Legal update: New COVID-19 guidance for adult social care settings and services from 4 April

The government has published new guidance from the Department of Health and Social Care (DHSC) for providers of adult social care settings and services in England. This guidance sets out some updated infection prevention and control (IPC) principles specific to COVID-19 to accompany the latest resource for wider IPC measures in adult social care (set out here).

This guidance, called the ‘COVID-19 supplement to the infection prevention and control resource for adult social care’, came into force on 4 April and aims to help providers reduce the spread of COVID-19 in their settings.

Our HR & Employment Law and Health & Safety experts have summarised the key points you need to be aware of below.

Vaccination

You’re advised to encourage and support staff to be vaccinated against COVID-19 and flu. You’re also advised to carry out risk assessments:

“To ensure the safety of people who receive care, providers should undertake risk assessments wherever possible. These should take into account the COVID-19 vaccination status of both staff members and the people they care for. Relevant clinical advice should be considered, including whether any individuals are at higher risk of severe COVID-19 infection. As a result of these risk assessments, providers may consider taking additional steps such as prioritising the deployment of vaccinated staff to care for those who are at higher risk of severe COVID-19 infection, where proportionate.”

 

Testing

This is covered in new UK Health Security Agency (UKHSA) guidance for COVID-19 testing in the sector (please scroll down for more on this).

Staff who develop symptoms

The guidance sets out what should happen when a member of staff develops COVID-19 symptoms. The symptoms in this part of the guidance are described as the traditional three main COVID-19 symptoms, namely:

• a new continuous cough
• a high temperature
• a loss of, or change in, your normal sense of taste or smell (anosmia)

However, the separate Testing guidance includes more symptoms in line with the latest NHS guidance, which is much broader and includes symptoms like shortness of breath and loss of appetite – again, we’ve included the full list below in the “Testing guidance” section.

The infection control guidance says that if a member of staff has any of the three key symptoms, they’re advised to stay at home, take a lateral flow device (LFD) test and take another one 48 hours later.

Staff who test positive

The guidance says they should follow the general advice about staying at home and avoiding contact with others from the day they test positive or develop symptoms. However, there’s some extra advice for social care staff – specifically, that those with COVID-19 should not attend work until:

• they’ve had two consecutive negative lateral flow test results (taken at least 24 hours apart)
• they feel well
• they don’t have a high temperature.

The first LFD test should only be taken from five days after the day their symptoms started, or the day their test was taken if they didn’t have symptoms.

If both test results are negative, they can return to work immediately after the second negative test if their symptoms have gone, or if their only symptoms are cough or anosmia (which can last for weeks).

The guidance says that where the individual cares for people at higher risk of becoming seriously unwell with COVID-19, the situation should be assessed carefully. You should consider only returning them to that role until 10 days after their symptoms started (or the day their test was taken if they did not have symptoms).

After that:

• If their LFD result remains positive on the 10th day, they should continue to take daily lateral flow tests and can return to work after a single negative LFD result.
• If they’re still testing positive on the 14th day, they can stop testing and return to work on day 15.
• However, if they work with people who are especially vulnerable to COVID-19, a risk assessment should be undertaken, and consideration given to redeployment.

The guidance says that managers can undertake a risk assessment of staff who test positive between 10 and 14 days if they don’t have a high temperature or feel unwell, with a view to them returning to work (depending on the work environment).

Staff with symptoms with a negative or inconclusive test result

They can return to work when they receive two negative results 48 hours apart as long as they are medically fit to return. However, the guidance says this should be subject to discussion with their line manager and a local risk assessment.

If the tests are inconclusive, they should take another one. Staff with symptoms should not return while waiting for the result of this test.

Close contacts of confirmed cases

Staff who are close contacts of confirmed cases can continue to work and continue with the usual testing regime. If they work with people who are especially vulnerable to COVID-19, you should carry out a risk assessment and consider redeploying them during the 10 days following their last contact with the positive case.

CQC policy is that inspectors are only allowed to visit care homes or other settings if they’ve been tested as per this policy. Following the setting’s testing policy is a requirement of the risk assessment they carry out before a visit to a care home or care setting.

Testing guidance

Although universal availability of free COVID-19 tests came to an end on 1 April, free testing continues to be available in health and social care settings and for people who are at risk of becoming seriously ill with COVID because of their immune system.

New UKHSA guidance has been issued for testing in social care, which can be found here. We’ve set out the key points from this below.

The guidance replaces all previous guidance for testing in adult social care and applies to:

• care homes
• homecare organisations
• extra care and supported living services
• adult day care centres
• personal assistants
• shared lives carers
• social workers

Availability of free tests

Free tests are available to:

1. Care homes and homecare organisations if they’re regulated by the CQC.
2. High-risk extra care and supported living settings. These are defined as extra care and supported living settings that meet one of the following criteria:

• the setting is a closed community with substantial facilities shared between multiple people
• it’s a setting where the majority of residents (more than 50%) receive the kind of personal care that is CQC-regulated (rather than help with cooking, cleaning and shopping)

3. Adult day care centres if they’re run by paid care staff and the services are provided within non-residential care settings that support the health and wellbeing of adults. This includes:

• purpose-built day centres
• day centres attached to or part of a care home or supported living setting
• other buildings in communities specifically used for regular adult day care

4. Personal assistants if they’re directly employed by an individual (or self-employed) to provide care and support to an adult to enable them to live as independently as possible. This care could include support in the home, or to go out into the community.
5. Shared Lives carers if they’re working with a regulated Shared Lives scheme to provide care and support to an adult to enable them to live as independently as possible (regardless of whether they live with the person they support or live separately).
6. Social workers if they work with adults requiring support for their health, wellbeing and social care needs and are regulated by Social Work England.

Testing staff and residents with symptoms

This testing requirement applies to all members of staff or volunteers who are regularly in the setting including cleaners, catering and support staff. It doesn’t include staff who don’t enter the settings (such as head office staff).

If an individual experiences any of the main symptoms of COVID-19, they should immediately take an LFD test and then repeat this 48 hours after the first test. Staff with symptoms should not come into work and should take the test at home.

They’ll be able to return to work if both LFD tests are negative and they feel well enough to work. If the setting is the service user’s home, it will include those who provide their care and support.

The guidance links to NHS guidance for further information on the symptoms of COVID – which is very broad and includes:

• a high temperature or shivering (chills) – a high temperature means you feel hot to touch on your chest or back (you don’t need to measure your temperature)
• a new, continuous cough – this means coughing a lot for more than an hour, or three or more coughing episodes in 24 hours
• a loss or change to your sense of smell or taste
• shortness of breath
• feeling tired or exhausted
• an aching body
• a headache
• a sore throat
• a blocked or runny nose
• loss of appetite
• diarrhoea
• feeling sick or being sick

Testing where there are no symptoms

The guidance says staff should take two LFD tests per week (before they come to work), spaced three to four days apart. There are additional requirements for care homes taking part in the Vivaldi study.

Positive tests

If an individual tests positive (staff or service user), all staff should conduct daily rapid LFD testing every day that they are working, for five days. This only applies to staff working in the setting during the five-day ‘rapid response’ period. The guidance says you shouldn’t bring people into work to get tested on their non-working days.

Negative tests

If the member of staff has a negative test result and has no symptoms, they can continue working. If they had symptoms, they’ll be able to return to work “if they are no longer unwell and they do not have a high temperature”.

Outbreaks in care homes

An outbreak is defined as when two or more positive (or clinically suspected) linked cases of COVID-19 occur in the same setting within a 14-day period. This applies to both staff and residents, and regardless of whether it was a PCR or LFD test.

If you suspect this has happened, you should contact the appropriate body. You may then be advised to carry out whole home outbreak testing. In these situations, all staff and residents should take both an LFD test and a PCR test on day one of the outbreak and another LFD test and PCR test between days four and seven. The guidance also sets out follow-up ‘outbreak recovery’ testing requirements.

Personal protective equipment (PPE)

The guidance advises that appropriate PPE should be worn by care workers and visitors to residential care settings, subject to a risk assessment of likely hazards such as the risk of exposure to blood and body fluids. This includes gloves, aprons, eye protection, and face masks.

For full guidance on the type of PPE that is recommended in certain circumstances, see here.

The aim is to reduce the transmission of respiratory illnesses (including during aerosol-generating procedures) and to protect from blood and bodily fluids.

The guidance also stresses that used PPE should be put on, taken off, and disposed of appropriately at all times.

See more

We know this a lot to take in. The government has published a useful summary of the changes to social care guidance here, which sets out the previous guidance and how it’s changed in this latest update.