Practical information: What to consider when re-opening day care services
Updated: May 2022
General health and safety check of buildings
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. The requirement for undertaking a specific COVID-19 risk assessment has been removed. However, it is still good practice to do so, particularly when considering the re-opening of buildings which have been closed for a long time. See guidance provided by the Health and Safety Executive (HSE) on conducting risk assessments which includes useful templates and examples.
- 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.
- 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.
Infection prevention and control
Although most people are now fully vaccinated, it is still possible to catch and spread COVID-19 and so it is important to mitigate the risks in other ways.
Vaccination, 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.
People using services
Anyone who uses the service that has any of the main COVID-19 symptoms should immediately take a lateral flow device (LFD) test as soon as they develop symptoms and take another LFD test 48 hours after the first test. Whilst there is no longer a requirement to self-isolate on confirmation of a positive LFD or PCR test, it is still strongly recommended that people using services try and stay at home and avoid contact with other people for five days after the positive result.
The day care service can direct people using services and carers who have a positive COVID-19 case to the guidance for people with symptoms of a respiratory infection including COVID-19. The day care manager and local authority should assess the risk of people who have had a positive test to decide when they can return to the service.
If someone using a service is a household or overnight contact of someone who tests positive for COVID-19, there is no longer a need to self-isolate. However, they should try to avoid contact with people with a higher risk of becoming unwell, limit close contact with people outside the household, wear a mask if they need to be a close contact with other people and wash their hands frequently. Again, the day care manager and local authority should assess the risk of people who have been a close contact, to decide when they can return to the service.
Staff and volunteers
Any staff who work for the service or in the building where services are run are considered social care staff. If a member of staff has symptoms of COVID-19, follow the 'If a staff member develops COVID-19 symptoms' section of the IPC COVID-19 Supplement.
Any staff who have symptoms of a respiratory infection, and who have a high temperature or staff who have symptoms of a respiratory infection and do not feel well enough to attend work should take a lateral flow device (LFD) test as soon as they feel unwell (day 0). Staff with respiratory symptoms who feel well enough to work and do not have a temperature, do not need to take a symptomatic test and can continue working.
- If symptoms begin at home (off-duty), they should not attend work while awaiting both lateral flow test results and should notify their employer or line manager immediately
- If symptoms begin at work, they should inform their employer or line manager and return home as soon as possible
If the LFD test result is negative, they should take another LFD test 48 hours later, staying away from work during this time. If this is also negative, they can return to work if well enough to do so.
If a staff member receives a positive lateral flow or PCR test result they should follow the advice in the section 'If a staff member receives a positive lateral flow or PCR test result' in the IPC COVID-19 Supplement. They should not attend work until they have had two consecutive negative lateral flow test results (taken at least 24 hours apart), they feel well and they do not have a high temperature. The first lateral flow test should only be taken from five days after day 0.
- If both lateral flow tests results are negative, they may return to work immediately after the second negative lateral flow test result on day 6, if their symptoms have resolved, or their only symptoms are cough or anosmia which can last for several weeks.
- If the staff member cares for people who are at higher risk of becoming seriously unwell with COVID-19 (seek clinical advice as necessary), careful assessment should be undertaken, and consideration given to redeployment until 10 days after their symptoms started (or the day their test was taken if they did not have symptoms). The staff member should continue to comply with all relevant infection control precautions and PPE should be worn properly throughout the day.
- If the staff member's lateral flow test result remains positive on the 10th day, they should continue to take daily lateral flow tests. They can return to work after a single negative lateral flow test result. If the staff member’s lateral flow test result is still positive on the 14th day, they can stop testing and return to work on day 15. Managers can undertake a risk assessment of staff who test positive between 10 and 14 days and who do not have a high temperature or feel unwell, with a view to them returning to work depending on the work environment.
Staff who receive an inconclusive test result should take another lateral flow test, and symptomatic staff who do not have immediate access to another lateral flow test should not attend work while waiting to receive another lateral flow test. If the repeat test result is positive, they should follow the advice on receiving a positive test; if their test result is negative, they can return to work.
Staff who are contacts of confirmed cases can continue working. They should comply with all relevant infection control precautions and PPE should be worn properly throughout the day. They no longer need to undertake any additional testing, and instead should continue their usual testing regime.
- If the staff member develops symptoms, they should follow the guidance for staff with symptoms (see above).
- If the staff member works with people who are especially vulnerable to COVID-19 (seek clinical advice as necessary), a risk assessment should be undertaken, and consideration given to redeployment during the 10 days following their last contact with the case.
Consideration should be given to how to ensure staff can deliver safe care during the 10 days after being identified as a close contact of someone who has tested positive for COVID-19. This includes applying the measures known to reduce risk such as distancing, maximising ventilation, PPE and cohorting. This should be built into the provider’s general risk assessments for responding to infectious diseases and ensuring safe staffing levels are maintained.
Finally, if a staff member or service user receives a positive result (from any test), then all staff should conduct daily rapid LFD testing every day that they are working, for five days. Only the staff working in the setting over the rapid response testing period need to be tested; those not working during this period do not need to be tested. People should not be brought into work to get tested on their non-working days.
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.
Vaccination is still the most effective way to prevent serious illness from COVID-19 and it is important to encourage and support all staff to get a COVID-19 vaccine and a booster dose as and when they are eligible, as well a vaccine for seasonal influenza.
Providers can do this by putting in place arrangements to facilitate staff access to vaccinations, and regularly reviewing the immunisation status of their workforce in line with immunisation against infectious disease ('the Green Book'). Also see the COVID-19 vaccination guide for employers, which contains information on actions employers can take to enable staff vaccination. There is also guidance available on the vaccines that are available through the NHS.
To ensure the safety of people attending day services, providers should undertake risk assessments wherever possible. These should take into account the COVID-19 vaccination status of both staff members and the people they support. Relevant clinical advice should be considered, including whether any individuals are at higher risk of severe COVID-19 infection. As a result of these risk assessments, providers may consider taking additional steps such as prioritising the deployment of vaccinated staff to care for those who are at higher risk of severe COVID-19 infection, where appropriate.
Particular attention should be given to how ventilation can be improved. Ventilation is an important control to manage the threat of COVID-19. Letting fresh air into indoor spaces can help remove air that contains virus particles, and prevent the spread of COVID-19.
- Open windows and vents more than usual - even opening a small amount can be beneficial.
- Opening high level windows is preferable to low level windows where there is a danger of creating draughts and causing discomfort. Where the room has multiple windows, it is usually possible to create a more comfortable environment by opening all windows a small amount rather than just one a large amount.
- Opening windows on different sides of a room will allow greater airflow. Where possible, opening external doors can improve ventilation. However, this may present security and safety issues, so would need proper consideration and risk assessment.
Where possible, rooms should be ventilated after any visit from someone outside the setting, or if anyone in the care setting has suspected or confirmed COVID-19. For mor information on improving ventilation please see guidance on the ventilation of indoor spaces to stop the spread of COVID-19.
Day care services should promote hand hygiene; ensuring that everyone, including staff, people attending the service and their carers, have access to hand washing facilities. Providers should also ensure that liquid soap and disposable paper towels are available at all sinks. Some day care users may need support to undertake hand hygiene as well as access.
Good practice in hand hygiene can include:
- 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 and before and after handling food.
- Alcohol-based hand rub (ABHR) can be used if hands are not visibly dirty or soiled when caring for a person with diarrhoea and/or vomiting. 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.
For further guidance on hand hygiene please see guidance on infection prevention and control: resource for adult social care.
Respiratory hygiene Open
Good respiratory hygiene reduces the transmission of respiratory infections. Being alert to people with respiratory symptoms is important as this may indicate infection with COVID-19. To help reduce the spread of infection, day care centres should:
- encourage people to cover the nose and mouth with a disposable tissue when sneezing, coughing, wiping and blowing the nose
- ensure a supply of tissues is in reach of the person or those providing care
- dispose of all used tissues promptly into a waste bin, which should be provided
- encourage everyone to clean hands after coughing, sneezing, using tissues, or after contact with respiratory secretions or objects contaminated by these secretions
- encourage people to keep contaminated hands away from the eyes, nose and mouth
- support people who need help with respiratory hygiene where necessary
Please see the catch it, bin it, kill it poster developed by the NHS.
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.
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. 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.
For further guidance on cleaning of the environment please see guidance on infection prevention and control: resource for adult social care.
Use of transport Open
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. While there are no longer any requirements for social distancing or wearing masks on public transport, providers should continue to consider the risks of close contact with others, particularly if they are at higher risk of serious illness as a result of weakened immune systems.
Where community transport is being used providers should consider the infection rates in their local areas and the specific health and welfare needs of their service users in order to make decisions about wearing masks, maintaining some social distance, setting a maximum capacity and the cleaning and maintenance of vehicles.
Face coverings for volunteers, carers and people using services
Wearing a face covering or face mask can reduce the number of particles containing viruses that are released from the mouth and nose of someone who is infected with COVID-19 and other respiratory infections. Volunteers, carers and people using services are encouraged to wear a face covering when:
- coming into close contact with someone at higher risk of becoming seriously unwell from COVID-19 or other respiratory infections
- COVID-19 rates are high and you will be in close contact with other people, such as in crowded and enclosed spaces
- there are a lot of respiratory viruses circulating, such as in winter, and you will be in close contact with other people in crowded and enclosed spaces
For more information on wearing face coverings and masks please see guidance on living safely with respiratory infections, including COVID-19.
Personal protective equipment (PPE) for staff
PPE refers to face masks, aprons, gloves and eye protection.
Staff should wear gloves for care tasks involving contact with non-intact skin, or mucous membranes, and all activities where exposure to blood, body fluids secretions or excretions is anticipated – such as dressing wounds or carrying out personal care. Further information about types of glove can be found in the Infection prevention and control: resource for adult social care under ‘gloves’.
Plastic disposable aprons should be worn when there is a risk that clothing may be exposed to blood, body fluids, secretions or excretions. This includes activities such as personal care or handling dirty laundry.
The use of surgical masks by care workers and visitors in all indoor care settings is still recommended, irrespective of whether or not the service user is known or suspected to have COVID-19. The specific type of surgical mask required will vary depending on the type of activity. 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. For more information on the different types of face masks and when they should be worn please see the COVID-19 supplement to the infection prevention and control resource for adult social care.
It is understood that the use of face masks can be distressing or inhibit communication for some people. There may be circumstances where the use of masks is challenging for the service user, for example, where lip-reading or facial recognition is important, or the use of PPE is causing distress. This should be taken into account as part of a risk assessment.
Consideration should be given to how best to put into practice PPE guidance to minimise any negative impact on people being supported, while maintaining infection prevention and control. The needs of the person being supported should be recognised and they should be as involved as they wish to be, and are able to be, in determining their needs in these circumstances. It may be appropriate in certain circumstances to consider transparent face masks. Guidance on technical specifications for transparent face masks has been provided by the government and should be consulted.
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 and people receiving support with no symptoms carrying COVID-19 who may pass this on to others, so action can be taken to stop the spread.
Regular testing is available for all individuals attending or working at adult day care centres that are open across England. The key points from the guidance on COVID-19 testing in adult social care as it relates to day care centres are:
- Staff should conduct two LFD tests per week, taking them before they begin work, spaced three to four days apart.
- Day care centres must have Unique Organisation Numbers (UONs) assigned by NHS Test and Trace which is needed to order test kits, register test kits and contacting the national COVID-19 contact centre for support.
- Centres must be signed up via the self-referral portal to gain access to testing.
- Reporting the result of every LFD test is encouraged, even if it is negative or void. Staff members can register LFD tests individually, or managers can register them in bulk using the multiple upload spreadsheet. However, the latter should only be used to register 100 tests at a time.
- Staff can now also use the Digital Reader for reading LFD test results as part of the self-report journey. This tool allows users to take a photo of their LFD and uses artificial intelligence to determine the result of the test. Please see the digital reader guidebook.
Eligible day care centres are those that are open and run by paid day care staff. Services must be for adults over 18 and provided within non-residential care settings that support the health and wellbeing of adults. This includes settings such as:
- purpose-built day care 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.
For more information about how to access testing and what the testing process looks like, terms and conditions and the testing privacy notice, please see guidance below.
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.
What to do if someone becomes unwell in a day care setting?
If anyone in a day care setting becomes unwell with symptoms of COVID-19 and has not had a negative test that day they must be sent home immediately and follow the guidance for people with symptoms of a respiratory infection including COVID-19.
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 two 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. The COVID-19 supplement to the infection prevention and control resource for adult social care recommends that gloves, aprons and eye protection should be worn when staff are providing close care for service user who has suspected or confirmed COVID-19. These should be removed and disposed of upon leaving the room.
Staff are recommended to wear a fluid-repellent type IIR masks when giving personal care to a person with suspected or confirmed COVID-19. These should be well-fitting and cover the nose, mouth and chin and should not be touched when worn.
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.
Outbreak of COVID-19
An outbreak is when there are two or more test-confirmed cases of COVID-19 among individuals associated with the same setting with illness onset dates within 14 days.
If an outbreak is suspected, the HPT (or community IPC team, local authority or CCG, according to local protocols) should be informed. A risk assessment should be undertaken with the HPT or other local partner to see if the clinical situation can be considered an outbreak and if outbreak management measures are needed.
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.
Group sizes and day care settings
There are no formal size limits on groups. Managers, local authorities and commissioners should consider the room/building size and layout, ventilation, activities, and client group when making decision about group sizes as part of a risk assessment.
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, consider setting a maximum limit for the number of people using a service at a given time.
Further general information can be found within guidance on living safely with respiratory infections, including COVID-19.