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Designated settings for people with COVID-19 leaving hospital
Updated 12 January 2021
CQC is continuing to work with the Department of Health and Social Care (DHSC), local authorities and individual care providers to provide assurance of safe and high-quality care in designated settings, which are part of a scheme to allow people with a COVID-positive test result to be discharged safely from hospitals.
These settings are admitting people who are discharged from hospital with a COVID-positive test who will be moving or going back into a care home setting. This is to help prevent the spread of COVID-19 (coronavirus) in care homes and will allow for a focus on the care that people who have contracted COVID-19 need. The Government’s aim is for each local authority to have access to at least one designated setting as soon as possible, CQC is working closely with the Department of Health and Social Care to ensure social care designated settings are appropriate.
For inspections of designated setting services, there are specific elements we are checking for in the environment to ensure infection control can be maintained. We will be checking this using our Infection Prevention and Control (IPC) framework. We will be checking if services are physically separating this group of residents, whether a dedicated workforce is in place and ensuring there’s an appropriate emphasis on ventilation.
We are inspecting care locations against eight areas and reporting with ‘eight ticks’ on infection prevention control which will give the public an overview including on whether:
- Adequate PPE is available for staff and residents to control infection safely
- Staff are properly trained to deal with outbreaks and the proper procedures are in place
- Shielding and social distancing are being complied with
- Layout of premises, use of space and hygiene practice promote safety.
Kate Terroni, Chief Inspector of Adult Social Care at CQC, said: "It is our role to ensure that proposed locations for the designated scheme, which is an initiative led by the Department of Health and Social Care, meet the IPC standards expected for people with a confirmed COVID-19 test result to be discharged into.
"We completed 521 IPC and inspections of designation schemes throughout October and November and since December until now we have completed 56 further of these inspections. We will continue to work with the Department of Health and Social Care, local authorities and care providers to ensure that all locations participating in the scheme are able to provide the high-quality care that people leaving hospital will need."
The Department of Health and Social Care have asked local authorities to speak to local care providers and find suitable designated locations where people that have tested positive for COVID-19 may be safely discharged to. Once these locations have been identified, they contact CQC and we go out and assess the location with an IPC inspection and a specific focus on a service’s ability to zone COVID-19 positive residents with a dedicated workforce and high levels of ventilation.
The results of that inspection will be published on our website through an inspection report, where the public can see how the care provider has performed against our 'eight ticks'. This means we are able to provide assurances on infection prevention control, whether people being cared for are in a designation area or in an existing location.
CQC’s infection prevention control (IPC) inspections include different kinds of inspection as outlined below.
- Inspections of proposed designated facilities
- Inspections in response to risk and information of concern
This is in addition to our risk-based inspections which are continuing alongside our IPC and designated settings inspection work. As of 5 January, we have conducted 2,562 risk-based inspections of Adult Social Care locations.
To provide additional re-assurance to the care sector and during these inspections, our inspectors will be getting weekly testing for Covid-19, following the Department for Health and Social Care’s decision to offer testing to key workers. Testing will be rolled out to all inspectors who participate in onsite visits in the coming weeks.
This is in addition to our existing protections, where all CQC staff engaging in inspection and registration visits must undertake a risk assessment prior to the visit. They must use the PPE identified, have gone through training on its use, and have completed the Infection Prevention and Control training. Where an inspector displays symptoms or a positive Covid-19 diagnosis, they are already required to self-isolate.
As of 5 January, there were 129 CQC IPC assured designated settings within 98 local authorities. There are a further 32 “alternative settings”, where local authorities have agreed with local NHS partners to make use of NHS settings to fulfil the role of a designated setting. The data section provides more detail on the figures. Please note that some local authorities will be sharing a designated setting that is located within another local authority.
Where a setting did not pass the CQC assurance process following inspection, the key reasons are:
- Location unsuitable – e.g. not enough separation between designated bit of service and the rest of the care home
- Location not ready - e.g. significant building work planned and impossible to assess until this is complete
- Staffing - no designated staff team to work exclusively in the designated setting.
We will continue to provide a weekly update on these figures on this website. Read more information about Designated Settings on GOV.UK.
Key data (as of 5 January 2021)
Some local authorities have chosen not to participate in the scheme and in some areas, they have agreed with local NHS partners to make use of NHS settings to fulfil the role of a designated setting. In this instance, it will not be necessary for that NHS setting to be inspected by CQC specifically for the purpose of this arrangement.
The data below highlights what we have laid out above, that there are three main reasons for different areas having varying rates of designated settings approvals: the location being unsuitable, the location not being ready and staffing issues. We’re in discussion with the Department of Health and Social Care, and system partners to address issues of capacity across country, particularly in areas where there is a shortage or lack of designated settings.
- Approved setting – a designated setting that has been CQC-assured. (likely a care home)
- Alternative Arrangement – a designated setting that is linked to an alternative settings such as a community hospital
- Response Outstanding – Local Authority has submitted and CQC are reviewing the location and where necessary scheduling an inspection
- Unsuitable – CQC has judged the location to be unsuitable based on the initial application received
- Withdrawn – the provider of service has withdrawn the location
- Pending Ext. Info – CQC has requested further information from the Local Authority or the provider
- Pending Judgement – CQC has inspected and is reviewing information to decide if the location can be assured
- Not Assured – CQC has inspected and have judged the location to be unsuitable
- Proposed settings – All applications from CQC plus alternative arrangements NHS settings.
|Region||Proposed LAs with a designated setting||Proposed settings||Total proposed beds||LAs with an approved setting||Approved settings||Approved beds||Alternative arrangement beds|
|East Midlands||8 / 9||33||183||8 / 9||16||190||0|
|East of England||11 / 11||27||310||10 / 11||11||174||41|
|London||21 / 33||38||411||16 / 33||8||73||311|
|North East||11 / 12||23||168||10 / 12||13||180||0|
|North West||20 / 23||44||313||15 / 23||20||229||73|
|South East||14 / 19||119||198||9 / 19||12||193||14|
|South West||8 / 15||34||115||6 / 15||4||33||77|
|West Midlands||12 / 14||39||496||10 / 14||11||122||341|
|Yorkshire and The Humber||15 / 15||45||357||14 / 15||34||381||12|
|Total||120 / 151||402||2,551||98 / 151||129||1,575||869|
|Region||1. Response outstanding||2. Unsuitable||3. Alternative arrangements||4. Withdrawn||5. Pending external info||6. Pending judgement||7. Not assured||8. Approved||Total|
|East of England||6||6||2||0||0||0||2||11||27|
|Yorkshire and The Humber||0||8||1||1||0||0||1||34||45|
- Last updated:
- 12 January 2021