California Daycare TB Test Requirement — Who Needs Clearance and How to Get It

Who Needs a TB Clearance

Every adult who resides in your home or has contact with children in your licensed family child care home must have a current tuberculosis clearance before your license is issued. Under Title 22 and Title 17, Section 6070, this includes:

• The provider (you)
• Any assistant provider
• All adult residents — everyone 18 and older living in the home, even if they have no role in the daycare
• Regular volunteers who are present during operating hours

The relevant question is whether the adult resides in the home or has contact with children. A plumber who comes once to fix a pipe ordinarily does not need a TB test if the plumber has no contact with children. But your adult child who lives in the home and is present during daycare hours does — whether they interact with enrolled children or not.

Accepted TB Test Types

Common screening methods for tuberculosis include:

Tuberculin Skin Test (TST / Mantoux / PPD): The traditional two-visit skin test. A small amount of tuberculin is injected under the skin of your forearm. You return to the provider 48–72 hours later for a reading. If the injection site shows no significant induration (swelling), you receive a negative result and your clearance documentation.

Interferon-Gamma Release Assay (IGRA / Blood Test): A single-visit blood draw (QuantiFERON-TB Gold or T-SPOT are the most common brands). Results typically come back within 24–48 hours. This option is more convenient because it doesn't require a follow-up visit for reading, and it avoids false positives in people who received the BCG vaccine — common among adults who grew up outside the United States.

Ask the provider handling your screening which method and documentation meet CCLD's current clearance requirement.

How Long Is a TB Clearance Valid?

Your TB clearance must be less than one year old at the time of your license application submission. After that, ongoing validity depends on your test result history:

• Negative result: The application materials require a TB clearance less than one year old. Keep the documentation current and confirm any later renewal interval with CCLD or your healthcare provider.
• Prior positive result with completed treatment: Ask a healthcare provider what follow-up documentation is needed and ask CCLD what clearance record it requires. Do not assume a prior positive result or an old chest X-ray satisfies the current application requirement.

What Happens If a Test Comes Back Positive

A positive TB skin test or blood test doesn't automatically disqualify you from operating a daycare. A positive result means you've been exposed to the TB bacteria — it doesn't necessarily mean you have active tuberculosis.

The next step is a chest X-ray to determine whether you have active TB disease or latent TB infection (LTBI). The outcomes diverge from there:

• Latent TB infection (positive test, clear chest X-ray): Follow your clinician's treatment recommendation and obtain the documentation CCLD requires before proceeding with your licensing application.
• Active TB disease (positive test, abnormal chest X-ray, confirmed by sputum culture): Follow public-health and clinical instructions, and obtain medical clearance and the CCLD documentation required before operating.

SB 792 Immunization Requirements

TB clearance is part of a broader health screening package. Under SB 792, all resident adults must also show proof of immunization or immunity for:

• Tdap (tetanus, diphtheria, pertussis)
• MMR (measles, mumps, rubella)
• Influenza (annual flu shot)

These are separate from the TB requirement. Keep proof with the other health documentation required for your application and ongoing records.

Getting It Done Efficiently

Schedule TB tests for every household adult at the same time — ideally at a clinic that offers the blood test (IGRA) so you don't need to coordinate a second visit for readings. County health departments often offer discounted or free TB screening for child care workers.

Keep the clearance documentation in your compliance binder alongside your CPR/First Aid cards, Mandated Reporter certificate, and immunization records. Your application must include copies of TB clearances for the covered adults.

If you're building your application packet now, the California Home Daycare Licensing Guide includes a document tracker that lists every health clearance with its validity period, so nothing expires while you're waiting for your inspection.

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