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Care homes

Last Updated 9:00am, 24 February 2021

Introduction

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

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:

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.

From Wednesday 17 January, there are now several key changes to care home testing policy and process.

  • With immediate effect, if someone tests positive with a PCR test, they should not be tested using PCR or LFD for 90 days. If they develop new symptoms during this time, they should be retested immediately using PCR.
  • Rapid response LFD testing for staff is being extended (from Monday 22 February). This should no longer automatically stop after seven days. Instead care homes should continue with rapid response testing until five days have elapsed since the last positive test. Staff should only be tested on the days they are due to attend work.
  • LFD testing for residents is being introduced (from Monday 22 February). This should be undertaken at the same time as the PCR testing in an outbreak – on day one and on an additional day between days 4 and 7. The usual principles of consent and best interest decisions apply to inform your decision whether this is appropriate for each resident.
  • PCR outbreak testing is moving from Pillar 1 to Pillar 2. The policy for when to carry out the outbreak PCR remains the same. All staff and residents should be tested on day one and on an additional day between days 4 and 7.

To support care homes with these changes, please see the following guidance:

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

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

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

Further details are available on the Testing page.

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

Care home staff can test at home

The Department of Health and Social Care gave approval for care home staff to take and register their twice weekly Lateral Flow Device (LFD) tests at home, before they arrive at the care home to start work. This only applies to care homes, not to other settings. If a care home has enough LFD tests to provide a staff member with a box of 25, please feel free to start this process. If not, then use the online replenishment portal to be launched in the week of 1 February. Please do not ring 119.

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.

Care homes and new isolation period

The self-isolation period for people who have been in contact with COVID-19 cases has been reduced from 14 to 10 days. Public Health England have confirmed that this does include contacts of COVID-19 cases in care home settings, including staff and residents.
Read the updated Government guidance
The main points are that:
If staff have been notified that they are a contact of a confirmed case in the community
Staff who have been notified that they are a contact of a confirmed case of COVID-19 in the community (outside the health or social care setting or their place of work) should inform their line manager and self-isolate for ten days, in line with the NHS test and trace guidance.
If staff have been notified that they are a contact of a co-worker who is a confirmed case
The ten day self-isolation period applies to staff who have been notified that they are a contact of a co-worker who has been confirmed as a COVID-19 case and contact with this person occurred while not wearing PPE.
Resident exposures in care settings
Residents who are known to have been exposed to a confirmed COVID-19 patient (an exposure like a household setting), should be isolated or cohorted only with residents who do not have COVID-19 symptoms but also have been exposed to COVID-19 residents, until ten days after last exposure.
The Government have also updated:

Visiting arrangements

Visiting arrangements in care homes

The national guidance which sets out how care homes can support families and visitors to visit residents has now been updated and the guidance above supersedes all previous guidance.

The guidance balances risks and benefits as they apply to residents, families, staff and providers, based on the intention that visits should be supported wherever they can happen safely.

Care homes are empowered to determine their own visiting policies within the framework of national and local advice, which must be tailored for individual residents and based on a dynamic risk assessment.

The main national messages from the Department of Health and Social Care and Public Health England are that:

Visits to residents in care homes should be supported wherever they can happen safely.

  • The registered manager of each care home is responsible for setting the visiting policy and for considering the individual needs of each resident.
  • Visits need to be arranged in advance and visitors are asked to be mindful of pressures on care homes; providers will need to communicate with them their policy and protocols clearly.
  • Visitors should avoid close/prolonged contact with other residents/staff.
  • There is a requirement to facilitate visits in exceptional circumstances, such as end of life.
  • Visits are prohibited in settings where there is an ‘active outbreak’, except at end of life.
  • The guidance allows indoor visits by visitors who’ve been tested and wear PPE; outdoor and screened visits for others including in visiting pods.
  • The guidance allows physical contact (including personal care provision, holding hands, hugging) where the visitor has tested negative, is wearing PPE and follows other IPC guidance, but within the care home’s own policy.
  • The CQC will include adherence to infection control measures for visitors as part of their infection prevention control inspections.

Testing

In order to support care home visiting, rapid testing kits are being delivered to all care homes in England.
To prepare for visitor testing you should:

  • decide where your designated entrance or outside dry space will be, for donning personal protective equipment (PPE)
  • decide where your testing and results waiting area will be, away from your main area, so visitors can social distance while waiting
  • find storage space for your test kits
  • take part in a webinar (care homes will receive links by email)
  • complete the online training (care homes will receive links by email)

Other issues to note are that:

  • Screening against respiratory infection symptoms should also take place, and no one in isolation or quarantine should be admitted.
  • Gifts should be cleaned at the care home and be suitable for cleaning.
  • Care homes should keep temporary records of visitors for Test/Trace purposes.
  • Homes must still adhere to the Mental Capacity Act legal and decision-making framework, with the support of local authority social workers.

Key Infection, Prevention and Control guidance

Infection control is a key aspect of safe visiting and guidance on the use of PPE must be strictly adhered to. This guidance covers best practice in social care settings.

Statement of support for care home visiting. Questions & Answers.

Devon County Council is working with care home providers and through the Devon Care Home Collaborative to support arrangements for family and friends to visit people who live in care homes. Please read the joint statement of support and questions and answers which have been compiled in line with the new lateral flow testing of visitors in care homes guidance.

Care home visits: Tier 4 applies

National lockdown: Stay at Home was updated following the announcement on 4 January.
Visits to care homes can take place with arrangements such as substantial screens, visiting pods or behind windows. Close-contact indoor visits are not allowed. No visits will be permitted in the event of an outbreak.

Arrangements for visiting out of the care home

This guidance applies to residential care settings for older people and, in particular, adults of working age. Please note that separate guidance will be issued for those in supported living settings.

As risks are usually significantly greater for older people than for those of working age, visits out of care homes should only be considered for working age residents. Care homes should, however, support visits out for older people in exceptional circumstances, such as to visit a friend or relative at the end of their life.

Coronavirus (COVID-19): support for care homes

Sets out the support package to keep care homes safe during the coronavirus pandemic

Vaccination

Care home: second vaccination - webinar on 25 February at 2pm

Care homes in a joint webinar with Primary Care Network representatives.

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.

Devon COVID-19 vaccination programme for care homes

A great amount of work is taking place across health and social care to roll out the COVID-19 vaccination to all those who are eligible. Thank you for your continued patience on what is a very complex and fast moving programme.

Care home staff and residents remain a priority group to be vaccinated, as set out by the Joint Committee on Vaccination and Immunisation. However, the number of vaccinations available is limited and the Pfizer/Biontech vaccine is complicated to deliver, so the details of how and when care homes will receive the vaccine for both staff and residents is still being worked through.

It’s likely that some early pilot sites will be trialled in the next couple of weeks, where smaller amounts of vaccine will be delivered directly to a limited number of care homes. We will update as soon as we have any further information.

Please be assured, every care home will be contacted when the vaccination is ready to be delivered from your site or when an alternative site becomes available where you can access vaccinations.

Some frequently asked questions about the 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

Vaccination: Frequently Asked Questions

Updated timeline and vaccinating where there is an outbreak

NHS England has published a letter bringing forward the target date for care home vaccination to be completed to 24 January (instead of the original 31 January target).
It also announced that it is expecting all primary care network local vaccination services to administer the first dose of the COVID-19 vaccine to residents and staff in the older adult care homes for which the PCN is responsible by the end of this week wherever possible and, at the latest, by the end of next week (Sunday 24 January).

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

Capacity Tracker

Capacity Tracker guidance for care home providers

Following the recent changes in the Capacity Tracker, a new video has been produced to support care home providers when inputting their Business Continuity information. The video is only 12 minutes long and answers many of the queries we have received over the past few weeks.

New vaccination questions for home care providers on the Capacity Tracker

The following new questions have been added to the daily update of the Capacity Tracker for home care providers:

  • How many staff in your organisation have face-to-face contact with people you support?
  • Number known to have had first dose of vaccine
  • Number NOT known to have had first dose of vaccine
  • Number where vaccination status of first dose of the vaccine is not yet known or undisclosed.

Guidance for the above questions can be found in the “What’s New” section “Home Care – Additional Workforce/Covid Vaccination Questions 2/2/2021”.

New survey for proxy medicine ordering for care homes

There is a new three question survey for care homes in the Capacity Tracker which needs to be completed by 28th February. The three questions are:

  1. Have you been setup by your GP practice to order online medication by proxy on behalf of your residents via GP online services? (Y/N)
  2. Have you been setup to access any additional information in the GP record such as test results or discharge information for residents? (Y/N)
  3. Where the answer is ‘No’ to the above, would you like support in setting this up? (Y/N)

You can find more details for the guidance and FAQ in the “What’s New” section of the Capacity Tracker. If you want any support with the above, please contact: england.carehomesgpproxy@nhs.net.

Capacity Tracker - update for care homes

We are aware of changes to the business continuity questions in the Care Homes Capacity Tracker, as follows:

  • New COVID vaccination questions
  • Revised Workforce data
  • Revised Flu Immunisation data
  • New requirement to record daily resident count

Important changes to Capacity Tracker from Friday 11 December 2020

Please note that new questions are being added to the Capacity Tracker for Care Homes. Please contact this helpdesk if you have any questions or queries regarding how to answer the questions and for any technical issues please email Capacity Tracker.

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:

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

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.

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

Dementia wellbeing in the COVID-19 pandemic - Guidance

NHS England and NHS Improvement published guidance to help address the needs of people with dementia in the COVID-19 pandemic. It complements the existing dementia wellbeing pathway and identifies specific actions to be taken at each stage. In addition to identifying key considerations, it also provides links to a wide range of resources, including those developed by NHS England and NHS Improvement, regional dementia clinical networks, the voluntary, community and social enterprise (VCSE) sector and the Department for Health and Social Care. This resource is primarily for clinicians working with people with dementia but can also be used by carers and people with dementia.

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.

Everything else

Care home infection control champions

This pandemic has shown just how important infection prevention and control (IPC) is within care homes. One of the most important elements of preventing infection is staff knowledge and empowerment.

To support care home staff who want to learn more about infection control, the Devon system are introducing a Care Home IPC Champions role.

Every home should have an IPC champion. These champions will link with senior infection control nurses for education and advice – learning sessions will be available to you.

What is a champion?

A member of staff with a passion in IPC – the champions develop their IPC knowledge and other skills useful to assist others in the home.
A link for other staff to get more information from – someone who constantly wants to review practice making changes to improve.

Who can be a champion?

Anyone with a passion for IPC. The champions are supported by the care home manager, proprietor and care team. It’s important that we don’t just limit these roles to senior staff.

Benefits of having a champion

  • Becoming a champion is a great way to motivate and develop staff.
  • Champions can do additional training and share with other team members.
  • CQC like homes to have champions.
  • Having an IPC Champion is one of the best ways to improve infection and control in the home.

If you would like to put yourself or a member of your care home staff forward to be an IPC Champion, please let us know: bryan.sycamore@devon.gov.uk

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.

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.

iPads in care homes

Ongoing guidance and support is available to help staff to use the iPads to deliver safe and compassionate care to residents.

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.

You can read the February newsletter and for further details please contact DCHC.

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.

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.

Incentive payment for the submission of CHC Assessment paperwork

NHS Devon CCG have launched an initiative to pay care homes and supported living providers an ex-gratia incentive payment for the submission of CHC Assessment paperwork. This will apply to all assessments requested from 21/12/20 – 31/03/21 by the CHC Hubs / CHS Healthcare Team across Plymouth, Devon and South Devon & Torbay (NHS Devon CCG footprint).

This incentive applies to all care homes and supported living providers.

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.

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