Residential respite/short break settings
The majority of residential respite/short break services for children were closed following Scottish Government advice in March 2020. The closure of these settings undoubtedly had an impact on the lives of children and their families throughout Scotland who used these services. There was little time to prepare for the changes and relationships and support were interrupted.
That is why Scotland’s route map through and out of the crisis included “access to respite/day care to support unpaid carers and for families with a disabled family member” as part of Phase 1. There has been a phased remobilisation of various forms of modified support since Phase 1 and this should continue in order to relieve some of the pressure on families and unpaid carers. This reflects a focus on ensuring that social care support is maintained with minimal interruption to ensure the safety, dignity and human rights of those who need support and their unpaid carers.
We know there are many considerations for adapting and remobilising services after a significant interruption. Scottish Government’s focus is on supporting local authorities and other service providers to ensure children and young people receive the support they need in an enjoyable and dignified way, while meeting the requirements of all core public health measures in relation to hygiene, and the prevention and control of the spread of infection.
However, given the extent of the impact of COVID-19 across society, it may take some time to ensure the appropriate modifications are in place. Services will also need to be aware of and respond to changing levels of infection risk in their local community and comply with local protection levels.
COVID-19 protection levels set out measures that can be applied nationally or locally depending on prevalence of the virus across Scotland. Please see coronavirus local protection levels guidance for up to date information and to check what level applies to your area.
Residential respite/ short break services can operate, in line with this guidance at protection levels 0 to 3.
At protection level 4, residential respite/short break services can operate in line with this guidance, where they are essential for the family’s wellbeing – for example where a family member’s health (including their mental health) and wellbeing would be significantly impacted by non-attendance. As noted elsewhere in this guidance, services operating at reduced capacity should already be prioritising children and young people, and their parents and carers who are most in need.
Children and young people who attend a residential respite/ short break service in a different local authority area from where they live can continue to do so, including where the setting or person’s home is in protection level 3 or 4. Please see COVID-19 guidance on travel for further information, including the exceptions to restrictions on travelling into and out of protection level 3 and 4 areas.
Due to the variety and range of settings used as residential respite/short break services, individual services must identify and set out the capacity for their setting. This should be considered through the risk assessment for the service, taking account the full range of factors including, but not limited to: the size and layout of the setting; the clinical vulnerability of those attending the setting, the staffing profile, arrangements for hand hygiene facilities and environmental cleaning (careful consideration should be given to the cleaning regime of specialist equipment and sensory rooms), and the capacity and ability to maintain physical distancing. If there are particular concerns or difficulties e.g. large proportions of highly vulnerable individuals, then the local Health Protection team can be contacted for advice. This will need regular review over the course of the pandemic.
Services may need to operate at reduced capacity compared to before COVID-19. It will therefore remain vital to maximise the availability of other forms of support alongside re-opening residential respite/short break services.
If a child is unable to, or the child and his/her family choose not to, attend the service once re-opened for any reason, consideration should be given to what other support may be available to them in order to meet their needs. Children and their families should be fully involved in all decisions about the support that would suit them best and those eligible for social care support may wish to explore whether moving to a different self-directed support option would support their goals. Read further guidance on self-directed support.
Coordination and communication with all partners will be key to successful remobilisation. Service providers, whether they are local authority, private or independent services, should ensure that they are properly engaging with their local Health Protection team and the Care Inspectorate to ensure the safety of all those attending. They should also engage with their staff, the children and their families regarding the re-opening of the service and the modifications that will be required. This is key to ensuring decisions made are suitable, and staff, children and their families feel comfortable and confident in returning to the setting.
Decisions regarding the re-opening of services must be made at a local level. Services should undertake a risk assessment, bringing in the local authority, Health Protection team and the Care Inspectorate, if required.
Service risk assessments are expected to consider all risks identified in respect of COVID-19 so that measures can be put in place to control those risks for everyone and must have regard to the COVID-19: Information and Guidance for Social, Community and Residential Care Settings guidance from Health Protection Scotland.
Each local partnership should consider the risk assessments and arrangements for the re-opening of a service. This should take place as part of the local oversight arrangements, involving the Director of Public Health, Chief Social Work Officer and other senior officers.
Once all partners are content the appropriate modifications have been made and risk assessments undertaken prior to re-opening a registered support service, the Care Inspectorate must be advised. This is managed through a “Changes to Service Delivery due to Coronavirus (COVID-19)” notification. This informs the Care Inspectorate about operational changes specifically related to COVID-19. This notification is available through the Care Inspectorate’s eForms.
Services that do not update their status, will be considered as closed by the Care Inspectorate.
Services intending to re-open should make themselves familiar with changes to the Care Inspectorate’s notification process as well as any new guidance that has been developed while the service has been temporarily closed. Services should also consider if there are any changes to the conditions of their registration that need to be discussed with the Care Inspectorate.
If regular statutory building/property maintenance or testing was due to take place during the closure and has not been undertaken, then it must be carried out before the building is re-opened as the Health and Safety Executive will expect 100% compliance.
Services are strongly encouraged to involve staff, those who use the service and their families in the development of plans to re-open and in any subsequent reviews which should take place on a regular basis, or when any significant change is required.
For staff, this will ensure they understand and follow any new procedures required to reduce the risk of spreading the infection and keeping themselves and those who use the service safe. Plans should be communicated to all staff. This must include those who are employed within the service but do not provide direct care to supported people such as ancillary, administrative, catering or cleaning staff.
For children and their families, effective communication will mean they know what to expect when they return to the service. It should help them understand any modifications made and the rationale behind them. This is particularly important where there are new routines and procedures that people will need to understand and follow.
In deciding who attends for a short break, providers will need to consider the supported person’s individual needs, behaviours and ability to deal with and understand social distancing restrictions and how these may impact on self or others. If capacity has been limited in the setting, services may have to consider prioritising those who are most in need of support at this time, taking into consideration the level of risk for each individual. Children and their families must be fully involved in these conversations and decision-making.
Every child and young person will have different levels of required support. Child’s plans and risk assessments should already exist for children and young people attending residential respite/short break facilities. These individual risk assessments should be updated as a matter of priority in light of any changes to provision such as environment and staffing and the individual needs of the child or young person. Risk assessments for the safe short stays of individual children and the consideration of measures which need to be in place for these stays should be undertaken in partnership with the young person, their parent/carer, the young person’s Social Worker (or other lead professional) and other identified partners to the child’s plan.
Where the need for PPE has been identified in these risk assessments, it should be readily available and provided and staff should be trained on its use. The use of PPE by staff should be based on a clear assessment of risk and need for an individual child or young person, such as personal care, where staff come into contact with blood and body fluids or lift children and young people.
In order to support NHS Scotland’s Test and Protect service, services should collect the details and visit dates of those who are accessing the setting. This includes staff, the children using the service, accompanying care workers and unpaid carers or family who enter the setting. More information on this, including on registration with the Information Commissioner’s Office, the lawful basis for data collection and managing data can be found in the Coronavirus (COVID-19): tourism and hospitality sector guidance.
Where a short stay is agreed, then it is important to ensure the child will not be arriving from a place where a household member has COVID-19 symptoms or diagnosed with COVID-19 (whether they have symptoms or not). Staff, children and their family should also not attend the setting if someone they have been in contact with has developed symptoms or tested positive for COVID-19. In these instances, they should follow the Test and Protect guidance.
If a child or young person becomes ill with COVID-19 symptoms while in the setting, arrangements should be made to allow them to isolate immediately, ideally in a ventilated space and arrangements should be made with the child or young person’s carer/parent for them to go home when it is safe to leave. They should follow the guidance for households with possible coronavirus infection and arrange to get tested. Where space allows, contact between the child or young person, and any other individual in the setting should be prevented. Care must be taken however for the appropriate levels of supervision of, and support for, all individuals at all times.
If it is an emergency, an ambulance should be called via 999 and the call handler should be informed that the unwell person may have COVID-19.
Any cases of COVID-19 in a member of staff or child/young person that has been in the service should be reported as set out in the Test and Protect guidance in the section Test and Protect in residential childcare.