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Covid-19 Coronavirus Frequently Asked Questions

Please continue to check the news page for the latest information. Also see our new weekly FAQs page which cover recent issues raised. 

Access FAQs relating to Domiciliary Care, Supported Living and Independent Living Financial Support here.

 

Categories

Staff Shortages
Mutual Aid
Crisis Planning
Day Services
Direct Payments
Payments (General)
Domiciliary
Hospital Discharge
NHS
Medication
Collaborating with Essex
PPE
Responding to Infection
Communication with Clients
Self-Isolation
Staffing (Non-Specific)
Vulnerable Adults
Schools
Accessing the Community
Social Distancing
Communication with Essex
Changes to Packages
Admissions
Children
Financial Concerns (General)
Food and Supplies
Key Workers
Restricting access

Testing

 

Staff Shortages

If a provider is unable to meet contracted hours as a direct result of emergency Government Policy (i.e Self Isolation or school closure) can it still charge?

For domiciliary care, your invoice submission will need to include the actual contact time delivered and submit the missed or calls of a shorter duration as frustrated visits.  ECC will work with providers on how the cost incurred where care cannot be delivered can be underwritten. Guidance will follow.  

 

We have had local authority advice that if there is an issue with staffing due to COVID 19 approaching families to support individuals in the family homes.

Update 23.03.20: ECC operations and quality colleagues have developed a set of guidelines on how we can collectively prioritise the needs of individuals and deploy available capacity including when it is appropriate to draw on family and friends.  If you are experiencing problems with staffing which affect your ability to deliver commissioned hours then contact ProviderResilience@essex.gov.uk at this stage. Providers have been asked to risk assess their current service users and share with adult social care colleagues.

 

If this is not an option and there is concern of level of staffing being below safeguarding levels i.e. in a high level 1:1 will there be need for amendments to DoLS to accommodate this.  with local authority and CQC have understanding during extreme circumstances that not all community based needs are being met and that 1:1 support being shared?

ECC is working with CQC as the situation develops to ensure we can be as flexible as possible to keep people safe and well.  We have a good relationship with CQC have they have worked very pragmatically with us in the past on individual issues. Where such issues arise please contact Quality.improvement@essex.gov.uk as early as possible. We will also work with you on deprivation of liberty issues including securing legal advice where needed.  However following good practice under the current legislation and guidance on mental capacity, best interests decisions and deprivation of liberty will be the approach.  If there is emergency legislation that affects these areas we will  advise you and assist with interpretation.

 

Could we use family and friends to help with basic duties in the home, making teas/snacks, in kitchen, laundry and activities?

Update 23.03.20: ECC operations and quality colleagues have developed a set of guidelines on how we can collectively prioritise the needs of individuals and deploy available capacity including when it is appropriate to draw on family and friends.  If you are experiencing problems with staffing which affect your ability to deliver commissioned hours then contact ProviderResilience@essex.gov.uk at this stage. Providers have been asked to risk assess their current service users and share with adult social care colleagues

 

Is there anyone we can advise our staff to speak to should they have to take time of work to look after poorly children who are at risk of contracting the virus

Clearly there are going to be issues related to staff needing to care for children, particularly with schools closed or to look after more vulnerable children.  The individual should seek health advice through 111 about their specific circumstances. 

 

What plans can we put in place if high staff shortage due to school closures and self isolation?

ECC operations and placement team colleagues are working on a process to be put in place as the virus spreads and staff are affected by school closures and significant numbers of staff are affected - guidance will follow. 

 

Will there be flexibility in terms of staff compliance if (for example) we need to cancel planned refresher training sessions etc.

ECC Quality team will work with you to manage this.  Please get in touch with Quality.improvement@essex.gov.uk  if you have any issues as early as possible.

 

If government pays for 2 weeks of staff absence, who funds the rest? What do we do in instances of repeated 'self-isolation'?

We think the financial flexibilities we have provided allow you to pay staff who are off sick. This would also cover repeated absences. Returning to work following a period of initial sickness would be a new instance of Statutory Sick Pay (SSP).

 

If/when ECC support with resident (in residential) whose needs cannot be met due to absence, or crisis of resident, will this include non-ECC funded residents?

Currently this is not part of our package but we will review moving forward.

 

What support is there if we lose staff members due to they themselves being identified of being at high risk?

We've asked providers to look at mutual aid across the system. We're also looking at ways of bringing people into the system.

 

Mutual Aid

Do you have a contingency plan from other providers that can be shared?

Update 23.03.20: ECC operations team and placement team are working on a process to support 'mutual aid' between providers and across areas - which has been shared and is on the provider portal.

 

We can't afford to share staff if our contract values are decreased. Are they paid by host?

We think that the 25% flexibility either way enables these arrangements to be put in place. If there are problems with this then let us know.

 

If staff work from another company what rate would they be paid. Would it be the rate of where they work or where they came from.

We would suggest that this would be agreed between you and the company they have come from. 

 

Is there a list of providers which we can call on should we need some help as this fully depends on our staffing to meet care packages.

Please see the guidance on mutual aid found on the provider hub. The CQC list of social care organisations with contact numbers for local providers can be found here:

https://www.cqc.org.uk/about-us/transparency/using-cqc-data

Download the 'CQC Care Directory - with filters' file.

In column Q select 'Essex' and the local areas are in column X 

 

Are there any additional legal issues with taking on staff members from other companies without DBS and reference checks?

We are actively speaking with the DBS service around getting further guidance on this issue. Further information will be shared on the hub when we get it.

 

Is there going to be a Whatsapp group/web hub set up for shared care? Obviously we all need to work together and support each other over these coming times

This is a good suggestion and we will look into how we might be able to support this. An update will be provided via the hub.

 

Where there is need for people to work in care homes from other companies i.e. day centre, if there is pay difference would this need to be paid if so by who?       

We would expect you to make arrangements between the two organisations based on the financial flexibilities we have given.

 

Is there any guidance if entire engagement fall ill or has to isolate          

If this happens we would ask you to follow mutual aid processes initially and use your business continuity plan to cover this eventuality.

 

When is Essex going to share their contingency plan should there be large volumes of staff off? We need to be able to make plans before admin staff are off etc      

We have shared proposals around mutual aid and financial flexibilities. We are asking you to work with other providers within your area and with local social care teams.

 

Crisis Planning

There are approx 43000 over 85's in essex with worst case scenario of mortality at 20% is there planning for around 8-10,000 additional deaths?

There are civil contingency plans in place to support provision for excess deaths above normal seasonal levels.  If this starts to happen we will share further information.  Meanwhile you should follow normal procedures.

 

When can we expect to receive ECC comprehensive strategy doc for dealing with the expected wider outbreak of Coronavirus to support and guide care providers

Given the fast changing nature of the pandemic we will be sharing current Public Health national guidance.  This will be posted on the provider portal website and emailed to providers as we receive it.  We will work with you on any points of clarification or concern - please email ProviderReslience@essex.gov.uk with any questions so we can collate responses

 

How are providers going to be supported when there is going to be an increase in waiting times for paramedics?

Should you need to wait with an adult for an ambulance for an increased amount of time ie in excess of the permitted 2 hour limit, please complete the attached SVO form under the One off Additional Emergency Support section including the details of the specific circumstances. Please send the form to SPT.PackageChanges@essex.gov.uk for processing to ensure payment. SPT will process these as usual - subject to a budget holder exceptions agreement.

 

If residents go into crisis (which is probable with an LD individual who cannot access services) will there be support for this?

Normal processes will apply - please make sure you refer to the social work teams through adult social care connect.

 

What happens if my care team go down?

Please speak to other providers in your area using guidance on the hub regarding mutual aid. Business continuity plans should be followed.

 

If we cannot cope with some residents what can we do?  Can they be transferred?

Please speak to SPT in the first instance and they will direct you further.

 

What additional Crisis Action Plans are in place for service users in supported housing

We should be using the normal escalation routes considered on a person-by-person basis.

 

What happens if a MH tenant in Supported accommodation becomes psychotic or has a rapid deterioration in their mental health

Use the normal routes to refer to MH teams. Normal procedures apply.

 

Day Services

Will day centre closures be likely to happen?

Update 27.03.20: Please see statement on the provider hub

 

Day opportunities centres that are running with spare capacity to accept more SU how can this capacity be publicised to accept temporary places.

Update 27.03.20: Please see statement on the provider hub

 

Parents are worried that if Day Services close for a long period of time, they will lose the Service entirely?

A recovery process will be implemented which will enable providers to come through the other side of this process.

 

Are virtual classes/activities and telephone welfare checks an acceptable form of alternative day opps?

In principle yes, please consider any risks that may be present and contact the Council if you have any doubt regarding the viability of your proposed support or have concerns about a named individual (excluding any urgent medical issues which should be referred to the NHS), please contact the Service Placement Team via: Service.PlacementTeam@essex.gov.uk.

 

Please clarify what you mean by 'outreach' as an alternative service in your letter re day opps.  We don't have sufficient staff for visits.

Please be advised that outreach provision would include but not limited to the provision of outreach support. In relation to outreach support, this could be conducted in a variety of ways, including but not limited to, conducting welfare calls, using video calls or social media to engage with clients, delivering shopping to people in remote rural areas. Please note that this list is not exhaustive and providers are expected to make reasonable endeavours to ensure the continuation of support to vulnerable people during this period of exceptional circumstances. However, if you have any doubt regarding the viability of your proposed support or have concerns about a named individual (excluding any urgent medical issues which should be referred to the NHS), please contact the Service Placement Team via: Service.PlacementTeam@essex.gov.uk  

 

What arrangements will be put in place for Day Services that have now lost all income including Direct Payments?

Please note that there is a separate direct payments workstream which are considering the implications for this cohort of service users who can be contact via: DP.Covid19@essex.gov.uk   This e-mail box is regularly monitored by a team which specialises in direct payments enquiries and is currently compiling a list of FAQs which will include specific guidance for day opportunities placements which are funded via direct payments.

 

Will there be an online activity session being put into place, and if so how do we access these?

There are a wide range of online activities that people are posting, please browse the resources available depending on the needs of the individual.

 

What financial support will be available to day services that have lost Service User's direct payments due to service closure?              

/media/717132/day-opportunities-direct-payments.pdf

 

Will short breaks services still receive payment?             

If this is in relation to day services, in relation to invoicing, at this stage the Council is not treating this issue as a conventional suspension of service and the POs are being retained on Mosaic to facilitate payments. Therefore, please continue to raise invoices as normal until instructed otherwise.

 

Direct Payments

Please see comprehensive provider FAQs for Direct Payments here. You can also access the guidance provided for people who use Direct Payments  and their responsibilities as an 'employer' of care staff.

 

Payments (General)

Will funds be made available by ECC to pay for additional and appropriate action taken by providers to keep SU's and staff safe and free from Coronavirus.

Update 23.03.20: ECC recognises that we will all have to put in place additional measures to keep people safe and well.  We are working on what financial support will be available - guidance on home care has been issued and guidance on care homes and other services will be issued soon. Meanwhile please talk to us about any measures you are proposing as we need to pre-authorise any arrangements and they should be in line with current Public Health advice. 

 

Do we have to pay SSP for longer than 14 days if the carer is in isolation longer

The guidance on SSP can be found here - https://www.gov.uk/government/news/coronavirus-covid-19-guidance-for-employees-employers-and-businesses

 

Domiciliary

Is there any guidance for domiciliary care services as online advice is mainly care homes?

The current guidance for social care covers both care homes and home care. 

Home care Guidance

Supported Living Guidance

We will work with you on any points of clarification or concern - please email ProviderResilience@essex.gov.uk  with any questions so we can collate responses.

 

If one domiciliary carer tests positive, how do we react?

Update 23.03.20: Anyone with symptoms of covid-19 (high temperature or new continuous cough) must self-isolate for 14 days.  This includes domiciliary carers.  When this happens self-isolation is all that is needed.  No contract tracing or notification is required.

 

What guidelines do you offer if a client is diagnosed with the virus and providing care in domiciliary setting?

When a client gets covid-19 they must self-isolate if they are well enough not to need to be hospitalised.  There is updated guidance on the Personal Protective Equipment (PPE) for carers giving personal care to client with covid-19 https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance.  This recommends: 

The risk of transmission should be minimised through safe working procedures. Care workers should use personal protective equipment for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids.  Aprons, gloves and fluid repellent surgical masks should be used in these situations.  In particular cases, if there is a risk of splashing then eye protection will minimise risk.

 

Dom care question.  What do we do if a SU is asked to self-isolate?  Who will care for them - we cannot insist our staff place themselves at risk.

To put this is context it is expected that most people in the UK will be infected with covid-19 and so occupational risks are only a fraction of the risks care staff face.  That said it is important to protect care staff and the essential services they perform as much as practicable. 

When a client gets covid-19 they must self-isolate if they are well enough not to need to be hospitalised.  There is updated guidance on the Personal Protective Equipment (PPE) for carers giving personal care to client with covid-19 https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance.  This recommends: 

The risk of transmission should be minimised through safe working procedures. Care workers should use personal protective equipment for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids.  Aprons, gloves and fluid repellent surgical masks should be used in these situations.  In particular cases, if there is a risk of splashing then eye protection will minimise risk.

 

We are a Domiciliary spot provider, can we also charge the full duration of visits if 75% is completed as per the webinar?

The letter released 18 March applies fully to SPOT and LAH providers also.

 

Can a provider of Dom care take on a new staff with a DBS from previous care employment and SOVA 1st check completed but no new DBS?

New staff with a SOVA 1st check would still need to work under supervision until new DBS comes through. We have not seen any relaxation of DBS processes yet.

 

Should all clients visited be informed if a staff member self-isolates with symptoms?

Disclosing a staff members' conditions is not necessary - the guidance should be followed that we have already shared.

 

Should we inform other clients being visited if we are visiting someone that has symptoms?
This is not necessary.

 

Hospital Discharge

Should we be providing care to service users currently in hospital?

Update 23.03.20: The greatest risk of passing on infection comes when symptoms starts.  If a service user does not have symptoms (high temperature or new continuous cough) they are at low risk of passing on infection.  If they do have symptoms then there should be an assessment of risk before they are discharged.

 

Are providers currently allowed to refuse individuals back to the home having been release from hospital?

People leaving hospital should have been assessed as appropriate for discharge.  This will be more challenging as hospitals are asked to free up beds rapidly based on the letter from the Chief Executive of NHS England yesterday. We have sought PHE advice on taking people who are symptomatic or diagnosed with Covid-19 

 

Patient not symptomatic of COVID 19 and hospital discharged to Care Home who isolates new Residents for safety. Patient wanders and has dementia. What to do?

Please manage this as effectively as possible and we recognise this is a challenging situation. You may want to seek advice from the OP/MH team for potential distraction techniques.

 

Is there a possibility of enforced placement into homes?             

No. We would expect providers to work with partners on the risk of discharge into the home.

 

We have 3 residents with high temperture and 2 in hospital. Could you please ensure that anyone in hosp from care home are tested before sent back to us

Testing for COVID-19 positive patients does not tell you that somebody is incubating if they don't have symptoms. This would be ineffective. They may develop a temperature within two weeks of leaving hospital. If somebody comes out of hospital without any symptoms they should be treated as normal. If they develop symptoms then they should self-isolate as per the care home guidance. Please view the presentation for a more detailed explanation.

 

NHS

Will there be community support from NHS in the case of high level intensive support for individuals who have mild to severe learning disability who, if they need to be quarantined and this leading to escalation of behaviour, are going into crisis due to this? 

We will need to deal with any issues like this on a case by case basis and based on capacity available.  ECC is working closely with the NHS to try and resolve issues.  Contact  dol.forms@essex.gov.uk as early as possible if you need assistance.

 

Do the CCG have a local resilience forum?

Emergency planning/local resilience is organised on an Essex wide basis

 

Do the CCG have a Disaster Management Plan?

The CCGs have business continuity plans and are part of the Essex wide resilience forum

 

Medication

Shortage of pharmacies staff due to infection. What assistance can we expect to receive to ensure SU's receive their Medication in a prompt and orderly fashion.

Update: 24.03.20: Please see update regarding pharmacies: Pharmacy opening times update and medication support from community pharmacies

 

Will there be extended use of respiratory "rescue packs" ie oral steroids prophylactic antibiotics etc agreed with the STPs for service users with COPD asthma

ECC will clarify this with NHS colleagues and you will receive further guidance

 

What about service users that are immune-suppressed?

Contact with this individual should be minimised and we should support them to self-isolate as much as possible based on guidance.

 

If Residents who are at extreme risk of escalation and crisis who are not prescribed PRN to help manage will GP's be able to support this at a distance

Please consult GP/appropriate specialist team.

 

Individuals due to extreme limited community activity and access who are escalating to crisis. Will there be a need for an emergency PRN protocol for them

Please consult GP/appropriate specialist team.

 

Our pharmacist will not supply in blister pack now as they are short with staff. This means more time with medication. Any suggestions would be helpful

We are not aware that administering from original packaging is any more time-consuming than dispensing from blister packs. Speak to your pharmacist if there are any particular individual problems. Please speak to the CCG medicine team if this is causing serious problems.

 

Collaborating with Essex

Is there anything extra we can do to help ECC and the NHS through the coming weeks? As a H/C trainer I could offer hand hygiene/infection control workshops etc

Offers of help and support are very much appreciated.  We will look at how we can collate offers of help and any requests for help and share with you including how others might help you.

PPE

How long should you use PPE when caring for those exhibiting symptoms?

A person is potentially infectious for seven days provided normal temperature for 48 hours. After the seven days no personal protective equipment is needed against Covid-19.

Update 28/04/20

PPE for COVID-19 is currently recommended for all care homes during sustained COVID-19 transmission and to all direct care in domiciliary services.

 

What support will we receive from ECC to help with the shortage of masks and other PPE that will be necessary when the outbreak becomes more prevalent.

There are contingency plans in place that we set up as part of pandemic flu planning for the NHS to secure and distribute PPE as infection spreads.  ECC is working with the NHS on how this will happen in practice and guidance will follow.  Meanwhile please follow the current social care guidance and don't use PPE where it is not required to ensure continuing availability of supplies.

 

Update 28/04/20

PPE for COVID-19 is currently recommended for all care homes during sustained COVID-19 transmission and to all direct care in domiciliary services.

What will providers get in regards to appropriate PPE stock/training if they are required to support service users with coronavirus in their own home

We have been advised that guidance on access to PPE will be coming out imminently - this will come through the NHS.  Guidance may also change if we move to a stage where isolating vulnerable indviduals is recommended.  The ECC Quality team will assist in supporting advice and training.

 

Running very low on hand sanitiser, etc.

We are looking at this currently and will come back to you. 

 

Eye PPE - we cannot source disposable eye protection. Can we use goggles and instruct de-con/sanitisation after use. Keep them at SU address so one per house.

In general, providers shouldn't need eye protection in line with guidance. Please follow the social care PPE guidance and this would only be required when undertaking aerosol generating procedures. This would be an acceptable interim solution if aerosol generating procedures are being carried out.

 

Domiciliary agencies are asking for people to be discharged with appropriate PPE. Nursing homes asking for testing prior to admission. Where do we stand on this?              

We are able to support providers with emergency PPE needs - please see the guidance published on the latest news page.

Update 28/04/20

PPE for COVID-19 is currently recommended for all care homes during sustained COVID-19 transmission and to all direct care in domiciliary services.

 

What is the your guidance on use of PPE. Some homes are using it, some are not? What happens when we run out of masks, there are none?          

PPE should be used in line with central government guidance. If you have a symptomatic adult and you don't have the PPE needed, contact us and we can make the small amount of urgent supply we have available. 

Update 28/04/20

PPE for COVID-19 is currently recommended for all care homes during sustained COVID-19 transmission and to all direct care in domiciliary services.

 

Responding to Infection

What do we do if a client in a shared house or other accommodation is suspected/confirmed as having Covid19?

Update 23.03.20: A person with symptoms of covid-19 in shared accommodation must self-isolate as much is possible for 14 days.  Guidance on what self-isolation means can be found on the official website: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance.  This will be difficult to do in shared accommodation but scrupulous hand hygiene everyone in the accommodation and avoiding coughing on others will help. 

 

Can we refuse entrance to visitor's who present symptoms, such as cough, sniffles etc? but are not diagnosed with anything in particular?

The guidance as at 13.3.2020 is that individuals who have a cough or fever should self isolate and should not seek Covid-19 testing.  It is reasonable to remind people that they are entering an area where people are vulnerable and if they are feeling unwell even with minor symptoms they should not enter.  Any visitors should be asked to wash their hands on entry and exit or use hand sanitiser if washing facilities are not available.

 

Will there be any emergency measures in place to contain and quarantine if any client is infected?

No.  When a client gets covid-19 they must self-isolate if they are well enough not to need to be hospitalised.  There is updated guidance on the Personal Protective Equipment (PPE) for carers giving personal care to client with covid-19 https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance.  This recommends: 

The risk of transmission should be minimised through safe working procedures. Care workers should use personal protective equipment for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids.  Aprons, gloves and fluid repellent surgical masks should be used in these situations.  In particular cases, if there is a risk of splashing then eye protection will minimise risk.

 

What would be the procedure if a person we support has been confirmed to have Coronavirus?

When a client gets covid-19 they must self-isolate if they are well enough not to need to be hospitalised.  There is updated guidance on the Personal Protective Equipment (PPE) for carers giving personal care to client with covid-19 https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance.  This recommends: 

The risk of transmission should be minimised through safe working procedures. Care workers should use personal protective equipment for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids.  Aprons, gloves and fluid repellent surgical masks should be used in these situations.  In particular cases, if there is a risk of splashing then eye protection will minimise risk.

Update 28/04/20

PPE for COVID-19 is currently recommended for all care homes during sustained COVID-19 transmission and to all direct care in domiciliary services.

Should a Service User / Staff member / visitor be diagnosed with the virus what measures / guidelines will we have to follow to safeguard other users and staff?

Anyone with symptoms of covid-19 (high temperature or new continuous cough) must self-isolate for 7 days.

When a client gets covid-19 they must self-isolate if they are well enough not to need to be hospitalised.  There is updated guidance on the Personal Protective Equipment (PPE) for carers giving personal care to client with covid-19 https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance.  This recommends: 

The risk of transmission should be minimised through safe working procedures. Care workers should use personal protective equipment for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids.  Aprons, gloves and fluid repellent surgical masks should be used in these situations.  In particular cases, if there is a risk of splashing then eye protection will minimise risk.

Update 28/04/20

PPE for COVID-19 is currently recommended for all care homes during sustained COVID-19 transmission and to all direct care in domiciliary services.

If we have a resident that tests positive for Covid 19 what would the process be? 

When a client gets covid-19 they must self-isolate if they are well enough not to need to be hospitalised.  There is updated guidance on the Personal Protective Equipment (PPE) for carers giving personal care to client with covid-19 https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance.  This recommends: 

The risk of transmission should be minimised through safe working procedures. Care workers should use personal protective equipment for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids.  Aprons, gloves and fluid repellent surgical masks should be used in these situations.  In particular cases, if there is a risk of splashing then eye protection will minimise risk.

 

If a resident in the home comes down with fever or cough does this mean the whole residential home would need to isolate as per a normal household?

The care home would count as a household.  If there are different separate units and the home is able to segregate them then they have more flexibility; they would have to use typical barrier/cohorting procedures eg separate out residents, separate out staff as it won't work as well if staff still move between units, using personal protective equipment, good personal and environmental hygiene etc.  Or if they can separate floors on the unit and can apply same cohorting.  Of course, the definition of an outbreak for care homes is the two or more cases but we believe coronavirus guidance supersedes this with isolation if one suspected case.    They should apply the usual principles of outbreak management.   You should seek health protection team advice on new admissions.

 

What will be happening in regard to respite stays. Is it recommended to stop this in homes with full time residents?

Currently we would recommend that you would continue as normal and notify us if any problems arise.

 

What does sustained transmission of Covid 19 actually mean please which is referred to on Table 4, when do we move from Table 2 to Table 4

Sustained transmission does not have a precise definition, but it is when community transmission is common enough for all patients to be at reasonable risk of having the virus. Public Health England have said that we are currently experiencing sustained community transmission. It is not a question of moving from table 2 to table 4 but following the advice on table 4 in addition to that on table 2 as they cover different groups of patients / clients.


Carers who have had contact with a confirmed case at hospital.  If they have no symptoms currently and they carry on working - my question is, should they be wearing masks to protect those they visit and work with on double carer visits in case they become symptomatic?

The answer is 'no'.  An asymptomatic carer need take no additional precautions regardless of previous occupational exposure.

Update 28/04/20

PPE for COVID-19 is currently recommended for all care homes during sustained COVID-19 transmission and to all direct care in domiciliary services.

 

Communication with Clients

Do we need to issue guidance for what staff should be telling clients about Covid-19 and what questions they should be exploring? 

There are no messages currently that must be communicated but encouraging hand hygiene for clients and their visitors would be useful.

When a client gets covid-19 they must self-isolate if they are well enough not to need to be hospitalised.  There is updated guidance on the Personal Protective Equipment (PPE) for carers giving personal care to client with covid-19 https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance.  This recommends: 

The risk of transmission should be minimised through safe working procedures. Care workers should use personal protective equipment for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids.  Aprons, gloves and fluid repellent surgical masks should be used in these situations.  In particular cases, if there is a risk of splashing then eye protection will minimise risk.

 

We need to create as much flexibilty as possible - visit times will change. Can ECC communicate with service users to advise them of inevitable disruption to service

ECC is working on communication to service users and a 'script' for staff to advise people with concerns.  We will also be contacting informal carers and people on direct payments.  We will share these messages with you when they go out.

 

Are we considering writing to service users/their families with advice

We are currently not considering this but it will be kept under review. There is clear guidance on the governmnet website https://www.gov.uk/coronavirus. We have written to all people in receipt of a direct payment.

 

In the case of residents going hospital who need 1:1 support. Where hospital does not allow others in, what can be done to ensure support for resident beyond hospital passports?

If you let the hospital know this then they would potentially be able to arrange someone to support. The most appropriate person with the knowledge of the individual's needs would need to discuss the risk with the hospital. This would have to be considered on a case-by-case basis depending on the needs of the individual.

 

Self-Isolation

 

Where a care worker has had contact with a confirmed case of Covid-19, whether in a residential setting or in someone's home, does that care worker need to self-isolate if they have no symptoms? 

No. The guidance states only those with symptoms or household members of those who have symptoms need to self-isolate.  The guidance is at: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection

If a member of staff is concerned they have COVID-19 they should follow the NHS guidance.

If they are advised to self-isolate at home they should follow the PHE guidance.

If advised to self-isolate at home, they should not visit or care for individuals until safe to do so.

If however someone provides 24h live-in care then they are defined as household and should have been self isolating including not working anywhere else; they should self isolate for the 14 days as per the guidance.

 

Do you have any thoughts on how we might best be able to support homeless people living in shared accommodation re self-isolation?

This is a challenging setting.  There is guidance on self-isolation on the government websites: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance.  It practices this will be difficult to instigate in shared accommodation.  Scrupulous hand hygiene and avoiding coughing on others will help. 

 

What is the situation regarding potential increased DOLS issues if we need to isolate individuals without capacity, or limit daily activities in the community?

The risk of transmission should be minimised through safe working procedures. Care workers should use personal protective equipment for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids.  Aprons, gloves and fluid repellent surgical masks should be used in these situations.  In particular cases, if there is a risk of splashing then eye protection will minimise risk.

 

Is a welfare check to service users who are self-isolated equivalent to a care visit

No. It isn't equivalent and will be coming back to you based on the RAG rated information with further advice

 

What can providers do in instances where adults are not self-isolating/social distancing and family visit and then care staff are being put at risk by visiting?

Please refer to the government guidance - https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults#what-is-the-advice-for-visitors-including-those-who-are-providing-care-for-you 

 

(scenario) If a resident breaches lockdown and visits a family member who is known to be ill, what do we do?

We would expect you to explain the circumstances to the individual if they have capacity, however they are able to make their own decisions around their actions. They may encounter the police if they go out. Take the same approach as you would in ordinary cases of managing risk to residents, explaining to them the potential consequences of their actions. They would only need to self-isolate in the facility if they are showing symptoms

 

What do we do if someone has the virus and they are 'walk with purpose' (referred to as 'wandering').               

Please see advice here - https://www.bgs.org.uk/resources/covid-19-managing-the-covid-19-pandemic-in-care-homes this gives some suggestions for walking with purpose. Consider how this would be managed with a respiratory infection outside of current circumstances. Usual procedures should be used to manage outbreaks.Please clean the touchpoints regularly throughout the day. 

 

If a client decides to self isolate who do you notify that you are not going in to provide care

Please notify SPT in the normal way as you would for any other frustrated call.

 

Staffing (Non-Specific)

Do Care staff who have been abroad on holiday need to be screened by their GP if not symptomatic

Update 23.03.20: Foreign travel is no longer of any significance.  Care staff without symptoms get straight back to work no matter where they have returned from.  Only those with symptoms (high temperature or new, continuous cough) need to self-isolate for 14 days.   

 

What advice do you have on staff wishing to travel abroad at this time?

Anyone wishing to travel should follow Foreign and Commonwealth Office advice 

 

There are staff who will not work with the right attitude and will expect more and then will be vindictive and call CQC helpline.  We had one and CQC closed it

We are working with the CQC, if you're having problems with the CQC then please let us know and we will deal with it.

 

What happens when we have care workers who are pregnant or over 70 but wish to remain working?

We would strongly recommend that national PHE guidance is followed. We will seek a view on the risk and provide an update. You may want to lookThe guidance is not mandatory (at least not yet) but what is deemed best practice or precautionary approach.  The aim with regard to vulnerable people is about their own risk of harm rather than any risk to others https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults

The guidance for infection control for healthcare staff is below and may provide a guide for care homes

A risk assessment is required for health and social care staff at high risk of complications from COVID-19, including pregnant staff. Employers should:

"Discuss with employees who are at risk or are pregnant the need to be deployed away from areas used for the care of those who have, or are clinically suspected of having, COVID-19; or, in the primary care setting, from clinics set up to manage people with COVID-19 symptoms.

Ensure that advice is available to all healthcare staff, including specific advice to those at risk from complications.

Bank, agency and locum staff should follow the same deployment advice as permanent staff."

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/872745/Infection_prevention_and_control_guidance_for_pandemic_coronavirus.pdf. You may want to look at your position around indemnities and insurance levels of cover in this circumstance. If you have any access to Occupational Health advice then please seek it.

 

Is the council going to support any staff who have to attend work on public transport/considering moving out of the family home to avoid the need to self-isolate

This is not something that we would routinely consider - if there are particular issues with providers that cannot be accommodated within the financial flexibility we have given, let us know and we can consider circumstances on an individual basis.

 

Is ECC going to give an enhanced rate to community care provider/staff? They are on the front line

We think this could be accommodated within the financial flexibilities we have given. We are lobbying nationally for this currently.

 

Our staff are upset people are paid 80% to sit at home often on more than care staff. They're front line. Is there extra support / danger money we will lose carers

We understand this is an issue and we are lobbying central government currently.

 

What can we do if there are staff who can work, but wish not to work due to their concern of catching COVID19.

This should be dealt with under your usual HR internal policies/procedures.

 

Will community care staff be recognized after this and paid accordingly? Most are as qualified as an HCA

We continue to value the role of staff working within the community and we hope this is something that gets considered.

 

Vulnerable Adults

In regards to resident who are NOT under DoLS and wish to access community what is the advice for this?

Please refer to current social distancing guidelines

 

Indoor activities. Shops that could have provided items for indoor activity are closed. Is there anywhere were providers can access sensory or other items

We will provide a further update on this if we are able to source any further information.

 

Schools

One of the school has told my staff that they will not support the children remaining at school, said partner must not work. Financially they cant afford that

The government has confirmed that care workers are considered key workers. https://www.gov.uk/government/publications/coronavirus-covid-19-maintaining-educational-provision/guidance-for-schools-colleges-and-local-authorities-on-maintaining-educational-provision

 

Accessing the Community

Should we be limiting community activities? Families are asking us to cease activities in the community.

Please refer to current social distancing guidelines

 

What do you suggest with our LD service users who access the community daily?

Please refer to current social distancing guidelines

 

Some providers not allowing residents out - is this deprivation of liberty or is this advice now?

Please refer to current social distancing guidelines. Providers should be talking to the DOLS team before taking action to get appropriate advice.  

 

Social Distancing

In regards to social distancing, there are local group that people meet away from providers, such as social groups to maintain health and wellbeing

ECC is looking at how we can work with community groups and voluntary sector organisations to support people who may be self isolating or to provide assistance if we have capacity issues with care staff.

 

Can adults return home to their families and then go back to their care home again? We are seeing these requests.

This would not be advised in line with social distancing guidelines.

 

How can adults with 2:1 still access community without breaching social distancing?

Please explain this if challenged based on circumstances. In broad terms social distancing guidelines should be followed wherever possible.

 

Residents with high LD and even ADS who will not accept having to stay in and are going into crisis due to this is there any support with this?

We are currently in contact with supported living providers to understand the scale of this problem and working with specialist teams to seek advice.

 

The response to my question about isolating wandering Residents was appropriate to normal circumstances NOT during once in a century Pandemic.

The British Geriatric Society has produced care home guidance onlineConsider cleaning your touchpoints in this situation (door handles, grab rails). Managing as you would in an 'influenza outbreak' - you have to manage as best as you can.

 

This would be an ideal time for Essex cc to offer some kind of online care worker basic training, now we are social distancing will this happen please?

We're working on a proposal for this

 

Training 2 Care are now offering webinar training courses for care staff info@training2care.co.uk or call 01376 573999.

Thank you, we will share this information

 

If a resident needs to attend a shop to buy items. Part of established routine (ASD) for wellbeing, e.g.a magazine, chocolate bar etc. would this be explainable     

The national guidance on social isolation recommends minimizing the number of excursions. Essential shopping only. The care plan may need to be modified in line with the guidance.

 

If a resident with capacity is deciding to breach the rules set out by central government and goes out, as a care provider where do we stand if they have FULL capacity?              

We would expect you to explain the circumstances to the individual if they have capacity, however they are able to make their own decisions around their actions. They may encounter the police if they go out. Take the same approach as you would in ordinary cases of managing risk to residents, explaining to them the potential consequences of their actions.

 

What should we do if a family member/s arrive at the home and demand to enter the building to see their loved ones.    

Risk assess the situation with humanity and compassion in line with social distancing guidance.

 

Communication with Essex

Where you have providers with multiple locations and services, it would be good to only have dedicated people having the links 

We will aim to have one set of guidance/conversation with you and a single point of contact within ECC. Intially this is via ProviderReslience@essex.gov.uk

 

It would be helpful if ECC were a little more realistic and provided reasons with requests for info, we are operating with 20% of staff in isolation/sickness

We are asking for information to help us keep track of demand and capacity in the system. We are trying to limit our information requests and we recognise this is beyond our normal ask. We understand the circumstances you are facing.

        

Changes to Packages

If community based activity stops will commissioners understand this for the purpose of costing for packages, and understand this impact on review with lack of community support

ECC will work with providers on how the costs incurred where care cannot be delivered could be underwritten - guidance will follow

 

Admissions

Is there any recommendation for new admission and transition admission into residential settings?

We are advised to follow usual procedures for influenza like illnesses. Two or more cases in a home in under 72 hours then please seek advice from the home protection team who will monitor and advise.  

 

Do ECC currently have any guidelines for providers in relation to new admissions and whether or not they should be taking on new adults?

Care homes should remain open to new admissions as much as possible throughout the pandemic.   Public Health England will be updating its advice on whether and when care homes should remain open on a regular basis.  If you have any specific concerns discuss with the local health protection team.

Care homes should be prepared for the possibility that at times during the pandemic this might involve receiving residents back from hospital who are COVID positive in order to isolate them in the care home. They should do what they can to support this, in order to ensure that the whole health and social care system has capacity to care for the sickest people, following official guidance. Patients can be discharged before resolution of symptoms provided they are deemed clinically fit for discharge and should be advised to self-isolate as per staying at home guidance.

Care homes should follow the advice from Public Health England when accepting residents without COVID back when there are confirmed COVID cases within a home. Care homes should have in place standard operating procedures for individual residents with suspected and confirmed COVID-19 infection, including appropriate infection control precautions to protect staff and residents.

 

Care homes saying they will refuse further admissions if they have resident(s) already in their care who are infected with Covid19.

If there is an outbreak and the care home has been asked to close by the HPT then the acute trust and care home manager can liaise with the duty CRC consultant to risk assess individual admissions. 

 

Care homes saying that they will not accept any new residents unless they have been swabbed and negative for COVID 19. 

Care homes should remain open to new admissions as much as possible throughout the pandemic. Patients being discharged from hospital into a care home or other setting do not require a negative swab for COVID-19 and will not routinely be swabbed on discharge.  If the patient is asymptomatic it is not an issue. If the patient has an influenza like illness a risk assessment will be required. Depending on when their symptoms started, they may need to be isolated in their room until the full 7 days from onset of symptoms is up. Appropriate PPE should be provided for staff if this is the case.

Public Health England will be updating its advice on whether and when care homes should remain open on a regular basis. Care homes should be prepared for the possibility that this could at times during the pandemic involve receiving residents back from hospital who are COVID positive in order to isolate them in the care home. They should do what they can to support this, in order to ensure that the whole health and social care system has capacity to care for the sickest people, following official guidance.

Children

Are there currently any differences in published guidance on the hub and the guidance that is being advised for children?

The current PHE advice if for social care which would also cover children but if you have specific question contact the Childrens inbox CFProviderResilience@essex.gov.uk

 

Financial Concerns (General)

Will ECC support enhanced rate to staff who work? And fund the provider or at least contribute to hourly rate increase?

We have already announced the financial support which will be given to home care. We are considering other sectors and will keep the situation under review.

 

Is ECC going to pay an enhanced rate to those working in the community?

We have shared information about our financial flexibilities as they currently stand - /media/714085/covid-19-letter-to-providers-18-march-2020.pdf

 

25% flex - We presume you are applying the same methodology around the total number of organisational commissioned hours that are via Direct Payments?        

Yes this is correct.

 

Govt is making available £1.6BN to LAs to help with CV-19. Has ECC considered how it will use this to support providers who may be incurring additional costs?           

The financial flexibilities we are giving are part of that.

 

Several care packages have fallen under 75% provision due to unable to access community. Does 75% apply on an individual package basis or across all provision?              

This would be applied across all provision.

 

We will require extra funding not just for supplies but staff.  When will we get uplift of fees for exising residents? Larger Care homes paying more & we stuggle   

Please see uplift announcements for 2020/21 - /working-with-us/rate-uplifts/

 

Who do we notify about service delivery falling under 75% and queries about invoicing in relation to this?         

Please email providerresilience@essex.gov.uk

 

Will Care homes be funded for additional 1:1 hours being provided due to closure of day centres?

We think this should be accommodated within the financial flexibilities we have laid out.

 

Costs have increased in the following ways: rise in overtime/agency costs, SSP from day 1 absence, increase in PPE and essential items. Will ECC support costs?      

We have given you a range of financial flexibilities which we think should cover the described. You need to let us know if there's further problems.

Food and Supplies

Is there support for food provisions due to current state of supermarkets.

Brakes are prioritising our care homes and you can find contact details on the hub news page

T: 0344 800 4900
M: 07483 952385
E: joseph.murgia@brake.co.uk

 

Will there be assistance with food shopping

For care homes, there is information for access to a food supplier (Brakes) on the provider hub. For home care, these people could be part of 'operation shield' - further information can be found here.

 

What support is being given for supermarket shopping. Brakes are expensive, wholesalers we don't need large volumes... we need our normal deliveries back?              

In these instances please speak to the supermarket branch manager and raise your concerns as necessary. There has been success with this approach. Supplies are now back on the shelf more consistently due to new policies introduced by supermarkets. We have also issued a letter which can be printed off and taken as evidence alongside the ID badge to support discussions. 

 

What's the plan for the residents who are sheilding and deemed high risk with the supermarkets? Any news from the government about how to sign them up with shops?

Residents will be contacted over the next week via a text from their GP. If you have concerns about an individual, you can refer them to Essex Welfare Service. Details are on their website.

 

Key Workers

Do we have any indication of when the definition of key worker will be released and can we assume that social care workers will be included?

This has been published and care workers are included- https://www.gov.uk/government/publications/coronavirus-covid-19-maintaining-educational-provision/guidance-for-schools-colleges-and-local-authorities-on-maintaining-educational-provision

 

For key line workers who have young children under school age. Is there any known provision for this?

We will check with our early years colleagues and provide an update on the hub.

 

Is there an indication to when carers/key workers can be tested.

Self-referral through the national government portal is now available.

 

Southend borough Council has issues us letter for us to hand out to staff for keyline proof. will Essex be doings this for providers in essex? 

Providers should issue their staff with their own ID. If this is proving problematic, let us know. We are not planning on doing this routinely.

 

Restricting Access

It is currently a highly contentious issue as to whether providers can/should be restricting visits to homes

Providers will want to take a balanced view on supported the recommendations on social isolation for people at the highest risk from Covid-19 and people's right to a family life.  The emergency legislation may change the balance and we are reviewing.  The legal advice we have had is that restricting access is reasonable in the current circumstances but that it should be for a defined period and reviewed.

 

Can homes restrict access for social workers intending to carry out safeguarding reviews

Adult Social Care is currently advising staff that only the highest priority visits should be undertaken to minimise contact with people at high risk from  Covid-19.  Safeguarding visits are the highest priority and we would not expect providers to refuse.  The only reason you would refuse such a visit would be if the person was symptomatic.  If you have any concerns you should speak to the Safeguarding team

 

What is happening in regards to DoLS and MCA assessments. I have had a DoLS assessment take place via telephone. but not sure this is correct for comprehension         

We will provide an update on this directly. We are trying to minimise the number of face-to-face visits, but we will look into this particular example.

 

With care homes in lock down how are you offering a chiropodist service to your residents especially those who are diabetic?

If anyone has any ideas please share on this. You could also seek guidance from community health services.

 

Our interpretation of the guidance on lockdown/self-isolation is chiropodists are classified as health professionals and should be allowed in the home with PPE    

This depends on the need of the individual. If the resident cannot walk because of toenail problems then a visit would be necessary. A routine visit should stop and specific circumstantial need should apply.

 

Will social work teams being making unaccounted visits? I ask as there is concern with cross contamination and media attention that Social workers not having PPE       

Adult social care teams will not be making unannounced visits; contact will always be made in advance and visits will only be made for serious safeguarding enquiries.

 

Testing

What are you doing re pushing for frontline testing for care staff?          

Self-referral through the national government portal is now available.

 

Furloughing

We have received various advise re Furloughing Shielding Care Staff. Please could you give an update on the situation based on current understanding?

Please see update from 1 May - How the sector is expected to interpret guidance on the Coronavirus Job Retention Scheme

 

Last updated: 6 May 2020

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