Practical information: What to consider when re-opening day care services

Updated: December 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 follow the guidance for people with symptoms of a respiratory infection including staying at home and avoiding contact with other people.

Individuals who are at the highest risk and therefore eligible for antivirals have access to free testing if they are symptomatic. In this case, individuals should follow the guidance for people whose immune system means they are at a higher risk if they develop symptoms.

In all cases, whether the individual has taken a test or not, the day care manager and local authority should assess the risk of people who have had symptoms to decide when they can return to the service. Even where an individual tests negative for COVID-19, they may have another infectious illness like flu and this should be considered as part of the risk assessment.

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

Staff and volunteers who work in a day care centre eligible for testing have access to free symptomatic testing. Further information about which day care centres are eligible for testing can be found in the Testing for Adult Social Care Services guidance.

In these services, if a staff member or volunteer becomes symptomatic, they should follow the ‘If a staff member develops COVID-19 symptoms’ section of the IPC (Infection Prevention and Control) COVID-19 Supplement including taking an LFD test as soon as they become symptomatic (day 0), and if this is negative, taking another test 48 hours later, and staying away from work in between. If either of these tests are positive, the individual should follow the guidance in the section ‘If a staff member receives a positive lateral flow or PCR test result’ in the IPC COVID-19 Supplement.

For all other staff and volunteers who work in day care services that are not eligible for free testing, if they become symptomatic, should follow the guidance for people with symptoms of a respiratory infection including staying at home and avoiding contact with other people.

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.

Staff who are identified as a household or overnight contact of someone who has had a positive COVID-19 test result should discuss ways to minimise risk of onwards transmission with their line manager. This may include applying measures known to reduce risk such as distancing, maximising ventilation and wearing a mask for source control. Further information can be found here: People with symptoms of a respiratory infection including COVID-19

Providers should carefully consider measures if the staff member works with people who are at higher risk of becoming seriously unwell with COVID-19 (seek clinical advice as necessary). Providers should also consider redeployment of staff in these circumstances during the 10 days following household or overnight contact with the case.

Staff should continue to comply rigorously with all relevant infection control precautions while they are attending work and follow the advice for staff with symptoms of a respiratory infection, including COVID-19 if they develop any symptoms.

See: COVID-19 supplement to the infection prevention and control resource for adult social care and the guidance on COVID-19 testing in adult social care.

For complex cases, providers may wish to contact the public health team in their local authority for more information on infection prevention and control (IPC) and PPE, as well as training and other resources.

Vaccination

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.

During the winter of 2022/2023, everyone eligible for a COVID-19 vaccination can either book their first dose, second dose and an Autumn booster dose online via the National Booking Service, by phoning 119, or attending a walk-in centre.

The seasonal flu vaccine should be provided to staff by employers as part of the organisation’s policy to prevent the transmission of infection. However, where frontline social care staff do not have access to an employer led occupational health scheme, they can access the flu vaccine through the NHS free of charge. Everyone eligible can book an appointment at a participating pharmacy online, or by contacting their GP.

The COVID-19 vaccination guide for employers contains further information on actions employers can take to enable staff vaccination, and there is specific flu vaccination guidance available for the social care sector . 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.

Face coverings or masks for visitors, carers and people using services

Wearing a face covering or face mask can reduce the number of particles containing viruses that are released into the environment from someone who is infected with COVID-19 or another respiratory infection.

Service users should be supported to wear a face covering whilst in the day centre in line with their personal preferences. Volunteers, carers and service users should consider wearing a face covering when outside the setting in line with guidance on living safely with respiratory infections.

Personal protective equipment (PPE) for staff and volunteers

PPE refers to items including face masks, aprons, gloves and eye protection. The COVID-19 supplement to the infection prevention and control resource for adult social care sets out the appropriate PPE that should be worn by care workers in a range of care scenarios.

Face masks

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.

Volunteers and care staff do not routinely need to wear a surgical face mask at all times whilst in the day centre. However, there remain several circumstances where it is recommended to wear face masks to minimise the risk of transmission of COVID-19 and other respiratory infections. These are:

• When providing supervision for someone at the service who has developed symptoms which may be COVID-19 and is waiting to be collected.
• If the volunteer or carer is a household or overnight contact of someone who has had a positive test result for COVID-19.
• If a service user is particularly vulnerable to severe outcomes from COVID-19 (e.g. potentially eligible for COVID-19 therapeutics) mask wearing may be considered on an individual basis in accordance with their preferences.

If a service user would prefer care workers and volunteers to wear a mask whilst providing them with care then this should be supported. Providers should also support the personal preferences of care workers and volunteers to wear a mask in scenarios over and above those recommended in this guidance.

If there is an event or gathering and it is assessed as having a particularly high risk of transmission of COVID-19, mask wearing may be considered.

The specific type of surgical mask required will vary depending on the type of activity. 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.

If masks are being worn, consideration should be given as to how best to put this into practice while taking account of the needs of individuals and minimising any negative impacts. If a person receiving care finds the use of PPE distressing, or their use is impairing communication, a local risk assessment regarding this can be made. This may be more likely to be relevant when caring for people with learning disabilities or cognitive conditions such as dementia, or supporting individuals relying on lip reading or facial recognition.

If, following a risk assessment, it is determined that the use of face masks should be limited while caring for an individual, appropriate and proportionate mitigations should be considered such as limiting close contact and/or increasing ventilation to maintain adequate infection prevention and control. The needs of the person receiving care should be recognised and they should be as involved as they wish to be and/or are able to be in determining their needs in these circumstances.

It may be appropriate in certain circumstances to consider transparent face masks, some of which could be considered for use as an alternative to type IIR surgical masks. Guidance on technical specifications for transparent face masks has been provided by the government and should be consulted.

Other PPE

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 gloves 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 could include activities such as personal care or handling dirty laundry.

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 should 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.

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.