Newlyn Court Covid Measures

During Covid we have taken measures to balance the safety of all our residents with the needs of residents and family to be able to keep in contact. The balance is not easy, we have to comply with Government guidelines and policies while doing as much as possible to maintain a near normal environment for everyone.

Our communal areas are large allowing us to keep residents 2 meters away from one another where possible.

New residents are tested on arrival and are also isolated for 14 days on a separate wing/isolation unit. This is staffed by a dedicated team who work solely in that area for the duration of the isolation period. This is to minimise the risk of spread to the other residents should a new resident unfortunately arrive with Covid.

If any resident develops symptoms or tests possible, then they are also nursed in isolation away from the other residents until better.

Visiting Policy Background

We are currently updating our visiting policy following the announcement by the Government on 27 January 2022. Until the policy has been updated we will continue to follow the existing policy as set out below. If you have any immediate requests that fall outside the policy then please contact us and discuss the matter before visiting.

• We recognise the significant impact the closure to visitors during the pandemic has had on our Service Users, their families, and on our teams. Newlyn Court Nursing Home will seek to enable visiting wherever it is safe to do so, in line with government guidance and where proportionate steps can be managed.
  Advice will be sought in line with the Guidance on Care Home Visiting from the Department of Health and Social Care and local advice from the Director of Adult Social Services at City of Wolverhampton Council. Newlyn Court Nursing Home will ensure that there are clear channels of communication between all stakeholders.
• In the event of any suspected or actual outbreak of COVID-19, or a suspected or known case of COVID-19 within Newlyn Court Nursing Home, or where national guidance dictates, 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 will be implemented in a transparent manner with open and clear communication to Service Users and relevant family members.
  Newlyn Court Nursing Home is responsible for ensuring that the right visiting arrangements are in place for each Service User, facilitating visiting as much as possible and appropriate to an individual's situation, but made as safe as possible, including the appropriate infection prevention control measures. We will ensure that we communicate well with Service Users to enable good and timely decisions around care and to support visits in the final months and weeks of life and this is reflected in their individual Care Plan and Visitors Care Plan.
• Newlyn Court Nursing Home will actively involve Service Users, their relatives or friends, any advocates, commissioners and appropriate members of the multidisciplinary team and, where appropriate, volunteers in decisions and procedures relating to visitors, including visitor testing.
• Newlyn Court Nursing Home will communicate the Visitor Code of Conduct. Where there is a violation of this agreement, Newlyn Court Nursing Home will discuss this with the Service User and/or visitor. Where the violation puts (or will put) staff, Service Users or the wider community at risk, Newlyn Court Nursing Home does reserve the right to reassess the visitors policy on a case-by-case basis.

Dynamic Risk Assessments

• Prior to visits being allowed within Newlyn Court Nursing Home, Amarjit Narwal will refer to advice from the local Director of Public Health, as well as any additional advice or guidance from the local Infection Control Lead from the Clinical Commissioning Group and the local Health Protection Team (HPA) and national guidance. They will assess the suitability of a specified level of visiting, taking into account relevant infection and growth rates. They will also advise Newlyn Court Nursing Home if visiting needs to cease in response to an outbreak.
• In addition, Newlyn Court Nursing Home will ensure that it submits requested information where required, such as test results of staff and Service Users and the Capacity Tracker information, that supports the HPA to determine the level of visiting.
• Newlyn Court Nursing Home will ensure that it has measures in place to immediately suspend visiting (except for exceptional circumstances such as end of life) in the event of a confirmed or suspected outbreak, or on public health instruction or as a response to national guidance.

Risk Assessment Process

Newlyn Court Nursing Home must take a dynamic, risk-based approach to how it facilitates and manages visits. This must take into consideration the following:

• The safety of the Service User receiving a visit
• The safety of all Service Users at Newlyn Court Nursing Home
• The safety of staff and visitors
• How to minimise the risk of any COVID-19 infection
• Mental Capacity and communication barriers where Lateral Flow Testing (LFT) is not available and outdoor or screen visits have to take place
• Whether Service Users or staff or visitors are in an extremely clinically vulnerable group. This however should not prevent a Service User receiving visitors in the same way as other Service Users and advice can be sought from the GP
• The provisions and needs outlined in the Service User's Care Plan
• The appropriate levels of staff to support the LFT of visitors
• The appropriate levels of staff to ensure adequate cleaning of indoor areas
• The results from staff and Service User testing
• The procedure for visitor testing at Newlyn Court Nursing Home
• The availability of LFT'S
• The availability of suitable outdoor visiting areas during the winter or screen visits where LFTs are not available
• The willingness of visitors to follow the visitor policy and code
• The willingness of Service User's to follow the visitor policy and code
• The government rules in place which impact on the type of visits allowed

Agreed outcomes identified from the risk assessment must be recorded on the Service User's Care Plan and communicated to staff. If a Service User has a social worker, they should be called upon if needed to determine the outcome of risk and the measures to put in place. Every Service User will have a Visitor Care Plan in place.

Types of Visits and National Restrictions

The Government varies restrictions depending on the impact of the COVID-19 virus. The restrictions include residential care and how visiting can be enabled. This guidance is subject to change and the up-to- date guidance should be followed.

Visits in exceptional circumstances, such as end of life, should always be supported and enabled. Families and Service Users should be supported to plan end of life visiting more deliberately, with the assumption that visiting will be enabled to happen not just towards the very end of life.

Human Rights During the COVID-19 Pandemic

When considering their visiting policy, Newlyn Court Nursing Home will consider the legal decision-making framework, offered by the Mental Capacity Act, individually for each Service User and will not make blanket decisions for groups of people. Newlyn Court Nursing Home will use the ethical framework for adult social care, and the wellbeing duty in section 1 of the Care Act 2014 as part of any decision making processes. Newlyn Court Nursing Home will ensure that:

• Service Users are consulted. Article 8 of the Human Rights Act can be breached to maintain public health, but the benefit of non-symptomatic relatives visiting must be assessed against the risk of virus transmission
• The least restrictive options must be considered and a proportionate response taken
• Any decisions taken are recorded
• Additional ways of supporting Service Users to stay in touch with family and friends outside Newlyn Court Nursing Home are used, such as WhatsApp video calls, phone calls etc. in between face-to-face visiting
• A range of meaningful activities are offered
• People with Lasting Power of Attorney will be considered and consulted
• There is a review of Service Users with Lasting Power of Attorney for Health and Welfare in place
• Newlyn Court Nursing Home will encourage Service Users who have the capacity to discuss how they would like to be treated if they become unwell

Alternative Approaches to Maintaining Contact with Relatives

All staff will continue to identify innovative ways of enabling Service Users to maintain contact with loved ones outside of face-to-face visits, so that the Service User can stay in touch with their wider group of friends and family who are not their designated constant visitor. Existing methods of virtual communication will continue to be promoted and will include the use of features such as Zoom, WhatsApp and Skype. Staff will ensure that Service Users are fully supported to use these features. Further information is available in the QCS Resource Centre on visiting in relation to technology use.

Keeping People Informed

The Registered Manager will ensure that Service Users, staff and family members are kept fully informed of how visits will be enabled and the circumstances in which Newlyn Court Nursing Home may have to close to visitors.

Amarjit Narwal will provide information that meets the communication preferences of Service Users and staff and will make use of the provided literature (refer to the 'Forms' section) that offers further explanation.

Amarjit Narwal will provide clear, fair guidance to enable all Service Users the opportunity for a visit. This may include identifying named visitors who will agree to undertake FT at each visit or the circumstances when visiting may have to cease (i.e. in an outbreak). Newlyn Court Nursing Home will keep up to date with the government guidelines on visiting.

Service User Visitors

• From 15 December 2021, Service Users must nominate three visitors who will be able to enter for regular visits at Newlyn Court Nursing Home. This does not include essential care givers
• All Service Users can nominate an essential care giver who will have testing and use PPE in line with staff at Newlyn Court Nursing Home. An essential care giver can enter Newlyn Court Nursing Home even in the event of an outbreak or during periods of isolation
• In some cases, a Service User may require support from more than one essential care giver, this will be considered on an individual basis by Amarjit Narwal
• Where Service Users lack the capacity to choose an essential care giver, Newlyn Court Nursing Home will discuss the situation with an attorney or deputy, or a relative or friend to determine the Service User's best interests

Close Contact with Someone with COVID-19

Where visitors are identified as a close contact of someone with COVID-19 but are fully vaccinated and not required to self-isolate, they should still not visit Newlyn Court Nursing Home unless it is absolutely necessary.

Where a visit is deemed necessary, the visitor must have received a negative PCR result prior to their visit, and a negative lateral flow test result earlier in the day of their visit.

Where Service Users have been identified as close contacts of someone who has tested positive for COVID-19, they do not need to self-isolate as long as they are fully vaccinated and they can continue to receive visitors as normal. Service Users should avoid receiving visitors who are clinically extremely vulnerable for 10 days after they have been in contact with a COVID-19 positive case, except in exceptional circumstances.

Where possible, Service Users identified as close contacts should undertake a PCR test, and following this, undertake daily lateral flow testing for up to 10 days.

Anyone not fully vaccinated and a close contact of someone with COVID-19 must follow self-isolation rules.

Visit Management Protocols at Newlyn Court Nursing Home Pre-Visit

• All visit arrangements should be planned in advance of the visit at Newlyn Court Nursing Home. Ad-hoc or unannounced visits may not be possible
• Visitors will be made aware when the visit is booked that they must not visit when unwell or displaying any signs of a cold/flu, respiratory or COVID-19 symptoms or if they have been in contact with anyone who has been/is displaying symptoms of COVID-19
• The Visitor Code will be clearly displayed and will be provided to the visitor(s) prior to their visit
• Visitors will be made aware not to travel to Newlyn Court Nursing Home if they are coming from an area that has been placed at high risk
• Visitors will be made aware of the visitor testing procedure at Newlyn Court Nursing Home
• It is strongly recommended that visitors are vaccinated prior to visiting Newly Court Nursing Home to reduce the risk of transmission of infection
• Newlyn Court Nursing Home will appoint an allocated member of staff to ensure that visitors' testing is completed correctly, and that visitors don and doff PPE correctly

On the Day

• On arrival, the visitor(s) must report to the designated testing area
• The visitor(s) will have a temperature check and complete a health screening questionnaire in relation to COVID-19 symptoms
• Any visitors displaying coronavirus symptoms within the last 10 days or anyone who is a household contact of someone with COVID-19, or who has been advised to self-isolate by NHS Test and Trace, will not be permitted entry
• Staff at Newly Court Nursing Home will record the contact name, phone number and email address (where available) of the visitor(s) to support any Test and Trace requirements. Staff can access the COVID-19 Visitor Tracker available within the QCS Management System to manage this process
• The visitor(s) and the Service User must have been given the Visitor Code at Newlyn Court Nursing Home and have agreed to it
• Formal consent for a COVID-19 test to be completed will be gained from the visitor(s)
• A lateral flow device test will be completed by the visitor(s) under staff supervision, and registered as per government guidelines, where one has not already been completed in line with section 5.10 of this policy
• The visitor(s) will wait in the designated waiting area until a test result has been received
• Where a positive result has been received, the visitor(s) will not be granted entry to Newlyn Court Nursing Home and must complete a confirmatory PCR test before leaving to self-isolate. The PCR test will be collected by priority courier from Newlyn Court Nursing Home
• Where an invalid result is received, repeat the process again with a spare LFD kit. If this still comes back invalid, it is recommended to follow the positive result process and not allow entry
• Where a negative result has been received, the visitor(s) will be permitted to visit a Service User
• Where visitors are exempt from retesting due to being within the 90-day window, they must use the result of their positive PC result to show that they are currently exempt. Once the 90-days is over, regular testing must commence
• Visitors will be reminded and provided facilities to wash their hands for 20 seconds or use hand sanitiser on entering and leaving Newlyn Court Nursing Home. Guidance on cough etiquette will be provided
• The correct PPE must also be worn by visitors, social distancing maintained, and the correct infection control measures followed
• Visitors, in line with national guidance, will be supported with physical contact, such as hugging with the Service User, as long as infection prevention and control measures are in place
• Risk assessments may identify that some visits may need to be supervised and this will be discussed before the visit
• Visitors will be informed that facilities such as toilets, access to refreshments etc. will not be accessible during the visit
• Visiting spaces will only be occupied by one Service User and their visitor(s) at a time. The space will be well ventilated, and enhanced cleaning of the space will take place in between visits. Where possible, visits should take place in a room that is practical and comfortable for the Service User, such as their own room
• If visitors bring in gifts and other items to the Service User, they will need to be wiped or washed before the Service User receives them
• Regular cleaning of the testing area (including registration devices) will take place between visitor testing

If a visitor does not follow the Visitor Code or the above rules, or any other requests issued by staff, Amarjit Narwal will be informed and restrictions may be applied to future visits.

Visitor Testing at Newlyn Court Nursing Home

Visitor testing for all care homes commenced from 14th December 2020 when the online registration portal opened. The Registered Manager will implement a visitor testing procedure for visitors to Newlyn Court Nursing Home in line with government guidelines. This will be communicated to staff, Service Users and visitors ahead of any visits being scheduled. The visitor testing procedure will:

• Identify a designated testing area that visitors will enter ahead of visiting Service Users. The designated testing area will be large enough to allow social distancing to be maintained before, during and after the testing process and have space for the storage of tests. LFD kits must be stored separately from PCR kits, but can be stored at room temperature. There should be a separate entrance from Newlyn Court Nursing Home, where possible, and a one-way system through the testing area. There should also be a waiting area for visitors to sit whilst awaiting their results. The testing area must meet fire safety regulations and must be well ventilated
• Ensure that visitors have no contact with Service Users prior to receiving their test results. Where a positive result is received, they must immediately leave the premises and self-isolate. A confirmatory PCR test should be completed by the visitor(s) when this occurs, which can be obtained by booking a test
• Ensure visitors are informed of testing quidance and the expectations at Newlyn Court Nursing Home by issuing the visitor testing quidance pack and resources available within the Forms section of this policy
• Ensure staff training in lateral flow devices is in place prior to testing being undertaken at Newlyn Court Nursing Home and the online NHS Test and Trace training is completed. Newlyn Court Nursing Home will receive an email to confirm access to this training. Where this is not received, call 119
• Ensure supplies of lateral flow devices are sufficient to support visitor testing at Newlyn Court Nursing Home. The government will provide sufficient supplies to allow the testing of five visitors per Service User, twice a week
• Ensure that there are appropriate PPE supplies in place in addition to testing processes taking place
• Prepare consent forms so that formal consent can be gained on the day of testing. A template consent form can be found in the Forms section of this policy
• Ensure that devices are available to support registration of the test kits where this is required
• Ensure that the Unique Organisation Number (UON) is visible within the testing area
• Ensure that the waiting area is cleaned between each visitor Ensure there is only one visitor waiting at a time

Visitor Self-Testing

While testing on site at Newly Court Nursing Home is preferable, Newlyn Court Nursing Home also recognises that everyone now has access to COVID-19 testing through other routes and Amarjit Narwal will consider, on an individual basis, allowing visitors to provide evidence of a negative test through other means if it has been taken that same day. Testing via other means can include:

• Assisted testing at another lateral flow site such as an Asymptomatic Testing Site (ATS)
• Self-testing at home through test kits provided by Newlyn Court Nursing Home once Newlyn Court Nursing Home has access to packs of 7 test kits (which the MHRA has authorised for self-test use)
• Self-testing at home using test kits provided by the government such as at a school, workplace, the universal testing offer, or collected from a pharmacy

All risks surrounding off-site testing will be considered by Amarjit Narwal including:

• The confidence and ability of the visitor to carry out testing away from Newlyn Court Nursing Home
• The increased risk of the visitor needing to use public transport to a testing site
• The visitor not having a mobile phone or email address to receive the results of the test

Where self-testing is authorised by Amarjit Narwal, this should be reported under the UON for Newlyn Court Nursing Home. Guidance for visitors in relation to self-testing can be found here. Care homes do not need to retain records of proof of lateral flow test results.

Visiting Professionals Testing

Visiting professionals, such as GPs, nurses and CQC inspectors may attend Newlyn Court Nursing Home as part of their work and will be required to demonstrate they are safe to enter the premises. Visiting professionals must follow the relevant testing requirements and will not be allowed entry unless:

• Proof of a negative test result is provided (for NHS staff this is within 72 hours of the visit)
• It is an emergency situation, such as a 999 response
• They fall within the 90-day window of not requiring a retest; in this instance proof of their positive PCR test should be shown
• They have received void or invalid results after repeat testing; a test must be completed the next day and the void results shown as proof

Where testing is being conducted at Newlyn Court Nursing Home, prior to entry, the 'on the day' process in will be followed. Further guidance around visiting professionals testing can be found here.

The vaccination status of a visiting professional will also be obtained prior to them entering Newlyn Court Nursing Home; in each case the professional must demonstrate that they are vaccinated or exempt. For further information, refer to CC182 - Mandatory COVID-19 Vaccination Policy and Procedure.

Staff Support

Staff will be provided with support to address any anxieties that may present as well as to offer guidance and advice as to how to facilitate visits safely and in line with all the relevant quidance. This includes supporting family members with the following in readiness for a visit:

• To support with the visitor testing procedure at Newly Court Nursing Home providing information and guidance on the new procedure in place
• How to prepare for a visit, giving training on how to communicate if face coverings are required, for example: Speaking loudly and clearly, Keeping eye contact, Not wearing hats or anything else that might conceal their face further. Wearing clothing or their hair in a way that a Service User would more likely recognise
• To provide reassurance to visitors, including that some people with dementia might struggle at first to remember or recognise them. Staff should try and prepare the Service User for a visit, perhaps by looking at photographs of the person who is due to visit, and talking to them about their relationship

Infection Control in the Wider Environment at Newly Court Nursing Home

All visiting at Newlyn Court Nursing Home will be undertaken in line with the infection control principles at Newlyn Court Nursing Home and CC18 - Infection Control Policy and Procedure will be adhered to. This policy also details extra infection control precautions that will be in place when visiting is underway at Newlyn Court Nursing Home, these are documented within the visit management rules in section 5.9 and include:

• Pre-screening visitors before entry to ensure that no one is currently experiencing symptoms or been in contact with anyone with COVID-19
• Visitor testing prior to entry to Newlyn Court Nursing Home; anyone with a positive test result will not be permitted entry
• A record of any visitors to Newlyn Court Nursing Home, as well as any interactions (such as, person visits their loved one who is also visited by a chaplain in the course of the visit)
• Facilities for visitors to wash their hands for 20 seconds or use hand sanitiser on entering and leaving Newlyn Court Nursing Home
• Visitors will be encouraged to avoid public transport, if they can, on their way to Newlyn Court Nursing Home
• Appropriate PPE will be worn during visits and availability of additional PPE, such as aprons and gloves, will be in place where they may be required. Visitors must wear face masks when visiting Newlyn Court Nursing Home, particularly when moving through the premises
• Where the use of PPE (such as face masks) cause distress to Service Users, they can be removed in these circumstances - when not in communal areas and after a comprehensive risk assessment has been undertaken by Newlyn Court Nursing Home
• Any guidance, procedures or protocols put in place by Newlyn Court Nursing Home to ensure compliance with infection prevention control will be provided to the visitor(s) to read on arrival
• Enhanced cleaning will take place of all visiting spaces after each visit and a time interval maintained between visits to allow ventilation, where it is not outdoors
• Visiting areas will be free of clutter to aid cleaning

Closing Newlyn Court Nursing Home to Visitors

In the event of an outbreak in Newlyn Court Nursing Home or evidence of community hotspots or outbreaks, Newlyn Court Nursing Home may rapidly impose visiting restrictions to protect vulnerable Service Users, staff and visitors, including stopping indoor visiting, except in exceptional circumstances such as end of life.

In this situation, Newlyn Court Nursing Home will set out alternative options to maintain social contact for Service Users, such as offering visits in well-ventilated spaces with substantial screens, visiting pods or from behind windows, while providing regular, personalised updates to Service Users' loved ones. Any home closure will be carried out in consultation with City of Wolverhampton Council, the Health Protection Team and the Director of Public Health.