Almost two-thirds of care homes (65%) inspected in August met all the major requirements around infection control, a Care Quality Commission (CQC) report has shown.
The regulator carried out infection prevention and control (IPC) inspections across 139 care homes selected for concerns about quality and safety, and 301 others identified as possible examples of good practice.
Inspectors judged the services as ‘assured’ (the highest score), ‘somewhat assured’ or ‘not assured’ across eight key areas.
Care home visits
The report showed that care homes were most successful at adhering to IPC standards for visits, with 97% of ‘good practice’ and 78% of ‘risk-based’ homes marked as ‘assured’.
Those services had ‘effective systems in place to ensure visiting could go ahead safely’, such as enabling garden visits, providing a robust system of screening and PPE for visitors, and facilitating non-face-to-face communication, the report said.
However, the inspectors found that some homes faced challenges in ensuring social distancing during visits, and shortfalls in the screening procedures and with signage.
The CQC said: ‘There are considerations for all providers going forward on balancing visiting restrictions based on current local advice against the rights, health and wellbeing of people who use the service and the risk of harm from isolation.’
Shielding and social distancing
The regulator found that most services had ‘suitable plans’ in place to care for both symptomatic and Covid-19 positive residents in the event of an outbreak, with social distancing also maintained wherever possible.
It found that 93% of ‘good practice’ and 68% of ‘risk-based’ care homes were complying with shielding and social distancing rules.
The CQC said good services carried out risk assessments and took simple and practical steps when social distancing posed a challenge, including when delivering personal care or supporting those with dementia.
Providers also ensured meaningful activities were available to mitigate the impact of isolation, and that residents were informed about the restrictions.
Where there were gaps, this mainly involved providers failing to consider social distancing in the layout of their services, or where staff did not maintain a distance in their interactions.
The inspectors also found 93% of ‘good practice’ and 79% of ‘risk-based’ homes were fully meeting safe admissions guidance.
It said those services routinely tested and isolated new admissions to help prevent the spread of infection. They carried out ‘effective admission assessments despite the challenges, considered mental capacity and took action to reduce the impact of isolation’, the report said.
However, in some cases, the 14-day isolation on admission had not taken place, it added. Some homes had also made blanket decisions to reuse admissions, which has ‘potential consequences’ on finances and local capacity, the CQC said.
Use of PPE
The two areas with the most gaps in assurance were effective use of PPE and having up-to-date IPC policies in place, the CQC found.
The inspections revealed 91% of ‘good practice’ homes were using PPE effectively to safeguard staff and residents, compared with 65% of ‘risk-based’ homes.
The CQC said: ‘Despite challenges at the beginning of the pandemic, the supply of PPE was seen to be working. Generally, inspectors were assured that staff understood the PPE guidelines and that safe procedures had been implemented.’
However, the regulator said it found some issues around compliance with the guidance on donning and doffing PPE, mask wearing and handwashing.
The picture was similar for IPC policies, with 91% of ‘good practice’ homes found to have an up-to-date policy that was being implemented effectively, compared with 62% of ‘risk-based’ homes.
Inspectors also found a large degree of variance in terms of how well providers planned for a Covid-19 outbreak.
Some providers had reviewed and updated their policies and communicated these well to staff, while others had not updated theirs since the start of the pandemic, and ‘contained no reference or out-of-date guidance on Covid-19, which had the potential to be dangerous’, the report added.
‘Most providers responding to challenges’
Kate Terroni, chief inspector of adult social care, said: ‘As this report shows most care providers that we have inspected have shown they are responding to the challenges of infection prevention control well, under these extraordinary circumstances. We have seen some providers using innovative and exciting practices to keep people safe.
‘They have been supported by staff who have gone the extra mile to keep the people in their care healthy, stimulated, and as independent as possible, while keeping family members and carers informed and engaged.’
She added: ‘By continuing to monitor and inspect these care locations we have and will continue to take action to protect people, share best practice and support providers to protect against the spread of Covid in care homes.’
The CQC said it plans to inspect another 500 care homes on infection control by the end of November.