Policy Statement

Having reviewed the latest public health evidence from clinical advisers in UKHSA and the SAGE Social Care Working Group, and with on-going robust infection prevention and control measures in place, the Dept of Health & Social Care have, from 31^st January 2022 eased the restrictions with regards to visiting care homes which was implemented in the response to the Omicron variant.

This Policy follows the guidance updated on 23^rd December 2022 and aims to ensure the continuation of safe visiting during the COVID-19 pandemic and the easement on visiting those who are vulnerable as a result of the sustained transmission of the Corona virus.  

The Trust welcomes that the default position set out in the guidance is that visits should be supported and enabled wherever it is safe to do so.

Amica Care Trust’s Care Homes and services have a duty of care to protect its residents and staff from intruders and anyone who threatens their safety and security.

This policy is to be used in conjunction with the visiting and visitor’s policy and the COVID 19 Testing policy.

This policy is also intended to assist decision making during a COVID-19 outbreak, which is anticipated to last for a sustained period, compared to the usual period for other infectious outbreaks. As the lockdown rules in England have been removed, it is important to recognise that for those in our care settings, there is still the need to balance the continued management of COVID-19 risk, with a cautious approach to enabling the opportunity to receive visitors.

Scope

Closure of the home to visitors

In certain circumstances the management of the home may decide to close to all visitors as they have always done so in the interest of safeguarding residents; this could be due to an infectious outbreak such as:

• Diarrhoea & or vomiting (Gastroenteritis)
• Norovirus
• Clostridium Difficile (C-Diff)
• Respiratory outbreak such as flu or chest infections
• During any pandemic in recent times such as COVID-19
• Discretion of management during any disaster or major event

During these times the home will operate a traffic light system Red, Amber or Green

• Green – open for visitors
• Amber – suspected cases – managers discretion – option to close the home 
• Red – confirmed cases of either staff / residents / Major incident affecting the home – home closed

As a result of the global pandemic all the Trust services have previously been closed to all visitors as residents are classified as extremely vulnerable and have been shielding on the advice of the Government. 

In order to ensure the residents safety, it has previously been necessary to limit visiting to open spaces such garden visits at these times when the homes were unable to accommodate indoor visits, these visits have been important for the emotional wellbeing of the residents in our care.

Human rights recognise that all people living in care settings have the right to freedom of movement and association, including the right for residents to see their families.

This policy and guidance seeks to balance the rights of an individual with the rights of the others within the care setting (residents and staff) and the duties and responsibilities of Amica Care Trust.

All visitors also have an important role to play – helping to keep their loved ones, other residents and staff safe by carefully following the policies described in the guidance, and the practical arrangements that care homes put in place, such as internal risk assessment and infection prevention and control protocols.

In the face of new variants of the virus such as the Omicron variant, we need to remain alert to ensure we protect those most at risk in care homes.

From 31^st January 2022 there is no limit to the number of visitors a resident is able to receive, and the duration of the visits are not limited.

As of 31 August 2022, the government announced that there is a pause on Asymptomatic Testing, regular twice weekly asymptomatic testing has ended for the social care workforce, the NHS, Asymptomatic testing has also ended for visitors and visiting professionals to care homes.

During an outbreak or a period of isolation each resident is able to have one visitor at a time inside the care home but this visitor does not need to be same person each time.

Following the opening of the restrictions a resident and relative survey was undertaken to ensure all parties continue to feel safe and this policy follows the majority wishes of our residents and visitors

• be free of any COVID-19 symptoms on the day of their visit
• must be well on the day of their visit’s, visitors should not enter the care home if they are feeling unwell, Transmissible viruses such as flu, respiratory syncytial virus (RSV) and norovirus can be just as dangerous to care home residents as COVID-19. If visitors have any symptoms that suggest other transmissible viruses and infections, such as cough, high temperature, diarrhoea or vomiting, they should avoid the care home until at least 5 days after they feel better.
• Visitors and residents are advised physical contact is now enabled. Physical contact like hand holding is acceptable if hand washing protocols are followed.
• Visitors (who are not legally required to self-isolate) are advised against visiting the care home (for 10 days) if they have been identified as a close contact of someone with COVID-19, unless absolutely necessary, even if they have been fully vaccinated.
• Vaccination is one of our best defences to combat infection. It significantly reduces the transmission of the virus, particularly following 2 doses and evidence suggests that having the booster (and second booster if eligible) will also give protection from the variances. It is strongly recommended that all visitors and residents take the opportunity to be vaccinated before conducting visits.

Each care home is unique in its physical environment and facilities, and the needs and wishes of their residents. As such, care home managers are best placed to develop their own practices to ensure that the visits described in the guidance are provided in the best way for individual residents, their loved ones, and care home staff.

Care home managers should feel empowered to exercise their judgement when developing practical arrangements or advice to put this guidance into practice so that visiting can take place smoothly and comfortably for everyone in the care home.

All visits have and will continue to have to follow safe visiting practices. Which are in line with Government guidelines and the wishes of our residents.

• A note to ensure visitors are wearing a face covering / face mask. Transparent face masks can be worn by visitors that meet technical specifications. (https://www.gov.uk/government/publications/technical-specifications-for-personal-protective-equipment-ppe/transparent-face-mask-technical-specification)  These must be purchased directly from the manufacturer and used subject to risk assessment. If you do purchase and want to wear a clear mask, then please let the manager know giving all the details of the mask before you visit to ensure a risk assessment is in place.
   

Types of visiting

Visits can take place in a room most practical and comfortable for the resident, such as their own room. IPC measures must still be adhered to by the visitors and good ventilation in the rooms is recommended.

It will continue with its policy of:

• “indoor” visits
• The home will ensure that all visits are conducted in a risk-managed way that considers the needs of our service users and the practicalities arising from the physical features and layout of the home
• It will continue to assess the rights and needs of individual residents, particularly those with specific vulnerabilities as outlined in their care plans and will consider the importance of visits in promoting their health and wellbeing
• It will continue to make appropriate best interest decisions with the help of all involved in their care in respect of residents who lack mental capacity and who might be subject to deprivation of liberty authorisations
• During an outbreak or a period of isolation each resident are able to have one visitor at a time inside the care home but this visitor does not need to be same person each time.

It will follow all government and local guidance in respect of the arrangements needed to ensure safe visiting of residents under the new testing procedures.
 

Additional measures

Each service will risk assess their environment to be able to accommodate visiting in areas of the home, each service will also take the following measures.

• Staff will ensure the visitor/s have washed their hands / used the alcohol hand gel when they arrive and leave the area.
• Visitors’ temperatures are taken, and questions asked about their general health on admission through the E-reception ipad.
• The visitor should have access to a face covering if needed, please ask the team if you do not have one.
• Where a visitor appears unwell / has a temperature the home / service will request the visitor leave and re book their visit.

If at any time visitors break the visiting protocol, they may be asked to leave, and a meeting arranged with the management of the home.

The health and wellbeing risks arising from the needs of our residents will be taken into consideration. Each resident will have a care plan detailing visiting information / requirements and a risk assessment.

Implementation

The Trust recognises that its visiting policy and arrangements will be very much subject to local circumstances and will have to be adjusted to meet any changes in these. These changes include:

• The circumstances of the care home in terms of, for example, its location, resident needs, current staffing situation and its experiences with the COVID-19 outbreak
• The local circumstances of the COVID-19 epidemic, including past and current incidence and transmission risks

Any arrangements made by the home will apply only when safe to do so, with the approval of the local Public Health authority and on the basis its “dynamic risk assessment”.
 

Communicating with Families and Visitors

The Trusts homes will follow Government guidance in respect of enabling visits to be conducted safety and successfully, including supporting visitors on how to prepare for a visit.

The Trusts homes accepts that the arrangements for each set of visits will vary and need to be highly individualised.
 

Visitors’ Risk Assessments

When visiting our care homes, we will still ask you to:

• Check with us before visiting that everything is in order and that you do not have any symptoms for COVID-19 via the E-Reception pad.
• Avoiding touching their eyes, nose, and mouth with unwashed hands
• Carry out stringent hand hygiene practice by always washing hands carefully before and after any contacts made - using the soap and hand sanitiser gels and paper towels provided
• Help staff to carry out the procedures that have been put in place to keep everyone safe from the virus and its spread
• Report and discuss with us any concerns you have about the health of the person whose welfare is your concern.

We are confident that with these precautions in place we will be able to keep our residents safe as possible.

The home will update this visiting policy in the light of further developments and the easing of restrictions as the risk decrease. It will, however, return to a tightening- up if there are further cases of COVID-19 in the home or evidence of increased risk from community transmission that has been identified by local Public Health.
 

Ability to suspend visiting

In the event of any suspected or actual outbreak of COVID-19, or a suspected or known case of COVID-19 within the home / service, will allow residents to receive one visitor who could also be an ”essential care giver” (though numbers may be increased in exceptional circumstances such as end of life )visitor restrictions may need to be immediately implemented which suspend some of these enabling approaches and will include exclusion of any non–essential visitors. (Exclusion of non-essential visitors may include any contractors visiting the home).

This will be implemented in a transparent manner with open and clear communication to residents and relevant family members; this could mean that a visitor will be turned away if a suspected case has come to light during the time, it has taken them to travel to the home. As explained above one visitor will be permitted in the event of an outbreak, this does not need to be the same visitor each visit.

The Trust will work within the guidance set out by the Government which states:

There will be no limit on the number of visitors a resident can have, and the duration of the visit is not limited.

There is no requirement for the resident to test and isolate after visits out, providing these visits are not deemed to be “high risk”.

The visits can now take place in a room most practical and comfortable for the resident such as their own room.

In the event of an outbreak of Coronavirus, the decision on visiting will be based on the advice from the director of public health, as well as any additional advice or guidance from the local infection-control lead from the CCG, and the local PHE HPT.

Role of providers and directors of public health (DPH) in providing a dynamic risk assessment

The priority is making sure those in care homes receive the care and support they need. This includes making sure that residents are not put at avoidable risk of contracting COVID-19, which can have such a devastating impact if it spreads through a care home, infecting vulnerable residents and potentially care staff.

Therefore, the provider will continue to assess and balance the risk of local prevalence and the ability of the care home to manage the visit safely. This dynamic risk assessment must formally take into account the advice of the local DPH. The DPH may choose to provide this through a dedicated care home outbreak management team or group, often in partnership with local social care commissioners. 

The role of the DPH includes formally leading efforts to suppress and manage outbreaks, and the local outbreak plan (overseen by the DPH) includes care homes. DPH also have powers to issue directions to homes to close to visiting, or to take further specific steps.

Care homes must also take into account the significant vulnerability of residents in most care homes, as well as compliance with obligations under the Equality Act 2010 and the Human Rights Act 1998, as applicable.

The care home’s visiting policy is made available and communicated to residents and families, together with any necessary variations to arrangements due to external events.

In the event of an outbreak in a care home, the home will rapidly move to limit visiting (except in exceptional circumstances such as end of life) to protect vulnerable residents, staff and visitors.

There may be local policy and outbreak management arrangements, which will be important to follow. These restrictions may continue until such time as it is understood that the outbreak has been brought under control and the care home has recovered – at this point visiting will be restarted but with the usual infection prevention and control measures and any enhancements required due to any risks identified following the recent outbreak.

In order to enable visits to happen safely it is vital that the DPH has a live view of the local conditions. The Capacity Tracker is a timely and rich source of information which will help inform the DPH’s advice on visits. Completing the Capacity Tracker monthly will help provide assurance and early warning if there were to be an outbreak, as well as helping to provide confidence on regular reporting and that any new cases would be rapidly reported to the local PHE Health Protection Team.
 

Rights and responsibilities

This policy includes the rights and responsibilities for both Amica Care Trust and visitors which put the welfare and wellbeing of residents/ people receiving care at the heart of the approach when developing this visiting policy.

Rights
Amica Care Trust has the right to	Visitors have the right to
Mitigate risk of infection by refusing entry to their home to anyone, or requesting that a person leave the premises, for any justifiable reason consistent with this policy / protocol.	Access care homes in accordance with the entry requirements set out in the visiting policy of the care setting.
Consider increased visitor restrictions when an outbreak (including non-COVID-19) occurs within the home or if there are other extraordinary circumstances that require them. Usage of such circumstances will be closely monitored.	Be notified by timely and regular updates and information about what is happening in the home in relation to visiting and local COVID-19 prevalence and transmission risk.
	Be provided and supported with additional ways to connect such as video conference or telephone calls in addition to one visitor per resident of in-person visits during a COVID-19 outbreak.

 

Responsibilities
Amica Care Trust has the responsibility to	Visitors have the responsibility to
Provide a clear policy and information on how they will facilitate visitors, using a dynamic risk-based approach, and make this publicly available as needed.	Follow the home's visiting policy and Visitor Code.
Provide clear information about how the visit will work and the infection and prevention control measures that must be followed.	Not to visit when unwell or displaying any signs of a cold/flu, respiratory or COVID-19 symptoms.
Treat all visitors with respect and courtesy, and to provide clear instructions about the visiting policy.	Treat all staff with respect and courtesy, and to follow their instructions on the visitor policy.
Proactive communication with residents and families where an outbreak occurs, and the impact on the visiting policy.	Follow visiting requirements including, infection and prevention control measures such as washing hands, remaining designated areas and social distancing requirements – as directed by the care home staff – and that failure to do so may affect the future ability to visit.

 

Visiting outside the care home

Spending time out of the care home has always been an important part of life for many people living in residential care, and residents leave their care home for a range of reasons. These might include to attend work or education, attend medical appointments and to spend time with friends and family.

For some residents, regular visits out may have been assessed as being a necessary part of their care plan, such as accessing care and support at day services, participating in community groups and volunteering. This might include regular planned overnight visits to the family home.

We recognise how important this is for residents’ health and wellbeing, their ability to remain at the heart of family and social networks, and, in some cases, to deliver the objectives of their care plan. 

However, spending time with others outside the care home will increase the risk of exposure to COVID-19 for the resident and potentially to other residents and staff on their return. This is the case even when we see community infection rates dropping and vaccine coverage increasing. 

Care home residents should not be asked to isolate or take a test following high-risk visits out of the care home including following emergency hospital stays (unless the hospital is in active outbreak.)

 

Supporting visiting – guidance

Providers are best placed to define their overall policy for how outward visits are supported in the care home, in a way that takes into account the assessed needs of their residents and what is possible within the facilities and resources of the care home.

The make-up of the care home community should be a key determinant of local arrangements for supporting outward visits. This is because residents are likely to have a range of needs, long-term conditions and other clinical vulnerabilities and levels of mobility.

Providers should consider both the benefits and potential risks involved in a visit out of the care home, in order to recommend measures to mitigate risks before, during and after the visit. Consideration should be given to the risk to other residents (who may be particularly vulnerable) and staff.

In the event of an outbreak, all movements out of a setting should be minimised as far as possible.

The Trust will have the right to change and adapt this policy in line with Government guidance at any time.

Visitors have the right to express their concerns through the Amica Care Trust complaints and concerns policy.

The Trust will not accept liability for any illnesses the visitor may contract following a visit to its services including COVID-19 as a global pandemic.