Home COVID19 The Trust Our Homes Services Independent Living Careers Volunteers News Contact Home / COVID19 Updated 23 July 2021 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. Document Date: 01 July 2021 Document Owner: Operations Approved By: Operations Manager Date Approved: 22 July 2021 Review Date: 30 November 2021 Version: 9 Policy Statement The policy aims to ensure safe visiting during the COVID-19 pandemic and the easement on visiting those who are vulnerableas a result of the sustained transmission of the Coronavirus. 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 the removal of 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 another 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: Diarrhoea & or vomiting (Gastroenteritis) Norovirus Clostridioides Difficile (C-Diff) Respiratory outbreak such as flu or chest infections During any pandemic in recent times such as COVID-19 Discretion of management during any disaster or major event During these times the home will operate a traffic light system Red, Amber or Green Green – open for visitors in line with the COVID-19 testing policy Amber – suspected cases – managers discretion – option to close the home 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 has been necessary to limit visiting to open spaces such as garden visits at these times when the homes were unable to accommodate indoor visits, these visits have been important for the emotional well-being 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, 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: 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 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: 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 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) 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) 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 that 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: Window visits: ground floor window access for both residents and their visitors and the relevant social distancing and PPE measures have been observed. Garden visits: Relevant PPE measures and social distancing have been used, and these visits have been pre-booked to ensure distancing is observed. 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 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. 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) Nominated named visitor indoors: Care home residents in England will be able to receive “named visitors” indoors from Monday 19th July as Covid restrictions continue to be eased. Regular visits still need to be undertaken carefully and with designed conditions to prevent transmission of COVID-19. The “named visitors” may include an essential care giver (where they have one) but excludes babies and preschool-aged children. To reduce the risk of infection home managers will continue to regularly update their risk assessments which will allow them to assess and ascertain a maximum what they assess is a safe number of visitors to their homeover the course of one day (essential care givers are exempt from this daily limit). The named visitors should be tested using rapid lateral flow tests in line with the testing regime, should wear the appropriate personal protective equipment (PPE), maintain social distancing and follow all other infection prevention and control measures (which the care home will guide them on) during visits. named visitors and residents are advised to keep physical contact to a minimum (excluding essential caregivers). Physical contact like handholding is acceptable if handwashing protocols are followed. Close personal contact such as hugging presents higher risks but will be safer if it is between people who are double vaccinated, without face-to-face contact, and there is brief contact only residents with higher care needs can also choose to nominate an essential care giver. As set out above, essential care givers are included in the named visitors but excluded from the 2-person limit per visit or per day care homes can also continue to offer visits to other friends or family members through arrangements such as outdoor visiting, rooms with substantial screens, visiting pods, or from behind windows Care home visiting should be supported and enabled wherever it is possible to do so safely –supported by this guidance and within an environment that is set up to manage risks. All visitors also have an important role to play –helping to keep their loved ones, other residents and staff safe by carefully following the policies described in the guidance and the practical arrangements that care homes put in place, such as internal risk assessment and infection prevention and control protocols. Local system leaders such as the directors of public health (DPH) and directors of adult social services (DASS) also have a key role in this partnership to support visiting. In the face of new variants of the virus, we need to remain alert to ensure we protect those most at risk in care homes while ensuring indoor visits can go ahead. Vaccination is one of our best defences to combat infection. It significantly reduces the transmission of the virus, particularly following 2 doses. It is strongly recommended that all visitors and residents take the opportunity to be vaccinated before conducting visits. Each care home is unique in its physical environment and facilities, and the needs and wishes of their residents. As such, care home managers are best placed to develop their own policies to ensure that the visits described in the guidance are provided in the best way for individual residents, their loved ones, and care home staff. Care home managers should feel empowered to exercise their judgement when developing practical arrangements or advice to put this guidance into practice so that visiting can take place smoothly and comfortably for everyone in the care home. The individual resident, their views, their mental capacity, their needs and wellbeing should be taken into account when decisions about visiting are made, recognising that the care home will need to consider the wellbeing of other residents as well. These decisions should involve the resident, their family and friends and the provider and other relevant professionals such as social workers or clinicians where appropriate. Throughout the guidance the use the phrase ‘family and friends’. This is intended to be a wide-ranging and inclusive term to describe the network of people around the resident who may wish to visit, or whom the resident may wish to meet. All visits have and will continue to have the to follow the visiting code/guidelines book visits in advance for a specific day and time, visits will be for a limited time to ensure all residents get visits each care home will confirm the length but is likely to be one hour –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 if being tested at the home, all visitors must provide evidence of a home test (ad hoc visits will not be enabled except for exceptional circumstances) check-in with the care service on the day prior to their visit, to ensure the situation in the service has not changed be free of any COVID-19symptoms on the day of their visit must be well on the day of their visits provide the necessary information required by the service 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 which could be the bedroom of loved one/relative. ensure they visit with a face-covering / face mask 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 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 named visitors should be tested using LFDs and wear appropriate PPE. Visitors can either be tested using LFDs on-site or at home. LFD testing must be conducted on the day of the visit, and evidence must be presented if self-testing at home. If a visitor cannot produce a negative test, they may be asked to reschedule or take a test on-site. Visitors will need to register test results themselves whether at home or on-site. Managers will need to give visitors the UON of the care home to do this. If a result is positive, the visitor and their household must self-isolate and take a confirmatory PCR test. essential care givers will be expected to follow the same PPE, IPC and testing arrangements as care home staff. This means a minimum of 2 LFD tests a week and a PCR test. The LFD tests can be done at home. The Trust continues to adopt the current Government guidance, which is based on the following principles: 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. 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: “outdoor” visits as indicated by the risk assessments, including those made using temporary facilities such as pods. “indoor” visits to dedicated areas that can be supported by rapid testing (see section on Indoor Visiting Supported by Testing) the homes will continue to enable “essential” visiting needed in exceptional circumstances such as when a person is receiving end of life care 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 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 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 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 Additional measures 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. 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. 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. Staff will ensure the visitor have washed their hands / used the alcohol hand gel when they arrive and leave the area. Please note that visits to our homes is still subject to the specific circumstances of the care home and those living and working in it. 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. This may mean limiting visitors per day and at least 2 hours apart to ensure touch points have been disinfected again 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 Visitors temperatures are taken, and questions asked about their general health If refreshments are offered / required,an allocation of disposable crockery will be supplied and disposed of in the provided pedal waste bin The visitor should have access to their own face covering and will not be permitted to visit without this 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: 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 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: Visitors will be provided with a letter from the care home and a copy of the Visitors Guidance, prior to the test being completed Consent forms will also be provided to gain formal consent for testing and sharing results if the home is conducting the test on behalf of the visitor Visitors who test at home must provide evidence of their negative result. Testing Area: 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 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 Other key aspects will be considered, to include social distancing, disability access, and fire safety regulations Day of Testing: Visitors will be provided with PPE upon entrance and consent gained to be tested Antibacterial wipes will be available for visitors to wipe down the seat including any arms of the chairs before and after the test. Hand washing facilities, a mirror (for throat swabbing) and tissues will be available in this area The care home will display the homes, Unique Organisation Number (UON) to enable visitors to register their test results The care home will prepare test kits including the swabs, extraction materials, test tube racks, LFD devices, and barcodes 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) Support will be available to support visitors with registering their kit online, if needed 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, should be tested on every visit in the same manner as visitors via the LFD test, this is if they have not tested at home, the care home has the right to ask for evidence of a negative test. For further visitor guidance please see the link below: https://www.gov.uk/government/publications/coronavirus-covid-19-testing-for-adult-social-care-settings 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. the importance to the wellbeing of the individual to have a resumption or continuation of visits the degree of harm that might occur without any visits the risk factors that are involved including the vulnerability to infection for the person concerned 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 the importance of visiting to the person in the context of their overall care plans the effectiveness of the current contact or visiting arrangements in place the willingness of prospective visitors to go through the new testing procedures if and when adopted by the home. Vaccination status of both residents and visitors. 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 or provide evidence that a test has been undertaken on the same day outside of the home 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 “named visitors” we will still ask you to: check with us before visiting that everything is in order and that you do not have any symptoms for COVID-19 ask if you have been overseas lately 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 in the last 14 days and take a decision about visiting based on your assessment of any risks 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 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 help staff to carry out the procedures that have been put in place to keep everyone safe from the virus and its spread 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. GDPR requirements for care homes (in relation to NHS Test and Trace) Care homes should support NHS Test and Trace by keeping a record of current and previous residents, visitors and staff. As per General Data Protection Regulation (GDPR) requirements, these records can be destroyed after 21 days. Visiting outside the care home Spending time out of the care home has always been an important part of life for many people living in residential care, and residents leave their care home for a range of reasons. These might include to attend work or education, attend medical appointments and to spend time with friends and family. For some residents, regular visits out may have been assessed as being a necessary part of their care plan, such as accessing care and support at day services, participating in community groups and volunteering. This might include regular planned overnight visits to the nominated family home. We recognise how important this is for residents’ health and wellbeing, their ability to remain at the heart of family and social networks, and, in some cases, to deliver the objectives of their care plan. 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. This is the case even as we see community infection rates dropping and vaccine coverage increasing. 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). This is to ensure that, in the event they have unknowingly become infected while out of the home, they minimise the chances of passing that infection on to other residents and staff. These activities are: overnight stays in hospital visits assessed to be high-risk following an individual risk assessment This remains under review, and it is the governments ambition that guidance on the need for self-isolation following overnight stays in hospital will be amended as soon as the data and evidence show it is safe. All other visits out of the care home that are not assessed as high risk should be supported without the need to isolate on return to the care home, subject to an individual risk assessment. Where applicable, attention should also be given to any additional local guidance provided by the local director of public health (DPH) and director of adult social services (DASS). All precautions relating to COVID-19 (including social distancing and those set out below) should be followed while out of the care home. Where residents are visiting a location with an existing testing regime – for example a workplace, day care centre or education setting – they should participate in the relevant testing regime for that organisation where possible. Our Care homes will always support visits out in exceptional circumstances, such as to visit a friend or relative at the end of their life. Supporting visiting – guidance Providers are best placed to define their overall policy for how outward visits are supported in the care home, in a way that takes into account the assessed needs of their residents and what is possible within the facilities and resources of the care home. The make-up of the care home community should be a key determinant of local arrangements for supporting outward visits. This is because residents are likely to have a range of needs, long-term conditions and other clinical vulnerabilities and levels of mobility. Providers should consider both the benefits and potential risks involved in a visit out of the care home, in order to recommend measures to mitigate risks before, during and after the visit. Consideration should be given to the risk to other residents (who may be particularly vulnerable) and staff. The local DPH and DASS both have an important role in supporting care homes to ensure outward visiting can happen safely. This support should assume that outward visiting should be possible unless there is evidence which suggests a more restrictive approach should be taken. In particular, the DPH and DASS should not recommend an approach across the whole of the local authority area that does not recognise variation between different areas with the local authority, and which does not take account of the different circumstances in individual homes and the need for any specific COVID-related infection control measures at a given time. Individual risk assessments No visit out of a care home during a pandemic is without risk, but there are steps we can take to reduce those risks. Care homes will discuss and agree arrangements with residents, residents’ named visitors, or their essential care provider in advance. Decisions about an individual resident’s visits out of a care home should be taken with the resident’s assessed needs and circumstances considered. The care home will balance the benefits of visits out of the care home against a consideration of the risks to others in the home, where necessary. It is important that the resident and their family are involved in discussions throughout this process. If undertaking a visit out is not possible because of the risk to the individual and other residents and staff, care home managers will communicate the reasons for this decision clearly to the resident and their family. Individual risk assessments 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 Where a care home is situated in a local community with high, or rapidly rising, levels of infection, and/or where there is evidence of variants of concern or variants under investigation, care home managers should seek additional local advice from their local authority DPH. Regard will also be given to the ethical framework for adult social care, and the wellbeing duty in section 1 of the Care Act 2014, and all decisions should be taken in light of general legal obligations, such as those under the Equality Act 2010 and Human Rights Act 1998, as applicable. Other steps to mitigate the risks around a visit out To support safe visits out of care homes and to minimise the risk of transmission of infection to care home residents and other people they live with in the care home, the following measures are advised and should be considered for all visits out of care homes: residents may be (but are not required to be) accompanied by: a member of care home staff one or more of their named visitors, and/or their essential care giver (where applicable) residents may meet other people but should maintain social distance from anyone who is not one of their named visitors, essential care providers, or care staff and, wherever possible, should avoid close physical contact with those who are supporting their visit to minimise the risk of infection where visits out are accompanied by a named visitor, the visitor should follow the relevant testing regime as referenced in the guidance on care home visiting and receive negative test results in the same way as if they were visiting in. Testing arrangements are outlined in more detail in the guidance on care home visiting where possible, anyone else who the resident meets as part of an indoor visit should undertake a lateral flow device test and receive a negative result on the day of the visit. This can be confirmed by the named visitor. All tests should be reported to the unique organisation number (UON) of the care home residents should avoid crowded places residents should avoid using public transport where possible, especially at peak times; travelling in a family car or private taxi is an acceptable alternative. Where residents are visiting a location with an existing testing regime, for example a workplace, day care centre or education setting, they should participate in the relevant testing regime for that organisation where possible. Others involved in the visit should take steps leading up to the visit to minimise the risk to the care home resident and others in the care home, recognising that introducing COVID-19 to a care home puts all those who live and work there at risk. This includes receiving a negative test and following good infection control practice including social distancing, hand hygiene, wearing face coverings and avoiding crowded places. Vaccination is one of our best defences to combat infection risk. It significantly reduces the transmission of the virus, particularly following 2 doses. It is strongly recommended that all visitors and residents take the opportunity to be vaccinated before conducting visits. In the event of an outbreak in the care home In the event of an outbreak, all movements out of a setting should be minimised as far as possible. These restrictions should continue until the outbreak is confirmed as over, which will be at least 14 days after the last laboratory confirmed or clinically suspected cases were identified in a resident or member of staff in the home. 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. 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