Provider FAQ – Version 10 – 23/03/2020

 The FAQs below have been produced by Hertfordshire County Council in conjunction with HCPA and will be updated on a regular basis, therefore, we recommend you revisit this web-page daily for the most up-to-date guidance.

FAQ CATEGORIES
Clinical Finance General PPE / Cleaning Staffing Visitors
           
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Who do I call for immediate advice if I suspect someone has the virus, either a person we are supporting, staff member, or a family / relative?

A staff member/resident’s family member needs to go home immediately and self-isolate for 7 days. They only need to contact 111 if their health deteriorates.

If associated with a Care Home, contact Public Health England (PHE) East of England Health Protection Team by phone on 0300 303 8537
(Out-of-hours for health professionals only: 01603 481 221)

Should we be carrying forward PRN Medication?
Due to the existing national situation regarding COVID-19 and demands on health care provisions, Herts Valleys & East and North Hertfordshire CCG Care Home team would like to remind Care Home staff that it is essential to carry forward PRN / ‘when required’ medication such as Paracetamol to safeguard stocks and enable Care Home providers to continue to provide effective care. »Reducing Medicines Waste in Care Homes
» When Required Medication PRN Guidance for Care Homes
What is the current guidance on Anti-Inflammatory Medications?

There have been concerns about the use of non-steroidal anti-inflammatory medications (NSAIDs) in relation to COVID-19 following a statement by the French Health Minister (a clinician) advising against the use of Ibuprofen.

This statement was based on provisional information reported from French care settings, which UK authorities have not seen and are, to date, unpublished. There is no current literature on the impact of NSAIDs and COVID-19.

There appears to be some evidence for SARS 1 that there may be an adverse impact on pneumonia. There is also some literature suggesting NSAIDs may increase complications from simple acute respiratory infections or slow recovery. However, the evidence is not conclusive overall.

There appears to be no evidence that NSAIDs increase the chance of acquiring COVID-19. In view of the current lack of clarity, the Committee of Human Medicines (an advisory body of MHRA) and NICE have been asked to review the evidence. It is therefore suggested that, in the interim, for patients who have confirmed COVID-19 or believe they have COVID-19, they should use paracetamol in preference to NSAIDs.

Those currently on NSAIDs for other medical reasons (e.g. arthritis) should not stop them.

What do I do if neither the individual in care nor the care worker have symptoms of COVID-19?

If neither the care worker nor the individual receiving care and support is symptomatic, then no personal protective equipment is required above and beyond normal good hygiene practices.

General interventions may include increased cleaning activity to reduce risk of retention of the virus on hard surfaces and keeping property properly ventilated by opening windows whenever safe and appropriate.

Care workers should follow advice on good hand hygiene.

What do I do if a Supported Living, Homecare or Care Home care worker is concerned they may have COVID-19?

If care workers are concerned they have COVID-19, they should follow the NHS’s advice.

If they are advised to self-isolate at home, they should follow the COVID-19: Stay at Home guidance.

If advised to self-isolate at home, they should not visit or care for individuals until safe to do so.

A care worker needs to report their compromised health condition to a manager who should speak to HPT for advice regarding contact within a Care Home.

Who do I call for immediate advice if I suspect someone has the virus, either a person we are supporting, staff member, or a family/ relative?

Anyone displaying symptoms of a high temperature (over 37.9) and / or a continuous cough should stay at home and self-isolate for 7 days. If you are concerned about a service user due to them being classed at a higher risk of complications, then you should visit the online COVID-19 service or call the NHS on 111. You should also contact 111 if their condition worsens or their symptoms do not get better after 7 days.

What will I do if the GP will not make a home visit and I am concerned about a person I am supporting?
If this happens, call the NHS on 111.
How will I find the money to pay Statutory Sick Pay (SSP), including staff on zero hours contracts?

The government will bring forward legislation to allow small- and medium-sized businesses and employers to reclaim Statutory Sick Pay (SSP) that is paid for sickness absence due to COVID-19. The eligibility criteria for the scheme will be as follows:

  • This refund will cover up to 2 weeks SSP per eligible employee who has been off work because of COVID-19
  • Employers with fewer than 250 employees will be eligible – the size of an employer will be determined by the number of people they employed as of 28 February 2020
  • Employers will be able to reclaim expenditure for any employee who has claimed SSP (according to the new eligibility criteria) as a result of COVID-19
  • Employers should maintain records of staff absences and payments of SSP, but employees will not need to provide a GP fit note
  • The eligibility period for the scheme will commence the day after the regulations on the extension of Statutory Sick Pay to those staying at home comes into force; the government will work with employers over the coming months to set up the repayment mechanism for employers as soon as possible
» GOV.UK: Sick pay from day one for those affected by coronavirus
Is the guidance available from the government for care services?
Further guidance has been released by the government on the 13th March, 2020. » COVID-19 residential care supported living and home care guidance
Is Quality Monitoring of services still taking place?

Hertfordshire County Council has taken the decision not to undertake monitoring visits at this time to allow providers to respond to the current outbreak. Your Monitoring Officer will be in contact to discuss monitoring support during this time.

What is the Hertfordshire mutual aid plan?

As well as the arrangements we have put in place to support providers with advice, guidance and information, Hertfordshire County Council wants to develop a Mutual Aid programme to ensure the most effective use of our Health and Social Care resources across the county in this time of heightened pressure and demand on services. The two key areas we want to develop with providers are:

  • The prioritisation of care: working together to coordinate risk assessments across providers to ensure the security of support to the most vulnerable service users
  • The most efficient and effective use of overall staff resource: working with communities, voluntary and statutory providers to ascertain which services have the capacity to provide additional support and share available workforce, including re-deploying staff who work at services that close

Hertfordshire County Council and HCPA are working with the CQC and other partners to clarify the compliance of arrangements. Hertfordshire County Council is in direct contact with its contracted providers about any changes to financial and payment arrangements that will be required to enable this to work.

Can I have a full list of contacts for the CCG and Hertfordshire County Council or will there be a call centre set up?
Please call the Social Care Provider Hub on 01707 708 108.
Can you give us a contingency checklist to support us in reviewing our business continuity plan?

Review your business continuity plans, with a specific focus on your workforce. At the moment, the duration of the outbreak is unpredictable and plans should take this into consideration.

Please utilise this checklist to review your Business Continuity Plan.

What training opportunities are available for, and during, the COVID-19 situation for Care staff?

Please use the Powerpoint slides and watch the video on this page.

Infection Prevention and Control (IPC) Nurses, HCPA, and CHIT can support and provide education at this stage, please email assistance@hcpa.info

» Our COVID-19 webpage
What is Hertfordshire County Council’s expectation of Residential care providers during this period?

We expect all care providers to respond appropriately to these unusual circumstances. For example, we expect the hospitals to discharge a number of people to Residential care in the next two weeks in order to free up beds for people with the Coronavirus.

If you are asked to accept a hospital discharge, please discuss any symptoms with the ward and find out as many details as possible, including any PPE requirements. If you do choose to accept, then ensure you are following your IPC policies and procedures – link to the DoH guidance around Prevention and Control of Infection in Care Homes.

There should be no reason for homes not to admit if the patient/resident has no symptoms and is not coming from a ward where there have been any.

» GOV.UK: Care Home Resources
is there any information from CQC we need to be aware of and when should we contact CQC?

We understand the reference to notifications in our letter yesterday has caused some concern. We are sorry about that and are pleased to have an opportunity to clarify this. We want to support the sector during this time and ensure appropriate attention is paid to the impact of COVID-19 on people with care and support needs. We are taking an active role in coordinating information locally and centrally. This is to make sure the risks are known and understood by both government and Regional Incident Centres – understanding what is happening means we will be well placed to galvanise the right level of support from them for Social Care.

There are no changes to the requirements to make notifications or the system used to make them. You should notify us of deaths and of events that stop you carrying on your service ‘safely and properly’ (Regulation 18). This will mean letting us know if your service operation is being negatively affected by COVID-19. It does not mean that you need to notify us of every single COVID-19 related issue.

Aside from making notifications in the usual way, we would encourage you to stay in touch with us. Please contact us if there are specific concerns and issues that you would like to make us aware of. This is new territory for all of us and we want to be able to advise and support you in any way that we can. We understand how important Adult Social Care is and the vital role it has in our Health and Social Care system.

If you have low staffing levels or other concerns, please either contact your inspector; if you do not have their number, then please call through to the 03000 616 161 number. That way, you can be transferred directly and a log [Enquiry number] will be created.

» How the CQC are responding to the outbreak
How can I help the wider Hertfordshire Care Home system during this time?

Please keep your Herts Care Search profile up-to-date on a daily basis. If you identify spare resource, please inform us.

Are there any areas on insurance I need to consider?

Businesses should check with their insurance provider if they are covered. Many businesses are unlikely to be covered as most business interruption insurance policies are dependent on damage to property, which will exclude pandemics. Some businesses may have purchased a specific add-on relating to notifiable diseases but some of these will still specify damage to the building. Some businesses may have purchased supply chain or denial of access cover, which may meet their needs in this case.

Do you have instructions on how to correctly use PPE?
These can be found in our Guidance and Resource section under Public Health England, Infection Control and Prevention Guidance.
» GOV.UK: Wuhan Novel Coronavirus Infection Prevention & Control
What is the advice for those providing care that involves close contact to people who may have, or have been confirmed as having, the Coronavirus?

Information on close contact with people and correct PPE use can be found under the Guidance and Resource section under Public Health England, Infection Control and Prevention Guidance here.

What is the correct process for putting on and taking off PPE?
Please follow Public Health England’s quick guide for Donning and Doffing PPE. »PHE’s COVID-19 ‘donning’ quick guide
Where will I obtain extra supplies of PPE and hand gels/soaps etc.?

We have now been advised by the National Supply Disruption Service (NDS) of the following:

  • NDS know that supplies of personal protective equipment to the care sector are fundamental for the good care of individuals with suspected symptoms of COVID-19. NDS are clear that no wholesaler has been asked to prioritise NHS provision over the Care sector nor should they be doing so.
  • Free distribution of fluid repellent facemasks from the pandemic flu stock started on Wednesday, 18th March, with every registered Care Home and Homecare provider receiving at least 300 facemasks. NDS anticipate the distribution will be complete by next Tuesday. This is aimed at tiding over the initial rise in demand following the change of guidance on facemasks last week.
  • Providers are not required to take action; the stock will be delivered to them
  • NDS is working rapidly with wholesalers to ensure a longer-term supply of all aspects of personal protective equipment including gloves, aprons, facemasks, and hand sanitiser.
  • For future PPE requirements, care providers should order PPE from their usual suppliers.
  • If care providers have immediate concerns overs their supply of PPE, there is now a dedicated line for you, the Health and Social Care sector
    The National Supply Disruption support line
    Tel: 0800 915 9964
    Email: supplydisruptionservice@nhsbsa.nhs.uk 
    Please note that our Hertfordshire provider support line is unable to deal with concerns over non-delivery from NDS and all enquiries on this PPE delivery must be directed to the above number and email. Unfortunately, we have no control over this.
  • In the future, if a care provider is unable to get PPE from their normal supplier, the provider will be asked to report this to the National Supply Disruption Response (NSDR) team supplydisruptionservice@nhsbsa.nhs.uk, who can advise on alternative suppliers.

Remember, this supply is still very limited and we would advise care providers to ensure that this stock is used in line with the following guidance.

What changes to our cleaning regime do we need to consider at this point?

You should consider frequent and thorough cleaning of well-used touchpoints, such as door handles and lift buttons, with regular cleaning of surfaces in communal areas including phones etc.

A combined detergent/disinfectant solution at a dilution of 1,000ppm with available chlorine or a general-purpose neutral detergent in a solution of warm water followed by a disinfectant solution of 1,000ppm is to be used.

There is government guidance on environmental decontamination.

» COVID-19 decontamination in non-healthcare settings
What should we be doing with waste for suspected cases in Residential homes, Homecare and Supported Living?

New PPE must be used for each episode of care. It is essential that used PPE is stored securely within disposable rubbish bags. These bags should be placed into another bag, tied securely and kept separate from other waste within the room. This should be put aside for at least 72 hours before being disposed of as normal; many Care Homes already have well-established processes for waste management.

Clean frequently touched surfaces. Personal waste (such as used tissues, continence pads and other items soiled with bodily fluids) and disposable cleaning cloths can be stored securely within disposable rubbish bags. These bags should be placed into another bag, tied securely, and kept separate from other waste within the room. This should be put aside for at least 72 hours before being disposed of as normal.

Do not shake dirty laundry – this minimises the possibility of dispersing the virus through the air. Wash items, as appropriate, in accordance with the manufacturer’s instructions. Dirty laundry that has been in contact with an ill person can be washed with other people’s items. Items heavily soiled with bodily fluids, such as vomit or diarrhoea, or items that cannot be washed, should be disposed of with the owner’s consent.

If the individual or provider does not have a washing machine, wait a further 72 hours after the 7-day isolation period has ended. The laundry can then be taken to a public laundromat.

If Homes have Category B infectious waste bins, then waste may be put directly into these streams and there is no need to double bag and wait for 72 hours.

Who should I speak to regarding cleaning and waste in care settings for positive cases?

Contact PHE East of England Health Protection Team by phone: 0300 303 8537 (option 1)

Out-of-hours for health professionals only: 01603 481 221

What social distancing guidance should we be following?
Can I get volunteers to come and support the care service if the staffing situation becomes desperate?

HCPA have launched the Volunteer Coordination Centre in partnership with Hertfordshire County Council and Team Herts Volunteering. If you have a request for volunteers, please complete this form.

We have a team working on volunteer requests.

What do I need to change within my recruitment processes to continue recruiting staff?

At this stage, we recommend completing WhatsApp video interviews or telephone interviews where possible. If you are completing face-to-face interviews, ensure that your effective hygiene processes are in place for any visitors.

You still need to complete pre-employment checks and carry out basic training for the individual to provide care and support. If you need us to support you with recruitment, send your job vacancies to the recruitment team here.

Are our staff classed as key workers?
The government guidance on key workers can be found here. » Guidance for schools, colleges and local authorities on maintaining educational provision
What do I do if one of my staff is pregnant?
Pregnant women full under the category of vulnerable people who need to socially distance. Please read the guidance and discuss this in detail with any staff. » Guidance on social distancing for everyone in the UK and protecting older people and vulnerable adults
Do you have guidance on what to do if a staff member's family member is in isolation?
Please find the government guidance here.
What do I do if I don’t have enough staff to cover our clients?

If you have low staffing levels where delivering care is unsafe, you need to contact the CQC and your contact manager.

For the CQC, contact your inspector. If you do not have their phone number, you can call 03000 616 161. That way, you can be transferred directly and a log [Enquiry number] will be created.

What advice should I be giving to my staff?

For the most up-to-date and accurate information on the Coronavirus, you should use the following resources here.

General advice for everyone to follow:

  • Ensure everyone maintains good hygiene at all gatherings, especially people who prepare or serve food, those handing out equipment, etc. or having other direct physical contact with numbers of people. This means washing hands often with soap and water for at least 20 seconds. Alcohol-based hand sanitiser that contains at least 60% alcohol can be used if soap and water are not available.
  • Provide hand gel at entrances and ensure there is a good supply of soap or hand gel in cloakrooms and kitchens etc.
  • Ask anyone with cold or flu symptoms to refrain from attending.
  • Regularly clean and disinfect surfaces people touch regularly, including such things as door handles, light switches, etc.
  • Put up posters reminding people to:
    • Catch it – sneeze into a tissue
    • Bin it
    • Kill it – wash your hands with soap and water
    • Don’t touch your eyes, nose and mouth unless you’ve washed your hands

Call 111 if you feel that you are experiencing symptoms of the Coronavirus, which include a cough, a high temperature, and shortness of breath. Do not go to your doctor or to hospital.

» NHS website for information on the virus and how to prevent it spreading; Public Health England have the most up-to-date information on the number of cases, the Government’s response and how to protect yourself
» GOV.UK: Coronavirus guidance to assist professionals in advising the general public
Should I ask my staff to cover other services and, if so, who will coordinate this?

It is worth considering what skills and experience your staff have, for internal or external redeployment. At the moment, this is not required but if it is Hertfordshire County Council and HCPA will provide a coordination role. Please be aware new guidance is due to come from the government regarding DBS checks.

If you do have additional capacity for staffing or other resources, please email volunteer@hcpa.info.

Staff should not be allocated to work with symptomatic clients / residents, if more than one has symptoms.

How do I prioritise my clients?

Review your list of clients and ensure that it is up-to-date, including levels of informal support available to individuals. Providers should consider how you can share this information electronically and if you receive a legitimate request, what the dataset might include.

Be ready to identify those who are most at risk from COVID-19, including people who fund their own care.

It may be helpful for providers to share the number of hours of care you provide to help with planning but providers will want to satisfy themselves that it is lawful for them to share that information.

You will receive a spreadsheet to complete from Hertfordshire County Council.

What do I do if employees do not want to come to work?

Some people might feel they do not want to go to work if they’re afraid of catching the Coronavirus.

An employer should listen to any concerns staff may have.

If there are genuine concerns, the employer must try to resolve them to protect the Health and Safety of your staff. For example, if possible, you could offer flexible working.

If an employee still does not want to go in, they may be able to arrange with their employer to take the time off as annual or unpaid leave; the employer does not have to agree to this.

If an employee refuses to attend work, it could result in disciplinary action.

If day services shut, how will we manage our clients as we don’t have staffing quotas for this?

If this becomes necessary, there will be specific conversations and decisions taken with the relevant providers. You should begin planning this now.

The provider hub is considering where day centre staff can be redeployed to care services.

All commissioned services will be receiving a letter from Hertfordshire County Council with regards to stabilising income during this period.

Who do we call if our nursing numbers reduce to a point where we feel it is unsafe to provide care to complex clients?
Redeploy and prioritise staff where possible and use agency staff. Contact the Provider Hub to see where they can support you and make sure you contact the CQC and commissioning to report concerns. » Infection, prevention & control guidance – February 2020
The process of self-isolating a service user is clear, however, the conversation with staff who have been in contact is less clear and this something we would need to discuss with 111, or PHE; is there any further advice?

If the staff member is showing any symptoms, they should follow self-isolation guidance.

Should we be asking staff who are high risk due to long-term health conditions to self-isolate or should we redeploy them elsewhere?

Identification of staff at risk of becoming very unwell with COVID-19 and planning on how they might be redeployed is a sensible precaution.

Should I still be sending staff on training during this period?

This will currently depend on your company policy. If staff members have symptoms, or are unwell, they should not be attending work or other work-related activities. Also, please speak to your training provider to understand if they will be posting training online or be applying cancellation charges.

Are there any rules with using agency staff to support us with staff shortages?

Make sure that you are working with agency staff with mandatory skills and enhanced DBS checks.

Discuss block booking agency staff with the agencies so you can just have them working within your service.

If an employee is not sick but the employer tells them not to come to work?
If an employee is not sick but their employer tells them not to come to work, they should get their usual pay. For example, if someone has returned from China, Italy or another affected area and their employer asks them not to come in. » ACAS Coronavirus information
What do I do if an employee needs time off work to look after someone?

Employees are entitled to time off work to help someone who depends on them (a ‘dependant’) in an unexpected event or emergency. This would apply to situations to do with the Coronavirus.

For example, if they have children that they need to look after or arrange childcare for because their school has closer or if they’re sick, or need to go into isolation or hospital, there is no statutory right to pay for this time off; but some employers might offer pay depending on the contract or workplace policy.

The amount of time off an employee takes to look after someone must be reasonable for the situation. For example, they might take 2 days off to start with, and if more time is needed, they can book annual leave.

» ACAS Coronavirus information
What do I do if someone infected with the Coronavirus comes to work?

If someone with the Coronavirus comes to work, the workplace does not necessarily have to close.

The local Public Health England (PHE) health protection team will get in contact with the employer to:

  • Discuss the case
  • Identify people who have been in contact with the affected person
  • Carry out a risk assessment
  • Advise on any actions or precautions to take
  • Find out more about PHE health protection teams on GOV.UK

The process may be different in Scotland and Wales.

» ACAS Coronavirus information
Is there Community Support that we can call upon when staffing levels are low?

The Provider Hub is currently capturing additional resources. Please contact the Hub about your concerns.

Do you have a poster we can share for families about what to do for our visitors to our care home?
Please consider displaying the ‘Catch it, Bin it, Kill it’ and hand washing poster. Make sure your front line staff at reception have the key messages to advise visitors, for example, washing hands before coming in. » NHS website for information on the virus and how to prevent it spreading
Do you have easy read advice we can use for clients?
Please find attached a link to an easy read information leaflet on COVID-19 and hand-washing, including a video for individuals on hand-washing. »Easy read flyer
»‘How to wash your hands’ video
As a provider we have made a decision to not allow non-essential visitors, is this ok?

We are following central government advice around social distancing, including if a Residential or Nursing home should cease external visitors. The current advice is that only essential visits should take place. If you do choose to take this decision then please make sure you have considered other ways for communication to the residents from families and relatives, such as skype and any other contingencies for residents. For example, those at end of life. It is important that you consider the impact that this could have on the mental wellbeing of your residents and be careful how you give the messages to families and relatives, so that you do not cause panic.

You also need to consider any actions you take to restrict your residents in line with DOLs legislation and the Mental Capacity Act, including capacity assessments and best interest decisions. You should consider taking your own legal advice. It is recommended that a risk assessment is undertaken around this decision.

If you do have an outbreak or suspected cases, you should be following isolation procedures and be in contact with the health protection team.

Our expectation is that essential health professionals should continue to be given access during outbreaks.