CDS Operations Under COVID-19

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.24.011

This Information Bulletin replaces DD.22.006.

Community Day Services (CDS) is a program of day habilitation that assists with acquisition, retention, or improvement in self-help, socialization, and adaptive skills that takes place in a non-residential setting, separate from the individual's private residence or other residential living arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, and personal choice.

CDS providers must be certified by the Bureau of Accreditation, Licensure and Certification as a CDS provider. CDS providers are able to bill 31U (site-based), 31C (community-based) and/or 31V (virtual) for services provided to individuals with intellectual and developmental disabilities.

Overarching:

The Division developed a tool for providers and individuals to use to assess risk, the Illinois CV Provider Preparedness Self-Assessment.

Providers continue to be responsible for implementing standards and safeguards to help protect individuals' health and safety.

When making decisions about prevention strategies, CDS providers should consider current information about COVID-19 New Hospital Admissions Rate, the risk of severe illness for the population served, as well as risks for transmission posed by lack of social distancing. See the map of COVID-19 New Hospital Admissions Rate in Illinois on the CDC Data Tracker.

The State developed the Illinois Risk Benefit Discussion Tool as a resource for individuals, their families/guardians, and their provider to have important discussions in weighing the benefits and risks of participation.

Helpful Links for Individuals and Providers:

IDPH - Coronavirus Disease 2019
Department of Human Services DDD COVID-19 Resources
Some people at higher risk for severe illness and death if they contract COVID-19. If they so choose, these individuals may opt to take additional precautions to protect themselves. For instance, they may choose to mask when it isn't required
Disability and Health
CDC COVID-19 Communication Tools and Resources

General Health Screening:

Signage should be placed at the entrance to buildings reminding providers and individuals to self-report if they have had close contact with someone who has COVID-19, or if they have symptoms of COVID-19. When COVID-19 New Hospital Admissions Rate is high, encourage staff, individuals, and visitors to check for symptoms of COVID-19 prior to traveling to or entering a CDS site.
Symptoms of COVID-19 include fever, chills, cough, shortness of breath, fatigue, muscle aches, headache, new loss of taste or smell, sore throat, runny nose, vomiting or diarrhea. Staff and individuals experiencing symptoms should remain home and seek evaluation by a health care provider. Providers should review the most updated guidance from the CDC.

Vaccination Status:

COVID-19 vaccines are both safe and effective. COVID-19 vaccines significantly reduce the risk of catching COVID-19, as well as the risk of severe illness, hospitalization, and death.

Vaccination is the leading public health prevention strategy for limiting the adverse consequences of COVID-19. CDS providers should promote COVID-19 vaccination, boosters, and additional doses, and if possible, provide opportunities for vaccination for all eligible staff and clients.
Because CDS providers provide services to individuals who are at higher risk for severe COVID-19 illness, CDS providers should encourage staff to be up to date on COVID-19 vaccinations.

Staff are considered "up to date" on COVID-19 vaccinations when they have received all CDC-recommended COVID-19 vaccines, and booster dose(s) when appropriate. A healthcare provider will be able to tell you if you are up to date, and what you should do to stay up to date.

Individuals should be encouraged to be up to date on their COVID-19 vaccinations, however, services cannot be denied based on vaccination status.

Core Infection Prevention Measures

Masking:

When COVID-19 New Hospital Admissions Rate is high, staff should wear well-fitting masks while providing CDS services.
When COVID-19 New Hospital Admissions Rate is high, it is recommended that individuals, especially those who are not up to date with vaccinations, wear a well-fitted mask or face shield while attending CDS. COVID-19 New Hospital Admissions Rate in Illinois on the CDC Data Tracker .
Staff and individuals may choose to wear a respirator (e.g., N95 if the staff or individual has had it fit-tested or KN95), which, if worn properly, can provide a higher level of protection than a cloth or procedural mask. CDS providers are not responsible for providing individuals with respirators.
CDS providers should have disposable surgical or procedure masks available for use by staff, individuals, and visitors.

Hand Hygiene

Signage should be posted in key areas, reminding individuals and staff to perform hand hygiene, either with soap and water or with Alcohol-based hand sanitizer.
Frequent hand hygiene by staff and individuals is important to limit the spread of COVID-19, and an adequate supply of soap/paper towels and/or alcohol-based hand sanitizer should be available.
- Providers should provide opportunities for regular hand washing or alcohol-based hand sanitizer to staff and individuals.
- Individuals should be supported to properly wash their hands at regular intervals.

Considerations for Improving Ventilation

When indoors, improving ventilation and increasing the number of times fresh or filtered air replaces all the air in the room can help reduce viral particle concentration and have been proven to decrease COVID-19 transmission (1) . For more information about improving ventilation, please see Appendix A.

Signage:

Signs should be displayed reminding staff, visitors, and individuals to wash their hands frequently and cover their nose and mouth with a tissue when coughing or sneezing.
Signs reminding staff, visitors, and individuals to report if they have had contact with anyone who has symptoms of COVID-19, or if they have symptoms of COVID-19 themselves, should be posted at entrances.

(1) Efficacy of Portable Air Cleaners and Masking for Reducing Indoor Exposure to Simulated Exhaled SARS-CoV-2 Aerosols - United States, 2021 MMWR Morb Mortal WKLY Rep / July 9, 2021 / 70(27);972-976 DOI:

Disinfecting/Cleaning Procedures:

Please reference CDC guidelines for recommended practices on disinfecting.
Water fountains and communal kitchen utensils should be cleaned frequently.
The entire facility, including equipment and furniture, must be cleaned each night or prior to a new group of individuals utilizing a space when COVID-19 New Hospital Admission Rates are high.
Sanitize items used in activities between users: game pieces, craft tools, etc. when COVID-19 New Hospital Admission Rates are high.

Staff and Individuals Who Have COVID-19 (Isolation)

Staff or individuals who are symptomatic or test positive for COVID-19 should be directed to remain at home or be sent home immediately and referred to a medical provider for evaluation if they become ill at the CDS site, per IDPH and CDC guidelines. See Isolation guidelines online:
Staff or individuals should not return to a CDS site until all the following are true:
- They have had no fever for at least 24 hours without the use of medicine that reduces fever.
- Symptoms, such as cough or shortness of breath, and overall condition have improved.
- At least 5 days have passed since symptoms first appeared, or after their positive test (if asymptomatic).
Providers should adopt a screening process and screen all staff and individuals prior to transport and/or participation in programming when COVID-19 New Hospital Admission Rates are high..
Asymptomatic COVID-19 positive staff may return to work after at least 5 days have passed since the date of their positive test.
Asymptomatic COVID-19 positive individuals may return to CDS activities after at least 5 days have passed since the date of their positive test.
Staff and individuals returning to CDS sites after at least 5 days of isolation should wear a well-fitted mask for an additional 5 days when around others (10 days total). If staff and individuals are not able to wear a well-fitted mask, they should not return to CDS until after 10 full days of isolation.
Educate staff and individuals on the need for early treatment for COVID-19 (within 5-7 days of starting symptoms) to avoid severe complications such as hospitalization and death. More information can be found at COVID-19 Treatments and Medications.

Staff and Individuals who have been Exposed to COVID-19

Develop protocols to address when a staff member or individual has been in close contact with someone who has tested positive for COVID-19. Close contact is defined as being within 6 feet for more than 15 minutes over a 24-hour period.

Staff and individuals who are exposed to someone with COVID-19

If staff and individuals are not able to wear a well-fitted mask, they should not return to CDS until after 10 full days of quarantine. If a staff member or individual develops symptoms, regardless of if they've been exposed, they should isolate at home for at least 5 full days (counting the day of symptom onset as day 0). They are eligible to return after:

Five full days have passed, counting as described above.
They have been fever-free for 24 hours without fever reducing medicines.
Their symptoms have started to improve and resolve.
- Please note that loss of taste and smell may persist for some time following recovery from COVID-19. It is not necessary for loss of taste and smell to improve for someone's isolation to end.
Staff and individuals who have been asymptomatic throughout their COVID-19 infection should isolate for 5 full days from their positive test (with the day of testing being counted as Day 0).

For exposed individuals, best practice would also include a test for SARS-CoV-2 at day 5 after exposure.
If symptoms occur, individuals should immediately isolate until a negative test confirms symptoms are not attributable to COVID-19.
In general, staff and individuals should not attend CDS with symptoms of an infectious disease until they have been evaluated by a healthcare provider or until symptoms subside.

Programming and Support:

The following are still considered appropriate recommendations:
- When possible and appropriate, programming should happen in the community or outdoors.
- When possible, encourage physical distancing as this is a valuable tool for preventing infections.
Providers should be prepared to explain policies and procedures, including safety measures and screening processes, to individuals using developmentally appropriate language that the individual can understand. The use of social stories can assist in this process.
In the event a provider becomes aware of a positive case of staff or individual in their CDS program, they should notify their local health department as well as impacted individuals, families, and partnering providers.
- Providers should thoroughly clean facilities and transportation vehicles, as soon as operationally feasible, with an EPA List-N disinfectant with claims again COVID-19 if exposure to COVID-19 has occurred.

Transportation Guidance:

For CDS programs that are providing individuals with transportation and when COVID-19 New Hospital Admissions Rate is high:

Providers should ensure every individual receives a screening for COVID-19 symptoms BEFORE being allowed to enter a vehicle carrying other people to a CDS site. This may be done by the driver, residential provider, family member, or other designated staff member.
Providers should provide alcohol-based hand sanitizer at the entrance of the vehicle. All riders should wash or sanitize hands prior to boarding or exiting the vehicle.
The interior of each vehicle should be cleaned and disinfected before and after use by individuals and staff.
Providers should ensure staff and driver(s) wear a well-fitted mask and encourage riders to wear a well-fitted mask or face covering when in the vehicle.
If a rider in the vehicle is identified as being COVID-19 positive, COVID-19 cleaning and disinfecting should be performed as soon after the confirmation as practical and before the vehicle is put back in service.
- Other riders who were transported in a vehicle with another rider who tested positive for COVID-19 must be notified immediately and should not participate in CDS until they receive guidance from the local health department.

This guidance should not be construed as legal advice. As a provider, you should consult your legal counsel.

Appendix A

When consulting with their HVAC professional, providers should consider the following approaches to improving ventilation:

Increasing the introduction of outdoor air.
Ensuring ventilation systems are operating properly as defined by ASHRAE Standard 62.1.
Optimizing the use of engineering controls to reduce or to eliminate exposures.
Exploring options to improve ventilation delivery and indoor air quality in all shared spaces. The higher number of air exchanges per hour will result in better results with respect to purging airborne contaminants. Refer to the CDC suggested options for Air Changes per Hour (ACH).
Using portable room air cleaners with a High-Efficiency Particulate Air (HEPA) filter to enhance air cleaning. Air cleaners need to have the appropriate Clean Air Delivery Rate (CADR) rating for the room size [e.g., a 300-ft2 room with an 11-foot ceiling will require a portable air cleaner labeled for a room size of at least 415 ft2 (300 × [11/8] = 415)]3. CDC FAQ #5.
The following resources provide evidence-based guidance:
- CDC Ventilation in Buildings (June 2, 2021)
- CDC/HICPAC Guidelines for Environmental Infection Control in Health Care Facilities (2003)
- American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), which provides COVID-19 technical resources PDF for health care settings.

Effective Date:

This Information Bulletin is effective January 1, 2024