1. Scope

1.1 Purpose

This policy sets out how provides care and treatment safely to every person it supports in their own home. It makes sure we meet Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It aims to prevent avoidable harm while protecting each person’s choice, independence and dignity.

1.2 Application

This policy applies to all staff working for or on behalf of . This includes employed, bank and agency staff, students, volunteers and anyone shadowing visits. It applies to every visit within a person’s package of care, including all elements of a bundled package.

1.3 Areas covered

The policy covers the following areas of safe care and treatment:

• Assessment of risk before and during care.
• Care planning and review.
• Staff competence, skills and experience.
• Safety of the person’s home, our equipment and lone working.
• Moving and handling.
• Medicines support.
• Infection prevention and control.
• Recognising deterioration and responding to emergencies.
• Missed, late and failed visits.
• Consent, capacity and least restrictive care.
• Sharing information with other providers when responsibility for care is shared.

1.4 Boundaries

Staff do not give clinical advice or carry out health tasks outside their training and competence. Health tasks delegated by a registered health professional are covered in section 6.4. Safeguarding, complaints, data protection and health and safety each have their own policies, which this policy links to.

1.5 How CQC assesses this area

CQC assesses safe care and treatment mainly under the Safe key question. It currently uses the Single Assessment Framework and quality statements, which replaced the earlier key lines of enquiry. CQC is consulting on and phasing in sector specific frameworks. The five key questions remain. This policy is written so that it supports evidence under the framework in force at the time of any assessment.

2. Legal and Regulatory Framework

Legislation/Regulation	Requirements
Health and Social Care Act 2008	Establishes CQC and the registration of providers. Requires registered persons to meet the regulations and the fundamental standards.
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014	Regulation 12 requires safe care and treatment, including risk assessment, competent staff, safe equipment, safe medicines management and infection control. Related duties are Regulations 9 (person centred care), 10, 11 (consent), 13 (safeguarding), 17 (good governance), 18 (staffing), 19 (fit and proper persons) and 20 (duty of candour).
Care Act 2014	Requires wellbeing, prevention of harm and statutory safeguarding duties. Providers must cooperate with local authorities in assessments and enquiries.
Mental Capacity Act 2005	Requires capacity to be presumed, decisions to be made in best interests where capacity is lacking, and the least restrictive option to be used. Deprivation of liberty must be lawfully authorised. Staff follow current guidance after the Supreme Court judgment of June 2026 and the continuing absence of the Liberty Protection Safeguards.
Health and Safety at Work etc. Act 1974 and Management of Health and Safety at Work Regulations 1999	Employers must protect the health and safety of employees and others affected by the work. They must carry out suitable and sufficient risk assessments and provide information, training and supervision.
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR)	Requires reporting to the Health and Safety Executive of specified work related deaths, injuries, diseases and dangerous occurrences, including certain incidents involving people receiving care.
Manual Handling Operations Regulations 1992, LOLER 1998 and PUWER 1998	Require hazardous manual handling to be avoided where reasonably practicable and assessed otherwise. Lifting equipment must be thoroughly examined and work equipment must be suitable and maintained.
Control of Substances Hazardous to Health Regulations 2002 (COSHH)	Requires assessment and control of exposure to hazardous substances, including cleaning products, body fluids and clinical waste.
Health and Social Care Act 2008: code of practice on the prevention and control of infections	Sets the criteria CQC uses to judge compliance with infection prevention and control duties under Regulation 12.
Human Medicines Regulations 2012 and Misuse of Drugs Regulations 2001	Govern the supply, administration, storage and record keeping of medicines and controlled drugs. Medicines must be given only as prescribed or directed by an appropriate prescriber.
UK GDPR and Data Protection Act 2018	Require lawful, fair and secure handling of personal and health data, including records of risk assessments, care and medicines.
Equality Act 2010 and Human Rights Act 1998	Require reasonable adjustments, protection from discrimination, and respect for rights to life, dignity, private life and freedom from degrading treatment.

Staff also follow NICE guideline NG67, Managing medicines for adults receiving social care in the community, and NICE quality standard 171. They also follow the Health and Care Act 2022 requirement for training in learning disability and autism, known as the Oliver McGowan Mandatory Training.

3. Definitions of Key Terms

Term	Definition
Safe care and treatment	Care that is provided in a way that prevents avoidable harm and manages inherent risks so far as is reasonably practicable, as required by Regulation 12.
Person supported	An individual who receives a regulated activity from in their own home.
Package of care	The combination of visits, tasks and support agreed with the person and any commissioner, including each element of a bundled package.
Risk assessment	A structured process to identify hazards to a person or staff member, judge the likelihood and severity of harm, and record controls.
Reasonably practicable	The standard of weighing the level of risk against the time, cost and effort of controlling it, while respecting the person’s choices.
Care plan	The personalised written record of a person’s needs, preferences, risks and the agreed way staff will support them.
Medicines support	Any help a person receives to manage their medicines, ranging from reminding and prompting to assisting and administering.
Medication administration record (MAR)	The record of medicines a person is prescribed, and of each dose given, prompted, declined or missed.
Mental capacity	The ability to make a specific decision at a specific time. It is assessed under the Mental Capacity Act 2005.
Best interests decision	A decision made for a person who lacks capacity, taking account of their wishes, feelings, beliefs and values, and consulting those close to them.
Competence	The demonstrated ability to apply knowledge, skills and experience safely in practice, confirmed through direct observation.
Incident and near miss	An incident is an event that caused or could have caused harm. A near miss is an event that was prevented or did no harm but had the potential to.
Duty of candour	The legal duty to be open and honest with a person, and where relevant their representative, when a notifiable safety incident occurs, including an apology.
Infection prevention and control	The measures used to stop the spread of infection, including hand hygiene, personal protective equipment, safe waste handling and cleaning.
Lone working	Working without direct supervision or immediate support from colleagues, as care workers do on most visits.

4. Policy Statement

4.1 Commitment

is committed to providing care that is safe in every visit. We will assess risk, act to reduce it, and keep staff competent. We will be open when things go wrong and we will learn from them.

4.2 Core Principles

• Safety and choice go together. We support positive risk taking and do not remove choice to remove risk.
• Every person is treated as an individual. Risks are assessed with them and, where appropriate, their family or representative.
• Staff only do what they are trained, assessed and authorised to do.
• Decisions are proportionate, recorded and reviewed.
• Learning is shared. Staff who raise concerns or report errors are supported, not blamed.

4.3 Risk and positive risk taking

A person has the right to make decisions that others consider unwise, if they have capacity. We record the risk, the information given, the person’s decision and the steps taken to reduce harm. We do not accept unsafe practice by staff under the banner of choice.

4.4 Safe staffing

We will only allocate visits to staff who have the competence, skills and experience required. Visit times, travel time and continuity of staff are planned so that care is not rushed. Staff are not allocated tasks that exceed their authorisation.

4.5 Openness and learning

All incidents, near misses and concerns are reported. We meet the duty of candour. Findings are used to improve practice and are shared with staff.

5. Roles and Responsibilities

Role	Responsibilities
All Staff	Follow this policy, care plans and risk assessments on every visit. Work only within their training and authorisation. Check for new hazards and changes in the person’s health at each visit. Record care accurately and at the time it is given. Report incidents, near misses, medicines errors and concerns immediately. Use equipment and personal protective equipment correctly.
Registered Manager ()	Hold overall accountability for safe care and treatment and for CQC compliance. Make sure there are enough competent staff and adequate resources. Approve and review this policy and oversee audits, learning and action plans. Make sure the duty of candour is met and CQC notifications are submitted. Report to the provider’s leadership on safety performance.
Duty Manager (day to day operational leadership, incident coordination, frontline decisions and staff supervision on shift)	Lead the service each shift and make frontline decisions on safe staffing, visit priority and escalation. Coordinate the response to incidents, emergencies, missed visits and medicines errors. Be the first point of contact for staff, who can ask for advice at any time during the shift. Supervise and support staff on shift, including spot checks and prompt follow up of concerns. Contact families, health professionals and commissioners as needed, and record all decisions. Hand over open risks and incidents to the next Duty Manager and report to the Registered Manager.
Safeguarding Lead ()	Advise staff when unsafe care may also be abuse or neglect. Make safeguarding referrals and liaise with the local authority and police. Review incidents for safeguarding themes and report them to the Registered Manager.
Health and Safety Officer ()	Maintain workplace and lone working risk assessments. Oversee equipment checks, servicing and thorough examinations. Investigate accidents and make RIDDOR reports where required. Advise on moving and handling, COSHH and personal protective equipment.
Data Protection Officer ()	Advise on the lawful handling of care, risk and medicines records under UK GDPR. Manage personal data breaches, including lost care records, and notify the ICO within 72 hours where required. Support subject access requests and information sharing agreements with other providers.
Care Coordinators and Schedulers	Match visits to staff competence and keep travel time realistic. Monitor live visit data and escalate late and missed visits to the Duty Manager. Make sure risk information is passed to care workers before first visits.
Field Supervisors and Senior Care Workers	Carry out risk assessments, care plan reviews, spot checks and competency observations. Coach staff and report practice concerns to the Duty Manager.

6. Procedures

6.1 Pre-service assessment and risk assessment

1. Before care starts, a trained assessor meets the person, and with consent their family or representative, and reviews commissioner information.
2. Assess needs and risks, including mobility, falls, skin integrity, nutrition and choking, continence, medicines, mental health, communication, cognition, allergies and infection risks.
3. Assess the home, including access, stairs, lighting, trip hazards, smoking, oxygen use, pets, fire safety, utilities and any risk to staff.
4. Decide whether we can meet the person’s needs safely. If not, tell the person and the commissioner and do not start care.
5. Record each risk, its controls and who is responsible. Share the plan with the person and obtain consent.
6. Review risk assessments at least every six months, after any incident, hospital stay or change in need.

6.2 Care planning

1. Write the care plan with the person. Record preferences, outcomes, routines and what they can do themselves.
2. Use clear, step by step instructions for high-risk tasks. Include equipment, number of staff and emergency actions.
3. Give care workers access to the current plan before every visit. Remove superseded versions.
4. Where responsibility is shared with another provider, family or health team, record who is responsible for what and how information is exchanged.
5. Review the plan at least every six months and whenever needs change.

6.3 Equipment and the home environment

1. Check equipment before use, including hoists, slings, beds and commodes. Do not use anything damaged or overdue for examination.
2. Report faults to the Duty Manager at once. Tell the person and their family. Arrange safe alternatives.
3. Record equipment owned by the person, by the provider and by the NHS or local authority, and who services it.
4. Report hazards in the home to the Duty Manager. Never take personal risks to complete a task.
5. Follow the lone working arrangements. Use the check-in system and report if a visit feels unsafe.

6.4 Medicines support

The level of support is agreed at assessment and recorded in the care plan, in line with NICE guideline NG67.

1. Staff only prompt, assist or administer medicines if they have completed training and been assessed as competent.
2. Administer only from the original labelled container or a pharmacy supplied compliance aid, as prescribed. Never give medicines from an unlabelled source.
3. Check the MAR, the person, the medicine, dose, time, route and allergies. Record immediately after giving.
4. Record refusals and omissions and the reason. If a refusal is regular or risky, tell the GP or prescriber and the Duty Manager.
5. Follow a written protocol for each as required (PRN) medicine and for topical products, including body maps.
6. Give time critical medicines, such as those for Parkinson’s disease, at the prescribed time. Escalate if this cannot be done.
7. Do not give medicines covertly unless a capacity assessment and best interests decision have been made with the prescriber and a pharmacist, and the plan is recorded.
8. Delegated health tasks, such as injections, catheter care or feeding tubes, only take place after a registered health professional has trained the individual worker and signed off competence for that person.
9. Store, transport and dispose of medicines safely. Return unused medicines to the pharmacy and record this.

Medicines errors

1. Make the person safe and seek urgent clinical advice from the GP, pharmacist, NHS 111 or 999 as the risk requires.
2. Tell the Duty Manager immediately and complete an incident report the same day.
3. Inform the person and their representative. The Registered Manager decides whether the duty of candour applies.
4. Review the cause and take action, including retraining and reassessment of competence.

6.5 Moving and handling

1. Use only the method and equipment set out in the moving and handling plan.
2. Do not lift manually. Where the plan requires two staff, do not proceed with one.
3. If the person’s condition changes or equipment is unsuitable, stop, make the person safe and call the Duty Manager.
4. After a fall, do not lift the person unless trained to do so and it is safe. Check for injury, summon help and follow section 6.7.

6.6 Infection prevention and control

1. Clean hands before and after contact, and at key moments during care.
2. Use gloves, aprons and other protective equipment according to risk, and dispose of them safely between tasks.
3. Handle laundry, waste and body fluids as set out in the care plan.
4. Staff with symptoms of infection must tell the Duty Manager before attending visits.
5. Report suspected outbreaks to the Duty Manager, who contacts the UKHSA health protection team where required.

6.7 Deterioration and emergencies

1. At each visit, look for changes such as new confusion, pain, breathlessness, skin damage, reduced eating or drinking, or a change in mood.
2. For a life-threatening emergency, call 999 and start first aid within your training. Then tell the Duty Manager.
3. For non-urgent concerns, contact the GP, community nurse or NHS 111 and inform the Duty Manager.
4. Stay with the person until help arrives or the Duty Manager agrees you can leave. Do not leave a person at risk.
5. Record observations, actions taken and advice given. Follow any recorded advance decisions or resuscitation decisions.
6. Tell the person’s family or representative unless the person has said otherwise.

6.8 Missed, late and failed visits

1. If a visit cannot be made on time, the worker or coordinator tells the Duty Manager at once.
2. The Duty Manager assesses the risk to the person, then reallocates the visit or contacts the person, family or neighbour.
3. If a person cannot be reached or does not answer, follow the no access procedure. Contact the family or key holder, then the Duty Manager decides whether to call the police on 999 or inform the adult safeguarding team.
4. Where a missed visit risks harm, inform the commissioning team promptly and review under the incident procedure.

6.9 Consent, capacity and restrictions

1. Presume capacity. Ask for consent before every task and respect refusals.
2. If capacity is in doubt, carry out and record a decision specific assessment. Support the person to decide where possible.
3. If capacity is lacking, make a best interests decision with those close to the person and choose the least restrictive option.
4. Do not use restraint or restrictions without a lawful basis. Bed rails, locked doors and constant supervision need a recorded assessment and the local authority involved. Where deprivation of liberty may arise, tell the Registered Manager so that the local authority and, if needed, the Court of Protection can be involved.

6.10 Restrictions, deprivation of liberty and valid consent

This procedure applies the Supreme Court judgment of 2 June 2026 ([2026] UKSC 16). The Cheshire West acid test no longer decides whether a person is deprived of their liberty. The assessment now looks at the person’s whole situation and weighs several factors. The judgment also confirms that a person who lacks capacity to decide about their care arrangements may still give valid consent to them for Article 5 purposes. Our duties under the Mental Capacity Act 2005 and Regulations 11 and 13 continue to apply. Staff never decide alone that a restriction is lawful.

1. Identify the restriction. This includes locked doors, withheld keys, bed rails, sensor mats, door alarms, GPS devices, constant supervision, physical intervention and limits on going out or on contact with others.
2. Record it in the care plan. State what the measure is, why it is used, who applies it, for how long, and which less restrictive options were tried or rejected.
3. Assess the factors together. Consider the type, duration, effects and manner of the restriction. No single factor, such as supervision or not being free to leave, decides the matter.
4. Record the person’s wishes and behaviour. Note what they say, how they react and whether they try to leave or show distress. Record dated examples, not general impressions.
5. Consider valid consent with care. The person must be aware of their surroundings, have a basic understanding of the arrangements and be able to express a view that they accept them. If there is serious doubt, do not conclude that consent is valid. Escalate instead.
6. Escalate the same day. Tell the Duty Manager, who informs the Registered Manager and Safeguarding Lead. They decide whether to ask the DoLS team to consider whether Court of Protection authorisation is needed. Record the decision and the reasons.
7. Involve others. Consult the person, family, any attorney and professionals. Where there is no suitable representative, refer to the independent advocacy provider.
8. Review regularly. Review every restriction at least every six months and monthly for the most restrictive measures. Review sooner after an incident, a hospital stay, or a change in the person’s wishes, behaviour or health.

Consent is not fixed. Staff must record any sign that a person no longer accepts an arrangement and report it at once. Any physical intervention is used only to prevent harm, is proportionate and lasts for the shortest time. It is reported as an incident and considered under the safeguarding procedure in section 11.

6.11 Business continuity and emergency planning

This procedure supports Regulation 12(2)(a) and (b). It sets out how keeps people safe when normal service is disrupted. The Registered Manager () keeps a current continuity plan and tests it with the team. The Duty Manager leads the response on shift.

Prioritising visits

The Duty Manager sorts visits using a risk rating that is agreed at assessment and held on the rota system.

• Red: visits for time critical medicines, insulin, tube feeding, people at high risk of falls or pressure damage, people with no other support, and end of life care. These visits are protected first.
• Amber: visits where a delay or shortened call is safe for a short period, with a check by phone.
• Green: visits that can be moved or offered by family or neighbours, with the person’s agreement.

Steps for common disruptions

1. Severe weather. Check forecasts and warnings. Plan routes and use staff living nearby. Move to the red, amber and green list. Tell people and families what to expect.
2. Staff shortage. Use bank and agency staff who are inducted, then office staff with current competence. Do not allocate tasks outside a worker’s authorisation.
3. System or IT failure. Switch to the printed paper rota, contact sheet and medicines record kept for this purpose. Staff enter paper records and the office transfers them when systems return.
4. Loss of call monitoring. The Duty Manager phones each worker at agreed intervals and confirms red visits by phone with the person or family.
5. Loss of power, phones or the office. Move to the on-call manager and the remote working arrangements in the plan.

Escalation

• Tell the commissioning team promptly when visits cannot be delivered safely or the service is at risk.
• Contact the emergency planning team where a local emergency affects the service or the people supported.
• Consider CQC notification duties under section 10.

Record every decision, visit changed and person contacted. Review each event within a week, update the plan and share the learning.

6.12 Safe transitions: hospital admission, discharge and transfers

Transitions are a time of high risk. This procedure supports Regulation 12(2)(i), which requires information to be shared to keep care safe. It builds on section 13.3.

On hospital admission

1. Tell the Duty Manager at once. Send a current summary to the hospital team, with consent or under a lawful basis. Include communication needs, medicines, allergies, risks, capacity and any advance decisions.
2. Send the MAR and a list of medicines, or confirm the list is in the person’s own documents.
3. Suspend visits and update the rota. Keep in touch with the ward and the family.

Before discharge

1. Ask for the discharge summary, medicines list, therapy and nursing plans, equipment and any changes to mobility, diet or capacity.
2. Do not restart care until a trained assessor has reviewed the information and confirmed that we can meet the person’s needs safely.
3. Ask the commissioning team to confirm the package, funding and any change in hours before the first visit.

Medicines reconciliation

• Compare the discharge medicines list with the home supply and the previous MAR.
• Note new, changed and stopped medicines. Remove stopped medicines with the person’s consent and return them to the pharmacy.
• Raise any difference with the discharging team, the GP or the pharmacist before giving a dose. Create a new MAR only from a reliable source.

First visit after discharge

• Reassess risk, including falls, skin, nutrition, continence, mood and the home. Check that new equipment is in place, safe and in date for examination.
• Update the care plan within 24 hours and tell all staff before their first visit.
• Review again after one week.

Transfer to another provider

• With the person’s agreement, hand over the care plan, risk assessments, MAR, key contacts and consent and capacity records.
• Pass on a verbal handover and confirm the start date and time.
• Record what was shared, when and with whom. Continue care until the new provider takes over safely.

6.13 Clinical risk management and recognising deterioration

Staff assess and respond to clinical risks within their training. They do not diagnose. They observe, record and escalate. This section expands sections 6.1 and 6.7 and supports Regulation 12(2)(a).

Structured escalation

• Use the RESTORE2 tool, or a comparable recognised tool, to spot early signs of deterioration. Staff trained to take observations use the NEWS2 score, with calibrated equipment, and escalate the score as the tool directs.
• Report concerns to the Duty Manager using the situation, background, assessment and recommendation format. Call 999 for a life-threatening change. Otherwise contact the GP, community nurse or NHS 111.
• Record the observations, who was told and the advice given. Return to the person at the agreed time.

Risk	What staff do
Pressure ulcers	Check skin at each personal care visit, especially heels, hips, sacrum and under devices. Follow the repositioning plan and use the right pressure relieving equipment. Report any redness that does not fade, blisters or broken skin to the community nurse the same day. Record on a body map.
Falls	Follow the falls plan. After a fall, check for injury, keep the person warm and follow section 6.7. Report to the GP or falls service for review.
Nutrition and choking	Follow the plan on food texture and drink consistency. Seat the person upright and stay with them. Stop and call 999 for choking that does not clear. Report coughing, wet voice or weight loss so a speech and language therapy assessment is requested.
Diabetes	Know each person’s plan and target ranges. If hypoglycaemia is suspected or glucose is below 4 mmol/L, give fast-acting carbohydrate as the plan states and recheck. Call 999 if the person is drowsy, unconscious or cannot swallow.
Epilepsy	Follow the seizure plan. Note the time, make the area safe and protect the head. Call 999 if a seizure lasts longer than the time in the plan, usually five minutes, or if a person does not recover.
Sepsis	Think sepsis where there is fever or low temperature, fast breathing or heart rate, confusion, mottled skin or a person who is just very unwell. Call 999 and say you suspect sepsis.

Each plan is written with the person and the health professional, and staff are trained before supporting that need.

6.14 High-risk medicines, controlled drugs, self-administration and psychotropic medicines

This procedure builds on section 6.4 and follows NICE guideline NG67, the Human Medicines Regulations 2012 and the Misuse of Drugs Regulations 2001. It supports Regulation 12(2)(g).

Controlled drugs

• Support is given only by staff trained and assessed for it.
• Record each dose given, the quantity held and the stock balance on the MAR or controlled drug record.
• Check stock at the agreed frequency. Report any discrepancy to the Duty Manager at once. The Registered Manager decides on further steps, including contacting the prescriber, police or safeguarding team.
• Return unused controlled drugs to the pharmacy and obtain a signature.

Other high-risk medicines

• Insulin: follow the written plan and give only if delegated and signed off. Check dose, device and timing, and the food plan.
• Anticoagulants: give at the same time every day. Report bleeding, bruising and missed doses to the prescriber the same day. Ask the prescriber for guidance after a fall.
• Oxygen: display signs, do not allow smoking, naked flames or emollient build-up near the equipment, and keep supplies stored safely. Ask for a fire safety check where needed.

Self-administration

1. Assess the person’s ability, understanding, risks and storage at assessment.
2. Record the decision and the support agreed, including safe storage where children or others may be at risk.
3. Review after any incident, illness or change in cognition.

Medicines errors and incidents

• Follow the steps in section 6.4 and report the incident within the same shift.
• The Registered Manager reports patient safety incidents through the national learning service, and sends suspected adverse reactions and device faults through the Yellow Card scheme.

Medication review and psychotropic medicines

• Ask for regular medication reviews through the GP or pharmacist, and after hospital stays.
• For people with a learning disability or autism, follow STOMP. For people with dementia, follow STAMP. Psychotropic medicines are not used to manage behaviour without a prescriber’s review.
• Record behaviour and response so that prescribers can consider non-drug approaches and reduce or stop medicines safely.

6.15 Safety alerts, recalls and equipment defects

This procedure supports Regulation 12(2)(e), which requires equipment and medicines to be safe and suitable. The Registered Manager () is accountable. The Health and Safety Officer () manages the equipment record.

Receiving and acting on alerts

1. The Registered Manager subscribes to MHRA drug and device alerts and to National Patient Safety Alerts. A named deputy covers absences.
2. Log each alert on the day received. Record the date, reference and the person who reviewed it.
3. Decide whether it affects any person or any equipment we use or support. Check medicines, devices, beds, hoists, slings, mattresses and oxygen equipment.
4. Act within the timescale in the alert. This may mean quarantining stock, stopping use, contacting the prescriber or supplier or swapping equipment.
5. Tell the person and their family. Record the action, the date and who completed it.
6. Close the entry only when the action is checked. Report the outcome to the governance meeting.

Defective equipment

• Take faulty equipment out of use, label it and report it to the Duty Manager.
• Arrange a safe alternative before the next visit.
• Report device faults and incidents through the Yellow Card scheme. Consider RIDDOR for serious injury.

LOLER examinations

Hoists and slings used to lift people need a thorough examination, normally every six months, and after any significant repair.

• Keep a register of all lifting equipment in each home. Record who owns it: the person, the NHS, the council or us.
• Record the last and next examination dates and the contact for servicing.
• Where the person owns the equipment, explain that examination is needed and help them arrange it. Where the NHS or council owns it, ask the owner to complete it.
• If an examination is overdue, do not use the equipment. Tell the commissioning team if no safe alternative is available.

Review the register monthly.

6.16 Advance care planning, resuscitation decisions and attorney checks

This procedure supports Regulation 11 and the Mental Capacity Act 2005. Staff respect valid decisions and do not act on documents that are unclear, out of date or not applicable.

Resuscitation decisions

1. At assessment and at each review, ask whether the person has a DNACPR decision, a ReSPECT form or any other emergency care plan.
2. Check that the form names the person, is signed by a senior clinician, is dated and records the reason. Note any review date.
3. Check it was made with the person or, if they lacked capacity, in their best interests after consulting those close to them.
4. If the form looks invalid, tell the Duty Manager. Follow the document unless it is clearly invalid. Ask the GP to confirm. Do not delay emergency care in a crisis.
5. Keep the original in the home where staff and paramedics can find it, usually at the front of the care record. Keep a copy in the office record and note the location in the care plan.
6. Tell staff of any change before their next visit.

Advance decisions to refuse treatment

• An advance decision must be in writing, signed and witnessed if it refuses life-sustaining treatment, and it must state that it applies even if life is at risk.
• Check that it applies to the present situation and has not been withdrawn.
• Do not apply it where it is unclear. Seek urgent clinical advice.

Lasting power of attorney

1. Ask for the registered document or a certified copy, and ask to see the Office of the Public Guardian registration.
2. Check which type it is. A health and welfare attorney can make care decisions only when the person lacks capacity for that decision. A property and affairs attorney cannot decide about care.
3. Check any limits and whether life-sustaining treatment is within the attorney’s authority.
4. Record the attorney’s details and the scope in the care plan.
5. If you doubt an attorney is acting in the person’s best interests, tell the Safeguarding Lead. They may refer to the adult safeguarding team and the Office of the Public Guardian.

Review all documents at each care plan review and after any hospital stay.

6.17 Infection prevention and control: outbreaks, vaccination and the code of practice

This procedure expands section 6.6 and supports Regulation 12(2)(h) and the Health and Social Care Act 2008 code of practice on infection prevention and control. names an IPC lead who advises staff, keeps guidance up to date and leads the infection audit.

Outbreak management

1. Report two or more cases of similar symptoms, such as diarrhoea, vomiting or respiratory illness, to the Duty Manager the same day.
2. The Duty Manager informs the IPC lead and the Registered Manager. They contact the UKHSA health protection team and follow its advice.
3. Use the right protective equipment. Allocate staff to reduce cross infection where possible. Tell the GP and the commissioning team if visits are affected.
4. Record cases and actions. Hold a review after the outbreak ends.

Staff vaccination and occupational health

• Offer seasonal flu and COVID-19 vaccination and other vaccines in line with national guidance. Record uptake and reasons for declining.
• Staff with relevant risks, including blood borne virus exposure, are referred to occupational health.
• Staff with diarrhoea or vomiting stay away from work until 48 hours after symptoms stop, and speak to the Duty Manager about other illnesses.

Cleaning and decontamination

• Clean shared equipment, such as hoists, slings, commodes and shower chairs, after each use with the agreed product and contact time.
• Use single person use slings where possible, and wash reusable ones at the recommended temperature.
• Do not use equipment that cannot be cleaned.

Sharps and clinical waste

• Use a sharps bin that meets the standard, and never re-sheath needles.
• After a sharps injury, encourage bleeding, wash with soap and water, and report to the Duty Manager. Seek urgent medical or occupational health advice and complete an incident record.
• Place clinical waste in the right bag, tie it safely and dispose of it as the local arrangements state.

Assurance

The IPC lead carries out the quarterly infection audit in section 8.1 against the code criteria. Findings go to the governance meeting and the improvement plan.

6.18 Staff personal safety, violence and aggression, and digital systems

The Health and Safety at Work etc. Act 1974 and the Management of Health and Safety at Work Regulations 1999 require risks to staff to be assessed. This section builds on the lone working arrangements in section 6.3. The Health and Safety Officer () keeps the staff risk assessments.

Violence, aggression and harassment

1. Leave the situation if you feel at risk. Your safety comes first. Go to a safe place and call 999 if there is immediate danger.
2. Tell the Duty Manager as soon as it is safe. Complete an incident record the same shift.
3. The Duty Manager checks on the worker, arranges support and decides whether visits continue and with how many staff.
4. Assess the cause. Behaviour may relate to pain, illness, confusion or fear. Review the care plan and seek clinical advice. Do not label the person.
5. Where a person or visitor commits harassment, discrimination or assault, the Registered Manager decides on warnings, changes to care and reporting to the police.
6. Consider whether the person is at risk. Refer to the Safeguarding Lead if abuse, coercion or neglect may be involved.
7. Report RIDDOR injuries, as set out in section 10.

Staff are never expected to tolerate abuse as part of the job. They are offered a debrief and support, and can ask for time to recover.

Digital systems

• Electronic care records: use only your own login, never share credentials and lock the device after use. Record at the time of care.
• Call monitoring: log in and out accurately. Report failures straight away. Do not record time not worked.
• Telecare: know how each alarm, pendant or sensor works. Test as the plan states, and report faults and alerts to the Duty Manager.
• AI tools: use only tools approved in writing by the Registered Manager after a data protection impact assessment by the Data Protection Officer (). Never enter identifiable information into public tools. A trained worker must check any output before it is used in care or records.

Report suspected data breaches under section 12.4.

7. Training and Development

7.1 Training requirements

All staff complete induction before working alone. Care workers without previous experience complete the Care Certificate. Induction includes shadowing and observed practice.

Mandatory training includes:

• Risk assessment and recording.
• Moving and handling and falls prevention.
• Medicines support, with refreshers at least annually.
• Infection prevention and control, including hand hygiene and protective equipment.
• Basic life support, first aid and recognising deterioration.
• Health and safety, fire safety and lone working.
• Mental Capacity Act and consent.
• Safeguarding adults and duty of candour.
• Information governance and record keeping.
• Oliver McGowan Mandatory Training on learning disability and autism, at the level suited to the role.

Specialist training, such as catheter care, diabetes or epilepsy, is provided before staff support a person with that need.

7.2 Competency assessment

1. Competence is assessed by direct observation by a trained assessor, not only by course attendance.
2. Medicines competence is observed on first assessment and at least annually. It is reassessed after any error.
3. Moving and handling competence is observed in the person’s home with the equipment used there.
4. Staff who are not yet competent are supervised and are not rostered to the task alone.
5. Outcomes are recorded on the training matrix and reviewed by the Registered Manager.

7.3 Supervision and continuous learning

• Staff receive regular supervision and an annual appraisal.
• Unannounced spot checks take place regularly and cover safety practice, records and attitudes.
• Team meetings and bulletins share learning from incidents, audits and compliments.
• Staff are supported to gain qualifications and to raise training needs.
• The Registered Manager reviews training compliance monthly and acts on gaps.

8. Monitoring and Review

8.1 Monitoring framework

The Registered Manager makes sure the following monitoring takes place and is recorded:

• Monthly audits of care records, risk assessments and MARs.
• Quarterly audits of medicines support, infection control and moving and handling practice.
• Spot checks and competency observations at agreed frequencies.
• Review of every incident, near miss, complaint and safeguarding concern for themes.
• Live visit monitoring data and monthly analysis of punctuality and missed visits.
• Regular feedback from people supported, families, staff and professionals.

8.2 Quality indicators

Indicator	Measure
Missed visits	Number and rate per month, each with a review.
Late visits	Percentage outside agreed time windows.
Medicines errors	Number, type and severity, with actions completed.
Risk assessments	Percentage in date and reviewed after changes.
Competence	Percentage of staff with in-date training and observed competence.
Incidents	Number reported, time to review, and duty of candour completed.
Experience	Feedback from people supported on feeling safe.

8.3 Policy review

The Registered Manager reviews this policy at least annually. An earlier review follows a serious incident, a CQC finding, or a change in law or guidance. Reviews check the policy against current regulations, NICE guidance and CQC’s assessment framework. Changes are communicated to all staff, and staff confirm they have read them.

8.4 Continuous improvement

1. Audit and incident findings go into a service improvement plan with an owner and a deadline.
2. The Registered Manager reviews progress monthly and reports to the provider’s leadership.
3. Actions are checked to confirm they worked, and outcomes are shared with staff and, where relevant, people supported.
4. Evidence of learning is kept ready for inspection and commissioner monitoring.

9. Reporting Concerns

9.1 Duty to report

Every member of staff has a duty to report any concern about the safety of care, treatment or the people we support. This duty applies to concerns about colleagues, managers, other professionals, family members and itself.

Staff must report promptly. They must not wait for proof. Reporting in good faith is always right, even if the concern turns out to be unfounded.

9.2 What to report

Staff must report all of the following:

• Any incident, near miss or error that caused or could have caused harm.
• Medicines errors, omissions, refusals and unexplained discrepancies.
• Unsafe moving and handling, faulty equipment or hazards in a person’s home.
• Missed, late or shortened visits that put a person at risk.
• Poor practice, shortcuts, falsified records or breaches of care plans.
• Abuse, neglect, exploitation, discrimination or restrictive practice.
• Unsafe staffing, inadequate training or lone working risks.
• Any attempt to prevent, discourage or punish a report.

9.3 Reporting channels

1. Tell the Duty Manager straight away. Call the on-call line if the office is closed.
2. If the concern involves the Duty Manager, or is not resolved, tell the Registered Manager ().
3. For abuse or neglect, tell the Safeguarding Lead (). Staff may go directly to the local authority if the Safeguarding Lead is not available or is implicated.
4. For data concerns, tell the Data Protection Officer ().
5. For workplace safety concerns, tell the Health and Safety Officer ().
6. If the concern involves the Registered Manager, or senior leaders have not acted, report to the provider’s nominated individual or directors.
7. Staff may also report externally to the Care Quality Commission, the local authority commissioners, the police or the Health and Safety Executive. Staff do not need to use internal routes first.

In an emergency, call 999 first. Then report internally.

9.4 Whistleblowing and protection from detriment

• The Public Interest Disclosure Act 1998 protects workers who make a qualifying disclosure in the public interest. The CQC is a prescribed person under this Act.
• will not tolerate victimisation, dismissal, reduced hours, bullying or any other detriment because someone raised a concern.
• Managers will keep the identity of the reporter confidential where possible. Staff are told if confidentiality cannot be guaranteed, for example where the law requires disclosure.
• Any person who victimises a reporter faces disciplinary action.
• Staff must never be asked to sign agreements that stop them raising safety concerns.
• Reporters receive feedback on the outcome, as far as confidentiality allows.

9.5 Investigation procedure

1. The manager receiving the concern records it the same day, with date, time, facts and the reporter’s own words.
2. The manager takes immediate action to make people safe. This may include medical help, removing a hazard or suspending a worker on a neutral basis.
3. The Registered Manager decides within one working day whether safeguarding, notification or duty of candour steps apply (see sections 10, 11 and 14).
4. The Registered Manager appoints an investigator who is independent of the issue and trained in investigation.
5. The investigator collects evidence: care records, rotas, electronic call monitoring data, medicines records, statements and, where appropriate, the views of the person and their family.
6. The investigator completes a written report with findings, root causes and recommendations, normally within 28 days.
7. The Registered Manager agrees an action plan with owners and deadlines, and informs the reporter and affected people of the outcome.
8. Actions are tracked to completion through the governance meeting. Outcomes are used for learning across the service.

10. External Notifications

10.1 Principles

meets all statutory notification duties. The Registered Manager is accountable for decisions to notify. In their absence, the Duty Manager must notify and inform the Registered Manager. Where there is doubt, notify first and clarify later.

10.2 Notification requirements

Body	What to notify and when
Care Quality Commission	Deaths of people receiving the regulated activity, without delay. Other incidents under the Care Quality Commission (Registration) Regulations 2009, including serious injury, abuse or allegations of abuse, police involvement, and events that stop or may stop the service running safely. Changes to registration details and absence of the Registered Manager as required. Use the CQC provider portal.
Local authority adult safeguarding team	Any adult at risk who is experiencing or at risk of abuse or neglect, as soon as the concern is identified.
Commissioners	Safeguarding concerns, serious incidents, service disruption and any other events required by the contract. Follow the contract timescales.
Police	Suspected crime, immediate danger, and unexplained death. Use 999 in an emergency and the non-emergency number otherwise.
Health and Safety Executive (RIDDOR)	Work related deaths and specified injuries to workers without delay. Injuries causing over seven days of incapacity within 15 days. Dangerous occurrences, occupational diseases and certain injuries to non-workers that arise from work activity and need hospital treatment.
Information Commissioner’s Office	Personal data breaches likely to risk people’s rights and freedoms, within 72 hours of becoming aware. The Data Protection Officer decides and submits.
Disclosure and Barring Service	Where a person is dismissed or removed from regulated activity because of harm, or would have been had they not left. Referral is a legal duty under the Safeguarding Vulnerable Groups Act 2006.
Local authority Designated Officer (LADO)	Allegations that a member of staff has harmed a child or may pose a risk to children, within one working day.
UKHSA health protection team	Suspected outbreaks of infection, or notifiable diseases, as advised by the GP or UKHSA.
Medicines and Healthcare products Regulatory Agency	Serious suspected adverse drug reactions and medical device incidents, through the Yellow Card scheme.
Professional regulators	Concerns about the fitness to practise of a registered nurse or other registrant, through the relevant regulator.

10.3 Notification procedure

1. Identify whether the event meets any threshold in the table. Check with the Registered Manager.
2. Notify the person’s next of kin or representative, unless this would increase risk.
3. Submit the notification within the stated timescale. Keep a copy of the confirmation.
4. Record who notified, when, to whom and the reference number in the incident record.
5. Update the notification when new information is available.
6. Review all notifications monthly to confirm none were missed.

11. Safeguarding Interfaces

11.1 When unsafe care becomes a safeguarding concern

Unsafe care can be neglect. Repeated missed visits, medicines omissions, unsafe handling, poor hydration or nutrition, and failure to act on deterioration may all meet the threshold. Staff must not treat these only as quality issues.

The Safeguarding Lead decides whether a safeguarding referral is needed. Any member of staff may refer if the Safeguarding Lead is unavailable.

11.2 Immediate steps

1. Make the person safe and get medical help if needed.
2. Preserve evidence, including records, medicines and equipment. Do not alter records.
3. Tell the Duty Manager and the Safeguarding Lead without delay.
4. Ask the person what outcome they want, unless this would increase risk. Follow the Making Safeguarding Personal approach.
5. Refer to the adult safeguarding team. Use the out of hours service when the office is closed.
6. Record the referral and the decisions made, including the reasons for any decision not to refer.
7. Cooperate with any section 42 enquiry under the Care Act 2014 and follow the multi-agency procedures of the Safeguarding Adults Board.

11.3 Children and young people

Staff may meet children in the homes of the people we support, including young carers. Staff must follow Working Together to Safeguard Children 2026. Concerns go to the Safeguarding Lead and then to the children’s front door. If a child is in immediate danger, call 999. Allegations about staff go to the LADO.

Local child safeguarding practice reviews have replaced Serious Case Reviews. will contribute fully to any review.

11.4 Related risks

• Mental capacity and liberty: if care may deprive a person of their liberty at home, tell the Safeguarding Lead. They will contact the responsible team about Court of Protection authorisation.
• Advocacy: where a person has substantial difficulty being involved and has no suitable representative, refer to the independent advocacy provider.
• Domestic abuse: signpost to the local domestic abuse service and follow the safeguarding steps above.
• Radicalisation: refer through the Prevent route after consulting the Safeguarding Lead.
• Modern slavery: staff may call the Modern Slavery and Exploitation Helpline on 08000 121 700, available 24 hours a day. is not a First Responder for the National Referral Mechanism. An adult must consent to a referral, unless a statutory duty applies. Labour exploitation can also be reported to the Fair Work Agency.

11.5 Safeguarding contacts

Service	Contact
Adult front door	Adult front door for the area where the service operates
Adult out of hours	Emergency duty team for the area where the service operates
Children’s front door	Children's front door for the area where the service operates
LADO	LADO for the area where the service operates
Police non-emergency	Local police non-emergency number
Integrated care board safeguarding	Integrated care board safeguarding contact for the area

12. Information Governance

12.1 Legal basis

processes personal and health data under the UK GDPR and the Data Protection Act 2018, including changes made by the Data (Use and Access) Act 2025 as they come into force. Safe care depends on accurate, available and confidential information. The Data Protection Officer () oversees compliance.

12.2 Safe records

• Record care at the time or as soon as possible after the visit. Entries must be factual, dated, timed and signed or attributable.
• Record medicines, risk assessments, incidents, consent decisions and any changes in a person’s condition.
• Never alter, backdate or destroy a record. Correct errors with a single line or a dated electronic amendment.
• Keep the home care record secure and accessible to the person. Return paper records to the office when care ends.
• Staff must not record using personal devices or personal messaging apps unless the service has approved them in writing.

12.3 Confidentiality and sharing

1. Follow the Caldicott Principles. Share only what is needed, with those who need it.
2. Use consent where possible. Explain what will be shared and why.
3. Share without consent only where the law allows, such as to protect life or prevent serious harm. Record the reasons.
4. Do not delay sharing where there is a risk of harm. Fear of breaching data protection is never a reason to withhold safeguarding information.
5. Use secure email or approved systems. Check recipients before sending.

12.4 Data breaches

1. Report any actual or suspected breach to the Duty Manager and the Data Protection Officer immediately.
2. Contain the breach, for example by recalling an email or securing a lost record.
3. The Data Protection Officer assesses the risk within 24 hours and records every breach.
4. Where required, the Data Protection Officer reports to the Information Commissioner’s Office within 72 hours.
5. Where there is a high risk to individuals, the Data Protection Officer arranges to tell them without undue delay.

12.5 Individual rights and security

• Requests for access to records are passed to the Data Protection Officer on the day received. The response is due within one month.
• Devices holding care data must be encrypted, password protected and reported lost at once.
• completes the Data Security and Protection Toolkit annually.
• Records are kept and destroyed according to the retention schedule held by the Data Protection Officer.

13. Communication Protocols

13.1 With the person and their representatives

• Explain risks, choices and care plans in a way the person understands. Follow the Accessible Information Standard and arrange interpreters or communication aids where needed.
• Involve family, friends, attorneys or advocates when the person wishes, or when a best interests decision is being made under the Mental Capacity Act 2005.
• Tell people promptly about any change to visit times, staff or care.
• Give people clear details of how to contact the office and how to complain.

13.2 Handover and escalation between staff

1. Care workers record visit outcomes before leaving the home.
2. Care workers pass any concern to the Duty Manager by phone straight away. Use the structured approach: situation, background, assessment and recommendation.
3. The Duty Manager records the concern, the advice given and any action agreed.
4. The Duty Manager passes relevant information to the next worker and the next shift.
5. Unresolved concerns are escalated to the Registered Manager the same day.

13.3 With health and care professionals

• Contact the GP, community nurse, pharmacist or 111 for non-urgent clinical concerns. Call 999 for emergencies.
• Record the name and role of the person spoken to, the time and the advice given.
• Follow up in writing where the advice changes the care plan or medicines support.
• Share the care plan and risk information with hospital teams at admission. Gather discharge information before restarting care.
• Inform the commissioners of any significant change in a person’s needs.

13.4 Out of hours

The on-call manager is available whenever care is being delivered. Staff must know how to reach them. The on-call manager keeps a log of calls and decisions, and hands it to the Duty Manager at the start of the next working day.

13.5 Communicating with staff

• Share learning from incidents in team meetings, supervisions and briefings.
• Give updates on changes to risk assessments before the next scheduled visit.
• Use only approved channels for messages about people we support.

14. Incident Management, Duty of Candour and Learning

14.1 Reporting an incident

An incident is any event that caused, or could have caused, harm. Near misses are included. Staff must report incidents to the Duty Manager immediately and complete an incident record within the same shift.

14.2 Immediate response

1. Check for injury and call 999 or the GP as needed.
2. Make the person and the environment safe.
3. Stay with the person until help arrives or the situation is stable.
4. Tell the Duty Manager. The Duty Manager decides on further action and informs the Registered Manager.
5. Record the facts, the actions taken and who was informed.

14.3 Grading

Grade	Description and response
Near miss	No harm occurred. Record and review for learning at the next team meeting.
Low harm	Minor harm needing first aid or observation. Duty Manager review within two working days.
Moderate harm	Harm needing extra treatment. Registered Manager review, duty of candour assessed, and investigation.
Severe harm or death	Serious or permanent harm, or death. Immediate Registered Manager involvement, notifications and full investigation.

14.4 Duty of candour

Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 applies to notifiable safety incidents. These are unintended or unexpected incidents that result in, or may result in, death, severe harm, moderate harm or prolonged psychological harm.

1. The Registered Manager decides whether the duty applies. Record the decision and the reasons.
2. Tell the person, or their representative, as soon as reasonably practicable. Do this in person where possible.
3. Apologise sincerely and give a truthful account of what is known.
4. Explain what further enquiries will take place and what support is on offer.
5. Confirm the account in writing. aims to do this within 10 working days.
6. Share the investigation findings and the actions taken.
7. Keep a copy of every communication.

An apology is not an admission of liability. Staff must never hide or minimise an incident.

14.5 Investigation and learning

• Use a proportionate method, such as a timeline and root cause analysis, to find system causes before individual causes.
• Apply a just culture. Treat honest errors as chances to learn. Treat reckless or deliberate acts under the disciplinary policy.
• Update care plans, risk assessments and training following each investigation.
• Review incident trends monthly by type, time, location, staff and person. Report the trends to the governance meeting.
• Share anonymised lessons with staff, and with commissioners where appropriate.
• Check after three months that actions have worked.

14.6 Support

Staff involved in incidents receive a debrief and support from a manager. The person affected, and their family, are offered support and a named contact.

15. Related Policies

This policy must be read alongside the following policies and procedures:

• Safeguarding Adults Policy
• Safeguarding Children and Young People Policy
• Medicines Management Policy
• Moving and Handling Policy
• Infection Prevention and Control Policy
• Mental Capacity, Consent and Deprivation of Liberty Policy
• Duty of Candour Policy
• Whistleblowing Policy
• Incident, Accident and Near Miss Reporting Policy
• Complaints and Compliments Policy
• Missed and Late Visits Policy
• Risk Assessment Policy
• Care Planning and Record Keeping Policy
• Data Protection and Confidentiality Policy
• Lone Working and Staff Safety Policy
• Health and Safety Policy
• Business Continuity and Emergency Planning Policy
• Safe Recruitment Policy
• Training, Supervision and Appraisal Policy
• Equality, Diversity and Human Rights Policy
• Disciplinary and Capability Policy
• Modern Slavery and Exploitation Policy