Our ref:
BMcN/kh/FOI 282
26th November 2020
By Email: xxxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx
Dear Ms Gilliland
FREEDOM OF INFORMATION ACT 2000 – INFORMATION REQUEST
Your request for Learning Disability Day Centre Infection Control Guidelines has now
been considered and the information requested is enclosed.
If you are unhappy as to how this request has been handled, you should write to the
FOI lead for the Trust. You have the right to seek a review within the Trust in the first
instance.
If, after receiving a response, you remain unhappy, you can refer your complaint to the
Information Commissioner at The Information Commissioner’s office, Wycliffe House,
Water Lane, Wilmslow, SK9 5AF. It is important to note that if you refer any matter to
the Information Commissioner, you will need to show evidence of having gone through
the Trust’s review procedure to try to resolve the matter with the Trust in the first
instance.
If you have any queries or concerns then please contact:
Head of Information Governance
Southern Health & Social Care Trust
Ferndale
Bannvale Site
10 Moyallen Road
Gilford
BT63 5JX
Tel: 028 37561458
Email:
xxx.xxxx@xxxxxxxxxxxxx.xxxxx.xxx
Information Governance Department, Ferndale, Gilford
Yours sincerely
__________________________
BARNEY MCNEANY
DIRECTOR OF MENTAL HEALTH & DISABILITY
Enc
Disability Day Care
There have been a number of studies completed during this pandemic phase, related to Covid-
19 and people with learning disabilities. They highlight that this population is particularly
vulnerable. Many live in group homes or receive care from therapists or carers who must
maintain close physical proximity to assist them. Many are medically frail to begin with, inclusive
of a myriad of co-morbidities, particularly respiratory problems, which increases susceptibility to
pneumonia further increasing the risks of poor outcomes if they become infected with Covid-19.
NHS England via the CQC (Care Quality Commission) has published some very stark data, in
that people with a learning disability already experience significant health inequalities, including
premature avoidable death. Respiratory conditions are the most common cause of death among
people with a learning disability, suggesting that they may be at greater risk of dying from
Covid-19. However, it was not until June 2020 that data were published by the Care Quality
Commission (CQC), which showed that between 10 April and 15 May, 386 people with a
learning disability receiving care from CQC registered providers died, compared to 165 people
in the same period in 2019—a 134% increase.
Syracuse University reported in June 2020 that people with disabilities who were living in group
homes had far higher rates of Covid-19 than compared with other residents and their risk of
dying was markedly higher.
To promote early detection, surveillance and mitigate the spread of Covid-19 infection, Southern
Health & Social Care Trust day services have established the following processes/safeguards:
The completion of a wellness check each day before the service user comes into any Disability
Day service. Contact information is given to the families in reference to Transport POCs and
families are urged to contact the relevant transport provider by 8am and the relevant Day
service 9am to inform both services if your family member cannot attend due to potential
COVID-19 symptoms.
Establishing whether the service user attending SHSCT Disability Day services or any of their
household exhibits any of the following symptoms either NOW or WITHIN the last 14 days.
A new and continuous cough
A High-temperature
Recent loss of, or change in normal sense of smell or taste
The establishment as to whether a family member attending Day services or any of the service
users household been in contact with a person who is confirmed or suspected of having
COVID-19 in the past 14 days.
Information Governance Department, Ferndale, Gilford
If the answer is YES to any of the above questions then the service user who attends Day Care
must not come into day services or enter transport.
Each centre has a staff, service user and carer/family member sign in/out book to promote
efficient contact tracing.
Temperatures are checked and recorded before accessing shared transport / day service and
again in the afternoon before leaving. Service users are not permitted to board transport or
enter the Day Service if they have a high temperature of 37.8°C or above, or as per the
wellness checker. The Service user / Carer will be advised by day service staff to contact the
111 helpline and their GP as appropriate. The Service user is to be notified at this point that with
a high temperature or other symptoms they will not have access to transport or the day service
until further confirmation is provided regarding their health status.
On transport: If the temperature is 37.8°C or above, staff measure the temperature 1 more time
and if it is still 37.8°C or above the service user wil return to their home and any ‘touch points’
are wiped down immediately with disinfectant surface wipes. The carer is advised to ring the
day centre at 9am when it opens for further advice. The Day Care Nurse or Person in Charge
advises the carer as per Day Service COVID Management SOP.
In the Day Centre: If the service user is already in the day centre If the temperature is 37.8 °C
or above, staff should measure 1 more time and if it is still 37.8°C or above staff should link in
with the Day Care Nurse or Person in Charge of group (Band 5 DCW) who can take a tympanic
reading. If no Day Care Nurse is available and if the temperature is still 37.8°C or above with
tympanic thermometer the service user should be assisted to leave via the nearest exit and go
directly to the identified isolation room to await their carer coming to collect them. Day Care
Nurse or Person in Charge of group (Band 5 DCW) to advise carer as per Day Service COVID
Management SOP.
Staff Members / Visitors should leave via the nearest exit and return home where they should
contact OH to seek up to date advice. Report any issues to person in charge.
Staff to be mindful of the following when taking temperatures:
Is it after physical exercise / activity
Is group room setting warm?
Is service user wearing correct clothing for current environment – too many layers?
Behaviours – is service user relaxed / excessive laughing / crying / distressed / displaying
behaviours which may be considered as challenging etc.
Staff will also report if any of the answers are yes to the wellness check in person or via
telephone to the person in charge within the day service. Staff should inform the Community
Case Manager via telephone. A follow up email should also be sent immediately to the
Manager, Community Case Manager, Team Leader and Transport Manager. Under no
circumstances would a service user with a high temperature or if presenting with symptoms as
outlined in the wellness check be permitted to enter the day service facility or embark on
transport.
Staff must have their temperature taken and a record made of same on arrival and before
leaving the day service each day. Staff follow:
https://www.publichealth.hscni.net/COVID-19-coronavirus/COVID-19-information-public
If a staff member has any COVID-19 symptoms they should remain at home and contact their
line Manager and Occupational Health for advice as soon as possible.
All visitors to day services facilities will have their temperature and wellness check undertaken
and recorded by the clerical officer or other trained staff members in their absence. All visitors
share their contact details for the purpose of contact tracing and have them recorded by the
clerical officer or other staff member in their absence. All visitors are required to wear amber
PPE in the interest of health and safety. Under no circumstances should a visitor with a high
temperature or if they are presenting with COVID-19 symptoms as outlined in the wellness
checker be permitted to enter the day service facility.
The majority of people who test positive for COVID-19 are symptom free.
The Office for National Statistics (ONS) said only 22 per cent are showing signs of coronavirus
when the test confirms they have it. The Centre for Disease Control states that ‘those at
greatest risk of infection are persons who have had prolonged, unprotected close contact (i.e.
Within 6 feet for 15 minutes or longer) with a patient with confirmed SARS-CoV-2 infection,
regardless of whether the patient has symptoms’.
IPC
While our staff wear PPE, for our day care service users, the use of PPE in the form of
facemasks may pose an additional danger or may cause distress. Most service users in the
area are either unable or unwilling to use them as intended. Social distancing is immensely
challenging to assure, this service user group is ambulatory and this significantly increases the
risk of Covid-19 viral spread. Thus there have been outbreaks within these areas.
With Covid-19 and outbreak scenarios, we have adopted the guidance as per the PHA, where it
is defined that outbreaks are when there are two or more residents or staff with symptoms
occurring within 14 days, in the same area
PHA guidance during an outbreak indicates that there should be no day centre attendance or
group activities during an outbreak to alleviate risk
(Public Health Agency V8 outbreaks
16072020)
Outbreaks are declared over 28 days after last known case of Covid-19 and if no new infections
are found. Thus we do not open the area until 28 days from the last known positive; this means
the closure could lengthen past the 28 period if other positive cases arise within that timeframe.
(PHA Guidance - what to do in outbreak situations)
With the incidence of asymptomatic spread and the risks posed to this service user population
we opt to close day care facilities when an outbreak is declared. We remain closed until the
outbreak is declared over as per the aforementioned PHA guidance, post whole area Covid-19
testing and appropriate environment cleaning.
The IPC guidance has been consistent, the two incubation period (28 days for COVID 19)
should be followed for day care.
Information Governance Department, Ferndale, Gilford
IPC have consistently highlighted concerns regarding day care and the risk of transmission of
COVID 19 to service users using day care at a time of sustained community transmission, today
the rate is approx. 180 cases per 100,000 population regionally. The IPC advice based on the
levels in community transmission is that day care should temporarily close from an IPC
perspective, we do understand there are other risks and that the Mental Health & Disability
Department were completing a risk assessment.
https://www.health-ni.gov.uk/sites/default/files/publications/health/doh-db-191120.pdf