Introduction and rationale

Delphside Ltd takes seriously the responsibility placed on it to provide a safe, well managed environment in which the residents it cares for live, staff work and others are allowed to visit in.

COVID-19 has provided unique and at times difficult to manage problems surrounding risk and changing risk control measures which have led to frustrations, these being especially evident with the suspension of visiting to the service.

To allow the lifting of the suspension on visiting, the following procedure is to be applied to all in order that COVID-19 transmission risks are minimised, whilst limited controlled visiting is allowed to proceed.

The arrangements are based on the guidance and directives provided to the service by the Government, the Director of Public Health for England, local Infection Control; further that guidance and direction incumbent upon us from the local commissioning council Knowsley MBC, which if not complied with would leave the service open to Safeguarding or CQC scrutiny.

Measures to be applied to allow Social Distanced visiting for relatives, friends and others

Prior to visit and visiting recommencing

The service has completed a risk assessment for visiting and has highlighted measures in addition to those provided in local and national guidance, those combined measures which MUST be applied, are noted here;

  • All staff, residents and visiting persons will be advised of the measures noted here for the safe visiting arrangements. In addition the service’s visiting policy is updated regularly with changes and visitors may request a copy should they wish.
  • The service and the manager reserve the right at any time to terminate any visit whereby social distancing and measures here are not complied with, further may suspend further visits by that individual to the home.
  • Should there be any symptomatic residents, visitors or staff, then visiting will be immediately suspended following national guidance. NWBH Infection Prevention and Control team will be contacted they will provide advice and ensure testing of the resident or person suspected. The service will remain closed in the interim and only open again to visiting when directed as safe to do so by NWBH IPC.
  • Staff will initially contact relatives and visitors and discuss the arrangements as noted here to allow those visiting to raise any issues about the procedures. This is to minimise and address any risk posed by visitors not wishing to or being unable to comply with the procedures and will determine an updated risk assessment and may mean visiting cannot proceed.
  • All regular visitors/relatives will have provided to them a copy of the Covid-19 screening form and will be aware of the forms contents, which note they do not attempt to attend if they answer yes to any of the screening questions.
  • Staff will ask visitors to go through this before their visit to ensure they do not contravene anything on the assessment which would mean they would not be allowed to visit.
  • Copies of the procedure and form will be made available on the homes website, sent electronically or by post to visitors prior to visiting recommencing.
  • The service will ask that whenever possible in light on the ongoing pandemic, that visiting in person is the last alternative of contact to minimise contact time and limit the risk of transmission of the virus. The service will continue to facilitate alternatives to visiting, such as through window visiting, virtual visiting and telephone contact. Those family members who have the means may wish to support their loved one by means of a pay as you go telephone, so direct telephone access is available to them at all times and equally does not tie up phone lines for other users and emergency needs.
  • Ensure that visitors are aware that when visiting a resident at the service that a member of staff will support the visit throughout to ensure social distancing is complied with and the visiting time and measures are managed to minimise risk. This may feel a little intrusive for some visitors, but staff need only explain it is for the visitors, their loved ones and everybody else’s safety.

Preparation for Individual Visits

The following is either directly taken for KMBC advice or amended from it following risk assessment at the service to meet the service needs re safety;

  • Even where direct visits are permitted, alternatives should still be facilitated and encouraged for example telephones and videos, window visiting to maximise safe contacts and minimise face to face contact, staff will explore this over the telephone prior to finalising any appointment time.
  • There will be a staff member available to oversee all visits and to ensure social distancing; hand hygiene and environmental measures are in place prior to, during and after each visit. By agreeing to attend the service for visiting, then it will be accepted by the visitor that this is the case.
  • Residents relatives and visitors will and have already been informed previously in most cases that, there will only be one consistent visitor for each resident wherever possible. This is to reduce the number of potential contacts in the home. This means the same family member visiting each time to limit the number of different individuals coming into contact with vulnerable residents and in order to limit the overall number of visitors to the service, therefore reducing risk of transmission and exposure for all.
  • It is understood the previous point may prove difficult for some in relation to work commitments, child care etc. therefore based on risks to each individual the service will determine with visitors, if absolutely necessary the following; a maximum number of one visitor for those residents who are being shielded and a maximum number of two visitors from the same household only, for those who are clinically vulnerable. If it is necessary that it is two named individuals from the same household, then the services manager will prepare a separate risk assessment and agree visiting based on that assessment. There will only however be permitted one visitor allowed to visit at any one time.
  • Guidelines note that Children under the age of 12 years should be discouraged from visiting due to the difficulties in maintaining social distancing, however at Avondale we will not be allowing visits by anybody under the age of 18 years old due to the fact that anybody under that age would require an additional adult to also be in attendance and would not therefore meet the requirements for visiting.
  • Family members will be advised that they need to call and book a visit prior to attending the home to ensure that there is adequate space available to accommodate the visit. Ad hoc visits will not be allowed. At Avondale visiting will be for 15 minutes per week until future review takes place. This is to allow access to visiting slots to be fairly allocated, time before and after visits for the environment to be suitably cleaned/made ready for others to use and for the allocation of staff to support the visit. Residents requiring End of Life care (EOL) will have separate pre agreed arrangements in place prior to visiting taking place.
  • Currently visiting will be during the week only to ensure that risk management measures in place are suitably adhered to and managed. Specified times will be made know to visitors via a covering letter when this procedure is sent out.
  • Visitors will not be allowed to have contact with other residents and minimal contact with staff members (less than 15 minutes at 2 metre distance in relation to staff). If an in-depth conversation is required this should be done by telephone prior to or following the visit, when staff will be happy to discuss any matters with visitors if confidentiality and consent allows the discussion to take place.
  • Visitors should be reminded and provided with facilities to wash their hands for 20 seconds or use hand sanitiser on entering and leaving the care home and to catch coughs and sneezes in tissues and clean their hands and dispose of tissues correctly.
  • Visitors should wear face coverings, preferably a mask during the visit, and should wash hands before and after putting it on and taking it off. Visitors should whenever possible utilise their own face covering/mask, masks will not be routinely provided and a face covering/mask will be necessary for the visit. There may be some instances when a visitor will need to wear PPE (beyond a face mask) appropriate to the need of their visit (for example compassionate visits/end of life) in these circumstances then the service will provide and manage that additional PPE.
  • We would ask that visitors be encouraged to walk to Avondale or use their own transport and not use public transport to limit contact times and limit potential of transmission of the virus prior to your visit.
  • Information for what visitors are to expect during the visit (see section below) is to be provided as here, for example adhering to social distancing, not to hug relative, there will be no refreshments, protocol for bringing gifts etc. any violation of the protocol will result in the visit being terminated.
  • Ensure the visitor has read the screening form on the day of the visit prior to attending the home and does not answer yes to any of the questions, if they do they call the home to discuss to ensure that they are ok to visit. Home will need to regularly check which foreign countries are under quarantine rules and any travel by a visitor needs to be made known to the service prior to visit so a check on if the visit can go ahead is made via https://www.gov.uk/guidance/coronavirus-covid-19-travel-corridors
  • The service is currently looking to put in place more formal/fixed provisions so visiting can take place outdoors rather than indoors using in the grounds, which can be accessed without anyone going through the shared building. Once up and running, visitors will be informed and allowed use of this area to support visiting.
  • If it is determined that visiting can be undertaken indoors the service will need to consider as part of the mitigating actions in the risk assessment when and where visits will take place. Currently the only area for visiting in person will be in a communal area which will be managed in relation to bookings for visiting and cleaning or in the garden area to the front of the property with social distancing in place. Visitors should not meet in cars, in numbers above that noted or in their own homes as this would necessitate the resident returning from visiting, returning to 14 days of self-isolation following that visit due to the risks posed to other highly vulnerable individuals at the service.

During the Visit

To allow the visiting to take place staff and visitors need follow and comply with the following so that the service can attempt to prevent transmission.

Staff and visitors

  • Check the screening form, if visitor does not bring it with them they must complete it on arrival. (Appendix 1). An ongoing assessment must be made by staff on the visitor’s ability to remain 2M from the resident and others, if that is not possible or staff observe this not to be the case then the staff member should intervene and request the visitor or resident comply with the measures and if they do not seek to end the visit with support from senior staff. The matter should be raised as on an incident form and the matter followed up formally by the manager The forms are to be kept readily available in reception areas of each home. Completed forms are to be retained for information. A new form is required to be completed for each visit.
  • Staff need to be aware of what the form asks as they will need to ask these questions whenever possible over the telephone prior to visits being booked, then confirm that said with the form on day of visit.

The risk assessment asks;

  • If the visitor or any member of their immediate family members have symptoms or have had a positive test within the past 14 days
  • If the visitor has been identified as a CONTACT of a positive case and must self-isolate for 14 days .
  • If the visitor has been in contact with any person experiencing flu like symptoms in the past 14 days.
  • If the visitor has been out of the country within the last 14 days. You will need to identify which countries are exempt.
  • If the visitor has experienced any symptoms they think could be COVID related.
  • If the visitor answers YES to any of these questions, the senior person on duty needs to explain that the visit should NOT go ahead for the well-being of the residents, staff and visitor.
  • Visitors are to consent to having their temperature taken and staff need determine based on DOH guidance, if visiting can take place; if the visitor has a temperature of 37.8°C or greater then entry will be denied and visiting rearranged.
  • A safe 2M distance will need to be maintained at all times.
  • Refreshments will not be offered to visitors and visitors should not share food or drink they bring with them with their relative, any violation of this will result in the visit being terminated.
  • If visitors bring toiletries or a gift for their relative this should be something that is easy to clean – these should be left in a plastic bag for staff to collect and disinfect before taking to the residents room. If visitors bring food this should be sealed and unopened.
  • Visitors will not be able to use the toilet facilities within the home and should be mindful that if they ask then staff will have no option but to decline the request.
  • Any and all breaches to this guidance by a visitor will be documented and addressed formally as part of risk management and safeguarding.

KMBC Guidance notes attached APPENDIX 2

Off site visits

As noted earlier and in relation to residents visiting loved ones off site, please note and be aware of the following.

If a resident, who has capacity, requests to go off site to visit family, this should be discussed with the manager, the resident and their family prior to that being agreed to and avoided if at all possible at this time.

Should that visit go ahead or is suspected to have taken place then the resident will need to understand that they will be required to self-isolate for 14 days after the offsite visit, in order to protect the safety and wellbeing of other residents and staff in the home. This extends to visiting in private vehicles on the car park or in the grounds when social distancing cannot be maintained.

As KMBC note, the recent Government guidance allows for “bubbles”, but this is more complex for people who share their home with others because of the potential vulnerability of other residents, therefore the service will always air on the side of caution to protect those in its care and employment, as well as the wider community.
Residents will be updated with all changes and conditions as here as and when they arise.

Review

Regular review of all that noted here will take place and staff, residents and visitors will be updated with any subsequent changes.


Dear Sir / Madam Appendix 1

To prevent the spread of Covid-19 in our home and reduce the risk of exposure, we request that you complete a risk assessment. We thank you for your support in our endeavour to maintain as much as possible, the safety and well-being of our residents and colleagues

 

Visitor information

Name:

Relationship to resident:

Contact number:

Contact Number (Mobile)

Name of resident being visited:

Date and time of visit

Declaration by visitor (all questions mandatory)

Have you been in close proximity within the last 14 days with any person who has tested positive for COVID 19?

YES

NO

Have you been in close proximity to any person experiencing flu like symptoms within the last 14 days?

YES

NO

Have you tested Positive for COVID 19 within the last 7 days or have you experienced flu like symptoms with the last 14 days?

YES

NO

Have you been told to stay at home and self-isolate by the Test and Trace team?

YES

NO

Are you experiencing any of the symptoms relating to COVID 19?

a. new continuous cough and/or

b. high temperature and/or

c. loss of, or change to, sense of smell or taste

YES

NO

Are you experiencing any other symptoms which may or may not be related to COVID 19?

For example, are you unwell in any way with diarrhoea, vomiting, rash or other new symptoms in the last 48 hour’s

YES

NO

If you have answered yes to any of the above questions, visiting would not be appropriate as you are putting the person you are visiting and others at risk. If you have had a recent negative test for COVID-19, please let the staff member know

Have you been told to stay at home, self-isolate or shield for health reasons

YES

NO

Have you visited a foreign country with the last 14 days?

YES

NO

If YES please do not set off to visit the home, please contact the home manager who will discuss with you if it is permissible for to visit.

Protocols to be maintained throughout the visit

We ask that you sign and declare that you agree to abide by the following protocols throughout the duration of the visit

  • I agree to maintain social distancing rules of 2m and not to have any physical contact with the person that I am visiting
  • I agree to not directly or indirectly give to the person I am visiting any items I have brought in with me
  • I agree to only visit for a fifteen minute period and will not vacate the area where the visit is to take place without permission being gained from a staff member
  • I understand that the visit is at the full discretion of the home manager and any violation of the protocols will result in the visit being terminated

Print Name

Date

Signed:

 

This Guidance has been written for visitors of Knowsley Councils’ care homes. It is based on national guidance. It outlines the safety measures that we are putting in place to ensure that all residents and their visitors can continue to meet each other is a meaningful and safe way.

 

It outlines

• Measures to facilitate social distance visits

• What we ask of visitors to support us

• What you can expect from us before and during your visit

Socially Distanced Visiting for Relatives, Friends and Others

People who are shielding and residing in long-term care facilities remain vulnerable and strict precautions need to continue. You may be aware that allowing visitors into care homes is subject to a number of things, for example the care homes risk assessment, whether there are any residents who are symptomatic and we need to take into account the presence of Covid-19 outbreaks in the community. For these reasons visiting practices are subject to change, sometimes at very short notice.

To support us to ensure all visits can be facilitated safely, all visits must be pre-booked. Ad-hoc visiting will not be allowed. Visits will be time limited and can be weekly. On arrival you will be asked to complete a risk assessment, by completing a short form. You may also be asked for permission to check your temperature prior to the visit.

In line with national guidance there should be a single consistent visitor for each resident, wherever possible, to reduce the number of potential contacts in the home. This means the same family member visiting each time to limit the number of different individuals coming into contact with your loved one.

Visitors should have no contact with other residents and minimal contact with staff members (less than 15 minutes at 2 metre distance). If an in-depth conversation is required you are asked to do this by telephone please.

To help keep our residents safe we ask:

• That on arrival you will wash your hands for 20 seconds or use hand sanitiser on entering and leaving the care home and to catch coughs and sneezes in tissues and clean their hands and dispose of tissues.

• That you wear face coverings during the visit, and wash your hands before and after putting it on and taking it off. (There may be some instances when a visitor will need to wear additional PPE). Wearing a face covering may make communication difficult so it is important to speak loudly and clearly, keeping eye contact with your loved one. Do not wear a hat or anything else that may conceal your face and it may help if you wear your hair in a way that a resident would be more likely to recognise

• Whenever possible please walk to the care home or use your own transport and avoid using public transport

• Adhere at all times to 2 metres social distancing and not to have contact with your loved one (no hugging/touching)

• If visitors bring toiletries or a gift for their relative this should be something that is easy to clean – these should be left in a plastic bag for staff to collect and disinfect before taking to the residents room

Unfortunately we will not be able to offer refreshments to visitors and ask that you do not share any food or drink that you bring in with you, with your loved one. The toilet facilities will also be unavailable for visitors.

If you are unable to physically visit your relative but would like to explore other options for example window visiting, drive by visiting or the use of technology please contact the care home to discuss.

We will be happy to discuss any other suggestions with you and support your needs

Government guidance remains in place:

We ask that you do not visit if:

• You have you been told to stay at home, self-isolate or shield for health reasons

• You or any of your immediate family members have symptoms or have had a positive test within the past 14 days

• You have been identified as a CONTACT of a positive case and must self-isolate for 14 days

• You have been in contact with any person experiencing flu like symptoms in the past 14 days

• If you have been out of the country within the last 14 days

• Have experienced any symptoms you think could be COVID-19 related in the past 14 days

We can all help control the virus if we all stay alert. This means you must:

• Stay at home as much as possible

• Work from home if you can

• Limit contact with other people

• Keep your distance if you go out (2 metres apart where possible)

• Wash your hands / sanitise regularly

• Do not leave home if you or anyone in your household has symptoms

Please talk to the Home manager or a member of their team if you require clarity in relation to any of this guidance.