Infections and Outbreaks in California Assisted Living: What Homes Must Do

Assisted living communities and board and care homes are licensed in California as residential care facilities for the elderly (RCFEs). They are not medical facilities, but the state's RCFE regulations include a full infection control section, Title 22 section 87470. It applies to a six-bed house and a large community alike.

Day to day, the regulation requires staff and volunteers to clean their hands immediately before and after resident care, before and after handling food, and before and after helping with medications. Gloves are required when there is contact with blood or body fluids, and one pair may not be used on more than one resident. Surfaces such as floors, toilets, sinks and tabletops must be cleaned and disinfected on a regular basis.

Each home must also write an Infection Control Plan as part of its plan of operation. The plan names a staff position as the Infection Control Lead, says how that person is trained, and sets out training for new staff before they work independently with residents. The home must review how it uses its infection control procedures at least once a year.

The Centers for Disease Control and Prevention (CDC) explains that tuberculosis is caused by a germ that usually affects the lungs and spreads through the air when a person with active TB disease coughs, speaks or sings. People with inactive TB are infected but do not feel sick and cannot spread TB to others. Testing is done with a skin test or a blood test, and further tests may include a chest x-ray.

California's rules reflect that difference. Under Title 22 section 87458, a home must obtain a medical assessment before it accepts a resident, signed by a licensed medical professional and made within the last year. The assessment must include the results of an examination for communicable tuberculosis, infectious diseases and contagious diseases. Section 87455 says no resident may be accepted or retained if the resident has active communicable tuberculosis.

Staff are screened too. Section 87411 requires a health screening for all personnel, including the licensee and administrator, that includes a chest x-ray or an intradermal test, which is a skin test. It must be done by or under the supervision of a physician, no more than six months before, or seven days after, the person starts work. The section does not use the word tuberculosis, so ask a home what its staff screening covers.

If your parent's TB test comes back positive, that is a question for the doctor, who can say whether it is inactive infection or active disease and what the home needs in writing. The rest of the paperwork is covered in move-in requirements for California assisted living.

Section 87455 says a resident suspected of having a contagious or infectious disease must be isolated, and a physician contacted to determine whether the resident is suitable to stay in the home.

When one or more residents are diagnosed with a contagious disease, section 87470 adds these duties:

• Enhanced cleaning and disinfection in any affected areas, and immediately after contact with the resident who is ill.
• Personal protective equipment for staff and volunteers giving direct care to that resident, which may include gloves, gowns, masks, respirators and eye protection.
• Advice from a medical professional, local health official or health department on the type of cleaning and protective equipment to use.
• Separation and care of residents whose illness requires separation, including quarantine or isolation, from others.

Some infections are beyond what an RCFE may handle. Title 22 section 87615 lists a staph infection or other serious infection among the prohibited health conditions, which means a home may not admit or keep the person unless the state grants an exception or the condition is covered under a hospice care plan. The whole list is in health conditions an RCFE may accept, and the next steps when a home cannot continue are in when assisted living is not enough.

The same 2025 notice says the Cal/OSHA COVID-19 workplace rules on masking, testing and work exclusion for facility staff expired on February 3, 2025. It adds that wearing a mask continues to be important for staff and visitors of care facilities where people at higher risk are present. Guidance of this kind changes, so ask the home what it is following now.

1. 1

   Report it

   Title 22 section 87211 requires occurrences such as epidemic outbreaks that threaten the welfare, safety or health of residents, personnel or visitors to be reported by telephone or fax to the licensing agency, and to the local health officer when appropriate. The deadline is 24 hours.

2. 2

   Step up its infection control

   The enhanced cleaning, protective equipment and separation rules above apply. The home must also review its infection control procedures if local public health determines that an epidemic outbreak has occurred.

3. 3

   Follow public health direction

   In a March 2025 notice to licensees, the Community Care Licensing Division said that when CDC, state public health, state licensing and local health department guidance or health orders differ, licensees should follow the strictest requirements.

4. 4

   Write an emergency plan if an emergency is declared

   When a state or federal emergency for a contagious disease is declared, the home must prepare an Emergency Infection Control Plan, send it to the Department of Social Services within 15 calendar days, and make it available to residents, staff and residents' representatives.

Residents have the right to have relatives and other people of their choosing visit during reasonable hours, under the Resident's Bill of Rights in Health and Safety Code section 1569.269, summarized in our guide to RCFE resident rights. If a home limits visits during an outbreak, ask which health department guidance or order it is following and how long the limit is expected to last.

For your own visits, CDC's guidance on respiratory viruses, updated in August 2025, is to stay home and away from others when you are sick. It says you can go back to normal activities when, for at least 24 hours, your symptoms are getting better overall and you have had no fever without fever-reducing medication, and that added precautions over the next five days matter most around people at higher risk of severe illness. Ask your relative's doctor which vaccines are recommended for them.

Hamssa Benrekia is a senior living placement specialist in Torrance with a background in hospice, palliative care and home health. She helps families in the South Bay and Harbor area of Los Angeles County find licensed assisted living communities, board and care homes and memory care, and she goes on tours with families, where these questions can be asked in person. She does not give medical advice or judge a home's infection control. More topics are in the California Assisted Living Placement Guide. To talk about a search, contact Hamssa.