Guidance for Child Care Providers and Programs

June 29, 2021


The State of California remains committed to taking actions that protect the health, safety, and welfare of the people in California. This guidance informs child care facilities and providers (generally referred to as “providers”) and the families they serve about infection control practices that prevent and mitigate the spread of Coronavirus Disease 2019 (COVID-19) infection in child care facilities. It is important for providers to maintain frequent communication with families and staff about implemented policies and practices to keep everyone safe.

This guidance supersedes prior COVID-19 guidance in the Guidance for Child Care Providers and Programs dated February 18, 2022.

Child care providers and staff should continue to follow COVID-19 requirements and guidance in all applicable California Department of Social Services (CDSS) Community Care Licensing (CCL) Provider Information Notices (PIN), in addition to guidance or requirements from California Department of Public Health (CDPH)California Department of Industrial Relations Division of Occupational Safety & Health (Cal/OSHA), and local public health departments, as applicable to the facility type.

If there are differing requirements between the most current CDPH, CCL, Cal/OSHA, and local health department guidance or health orders, providers should follow the strictest requirements. Implementation of this guidance should be adapted for the setting in which care is provided and may require training and support for staff and adequate consideration of children and family needs.

In workplaces, employers are subject to the Cal/OSHA COVID-19 Emergency Temporary Standards (ETS) or in some workplaces the Cal/OSHA Aerosol Transmissible Diseases (ATD) (PDF) Standard and should consult those regulations for additional applicable requirements.

Every child care program is expected to continue to minimize the spread of COVID-19 and to ensure the safety of children, providers, and families. All providers should apply new and updated policies and requirements that address the need for continued infection control and should update their emergency preparedness plan to ensure implementation.

  • Facilities should have a written plan for when a child or staff member has been exposed to someone with COVID-19, has symptoms of COVID-19, or tests positive for COVID-19.
  • It is recommended that providers develop a written communication plan with parents, guardians, and caregivers to share information and guidelines in their preferred language.

Vaccination is the leading public health prevention strategy to end the COVID-19 pandemic. Promoting vaccination, including boosters, among all eligible individuals can help child care programs protect staff and children in their care, as well as their families.

COVID-19 vaccination is strongly recommended for all eligible people in California, including providers, teachers, staff, children, and individuals sharing homes with members of our child care communities. 

For information on vaccinations, please see the Centers for Disease Control and Prevention (CDC) COVID-19 Guidance for Operating Early Care and Education/Child Care Programs ( and the California-specific vaccine access information available on the Safe Schools Hub and Vaccinate All 58 – Let’s Get to Immunity.

  • Providers are eligible to receive vaccinations at no expense. There are several ways to obtain vaccination. Please see PIN 21-06-CCP (PDF) COVID-19 Vaccines for the Child Care Sector for more information on vaccine safety, benefits, and how to get the vaccine.
  • The CDC’s Workplace Vaccination Program has information for employers on recommended policies and practices for encouraging COVID-19 vaccination among workers.
  • Please share information about vaccines with staff and families and direct them to the California COVID-19 Vaccine Website My Turn.
  • If a licensee or provider requests confirmation that a staff or child has received the COVID-19 vaccine, it is recommended the confirmation be documented in the same way immunizations are documented and maintained in the facility file. Those confirming may review and accept a hard copy or digital record of vaccine receipt.
  • Remind families that children should get all routine vaccinations to help protect themselves and others from vaccine-preventable diseases in addition to regular well-child visits and preventive screenings.  Remind staff and families about routine vaccinations for adults.  See CDPH Immunization Branch for more information.
  • Be aware that some programs, including Head Start programs, may have additional requirements for vaccination. The following are links for the Head Start Program:  Head Start vaccine requirementCOVID-19 General Vaccine Information, and the overview of federal vaccination efforts.

Diagnostic Screening Testing can be used to help evaluate and adjust prevention strategies and provide added protection for child care programs that are not able to provide optimal physical distance between children.  

Testing is one layer in a multi-layered approach to COVID-19 prevention. For more information about testing, including where to get access to free testing, please see: 

  • Updated COVID-19 Testing Guidance.
  • for free at-home tests. Every home in the U.S. is eligible to order free at-⁠home COVID-⁠19 tests, through the U.S. Department of Health and Human Services and the U.S. Postal Service. The tests are free. Orders will usually ship in 7-12 days.
  • Low or no-cost COVID-19 tests are available to everyone in the U.S., including the uninsured, at health centers and select pharmacies nationwide. Additional testing sites may be available in your area. Contact your health care provider or your state or local public health department for more information.
  • Find a testing site online, call (833) 422-4255 or 211, or visit to learn more about testing options in California.


Types of Testing:

  • Diagnostic Testing is the testing of people with COVID-19 symptoms or who have been exposed to a person with COVID-19 to determine if they have been infected with COVID-19.
  • Diagnostic Screening Testing is regular testing at a frequency of at least once a week for the purpose of identifying individuals who are asymptomatic but COVID positive so that measures can be taken to prevent further transmission. In child care programs, diagnostic screening testing can help promptly identify and isolate people who have COVID-19, identify exposed people so appropriate action can be taken, and identify clusters of cases to reduce the risks to staff and children in care.  

After March 11, 2022, CDPH Guidance for the Use of Face Masks strongly recommends that all individuals in child care settings use face masks indoors, regardless of vaccination status, to reduce the spread of COVID-19.

Follow your local public health requirements if they require a higher level of masking. Additionally, providers have the right to require face masks in their facility and the use of masks must be allowed by all individuals who want to use them.

Every provider should be familiar with the Guidance for the Use of Face Masks and keep in mind the following:

  • Never place face masks on babies or children under 2 years of age because it poses a danger and risk for suffocation.
  • Children should not wear face masks while sleeping.
  • Providers must ensure the use of face masks does not cause children to overheat in hot weather.
  • See CDPH Masks for Kids: Tips and Resources.
  • Learn more from CDPH’s Get the Most out of Masking. Surgical masks or higher-level respirators (e.g., N95s, KN95s, KF94s) with good fit are recommended for adults.

Use the chart below for a quick reference to protective equipment and supplies to use in child care environments. Further information about face masks, hand hygiene, and disinfecting and cleaning is provided within this document. 

Note: Providers may contact their local Child Care Resource and Referral Agencies or local First 5 offices for information about obtaining Personal Protective Equipment (PPE) and supplies.


ItemsChild Care WorkforceChildren

Face Coverings/

Face Masks

Strongly Recommended

Providers should follow the current CDPH Guidance for the Use of Face Masks. CDPH strongly recommends that all individuals in child care settings use face masks indoors

Providers must ensure compliance with the Cal/OSHA COVID-19 Prevention ETS, and any additional local health jurisdiction requirements that go beyond this statewide guidance.  .

 Strongly Recommended

CDPH strongly recommends that all individuals in child care settings use face masks indoors.



for tasks such as serving food, diapering, handling trash, laundry of an ill person, or using cleaning and disinfectant products.


Hand Sanitizer

Should contain at least 60% ethyl alcohol (preferred) or at least 70% isopropyl alcohol (a neurotoxin and eye irritant). WARNING Do not use any products that contain methanol.

Yes, Optional

Note that frequent handwashing is more effective than the use of hand sanitizers.

May be used under adult supervision only and must be kept out of children’s reach. Call Poison Control if consumed: 

Note that frequent handwashing is more effective than use of hand sanitizers. Sanitizer must be rubbed into children’s hands until completely dry. Hand sanitizer is not recommended for children under 24 months.

(PPE) and supplies.

  • Physical distancing is an infection control practice that may be implemented as an additional safety layer between groups of children and staff to reduce the spread of COVID-19.
  • Child care settings typically have a stable group model with the same groups of staff and children each day, and providers should consider continuing to implement stable groups as a best practice.

Ventilation is one component of maintaining healthy environments and is an important COVID-19 prevention strategy for child care programs. Good ventilation can reduce the number of virus particles in the air. Along with other preventive actions, ventilation can reduce the likelihood of spreading disease and assists in ensuring a safe and healthy environment for children in care. (See for example, ventilation requirements, Title 22 California Code of Regulations (CCR) sections 101216(e)(2)101223(a)(2)101238(a)102416(c)102417(b), and 102423(a)(2).)

  • All businesses permitted to operate indoors should follow the recommended CDPH Interim Guidance for Ventilation, Filtration, and Air Quality in Indoor Environments. This guidance includes practical steps to promote better ventilation, filtration, and air quality indoors to reduce the spread of COVID-19 and ensure the buildings and grounds are safe.
  • Consider how to safely bring fresh air into the child care facility.
  • Consider using child-safe fans to increase the effectiveness of open windows. Fans should be pointed to blow air outwards. 
  • You may also consider other approaches for reducing the amount of virus particles in the air, such as using portable air cleaners and exhaust fans and increasing air filtration.
  • Ventilation considerations are also important to have inside your transport vehicles, such as buses or vans. It is recommended to open windows to increase airflow from outside when safe to do so.
  • Additional information for child care facilities can be found on the CDC Ventilation in Schools and Childcare Programs webpage.

In general, routine cleaning is usually enough to sufficiently remove potential viruses that may be on surfaces. However, in addition to routine cleaning for COVID-19, child care programs should follow recommended procedures for cleaning, sanitizing, and disinfection in their setting such as after diapering, feeding, and exposure to bodily fluids. Train and monitor staff to follow the infection control practices below related to requirements for cleaning and disinfection, housekeeping and sanitation principles, and universal health precautions. (See cleaning and disinfection requirements pursuant to Title 22 CCR sections 101216(e)(2), 102416(c)101238(a) and 102417(b).) These practices also help ensure buildings and grounds are clean, safe, and sanitary, and the personal right to safe and healthful accommodations. (See for example, the cleaning and healthful accommodations requirements pursuant to Title 22 CCR sections 101216(e)(2)101223(a)(2)101238(a)102417(b), and 102423(a)(2).)

  • It is important to know the difference between cleaning, sanitizing, and disinfecting and when to do each in order to maintain a healthy child care environment and the well-being of children in care. See CDC guidance on Cleaning and Disinfecting Your Facility for detailed information on infection control practices related to cleaning and disinfection.
  • Laundry, such as clothing and bedding, should be washed using the appropriate hot water setting and allow items to dry completely. If handling dirty laundry from a person who is sick, staff should wear gloves and are strongly recommended to wear a mask.  See PIN 20-14-CCLD (PDF) for more information.
  • When choosing cleaning products, consider using those approved for use against COVID-19 on the Environmental Protection Agency (EPA)-Approved List “N” and follow product instructions.
  • Always follow the directions on the label to ensure safe and effective use of the product.
  • The Healthy Schools Act requires that anyone using disinfectants at child care centers complete annual California Department of Pesticide Regulation-approved training. Online training can be found by going to the California School & Child Care Integrated Pest Management website. Note: This does not apply to family child care homes.

Adhering to recommended practices for hand and respiratory hygiene can reduce the risk of infection. Train and monitor staff to follow these strongly recommended universal health precautions and preventative health practices. (See handwashing and hygiene requirements in Title 22 CCR sections 101216(e)(2) and 102416(c).) Learn more from CDPH’s Get the Most out of Masking.  

Children who are ill should not attend child care programs. Getting tested for COVID-19 when symptoms are compatible with COVID-19 infection will help with rapid contact tracing and prevent possible spread. Providers should be prepared to implement prevention and mitigation actions when someone tests positive for COVID-19. 

Providers must exclude or isolate any child, parent, caregiver, or staff showing symptoms of a contagious disease or illness as required pursuant to Title 22 CCR sections 101216(h)101226.1(a)(1), 101226.2101426.2101526.1101626.1101626.2, and 102417(e). Providers should also follow the steps below:

  • Take action to isolate children who begin to have COVID-19 symptoms while in care from other children and staff.
  • Providers should follow the recommendations in CDPH Guidance for Local Health Jurisdictions on Isolation and Quarantine of the General Public  which strongly recommends use of a well-fitting mask by children 2 years of age and older during the 10 day period after exposure.  The following exceptions apply for child care attendees:
    • Children under 2 years of age with COVID-19 infection may discontinue isolation after day 5.
      • Testing may be considered on day 5 but is not necessary before discontinuation of isolation.
    • Children 2 years of age and older with COVID-19 infection may discontinue isolation after day 5.
      • Testing is recommended at day 5.
  • Ensure that isolated children continue to receive adequate care and supervision and that the health of the child is continually observed throughout the day according to licensing requirements.
  • If an individual who resides in a family child care home is exhibiting symptoms of COVID-19, the facility should follow public health guidelines for quarantine or isolation of the individual.
  • Notify local health officials, staff, and families immediately of any confirmed case of COVID-19. Providers must inform families as required pursuant to Title 22 CCR sections 101212(f) and 102416.2(g).

Changes may be made during meal times to help mitigate the spread of COVID-19.

  • Moving tables to spread children out or the use of name cards to provide adequate spacing of children is recommended.
  • Providers should follow proper handwashing, cleaning, and disinfection practices before and after eating.
  • Maximize physical distance as much as possible while eating, especially indoors. When possible, consider using additional spaces for meal time seating, including eating outdoors or in well-ventilated spaces.
  • At this time, there is no need to limit food service operations to single use items and packaged meals.
  • Review and update rules for visitors and family engagement activities to reduce the risk of infection, including the strongly recommended use of face masks while indoors unless required by the local public health department, and any other health and safety protocols that have been established.  
    • The responsible parent or guardian of a child receiving services in a child care facility has the right to enter and inspect the facility without advance notice during the normal operating hours of the facility or at any time that the child is receiving services in the facility as specified in Health and Safety Code Section 1596.857.
  • Provide access for direct service providers (DSPs), such as paraprofessionals, therapists, early intervention specialists, and mental health and healthcare consultants.
    • Ensure direct service providers are following currently recommended prevention strategy guidance including vaccination, COVID-19 testing, and contact tracing in combination with isolation/quarantine.
  • Provide access to essential visitors, including CDSS staff. (Title 22 CCR sections 101200 and 102391).

Child care programs should continue to collaborate with state and local health departments, to the extent allowable by federal, state, local, tribal, and territorial privacy laws, regulations, and other applicable laws, to confidentially provide information about people diagnosed with or exposed to COVID-19. This allows identifying children and staff with positive COVID-19 test results who should isolate, and which close contacts should quarantine, based on vaccination status and history of prior infection.

  • A COVID-19 exposure is defined as being within 6 feet of an infectious person for at least 15 minutes in a 24-hour period. In child care settings when it may be difficult to identify individual contacts, all those in a shared indoor airspace for at least 15 minutes with an infectious person may be considered exposed.
  • Providers should have a plan in place for responding to COVID-19 exposures or outbreaks.
  • Actively encourage staff and families to notify the facility if they test positive for COVID-19 or have been exposed to someone with COVID-19 symptoms or a confirmed or suspected case.
  • Asymptomatic exposed persons who have had COVID-19 infection within the last 90 days do not need to be tested or quarantined regardless of vaccination status.
  • Providers should follow the recommendations in CDPH Guidance for Local Health Jurisdictions on Isolation and Quarantine of the General Public  with the following exceptions for child care attendees:
    • Providers may consider permitting asymptomatic exposed children to attend child care, regardless of their COVID-19 vaccination status, with a strong recommendation for use of a well-fitting mask by children 2 years of age and older during the 10 day period after exposure.
    • Exposed children should be monitored for COVID-19 symptoms and tested if symptoms develop.
  • Exposed persons are recommended to test on day 5 or later after exposure. In addition, they may consider testing upon notification of exposure, as noted in the CDPH Guidance for Local Health Jurisdictions on Isolation and Quarantine of the General Public
  • Child care centers are required to report epidemic outbreaks and individual COVID-19 cases or deaths to CCL through their local Regional Office (PDF) as required pursuant to Title 22 CCR section 101212(d).
  • Family child care homes must report a communicable disease outbreak, when determined by the local health authority, to CCL through their local Regional Office (PDF) pursuant to Title 22 CCR section 102416.2(c)(3).
  • Providers are required to report the death of any child from any cause to CCL by telephone or fax within the next working day and during its normal business hours pursuant to Title 22 CCR section 101212(d)(1)(A) or 102416.2(b). In addition, a written report containing specified information must be submitted to CCL within seven (7) days. Child care centers and family child care homes must complete an Unusual Incident Report (UIR) within one business day (LIC 624 (PDF) for centers or LIC 624B (PDF) for family child care homes).

Information for families or staff considering travel is available in the CDPH’s Travel Advisory ( and CDC’s Travel webpage.

The COVID-19 pandemic has had a major effect on our lives. Many are facing challenges that can be stressful, overwhelming, and cause strong emotions in adults and children. It is natural to feel stress, anxiety, grief, and worry during the COVID-19 pandemic. Below are a few recommendations to help yourself, staff, children, and families manage stress:

  • California’s playbook on Stress Relief during COVID-19 (PDF) provides guidance on how to notice stress in kids and outlines tools and strategies on how to reduce stress for children and adults.
  • Promote healthy nutrition, sleep, and physical activity habits and self-care.
  • Discuss and share stress reduction strategies.
  • Encourage staff and children to talk with people they trust about their concerns and feelings.
  • Communicate openly and often with staff, children, and families about mental health support services available in the community, including if mental health consultation is available to the program.
  • Consider posting signage for CalHOPE and the national distress hotline: 1-800-985-5990, or text TalkWithUs to 66746.
  • Encourage staff to call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255), 1-888-628-9454 for Spanish, or Lifeline Crisis Chat if they are feeling overwhelmed with emotions such as sadness, depression, or anxiety; or call 911 if they feel like they want to harm themselves or others.
  • Domestic Violence Prevention assistance contact number and links: