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Supporting health and social care providers in Devon

Care homes, supported living, shared lives and extra care

Last Updated 10:07am, 18 September 2020


Introduction

If you have any specific issues or questions that you would like to raise with us please do so as follows:

Support to the market

Devon County Council made its first offer of support to the market on 24 March 2020 (Financial Support Arrangements letter).

As well as the original market support offer, Devon County Council, Devon Partnership Trust and NHS Devon CCG issued further financial support to care homes outlined in this letter, sent to providers on 29 April.

The support has been reviewed and updated with effect from July 2020. (Financial Support Arrangements letter July 2020).

Care homes

Visitors to Care Homes

Devon’s Director of Public Health has written to care homes on 11 September advising that at present, providing infection control guidance is followed, care homes can continue with their own visiting policies. However, this situation is subject to an ongoing dynamic risk assessment and may change in the future, at which point care settings will be notified. Our priority is to ensure that everyone is as safe as possible, should we see an increase in local coronavirus cases.

Please take this opportunity to review the guidance for visiting arrangements in care homes. Section 4 sets out considerations and precautions which should be taken into account by the provider. Providers may apply different rules for different residents or categories of resident, if they think it appropriate, based on an assessment of risk of contracting COVID-19 in relation to such residents.

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

Promoting weekend testing in care homes

A campaign is being launched this week to promote weekend testing in care homes. The Government are asking care homes to consider testing at weekends where possible to help them get a test to everyone who needs it. Additionally, if homes test at the weekend, the labs are less busy, and result will be quicker.

Devon County Council would like to encourage care homes to test over a full seven days wherever possible to make full use of the testing capacity.

Information on testing can be found on the testing part of the PEN website.

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.

Visiting Care Homes

The national guidance on visiting arrangements in care homes published on 22 July 2020 requires the local authority Director of Public Health to make a risk assessment about visiting care homes in their area.

Currently our COVID-19 incidence, and therefore risk levels in Devon, are very low and Devon’s Director of Public Health for Devon has stated that there are no restrictions recommended at the moment, as long as national and local guidance is strictly followed, including the need for a dynamic risk assessment.  We are monitoring the situation closely and if any restrictions are required we will communicate them both directly to affected providers and via this website.
On occasion, a local situation may arise where the advice from Public Health England is that visiting should be suspended.  Under these circumstances the Care Home will be notified of this until such time that it is deemed safe to do so.

Care home visitor policies must be in line with government guidance on visiting care homes and on working safely in care homes, comply with the advice of the Director of Public health and result from a dynamic risk assessment and we encourage care homes to communicate their policy to the family and friends of their residents.

Principles for visiting health and care professionals

Aim: NHS and Local Authority health and care staff including therapists, who are required to visit care homes across Devon will provide a consistent approach in ensuring the ongoing protection and welfare of residents in care home settings by minimising the infection risks.

What can the care home expect from visiting health and care staff

1. Virtual visits will continue to be used for routine interactions wherever possible, using telephone or video conferencing.

2. Face to face visits will only be made where necessary for clinical assessment /treatment; or deemed necessary for the health and wellbeing needs of individual residents. Where a face to face visit is required to support the health and wellbeing of a resident, a pre-visit planning call and check discussion will be undertaken a minimum of 1 hour in advance. This call may include:

  • Request for information about any current symptomatic or Covid-19 positive (+ve) cases in the home
  • Environmental factors and risks e.g. car parking or home entry routes
  • Estimated ‘time window’ that the visit will take place within

3. Infection Prevention and Control – All visiting health & care  staff will follow national and local infection prevention & control policies including the use of appropriate PPE in all face to face situations. We will ensure that our staff who visit have not had unprotected contact with people who have tested positive for COVID-19 or other symptomatic individuals.

4. Care Home Policies – We will support each care homes visiting policy wherever possible but recognise that these may differ. We will complete any visiting document required to support the NHS Track and Trace process.

Expectations of care homes

1. The care home is contactable by telephone to assist with the pre- visit planning and checks.

2. All visits – virtual or planned face to face will be supported by a member of the home staff in relation to the individual needs of the resident. Resident will be ready within a well-ventilated room with good lighting. The exception would be an emergency visit.

3. Hand washing facilities to be made available when entering and leaving the building

4. Minimising time by visitors walking through other parts of the care setting and social distancing at all times.

5. Appropriate PPE must be worn at all times in all face to face situations.

Remote Mental Capacity Assessments

The Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) are still fully in effect and the government has issued guidance on the application of the MCA and DoLS during the Covid-19 pandemic.

Further guidance is available from the independent Mental Capacity Law and Policy website

Care homes are reminded that the local guidance relating to mental capacity assessments remains that assessments should be carried out by remote means wherever possible at this time. It may be appropriate for someone who is able to communicate directly with the person to assist with or carry out a capacity assessment.

National hospital discharge guidance

Please refer to government guidance about changing your arrangements – Coronavirus (COVID-19): hospital discharge service requirements.

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’. Updated on 2 September 2020.

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.

Support to Care Homes from July

From 1 July voids will no longer be paid. The Infection Control Grant, which is being paid to each care home in 3 instalments, provides resources to meet other costs.

Infection Control Fund

The Government has devolved £600m to local authorities to support care homes with infection control. Information on the level of funding and how to access it was sent to care homes on 3 June and the following information is listed below to help fund applications:

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

Hospital Emergency Department process for care homes

Message sent on behalf of Northern Devon District Healthcare NHS Trust, Royal Devon and Exeter NHS Foundation Trust and Torbay and South Devon NHS Foundation Trust.

The NHS takes all possible measures to shield care home residents, care home staff (including domiciliary workers) and NHS clinical staff if they present to the Emergency Department (ED).

To follow the necessary coronavirus testing procedures, hospitals must ensure there are dedicated areas to treat and test patients who present in their ED.

This means that the risk of being exposed to the infection in ED is kept to an absolute minimum.

COVID swabs will only be taken from patients who require admission to hospital, or those who have COVID  symptoms. Swabs would be taken before they are discharged back to their care home, even if they are not admitted.

Devon Residential and Nursing (DRN) WhatsApp group

A WhatsApp group has been set up for Devon residential and nursing home managers and owners.

We would encourage all registered managers and owners to join the group using the online registration form.

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.

Managing medication

DCC’s Quality Assurance & Improvement Team have 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.

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.

RDE, Northern Devon and Torbay Hospital process for care home patients and staff

Message sent on behalf of Northern Devon District Healthcare NHS Trust, Royal Devon and Exeter NHS Foundation Trust and Torbay and South Devon NHS Foundation Trust.

The NHS takes all possible measures to shield care home residents, care home staff (including domiciliary workers) and NHS clinical staff if they present to the Emergency Department (ED).

To follow the necessary coronavirus testing procedures, hospitals must ensure there are dedicated areas to treat and test patients who present in their ED.

This means that the risk of being exposed to the infection in ED is kept to an absolute minimum.

COVID swabs will only be taken from patients who require admission to hospital, or those who have COVID symptoms. Swabs would be taken before they are discharged back to their care home, even if they are not admitted.

Supported Living

National Supported Living guidance

The Government has published guidance for providers of Supported Living, covering safe systems of working including social distancing, respiratory and hand hygiene, enhanced cleaning and how infection prevention and control and personal protective equipment applies to those settings.

Supported Living, One to One Enabling, Day Services, Shared Lives and Extra Care Housing from July

We recognise that this is not a single market and requires a differentiated approach.
From 1 July we will no longer pay for voids, other than those that form part of a pre-existing contractual agreement.

The additional costs of PPE will, for most providers, be met to the end of September through a single payment, calculated for each provider.

Day Services and Shared Lives exceptions from July

The exceptions to our standard PPE arrangements are for Day Services, where we will issue a supply of PPE to meet need (because requirements for PPE are not always clear), and Shared Lives settings which do not require PPE as they are households.

In addition, for Day Services, we have already announced an extension of the support package to the end of September. This is to give providers longer to remodel their businesses in relation to the consequences of Covid-19. We have written separately about that offer.

Supported Living targeted support from July

For Supported Living we recognise that there are significant risks of community transmission of the virus and heightened risk due to the shared environment. Research also shows that people with a learning disability and/or autism are at higher risk. Consequently, we intend to target additional support to this market.

Financial support to Supported Living, Shared Lives and Enabling Day Services

As well as the overall support package to the market announced in March and April, on 19 May Devon County Council has decided to pay all designated contracts a single payment to a value of 5% of our commissioned services for a 3-month period. This would be limited to Devon County Council held contracts but would be for all care groups including people with learning disabilities, mental health needs, physical and/or sensory disabilities and older people. Following review at the end of June 2020 a decision will be made about whether any further payments will be made should the COVID-19 period and associated financial risks extend beyond this date.

The payment is available to use at your own discretion but is primarily a response to representations made by providers relating to their wish to offer additional reward to staff during the Covid period. We therefore anticipate that the additional money is most likely to be used to recognise and value the contribution made by your workforce.

The payment will be made as soon as possible (but by the end of May 2020) and will be backdated to 1st May 2020. The payment will be based on the rates paid to you after applying this year’s inflationary uplift and will be made to you automatically by DCC.

Please note that this payment only applies to DCC funded agreements and does not include any S117 arrangements. Discussions are continuing about those payments with our NHS partners.

National guidance for Supported Living

National guidance for Supported Living has been withdrawn on 13 May 2020.

Further national guidance for this sector is under development.

For advice on the use of personal protective equipment (PPE) in supported living settings and in home care settings, you may find it useful to refer to Personal protective equipment (PPE) – resource for care workers delivering homecare (domiciliary care) in England.

In addition, more detailed information is available in the infection prevention and control guidance.

Devon Housing with Support WhatsApp group

We would encourage all registered managers and owners to join the group using the online registration form.


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