guidance, for source control whenever they leave their room or are around others, including whenever they leave the NF. Page | 38 The NF has a responsibility to ensure the resident is making an informed decision when leaving the NF. Specifically, the NF must ensure the resident understands the risks and benefits of spending time in the community, including the potential risk for being exposed to or contracting COVID-19. If the resident makes an informed decision and chooses to leave the NF, the NF must also educate the resident and the companion taking the individual into the community about infection control and prevention procedures, including: • avoid crowds; • wear a facemask or face covering, in accordance with CMS and CDC guidance; • perform hand hygiene; • perform cough and sneeze etiquette; • maintain physical distancing in accordance with CMS and CDC guidance; • be aware of others who may potentially or actually have COVID-19; and • report any contact with another person who may potentially or actually have COVID-19 to the NF. Upon the resident’s return to the NF, the NF must ensure that: • the resident's facemask worn outside the NF is discarded or cloth face covering is laundered; • the resident's hands are washed thoroughly, or alcohol-based hand sanitizer is used; • all hard surface items the resident brings back into the NF are disinfected appropriately; and • the resident is screened, as is required for anyone entering the NF. A resident who leaves the NF, is not gone overnight, and did not have contact with others who may potentially or actually have COVID-19 does not have to be quarantined upon returning to the NF, even if the resident leaves with someone other than an essential caregiver or NF staff. The resident status would remain the same as it was before leaving the NF, as long as all infection prevention protocols are followed. If a resident returns on the same day, the NF should discuss with the resident (or their companion) what activities occurred while the resident was outside the NF, using the following questions as a guide: • Were you in any crowded spaces, whether that be in public or at a larger household gathering? • Were you unable to maintain a physical distance of at least 6 feet from someone who was not wearing a facemask, excluding mealtimes, when you were in out in public or visiting with others in a household? • Did you encounter anyone who tested positive for COVID-19 within the last 14 days or, or who does not yet meet CDC end of isolation criteria? • Did you encounter anyone who was exhibiting any symptoms related to COVID-19, whether that be in public or at a household gathering? Page | 39 A “yes” to any of these questions should be further investigated. Ask the resident or their companion the following questions to help determine whether exposure occurred: • If you attended a gathering at a family member or friend’s household, how many others attended? Was the gathering mostly indoors or mostly outdoors? Did attendees maintain social distancing, wear face masks, or practice other infection control measures such as proper hand hygiene? • If you came in close contact with someone at a household gathering who was not wearing a face mask or practicing other infection control procedures, how long did that close contact occur? • Did attendees at the household gathering maintain social distancing during mealtimes, when they were unable to wear a face mask? If the NF determines that a resident who left the NF and returned the same day requires quarantine, the NF must document the decision and its rationale. If a resident is gone overnight, he or she will return with unknown COVID status and require quarantine per CDC guidance. CDC guidance provides exceptions to quarantine for those who have recovered from COVID-19 within the last 90 days AND remain asymptomatic, as well as for asymptomatic residents who have not had close contact with a person infected with COVID-19 [and are up to date with all recommended COVID-19 vaccine doses including any booster doses]. Control Measures for Staff Active screening – The CDC and CMS recommend, and the NF COVID-19 Response rules require, that NFs screen all staff prior to entering the NF at the beginning of their shift for fever and other symptoms consistent with COVID-19. Actively take their temperature and document absence of or shortness of breath, new or change in cough, sore throat, or other symptoms of COVID-19. If they are ill, have them put on a facemask, immediately leave the NF, and self-isolate at home. Read table Comparing Symptoms of COVID-19 Infection, Flu, and Seasonal Allergies for additional information on ruling out COVID-19 infection. Staffing contingency plan – Develop a staffing contingency plan in case a large number of staff must self-quarantine or isolate because of potential exposure, being probable of, or positive for COVID-19. NFs must: • have sufficient staff to provide nursing and related services - 26 TAC §554.1001 • have a system for preventing, identifying, and controlling infections and communicable diseases for all residents, including staff policies for the control of communicable diseases in employees and residents - 26 TAC §554.1601 • develop and maintain an emergency preparedness plan that is based on a facility-based and community-based risk assessment, utilizing an all-