Coronavirus (Covid-19) Management for Domiciliary Care Policy

Policy Statement

This policy reflects latest government guidance, which further marks the movement away from a regulatory approach to control the impact of Covid-19 to a non-regulatory risk-managed approach. This has been signalled by the removal of mandatory requirements, which have been replaced by guidance and advice on how people should prevent and control any further spread of SARS-CoV-2 and other infectious illnesses.

{{org_field_name}} is aware that it should follow the:

Covid-19 Supplement to the Infection Prevention and Control: Resource for Adult Social Care (updated 25 April 2023)
Infection Prevention and Control: Resource for Adult Social Care (April 2022)
Hospital Discharge and Community Support Guidance (updated 1 July 2022).

Note:

Covid-19 Testing in Adult Social Care was withdrawn on the 3 April 2023 with all relevant information included in Covid-19 Supplement to the Infection Prevention and Control: Resource for Adult Social Care (as updated).

Note:

There is separate guidance for:

Wales, available from phw.nhs.wales
Scotland, Covid-19: Guidance for Domiciliary Care, Health Protection Scotland
The NHS Scotland National Infection Prevention and Control Manual (NIPCM), which has also been adopted in Wales.

A. Infection control and prevention procedures

{{org_field_name}} continues to adhere to high standards of infection prevention and control as the best way to prevent the person-to-person spread of Covid-19 and other infectious diseases in order to keep people receiving care and staff safe.

{{org_field_name}}’s infection control policies and procedures against Covid-19 have included, when necessary, the following procedures.

Keep a safe distance of at least one metre from another person in social interactions that do not require close contact (as when delivering personal care).
Wear face masks or coverings in enclosed situations particularly where recommended physical distancing is difficult to maintain.
Cover their mouth and nose with a tissue or their sleeve (not their hands) when they cough or sneeze.
Put used tissues in a bin immediately.
Wash their hands with soap and water regularly for 20 seconds and use hand sanitiser gel (at least 60% alcohol) if soap and water are not available.
Try to avoid close contact with people to whom they are not delivering care who are unwell.
Avoid touching their eyes, nose and mouth with unwashed hands.
Clean and disinfect frequently touched objects and surfaces.

{{org_field_name}} provides the necessary approved hand sanitiser gels for staff to use during and between their visits or where it is difficult to follow usual hand washing procedures, for example, because of lack of suitable facilities in the homes of people using the service.

It also encourages people using the service and other members of their households to follow good infection control practices, including regular cleaning of frequently touched hard surfaces with a suitable disinfectant and cleanser.

{{org_field_name}} policy is to communicate all public health messages, including those relating to testing, wearing of masks and PPE, and staff movement to staff, people who use services and relatives so that everyone knows what is permitted and what is not.

See also Infection Control and Cleanliness in Domiciliary Care (England) Policy.

Testing

{{org_field_name}} understands that symptomatic testing of staff or people using the service is now advised only for those eligible for Covid-19 treatments and during suspected outbreaks in care homes.

People who meet the eligibility criteria will have access to LFD tests, which they should use immediately at onset of Covid-19 symptoms, and avoid contact with other people if positive. If the test is negative they can resume their normal activities (though they might have another infection which might require precautionary measures and treatment).

Care staff who are not clinically vulnerable as defined and have symptoms of a respiratory illness such as Covid-19 will follow the service’s policy and procedures described in Section C.

B. Care of People Who Use the Service

Vaccination policy

{{org_field_name}} will support the Covid-19 vaccination, including boosters, of all current and prospective people who use its service. It will work with local GPs and local NHS and other vaccine delivery teams where necessary.

{{org_field_name}} keeps records (with their consent and in line with data protection requirements) of people’s vaccine status. It reviews their care plans and supports those who require support to access vaccination.

People receiving care with Covid-19 symptoms

{{org_field_name}} will advise people receiving care or anyone in their household who develops Covid-19 symptoms to contact NHS 111 and stay at home. They might test themselves using a lateral flow test, which they can obtain privately.

Care workers should report suspected cases of Covid-19 to their manager. {{org_field_name}} will then work with its partner agencies and professionals to review and assess the impact of risk on the individual’s care needs if they have symptoms and if they test positive after a test taken as a clinically vulnerable person eligible for Covid-19 treatments.

Covid-19 Treatments for people at higher risk of severe outcomes

As a domiciliary care service we will, in line with government guidance:

check if a person using our service will be higher risk of severe outcomes of Covid-19 and their eligibility for Covid-19 treatments if becoming unwell
recommend that in the event of their showing symptoms of having a respiratory illness, including high temperature, sore throat, cough, etc they seek medical advice for their symptoms with a view to being tested and receive treatment if positive
recommend early treatment as the correct course of action in symptomatic cases.

For any person using out service one who is not eligible for Covid-19 treatments but who become symptomatic, {{org_field_name}} will advise them to avoid contact with other people until their symptoms clear.

Suspending care (by a Covid-19 affected people using the service or third party on their behalf)

If someone who uses the service (with symptoms or who test positive) wishes to suspend their care, or someone asks this on their behalf, {{org_field_name}} will alert the service commissioner (if applicable) so that they can work out how best to meet the person’s support needs and how to ensure that they can receive all essential items while staying at home until they receive an all-clear.

It is expected that {{org_field_name}} will be involved in any risk assessment that the service commissioner carries out, which will be particularly important if the person receiving care is living in isolated circumstances or who might lack mental capacity to take the necessary decisions to ensure their wellbeing.

{{org_field_name}} will also alert the local safeguarding adults’ team if a request to suspend {{org_field_name}} puts the person at risk of harm from any decision taken that appears to have been made without their consent.

Suspending care (because of staff shortages)

{{org_field_name}} will trigger its business continuity plans in the event of it being unable to deliver agreed services because of Covid-19-related staffing shortages.

It will proceed to prioritise its staffing capacity to ensure that those who are most at risk will have some service continuity. It will do this with service commissioners and partnership agencies and professionals.

{{org_field_name}} will assess the risks to the person from a reduction or suspension of visits or care and even if they are self-funded, it could seek advice from the relevant local authority.

(For further information refer to the Emergency Planning in Care topic and resources.)

Delivering services to people discharged from hospital

{{org_field_name}} will follow the care pathway developed for anyone recently discharged from hospital and help to implement the care plan that has been agreed.

{{org_field_name}} will liaise closely with the person responsible for co-ordinating the hospital discharge arrangements and over any issues arising.

(For further information, {{org_field_name}} will refer to the government guidance Hospital Discharge and Community Support Guidance.)

Care planning and referrals

{{org_field_name}} keeps people’s care plans under constant review to ensure that their needs are being met. It also carries out full risk assessments in relation to any new referrals in order to ensure that the person who would like to use the service and care staff are kept safe from cross infection of the coronavirus and other viruses.

{{org_field_name}} ensures that clinically vulnerable people are identified and plans are in place to ensure their safety. {{org_field_name}} communicates with, consults and involves as fully as possible, relatives and others involved in a person’s care, particularly where they might lack mental capacity over the decisions to be taken.

People using the service who are clinically vulnerable will in most circumstances be eligible for Covid-19 treatments if they become ill with Covid-19.

Safeguarding and protection

{{org_field_name}} continues to apply all measures to keep people safe in line with its current policies and local authority safeguarding procedures. It continues to alert the local authority to any safeguarding issue and comply with its current notification requirements and procedures.

{{org_field_name}} will continue to exercise its duty of candour where it has made mistakes that have caused serious harm to the people using the service.

Mental capacity and deprivation of liberty

{{org_field_name}} is aware of the implications of the current situation for people receiving care who lack mental capacity to understand the decisions that are being taken or to act in line with them. {{org_field_name}} will do everything it can to ensure that it applies “best interests” principles in communicating with people without capacity and in taking the decisions that are required, including where it is evident that people are being deprived of their liberty.

(See the Mental Capacity and Human Rights and Deprivation of Liberty topics for further policy guidance.)

C. Staffing Matters

Staff vaccination

{{org_field_name}} supports all its staff and the people using its service to be vaccinated against Covid-19, including boosters. {{org_field_name}} will continue to encourage its staff to be fully vaccinated as the best way of keeping everyone safe from Covid-19 and will follow any new government guidance on the vaccination programme.

Staff health and stay at home procedures

{{org_field_name}} will support its staff who are at risk of severe outcomes from Covid-19, and who are eligible for early treatment to secure the help with testing and potential therapeutics that they need at onset of any symptoms.

{{org_field_name}} maintains its procedures and practices in line with the guidance found in Covid-19 Supplement to the Infection Prevention and Control: Resource for Adult Social Care. Routine testing is not required except for people who are eligible for Covid-19 treatments. It accepts that any testing carried out would be done by individuals at their discretion with test kits obtained privately.

In line with the April 2023 government guidance, this domiciliary care service is putting the following measures in place.

If a staff member develops recognised Covid-19 symptoms:
– they should stay away from work for a minimum of five days from feeling unwell and symptom onset
– they should also stay away from work for five days if they have from their own initiative (or the service’s suggestion) tested positive for Covid-19
– if at home (off duty), they should notify their manager immediately and not attend work for the five days until well again or without a risk assessment being carried out by their service manager
– if at work, they should inform their manager and return home as soon as possible to recover, and not return to work until feeling well enough, as described above.
As described in the government guidance, {{org_field_name}} will ensure that its staff, who through testing or continuation of symptoms, might be at risk of still being infectious, will avoid contact with anyone (person using the service or staff), who are at higher risk from becoming seriously ill with Covid-19.

Staff and personal protective equipment (PPE)

In {{org_field_name}} the use of PPE for infection control purposes is informed by best practice guidance and subject to risk assessment supported by line managers and supervisors. {{org_field_name}}’s policy is in line with the protocols set out in Infection prevention and control resource for adult social care and Covid-19 supplement to the infection prevention and control resource for adult social care.

{{org_field_name}} follows protocols that consider the ways that infection might be passed on and how to prevent this through use of PPE in terms of three main “what if” scenarios, when:

providing direct personal care
having other contact within 2m of anyone else
carrying out domestic duties or other activities.

{{org_field_name}} regularly assesses and reviews all risks in line with health and safety and infection prevention and control guidance and best practice to decide the PPE to be used by staff when delivering care.

{{org_field_name}} continues to train its staff in the safe and correct use of PPE, including how to put PPE on and take it off. Line managers and staff supervisors keep a continuous check on its use. {{org_field_name}} location displays posters showing the PPE requirements and how to put it on and take it off, and make these available to anyone who needs them.

Care managers keep the PPE guidelines under review and complete appropriate risk assessments. {{org_field_name}} is aware that it will need to intensify its use of PPE during periods of “sustained transmission” of Covid-19 or of any other infectious illnesses in the community.

{{org_field_name}} manager will make every effort to ensure that adequate stocks of appropriate PPE are maintained and that PPE is readily available for staff to use.

(For further information refer to the Personal Protective Equipment topic and policies.)

Face masks

{{org_field_name}} follows current government guidance on mask wearing to the effect that:

staff do not routinely need to wear a face mask
there are circumstances where we would ask staff to wear masks to minimise the risk of transmission of SARS-CoV-2. For staff these include:

– where someone receiving personal care is known or suspected to have a SARS-CoV-2 infection or Covid-19, which requires care staff to wear a type IIR ﬂuid-repellent surgical mask

– where the staff member is a contact of someone who has had a recent positive SARS-CoV-2 test result or is symptomatic with Covid-19

– during a local outbreak where there is a high risk of viral spread

from our risk assessment where we consider a person is vulnerable to severe outcomes from Covid-19 and the person feels safer with people with whom they are in contact wearing a mask
in home care situations where there is an assessed risk of viral spread
where a person using our service feels safer with their carers or visitors wearing masks or face coverings
where staff feel safer by wearing face masks or coverings in the presence of others.

{{org_field_name}} will use professional judgement to decide if staff should wear masks or face coverings, when otherwise indicated, in relation to anyone who is made anxious or distressed by other people wearing masks or from the idea of their wearing a mask.

In these situations and where there are clear risks of infection, {{org_field_name}} will consider the sue of transparent masks as an alternative methods.

{{org_field_name}} will follow all government guidance on the type of masks to be used in the situations where they are recommended (ie type IIR, and 1 and 11) and their use in the situations in which they are used (eg during care activities, carrying out aerosol generating procedures or where there are risks of contact with body fluids).

D. Environmental and General Issues

Ventilation

{{org_field_name}} recognises the importance of delivering their care under hygienic conditions in which the homes being visited are reasonably well ventilated in order to remove air that might contain virus particles, which increase the risk of viral spread.

In making recommendations about the ventilation of people’s homes {{org_field_name}} will take fully the needs of the people receiving its service into account, and the health and safety of its staff by carrying out risk assessments and putting control measures in place as required in order to balance the different needs.

Waste management

{{org_field_name}} follows government guidance for domiciliary care services which recommends that waste visibly contaminated with respiratory secretions (sputum, mucus) from a person suspected or conﬁrmed to have Covid-19 should be disposed of into a sealed bin liner before disposal into the usual waste stream. Other clinical waste should be disposed of in line with {{org_field_name}}’s waste management policy and procedures.

Staff recruitment

{{org_field_name}} will continue to maintain its safe recruitment policies and procedures in line with its registration requirements. In the event of {{org_field_name}} being unable to maintain its staffing complement and levels because of shortages caused by staff sickness or having to self-isolate, it will follow the guidance produced by the CQC and Skills for Care (England).

Travel restrictions

{{org_field_name}} asks its staff to comply with any current official government advice regarding international travel and to inform their line manager wherever it might affect any return to work.

Latest travel advice can be found on the GOV.UK/Welsh/Scottish Government websites.

E. Business Continuity Procedures and Covid-19 Recovery Planning

{{org_field_name}} continues to review and update as necessary its business continuity and recovery planning policies and procedures and its Covid-19 recovery and resilience plan.

It has found the following contingency measures to be particularly important and will maintain these for as long as necessary.

Its communications strategy ensures that staff, people receiving care and their families are always provided with up-to-date and accurate information on current situation and on the service response.
It makes every effort to provide people with the information they need to understand what is happening to them in formats that they can understand and that meet the Accessible Information Standard.
It makes extensive use of information technology to communicate with staff, including email, texting, etc which is proving to make efficient use of time as well as reducing the risks that come from face to face discussions and contacts, though it recognises that these are also very important when conditions allow.
It has adapted its training to make greater use of online e-learning and other electronic forms with any face-to-face training still being conducted in physically distanced ways and appropriate wearing of masks.
{{org_field_name}} is continually checking and reviewing its sickness leave and absence policies, including payments, with the changing situation.

{{org_field_name}} manager will continue to link with local resilience forums relevant to health and social care provision.

The care manager is responsible for ensuring that staff understand {{org_field_name}}’s Covid-19 recovery plan policy and procedure. Staff should familiarise themselves with the procedure and should speak to their line manager if they have any questions or concerns.

The procedure aims to ensure that {{org_field_name}} will be able to continue to provide care to people during any future infectious disease outbreak.

Information

{{org_field_name}} will keep up to date with the latest public health and national government information about Covid-19.

The infection control lead for the service will maintain close links with local health protection teams and will be responsible for circulating essential information to staff and, where necessary, to people receiving care and their families. They will also update the management team.

Monitoring and Review

This policy will be continuously monitored and updated to take account of any changes to the official advice provided about the Covid-19 situation.

Training

Care staff are trained to follow the operational guidance in respect of Covid-19 infection and control and are fully kept up to date with current policies.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next review date: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.

DW42. Coronavirus (Covid-19) Management for Domiciliary Care