Standard Operating Procedure for the management of COVID-19 outbreaks across all adult social care provider services
Changes have been made to the Standard Operating Procedure for supporting Care homes through Outbreaks of Covid 19. A key change has been in relation to the process through which homes can consider taking new admissions while outbreak control measures are still in place.
Previously, the Community Services Manager (CSM) would complete a risk assessment and make a decision for each prospective resident.
From this point forward, the CSM will be involved in the decision-making only if an Outbreak Control Team meeting is in place (and this would usually be where there is an exceptionally serious or escalating outbreak). In all other situations the Care Home Manager will be responsible for making the decisions as to whether they can safely meet the needs of a prospective resident while the home is in outbreak.
A checklist has been adapted to support Care Home Managers with understanding the factors they should consider. You may wish to keep a record of the risk assessment.
Please do continue to contact the Community Health and Social Care Team or Devon Public Health if there are situations where you consider that advice would be helpful in supporting safe decisions.
Movement in and out of care homes
Full visiting guidance is available on the government’s website.
Essential visitors guidance. A poster has been developed providing advice to essential care givers on safe practice while they are visiting the home.
Residents returning to care homes following admission or visit to hospital
Local guidance to support care homes when residents return to the care homes from the hospital admissions or visits.
Guidance on management of staff and exposed patients
Guidance on the management of staff and exposed patients in health and social care settings:
- Managing healthcare staff with symptoms of respiratory infection
- Coronavirus prevention and control
- COVID-19 testing for adult social care settings
Care homes are not currently required to limit staff movement between sites or services. However there may be times that care homes are asked to limit staff movement by the local director of Public Health or Health Protection Team (HPT). This may be requested of care homes if there is a high prevalence of COVID-19 locally or if the care home is in outbreak with risk assessed measures which may include Restriction of movement of staff providing direct care to avoid ‘seeding’ of outbreaks between different settings. See guidance
The Quality Assurance Improvement Team’s (DCC) has issued advice to providers in the event of requiring agency supporting the safe management of agency staff when movement occurs.
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.
NHS staff visiting care homes
Letter sent to health professionals with advice on infection prevention measures (February 2022).
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
For information on vaccination please go to the vaccination page.
Hospital discharge and community support
Short Term Hospital Discharge Service for 1:1 care and support
A service to support complex individuals from hospital into a care or nursing home setting who require short or longer term 1:1 support. The offer is to provide a care worker to go with the individual into the care home for 5 – 28 days.
Hospital discharge continuation
As providers will be aware, the CCG has supported the payment of an enhanced discharge rate for all new placements made for individuals on discharge from hospital. These rates are £825 for non-nursing placements and £1200 for nursing placements. This funding pathway had been due to cease at the end of March 2022, however, the Department of Health and Social Care are actively discussing the initiative’s future and will announce the central government’s position in due course. However, regardless of any central government decision to cease this approach, locally a decision has been taken to continue the existing Discharge to Assess scheme within Devon.
From April 2022 the scheme will continue on the same basis, and the CCG will retain these enhanced rates at their existing level during this time. These rates will remain under review and the CCG will work with provider colleagues in the coming months to review and better understand the fee setting process and costs associated with hospital discharge placements. The rates may be withdrawn or varied at a future date however, the CCG will ensure any removal or change to these rates (which would be applicable to new discharges only) are communicated to the care home sector in advance of their withdrawal/change.
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.
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’.
Discharge into care homes
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
The Capacity Tracker team are recommending that you update the Tracker on a daily/weekly and monthly basis and this is dependant on the different data sets within this.
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.
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: email@example.com or the Support Centre 01916913729 from 8.00am to 5.00pm, Monday to Friday, excluding Bank Holidays.
Care home Q&A sessions
Donna Schell (firstname.lastname@example.org) is the current South West representative for the Capacity Tracker. She schedules introduction and refresher demos including Q&A sessions for care homes and home care providers (details will be posted in the PEN newsletter). These sessions provide an opportunity to update you on the most recent changes in the Tracker and urgent messages from the Department of Health and Social Care and NHS England.
For queries about the regular meetings or local South West issues, please contact: Donna Schell email@example.com Mobile: 07563644777
For care home ICF2/ASC fund weekly and monthly questions: Capacitytrackerfirstname.lastname@example.org
For any technical / system queries, please contact the Capacity Tracker team: email@example.com
For the Capacity Tracker Support Centre on 0191 691 3729 or via email: firstname.lastname@example.org
For interpretation of questions on the Tracker: email@example.com
For home care survey questions: firstname.lastname@example.org
COVID-19 vaccination team (including interpretation of questions): email@example.com
DHSC Workforce survey: Capacitytrackerfirstname.lastname@example.org
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 6.00pm to 8.00am 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 email@example.com
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.
Care home locality support meetings
Care home locality support forums
These forums are engagement opportunities for care home providers and their registered managers, DCC Market Management Team and the locality Assistant Director/Social Care Operational team. You can view all of the previous meeting minutes in the online library.
The next care home locality forums:
- East – Tuesday 24 May, 10.00am to 11.00am
- North – Thursday 26 May, 3.00pm to 4.00pm
- South & West – Friday 27 May, 3.00pm to 4.30pm
If you have not received the calendar invite please email firstname.lastname@example.org stating which locality meeting you would like to receive invites for (North, East or South & 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: email@example.com with your request. Please note it is one contact per care home.
NHS Devon care homes newsletter
Local guidance on air filters in care homes
Devon County Council has published advice on investment in air purification in care homes and other environments at high risk from the spread of infectious diseases.
DILIS community equipment loans into care homes
Devon NHS CCG has agreed additional temporary funding until the end of March 2022 to improve support to care home providers through the provision of community equipment into care homes on a loaned basis to individual residents, in the following circumstances:
- to support a hospital discharge
- to prevent the admission of a resident into hospital
- to enable a resident to continue to remain living in the care home when their needs change and the care home doesn’t have the correct equipment / cannot source the correct equipment to meet the changed need.
Any equipment required must be ordered by a health or social care professional who is an authorised prescriber with Millbrook Healthcare (the commissioned community equipment provider). The equipment will be loaned for an initial four week loan period and will be reviewed within this period. Following review, if the equipment is no longer required by the resident, it will be collected and must not be retained by the care home provider for use by another resident. This will allow us to recycle and reuse the limited supply of equipment that we have seen in recent months due to the pandemic and other factors, and to ensure that we can keep stock available for care homes use. The loan period can also be extended if required to continue to support a short stay resident. If the review identifies the equipment is required on an ongoing basis, the loan will become a permanent loan to that resident, but will be collected and must be returned when it is no longer required by that individual.
Over the coming months, COVID-19 work pressures permitting, the Council is planning to work with care home providers to review the Council and NHS’s care home equipment policy, within the context of the legislative position and the fee model review work, to arrive at a clear position longer term with regards to equipment provision by the care home provider and what will be loaned by the Council/NHS.
NHS England have released a set of informative cleaning resources for care homes and their staff, on the following topics:
- 10,000 Dilution using tabs body fluids
- Care home top tips (electronic version)
- Care home top tips (printing version)
- Cleaning and disinfection wipes leaflet
- Cleaning premises using fog
- Sluice poster for tablet dilution
PPE guidance for care unchanged
Due to vulnerabilities of care home residents there is no change to PPE use in care homes.
This guidance is intended for all care workers working in care homes in England. It can also be applied to visitors or essential care-givers within the care home setting.
This guidance is of a general nature and is intended to be compatible with legislation. If this guidance differs from any requirement covered by legislation, then the legislation should be followed. The guidance remains under review and may be updated in line with the changing situation as required.
Employers and managers must provide workers with safe conditions of work, complying with all applicable legislation, including the Health and Safety at Work Act 1974 and the Health and Social Care Act 2008: code of practice on the prevention and control of infections.