Conducting risk assessment to deliver safe adult day care
Individual assessments of welfare and support needs
As part of the conversations between providers, people who access services and their carers and families, and the prioritisation of face-to-face and group activities, an individual assessment of needs for care and support will need to be conducted for those who would normally access the service where their needs are likely to have changed. This is to enable providers and commissioners to both understand people’s needs and how they may be met, and to prioritise those whose need for face-to-face services is greatest.
Areas to consider:
- Safeguarding concerns raised
- The sustainability of current paid or unpaid care arrangements
- The extent to which current care arrangements meet their needs
- Wellbeing of carers
- Support needs, including changes in mental, physical or cognitive wellbeing
- Ongoing access to food and medication
- What alternative services they received whilst the day service has been closed – what support has been effective
- The person and their family/carer’s current view on returning to the day centre/service if they start planning to reopen
- Any relatively simple to make adjustments that could be made to provision to better support someone’s needs and wellbeing
Individual risk assessments for COVID-19 for face-to-face services
Staff and volunteers Open
All staff and volunteers should be risk assessed using a two-stage process:
- Identification of those who are potentially at higher risk of contracting COVID-19 or poorer outcomes from being ill.
- Assessing the risks associated with those individuals and identifying actions to minimise the risks.
The first stage could be undertaken with individual conversations or a form or survey. A conversation should then be had with those identified as being at higher risk including those who are clinically vulnerable.
Risk factors include: Age, ethnicity, sex, some underlying health conditions, pregnancy.
Staff and volunteers who have not been vaccinated or fully vaccinated are at higher risk of catching and spreading COVID-19, as well as at risk of poorer health outcomes if they catch it.
Care has to be taken when asking for personal health information and this should only be asked for when it’s required to support the worker. The level of detail provided should be no more than is necessary and reasonable.
More information on risk assessing staff and volunteers and options for those who may be at greater risk can be found as part of the COVID-19: adult social care risk reduction framework. Staff from black, Asian and minority ethnic (BAME) backgrounds may have increased concerns about COVID-19, and employers / organisations should handle these conversations sensitively.
A health declaration form may help with this process. Ofsted’s 'social care health self-declaration form’ could be adapted for this use.
Day centres are staffed by a wide range of people and some may be more vulnerable to infection, for example, because they have an underlying health condition. Staff whose health makes them clinically extremely vulnerable are recommended to follow the guidance on protecting people who are clinically extremely vulnerable persons from COVID-19.
Those using face-to-face services Open
Identifying those who are at higher risk of COVID-19 in terms of:
- People who may not be able to follow guidelines that help protect them and others from the spread of COVID-19. For example, not being able to keep their distance from other people, wear a mask, issues with staff or volunteers wearing a mask when working with them, difficulties with regular hand washing.
- People who have not been vaccinated or fully vaccinated are at higher risk of catching and spreading COVID-19, as well as at risk of poorer health outcomes if they catch it.
- People who would be at risk of a poorer outcome if they were to become infected. There is a great deal of overlap between higher risk groups and those groups that use day care services. In addition, the same consideration as for staff should be included: Age, ethnicity, sex, some underlying health conditions, pregnancy.
- Regular coughing, sneezing and other risks regarding bodily fluids may apply to some individuals.
- People that require support with aerosol generating procedures (AGP) should be carefully risk assessed and specific AGP guidance should be followed. This could include the use of portable ventilators.
- Risks around anxiety, stress and behavioural changes as a result of the changes to social interactions and routines as a result of COVID-19. For example, distress in relation to PPE, changed routines and physical distancing.
- People whose health makes them clinically extremely vulnerable are recommended to follow the guidance on protecting people who are clinically extremely vulnerable from COVID-19.
Risk assessment of COVID-19 for the provider or group
The provider, each service and/or each group will require a risk assessment which includes contingency planning. It is at this level that overall numbers attending services, staffing, and how the service would respond to an occurrence of infection, localised lockdown or other COVID-related events should be set out.
People attending face-to-face services and their carers and families should be made aware of the key contents of this risk assessment so they understand under which circumstances face-to-face support may have to be withdrawn or reduced.
Day Services for Adults – things to consider when doing a Risk Assessment for re-opening – Worcestershire example
Example of the type of form that could be used - Kings College London
Risk assessment for specific locations, objects or activities
A risk assessment will need to be undertaken for each building or regular location used. This should include:
- Flow for people entering and leaving the building
- Maximum number of people that can be in the building and within each room or part of the building at one time
- Maximum number of people that can be in boundaries outdoor spaces at a time (e.g. car parks, outside activity areas and gardens)
- Toilet and changing facilities – ideally limit use within a bubble, provide liquid soap and paper towels to allow good hand hygiene
- Cleaning of shared hoists and mobility equipment between client uses
- Kitchen or refreshment facilities
- Surfaces most frequently touched
Some activities will need to be risk assessed on an ongoing basis in line with wider guidelines. These include:
- Activities involving shared objects (for example, games involving shared objects such as inflatable balls, parachutes, or a dice). The use of clean objects is advised.
- Playgrounds, activity areas and sensory rooms. Consider the guidance on avoiding soft furnishings, regular cleaning and outdoor areas
- Activities where participants are less likely to be able to, or remember to, socially distance
- Activities that involve increased blowing or breathing out – for example, singing or exercise. Risk can be reduced by moving activities outside or in well ventilated rooms.
- Bathing and hairdressing services should be risk assessed in line with government guidelines (see home care guidance for information on bathing and for hairdressing).