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COVID-19 additional guidance for residential care providers

Our adult social care, Derby City Council and Derby and Derbyshire Clinical Commissioning Group (Health) are required to maintain a view on the care home and home care market to support hospital discharge.
Derby City Council NHS Derby and Derbyshire Clinical Commissioning Group

We require regular updates, as the situation is ever changing and your response to it is likely to be. Providing us with accurate information as soon as you are able will allow us to manage this situation to the best of our ability and effectively identify where there is the most critical need.

We're aware that these are times of unprecedented uncertainty. We're actively engaging with central government contacts to try to obtain the most practical guidance to allow us to support you, and access the resources that you need as well as trying to co-ordinate local crisis management initiatives for the challenges that lie ahead.

Two documents providing a good practice guide for care homes during the COVID-19 pandemic are attached to this page.

COVID-19 testing for care homes

All care home staff and residents are now eligible for testing with priority for those in homes that look after the over-65s. The government has announced that all care home staff and residents are now eligible for testing with priority for those in homes that look after over-65s.

Get coronavirus tests for a care home. Read the latest care home testing guidance from government.

It's critical that all adult care homes in England conduct weekly testing of all staff and test residents every 28 days.

Even with the recent delays in test results, it is really important that staff are tested weekly. Testing staff less often than weekly means that the infection could go undetected for longer and spread to many more people within the care home. For example testing staff fortnightly could mean there is an additional week of spreading the infection within a care home before the infection is detected.

Testing staff weekly is therefore essential in order to identify the infection quickly and take action to limit the spread, and is of increasing importance given the rise in prevalence in the community.

The only exceptions to weekly testing of staff are:

  • in the case of a new outbreak in a care home your local health protection team will conduct rapid outbreak testing whereby the whole home will be tested, with follow up tests after 4 to 7 days for all those who had a negative test result
  • where staff and residents have tested positively previously, completed their isolation period - those individuals should not rejoin the regular asymptomatic testing for 90 days - if they develop new COVID-19 symptoms in this time, they should isolate and be tested again as this could be a new infection - see the COVID-19: management of staff and exposed patients or residents in health and social care settings

Regular testing and the importance of this is detailed within the Adult Social Care Winter Plan.

Webinars are available, lasting 90 minutes and give detailed information about all aspects of care home testing, including:

  • ordering tests
  • preparing for testing
  • test kit delivery
  • a test kit demonstration
  • testing certain care groups
  • registering test kits
  • booking your collection
  • results and what they mean for your home

The session will include live questions and answers with representatives from the national care home testing team, who will be able to answer your questions and address any concerns in the session.

Sign up to attend our new care home testing webinars.

Care Home Support Service

The Care Home Support Service is part of Derbyshire Community Health Services NHS Trust and are available to help providers with advice, signposting and education. Like you, we are passionate about the care your residents receive and are here to work alongside the care home to up skill and empower your staff to deliver even greater standards of care.

Please don't hesitate to contact us using our dedicated phone line tel: 01773 546385 if you feel we can help or if you wish to share examples of good practice with us.

Welcoming visitors back to care homes

Please see further council guidance, issue on 19 November 2020 attached to this page.

Care Provider Alliance (CPA) have guidance to consider when re-opening care homes to visitors. The CPA is the collective, national voice of adult social care providers in England.

Read the latest government guidance on the arrangements for allowing visitors back to care homes.

Visits out of care homes

It's recognised that opportunities for care home residents to make visits out of the home are important. However, it's imperative that care homes, residents, family and friends take steps to manage and mitigate any potential risks that may be associated with this. Get further guidance about visits out of care homes.

National roll-out of lateral flow tests to care homes

The Department of Health and Social Care is commencing the national roll-out of lateral flow tests (LFT) to care homes.

Derbyshire is one the areas who are receiving the lateral flow tests from the Department of Health and Social Care. They are to be used twice weekly in addition to the current PCR regular retesting in care homes. You can view the latest care home COVID-19 testing guidance for staff and residents at Care England.

How does LFT work?

LFT is a new technology which enable rapid display of COVID-19 test results within 20 to 30 minutes and do not require a lab to process. The LFT tests can be self-administered via nasal and throat swabs similar to the current PCR tests.

The Department of Health and Social Care will be providing care homes with access to online training to prepare for the testing, as well as materials to prepare your home and visitors. In the coming weeks, care home providers will be sent an email confirming the delivery of their LFT kits, in addition to instructions on how to undertake the testing and further details on preparing the care home and visitors for this process.

LFT test training

To prepare staff to use LFT for testing, NHS Test and Trace have created an online training portal. The training videos last about 15 minutes followed by a competency assessment. It is critical that each care home manager identify staff members that need access to the training portal. Providers will receive an email in due course that will include a link and a token that will provide you with access to the online training portal. The email will be sent from testertraining@dhsc.gov.uk. Testing staff can complete this training before or after the webinar, but it's critical that care homes do not begin testing until all relevant staff have completed the assessment.

To ensure providers have enough PPE for scheduled visitors to care homes, the Department of Health and Social Care we will be sending out a one-off push of PPE to every CQC-registered care home provider. If already registered on the PPE portal, you do not need to take any action in order to receive this PPE. If you are not registered on the PPE portal, you must register before 2 December 2020 (you do not have to place an order). Without registering on the portal, you will not receive this one-off push of PPE to support visitors.

Providers can register on the PPE portal. If you have any issues with this, please contact the PPE portal customer support service tel: 0800 876 6802.

LFT webinars

It is advised that all testing staff attend one webinar to prepare for LFT testing.

The webinar lasts 60 minutes and provides detailed information about the testing process, following a similar format to webinars that have been previously run for care homes. The session will also include live questions and answers with representatives from the national care home testing team, who will be able to answer your questions and address any concerns in the session.

Please follow government guidance for the safe disposal of used LFD tests.

NHS requirements

Register on the capacity tracker for hospital discharge services

The following providers are required to register immediately on the care home capacity tracker to keep updated for the period of the COVID-19 outbreak:

  • care homes
  • hospices
  • in-patient community rehabilitation
  • end of life care

Data being collected will include:

  • number of beds
  • number of bed vacancies
  • current status
    • open or closed to admissions (care homes only), including the number of COVID-19 residents
    • workforce and staffing levels (care homes only)

A user guide for the capacity tracker is attached to this page.

Sign up for NHS mail

As part of the hospital discharge requirements all providers are required to sign up for NHS mail. This has been supported by the COVID-19 hospital discharge service requirements. This includes:

  • social care
  • care homes
  • hospices
  • domiciliary care agencies

Admissions and deaths in a residential setting

The government has published coronavirus guidance on the admission and care of people in care homesand managing delirium in confirmed and suspected cases.

If a resident dies of suspected coronavirus (COVID-19) in a residential care setting:

  • ensure that all residents maintain a distance of at least 2 metres (3 steps) or are in another room from the deceased person
  • avoid all non-essential staff contact with the deceased person to minimise risk of exposure
  • if a member of staff does need to provide care for the deceased person, this should be kept to a minimum and correct personal protective equipment (PPE) is used
  • you should follow the usual processes for dealing with a death in your setting, ensuring that infection prevention and control measures are implemented

Read the guidance for care of the deceased with suspected or confirmed coronavirus (COVID-19).

Remote training and support sessions for care home staff

The COVID pandemic has affected many people in different ways. Care homes in particular may be struggling with the effects of the virus which can put a strain on staff.

The following sessions have been organised by Diana Gibson, community end of life care facilitator at Ashgate Hospice, to try to provide care home staff with support and relevant education during the COVID-19 pandemic.

These sessions are for all staff in care homes who may be struggling with how the virus has affected them, their workplace or their families. The support team at Ashgate Hospice will provide a safe space for you to air your feelings and thoughts about how this situation has affected you.

These sessions will last about 40 minutes in total.

Infection Protection Society (IPS) training package for care homes

A set of training slides has been prepared in conjunction with the IPS Care Home SIG for COVID-19 infection prevention and control for nursing and residential care homes. The training package is listed on the IPS COVID-19 advice and guidance.

Immunisation training for nurses

Due to current COVID-19 restrictions, there are now temporary measures in place for immunisation training. This is to ensure that staff can maintain competencies and meet immunisation training and PGD requirements during these unprecedented times. We are expecting further guidance from the national immunisation team, but in the meantime, please see the attached guidance for practitioners. This should be followed until such a time that immunisation training sessions can recommence or further guidance is circulated.

If you have any questions regarding training, please email england.scrimms@nhs.net

Confirming death

During COVID-19 the normal processes for verifying death may be unable to take place. For example, it's unlikely that a GP will come out to verify a death. This training package has been developed to provide care staff with the underpinning knowledge and skills to be able to verify an expected death. It is suitable for registered nurses and senior carers.

For future training dates, please contact Diana Gibson, email diana.gibson@ashgatehospicecare.org.uk who will be happy to help.

After registering for an event, the training resources will be sent to you directly along with an invitation to the Microsoft Teams meeting. You will be expected to have gone through the training package (presentation and audio) before the session. On the day of the session the trainer will be available to go through the slides and answer any questions.

This is free training for registered nurses that meet NMC requirements and has been extended to senior carers working in residential homes and domiciliary care.

The training has been approved for use during the COVID-19 pandemic.

For further information please contact Community End of Life Care Facilitators, Diana Gibson, email diana.gibson@ashgatehospicecare.org.uk.

Role of the mortuary and funeral directors after death

This 90-minute informal workshop will look at the roles of mortuary staff and funeral directors following a death.

The main aims and objectives of this session are to provide care home staff with a safe environment to ask questions and to dispel some myths around these 2 areas.

For further information visit the Eventbrite website or contact Diana Gibson, email diana.gibson@ashgatehospicecare.org.uk

Health professional input

A document developed by the National Falls Prevention Coordination group which details how to manage a fall during the pandemic is attached to this page.

Accessing end-of-life support - dedicated advice line

The care home advice line is a designated line that is hosted by Derbyshire Health United (DHU) has a nurse with end of life care expertise from 8am to 8pm 7 days a week, for advice and support relating to end of life care. Tel: 111, 9,*6,*6.

For care home staff to get to a clinician directly the staff need to tel: 111, press 9 to continue then immediately *6, then wait for the message, there may be a short pause, then immediately press *6 again.

If the query is made between 8pm and 8am then the number can still be used and you will get a quick call back by a clinician on the out of hours service.

A guide to end-of-life visiting in care homes during the pandemic is attached to this page.

Care Home COVID Support Service

Derbyshire Community Health Services is offering support from a multi-disciplinary team providing support to maintain the health and function of residents during the challenges faced as a result of the pandemic.

The team consists of nursing, physiotherapy, occupational therapy, podiatry, speech and language therapy, continence, tissue viability and pharmacy advice.

This service is available on Monday to Friday from 9am to 4pm. Tel: 01773 546835 or email: dchst.carehomecovid19@nhs.net

PPE procurement advice

Read more about the supply arrangements for personal protective equipment in the private, voluntary and independent sector.

Prescribed medication supply

Obtaining medication when demand is high or you've run out of your 6 week stock

Please liaise directly with the registered GP of the client concerned, who will advise accordingly on a case by case basis.

Using paracetamol prescribed for specific individuals (packaged and in blister packs) due to be returned as homely for other residents as remedy stock if risk assessed and signed in

The use as requested has not been authorised by regional pharmacy leads due to legalities and governance. However, this may change in the coming weeks so the advice is to safely quarantine medicines in case guidance is changed.

Accessing urgent end of life medications to keep people at home and prevent hospital admission

In the first instance your business continuity plan should clearly identify how the home should continue to be staffed at a safe and appropriate level for the residents you have. As per your business continuity plan if you are short of nursing cover you must ensure agency nurses are engaged. In extreme circumstances where you have been unable to get this support the CCG are currently working with a group to identify how they may support you with 'virtual' nursing support and advice.

Contact is currently underway with nursing homes in Derbyshire to identify the types of nursing tasks and support that are being delivered within each home so that a 'task and appropriate actions' sheet can be drafted and circulated. In addition we will be asking you if we are able to create a virtual platform that can support with clinical queries in the event that you have no nursing cover what would be the most appropriate. We will keep you updated on this work.

Staffing

No nurse cover available due to staff having to self-isolate

In the first instance your business continuity plan (BCP) should clearly identify how the home should continue to be supported. This should be in accordance with regulatory requirement.

If you are short of nursing cover, in line with your BCP, you should consider whether your nursing staff are able to cover additional shifts and, or whether you should cover this with agency nurses.

For extreme circumstances, where you have been unable to get this support, the Clinical Commissioning Group are currently working with a group to identify how they may support you with telephone contact and or 'virtual' nursing support and advice. We will provide further advice as soon as it becomes available.

Suppliers and maintenance workers

Dealing with suppliers and maintenance workers will not enter the premises, but their input is necessary

Only essential works where failure to undertake these places a high risk to residents and staff are to be undertaken, and only following a thorough risk assessment that considers how stringent infection control measures can be implemented to help reduce the risk of spread of infection.

For delivery of supplies, providers should only be in receipt of essential and necessary supplies, and measures put in place to minimise social contact. Thorough infection, prevention and control practices undertaken at all times.