As part of the Government’s Adult Social Care Winter Plan published on 18 September 2020, the DHSC has implemented a scheme in collaboration with CQC to provide dedicated care locations or ‘designated settings’ to allow the safe discharge of COVID-19 positive patients into or back into a registered care home setting for the remainder of their required isolation period. The scheme is intended to run over the winter period with the aim of preventing the spread of COVID-19 in care homes, enabling COVID-19 positive people to receive the care that they need and also to free up much needed hospital beds.
Designated settings are identified by local authorities in consultation with care providers, and are inspected by CQC to ensure that they are appropriate to receive COVID-19 positive people. The Government’s aim is for each local authority to have access to at least one designated setting as soon as possible. Additionally, local authorities have also identified NHS settings, known as “alternative settings”, in agreement with local NHS partners to fulfil the role of designated settings. The DHSC has stated that the costs of the designated settings will be met through the £588 million discharge funding until the end of March.
The DHSC has stated that the designation scheme applies to care homes who provide accommodation for COVID-19 positive people who need personal or nursing care, including registered residential care and nursing homes for older people, people with dementia, and people with learning disabilities, mental health and/or other disabilities and older people.
The following cohorts are excluded from the designation scheme:
The DHSC requires that designated settings:
Care home providers should also ensure they have sufficient insurance cover to provide the services. Providers who cannot obtain sufficient cover should notify their local authority and/or CQC contacts.
DHSC also has further expectations regarding infection prevention control and clinical support, including that there should be adequate separation (zoning) of the designated setting and that the setting must accommodate each individual in the setting in their own room.
In respect of inspections of designated settings, CQC is using its Infection Prevention Control (IPC) framework, which is being used on all care home inspections, with additional specific elements focused on: checking if services are physically separating Covid positive residents; whether a dedicated workforce is in place; and ensuring that there is a high level of ventilation. CQC will prioritise inspections in local authorities in tier 2 or tier 3.
The locations are inspected against eight areas and reported with ‘eight ticks’ on IPC and are intended to give the public an overview on whether:
The eight areas that are assessed during an IPC inspection are listed below (key line of enquiry S5). CQC judges each area as ‘assured’, ‘somewhat assured’ or ‘not assured’ by the provider of the service. Please refer to CQC’s ‘Adult social care inspection information gathering tool: infection prevention and control’ for further information and guidance for inspections (here).
According to the CQC, the key reasons where a setting did not pass the CQC assurance process following inspection are:
CQC’s judgements following IPC inspections can be found on the profile page for care homes that have been assessed and are also published in inspection reports. An example of a CQC IPC inspection report is available on CQC’s website for Gorsey Clough Nursing Home (here) which was recently inspected by CQC following identification as a designated setting by the relevant local authority. CQC were assured that this service met good infection prevention and control guidelines as a designated care setting.
As of 8th December, there were 117 CQC IPC assured designated settings within 90 local authorities and a further 28 alternative settings. CQC will provide a weekly update of assured designated locations on its website. CQC has also recently published data regarding the numbers of approved settings across regions in its Covid Insight 6 report (here). The data shows that there is a wide regional variation in these numbers, for example, the lowest figure of designated beds per 100 care home beds is in the South East and the highest figure is in London.
The designation scheme appears to be progressing well, however, there are concerns from the sector regarding the lack of operational detail as well as difficulties with obtaining the necessary indemnity insurance.
Another aspect that remains unclear is whether CQC will carry out repeat inspections of designated settings. In view of the fact that these settings are necessarily highly infectious, and house vulnerable populations, it is likely that CQC will carry out follow-up IPC inspections to avoid any lapses in the complex requirements that ensure operational integrity and limit the spread of infection.