Coronavirus (COVID-19) testing for adult social care services - GOV.UK - ISS-G20 Laboratorium Repository

This guidance is for adult social care providers and staff to set out the current testing regime across adult social care. Based on the latest clinical advice, the aim of this testing regime is to enable positive cases to be identified quickly, so action can be taken to stop the spread. We will keep this guidance under review as prevalence changes.

1.1 How to use this guidance

This guidance replaces all previous guidance for testing in adult social care and applies to:

• care homes
• homecare organisations
• extra care and supported living services
• adult day care centres
• personal assistants
• shared lives carers
• social workers

Sections that are specific to a type of service will be clearly signposted.

This guidance uses the term ‘testing coordinator’ to describe the role that the person ordering and overseeing testing has in the process. The testing coordinator may be the service manager, or someone else who has responsibility for testing in the service.

1.2 Eligibility for free testing in adult social care

Staff in an organisation eligible for testing include paid members of staff or volunteers who regularly attend a service (for example, a care home or adult day care centre). This includes cleaners, catering, and support staff but does not include office-based staff members who do not enter these settings. In the context of an individual’s own home, staff includes those who provide care or support to the individual.

Care homes and homecare organisations are eligible for free testing if they are regulated by the Care Quality Commission (CQC).

Extra care and supported living settings are eligible if they meet at least one of the following criteria:

• the setting is a closed community with substantial facilities shared between multiple people
• it is a setting where the majority of residents (more than 50%) receive the kind of personal care that is CQC-regulated (rather than help with cooking, cleaning and shopping)

If your setting meets both criteria above, it is classified as a ‘high-risk extra care and supported living setting’. Where there is a distinction in testing for high-risk settings, this is made clear throughout the guidance.

Day care centres are eligible if they are run by paid care staff. Services must be for adults over 18 and must be provided within non-residential care settings that support the health and wellbeing of adults. This includes settings such as:

• purpose-built day centres
• day centres attached to or part of a care home or supported living setting
• other buildings in communities specifically used for regular adult day care

Personal assistants are eligible if they are directly employed by an individual (or self-employed) to provide care and support to an adult to enable them to live as independently as possible. This care could include support in the home, or to go out into the community.

Shared Lives carers are eligible if they are working with a regulated Shared Lives scheme to provide care and support to an adult to enable them to live as independently as possible. This includes both carers who live with the person they support and those who live separately.

Social workers are eligible if they work with adults requiring support for their health, wellbeing and social care needs and are regulated by Social Work England.

2. Testing regimes for adult social care

2.1 Symptomatic testing for staff and residents

Symptomatic testing is available for staff of adult social care organisations who are eligible for free testing. Free symptomatic testing is available for residents in care homes, and also for residents in extra care and supported living services which meet one or both of the criteria above. For details of COVID-19 symptoms and when symptomatic testing is needed, see the COVID-19 supplement to the infection prevention and control (IPC) resource for adult social care.

As far as possible, residents should be offered the choice to either self-administer the tests or to have the tests administered by a suitable member of staff.

2.2 Asymptomatic staff testing

Staff should conduct 2 LFD tests per week, taking them before they begin work, spaced 3 to 4 days apart. This also applies to care workers who live with the individual they provide care and support to.

Care homes enrolled in the Vivaldi study may be asked to undertake additional asymptomatic testing to support ongoing research and surveillance in the sector. Further guidance will be issued in due course to homes that are participating in this study.

2.3 Rapid response testing in care homes and high-risk extra care and supported living

If one or more positive cases (staff or resident) are found in a care home, or high-risk extra care and supported living setting, then all staff should conduct daily rapid LFD testing every day that they are working, for 5 days. This is not extended if further positives are found within the 5 days. Only the staff working in the setting over the rapid response testing period need to be tested; those not working during this period do not need to be tested. You should not bring people into work to get tested on their non-working days.

2.4 Outbreak testing in care homes

An outbreak consists of 2, or more, positive (or clinically suspected) linked cases of COVID-19 that occur in the same setting within a 14-day period. This applies to both staff and residents, and includes PCR and LFD results.

If the manager suspects an outbreak in your care home, they should contact the health protection team (HPT) (or community infection prevention and control team, local authority, or clinical commissioning group (CCG) [in accordance to local protocols]) who will conduct a risk assessment, including whether the cases are likely to be linked. Following this risk assessment, the HPT may advise whole home outbreak testing.

If the setting is advised to initiate whole home outbreak testing, in addition to completing rapid response testing for staff, all staff and residents should conduct both an LFD test and a PCR test on day 1 of the outbreak and another LFD test and PCR test between days 4 and 7. The LFD test will allow you to identify and isolate the most infectious cases immediately whilst awaiting PCR results, therefore reducing the risk of the virus spreading.

If either test is positive, it is highly likely that the individual has COVID-19. After the first week of outbreak testing has been completed, staff should continue regular twice-weekly asymptomatic LFD testing. Once there have been at least 10 days with no new COVID-19 cases or newly symptomatic individuals, outbreak recovery testing should be undertaken (see section 2.4.1).

The local HPT may decide to differ from this approach based on their professional judgement, and where possible their instructions should be followed. For example, there may be circumstances in which the HPT or other local partner advises that the original cases were considered highly unlikely to be linked to transmission within the setting (a cluster) and they advise that outbreak restrictions may be stood down after 2 rounds of whole home PCR testing and regular staff LFD tests reveal no further cases (at around the 7 day point).

2.4.1 Outbreak recovery testing

For outbreak recovery testing, all staff and residents (who have not tested positive in the last 90 days) should be tested with a PCR test, no earlier than 10 days after the last resident or staff member had a positive test result or showed COVID-19 symptoms.

2.4.1.1 If there are only negative results from outbreak recovery testing

If there are no positive PCR results from outbreak recovery testing, the HPT will advise that outbreak restrictions can be lifted and the normal regular staff testing pattern should be followed.

2.4.1.2 If there are any positive results from outbreak recovery testing

If there are further positive results from outbreak recovery testing, then the HPT may advise that outbreak restrictions should continue until no further positives are found before advising that the outbreak has ended. If there are 2 or more positive cases after outbreak recovery testing, this should be classed as a new potential outbreak and the care home must contact the HPT.

2.4.1.3 Outbreak recovery testing and Variants of Concern

The local HPT will contact the care home if they have identified a particular Variant of Concern/Variant under Investigation which requires additional actions/restrictions. They will discuss whether additional measures need to be put in place to enable additional protection and how this impacts the testing required. This might include delaying the whole home outbreak recovery testing until 28 days from the last positive test.

3. Step by step testing process for adult social care

3.1 Ordering test kits

3.1.1 Accessing through a unique organisation number (UON) - applies to care homes, homecare, extra care and supported living and day care centres only

Personal assistants, Shared Lives carers and social workers should go straight to section 3.1.2.

3.1.1.1 Unique organisation number

NHS Test and Trace assigns all participating organisations a single Unique Organisation Number (UON).

A UON is an 8-digit number that is exclusive to an individual organisation. This can be used to log in to all online elements of the testing process.

The UON will be needed for:

• ordering test kits
• registering test kits
• contacting the national COVID-19 contact centre for support (dial 119)

Make sure that your UON is correct when you log into the portal. If the UON entered is not valid, you will be prompted by a new error message screen. To find out your UON use the online UON look-up page, or call 119.

3.1.1.2 Onboarding for testing in extra care, supported living, and adult day care centres

Use the self-referral portal to request a testing account. To do this, the manager should complete the following steps:

1. On the portal, where you are asked to enter the ‘Referrer’s Unique Organisation Number’, enter is 99874802 for extra care and supported living or 99915258 for adult day care centres. You will only need to use this code once and it cannot be used to order test kits.
2. Complete the eligibility questions.
3. Enter the information for your setting, including delivery address and contact details.
4. Submit referral.

Once your referral is submitted, the following happens:

• the referral is sent to the local authority for approval
• the local authority assesses if the setting meets the eligibility criteria, and approves or denies the referral request
• if eligible, the setting is on-boarded onto the system and will be eligible to place an order for test kits
• a confirmation email will be sent to the email address registered on the self-referral portal once your setting has been onboarded – and will include a UON you will be able to use to order test kits

3.1.1.3 Ordering test kits with a UON – applies to care homes, homecare, extra care and supported living and day care centres only

Place an order of COVID-19 tests online. If you are a care home returning PCR tests through a courier you can also order return boxes through the same portal. To apply, you will need:

• your UON
• total number of staff for testing

Once you have placed an order, you will receive a confirmatory email from organisation.coronavirus.testing@notifications.service.gov.uk

The testing coordinator will receive an email from organisation.coronavirus.testing@notifications.service.gov.uk when their test kits have been dispatched, informing them of their delivery date.

Test kits will be delivered to the address registered to the UON.

If you have any questions about your order, call 119. If you are close to running out of stock and require an urgent and emergency delivery, you should also call 119.

3.1.2 Ordering test kits without a UON – applies to personal assistants, Shared Lives carers, and social workers only

Personal assistants, Shared Lives carers and social workers should order tests via the online government portal. You do not need a UON.

Please do not access tests through this route if you are already part of a regular testing regime at work.

You can choose which address your tests kits are delivered to. Once you have placed an order, you’ll receive a confirmatory email.

If you have any issues with ordering test kits, please call the national COVID-19 contact centre on 119.

3.2 Receive test kits

When you receive the test kits, please ensure that all kits are stored in line with manufacturer’s instructions.

3.3 Testing days

All staff should take an LFD test twice a week, 3 to 4 days apart, before they begin work. If they only work 2 days per week, they should take LFD tests on these days before beginning work.

See section 2.3 ‘rapid response testing in care homes and high-risk extra care and supported living’ and section 2.4 ‘outbreak testing in care homes’ for any additional testing that may need to be carried out in a setting following a positive test result.

3.4 Registering and reporting testing

3.4.1 Register and return PCR tests – applies to care home outbreak testing only

You must register every COVID-19 test to receive a result. Where applicable, PCRs should be registered using the organisation’s UON. Note the barcode number and time of each PCR test against the name of the person tested. Register the completed test online as close as possible to the time of the swab. You can register PCR tests individually or register them using the multiple upload spreadsheet (see section 3.4.3).

You can return PCRs using priority post boxes. In care homes, couriers are also available for returning 9 or more tests, please see the outbreak testing section.

3.4.2 Report LFD test results

Reporting the result of every LFD test is encouraged, even if it is negative or void. Staff members can register LFD tests individually, or managers can register them in bulk using the multiple upload spreadsheet (see section 3.4.3). Where organisations have a UON, staff should report results using that UON.

Providers do not need to retain records of proof of registrations.

In extra care and supported living, adult day care centres, and homecare staff can now use the Digital Reader for reading LFD test results as part of the self-report journey. This tool allows users to take a photo of their LFD and uses artificial intelligence to determine the result of the test. Research has shown that users can correctly identify more positive results using this technology than without it. For detailed information, download the Digital Reader guidebook.

3.4.3 Multiple registration spreadsheet

Only use the multiple upload spreadsheet to register up to 100 tests (both PCR and LFD) at a time.

You will need to use separate record keeping spreadsheets for staff and residents.

Once you have successfully registered each PCR and LFD you will receive a confirmation email or text message. When you receive the test result email, this may not include the name of the resident or staff member. You should therefore retain a careful record of each test barcode and the name of the resident or staff member. Staff members should also retain a record of their own test barcode.

3.4.4 Registering and reporting on behalf of others

If staff or residents cannot report their own LFD test result online:

• results can be reported on the individual’s behalf
• the person reporting on behalf of the individual will need all test results and test strip ID numbers so that they can report results on their behalf
• make sure that you delete or destroy any forms containing the tested person’s personal details as soon as you complete the online registration

If an individual cannot register their own PCR test, please follow the details in section 3.4.1 to do this individually or section 3.4.3 to do this for a group of people.

If any individual cannot complete the online form and someone can’t report the result on their behalf, they can call 119 and select option 1 to report their result.

3.5 Results

Full information about what to do if you or your staff receive a positive PCR or LFD test result can be found in the COVID-19 supplement to the IPC resource for adult social care.

If anybody tests positive on-site, they should wear a face mask if possible and should return home immediately and follow the guidance for people with symptoms of a respiratory infection including COVID-19. If possible, they should return home using private transport.

3.5.1 Individuals with a negative COVID-19 result

A symptomatic individual who tests negative for COVID-19 may have another infectious illness like flu.

Staff members who receive a negative result and remain without symptoms can continue working. Staff can return to work if they are no longer unwell and they do not have a high temperature.

Symptomatic people receiving care should be advised to keep away from others until 48 hours after their symptoms have resolved. Further actions may still be needed to limit transmission including using appropriate PPE when working with people who are unwell.

3.5.2 When to contact your HPT (or local public health response contact)

Contact your HPT after receiving 2 or more linked positive COVID-19 results in the same setting within a 14-day period. Do not delay contacting your HPT, as interventions are more effective the earlier, they are started. If locally you speak to a community infection prevention and control team, LA or CCG, contact them to notify of the suspected outbreak. In these settings, you may be advised that additional testing outside of the ‘rapid response testing’ may be needed.

3.5.3 Testing within 90 days of a positive result

3.5.3.1 Exemptions from routine testing for individuals who have previously tested positive for COVID-19 within 90 days

Fragments of inactive virus can be persistently detected by PCR tests in respiratory tract samples following infection, and for some time after a person has completed their isolation period and is no longer infectious.

Asymptomatic staff and residents who do not have severe immunosuppression, and who have previously tested positive for COVID-19 by LFD or PCR test should be exempt from routine testing by PCR within 90 days from initial illness onset or test date. This does not apply if they develop new COVID-19 symptoms.

This exemption includes patients without severe immunosuppression, who require routine testing within 48 hours prior to discharge to a care home.

3.5.3.2 Assessment of repeat PCR positive test results within 90 days of a prior positive test

If an individual is re-tested by PCR within 90 days of initial illness onset or prior positive COVID-19 test and the PCR test result is positive, a clinical risk assessment should be used to decide whether new infection (‘reinfection’) is a possibility and to inform subsequent action including whether isolation is required.

Guidance on reinfection and performing clinical risk assessment is detailed in the Investigation and management of suspected SARS-CoV-2 reinfections: a guide for clinicians and infection specialists.

The advice of an infection specialist should be sought to inform clinical risk assessment.

3.5.3.3 Routine testing with LFD tests within 90 days of a prior positive test

If a staff member has returned to work after testing positive for COVID-19, they should resume routine LFD testing, even if this is within 90 days of the positive COVID-19 test result. If staff or residents are tested with an LFD test within 90 days of a prior positive LFD or PCR test and the result is positive, residents should start a new period of self-isolation and staff should stay at home (see COVID-19 supplement to the IPC resource for adult social care), unless a clinical or risk assessment suggests that a re-infection is unlikely. This risk assessment should inform subsequent action including whether isolation is required.

Guidance on reinfection and performing clinical risk assessment is detailed in the Investigation and management of suspected SARS-CoV-2 reinfections: a guide for clinicians and infection specialists.

3.5.4 Accessing COVID-19 treatments for people in the highest risk group

Individuals who are in the highest risk group from COVID-19 can access new COVID-19 treatments directly.

Tests are being sent directly to these individuals to enable faster treatment of COVID-19 if they develop symptoms.

Eligible individuals will receive a ‘pre-notification’ letter or email (to the contact details specified in their GP record) to alert them that they have a condition that may make them eligible should they test positive for COVID-19.

Service and care managers are requested to support residents who are eligible for treatment with where to store these priority tests so that they are available when needed. Each priority treatment test kit will have an information leaflet enclosed which details how these kits should be stored and provide full testing instructions.

If positive for COVID-19, the resident will be contacted by a COVID-19 Medicines Delivery Unit clinician who will assess the resident’s eligibility and decide on the appropriate treatment. In most cases the treatment prescribed will be monoclonal antibodies, which are given intravenously, however, if monoclonal antibodies are unsuitable for the individual, they will be given oral antivirals.

If the resident is not contacted within 24 hours of receiving the positive result, contact their GP or call 111.

Further information on treatments for COVID-19 is available on the NHS website. Any queries regarding priority treatment tests can be raised via 119.

Entire content available on: https://www.gov.uk/government/publications/coronavirus-covid-19-testing-for-adult-social-care-settings/covid-19-testing-in-adult-social-care