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Fitzpatrick JM, Rafferty AM, Hussein S, et al. Challenges and guidance for implementing social distancing for COVID-19 in care homes: a mixed methods rapid review. Southampton (UK): National Institute for Health and Care Research; 2024 Nov. (Health and Social Care Delivery Research, No. 12.45.)

Cover of Challenges and guidance for implementing social distancing for COVID-19 in care homes: a mixed methods rapid review

Challenges and guidance for implementing social distancing for COVID-19 in care homes: a mixed methods rapid review.

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Appendix 4A summary of the routinely collected care home data by case study site

Care home 1Care home 2Care home 3Care home 4Care home 5Care home 6
Date of data collection22 March 202113 April 20217 July 202121 February 2227 September 20219 December 2021
CH data
Location of CH MidlandsSoutheast EnglandMidlandsNorth EnglandLondonLondon
CQC rating of homeGoodOutstandingOutstandingGoodGoodGood
CQC registration typeDual registrationWith nursingWith nursingWith nursingWithout nursingWithout nursing
Type of service providedAdults over 65 years, Adults under 65 years, Dementia, Physical disabilitiesAdults over 65 yearsAdults over 65 years, Adults under 65 years, Dementia, Learning disabilities, Mental health conditions, Physical disabilities, NeurorehabilitationAdults over 65 years, Adults under 65 years, Dementia, Physical disabilitiesAdults over 65 years, Dementia,Adults over 65 years, Dementia, Learning disabilities, Mental health conditions
Funding sourcesLA, NHS and CCG, Self-funders, CombinationSelf-fundersLA, NHS and CCG, Self-fundersLA, NHS and CCG, Self-fundersLA, Self-fundersLA, Self-funders, Combination (LA funding with client contribution)
Number of beds offered in home643745736448
Average bed occupancyJanuary 2020: 64
February 2020: 64
March 2020: 63
April 2020: 64
May 2020: 61
June 2020: 64
July 2020: 63
August 2020: 63
September 2020: 63
October 2020: 61
November 2020: 61
December 2020: 60
January 2021: 63
February 2021: 62
January 2020: 26
February 2020: 26
March 2020: 27
April 2020: 30
May 2020: 30
June 2020: 29
July 2020: 26
August 2020: 26
September 2020: 26
October 2020: 26
November 2020: 26
December 2020: 26
January 2021: 26
February 2021: 25
January 2020: 44
February 2020: 44
March 2020:44
April 2020: 44
May 2020: 44
June 2020: 44
July 2020: 44
August 2020: 44
September 2020: 44
October 2020: 44
November 2020: 44
December 2020: 44
January 2021: 44
February 2021: 45
January 2020: 71
February 2020: 71
March 2020: 71
April 2020: 63
May 2020: 59
June 2020: 62
July 2020: 62
August 2020: 63
September 2020: 64
October 2020: 63
November 2020: 62
December 2020: 65
January 2021: 69
February 2021: 71
January 2020: 98%
February 2020: 99%
March 2020: 94%
April 2020: 75%
May 2020: 67%
June 2020: 90%
July 2020: 91%
August 2020: 87%
September 2020: 89%
October 2020: 88%
November 2020: 88%
December 2020: 88%
January 2021: 89%
February 2021: 90%
January 2020: 48
February 2020: 48
March 2020:48
April 2020: 48
May 2020: 46
June 2020: 46
July 2020: 46
August 2020: 48
September 2020: 46
October 2020: 45
November 2020: 45
December 2020: 48
January 2021: 48
February 2021: 48
Impact of COVID-19 on average bed occupancyData not providedClosed one floor to be able to isolate floors and staff if had outbreak, so only had 26 rooms available from July 2020.Zero impact. Although the number of beds offered is 45, this has been since January 2021, prior to that it was 44.Significant reduction in occupancy over a period of a month during the first outbreak. This then took almost 12 months to fully recover.Due to the impact of COVID-19, 16 beds were made unavailable from June 2020. From that period, the percentage is occupancy based on the number of beds available rather than number of registered beds.No severe impact on bed vacancies. They have always stayed at a high level.
Number of positive COVID-19 cases since March 2020March 2020: 0
April 2020: 18
May 2020: 10
June 2020: 2
July 2020: 2
August 2020: 0
September 2020: 0
October 2020: 9
November 2020: 27
December 2020: 22
January 2021: 24
February 2021: 12
March 2020: 2
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021: 0
March 2020: 0
April 2020: 1
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021: 0
March 2020: 0
April 2020: 4
May 2020: 3
June 2020: 7
July 2020: 0
August 2020: 0
September 2020: 1
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 1
February 2021: 5
March 2020: 11
April 2020: 4
May 2020: 1
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 1
February 2021:0
March 2020: 0
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 1
September 2020: 0
October 2020: 2
November 2020: 0
December 2020: 0
January 2021: 1
February 2021:0
Number of residents dying within 28 days of a first positive COVID-19 test (between 1 March 20 and 1 March 21)Deaths in care home: 2
Deaths in hospital: 0
Deaths in another care home: 0
Death in other place: 0
Deaths in care home: 0
Deaths in hospital: 0
Deaths in another care home: 0
Death in other place: 0
Deaths in care home: 1
Deaths in hospital: 0
Deaths in another care home: 0
Death in other place: 0
Deaths in care home: 4
Deaths in hospital: 0
Deaths in another care home: 0
Death in other place: 0
Deaths in care home: 5
Deaths in hospital: 5
Deaths in another care home: 0
Death in other place: 0
Deaths in care home: 0
Deaths in hospital: 1
Deaths in another care home: 0
Death in other place: 0
Did CH procure and carry out private testing for residents?Yes – residents receive PCR tests every 4 weeks.NoNoNoNoNo
Date testing commenced following government guidance8 June 20209 June 20201 September 20201 June 202018 May 20206 July 2020
Number of residents admitted to hospital with or suspected of having COVID-19.March 2020: 0
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021: 0
March 2020: 0
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021:0
March 2020: 0
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021:0
March 2020: 0
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021:0
March 2020: 9
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021:0
March 2020: 0
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 1
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021:0
Number of residents transferred to the CH from hospital and/or the community with COVID-19.March 2020: 0
April 2020: 18
May 2020: 10
June 2020: 1
July 2020: 2
August 2020: 0
September 2020: 0
October 2020: 9
November 2020: 27
December 2020: 22
January 2021: 24
February 2021: 12
March 2020: 1
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021:0
March 2020: 0
April 2020: 1
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021:0
Data not providedMarch 2020: 0
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021:0
March 2020: 0
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 0
February 2021:0
Since March 2020 have any residents been taken from the CH by family because of COVID-19?NoNoNoYes, 1Data not providedNo
Start date of vaccination programme for residents16 January 202131 December 20201 January 202131 March 2020Data not provided5 December 2020
Are all residents vaccinated?No – 1 resident refused the vaccine on several occasions. Two residents are not currently able to have the vaccine due to previously testing positive for COVID-19.Yes – Fully vaccinated (second jabs, March 2021)No – 44 residents are vaccinated, only one who is not and that is because they are clinically exempt due to severe allergies.YesNoYes – all fully vaccinated including boosters
Monthly staffing vacancy rates in February 2020 (pre-COVID-19) – registered manager0%0%0%CH provided this data in an unorthodox way which could not be used.CH provided this data in an unorthodox way which could not be used.0%
Monthly staffing vacancy rates in February 2020 (pre-COVID-19) – care worker0%HCAs 4 × 36 hours5%CH provided this data in an unorthodox way which could not be used.CH provided this data in an unorthodox way which could not be used.0%
Monthly staffing vacancy rates in February 2020 (pre-COVID-19) – senior care workers0%0%0%CH provided this data in an unorthodox way which could not be used.CH provided this data in an unorthodox way which could not be used.0%
Monthly staffing vacancy rates in February 2020 (pre COVID-19) – RN 1 × 44 hours night nurse vacancy0%0%CH provided this data in an unorthodox way which could not be used.CH provided this data in an unorthodox way which could not be used.N/A
Monthly staffing vacancy rates between March 2020 and January 2021 (during COVID-19) – registered manager0%0%0%CH provided this data in an unorthodox way, which could not be used.Data not provided0%
Monthly staffing vacancy rates between March 2020 and January 2021 (during COVID-19) – care worker0%HCA 36 hours10%CH provided this data in an unorthodox way, which could not be used.Data not provided2 posts (70 hours)
Monthly staffing vacancy rates between March 2020 and January 2021 (during COVID-19) – senior care worker0%0%0%CH provided this data in an unorthodox way which could not be used.Data not provided0%
Monthly staffing vacancy rates between March 2020 and January 2021 (during COVID-19) – RN 1 × 44 hours night nurse vacancy0%10%CH provided this data in an unorthodox way, which could not be used.Data not providedN/A
Has the CH taken measures to avoid front-line staff moving between CHs?Yes – staff are currently working solely at this CH.Yes – stopped staff going to other CHs in the organisation. If they worked between two or more, they went to the home with the greater need.Yes – staff only work at this CH.Yes – the teams have not moved between villages as they normally would have done pre-COVID. Where possible, the teams have been allocated to individual households and encouraged to minimise the movement between households.Yes – managed through effective resource planning, overtime and utilising bank colleaguesYes
Have front-line agency staff been employed during the COVID-19 pandemic since March 2020?NoNoYes – during the pandemic, used one Night Healthcare Assistant from an agency. This assistant only worked at this home.Yes – single agency and block booking of staff to try and ensure familiarity and minimise the risk of contamination.Data not providedYes – Two agency staff members (same staff that only worked within this CH, not agency staff who worked in multiple CHs)
Did any front-line staff move into the home during the pandemic?No, however there was a contingency plan in place if required.NoYes – Deputy Manager stayed at the home during her block of shifts. This was to protect the residents and her elderly parents who she lives with. This was a great support to the manager, as she helped with on-call duties overnight and at the weekend.Yes – one member of night staff moved in for a period during the height of the pandemic.NoNo
Have any front-line staff been off work due to having COVID-19 symptoms?March 2020: 4
April 2020: 9
May 2020: 2
June 2020: 0
July 2020: 0
August 2020: 1
September 2020: 2
October 2020: 2
November 2020: 1
December 2020: 0
January 2021: 0
February 2021: 1
March 2020: 2
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 2
January 2021: 1
February 2021:2
March 2020: 0
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 1
October 2020: 0
November 2020: 0
December 2020: 1
January 2021: 1
February 2021:0
March 2020: 10
April 2020: 16
May 2020: 6
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 3
October 2020: 6
November 2020: 3
December 2020: 8
January 2021: 6
February 2021:2
March 2020: 10
April 2020: 2
May 2020: 0
June 2020: 0
July 2020: 1
August 2020: 1
September 2020: 2
October 2020: 2
November 2020: 1
December 2020: 2
January 2021: 1
February 2021:1
March 2020: 0
April 2020: 2
May 2020: 2
June 2020: 2
July 2020: 1
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 1
January 2021: 0
February 2021:0
Have any front-line staff been off work due to the need to self-isolate because of family/others having COVID-19 symptoms?March 2020: 3
April 2020: 2
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 1
February 2021: 0
March 2020: 2
April 2020: 0
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 2
January 2021: 2
February 2021:0
March 2020: 2
April 2020: 1
May 2020: 1
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 0
October 2020: 0
November 2020: 0
December 2020: 0
January 2021: 1
February 2021:1
March 2020: 5
April 2020: 7
May 2020: 1
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 13
October 2020: 17
November 2020: 4
December 2020: 3
January 2021: 3
February 2021:0
March 2020: 14
April 2020: 1
May 2020: 0
June 2020: 0
July 2020: 0
August 2020: 0
September 2020: 1
October 2020: 0
November 2020: 1
December 2020: 0
January 2021: 0
February 2021:0
March 2020: 1
April 2020: 3
May 2020: 5
June 2020: 0
July 2020: 0
August 2020: 2
September 2020: 0
October 2020: 2
November 2020: 0
December 2020: 1
January 2021: 0
February 2021:0
Did the CH procure and carry out private testing for staff?Yes – staff have their PCR tests every week and have LFTs twice a weekYes – antibody testingNoNoNoNo
When did lateral flow testing for staff commence?4 January 20211 December 20201 September 202113 August 202023 December 2020December 2020
When did the vaccine programme for staff start?Some staff travelled to a hospital for their vaccine and the first appointment was on 17 December 2020. The majority of staff were vaccinated at the home on 16 January 202131 December 20201 January 202111 March 2021Data not provided5 December 2020
What percentage of CH staff have been vaccinated?85% of staff have received first vaccine. Out of the remaining staff, three have been booked in to have their vaccine, three staff cannot have the vaccine, three staff are on maternity leave and the remaining two staff have declined.98%98% plus three staff clinically exempt100%88%100%
How has testing of visitors to the CH been managed?At the moment, we are open to essential appointments and booked visits for the residents (visitors are from the nominated persons list). All visits are pre-arranged, and visitors are informed that they are to arrive half an hour before their scheduled time and report to a member of staff. At this point, we then ask them to complete the necessary paperwork and an LFT test then they are to await the results. As long as the result is negative, the visit can continue. With regard to professional visiting, if the visitors are from an organisation that complete LFT testing at home, they must show proof of a negative test that has been completed within the last 72 hours; if they are unable to provide this evidence, then they are to follow the guidance for completing the LFT testing within the home.Data not providedThis has involved a lot of time with weekly PCR testing for all staff, twice weekly LFT testing for all staff, four weekly PCR testing for residents. Once visiting opened up again, all visitors are required to have a LFT, they then have to wait for 30 minutes and if the result is negative, they are then able to visit. Any professionals visiting the home also have to either have a negative LFT that is taken here or need to provide a negative result taken no longer than 30 minutes prior to coming to the home. Our hairdresser has been back for 8 weeks now, she takes part in the staff weekly PCR testing and has to have an LFT, again with a negative result, prior to starting work on the day she comes. The registration of all tests is very time consuming, with the website regularly crashing, and this can take several hours per day. Then starts the anxiety of waiting for the PCR results to come through.Testing station set up in the village for testing to be carried out on all visitors. Relatives were asked to attend 30 minutes before a scheduled visit so that a LFT could be carried out by a member of staff. Records of the test were kept for 21 days before being destroyed.Data not providedData not provided
Organisational data
Number of CHs in the organisation63211371147
Number of beds offered across the organisation491111637675005875304
Location(s) of homes across the countryMidlandsSouth EnglandSouth EnglandNorth EnglandNorth England
Midlands
South England
South England
Ownership of organisationPrivate organisationPrivate family runPrivate organisationVoluntary/not for profitVoluntary/not for profitPrivate family run
Copyright © 2024 Fitzpatrick et al.

This work was produced by Fitzpatrick et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.

Bookshelf ID: NBK609217

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