While some Bay Area counties have issued health code orders banning visitors from skilled nursing homes, as of Friday, most local counties have not.

California is home to more than 1,200 skilled nursing homes in which nurses and healthcare staff care for more than 400,000 elderly or sick Californians, according to the California Association of Health Facilities. These are people the Center for Disease Control say are the most vulnerable to serious illness from COVID-19.

NBC Bay Area’s Investigative Unit reached out to every Bay Area county. As of Friday, Sonoma, San Francisco and San Mateo counties have issued visitor restriction orders to nursing facilities. Others have issued guidelines or directed nursing home operators and patients to state guidance.

“I don’t think that’s soft. I think it’s collaborative,” said Nicole Howell, Executive Director of Ombudsman Services for Solano, Contra Costa and Alameda County. “People are more likely to hear that if you come a little more open than simply telling them what they have to do.”

Friday evening, the federal government took a stricter stance indicating it plans to ban all nursing home visits across the country.

At Laguna Honda, one of the Bay Area’s largest skilled nursing facilities, staff said they struggle with staffing levels and underfunding.

“I don’t think we are nearly as prepared as we should be to deal with this because this is so new to us,” said Brandon Dawkins who is an activity therapy supervisor at Laguna Honda.

Howell said more staffing problems can mean added risk to a facility’s health safety plan.

“So many caregivers work multiple jobs at multiple facilities, maybe even multiple counties. It also places us at an additional risk because a caregiver could not know they’re sick and go from one facility to another,” she said.

Our Investigative Unit reached out to the San Francisco Department of Public Health with specific questions about staffing and equipment. The department oversees Laguna Honda. An official said they had no statement referring us to the hospital’s website.

Over the years, skilled nursing facilities have generally received less than stellar safety scores compared to other health facilities, like hospitals and surgical clinics, according to state data. State health data also shows “infection control” is the most common type of code violation.

It’s a problem, Dawkins says, that’s as serious as it is socially isolating for his long-term care residents.

“I have a strong feeling as days and weeks go on it’s going to get more confusing to them,” he said.