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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 and Clinical Commissioning Group logos

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 are 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

Following publication of the DHSC/PHE letter (Further information on COVID-19 testing in social care) on 27 April 2020 Derby and Derbyshire CCG as part of Joined Up Care Derbyshire are developing a process for extending the provision of COVID-19 testing to care homes.

The current process follows and further information will be provided as national guidance is updated.

When a care home recognises it has its first potential symptomatic case or cases of COVID-19, they should contact the local PHE health protection team (HPT) tel: 0344 225 4524 option 1.

PHE health protection team (HPT) will contact DHU Healthcare who will arrange for testing of symptomatic patients.

Care home staff who are symptomatic or who are absent from work because a family member living in the same household is symptomatic (and within 4 days of first onset of symptoms) can be referred for COVID-19 testing. The care home manager can refer these staff by emailing ddccg.covid19keyhcwtesting@nhs.net detailing staff member name and telephone number. The individual will then be contacted by the health care workforce testing team and an appointment will be arranged for the next day. The individual will need to be able to drive – this is a drive through testing facility.

Care home staff who are displaying no signs of COVID-19 and who wish to be tested should apply for a coronavirus test.

Care home staff who are displaying symptoms of COVID-19 and cannot drive should be guided to apply for a coronavirus test.

If you have any questions or would like to ask about a topic please contact Sally Watkin, email sally.watkin@nhs.net

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.

Welcoming visitors back to care homes

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.

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.

Training presentations

The Royal National Orthopaedic Hospital has presentations relating to infection prevention and controlincluding hand washing, PPE, donning and doffing and swabbing. Printable resources are also attached to this page.

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.

The following courses are available to book:

After you have registered on 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, Jill Davies, email jill.davies@ashgatehospicecare.org.uk or 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.

District nurses are unable to support individuals assessed as residential as they normally would in the home

There have been cases of district nursing teams advising care home providers that they are unable to undertake routine visits. In cases concerning nursing homes, current guidance issued by Care Quality Commission (CQC) advises that the care and treatment undertaken by district nursing teams can be completed by registered nurses employed by the home, as they are already registered for TDDI activity.

The homes that are not registered for TDDI activity will need to change their registration. This will be considered as a priority. CQC have advised us that they will be making judgements which keep the system moving, and strongly advise the provider to telephone them to discuss their situation.

Contact the CQC

email: enquiries@cqc.org.uk
tel: 03000 616161
Fax: 03000 616171

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) which is manned by 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 ring 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 will be offering support from a multidisciplinary team providing support to maintain the health and function of residents during the challenges faced as a result of the pandemic.

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

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

Personal protective equipment (PPE)

Care home and hospices should follow the most recent PPE flowchart sent directly to you by the CCG. This flowchart provides you with a list of PPE suppliers to contact in the first instance if stocks cannot be obtained from your usual provider.

If you cannot obtain supplies from any of these sources and you only have stock for 3 days or less, please let us know by emailing ppesupplies@derbyshire.gov.uk The PPE flowchart is attached to this page.

This email is monitored Monday to Sunday from 9am to 5pm. Your email will be logged and someone will be in contact with you, so you should ensure you provide your contact number or an email address that will be monitored.

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.