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 10 days, they should not go to the day centre.

Latest guidance for households with possible or confirmed COVID-19 infection

Infection prevention and control for everyone:

  1. Hand hygiene. Regular handwashing is essential for everyone. Soap and water or alcohol gel can be used for cleaning. Skin-friendly wipes are an alternative option.
  2. Remember to avoid touching your face, eyes and mouth if possible.
  3. Coughing and sneezing: Cover the mouth, make sure there is somewhere for the safe disposal of tissues and a supply of new ones, wash hands after coughing or sneezing onto them.
  4. Some day centre attendees may require help with hand and respiratory hygiene.
  • 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.

  • 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.

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.

The Department of Health and Social Care has rolled out weekly routine staff testing to all day care centres that are run by paid care staff and deemed critical to be open during lockdown by local authorities. 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. In addition, staff have been prioritised due to the enhanced risk from staff movement and following consultation with the sector.

Weekly PCR testing should be undertaken by all staff and volunteers working regularly in these centres, as well as private transport staff who support service users to attend.

Day care services should begin testing as soon as possible to continue to remain open safely. Where eligible day care services are unable to access whole centre testing in the short term, they should use local routine testing sites for staff if possible, or centres should reduce activity to include tested staff or pause activity until they have a regular testing regime in place.

For information about how to access testing and what the testing process looks like, please see the short guidance document below and join an interactive webinar being run by NHS Test and Trace specifically for day care centres. For any testing queries or issues, you can call 119.

If a member of staff needs a COVID-19 test because they have symptoms, they should be self-isolating and can access testing through the online Government portal or by calling 119 to book testing.

View/download: Testing for adult day centres: poster

NHS Test and Trace

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.

Restrictions and day care provision: What is allowed?

National lockdown rules from 5 January 2021

Most adult day care provision continues to be considered a support group and the following rules apply:

Support groups that have to be delivered in person can continue with up to 15 participants where formally organised to provide mutual aid, therapy or any other form of support – but they must take place at a premises other than a private home.

Where a group includes someone covered by an exception (for example, someone who is working or volunteering), they are not generally counted as part of the gatherings limit. This means, for example, a tradesperson can go into a household without breaching the limit, if they are there for work, and the officiant at a wedding would not count towards the limit.

Further information can be found within the ‘Where and when you can meet in larger groups’ section of the Government guidance.

It is recommended that due to the increase of COVID-19 cases across the country, 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.

Social distancing

The national advice on social distancing is to maintain 2 metres. This is especially true in day care settings where the populations being cared for are vulnerable. Therefore, in this guidance document we recommend to continue to use 2 metres in all settings. Whenever possible, staff should follow social distancing guidance being more than 2 metres away from the person they support. If this is not possible, a risk assessment should be undertaken, including the potential to withhold services where safe practice cannot be achieved

Where social distancing is not possible (e.g. on transport), face coverings should be used 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.

Staff members must also observe a 2 metre social distancing rule: between those using services and staff members, and between staff and those using services. To reduce the risk of transmission, correct PPE should be used by staff (see section below). In circumstances where the use of PPE is considered too distressing or fully prevents communication, a suitable risk assessment should be undertaken (see Risk assessments).

  • Consistent groups/Bubbles Open

    Bubbles are small, consistent groups of service users, volunteers, and staff together throughout the day. Each group or bubble is kept apart from each other as far as possible. Guidance for early years/schools may be useful to draw on as they are using a bubble model.

    Things to think about:

    • Keep a record of those in the same bubble
    • Staff and the people they support should stay in the same group/bubble throughout the week
    • People using services should only be in one bubble. For those who would usually use more than one service (this could be across providers) it is recommended they use only one face-to-face group service. Where the risk to an individual not using more than one service is found to be high, it may be possible to support a cross-service risk assessment to enable more than one to be attended.
    • Where possible each bubble should use the same base room. Alternatively, it may be possible to divide rooms with temporary dividers
    • Transport can be included in the bubble where group transport is in use
    • Where it is possible to use multiple entrances try to have separated entrances for different rooms
    • Consider staggering arrival/departure times and refreshment/meal times for each bubble
    • Signage for safe practice and usage of rooms
    • Measure each room and state clearly on the door how many people can be in each room at one time
    • Arrange furniture or activities 2m apart. Arrange furniture or activities so staff can stand/sit next to the person they are supporting and not face to face

    Please note: The term bubble is commonly used in relation to groupings within organisations or activities, such as pupils within schools. It is separate to (but with a similar infection prevention and control purpose) ‘support bubbles’ which were introduced for single adult households.

Personal protective equipment (PPE)

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 above government guidance recommends the use of surgical masks by care workers in all indoor care settings. 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 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 alone will not protect fully against aerosol transmission and are therefore less effective for infection, prevention, control (IPC) measures than face masks and should only be used following a risk assessment or in combination with a face mask. 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 June 2021. Day centres can access this through local resilience forums (LRFs), or local authorities where LRFs have stood down regular PPE distribution.

Food preparation

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.

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, been a household contact or a close contact of someone with COVID-19 symptoms in the past 10 days and/or have not been asked to isolate by NHS Test and Trace.

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.

Outbreak

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.

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
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