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, consider undertaking 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.
- Consider arranging an ‘enhanced clean’ if the building is under your control – or ask the owner about this.
- Check fire alarm procedures in relation to social 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.
Infection prevention and control
If anyone who uses the service, works for the service or works in the building where services are run has any COVID-19 symptoms, including mild symptoms, or has been in contact with a confirmed case in the past 14 days, they should not go to the day centre.
Infection prevention and control for everyone:
- Hand hygiene. Regular handwashing is essential for everyone. Soap and water or alcohol gel can be used for cleaninf. Skin-friendly wipes are an alternative option.
- Remember to avoid touching your face, eyes and mouth if possible.
- Coughing and sneezing: Cover the mouth, make sure there is somewhere for the safe disposal of tissues and a supply of new ones, wash hand after coughing or sneezing onto them.
- Some day centre attendees may require help with hand and respiratory hygiene.
NHS Test and Trace Open
Providers will need to be familiar with the NHS Test and Trace guidance for employers. 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.
All day care workers and people using services with symptoms can access testing. Staff and people using services with no symptoms are not expected to be tested before starting or returning to work.
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 can be disinfected using sprays designed for use on fabric.
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 group/bubbles or individuals. Sensory activities involving a lot of touching can be considered if the surfaces can be disinfected and this is done regularly. Providers, cleaners and any staff undertaking cleaning activities should follow this government guidance.
Personal protective equipment (PPE)
PPE is required for staff when they are providing close personal care in direct contact with the person they are supporting – this refers to touching and to supporting personal care. It is also recommended when working with someone who is coughing.
Government recommendations for domiciliary or home care are relevant to day care settings, and should be followed where possible particularly for indoor activities. The recommendations for home care includes details on face mask types and the use of visors. Information and posters for staff on putting on and taking off PPE can also be found with this guidance. In addition, this illustrative PPE guide for community and social care settings is relevant to day care.
It is understood that there will be exceptions in relation to the wearing of PPE, in particular face masks where it 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.
PPE can be accessed through your business-as-usual (BAU) channels. This may be your local authority or through public sector buying organisations, or other commercial routes you may have already established.
Where refreshment and food preparation are undertaken, guidance for food businesses will apply.
An alternative approach that may be necessary, especially if social 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 have reduced capacity. As well as travel to the activity or centre, arrival, exiting vehicles and entering the venue or building will need planning.
- 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. It is acknowledged that this will not be possible for all families.
- For those requiring transport to attend a day service location, providers need to assess their transport fleet and options in line with guidance.
- 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 facemasks, the transport will need a lower capacity than where all passengers can wear a mask.
- Protocols for the modification, cleaning and maintenance of the vehicles should be implemented by all service providers.
- Consider seating arrangements to maximise distance between people in the vehicle.
- Passengers should face away from one another.
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
Many face-to-face day care activities have had to be stopped or have only been available to a very small number of people considered to have the greatest need or to be at risk without the service. It is important to highlight that for most services, the same level of face-to-face provision that was available before lockdown may no longer be possible. 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, social distancing requirements.
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.
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 and advised to follow the COVID-19: guidance for households with possible coronavirus (COVID-19) infection 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.
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.
Resources which may be helpful for supporting transition Open
- Easy to understand range of resources and videos (Learning Disability England)
- National Autistic Society
- Explaining Coronavirus for People with Learning Disabilities and other videos (Surrey and Borders Partnership Trust)
- Coronavirus support for people affected by dementia (Alzheimer’s Society)