Updated April 2021

Here at Amica Care Trust we strive to keep all of our residents and staff as safe as we possibly can throughout these unprecedented times, and we have always sought to enable visitors to see their loved ones in line with the Government Guidelines. Not only have we invested in providing visitor pods to enable visiting to continue through the height of the pandemic, but we are now pleased to be able to facilitate one designated visitor for each resident and from 12 April, two designated visitors for each resident.

We operate a booking system in all of our homes to enable us to support each visit in the safest way we can, all visitors will be expected to undertake an LFD test which takes 30 minutes, prior to the visit commencing, as well as wearing personal protective equipment (PPE). To enable all residents who want to have visitors this opportunity, we do have to limit each visit to one hour, but I am sure you will understand this.

Please be assured that we operate COVID secure homes and have robust COVID-19 protocols in place which are updated in line with the Government Guidelines.

If you wish to visit your loved one please contact the home directly to book an appointment.

If you wish to bring a gift, this will need to be quarantined for 72 hours before the resident can receive it.

We are working closely with the Local Authorities, Public Health England, CCGs and Government advice to ensure that any risks of COVID-19 are well managed and people are protected.

We have robust COVID-19 protocols in place, staff have received training and we have adequate supplies of quality Personal Protective Equipment.

HOMES STATUS

New Admissions:

All of our homes are open to new residents and we welcome any enquiries if you are requiring support to care for your loved one. Please contact the home directly for up to date information.

Policy Statement                                         Visiting during a Pandemic

The policy aims to ensure 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 policy thus aims to minimise the risks to residents’, the employees of the Trust and to the visitors themselves, the Government has released guidance and this policy outlines out compliance with the dynamic risk assessment approach. 

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.

The policy is also in line with Care Quality Commission guidance, the Department of Health and public Health England.

This policy is intended to assist decision making during the COVID-19 outbreak, which is anticipated to last for a sustained period, compared to the usual period for other infectious outbreaks. As we see other parts of our community experiencing a small degree of easement of the lockdown rules in England, it is important to recognise that for those in our care settings, there is a need to balance the continued management of COVID-19 risk, with a cautious approach to enabling the opportunity to receive visitors, the prevalence of this is highlighted again with the new strain of the Covid-19 virus and the known enhanced spread of the virus.

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:

1. Diarrhoea & or vomiting (Gastroenteritis)
2. Norovirus
3. Clostridioides Difficile (C-Diff)
4. Respiratory outbreak such as flu or chest infections
5. During any pandemic in recent times such as COVID-19
6. Discretion of management during any disaster or major event

 

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

1. Green – open for visitors in line with the Covid-19 testing policy
2. Amber – suspected cases – managers discretion – option to close the home 
3. 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 had been necessary to limit visiting to open spaces such garden visits at these times when the homes were unable to accommodate in door 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.

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

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, in order for visits to happen, the provider needs 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. DPHs 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 stop 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 may 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 making their judgement the director of public health should consider as a minimum:

1. local testing data, including test and trace data, to form a view on the accuracy of local outbreak information including data on uptake, results and frequency of testing in the local area, as well as to form a view of community prevalence
2. any national oversight taking place in an area due to transmission risks

In addition, in making their decision about visiting policy, providers and the director of public health should, where possible, consider:

1. any testing that takes place outside of the care home, for example community or home testing.  Staff must inform the care home so that the result is factored into the decision-making process to help inform the visiting policy
2. results from weekly testing of staff and monthly testing of residents. This data will enable the risk assessment to be well informed. Evidence of outbreaks and recovery from outbreaks should also be considered (a recovered outbreak is defined as 28 days or more since the last suspected or confirmed case reported)
3. local intelligence on risk factors relevant to transmission in the care home, for example a nearby concentration of locations where there is a higher potential risk of transmission (for example, food processing plants)
4. readiness of the care home to respond quickly when there is a confirmed or suspected COVID-19 case within the care home, to immediately return to essential visits only (for example, end of life), with no exceptions. This assessment of readiness may be based on Care Quality Commission reports, experience of a care home’s responsiveness throughout the pandemic and other local qualitative information

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 daily 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.

Visits should always take place with appropriate infection-control precautions.

Types of visiting

The Trust’s services have engaged in a variety of visiting options which have included:   

1. Window visits:  ground floor window access for both residents and their visitors and the relevant social distancing and PPE measures have been observed.
2. Garden visits: Relevant PPE measures and social distancing have been used, and these visits have been pre-booked to ensure distancing is observed.
3. Designated areas within a care setting where settings allow for this: depending on the physical layout of the care setting, we have enabled visits to an identified location inside our services reserved for this purpose, these areas have been made to the best of our abilities COVID-19 secure
4. In-room visits: These visits have been implemented as appropriate, in line with national guidance in relation to essential / end of life visits to ensure the person can die with dignity and comfort, taking into account their physical, emotional, social, and spiritual support needs.
5. Visiting Pods: the pods have been designed for Covid secure visiting with a screen between the resident and visitor, visitors are still required to have a lateral flow test for Covid-19, where possible visiting pods are the preferred visiting option as these are the safest option; this is also due to the current new strain of the virus and its ability to spread more easily and quickly between person to person, this option is also for those who are not “named visitors” (as below)
6. Nominated single named visitor indoors: Guidance changes from 8 March 2021 means the home can now have a named visitor who will be able to meet indoors with their loved one / Friend, - every care home resident will be able to nominate a single named visitor who will be able to enter the care home for regular visits. These visitors should be tested using rapid lateral flow tests before every visit, must wear the appropriate personal protective equipment (PPE) and follow all other infection control measures (which the care home will guide them on) during visits. Visitors and residents are advised to keep physical contact to a minimum. Visitors and residents may wish to hold hands, but should bear in mind that any contact increases the risk of transmission. There should not be close physical contact such as hugging.
7. Nominated single attendance 2^nd named visitor indoors: Care home residents in England will be able to receive 2 visitors indoors from Monday 12 April as Covid restrictions continue to be cautiously eased.   Regular visits are being extended from one to 2 people under carefully designed conditions to prevent transmission of Covid-19. Visitors will be asked to provide a negative test result and wear PPE during the visit to keep themselves, staff and residents safe. Visitors who are parents will also be able to visit with babies and very young children, who will not count as one of the visitors. This means grandparents and great-grandparents will be able to meet the newest members of their families for the first time. Further opportunities for relatives and contacts to have outdoor, pod and screen visits will continue in line with the published guidance which has been in place during lockdown.

All visits have and will continue to have the to follow the visiting code / guidelines

1. book visits in advance for a specific day and time, visits will be for one hour only – this must be adhered to; visitors are expected to also give their up-to-date contact details, and consent to having a lateral flow test (ad hoc visits will not be enabled)
2. check in with the care service on the day prior to their visit, to ensure the situation in the service has not changed
3. be free of any COVID-19 symptoms on the day of their visit
4. must be well on the day of their visits
5. provide the necessary information required by the service at the visits (e.g., honest response to screening requirements about COVID-19 risk factors)
6. comply with the infection prevention and control measures, including a temperature test, mandatory hand hygiene, the use of PPE as required and social distancing requirements, remaining in the designated visiting area which could be the bedroom of loved one / relative.
7. ensure they visit with a face covering / face mask
8. ensure that any gifts brought to give to the individual they are visiting can be sanitised, in line with relevant infection prevention and control (IPC) guidance
9. Wherever possible, visitors should try to walk or travel by car and avoid public transport when visiting the home, in line with the latest Government advice on travel during COVID-19

The Trust continues to adopt the current Government guidance, which is based on the following principles:

1. 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.
2. The Trust will do so based on a dynamic risk assessment taking into consideration the needs of individuals within their homes and with regard to the advice of the local Director of Public Health (DPH) through their outbreak management team or group.

It will continue with its policy of:

1. “outdoor” visits as indicated by the risk assessments, including those made using temporary facilities such as pods.
2. “indoor” visits to dedicated areas that can be supported by rapid testing (see section on Indoor Visiting Supported by Testing)
3. The homes will continue to enable “essential” visiting needed in exceptional circumstances such as when a person is receiving end of life care
4. 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
5. 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
6. 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
7. 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

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.

1. Where an area is available, staff will facilitate the visit. This will be to ensure the area has been disinfected before and after the visit, (visiting spaces must be used by only one resident and visiting party at a time. Between visits there must be appropriate cleaning and an appropriate time interval) but also to support PPE requirements, and residents’ needs.
2. Although every effort is made to provide privacy for visiting due to the risk of some residents’ staff need to support them. For example, if a resident poses high risk of falls, staff need to be close by to reduce the risk and support mobility.  Should a fall occur, to ensure compliance with social distancing, family members would be unable to support.    
3. Staff will ensure the visitor have washed their hands / used the alcohol hand gel when they arrive and leave the area.
4. Visitor numbers will be limited in line with Government guidelines . Any adaption to this would be discussed with the senior management of the Trust and circumstances considered for approval measuring the risk factors, home managers will complete an Ethical decision tool in collaboration with the senior management team.
5. Only 3 visitors per day and at least 2 hours apart to ensure touch points have been disinfected again
6. social distancing (between visitors and residents, staff, and visitors from other households) must be always maintained – during the visit, and around the care home building and grounds
7. Visitors temperatures are taken, and questions asked about their general health 
8. If refreshments are offered / required, an allocation of disposable crockery will be supplied and disposed of in the provided pedal waste bin
9. The visitor should have access to their own face covering and will not be permitted to visit without this
10. Any items brought into the home will be placed in a designated area to be sanitized by the staff team

 

• 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. This will include both whether their needs make them particularly vulnerable to COVID-19 and whether their needs make visits particularly important (for example, people living with dementia, may be permitted visitors when restricting visitors could cause some of the residents to be distressed) 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:

1. 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
2. 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”.

Its decisions will continue to be based on balancing the benefits to its residents (and reducing harm because of lack of visits) against the risks of increasing COVID-19 infections and their consequences to a vulnerable group of people.

The home recognises that decisions to allow visiting and under what circumstances will be made in line with local intelligence from testing on the community and of residents and staff, transmission risks in the local community and other information provided by the home, for example, through its Capacity Tracker updating.

Indoor Visiting Supported by Testing

Testing Process:

1. Visitors will be provided with a letter from the care home and a copy of the Visitors Guidance, prior to the test being completed
2. Consent forms will also be provided to gain formal consent for testing and sharing results
3. The Care home will prepare a scheduled date and time for visitor testing

Testing Area:

1. A separate area within the care home will be made available for visitors to enter, test and await results without entering other parts of the care home
2. Where possible, the area will have a separate entrance. Where this is not possible, visitors will be requested to don PPE before entering the care home
3. Other key aspects will be considered, to include social distancing, disability access, and fire safety regulations

Day of Testing:

1. Visitors will be provided with PPE upon entrance and consent gained to be tested
2. Antibacterial wipes will be available for visitors to wipe down the seat including any arms of the chairs before and after the test.
3. Hand washing facilities, a mirror (for throat swabbing) and tissues will be available in this area
4. The care home will display the homes, Unique Organisation Number (UON) to enable visitors to register their test results
5. The care home will prepare test kits including the swabs, extraction materials, test tube racks, LFD devices, and barcodes
6. The care home will also ensure, devices are available to register tests and results if required for the visitor (the visitor may not have a smart phone /device to add these details) 
7. Support will be available to support visitors with registering their kit online, if needed
8. Once the test is completed, visitors will need to follow the instructions given by the home manager/person in charge.

Visiting Professionals:

All visiting professionals who are not regularly tested through another route such as NHS staff or CQC inspectors, should be tested on every visit in the same manner as visitors via the LFD test.

For further visitor guidance please see the link below:

https://www.gov.uk/government/publications/coronavirus-COVID-19-lateral-flow-testing-of-visitors-in-care-homes

Visiting Schedules

Under the present circumstances, the home recognises that all visits will have to be pre-booked and with limited availability some order of priority might need to be established.

It will base its priorities on the following.

1. the importance to the wellbeing of the individual to have a resumption or continuation of visits
2. the degree of harm that might occur without any visits
3. the risk factors that are involved including the vulnerability to infection for the person concerned
4. the degree of compassion that is involved, e.g., if the person is receiving end of life care or is likely to be receiving it in the near future
5. the importance of visiting to the person in the context of their overall care plans
6. the effectiveness of the current contact or visiting arrangements in place
7. the willingness of prospective visitors to go through the new testing procedures if and when adopted by the home.

The home will ensure that the visiting arrangements will be planned, including times, frequency, and duration, and agreed in consultation with residents and their families and with professionals involved in a person’s welfare.

Visitors will need to be tested on entry every time they visit the care home, regardless of the date of their previous visit

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, including where testing is being carried out.

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 as an agreed “essential visitors” we will still ask you to:

1. check with us before visiting that everything is in order and that you do not have any symptoms for COVID-19
2. check if you might have had any contact with anyone who might have been in contact with an infected person or someone carrying the virus and take a decision about visiting based on your assessment of any risks
3. sign a short disclaimer to this effect
4. be extra careful about being in physical contact with the person you are visiting and other people whom you might meet by:
   • avoiding close contact with people, particularly if they are unwell
   • avoiding touching their eyes, nose, and mouth with unwashed hands
   • keeping to designated areas of the building which we will inform you about
5. 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
6. help staff to carry out the procedures that have been put in place to keep everyone safe from the virus and its spread
7. 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.

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, visitor restrictions may need to be immediately implemented which suspend some of these enabling approaches and will include exclusion of any non–essential visitors. (this includes 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.

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 declared outbreak / clusters have occurred within the home's local area or if there are other extraordinary circumstances that require it, and 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 a limited number of in-person visits.

 

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, including booking in advance.
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.
Appropriately support staff to facilitate visits including written processes and procedures.	Respond truthfully to COVID-19 screening questions asked by the home's staff and to sign the checklist / visitor.
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, use of visiting windows, 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.

 

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.

Amica Care Trust services will request that visitors complete the questionnaire and give consent provided by the services and this is a true and honest reflection.

Each of the Trust’s services will keep a visitor log in line with the Track and trace initiative.