Visiting Arrangements (including COVID 19 restrictions) Policy

Policy Statement
Our priority continues to be to reduce the risk of coronavirus (COVID-19) transmission within our care homes and prevent future outbreaks, to ensure the health and safety of both care workers and residents.
Visiting is a central part of care home life, it is important for maintaining the health, wellbeing, and quality of life of residents and for family and friends to maintain relationships with their loved ones.
We will continue to follow government advice to support safe visiting, limitations may vary from time to time dependent on current government advice, including any local restrictions in place as well as considering the needs of the resident and the layout and facilities within the individual care home.
Further details of visiting arrangements as relevant at the time can be obtained from the individual care home direct.
Some residents will have particular needs (for example those who are unable to leave their rooms, those living with dementia or those who may lack relevant metal capacity, the home manager will discuss this on an individual basis.
The care home will support NHS Test and Trace by keeping a record (including address and phone number) of all visitors.
NB All residents will have an individual ‘Visiting Plan’ which must then be adhered to

Visiting Guidelines
*These guidelines apply to all visitors and all types of visits

• • All visitors should make arrangements directly with the care home in advance of the visit, so that the home can manage the number of people attending at any one time to ensure safe visiting practices can be maintained taking into account the size and layout of the care home. This will down to the registered managers decision.
  • The duration of visits should not be limited if safe visiting practices can be maintained
  • Visits should take place in a room most practical and comfortable for the resident (for example, residents with dementia may be more comfortable in their own room with familiar belongings)
  • Visitors should receive a negative lateral flow test result and report it on the day of their visit, either by conducting the test at home or when they arrive at the care home – essential care givers need to follow the testing measures in line with the care home staff testing regime. The home will need to see the result or the visit will not be permitted.
  • Every care home resident should be supported to have an identified essential care giver who may visit the home to offer companionship or help with care needs – essential care givers should be able to visit inside the care home even during periods of isolation and outbreak, providing the essential care giver does not have COVID-19
  • During an outbreak, we should also continue to offer visits outdoors, in visiting pods or from behind windows – rooms should be left to ventilate with external doors and windows open between uses wherever possible, while aiming to maintain a comfortable temperature for residents and visitors. This will be dependent on the local IPC advice/directive and the judgement of the registered manager.
  • Subject to a risk assessment by the health protection team (HPT), outbreak restrictions may be lifted if 14 days have passed since the onset of symptoms in the most recent case, a round of PCR recovery testing of all residents and staff is undertaken, and there are no PCR positive results
  • Physical contact should be enabled to help health and wellbeing, as long as IPC measures are in place, such as visiting in a ventilated space, using appropriate personal protective equipment (PPE) for the visit, and hand washing before and after visiting – gloves are not needed for handholding and stringent adherence to hand washing is advised
  • Residents should be supported to undertake visits out of the care home as appropriate, following the reasonable precautions and testing arrangements outlined in this guidance
  • All residents should isolate for 10 days (with testing to end isolation sooner) following a high-risk visit out, including an emergency stay in hospital, or if they test positive for COVID-19
  • Vaccination is one of our best defences to combat infection, particularly after 2 or more doses. It is strongly recommended that residents and visitors receive 2 doses of the COVID-19 vaccine, plus their booster. The data shows that booster doses are required to provide higher levels of protection against symptomatic infection. If eligible, visitors should also get their flu jab when it is offered to them
  • Visitors should not enter the care home if they are feeling unwell, even if they have tested negative for COVID-19 and are fully vaccinated and have received their booster. 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 who are not legally required to self-isolate are advised against visiting the 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. Where visits do occur, visitors should have received a negative lateral flow test result earlier in the day of their visit
  • The registered manager is responsible for the safety within their home and will need to monitor and alter visiting regimes should they feel the need to do so, working alongside the IPC.
  • PPE guidance must still be followed, the wearing of a mask is mandatory.
  • Visitors must still complete the Risk Assessment on every visit, this includes professionals and HO staff.
  • Track and Trace records remain in place

Type of Visit
Every resident can now have unlimited nominated visitors, but these must be entered on the visiting plan
This will be agreed with residents and visitors following the individual risk assessment in line with the visitor plan. Varying levels of staff supervision may be required dependent on individual circumstances.
If visitors wishing to see a resident that are not on the visiting plan the decision for visit will be the responsibility of the Home Manager or person in charge

Designated Visitors Room
A designated visitor’s room complete with a sealed compartment is provided in each care home and this may still be used if required
Staff will complete the ‘Visitors Room Checklist’ immediately prior to and following each visit. This must be returned to the office upon completion and stored safely for future inspection.

Visits in Resident’s own rooms
These visits may continue to be facilitated as appropriate, in line with national and local IPC guidance, including 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.
The visitor should go there directly upon arrival and leave immediately after. The visitor must confine themselves to the resident’s room and not engage with any other person including staff members
Visitors to residents’ rooms WILL be required to wear additional PPE as necessary and must avoid any direct physical contact.

Garden Visits

• • Where available, a separate entrance to the garden is to be used
  • In the event of the visitor having to access the garden through the home, the full Coronavirus Risk Assessment process must be completed.
  • The home must physically mark out distance measures minimum 2 metres apart
  • A chair for visitors must be provided and this needs to be cleaned after each visit
  • A table can be placed between the visitor and the resident to maintain the social distance – this also needs to be cleaned after each visit.
  • Where possible a covered area will be provided e.g., garden gazebo

Staff will complete the ‘Garden Visit Checklist’ immediately prior to and following each visit. This must be returned to the office upon completion and stored safely for future inspection.

Window Visits
In some homes window visits may be the most appropriate form of visiting for residents accommodated in ground floor rooms. The relevant social distancing and PPE measures will still need to be observed by the resident and supervising staff indoors, Visitors must remain separate from other households or visitors according to the national rules at the time.

Drive Through Visits
These are facilitated visits in the car parks of homes. Again, any relevant social distancing and PPE measures will still need to be observed.

Exceptional Circumstances
In exceptional circumstances, a very small number of people may have great difficulty in accepting staff or visitors wearing masks or face coverings. The severity, intensity and/or frequency of the behaviours of concern may place them, visitors, or the supporting staff at risk of harm. A comprehensive risk assessment for each of these people identifying the specific risks for them and others should be undertaken for the person’s care, and this same risk assessment should be applied for people visiting the person. If face visors or clear face coverings are available, they can be considered as part of the risk assessment. Under no circumstances should this assessment be applied to a whole care setting.
Where face coverings are required, visitors should be advised to:

• • speak loudly and clearly
  • maintain eye contact
  • not wear hats or anything else that might conceal their face further
  • wear clothing or their hair in a way that a resident would more likely recognise
  • Staff should provide reassurance to visitors, including that some people with dementia might struggle at first to remember or recognise them.
  • Where possible, staff should try and prepare the resident for a visit, perhaps by looking at photographs of the person who is due to visit and talking to them about their relationship.
  • In addition, there are exceptional occasions where a visit can still take place when the home is closed to all other visitors e.g., essential care giver visits and end of life visits can take place during an outbreak.
  • The visitor will be informed that there is COVID on the premises so that they are aware of the risk to themselves before visiting.

Essential Care Givers
Residents with higher care needs may be able to nominate an ‘essential care giver’ who can provide close contact personal care where it is critical to the resident’s immediate health and wellbeing and their health or wellbeing could deteriorate rapidly without it. It is likely that the requirement for this support from the resident’s loved one will already be part of and documented in the care plan. These ‘essential care givers’ will be supported to follow the same testing arrangements, and the same PPE and infection control arrangements as care home staff. These visitors would also be required to be observed by an experienced member putting on and taking off PPE on the first few visits to ensure it is being done properly.
Visiting during a resident’s self-isolation period: essential care givers
When a resident is newly admitted into a care home, the care home should always enable visits from the resident’s essential care giver, including during the 14-day period of self-isolation (but not when a care home resident has tested positive for COVID-19). Essential care givers are loved ones who provide a greater degree of personal care or support, to maintain a resident’s immediate health and wellbeing. They may help the resident to settle into their new environment.
Care homes should undertake an assessment of each resident, including those newly admitted to the care home, to ensure all residents are able to nominate an essential care giver if they wish to.
Further information on essential care givers can be found in section 2.2 in the guidance for visiting arrangements in care homes
Where the resident lacks the capacity to make this decision, a person can only be nominated if this has been determined to be in the resident’s best interest in accordance with the empowering framework of the Mental Capacity Act. Where necessary advice may be sought from external health and social care professionals to help resolve any issues or concerns related to an individual circumstance.

Visitor Screening
All visitors will be screened for symptoms of COVID 19 before being allowed to enter the care home / visitors room / garden visiting area, including temperature check, completion of a Coronavirus Risk Assessment and Lateral Flow Device COVID -19 test. This includes external professionals, local authority/NHS staff, statutory inspectors, and contractors.
No-one who is currently experiencing, or first experienced, coronavirus symptoms in the last 10 days, will be allowed to enter the premises, nor anyone who is a household contact of a case or who has been advised to self-isolate by NHS Test and Trace. There are exceptional circumstances where a visit is facilitated in an emergency or end of life situation where there will not be a need for testing due to the circumstances. However, all infection control precautions will still need to be followed.
The home reserves the right to refuse entry to anyone who is assessed as a potential infection control risk.
Visitors must provide the home with evidence of a recent PCR or LFD test ie Within the last 48 hours or this can be undertaken prior to the visit in consultation with the manager

Outbreaks of COVID-19
Family and friends should be advised that if there is a declared outbreak in a care home then the visiting guidance will need to be immediately restricted for a period of time until the care home has been assessed to be in recovery.
If there is a restriction to visitors in place, alternative ways of communicating between residents and their families and friends should be discussed and offered. The care home should also provide regular updates to residents’ loved ones on their mental and physical health, how they are coping and identify any additional ways they might be better supported, including any cultural or religious needs.

Visitors Charter
All visitors are expected to abide by the Visitors Charter prior to and during any visit. All visitors must:

• • follow any guidance, procedures or protocols put in place by the care home to ensure compliance with infection prevention control.
  • be free of any COVID -19 symptoms on the day of their visit
  • not be unwell on the day of their visits
  • provide the home with evidence of a Lateral Flow Test or a PCR test within the last 48 hours
  • if evidence cannot be provided then a test can be undertaken in the home at the discretion of the person in charge, the teat will take approx. 20 mins and the visit cannot commence until the test is completed
  • provide the necessary information required by the provider at the visits (e.g. honest response to screening requirements about COVID-19 risk factors)
  • 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
  • no visitors will be permitted without evidence of testing

Visits out of the care home
We recognise that opportunities for residents to make visits out of the home are an important part of care home life. 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. There are certain types of activity where the risks are inherently higher and will mean that the resident should self-isolate on their return to the care home. All precautions relating to COVID-19, including social distancing should be followed whilst out of the care home.
Decisions about an individual resident visits out of the care home should only be taken following a risk assessment with the residents assessed needs and circumstances considered. The individual risk assessment should take into account:

• • The vaccination status of residents, visitors and staff, including the extent of 2nd vaccinations.
  • Any testing of those accompanying the resident or who they intend to meet on their visit out
  • Levels of infection in the community
  • Variants of concern in the community
  • Where the resident is going on a visit and what activities they will take part in while on the visit
  • The mode of transport that residents intend to use

From the 4th of May 2021 Government guidance states that residents may leave the care home without the need to self-isolate for 14 days, for a visit to an open space or a nominated visitors garden in line with the following:

• • The vaccination status of residents, visitors and staff, including the extent of 2nd vaccinations.
  • Any testing of those accompanying the resident or who they intend to meet on their visit out
  • Levels of infection in the community
  • Variants of concern in the community
  • Where the resident is going on a visit and what activities they will take part in while on the visit
  • The mode of transport that residents intend to use
  • The visiting care plan will be updated to state who the nominated person is who will taking the resident out.
  • The outdoor visit must be arranged beforehand, so staff are aware
  • The risk assessment / visiting out agreement will be required to be completed and signed prior to the event.
  • Visits out of the home are unrestricted
  • The resident will be required to undertake an LFD test immediately before the visit out
  • Where visits out are accompanied by a named visitor, the visitor will be required to have evidence of a LFD test within the last 48 hours
  • Residents may meet other people but should maintain social distancing and avoid close physical contact with those who are supporting their visit to minimise the risk of infection.
  • Where possible anyone else who the resident intends to meet with should undertake a lateral flow device test and receive a negative result on the day of the visit. This can be confirmed to the home by the named visitor. All tests should be reported to the unique organisation number (UON) of the care home.
  • Relatives should be reminded that these visits should take place solely outdoors and taking their loved one inside a building (apart from using the lavatory) is not permitted
  • Use of public transport to and from ‘the visit’ must adhere to national or local guidelines, Abbey Healthcare recommends masks should be worn in all public areas
  • Social distancing should still be observed along with PPE as appropriate including the wearing of face masks
  • In the interests of everyone safety any breeches in social distancing and/or possible contact with anyone with possible COVID 9 infection must be reported immediately to the person in charge at the home
  • If there are any reported cases of COVID 19 in the home, all visits out will cease.