health Ontario). IPAC recommendations for use of personal protective equipment for care of individuals with suspect or confirmed . 6th revision. Toronto, ON: Queen’s Printer for Ontario; 2021.
- footnote Back to paragraph Note that per clause 2(3)(a) in Schedule 1 of O. Reg. 364/20, the person responsible for a business or organization that is open must post signs at all entrances to the premises of the business or organization, in a conspicuous location visible to the public, that inform individuals on how to screen themselves for prior to entering the premises.
- footnote Back to paragraph Note that all businesses are required to have a written safety plan as per s. 3, Schedule 1 of O. Reg 364/20. For more information, see MLTSD's webpage.
- footnote Back to paragraph A PCR/POCT test upon admission or transfer is optional for the resident and should take place 5-7 days following admission to account for potential incubation period
- footnote Back to paragraph While the isolation of asymptomatic contacts is technically termed “quarantine,” the common use of “self-isolation” is used to refer to both symptomatic/infected and exposed individuals. As such, for ease of understanding, in this document, the term “self-isolation” refers to both asymptomatic close contacts who are negative or not tested, in addition to those who are symptomatic and/or infected.
- footnote Back to paragraph This section will refer to workers as defined under the Occupational Health and Safety Act.