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Care homes

Last Updated 14:00pm, 10 May 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:

What to do if a PCR COVID-19 test result could not be read or it is a void test result (inconclusive)

If you had a PCR test (test that was sent to a lab) and your sample could not be read, you will need to get another test as soon as possible. If the staff member does not have symptoms, and is not a contact, then they can continue working pending the result of the second PCR test.

Staff should self-isolate until they get the result of the second test if:

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.

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:

Vaccination

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.

Consultation launched on staff COVID-19 vaccines in care homes with older adult residents

A consultation has launched on making COVID vaccination a condition of work for people who work in care homes with older adult residents.

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

Movement in and out of care homes

Care homes residents allowed more out-of-home visits

Residents will be able to leave care homes for low-risk visits without needing to self-isolate on their return.

Arrangements for visiting out of the care home

This guidance sets out how care homes can support residents on visits outside of the care home.

Care home residents can have two named visitors

Following the recent government announcement, the Department of Health and Social Care are pleased to confirm that from 12 April 2021 every care home resident will be able to nominate two named visitors, who are able to enter the care home for regular visits.

These visitors must be tested before entry to the home, must wear appropriate personal protective equipment and follow all other infection control measures during their visit.

Full visiting guidance are available on the Government’s website.

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.

Capacity Tracker

Latest Capacity Tracker changes

Every time there is a change to the reporting requirements on the Capacity Tracker, we notify providers using our weekly PEN newsletter. The latest changes are:

Second COVID-19 vaccination questions on Capacity Tracker
The second vaccination questions should be live by Friday 16 April, with the Help/What’s new section updated for support.

Weekly Q&A sessions
The Capacity tracker Team has restarted their weekly Q&A sessions. You can start attending them from Tuesday 20 April (from 1.00pm to 2.00pm) to help with any aspect of the tracker. You should have received an invitation to join using MS Teams.

Comparisons of your data against other local/regional data
This week Capacity Tracker data will be available to all provider groups – care homes, home care, hospices, substance misuse and community rehabilitation organisations, giving reports at organisation level and national level. The Capacity Tracker team is also introducing a new Comparative Analysis, which will allow users to view their location data against a local or regional geographical data set. Workshop invitation have been sent out about this. Please see the Help/What’s new section on the Capacity Tracker for further details.
For all queries please contact the Capacity Tracker team directly:

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.

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 and out of hospital webinar - Thursday 13 May

The next joint Devon, Plymouth and Torbay system webinar for care homes and out of hospital care providers is due to take place this week at 3pm on Thursday 13 May 2021.

Please follow this link to access the webinar.

The focus of this month’s webinar is ‘Staff Health and Wellbeing’ and in addition to the usual system updates and Q&A will have presentations on the Talkworks support offer. As this week is Diabetes Prevention Week we will also share details of the local Type 2 Diabetes Prevention Programme.

Support for care homes

Support for care homes sets out the support package to keep care homes safe during the coronavirus pandemic.

Update on CQC's regulatory approach

The three Chief Inspectors have published a statement about CQC’s future approach, outlining changes that will take effect from April and what they mean for providers from all sectors.
You can read the full statement.

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.

South West Care Home Network coming soon

South West Care Home Network coming soonThe South West Academic Health Sciences Network (SW AHSN) will be setting up a South West Care Home Network with quarterly events aimed at care home managers and staff with a range of speakers and case studies to showcase the great work carried out by the sector. The first event is scheduled on Tuesday 18 May from 1.00pm to 3.00pm. Invitations will be sent out in coming weeks. The SW AHSN is keen to hear what you think should be covered in the events so please complete this brief survey.

To join the Network please complete this form.

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).

North
Tuesday 11 May from 3:00pm to 4:00pm
Tuesday 8 June from 3:00pm to 4:00pm
Tuesday 13 July from 3:00pm to 4:00pm

East
Tuesday 11 May from 11:00am to 12:00noon
Thursday 10 June from 11:30am to 12:30pm
Thursday 15 July from 11:30am to 12:30pm

South
Friday 14 May from 2:00pm to 3:00pm
Friday 11 June from 2:00pm to 3:00pm
Friday 16 July from 2:00pm to 3:00pm

West
Wednesday 12 May from 2:00pm to 3:00pm
Wednesday 9 June from 2:00pm to 3:00pm
Wednesday 14 July from 2:00pm to 3:00pm

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

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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