Designated settings for people with COVID-19 leaving hospital

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.

Several weeks after we've assured the Infection Prevention and Control (IPC) practice in a designated setting, we’ll be giving them a supportive phone call. Read the questions inspector’s will use to guide their conversation.

For inspections of designated settings, 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 check 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.

Using our IPC framework 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.

"Since October we have undertaken over 6,300 inspections, including 1,531 IPC and designated setting 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. These include:

• Inspections of proposed designated facilities
• Inspections in response to risk and information of concern.

Designation scheme

Recently we have received an increase in requests to 'switch off' designated settings due to a reduction in local demand. As of 25 Mayl, there were 87 CQC IPC assured designated setting beds within 78 local authorities. There are a further 40 "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 area 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 25 May 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.

List of designated settings by region