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Coronavirus (Covid-19) Management for Care Homes Policy

Policy Statement

This policy reflects latest government guidance 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:

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, staff, people receiving care and visitors always safe.

{{org_field_name}} will continue to apply effective infection prevention and control measures in the post Covid-19 period with reversion to more stringent measures in the event of an outbreak of Covid-19 or other infectious diseases in {{org_field_name}}.

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

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

Outbreak Management

Where there is any suspicion of a new Covid-19 outbreak (two or more people with disease symptoms) or where it has been 28 days or longer since the last case and there are new cases, {{org_field_name}} manager will carry out a risk assessment and contact the local health protection team (HPT). The HPT will provide advice on the outbreak control measures to be used to mitigate the risks to people receiving care and to arrange for any initial testing required.

The risk assessment should help to decide if the cases are likely to have been the result of transmission within {{org_field_name}}, and if cases are therefore linked. In determining whether they are linked, the risk assessment should consider the following.

• If there is a known source of infection.
• How much contact there might have been between people (increasing the risks of it spreading).
• If there was been contact between other people with suspected or confirmed Covid-19.
• If the first identified case originated in {{org_field_name}} or was imported.

{{org_field_name}} will not consider cases to be linked if:

• symptom onset has been more than 14 days apart
• people have had no contact with each other in the last 14 days.

{{org_field_name}} will also follow current government guidance to the effect that:

• during a suspected outbreak, there is no longer a need to test the whole home to identify Covid-19 cases
• linked asymptomatic cases are no longer defined as outbreaks
• if two or more linked people using services in {{org_field_name}} develop symptoms of a respiratory infection on within 14 days of each other, the first five people with symptoms should take a Covid-19 LFD test, whether or not they are eligible for Covid-19 treatments
• only people in {{org_field_name}} who are eligible for Covid-19 treatments should take an LFD test if they become symptomatic
• if an outbreak is identified, care homes should follow the guidance for management of single cases five days after the last positive or symptomatic case
• further LFD testing in an outbreak should only be done following an HPT risk assessment and on HPT advice in relation to specific concerns.

In the event of any confirmed outbreak {{org_field_name}} will take proportionate measures to control it, which will be based on best practice and HPT advice. {{org_field_name}} will keep the people living in the home, staff, visitors and others connected with the home and its people well informed of the decisions taken and the reasons.

{{org_field_name}} will lift its outbreak measures five days after the last suspected or conformed case but will continue to monitor the situation for a further five days. {{org_field_name}} will ensure that anyone who is very unwell or at risk of becoming unwell obtains the necessary medical advice and treatment.

In any outbreak, care staff with symptoms should immediately keep away from work and arrange any testing through self-referral or employer routes. Staff should co-operate with all instructions given by HPT personnel.

See also the policy on Infection Control and Cleanliness in Care Homes (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 living in the home 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 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.

{{org_field_name}} ensures that people receiving care are tested in line with current protocols prior to their admission or re-admission to {{org_field_name}}, including on discharge from hospital.

B. People Living in {{org_field_name}}

Vaccination policy

{{org_field_name}} will support the vaccination, including boosters, of all current and people considering using the service. It will work with local GPs and local NHS and other vaccine delivery teams where necessary.

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

{{org_field_name}} has a separate policy, Coronavirus (Covid-19) Vaccination of People Receiving Care and Staff in Care Homes Policy, which should be referred to.

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

{{org_field_name}} will:

• assess, with medical help, people living in the home to identify if they are at higher risk of severe outcomes of Covid-19 if infected and to check their eligibility for Covid-19 treatments if becoming unwell
• keep a record of people who have been alerted to their eligibility so that it can act quickly in the event of their showing symptoms of having a respiratory illness, including high temperature, sore throat, cough etc
• arrange for the person to be given an LFD test on becoming symptomatic using a test kit that the person might already have or one from the home’s supply
• arrange for the result to be reported following the instructions given
• link with the responsible Covid-19 Medicines Delivery Unit (CMDU) clinician in the event of the test being positive so that a decision about the correct treatment can be made
• recommend early treatment as the course of action in symptomatic cases; a NHS arranged PCR test might be requested.

For anyone living in {{org_field_name}} 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. Following government guidance, {{org_field_name}} will not require the symptomatic person to take a LFD test.

Staff should be aware that some people receiving care will need additional support, such as those with serious health conditions or with mental health issues, dementia or leaning difficulties, etc.

Where required, the home will seek medical help and additional advice from the local public health protection teams.

Admission procedures

{{org_field_name}} will follow all recommendations concerning admissions set out in Covid-19 Supplement to the Infection Prevention and Control: Resource for Adult Social Care.

Admission from the community or another care home

{{org_field_name}} understands that following current government guidance, anyone who it admits from the community or another care setting does not need to be tested before they are admitted into the home

Admission from hospital

{{org_field_name}} will expect that every individual who applies for admission after discharge from hospital will have had a negative LFD test result within 48 hours before being discharged.

{{org_field_name}} will expect to see the test results in advance, and that these have been shared with the individual and their key relatives or advocates.

{{org_field_name}} could still admit a person who has tested positive prior to their hospital discharge if it is satisfied that they can be cared for safely and other people receiving care are not put at risk.

The person will be asked to keep away from other people living in the home or engaged in communal activities until; it is assessed as safe for them to do so.

Care planning and referrals

{{org_field_name}} keeps people’s care plans under constant review to ensure that their needs are being met. It carries out full risk assessments in relation to any new referrals in order to ensure that the individual and their staff are kept safe from cross-infection of the coronavirus.

{{org_field_name}} identifies and records all clinically vulnerable individuals and put plans 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.

Safeguarding and protection

The home 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.

The home continues to exercise its duty of candour where it has made mistakes that have caused serious harm to people receiving care.

Mental capacity and deprivation of liberty

The home is aware of the implications of the difficulties faced by people receiving care who lack mental capacity to understand the decisions that are being taken or to act in line with them.

The home 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.)

Care home visiting

In line with {{org_field_name}}s’ Visiting In and Out of Care Homes Policy there are no restrictions on visiting unless there is an outbreak when some restrictions might be necessary.

Visitors are asked to follow usual infection control measures when visiting and any specific measures being taken in an outbreak

In an outbreak, the home will always allow people living there to have at least one named visitor who will be asked to follow the home’s current infection control procedures.

C. Staffing Issues

Staff health and stay at home procedures

{{org_field_name}} continues to encourage and support its staff to access vaccinations and boosters as the best way of keeping everyone safe from Covid-19 in line with the Government’s Green Book Immunisation Against Infectious Disease.

[See the Coronavirus (Covid-19) Vaccination of People Receiving Care and Staff in Care Homes Policy.]

Staff health and stay at home procedures

{{org_field_name}} will support 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}} has adjusted its procedures and practices in line with the latest guidance found in Covid-19 Supplement to the Infection Prevention and Control Resource for Adult Social Care.

{{org_field_name}} is adjusting 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. It notes that routine testing is no longer required. Any testing will be carried out at individuals’ discretion with test kits obtained privately.

To follow this guidance care home is putting the following measures in place.

1. If a staff member develops recognised Covid-19 symptoms:
2. – they should stay away from work for a minimum of five days from feeling unwell and symptom onset
3. – they should also stay away from work for five days if they have from their own initiative (or the service’s own policy) tested positive for Covid-19
4. – 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
5. – 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.
6. 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 two metres of anyone else
• carrying out domestic duties or other activities.

The home 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 and in the maintenance of the home.

{{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. The home displays posters showing the PPE requirements and how to put it on and take it off.

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 any other infectious illness in the community regardless and when there are outbreaks in the home.

{{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 and visitors do not routinely need to wear a face mask
• there are circumstances where we would ask staff and visitors 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 an outbreak as part of the home’s outbreak management policy
• 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 communal situations and gatherings 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 or visitors feel safer by wearing face masks or coverings in the presence of others.

{{org_field_name}} will use professional judgement to decide if staff or visitors 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, the home will consider the use 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, visiting, outbreaks, 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 keeping the premises well-ventilated in order to remove air that might contain virus particles, which increase the risk of viral spread. In keeping the premises well ventilated {{org_field_name}} will take fully the needs of the people receiving care into account and the health and safety of staff by carrying out risk assessments and putting control measures into place as required in order to balance the different needs.

Waste Management

{{org_field_name}} follows government guidance which recommends that:

• in a care home with nursing, waste generated from people with confirmed Covid-19 should enter the hazardous waste stream (usually an orange bag) if one is available.
• other care homes may have a hazardous waste stream and should use it if available
• waste visibly contaminated with respiratory secretions (sputum, mucus) from a person suspected or confirmed to have Covid-19 should be disposed of into foot-operated lidded bins which should be lined with a disposable waste bag
• if there is not access to a hazardous waste stream, this should be sealed in a bin liner before disposal into the usual waste stream.

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 the home 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 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 home’s response.
• It makes every effort to provide people receiving care 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, test, 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 socially distancing 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.

The management of the home will continue to link with local resilience forums relevant to health and social care provision.

Line managers and supervisors are 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 the home will be able to continue to provide care to people receiving care during any future infectious disease outbreak.

Information

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

The infection control lead for the organisation 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 coronavirus and the further lifting of restrictions.

Training

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

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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.

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