September 2021

Introduction

In June 2021, the province introduced the Roadmap to Reopen, its three-step plan to safely and gradually lift COVID-19 public health measures based on ongoing progress of provincewide COVID-19 vaccination rates and improvements of key public health and health care indicators.

The Ministry of Children, Community and Social Services (MCCSS) is also continuously reviewing emerging evidence in collaboration with health system partners and technical experts to understand the most appropriate COVID-19 infection prevention and control measures to take moving forward within MCCSS-funded service settings, including day supports program for adults with developmental disabilities.

These guidelines are intended to support re-opening and/or continued operation of in-person adult day supports within the context of Ontario’s Roadmap to Reopen.


How to use this guidance

This guidance outlines Ministry-specific direction for MCCSS-funded in-person day support settings.

This guidance is intended to be followed in addition to other applicable legislation and health guidanceincluding, but not limited to:

Service providers, as employers, are obligated to adhere to applicable legislative or regulatory requirements related to health and safety such as those in the Occupational Health and Safety Act (OHSA) and its regulations.

This document replaces the version issued in July 2020.


Summary of key changes in this version

  • Refined language and re-ordered sections.
  • NEW reference to relevant regulations under Re-Opening Ontario (A Flexible Response to COVID-19) Act for social gathering provisions.
  • NEW section on use of rapid antigen testing for screening.
  • UPDATED section on personal protective equipment (PPE) for staff, participants, visitors.
  • NEW section on PPE supply information (Critical Supply and Equipment (CSE) survey and Ontario Association for Children’s Aid Societies web portal).
  • NEW section on considerations for re-opening.
  • NEW section for frequently asked questions.

Working with the local public health unit (PHU)

While the Ministry is providing guidance on how day supports are to operate, service providers must follow the advice of local public health units (PHU) when establishing health and safety protocols. In addition to providing direction on some issues, your PHU can also provide advice at your request that may assist if you have specific questions about how to safely re-open programs and implement high quality infection prevention and control (IPAC) practices.

The Ministry recognizes that implementation of these protocols may result in regional differences but given the unique needs and circumstances in each community and setting/service provider, it is important to first and foremost follow the advice of local PHUs to keep people, their families and staff safe in their respective communities. As a result, the guidance in this document is subject to modification based on the advice or direction of your PHU.

Employers are also reminded that the provisions of the Occupational Health and Safety Act(OHSA) continue to apply in all workplaces. In the event of a conflict, the requirements of the OHSAwould prevail.

Contact information for local PHUs.


Planning

Establishing an Occupational Health and Safety Plan

The Occupational Health and Safety Act (OHSA) requires employers to take every precaution reasonable in the circumstances for the protection of a worker. This requirement includes protecting workers from all hazards including infectious diseases such as COVID-19.

All workplace parties (e.g. employers, supervisors, workers) have statutory responsibilities related to health and safety in the workplace.

  • The guide to developing a COVID-19 workplace safety plan can help employers develop and implement control measures.
  • The safety plan can be modified to incorporate new information about risks and how to minimize them and to reflect changes in legislated requirements, as appropriate. The requirement to protect workers will not change through the stages of reopening.

Maximum group size and ratio

Service providers must follow relevant provisions for social gathering and organized activities in the Roadmap to Reopen regarding maximum group size for the service setting.

In order to limit the number of participants that staff come into contact with, and participants coming into contact with each other, programs must operate in cohorts of staff, day program participants, and support staff for day program participants who stay together throughout the day, with the following considerations:

  • While close contact may be unavoidable between all staff/participants, physical distancing and general infection prevention and control practices must be practiced as much as possible.
  • If a participant requires a support worker or other additional personal assistance, this person(s) must be included in the staff/participant count follow all guidance provided herein.

There can be more than one day support program or cohorted group of staff and participants operating in a building as long as they are able to maintain a separation of at least 2 metres /six feet between cohorts and follow all health and safety requirements.

Cohorted groups cannot mix with other cohorted groups. This includes, but is not limited to, during pick-ups, drop-offs, mealtimes, and outdoor activities.

Programs that use a room/space that is shared by more than one cohort or has other user groups (e.g., programs in museums, community centres, etc.) must ensure the room/space is cleaned before and after using the space. A cleaning log must be posted and used to track cleaning.

Staff training

In addition to the provisions below, service providers are expected to adhere to and comply with applicable regulations under the Reopening Ontario (A Flexible Response to COVID-19) Act and requirements outlined in Ontario Regulation 299/10: Quality Assurance Measures (QAM).

Standard first aid training, including CPR

Service providers are encouraged to continue to monitor the WSIB website for any updates on First Aid/CPR certificate extensions for any staff whose certification expired as of March 1, 2020.

Infection prevention and control (IPAC) training

Service providers must ensure that training is provided to all staff on the health, safety and other operational measures outlined in this document and any additional local PHU requirements are in place prior to re-opening (e.g. IPAC and proper use of personal protective equipment (PPE)). Education must be provided about the safe use, limitations and proper care of surgical/procedure masks and eye protection and any additional PPE that staff need to use. See Ontario’s COVID-19 website and PHO’s website for additional information.

Training should also include instructions on how to clean the space and equipment, safely conduct daily screening, ensure proper physical distancing and keep daily attendance records, and what to do in the case that someone becomes sick.

Liability and Insurance

All respective requirements under the MCSS Act, SIPDDA and CYFSA must be upheld in addition to the enhanced health and safety measures outlined in this document and by the local PHU.


Use of personal protective equipment

All personal protective equipment (PPE) and source control equipment required to be used by staff, participants and visitors must be provided by the service provider. See section below for additional information on personal protective equipment (PPE) supply.

Universal masking for staff

Regardless of vaccination status, all staff in MCCSS-funded day supports programs must wear a surgical/procedure mask at all times except when:

  • Eating and drinking (and maintaining physical distance of at least 2 metres / 6 feet from others).
  • Alone outside.
  • Alone in an office.

“At all times” includes:

  • When travelling in a vehicle for work purposes and when accompanying a participant in the community.

The exceptions outlined above, namely eating and drinking, apply in a community setting (e.g. dining on a patio).

Masks are intended to be worn for extended periods and re-used for the entire shift however the mask should be replaced if the mask is:

  • soiled;
  • contaminated (e.g., if someone coughs on you);
  • moist or wet; and/or
  • damaged.

Service providers should provide staff additional mask(s) in cases where the initial supplied mask needs to be discarded.

Masking is NOT A SUBSTITUTE for other important infection prevention and control practices, including active symptom screening, hand hygiene, and physical distancing.

Refer to Public Health Ontario resourcesfor how to properly wear and take off masks.

Eye protection for staff

Regardless of immunization status, eye protection (i.e. face shield, goggles, safety glasses) must be worn by staff when providing direct care to a participant (i.e. care provided within 2 metres) indoors, or in an enclosed space like a vehicle.

Personal protective equipment (PPE):

Staff providing direct care to a participant (e.g., care provided within 2 metres) should assess the need for additional PPE based on the nature of the planned interaction with a participant, what is known about the participant’s health status, and any other applicable considerations. See, for example, Risk Algorithm toGuide PPE Use, as well as any relevant legislation, which may include but is not limited to the Reopening Ontario (A Flexible Response to COVID-19) Act, 2020 and its regulations, and any applicable directives and/or orders.

PPE is to be supplied by the employer.

Masking for participants and visitors

Service providers are advised to follow mandatory masking and PPE provisions outlined in relevant regulations under the Reopening Ontario (A Flexible Response to COVID-19) Act, 2020 and local public health advice with respect to masking requirements for program participants and visitors.

Currently, regardless of immunization status, all persons are expected to wear masks when indoors.

Service providers should develop a policy to address circumstances where an exception to mandatory masking provisions applies.

Hand hygiene

Staff should perform and promote frequent, proper hand hygiene (including supervising or assisting participants with hand hygiene) through active reminders and visible signage throughout the day supports setting. Hand washing using soap and water is recommended over alcohol-based hand rub when hands are visibly soiled. Refer to Public Health Ontario’s How to Wash Your Hands fact sheet.

Personal protective equipment (PPE) supply

Service providers should forecast their requirements in the CSE survey portal. In case of an emergency (i.e., COVID-19 outbreak, having less than a 5-day supply of PPE) organizations requiring additional surgical masks, eye protection and isolation gowns can request additional supply from the OACAS Shared Services PPE Order Page.

Core PPE

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.

Niche PPE

Eye goggles and safety glasses 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 (i.e., eye goggles or safety glasses) and should default to using core PPE (i.e., face shields) when operationally feasible as access and supply to these products is more stable.


Operational guidance

Pre-supports considerations

Communication with caregivers

Communication with families/caregivers regarding the enhancement of health and safety measures facilitates transparency of expectations. New policies should be identified to families/caregivers, for their information and active participation in helping to keep all participants and staff safe and healthy.

Service providers should develop a fact sheet to communicate the enhanced health and safety measures being implemented as well as any new expectations of staff and caregivers as well as other service providers.

In reopening day support programs, service providers are not required to revise their policies and procedures document(s) unless there are respective policies that are impacted by enhanced health and safety measures due to COVID-19.

Service providers may want to consider providing links to helpful information, as well as detailed instructions regarding screening, group/shared transport and pick-up/drop-off procedures, and protocols if a participant or staff becomes ill.

Priority/waitlist policies may need to be updated to account for limited capacity during re-opening phases. Any changes should be communicated to participants/caregivers, so they are aware of the changes and the equitable approach undertaken to assess priority for support.

Where possible, the use of in-person communication with families/caregivers should be limited.

Access and prioritizing participants

When determining prioritization of individual access to limited day support spaces, Developmental Service Ontario (DSO) offices (where appropriate), service providers, and day supports providers may wish to consider the following:

  • Physical and/or health risk of individuals;
  • Other supports available or being utilized by the individual;
  • Supports for people where caregivers must return to work and that work is outside of the home;
  • Continuity of service for people who had previously received supports;
  • Individual choice and informed risk; and;
  • Other local circumstances.

DSOs and service providers should also consider that some people they used to serve may no longer require supports or might require a different level of support (i.e., partial days).

Assessing demand for supports prior to re-opening, for example via conducting a survey, is advised.

In-Supports Considerations

Drop-off and pick-up procedures

Service providers should develop procedures that support physical distancing and separate cohorts (i.e., participants of one cohort enter door A and  participants of another cohort enter door B, or staggered entrance times).

Caregivers should not go past the screening area.

All entrances should have hand sanitizer.

Service providers should use signage that defines physical distancing requirements and consider using ground markings that direct people through the entry steps.

Personal belongings should be limited to essential items. If brought, belongings should be labeled and kept in the participant’s designated area.

Screening for symptoms

Anyone entering a day-supports setting, including staff, must be actively screened each time they enter the setting. A formal process should be established to ensure rigorous screening activities. Settings may wish to consult and adapt the screening tool found on the MOH’s COVID-19 website.

Screening activities should:

  • Limit points of entry into the setting to help facilitate screening.
  • Place a physical barrier (e.g., plexiglass) that staff can be behind in order to conduct screening at entrances to provide further protection from droplets.
  • Maintain space and layout of the entrance in a manner that supports physical distancing while staff conduct screenings.
  • Provide alcohol-based hand rub (ABHR), tissue, and lined no-touch waste basket or bin for use.
  • All participants and staff should use ABHR before entering the premises.
  • Advise each person that is screened that if they start to feel unwell, they should immediately notify a designated individual (either staff or a supervisor).
  • All service providers must keep daily records of their screening results.

Providers must deny entry to the premises to any person who does not pass active screening.

  • Participants and caregivers should be reminded of this requirement when participants are first registered for the supports, and through visible signage at the entrances and drop-off areas.

For information and resources on COVID-19 symptoms, protections, and seeking health care please consult the province's COVID-19 website.

Rapid antigen testing as a screening tool

  • Rapid antigen screening can quickly identify asymptomatic cases of COVID-19 that would have otherwise gone undetected and can help stop the spread.
  • The government is providing rapid antigen screening tests, free of charge, to MCCSS-funded and licensed service settings through the Provincial Antigen Screening Program (PASP).
  • Rapid antigen screening is a tool to enhance existing IPAC measures for unvaccinated individuals living, participating and working in congregate settings or receiving in-person services.
  • The use of rapid antigen screening in a setting, including a negative result on a rapid antigen screening test, does NOT replace or remove the need to adhere to other IPAC measures in place.
  • Service providers that are interested in participating in the PASP may apply here.

Attendance records

Service providers must keep daily records of everyone entering the day support setting (such as staff, participants, visitors, cleaners, people doing maintenance work, people providing therapeutic supports etc., those delivering food, etc.).

Records (e.g. name, contact information, time of arrival/departure, etc.) must be kept up-to-date and available for a minimum of 30 days to facilitate contact tracing in the event of a confirmed COVID- 19 case or outbreak.

Space set-up and physical distancing

When setting up the day supports space, service providers are expected to ensure physical distancing between people within a cohort (2 metres/6 feet) by:

  • spreading people out into different areas, particularly at meal time;
  • incorporating more individual activities or activities that encourage more space between people; and
  • using visual cues such as tape on the floor to promote physical distancing, limiting available seating, use of plexiglass.

Shared spaces and structures that cannot be cleaned between cohorts should not be used.

Plans should also be made to prevent mixing of cohorts at the same time in common spaces such as washrooms, changerooms, kitchen, lunchrooms, and to frequently clean and disinfect shared surfaces in these spaces. Where applicable, a capacity limit should be set to ensure proper physical distancing.

Recognizing that physical distancing can be difficult, particularly with people who have hearing and visual impairments, exhibit behavioural issues or require physical supports for activities of daily living (i.e. changing out of soiled clothing) additional suggestions include:

  • planning activities that do not involve shared objects or equipment;
  • whenever possible, moving activities outside to allow for more space and ventilation;
  • avoiding singing activities indoors; and
  • avoid sharing of intervenors where there are people who require tactile communication and/or when sighted guide is required.

Cleaning

Day supports program spaces must be cleaned daily. In addition, all surfaces that are touched and used frequently by participants and staff should be cleaned at least twice a day and when visibly dirty (e.g., door knobs, light switches, toilet and faucet handles, electronic devices, and tabletops). Water fountain/ refill stations should only be used to refill individually assigned bottles. Drinking directly from a water fountain should be prohibited. Water fountain/ refill station equipment should be cleaned frequently.

A cleaning log must be posted and used to track and demonstrate cleaning schedules.

For more information on cleaning please refer to Public Health Ontario’s Environmental Cleaning Fact sheet.

Where possible, each equipment should be used by one cohort only.

Mouthed equipment should be removed immediately for cleaning and disinfecting and should not be shared amongst participants.

Outdoor activities

Service providers should schedule outdoor activities by cohort in order to facilitate physical distancing and align with provincial parameters for outdoor social gatherings in the Reopening Ontario (A Flexible Response to COVID-19) Act.

Where the outdoor area is large enough to accommodate multiple groups, service providers may divide the space with physical markers to ensure cohorts remain separated.

If recreational structures (benches, chair swings) are to be used by more than one cohort, the structures can only be used by one cohort at a time and must be cleaned before and after each use by each cohort.

Food provision

 Service providers must change meal practices to prohibit self-serve or shared food at mealtimes. At a minimum:

  • Serving utensils should be used to serve food.
  • Meals should be served in individual portions to the participants.
  • There should be no items shared (e.g. serving spoon or saltshaker).
  • Outside food should be limited and any food that is brought in should be clearly labelled to avoid accidental sharing.

Service providers should ensure proper hand washing and hygiene are practiced when staff are preparing and serving food, and before mealtimes for all participants.

Participants must also practice physical distancing while eating. Monitoring by staff must continue during mealtime.

Protocols when a program participant becomes sick

If a participant becomes sick while in attendance at the day support program, they should be isolated and given a surgical/procedure mask (if they are not already wearing one), and arrangements should be made for a caregiver or appropriate congregate care residential staff to be contacted for pick-up.

The sick participant should be reminded of hand hygiene and respiratory etiquette while waiting to be picked-up. Tissues should be provided to the day program participant to support proper respiratory etiquette, along with a method for the proper disposal of the tissues.

If a separate room is not available, the sick person should be kept 2 metres/6 feet from others.

Staff should remain with the participant until the appropriate person arrives. They should avoid interactions with other people and should avoid contact with the participant’s respiratory secretions.

The isolation space and all items used by the sick person should be cleaned and disinfected immediately after use. All items that cannot be cleaned (paper, books, etc.) should be removed and stored in a sealed container for a minimum of 7 days.

Service providers should encourage the sick person to be clinically assessed by their primary care provider and/or be tested for COVID-19.

In the event that there is a confirmed case of COVID-19 at the day support program, the local PHU will provide specific advice on what control measures should be implemented to prevent the potential spread.

Where a day program participant or a staff member is suspected of having or has a confirmed case of COVID-19, service providers must submit a Serious Occurrence Report to the Ministry in SOR-RL.

Service providers should consult the supplement entitled “MCCSS COVID-19 Serious Occurrence Reporting Category and Subcategory Selections” for clarity.

Where a day supports program is required to close due to COVID-19 (per direction from the local PHU), service providers must report this to the Ministry as a serious occurrence, as soon as possible and no later than 24 hours in the case that an outbreak has been declared.

Under the Occupational Health and Safety Act, 1990, an employer must provide written notice to the Ministry of Labour, Training and Skills Development within four days of being advised that a worker has an occupational illness, and under the Workplace Safety and Insurance Act, 1997 (WSIA), must report to Workplace Safety Insurance Board (WSIB) within 72 hours of receiving notification of said illness.

Testing requirements

If a staff member is showing symptoms of COVID-19 they should be instructed to self-isolate immediately and be encouraged to get tested for COVID-19. Staff should also contact their immediate supervisor/manager or occupational health and safety representative.

Staff with symptoms within 48 hours post-vaccination may be exempt from exclusion from work as per the Guidance for Employers Managing Workers with Symptoms within 48 Hours of COVID-19 Immunization guidance.

Staff/ participants who test negative for COVID-19 must not return to work at an in-person day program for a minimum of 24 hours after symptom resolution.

Those who test positive for COVID-19 must be excluded from the program until clearance has been received from the health care provider or, where applicable, the local PHU.

Staff and participants awaiting test results who are/have been symptomatic or have been advised to self-isolate by the local PHU must not attend the day supports setting.

In the event that an outbreak is declared by the local PHU, the PHU will provide direction throughout the duration of the outbreak.

Considerations for Re-Opening

As the province moves through the phases of recovery, there is a need to balance the consistency across regions with the need for a tailored approach that reflects local needs and priorities within the existing constraints to manage risk.

There is recognition that service providers continue to engage with each other, Ministry staff and broader service system partners to proactively identify and manage risks. The intention is to continue to leverage community planning mechanisms to adopt a proactive, supportive, coordinated, and integrated approach that builds upon existing local practices, particularly as we move through recovery and re-opening phases.

Where there are limitations to a resumption of normal service activities, and agencies could benefit from working jointly to pool resources to address local needs, TPRs are encouraged to consider innovative service delivery models, including identifying a lead agency to deliver services on behalf of other agencies, where appropriate. These community-based responses are aligned with and supported through funding flexibility and the reconfiguration of service targets for 2021/22.

As part of local community planning in response to limitations to resumption of normal service activities, the following factors should be considered when making decisions. Outcomes of the discussions should be documented.

Theme and objective Factors for consideration
Determining Community Needs

Objective:Identification of people and their needs to determine the best way of providing available services and supports
  • What needs of clients and risks have been identified?
  • How will this assessment inform the most critical supports and services to avoid family breakdown or health/mental health breakdowns/ crisis?
  • What is the plan for stakeholder engagement (i.e. people supported, their families/caregivers, employees) to seek input, identify needs and/or communicate direction?

Service Delivery

Objective: Considering alternate models of service delivery and support agreed upon solutions

  • What local strategies have been developed to increase service options for individuals and families?
  • How have existing models of service delivery been modified to comply with public health advice and address infection prevention and control (IPAC) risks. For example, the hierarchy of controls has been applied to a) in person services b) virtual services c) in the case of outbreak?
  • To what extent are linkages or implications on other services as a result of changes to program models being considered?
  • Are there other methods of service delivery that would help to avoid family breakdown or mental health challenges/ crisis including “non-traditional” supports?

Collaboration/Partnerships

Objective: TPRs identify strengths/ resources locally to best meet the needs of people supported

  • Are local plans consistent with a local pandemic response and recovery plans, including local cross sectoral partners (i.e., municipal service managers, health)?
  • Is there an opportunity to share and leverage resources across local partners (i.e., Sharing spaces that allow for social distancing and/ or staff to resume day program operations)?
  • Are there practices and protocols in place to support a changing environment (e.g., leveraging resources across TPRs such as IPAC, training capacity, PPE)?

Workforce

Objective: Leveraging staffing resources to support local planning.

  • Are there sufficient and appropriately trained staff to maintain critical residential services while providing other non-residential supports?
  • To what extent are service providers able to access additional staffing resources through temporary staffing/ hiring or redeployment?
  • Are there resources in place to support training and capacity building i.e., for IPAC or other training needs?
  • How are the mental health needs of the workforce being addressed?

Resources/Tools

Objective: Leverage existing tools and resources and develop the most appropriate solution for their local community

  • What are some planning tools, templates and/or other existing resources that could be shared between TPRs to facilitate non-centre based or congregate approaches?
  • What gaps in information or resources (non-financial) have been identified that could be mitigated through a community-based approach?

Frequently Asked Questions:

As a staff person who has been fully vaccinated, do I still need to wear a mask?

Yes. Regardless of immunization status, staff are required to wear a medical (surgical/procedure) mask at all times except when:

  • Eating and drinking (and maintaining physical distance of at least 2 metres / 6 feet from others).
  • Alone outside.
  • Alone in an office.

“At all times” includes:

  • When travelling in a vehicle for work purposes and when accompanying a participant in the community (e.g. to a shopping mall, medical appointment).

The exceptions outlined above, namely eating and drinking, apply in a community setting (e.g. dining on a patio).

As a staff person who has been fully vaccinated, do I need to wear eye protection in the community (i.e. outside of a service-provider operated day program space)?

Yes. Regardless of immunization status, eye protection (i.e. face shield, goggles, safety glasses) must be worn by staff when required to be within 2 metres/6 feet of a day support participant indoors, or in an enclosed space like a vehicle.

This includes time spent indoors in a community space.

Can staff eat on a patio with day support participants?

Yes, staff can remove their mask to eat on a patio with day support participants so long as physical distancing can be maintained.

Are there restrictions on the type of community activities day support participants can partake in?

Day support activities are permitted in alignment with the Reopening Ontario (A Flexible Response to COVID-19) Act and relevant regulations.

Service providers are also encouraged to seek advice from their local PHU regarding the need to additional precautions related to local community spread.

Can changes be made to cohorts after they have been established?

Yes, changes can be made to cohorts as needed at the discretion of the service provider. The intent of cohorting is to limit the number of other people participants and staff are exposed to. Changes should only be made where there is strong rationale.

Will these guidelines continue to apply when Step 3 of the Roadmap to Reopen ends?

The Ministry is continuously reviewing emerging evidence in collaboration with health system partners and technical experts to understand the most appropriate COVID-19 infection prevention and control measures for MCCSS-funded service settings. Updates to guidance will be issued moving forward as appropriate.