To help stop the spread of COVID-19, all non-youth justice congregate care settings funded by the Ministry of Children, Community and Social Services in all regions must continue to follow the interim direction until further notice.

The interim direction replaces previous guidelines and directions, which have been suspended:

• MCCSS Visitor's Guidelines 2.0: Re-Opening Congregate Living Settings
• MCCSS Wave 2 Enhanced Precautions memos that have been issued
• Operational Guideline on Universal Source Control

As the COVID-19 outbreak situation changes, further direction may be provided.

As it pertains to residents who are away from congregate care settings at the time this direction comes into effect, the interim direction should be followed upon their return to the congregate care setting.

Interim Direction

Essential visits in congregate care settings

Indoors

Indoor visits are permitted for essential visitors ONLY.

An essential visitor is generally a person who:

• Performs essential services to support the ongoing operation of a service agency (including a contractor); and/or
• Is considered necessary to maintain the health, wellness and safety, or any applicable legal rights, of a congregate care resident.

An essential visitor may include but is not limited to the following:

• A parent/guardian
• Social service worker (e.g., child welfare workers, day program operators etc.)
• Health care providers (e.g., doctor, nurse, personal support workers, etc.)

Virtual visits are to be strongly encouraged and facilitated wherever possible

Agencies should consider residents and staff health and susceptibility to the virus as well as the overall well-being of all the residents in congregate care settings in determining whether essential visits are appropriate.

Essential visitor personal protective equipment requirements while indoors:

All essential visitors must wear a surgical/procedure mask AND eye protection at all times while inside the congregate care setting.

Essential visitors are to be advised during screening at the door that strict adherence to the masking/eye protection requirements are a condition of entry and failure to adhere may result in them being asked to leave the premises.

Service providers are to supply essential visitors with a surgical/procedure mask and face shield as needed.

Outdoor

Outdoor visits are permitted for essential visitors ONLY.

Essential visitor personal protective equipment requirements while outdoors:

All essential visitors must wear, at a minimum, a surgical/procedure mask at all times while the outdoor visit is taking place.

Service providers are to supply outdoor essential visitors with a surgical/procedure mask as needed.

Short-stay absences and outings

Essential health and well-being activities outside the residence are permitted.

Such activities may include, for example, a medical appointment or work, given they are:

• Authorized through screening for the activity and/or public health advice; or,
• Essential for medical purposes only and virtual care is not possible.

Service providers are to follow local school board direction regarding school attendance. Organized recreational activities outside of the congregate care setting are suspended. This includes day programming or other group/public setting activities where social interaction is likely.

Off-site activities for physical/mental health that allow physical distancing are permitted (e.g., going for a walk).

All residents of congregate care are expected to stay in their setting as much as possible.

Essential overnight absences

As residents are expected to stay in their setting as much as possible, absences from the setting are strongly discouraged.

Where an absence (e.g., to a family home) is necessary to maintain the health, wellness and safety, or any applicable legal rights, of a resident it is permitted.

Residents and caregivers are to be advised before an overnight visit takes place of required enhanced precautions that are to be implemented upon return of the resident from an overnight visit.

Enhanced precautions post essential overnight visit

A resident returning to the congregate care setting from a permitted essential overnight absence must upon return, follow enhanced precautions for 14 days post essential overnight visit, including:

• Upon return, pass an active screening questionnaire that screens for signs and symptoms of, and potential exposures to COVID-19;
• Only receive outdoor visitors during the 14 days;
• Monitor for symptoms;
• Avoid using common areas; however, if a common area cannot be avoided, the resident must wear a surgical/procedure mask if tolerated;
• Limit contact with other residents;
• Only participate in group activities if physical distancing is maintained (i.e., 6 feet or 2 metres) and the use of a surgical/procedure mask;
• Practice proper hand hygiene by washing their hands often (using soap and water, or use alcohol-based hand sanitizer);
• Adhere to respiratory etiquette; and,
• Continue to follow appropriate physical distancing guidelines (i.e., maintaining a distance of 6 feet or 2 metres).

These precautions are critical to helping control the risk of COVID-19 transmission within the setting.

Enhanced personal protective equipment for staff

• All staff must wear a surgical/procedure mask AND eye protection (face shield, eye goggles or safety glasses) at all times except when:
  • eating/drinking (as long as a full 2-metre/6-foot physical distance from others can be maintained);
  • outside and physical distance can be maintained; or,
  • alone in an office.
• Staff must where an isolation gown also, when providing direct care to residents with respiratory symptoms and/or are under droplet/contact precautions.

Eye protection needs to be:

1. intended for protection of mucous membranes involving the eyes; and
2. a barrier to provide that protection.

Eye protection should have some means of shielding the sides of the eyes/face by the way they wrap around so that droplets are less likely to land on the eyes.

Prescription glasses and sunglasses alone are not considered adequate eye protection.

As a reminder, Public Health Ontario has provided the following guidance for staff areas:

• All activities that require close contact are discontinued, including group in-person meetings.
• Schedules for using common areas are staggered.
• Furniture is moved to support keeping 2-metre distance apart and tape is used on the floor to indicate where furniture should stay.
• Common areas are cleaned and disinfected at least twice daily.

IMPORTANT NOTE: Failure to abide by the careful use of PPE and strict limitations on PPE removal in the congregate care setting is a known contributor to the spread of COVID-19 between staff and residents, and among staff.

Screening questions

Screening in congregate care settings must continue to include the following question to all individuals seeking to enter the setting:

1. “Are you aware of the recommendations and restrictions in this community regarding gathering size, hand and respiratory hygiene, and the use of face coverings and masks?
   1. Are you following these recommendations and restrictions regularly outside this setting you are seeking to enter?”

Agency screening must also continue to be enhanced for staff with the following questions:

1. “Do you understand that you are expected to properly don your personal protective equipment and wear it at all times in this setting with the exception of when you are eating?
2. Do you acknowledge that at any time your PPE is removed you must maintain a distance of 2 metres or 6 feet from others?”
   Please remember that interacting with colleagues outside of work without face coverings and social distancing raises the risks of COVID-19 transmission.”

For a list of all COVID-19 symptoms and access additional screening tools please refer to the to the Government of Ontario COVID-19 Information Website.

Precautions for settings in an active outbreak

If a congregate care setting is in an active COVID-19 outbreak (one or more positive COVID-19 case), the following additional measures must be followed:

• Seek outbreak-specific training resources available via Public Health Ontario (PHO), including the appropriate use of PPE and infection prevention and control (IPAC) practices.
• Implement enhanced cleaning practices.
• Restrict new admissions (where possible) in settings experiencing an outbreak.
• Seek support from your local public health unit (PHU) to assess the need for testing of all residents and staff who may have been exposed.
• Where an emergency order applies to the setting (e.g., developmental services, intervenor services, anti-human trafficking residences, violence against women programs) limit staff mobility to working in outbreak site only.
• Staff who are asymptomatic but test positive for COVID-19 must follow outbreak precautions and isolate for 14 days. These individuals must not return to work for 14 days.

Visitors and Absences

• Indoor visits are permitted for essential visitors ONLY.
• Essential visitors must wear full PPE required for outbreak conditions.
• Organized recreational activities outside of the congregate care setting are suspended.
• Residents should only exit for essential reasons and must wear a mask. Wherever possible, infection or close contact status should be disclosed prior to the appointment or absence in order to receive additional direction.
• Essential overnight visits are prohibited.
• Avoid group activities in the setting and encourage physical distancing for non-infected residents as much as possible. Follow isolation procedures for symptomatic or COVID-19 confirmed residents.

Other measures

The measures above are essential tools to addressing the risks of COVID-19 transmission in MCCSS-funded congregate settings.

While direct interactions connected to the workplace and congregate care settings are key, what we do in our personal lives also contributes directly to infection risks in those settings. All Ontarians including staff of congregate care settings MUST adhere strictly to practices in their personal life that help stop the spread of COVID-19.

These practises include maintaining at least 2 metres or 6 feet physical distance from others, using a face masks or covering when outside of your home, hand and respiratory hygiene, and limiting close contact (within 6 feet or 2 metres) only to people you live with in the same household.

To support these efforts, agencies should supplement these practices by setting measures to maintain and enhance work from home arrangements where it is not essential for employees to attend the workplace.