Practical information: What to consider when re-opening day care services

General health and safety check of buildings

Aside from preparing the building for protecting those using them from COVID-19, standard health and safety checks will be needed, especially for buildings that have been closed or for buildings that you did not previously use.

  • If the site/building has been out of use, undertake a health and safety check of, for example, hot/cold water systems (including legionnaire’s checks), gas safety, fire safety, kitchen equipment, security including access control and intruder alarm systems, ventilation. Guidance on specifics have been set out for schools; although you are not a school it might be relevant.
  • To help decide which actions to take prior to re-opening the building for permitted activity, a COVID-19 risk assessment should be completed, taking account of the core guidance and encouraging physical distancing where possible. This will be in addition to any risk assessment which is already in place for the community facility. See Conducting a risk assessment.
  • Consider arranging a ‘deep clean’ (cleaning and decontamination) if the building is under your control – or ask the owner about this. This would include removing clutter and items of equipment which are not used regularly to enable effective cleaning of surfaces. See guidance on cleaning in non-healthcare settings.
  • Check cleaning schedules and services are back to usual operating and review whether the scheduling of these works for your activities; cleaning frequencies may be increased for heavily populated spaces or frequently touched surfaces.
  • Check fire alarm procedures in relation to physical distancing and the use of space. Do they need to be adjusted (e.g. changing assembly points)? If so, plan how you will let staff, volunteers and people who use services know about any changes.

See specific guidance on the safe use of multi-purpose community facilities available.

See guidance on cleaning, hygiene and handwashing to reduce coronavirus (COVID-19) transmission.

Infection prevention and control

Although most adults are now fully vaccinated, it is still possible to catch and spread COVID-19 and so important to mitigate the risks in other ways.

Physical distancing, washing your hands regularly, good respiratory hygiene (using and disposing of tissues), cleaning surfaces and keeping indoor spaces well ventilated are the most important ways to reduce the spread of COVID-19.

Infection and control measures in the workplace should be robustly implemented and adhered to, including supporting continued physical distancing, optimising ventilation, use of personal protective equipment (PPE) where indicated, hand and respiratory hygiene and enhanced decontamination/cleaning (especially frequently touched surfaces).

Anyone who uses the service that has any COVID-19 symptoms, including mild symptoms, should not go to the day centre and instead should self-isolate for 10 full days from the day the symptoms started. The day care service can direct people using services and carers who have a positive COVID-19 case to the guidance for households with possible or confirmed COVID-19 infection, which includes easy-read versions.

If someone using a service is unvaccinated or partially vaccinated and is notified as a contact of a COVID-19 case by NHS Test and Trace or their workplace, they must self-isolate as advised unless they are exempt.

If someone using the service is fully vaccinated and has been exposed to someone with possible or confirmed COVID-19 but is asymptomatic, they no longer need to self-isolate provided they have received a negative PCR test and undertake a daily lateral flow test (LFT) during their contact period (up to 10 days). The day care manager and local authority should assess the risk of people who have been exposed but have been fully vaccinated attending group day care.

Any staff who work for the service or in the building where services are run are considered social care staff. If they develop any of the symptoms of COVID-19 they should follow the stay at home guidance and arrange to have a PCR test either through their workplace arrangements or the NHS Test and Trace service, as soon as possible. If a staff member is identified as a contact of a COVID-19 case, the need to self-isolate relates to vaccination status. See COVID-19: management of staff and exposed patients or residents in health and social care settings.

If an unvaccinated or partially vaccinated staff member is notified as a contact of a COVID-19 case by NHS Test and Trace or their workplace, they must self-isolate as advised unless they are exempt (because they are under 18, unable to be vaccinated due to medical reasons or are taking part or have taken part in a clinical trial for a COVID-19 vaccine).

From 16 August, fully vaccinated staff who receive a negative PCR test result can usually return to work providing they are medically fit to do so, subject to a discussion with their line manager/ employer and a local risk assessment. Fully vaccinated health and social care workers who have been in contact with someone with COVID-19 and asked to isolate by NHS Test and Trace, will not be required to isolate, and can continue working provided they have received a negative PCR test and receive a daily negative LFT for the duration of their otherwise isolation period.

If the staff member develops symptoms of COVID-19 during this period, they should follow the Government guidance (section 2.1).

For complex cases, contact with the public health team in your local authority should be made to connect providers with infection prevention and control (IPC) and PPE as well as training and other resources.

Further information can be found in the guidance on COVID-19 management of staff and exposed patients or residents in health and social care settings.

  • Hand hygieneOpen

    Promote hand hygiene, ensuring that everyone, including staff, service users and their carers, have access to hand washing facilities. Some day care users may need support to undertake hand hygiene as well as access.

    Washing hands with soap and water for at least 20 seconds is essential before and after all contact with the person being cared for, removal of protective clothing and cleaning of equipment and the environment.

    Ensure that liquid soap and disposable paper towels are available at all sinks.

    Alcohol-based hand rub (ABHR) can be used if hands are not visibly dirty or soiled, and should have adequate provision and be accessible. Dispensers should be safely sited and adequately provided to be accessible to users and staff.

    Day centre managers should regularly audit hand hygiene practice and provide feedback to employees.

  • Respiratory hygiene Open

    • Limit close contact with others. The main way of spreading COVID-19 is through close contact with an infected person. When someone with COVID-19 breathes, speaks, coughs or sneezes, they release particles containing the virus that causes COVID-19. These particles can be breathed in by another person.

    Remember to avoid touching your face, eyes and mouth if possible.

    Disposable single-use tissues should be used to cover the nose and mouth when sneezing, coughing or wiping and blowing the nose. Used tissues should be disposed of promptly in the nearest foot-operated waste bin.

    Hands should be cleaned with soap and water if possible (and hand gel if not), after coughing or sneezing, using tissues or after contact with respiratory secretions and/or contaminated objects.

    Some day centre attendees may require help with respiratory hygiene.

  • Cleaning Open

    COVID-19 spreads from person to person through small droplets, aerosols and through direct contact. Surfaces and belongings can also be contaminated with COVID-19 when people with the infection cough or sneeze or touch them. The risk of spread is greatest when people are close to each other, especially in poorly ventilated indoor spaces and when people spend a lot of time together in the same room.

    Regular cleaning plays a vital role in limiting the transmission of COVID-19 as it reduces the presence of the virus and the risk of contact.

    Reducing clutter and removing difficult-to-clean items can make cleaning easier. Increase the frequency of cleaning, using standard cleaning products such as detergents and bleach, paying attention to all surfaces but especially ones that are touched frequently, such as door handles, light switches, work surfaces, remote controls and electronic devices.

    When cleaning surfaces, it is not necessary to wear personal protective equipment (PPE) or clothing over and above what would usually be used

  • Unnecessary items and soft items/furnishings Open

    Government advice is to remove items that are hard to clean, such as those with intricate parts, and remove soft furnishings (e.g. cushions, rugs, blankets, soft dolls). Non-absorbent seating coverings are preferable to fabric seating. Day care providers should not provide soft ‘comfort’ items such as soft toys and blankets, but rather attendees should bring them in and take them home again.

    Thinking about ‘unnecessary’ items is a matter of judgement as soft items may be needed for comfort and feelings of security. Any necessary soft items should be cleaned in accordance with the manufacturers’ guidance. Where fabric items are required for therapeutic or sensory care, these should be allocated to the individual for the duration of the care period and decontaminated before use by another client.

  • Frequently touched surfaces Open

    Think about and list those areas and surfaces (e.g. door handles/plates, grab rails) that are frequently touched as they will require more frequent cleaning between individuals. Sensory activities involving a lot of touching can be considered if the surfaces can be cleaned and this is done regularly. Providers, cleaners and any staff undertaking cleaning activities should follow this government guidance.

    As a minimum, frequently touched surfaces should be wiped down twice a day: one of these should be at the beginning or the end of the working day and the other during the day, especially after periods of high activity. Cleaning should be more frequent depending on the number of people using the space, whether they are entering and exiting the setting and access to handwashing and hand-sanitising facilities. Cleaning frequently touched surfaces is particularly important in bathrooms and communal kitchens.

  • Risk assessmentOpen

    Providers of day care services should take all possible steps to secure safety of users and staff when open, and should decide to remain closed if they are not able to safely adhere to the guidelines outlined in the section on risk assessments.

For more information about COVID-19 infection control see our quick guide and e-learning course.

See PHE guidance on Cleaning, hygiene and handwashing to reduce coronavirus (COVID-19) transmission.

Face coverings for volunteers, carers and people using services

Volunteers, carers and people using services are encouraged to wear a face covering when:

  • in any public indoor setting (this includes an indoor day care setting)
  • using shared transport with people outside their household.

Limiting close contact

There is no longer a legal restriction around social or physical distancing for support groups. Although most adults are now fully vaccinated, it is still possible to catch and spread COVID-19. Current government guidance states:

  • You do not need to stay two metres apart from people you do not live with. There are also no limits on the number of people you can meet.
  • However, in order to minimise risk at a time of high prevalence, you should limit the close contact you have with those you do not usually live with, and increase close contact gradually. This includes minimising the number, proximity and duration of social contacts.
  • You should meet outdoors where possible and let fresh air into homes or other enclosed spaces.

Risk assessments should be undertaken for individuals and services when considering close contact between people using services, staff, volunteers and carers.

This risk assessment should also include other factors such as an indoor setting, ventilation, number of people, client group and the risk to them and face coverings/PPE.

Maintaining phsyical distance indoors is still encouraged and the risk of reducing the need to distance needs to be balanced with factors such as an indoors setting, ventilation, number of people, client group and the risk to them and face coverings/PPE.

Where physical distancing is not possible (e.g. on transport), and when indoors in a public setting, face coverings should be worn by those using services. These do not need to be to a clinical standard, but they reduce the risk of the wearer spreading the infection if they have COVID-19. Face coverings do not replace physical distancing. Even if a face covering is used, staff and users should continue to wash hands regularly and maintain physical distancing. It is important to use face coverings properly and thoroughly wash hands before putting them on and taking them off.

Government guidance on keeping yourselves and others safe states:

COVID-19 spreads through the air by droplets and aerosols that are exhaled from the nose and mouth of an infected person. The Government expects and recommends that people wear face coverings in crowded areas such as public transport.

Staff members are no longer required by law to observe the 2-metre social distancing rule between themselves and those using services. However, where 2 metres cannot be maintained and for activities involving touch (such as personal care), appropriate PPE will need to be used by staff. In circumstances where the use of PPE is considered too distressing or fully prevents communication, a suitable risk assessment should be undertaken.

The need for minimising close contact with service users, considering wearing a face covering indoors and staff wearing appropriate PPE, gives rise to the following considerations:

  • Greater space per person than would normally be needed
  • Physical distancing and/or wearing a face covering or being supported by someone wearing PPE is challenging for some people using services

There is further information on social distancing and risk mitigation in the guidance for the safe use of multi-purpose community facilities.

Personal protective equipment (PPE) for staff

PPE refers to masks, aprons, gloves and visors. It is essential that PPE is used correctly to protect staff and those they care for. Government recommendations for domiciliary or home care are relevant to day care settings, and should be followed as far as possible to reduce the risk of transmission. This includes guidance on how to put on and take off PPE safely. An illustrated PPE guide is also available and explains which items of PPE are required in different scenarios.

Please note that the use of surgical masks by care workers in all indoor care settings is still recommended. The specific type of surgical mask required will vary depending on the type of care being provided. There is not sufficient evidence to recommend the use of face coverings or cloth masks instead of surgical masks by staff delivering health and care activities, therefore they should not be used by staff in day centres.

It is understood that there will be individuals for whom the wearing of PPE, in particular face masks, is distressing, prevents communication or poses an additional risk of items being grabbed. Staff should assess the risk for each activity where PPE is problematic for the person being supported, including the potential to withhold services where safe practice cannot be achieved. Visors are less effective at protecting against contact with respiratory particles than face masks and should only be used following a risk assessment or in combination with a face mask. Visors and eye protection goggles are helpful in reducing the risk of contact into the eyes from small viral particles. The recommendations for domiciliary or home care guidance contains advice on the use of PPE when supporting autistic people or those with learning difficulties.

Recognising the increase in demand for PPE this year, the Government has committed to providing free PPE for COVID-19 needs to the adult social care sector until the end of March 2022. Day centres can access this through local resilience forums (LRFs), or local authorities where LRFs have stood down regular PPE distribution.

Testing for a COVID-19 infection

Testing is an important measure to support day care centres to remain open safely. Regular testing can identify staff with no symptoms carrying COVID-19 who may pass this on to other staff members and people who use day care centres. Through testing, people who test positive are able to isolate and break the chains of transmission.

NHS Test and Trace is offering PCR and rapid lateral flow tests (LFT) to adult day care centre staff and service users in England. Routine testing is being offered to reduce infection risk in open adult day care centres and to identify any positive cases in these settings as early as possible.

Eligible day care centres are those that are open and run by paid day care staff. Services must be for adults over 18 and are provided within non-residential care settings that support the health and wellbeing of adults. This includes settings such as:

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

These criteria have been developed based on clinical advice about risk factors within day care services. As a result, settings meeting these criteria are ones where the risk of transmission and outbreak are higher, and the impact on service users may be high given their vulnerability.

Weekly PCR testing and twice weekly LFTs, three to four days apart, are strongly encouraged to be undertaken by all staff and volunteers working regularly in these centres, as well as private transport staff who support service users to attend.

Service users are encouraged to undertake up to twice weekly testing:

  • LFTs twice a week, every three to four days
  • If a service user is only visiting once or twice per week, they only need to test on the day of their visit(s). Testing should not be mandatory for attendance, but is encouraged if possible
  • Service users can be tested either at home or on site assisted by staff.

Everyone who tests positive will need to undertake a confirmatory PCR and self-isolate at home immediately until they receive their result.

For more information about how to access testing and what the testing process looks like, please see full guidance below. Before your centre begins rapid lateral flow testing, please join or watch a recording of webinars being run by NHS Test and Trace specifically for day care centres and download our supporting material.

See guidance on regular testing for adult day care centres in England.

For detailed guidance documents see Coronavirus (COVID-19) testing for adult social care (ASC) settings:

For accessible instructions on lateral flow testing, please refer to the rapid lateral flow home test instructions.

For any testing queries or issues, please call 119.

NHS Test and Trace

Providers will need to be familiar with the NHS Test and Trace guidance for employers as well as the guide for the management of staff and exposed patients or residents in health and social care settings. How this impacts staff and those using services will differ depending on your service, and where different people or groups or people are in contact with each other.

It is important that:

  • people using services, families, carers and day care staff are all aware of what to do if they are contacted, and that they must contact the service
  • the service keeps up-to-date record as to which individuals have been in contact or possible contact within the day care service or services
  • services understand their duty to report to local Health Protection Teams if there are confirmed or suspected cases of COVID-19.

Restrictions and day care provision: What is allowed?

Step 4 of the national roadmap out of lockdown, from 19 July 2021

Most legal restrictions to control COVID-19 have been lifted at step 4. This means that:

  • You do not need to stay 2 metres apart from people you do not live with. There are also no limits on the number of people you can meet.
  • However, in order to minimise risk at a time of high prevalence, you should limit the close contact you have with those you do not usually live with, and increase close contact gradually. This includes minimising the number, proximity and duration of social contacts.

There is no longer a specific ‘support group’ section of the Government guidance and no formal size limits on groups. Further general information can be found within the Government guidance.

As part of their risk assessment, local authorities and commissioners are encouraged to consider the COVID-19 infection rates in their area and in consultation with providers, set a maximum limit for the number of people using a service at a given time. Previously there was a limit of 15 which increased to 30. There is no longer a set limit, but local authorities should consider setting one themselves.

It is recommended that services update their risk assessments for staff and people using services. Further information about risk assessments can be found at Individual risk assessments for COVID-19 for face-to-face services.

Food preparation

Where refreshment and food preparation are undertaken, guidance for food businesses will apply.

An alternative approach that may be necessary, especially if physical distancing is not possible in food preparation areas, is for everyone to be asked to bring their own food and refreshments. Only supply food and refreshments to those unable to do so.

Use of transport

Transport is an integral part of many day care services and may include provider-owned vehicles, community transport, public transport, family or carers driving, or taxis. Transport will need to be planned in advance and it is likely that group vehicles, such as minibuses will continue to have reduced capacity. As well as travel to the activity or centre, arrival, exiting vehicles and entering the venue or building will need planning.

As set out in safer transport guidance, from 19 July social distancing rules (2m or 1m+) were lifted on domestic public transport. This means that people using transport do not need to stay 2 metres apart from people they don't live with. Providers should, however, continue to consider the risks of close contact with others, particularly if they are not fully vaccinated or in one of the higher risk groups for a poor outcome from COVID-19.

The requirement to wear face coverings in law has been lifted. However, the Government expects and recommends that people wear face coverings in crowded areas such as public transport. It is recommended you wear a face covering when travelling in a private vehicle with people you do not usually meet.

  • Families should be asked to provide transport for the person accessing day-to-day services on the day/s that they are going to attend a day service location and avoid using public transport where possible, especially at peak times. It is acknowledged that this will not be possible for all families.
  • Car sharing should not be encouraged for staff or for people using services.
  • For those requiring transport to attend a day service location, providers need to assess their transport fleet and options in line with guidance.
  • People using shared transport are encouraged to wear face coverings (unless exempt).
  • The car/minibus will need to be cleaned before and after their use and have open windows or car vents for ventilation that use outside air, not recirculating internal air.
  • The provider, together with the transport service (if it is not in-house) should agree the number of service users that can be transported safely at any time. This will vary depending on the needs of service users and their understanding of the behaviours required to minimise the risk of infection from COVID-19.
  • Where people using the transport are unable to wear face masks, the transport should consider a lower capacity than where all passengers can wear a mask.
  • Consider seating arrangements to maximise distance between people in the vehicle.

Protocols for the modification, cleaning and maintenance of vehicles should be implemented by all service providers:

Numbers and prioritisation of face-to-face and group activities

As part of their risk assessment, local authorities and commissioners are encouraged to consider the COVID-19 infection rates in their area and in consultation with providers, set a maximum limit for the number of people using a service at a given time.

It remains the case that for many services, the same level of face-to-face provision that was available before lockdown may still not be possible or preferable. A combination of lower numbers taking part in face-to-face activities and a lower number of contact hours, may be required in order to manage infection control and prevention requirements and to enable continued physical distancing.

Re-assessing needs and preferences

It is recommended that conversations about the support people and their carers will need takes place as soon as possible. This can be via a review of care and support plans. Any need identified for reassessment will need to be flexible and in line with requirements of provisions the Care Act (2014) and potential for ongoing changes in the Government's rules on lockdown and re-opening of services and society.

New needs may have emerged. Much has been changed by coronavirus, but the personality, preferences and interests of the person being supported will likely not have done. There are also some new opportunities that have been developed to support people and their carers that might need to be factored into the review of care and support plans.

Some individuals will not wish to return to face-to-face services while the risk of COVID-19 persists, for example those that have been shielding.

Many day care providers have continued to provide support remotely or with minimum contact. This has included virtual meal clubs, evening social groups and maintaining regular contact to groups that were shielding, by visiting at their window. Many of these activities can continue or evolve ensuring some level of support for a wider range or people than can access face-to-face services.

Attendance of users

When service users and their carers attend face-to-face services, the provider should reassure themselves that the user and their carer have not had COVID-19 symptoms or tested positive for it in the past 10 days.

Anyone who uses the service that has any COVID-19 symptoms, including mild symptoms, should not go to the day centre and instead should self-isolate for 10 full days from the day the symptoms started. The day care service can direct people using services and carers who have a positive COVID-19 case to the guidance for households with possible or confirmed COVID-19 infection, which includes easy-read versions.

If someone using the service is unvaccinated or partially vaccinated and is notified as a contact of a COVID-19 case by NHS Test and Trace or their workplace, they must self-isolate as advised unless they are exempt.

If someone using the service is fully vaccinated and has been exposed to someone with possible or confirmed COVID-19 but is asymptomatic, they no longer need to self-isolate provided they have received a negative PCR test and undertake a daily LFT during their contact period (up to 10 days).

What to do if someone becomes unwell in a day care setting?

If anyone in an day care setting becomes unwell with a new, continuous cough or a high temperature, or has a loss of, or change in, their normal sense of taste of smell (anosmia), they must be sent home immediately and advised to isolate and follow the Stay at home guidance.

If a person is awaiting collection, they should be moved, if possible, to a room where they can be isolated behind a closed door, with appropriate supervision as required. Ideally, a window should be opened for ventilation. If it is not possible to isolate them, move them to an area which is at least 2 metres away from other people.

If they need to go to the bathroom while waiting to be collected, they should use a separate bathroom if possible. The bathroom should be cleaned and disinfected using standard cleaning products before being used by anyone else.

PPE should be worn by staff supporting the person who is unwell.

In an emergency, call 999 if they are seriously ill or injured or their life is at risk. Do not visit the GP, pharmacy, urgent care centre or a hospital.

If a member of staff has helped someone with symptoms, they do not need to go home unless they develop symptoms themselves (and in which case, a test is available) or the person subsequently tests positive. They should wash their hands thoroughly for 20 seconds after any contact with someone who is unwell. Cleaning the affected area with normal household disinfectant after someone with symptoms has left will reduce the risk of passing the infection on to other people. See the COVID-19: cleaning of non-healthcare settings guidance.

Outbreak of COVID-19

In the event of a suspected or confirmed outbreak, day care managers should contact their local health protection team (HPT) immediately for further advice.

An outbreak is when there are two or more test-confirmed cases of COVID-19 among individuals associated with a specific non-residential setting with illness onset dates within 14 days, and one of:

  • identified direct exposure between at least two of the test-confirmed cases in that setting (for example, under one metre face to face, or spending more than 15 minutes within two metres) during the infectious period of one of the cases
  • when there is no sustained local community transmission - absence of an alternative source of infection outside the setting for the initially identified cases.

Providers are reminded to remain vigilant for outbreaks caused by other infections and to report any suspected outbreaks or serious incidents relating to infection, in a timely manner, to their local health protection team.

Supporting individuals with transition back into a service

Consideration of how to support people to transition back into a service will be necessary. The current health crisis has increased confusion, fear and anxiety for everyone, and inevitably it will bring additional challenges. There may be a need for detailed planning where people will need to adjust to returning to a service, having adapted to new routines during lockdown, and where they are unsettled or even traumatised by change (potentially resulting in escalation of behaviours that challenge or unmet needs). Some people returning to face-to-face activities may have experienced a loss of confidence or be anxious about whether will they be able to remember the new measures.

Delivering safe day care
Previous section | All sections | Next section