Care homes

Movement in and out of care homes

Visiting guidance

Full visiting guidance is available on the government’s website.

Visiting arrangements in care homes sets out how care homes can support families and visitors to visit residents. Updated to state that: 1. Care home residents should isolate following a visit only where it includes an overnight stay in hospital, or is deemed high-risk following an individual risk assessment. 2. Residents no longer should isolate on admission into the care home from the community. 3. Every resident can nominate an essential care giver.

Visiting arrangements out of care homes
On 16 July 2021 the Department of Health and Social Care released new guidance regarding how care homes can support residents on visits outside of the care home. It has been updated to clarify advice on self-isolation and arrangements for care home staff accompanying residents out of the care home.

Care home visiting Q&A and supporting resources
The Department of Health and Social Care has pulled together some Q&A on visits into a care home and visits out of the care home.
Face covering poster that can be displayed to support the management of visitors PPE.
This letter template can be used by providers to help and support visiting into the care home.

Admission and care of residents in a care home during COVID-19: summary of updates (23 June 2021).

Restricting workforce movement between care homes and other care settings

The Department of Health and Social Care issued guidance on limiting care home staff movement between settings in all but exceptional circumstances to help reduce the spread of the COVID-19 virus.

Exceptional circumstances can be when an adult social care provider has reported a COVID-19 outbreak. During this period it is important to restrict where possible the movement of staff. However, it is recognised that to maintain the safe delivery of care to residents may not always be possible. The Quality Assurance Improvement Team’s (DCC) has issued advice to providers in the event of requiring agency staff to support the safe management of agency staff when movement is unavoidable.

Staff movement: a risk management framework

The Care Provider Alliance has published a risk management approach briefing (developed by CPA member – the Registered Nursing Home Association) that care homes can use to manage restrictions on staff movements.

Testing/tracing

Contact tracing local guidance

Public Health England SW Health Protection Team guidance to support care home managers on contract tracing requirements for staff in care settings who have tested positive:

• Contact tracing checklist for care settings when a staff member or resident is COVID-19 positive
• Contact tracing flowchart

Testing in care homes

All care homes can now apply for coronavirus testing kits to test residents and staff, regardless of whether or not anyone has coronavirus symptoms via the National Testing Portal. Read more about whole care home testing.

Care homes should receive regular COVID-19 testing updates directly from the Department of Health and Social Care (DHSC) via email. If you aren’t successfully receiving it, please contact the DHSC (119) in the first instance to check the email address they have for your organisation.

Testing is, however, only one part of the approach to reduce risk and it is critical that visiting professionals don and doff PPE appropriately and follow the relevant infection control measures when visiting a care home including hand hygiene and distancing, in order to help keep care home residents and staff safe.

New guidance for admission into care home

From 21 June, people admitted to a care home from the community will no longer have to self-isolate for 14 days on arrival, so residents will have a less disruptive introduction to their new home.

To ensure this happens as safely as possible, the person is subject to an enhanced testing regime consisting of:

• a PCR test before admission within 72 hours (an LFD test will not be accepted by the care home)
• a PCR test on the day of admission (day zero)
• a further PCR test seven days following admission (day seven)

If a resident has been discharged from hospital, from an interim care facility or transferring from another care home, they should self-isolate upon arrival for 14 days within their own room. Care home settings can differ significantly and care home managers can undertake a risk assessment to consider if any proposed self-isolation period upon admission is appropriate directly after admission from another care home or care facility.

For urgent admissions (regardless of symptoms) the individual should be tested upon arrival and self-isolate for 14 days within their own room, even if they have a negative COVID-19 test result. This is because of evidence of the asymptomatic spread of the virus and the effectiveness of isolation in stopping this transmission

Please see below a helpful table to use as a reference:

Testing guidance for professionals visiting care homes

There is now a Devon wide guidance for health and social care professionals visiting care homes, which builds on the national guidance for professionals visiting care homes.

The guidance provides clarity for professional visitors about what is required to promote safe access into a care home with an ethos of working with the home to meet their safe visiting policy.

Providers may wish to display this visiting professionals poster to serve as an informative reminder to professionals entering their home.

Admission and care of residents in a care home during COVID-19

This note outlines the changes made to ‘Admission and care of residents during COVID-19 incident in a care home’.

Designated settings scheme

Guidance on the designated settings scheme for people discharged from hospital to a care home with a positive coronavirus (COVID-19) test.

These letters set out arrangements for the designated settings scheme for people discharged to a care home with a positive COVID-19 test.

Further details are available on the Testing page.

Guidance for stepdown of infection control precautions and discharging patients to home settings

Advice on appropriate infection prevention and control precautions for stepdown in hospital or discharge to home or residential settings for COVID-19 patients. For information on isolation and IPC measures for asymptomatic SARS-CoV-2 infected individuals see section 7.

National care home safety guidance

Public Health England guidance on how to work safely in care homes during this period of sustained transmission of COVID-19, including a video and clear instructions about putting on and removing PPE.

Quality assurance of swabbing

The Department of Health and Social Care recommend that carer staff and nurses who will be swabbing residents in care homes complete the online care home swabbing competency assessment provided by the national quality assessment provider GenQA.

Individuals can register at GenQA or care home managers can create an organisational account by contacting info@genqa.org

Free home testing kits for social care workers

From Friday 9 April, everyone in England is being encouraged to take a free rapid coronavirus test twice a week using Lateral Flow Devices. Alongside vaccine roll-out, regular testing is at the heart of plans to reopen society and the economy, helping to suppress and control the spread of variants.

How to order home-testing kits

All front line staff, including personal assistants, can order and collect testing kits at the same time as their free PPE supplies using this simple online request form.

All collections are arranged in advance, please do not turn up without an agreed collection time. Staff can order as an individual or on behalf of their team and can collect two packs of home test kits per staff member. Each pack contains seven tests.

Emergency supply of test kits is also available via this route if any providers who already test weekly are having problems accessing tests through normal routes.

Mobile community testing

Devon County Council is also running a mobile community testing service throughout the county. This allows you to get tested and, from Friday 9 April 2021, to collect home-testing kits.

Anyone 18 or over can collect from a Community Collect Van. There is no need to book, you can just turn up and collect your tests. Please see the timetable for the mobile testing van’s visits.

Other ways of ordering test kits

Businesses with more than ten employees can offer on-site testing to their staff and it is not too late to register.

Anyone 18 or over can also:

• order home-testing kits from the NHS by post. You can order one pack of home test kits containing seven tests for home delivery. Your tests should arrive within two days
• collect home-testing kits from NHS testing locations and pharmacies that are part of the Pharmacy Collect scheme.

For further information please visit: Community lateral flow testing – Coronavirus (COVID-19).

Care homes accessing lateral flow tests

The below are points to note about deliveries of lateral flow device (LFD) tests. Please see additional guidance about personal information contained in returned test kits.

• All care homes are receiving a second order of LFDs in January. (Unrelated to requests for more kits)
• Every call to 119 requesting additional LFDs due to outbreak will be logged and actioned.
• If following an outbreak a home needs extra test kits they should contact 119
• When the call is placed to 119, this is escalated to the Department of Health and Social Care escalations team which can place an urgent order, typically arriving the next day. Ringing 119 means this request has been received and is being processed; we ask therefore that care homes ring only the once.
• The general guidance to care homes is that they will receive an update on their case within 48 hours. However, requests for more kits following an outbreak are treated as urgent and will typically be processed same day.
• The care home will not receive a call back from the escalations team when the order is placed, but instead will receive an email confirming that an urgent order has been placed.

Care home testing is expanding to include lateral flow tests

Care home testing is expanding to include later flow tests (LFT) alongside the existing testing programme. All care homes should have received information regarding the update from the Department of Health and Social Care (DHSC). It is advised that all care home should watch the pre-recorded webinar explaining the process.

The DHSC advises care homes to check that they have enough LFT kits to begin testing staff twice a week and to contact 119 if they are running low.

Vaccination

Care homes requiring vaccinations should contact GPs

If a care home has residents who require either their first or second vaccine dose then the care home should request the outstanding vaccination by contacting the GP who links to the care home.

Use of PPE by vaccinations teams in care home

As immunisation teams start re-visiting care homes for second doses, a reminder of the PPE that is recommended for delivery of COVID-19 vaccine in all care home settings:

• Sessional fluid resistant surgical masks
• Apron changed after delivery of each vial or more frequently if required
• Gloves changed following every vaccination administered
• Strict hand hygiene
• Visor can be used, based on risk assessment e.g. if risk of patient spitting/coughing
• Full change of PPE and hand hygiene between each vial.

NHS Devon has reminded the vaccination teams about the PPE requirements when going into care homes for second vaccinations. If a home remains concerned, please discuss with the vaccination team in advance of the visit or, indeed, with the lead clinician at the start of the visit on the day.

Information for managers regarding recording adverse events in care homes

This information sheet provides advice regarding the reporting process of any significant adverse reactions to the COVID-19 vaccine.

Care home vaccination follow-ups

How to contact us if your eligible care home in England has not yet been visited for the COVID-19 vaccine.

Vaccination preparation

The national roll-out of mass vaccination has continued at pace with the following headline messages:

• Primary Care Networks now have the facility to apply for smaller doses of vaccines to offer to care homes in their areas
• The first care homes have had their vaccinations and NHS Devon, pharmacy and nursing staff are working closely with GP practices and care homes to learn from the first sites
• Plymouth and Exeter hospitals are also now offering vaccinations to care home staff in their areas
• The most important NHS message to care homes remains the same as the message to the public: please wait to be contacted when it is your turn.

While waiting for your turn in the vaccination process, here are simple steps you can take to help prepare:

• put together staff lists, including basic details (name, gender, date of birth, NHS number, GP details) for each staff member
• be ready to provide each staff member with a letter confirming their employment in the care sector
• keep staff records of vaccinations and report via the Capacity Tracker (as you do with flu vaccination)
• consider the covid-secure logistics of releasing staff to receive their vaccine, while maintaining staffing levels within their home
• take steps now to ensure that staff understand need for obtaining consent, so that they in turn can help residents and families to
• complete the necessary forms when a vaccine is ready to be delivered within a care home.

New regional care homes vaccines advice

The NHS Regional Clinical Advice Response Service has issued this very useful information for care homes based on learning from the first few weeks of the vaccination programme. Please contact them for any COVID-19 vaccination related queries or to report an incident.

Visit NHS England and NHS Improvement South West care home guidance pages.

Care home vaccination mobilisation

National support pack and checklist (8 January 2021), which has been emailed directly to care homes.

Guidance for COVID-19 vaccination in care homes that have cases and outbreaks

Guidance for COVID-19 vaccination in care homes that have cases and outbreaks (31 December 2020), which has been emailed directly to care homes.

Vaccination: FAQs

FAQs on second vaccinations in care homes

Vaccination: Frequently Asked Questions

Standard Operating Procedure and programme launch letter

More detailed guidance to support this preparation is part of the national Standard Operating Procedure.

A letter from the Minister for Care explains the national care homes vaccination programme COVID-19 vaccinations and care homes: programme launch.

COVID-19 vaccination: care home and healthcare settings posters

Information and promotional resources to support the coronavirus (COVID-19) vaccination programme.

Recordings of care home COVID-19 vaccination roll-out webinars

Recordings of various vaccination webinars

Hospital discharge and community support

Discharge to Assess Funding changes

In response to the COVID-19 pandemic, the Department of Health & Social Care mandated the introduction of Discharge to Assess pathways for individuals leaving an acute hospital.

These pathways covered support for individuals returning home with a package of care and those discharged into a care home.

To enable local areas to fund these pathways the cost of this has been met by central government and has been extended a number of times since being introduced in March 2020.

From Thursday 1 July 2021, the Discharge to Assess pathway will reduce from the current maximum of six weeks to instead cover care up to a maximum of four weeks. This extension will cease in its entirety from Friday 1 October 2021.

Individuals will continue to be supported under the DTA pathway, and when discussions take place with individuals they will be made aware that the funding is short term in order to support their discharge, longer term assessment and any onward care journey. This will take place as soon as it is identified they have met their rehab goals or a longer-term funding assessment has been concluded (and in all cases within four weeks).

NHS and Social Care Commissioners acknowledge that by exception an extension to this period may be necessary, either to ensure goals have been met or due to challenges with assessment capacity, and in any such case commissioners will ensure payment arrangements continue automatically until the individual has been supported to exit the pathway.

For the duration of this central government funded extension, the existing enhanced discharge rates will be maintained.

Hospital discharge and community support: policy and operating model

The guidance sets out how health and care systems should support the safe and timely discharge of people who no longer need to stay in hospital.

Designated settings scheme

Guidance on the designated settings scheme for people discharged from hospital to a care home with a positive coronavirus (COVID-19) test.

These letters set out arrangements for the designated settings scheme for people discharged to a care home with a positive COVID-19 test.

Further details are available on the Testing page.

Admission and care of residents in a care home during COVID-19

This note outlines the changes made to ‘Admission and care of residents during COVID-19 incident in a care home’.

Capacity Tracker

Please ensure the Capacity Tracker is updated regularly. The Capacity Tracker team would like to thank you for your co-operation as the information this provides goes towards significant updates to government policy in the areas of regulated care.

Updating the Capacity Tracker – every two days
The Capacity Tracker team are recommending that you update the Tracker a minimum of every two days, including weekly data if that has changed.

Weekly Provider Q&A sessions (for all providers, nationally)
Every Tuesday from 1.00pm to 2.00pm until further notice. Please take this opportunity to raise any questions/issues with other providers.
To access the invite, logon to the Capacity Tracker, go to Help – Resource Centre – Events – Capacity Tracker Q&A sessions – National Q&A Provider Call Teams Link, and copy this into a reoccurring tentative appt in your diary.

Comparing your figures with Devon’s
You can now check your performance against aggregated Devon figures. If you select Reports/Overview/Comparative analysis, you can compare yourself against local STP, CCG or the Local Authority.

Video ‘How To’ guides
There is a number of video guides on the Capacity Tracker available now.

Care home GP Clinical Leads list
In response to feedback from care homes received on the Capacity Tracker, NHS Devon has produced a look-up list of GP Clinical Leads to help providers update the Tracker with relevant GP Leads. If you have any queries about any of the above, please contact the Capacity Tracker team: capacitytracker-guidance@dhsc.gov.uk or the Support Centre 01916913729 from 8.00am to 5.00pm, Monday to Friday, excluding Bank Holidays.

Care home Q&A sessions
Donna Schell has replaces Katherine Emmerton as the South West representative for the Capacity Tracker. She set up weekly Q&A sessions on every Thursday from 8.30am to 9.30am starting from Thursday 29 July so you can ask about any issues you might have about the Tracker. This also provides an opportunity to update you on the most recent changes in the Tracker and urgent messaged from the Department of Health and Social Care and NHS England.

Medication

Reuse of medicines in care homes and hospices during COVID-19

During the pandemic, it may become necessary to make use of the national standard operating procedure (SOP) for the re-use of medicines. This SOP should only be used in exceptional circumstances where it is not possible to obtain medication through normal routes, but it is important to plan ahead and decide if your home wishes to make use of this arrangement if necessary. In advance of needing to implement the SOP, it is important to put processes in place to enable re-use of medication safely and appropriately and to ensure that these processes are clearly documented so that staff are able to follow them.
Other things worth considering are:

• Who would be nominated to be in charge of the re-use processes on any particular day if large numbers of your regular staff are off sick?
• Who would be designated specifically for controlled-drug management if large numbers of regular staff or senior team are off?
• Is the required paperwork in place and accessible, is it clear who is responsible for completing this?
• How will any agency nurses or supporting health care staff be made aware of the process and the recording requirements?

The NHS Devon Medicines Optimisation Team has produced an article Re-use of Medicines in Care Homes and Hospices during the COVID-19 Pandemic.

The Coronavirus (COVID-19): reuse of medicines in a care home or hospice webpage contains links to the SOP document, supporting information and some template documents.

Hydration resources during COVID-19 due to increased risk of dehydration

Hydration resources during COVID-19 due to increased risk of dehydration
COVID-19 positive care home patients are at higher risk of dehydration. In some cases increased drowsiness results in difficulty in fluids being taken. A raised temperature also increases fluid requirements alongside an existing poor fluid intake in many older people. It is particularly important to encourage fluids early on and monitor fluid intake, helping to reduce the need for a hospital admission and IV fluids:

• Good visual leaflet/poster tailored for older people
• Menu adaptations to increase fluid intake
• Nourishing fluid recipes which could help for those also not eating very well/risk of malnutrition.

More detailed hydration resources, training videos and a hydration toolkit to support care homes in South Devon and Torbay is also available from Support with nutrition for care homes – Torbay and South Devon NHS Foundation Trust. Contact details: Tel: 01803 654396, email.

Medicines and Healthcare products Regulatory Agency (MHRA)

The MHRA publishes a range of guidance on issues relevant to social care providers. You can subscribe to their mailouts to receive updates.

Support to care homes to order medications through proxy access

NHS England has published a step-by-step guide to granting authorised care home staff proxy access to their residents’ GP online services accounts.

Care homes business continuity planning for COVID-19 outbreaks

DCC’s Service Recovery Team has issued Care homes business continuity planning for COVID-19 outbreaks.

Managing medication in emergencies

DCC’s Quality Assurance & Improvement Team has issued Emergency planning guidance for medication administration in care homes.

Please also see the NICE guidelines for managing medicines in care homes.

DEVON CCG Caring for Care Homes team information, guidance sheets and resources.

GP, hospital and medical support

GP support for care homes from Devon Doctors 111 out of hours service

Urgent GP support for care homes from Devon Doctors / NHS 111 out-of-hours period i.e. from 6pm to 8am overnight, as well as at weekends and on bank holidays.

• Dial 111
• Follow the prompt asking you to ‘Press 9 to continue’ and, having done so, immediately press the * button and then 6.
• You will be connected to a Call Handler at Devon Doctors who will arrange for you to receive a clinical call back.

To feedback on this service contact ddooh.projects@nhs.net

Infection, Prevention and Control (IPC) Compliance Assessment Tool

This compliance assessment is a simple tool which has been developed using the most recent information from the CQC and others. It will help you know how well you are doing, identify areas in which you need to improve and bring the guidance together into one place.

Managing falls in care homes during the pandemic

The National Falls Prevention Co-ordination Group has produced guidance in the form of a managing falls poster, which also contains links to moving and handling video resources.

COVID-19 Oximetry at Home (CO@h)

CO@h is a service for adults likely to experience worsening or life-threatening hypoxia and it is available for people in care homes and their own homes. This information for care homes contains a quick reference guide and monitoring log sheet.

Provider engagement

Care home locality support meetings

This is an open invitation for care home providers and registered managers to attend the care home locality support meetings. These are informal engagement opportunities for care home providers / managers, Devon County Council / Market Management Team and the locality Assistant Director / Social Care Operational teams to get together to share and exchange information, such as emerging issues / concerns, discuss market support offers and hear local system updates.
If you have not received the invites and wish to be added to the distribution list please can you email socialcarebusinessrelations-mailbox@devon.gov.uk stating which locality meeting you would like to receive invites for (North, East, South or West).

Devon Care Homes Collaborative (DCHC)

DCHC was created to continue the engagement and achievements of the initial COVID-19 response. Its primary mission is to provide a platform for care providers to connect and share good practice, whilst communicating effectively to the general public and other sector professionals.

For further details please contact DCHC.

Devon Residential and Nursing (DRN) WhatsApp group

Devon Care Home Collaborative (DCHC) runs a WhatsApp group for care home providers or managers to join a peer to peer support group that provides quick responses on questions you may have as well as flagging up resources, training and gathering your feedback on key issues. Please email: info@devoncarehomes.org with your request. Please note it is one contact per care home.

NHS Devon care homes newsletter

NHS Devon’s Caring for Care Homes Team produce a quarterly newsletter for care homes.  It can be viewed online and care homes can join the mailing list by emailing them.

Everything else

CQC to publish death notifications in care homes at location level

The Care Quality Commission (CQC) is going to publish data about the number of death notifications relating to COVID-19 they have we’ve received from 10 April 2020 to 31 March 2021, from every CQC registered care home location in England. They plan to bring that data to their Public Board meeting on Wednesday 21 July and publish it on their website that day. For further information please visit the CQC website.

Care homes who have notified the CQC will be contacted by the CQC who will share the data they intend to publish for their location in a process which commenced on Monday 5 July and will run until Friday 9 July.

The data includes all death notifications submitted between 10 April 2020 and 31 March 2021 where COVID-19 was either suspected or confirmed regardless of the place of death.

The CQC knows that most providers have done all they can to ensure that information about the circumstance of peoples’ death is shared appropriately and will continue to engage with trade associations before publication.

Devon County Council (DCC) understands the potential impact that publication of this data may have on care homes and is able to offer homes media support if they are approached by their local press. If any Devon care home finds itself in this situation please notify DCC.

Care home help with iPads

Care homes are now being encouraged to make sure staff take up support including a helpline service desk from Jigsaw24 to help with any technical issues related to the NHSX iPads.

Guidance and weekly webinars from Digital Social Care

Contact Jigsaw24 Service Desk on: 03332 409 234 or send an email.

Barclays Digital Eagles

They are offering FREE training webinars to all care homes covering different learning areas, provided via short bite-sized learning modules, which you can attend as many times as you like.  Further information. To book a place email Barclays Digital Eagles.