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Infection prevention and control in care homes

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  • Organisations we regulate

Our inspectors use this set of questions and prompts to look at how well staff and people living in care homes are protected by infection prevention and control (IPC) - key line of enquiry S5.

The questions help us to gather information about the service's strengths. They also help us understand if there are any gaps or concerns about infection prevention and control. Where there are we aim to signpost the service to resources that could help.

We are publishing the questions to help you prepare for the risk of a second wave and the impact of winter pressures.

Although the questions are written for care homes, we plan to adapt them to other types of service.

Adult social care inspection information gathering tool: infection prevention and control

Instructions and guidance

This form must be completed on all types of inspections for care homes where a site visit is made.

The tool will help you collate relevant information to provide assurance that a care home has appropriate infection prevention and control measures in place.

Add in your notes and observations with evidence to support your findings. Highlight good practice and, where there are shortfalls, please support services by signposting to relevant resources.

You should pre-populate the form as much as possible from other sources before or after the site visit to reduce time spent on premises and minimise exposure to risk. Use information such as the TRA, monitoring information, notifications and feedback.

Choose whether you are assured, somewhat assured or not assured for each topic question. This will provide a quantitative measure to understand how well the care home sector is responding to key areas of IPC practice.

For the key practice findings, you only need to record key practice and innovation that you think other services could learn from rather than what we expect providers to be doing in complying with guidance. With poor practice, we want you to highlight unexpected failings and concerns that are things that providers may not recognise but has considerable impact on safety in relation to IPC.

At the end of the form are a series of closed questions that we want you to answer (mainly) yes or no based on your assessment of the service. This will provide us with a better understanding of implementation of IPC in care homes and allow us to collate and report our findings in a timely manner.


1. Are all types of visitors prevented from catching and spreading infection?

  • What measures can you see in place to prevent relatives and friends, professionals and others visiting from spreading infection at the entrance and on entering the premises?
  • What procedures must people follow during the visit? How is this communicated to people? Do the procedures appear to be complied with by visitors?
  • What alternative arrangements to visiting in person have been put in place?
What good looks like and guidance

What good looks like

Note: the decision on whether to allow visitors is ultimately the provider's responsibility with due consideration to local public health advice.

  • Provider is transparent in terms of sharing information and communication with friends and family about number of deaths and infections so they can understand decisions around visiting and restrictions
  • People have individual visitor plans as part of their care plan to make sure their social contact needs are met
  • Visitors are limited, for example ideally to one visitor, or to two visitors from the same household, per resident at a time
  • There is a booking system in place to stagger visitors and visiting times to minimise visitor numbers
  • Visitors have no contact with other residents and minimal contact with care home staff
  • Facilities are in place to wash hands for 20 seconds or use hand sanitiser on entering and leaving the home
  • Visitors are supported to wear a face covering when visiting, and wash hands before/after mask use
  • All visitors are screened for symptoms of acute respiratory infection before being allowed to enter the home
  • There are prominent signage and instructions to explain what people should do to ensure safety
  • Information is easily accessible on arrival or before visits to ensure visitors follow guidance, procedures or protocols to ensure compliance with infection prevention control
  • Alternative forms of maintaining social contact are used for friends and relatives; for example: keeping in touch using video calls, weekly newsletters to family members, visiting in communal garden or through meeting at a closed window and using a phone to communicate with. Remote considerations are also considered by other visitors such as professionals and clinical consultations

COVID-19 guidance

Support and resources


2. Are shielding and social distancing rules complied with?

  • How do staff and people using services achieve social distancing and shielding?
  • What has been the impact on wellbeing of people using the service? How have they been supported? What arrangements have been maintained to enable people using the service to go out/return safely?
  • What mitigation is in place where it is not always possible to socially distance?
  • Is isolation, cohorting and zoning implemented effectively where there is infection or an outbreak?
What good looks like and guidance

What good looks like

Note: from 1 August, the government will pause shielding unless the transmission of COVID-19 in the community starts to rise significantly.

  • The service has identified which people are in the clinically extremely vulnerable group and are separated from others if isolating, and/or if shielding measures need to be implemented
  • Staff wear a fluid repellent surgical mask, gloves and apron when delivering personal care to all people
  • Staff wear a surgical mask, gloves, and apron in all rooms where someone is shielding irrespective of 2m distance rule
  • Staff wear PPE in services where 2m social distancing cannot be maintained or achieved
  • Symptomatic residents are ideally isolated in single occupancy rooms. Where single room occupancy isn’t practical, symptomatic residents are cohorted together - while ensuring those untested, tested positive and tested negative are kept separate from each other where possible for the duration of the isolation period
  • Residents in isolation do not attend communal areas, including shared lavatories and bathrooms. Alternative facilities are provided
  • Measures such as isolation and cohorting of exposed and unexposed residents have been risk assessed, covering duration and nature of contact that should be carried out
  • Arrangements are in place so staff appropriately social distancing during breaks
  • Zoning measures are in place based on training delivered by Mutual Aid trainers

COVID-19 guidance

Support and resources


3. Are people admitted into the service safely?

  • What measures are in place to prevent people from spreading infection when admitting a person to the service from a health or social care service? And from the community?
  • Did the process for the most recent admission follow current admissions guidance?
What good looks like and guidance

What good looks like

  • The service ensures patients have been tested for COVID-19 by the hospital and from the community before the service agrees to admit them
  • Admissions from hospital or interim care facilities, and new residents admitted from the community, are isolated for 14 days within their own room. There are clear procedures from point of entry into the care home that minimise risk of transmission when moving people to their rooms
  • Residents are assessed twice daily for the development of a high temperature (37.8°C or above), a cough, as well as for softer signs such as shortness of breath, loss of appetite, confusion, diarrhoea or vomiting
  • For people who lack mental capacity, the service has considered if any new measures and arrangements in relation to IPC amount to a ‘deprivation of liberty’ and take appropriate action – see annex A and annex B

COVID-19 guidance

Support and resources


4. Does the service use PPE effectively to safeguard staff and people using services?

  • Where and how are staff donning and doffing PPE? How is PPE disposed of after use?
  • Do the levels of PPE used comply with current guidance?
  • What specific PPE training has been provided during the pandemic?
  • People using the service may be fearful or anxious seeing staff wear PPE. What measures are in place to support communication and reassurance? (For example people who are deaf, autistic people, people with dementia.)
What good looks like and guidance

What good looks like

  • Use of PPE is in accordance with current government guidelines COVID-19 personal protective equipment (PPE):
    • There are designated areas for donning/doffing PPE, separate areas is preferable
    • Signage on donning/doffing PPE and handwashing is visible in all required areas, including for visitors
    • Staff observed to put on/take off PPE as per guidelines
    • Staff observed to follow good hand and respiratory hygiene practices using appropriate products
    • Disposal of used PPE prevents cross-contamination is follows local protocols, in particular single use items and how PPE is disposed of at the end of shifts safely
  • Staff have received some form of training from local Health Protection Team, IPC specialist at CCG, Mutual Aid training or similar
  • The provider has assessed the impact on residents of how PPE may cause fear and anxiety for residents, particularly those who have limited mental capacity and has mitigated these concerns using the COVID-19 risk reduction framework
  • The provider has addressed issues where PPE may not fit appropriately because of staff gender or other protected characteristics

COVID-19 guidance

Existing guidance

Support and resources


5. Is there adequate access and take up of testing for staff and people using services?

  • How do staff and people using the service access regular testing? What is the frequency of testing?
  • What does the service do if someone becomes symptomatic or when a positive test occurs?
  • What does the service do if people and staff refuse a test? And understand why they refuse?
What good looks like and guidance

What good looks like

  • Testing scheme for all staff and residents has been conducted – known as ‘whole home testing’
  • Care home managers have or know how to apply for coronavirus testing kits to test residents and staff of their care home via the online care home portal
  • Risk assessments have been carried out on people using services and staff belonging to higher risk groups and actions have been taken to reduce the risks
  • All care home workers have had a test without delay once they become symptomatic. Staff with people in their own households displaying symptoms have also had a test. Frequency of testing follows current guidance
  • Managers and staff have processes in place to ensure they know how to access the online self-referral portal or obtaining login details via email portalservicedesk@dhsc.gov.uk

COVID-19 guidance

Existing IPC guidance

Support and resources


6. Does the layout of premises, use of space and hygiene practice promote safety?

  • Do the premises look clean and hygienic? How is cleaning scheduled and sustained? What cleaning products are used?
  • How has the layout and facilities of the premises been changed to support IPC and good ventilation?
  • How have communal indoor/outdoor spaces been optimised to use safely?
What good looks like and guidance

What good looks like

  • Rooms are designated for specific activities such as for visitors, and are subject to regular enhanced cleaning
  • Communal areas such as outdoor spaces and garden areas are used creatively to help with IPC
  • Plastic or glass barriers are used to help prevent infection but do not restrict people’s access and mobility
  • Where there are multiple entrances, they are restricted for use by different people such as staff or visitors
  • If the design and capacity of the care home and the number of residents involved is manageable, it is preferable to isolate residents into separate floors or wings of the home
  • Environmental measures such as effective ventilation have been implemented
  • Process in place to ensure personal items, toiletries are not mixed up or shared across residents
  • All areas are uncluttered so cleaning can take place effectively
  • There is a designated lead for cleaning and decontamination within the service. They have instituted a form of zoning, such as colour coding around equipment and rooms to easily highlight for staff the levels of cleaning required
  • Cleaning staff have cleaning schedules, which they are required to complete and that includes frequency of cleaning of high touch areas, eg light switches, keyboards, door handles. Records/checks of cleaning show compliance with the cleaning schedule
  • Evidence of liaison with cleaning staff to review processes are in line with national guidance on cleaning of areas where possible exposure to suspected COVID-19 and to include risks to cleaning staff
  • System for cleaning shared bathrooms and toilet facilities between people with possible COVID-19
  • Designated room for storage and managing laundry. Laundry rota and processes in place so clothes are not mixed and washed together. Good practice for linen and laundry guidance (pg 60) is followed
  • Waste management good practice guidance (pg. 65) is followed and care home guidance Annex J (pg 65)

COVID-19 guidance

Existing guidance

Support and resources


7. Do staff training, practices and deployment show the service can prevent transmission of infection and/or manage outbreaks?

  • How is staff movement and transmission in and between care homes minimised? How have staff rotas, shift patterns, handovers changed to improve IPC?
  • If agency staff are used, how is their compliance with IPC measures and not working between other services assured?
  • What recent IPC training has been given to support staff to provide safer care?
  • How is staff wellbeing supported, including becoming unwell, sick leave and returning to work safely?
What good looks like and guidance

What good looks like

  • Employees in the clinically ‘extremely vulnerable’ group do not work in the care setting
  • All staff in high risk groups such as BAME have been risk assessed, and adjustments have been made
  • All members of staff work in only one care setting, this includes part-time and agency staff in accordance with guidance – with support from Infection Control Fund if needed
  • In larger settings, 'cohorting' staff to individual groups of patients or floors/wings is practiced
  • Risk assessment and action has been taken to limit the use of public transport by members of staff
  • Staff have undertaken Mutual Aid training provided by NHSI/CCGs on IPC
  • Staff room is locked when not in use and breaks are staggered so 1-2 staff only use it at any one time and can maintain social distancing
  • Handovers are done virtually, utilising messaging apps such as WhatsApp
  • The service has through NHS ‘mutual aid’ have been trained to use equipment such as pulse oximeters and well evaluated tools such as RESTORE2 and NEWS2 (supported in current British Geriatric Society (BGS) guidance). They have also accessed specific equipment such as pulse oximeters, to help determine whether a resident is unwell
  • Staff are trained and know how to immediately instigate full infection control measures to care for the resident with symptoms to avoid the virus spreading to other residents and staff members
  • Staff who are isolating in line with government guidance receive their normal wages while doing so

COVID-19 guidance

Existing guidance

Support and resources


To complete after site visit

8. Is IPC policy up to date and implemented effectively to prevent and control infection?

  • Are infection risks to people thoroughly assessed and managed? What action has been taken to consider and reduce any impact to people/staff who may be disproportionately at risk of COVID-19? (BAME, learning disabilities, dementia)
  • What changes have been made following the most recent audit?
  • What contingency planning is in place to address future coronavirus and other infection outbreaks and winter pressures?
What good looks like and guidance

What good looks like

Note: This section is likely to be a summation of the findings above and whether it accords with the service’s current IPC policy and implementation of current government guidance.

  • There is a designated IPC lead who is sufficiently knowledgeable to fill this role. Evidence of effectiveness includes knowledge of current guidance, dissemination to staff and others, liaising with relevant agencies, communication and transparency with people using services and their family and friends
  • IPC policy is up to date in line with code of practice 10 criteria, has been audited during the pandemic to reflect best practice, and staff know how to immediately instigate full infection control measures to care for the resident with symptoms to avoid the virus spreading to other residents and staff members
  • People know how to raise any concerns or complaints around IPC practice if they think it is unsafe or not effective without fear or discrimination. There is evidence of responsive action to concerns made
  • Care home managers have contacted their local health protection team (HPT) if they suspect their care home has a new coronavirus outbreak and/or it has been 28 days or longer since the last case and there are new cases
  • All equipment used to support the monitoring of residents meets infection control and decontamination standards and guidance/code of practice
  • In compliance with the code of practice, there is a decontamination policy in place that overs what to do if there is a spillage of blood or body fluids
  • Where a person’s usual care and treatment arrangements have changed to ensure safety that may amount to a ‘deprivation of liberty’, appropriate guidelines have been followed – see annex A and annex B
  • For end of life care, the visiting guidance and care home guidance (pg. 16) are implemented and followed
  • Where a resident has passed away, the following guidance has been followed

COVID-19 guidance

Existing IPC guidance

Support and resources


Additional mandatory questions

  1. Does the service have sufficient and adequate supply of PPE that meets current demand and foreseen outbreaks?
  2. Are staff using PPE correctly and in accordance with current guidance? 
  3. Has the service received external PPE training during the pandemic sourced from a Mutual Aid trainer or of similar equivalence?
  4. Does the service know where to go for advice should there be an outbreak – which authorities and what their role and responsibilities are?
  5. Is the service participating in the testing program that is currently provided for residents and staff members?
  6. Do staff in the service understand the principles of isolation, cohorting and zoning appropriately?
  7. Has the service implemented isolation, cohorting and zoning appropriately?
  8. Has the service adequately taken measures to protect clinically vulnerable groups and those at higher risk because of their protected characteristics (BAME, physical and learning disabilities)?
  9. Has the service got a named clinical lead as assigned by the Primary Care Network?
  10. What position/profession is your named clinical lead? For example GP
  11. Do they conduct a home/ward round?
  12. What clinical support has been provided direct into the care home, by whom, and what has been its impact?
Last updated:
03 November 2020