Hand Book V2 18

Valuing People Objectives

Objective 1: Maximising Opportunities for Disabled Children

To ensure that disabled children gain maximum life chance benefits from educational
opportunities, health care and social care, while living with their families or in other
appropriate settings in the community where their assessed needs are adequately met and
reviewed.

Objective 2: Transition into Adult Life

As young people with learning disabilities move into adulthood, to ensure continuity of care
and support for the young person and their family and to provide equality of opportunity in
order to enable as many disabled young people as possible to participate in education,
training or employment.

Objective 3: Enabling People to Have More Control Over Their Own Lives

To enable people with learning disabilities to have as much choice and control as possible
over their lives through advocacy and a person-centered approach to planning the services
they need.

Objective 4: Supporting Carers

To increase the help and support carers receive from all local agencies in order to fulfill
their family and caring roles effectively.

Objective 5: Good Health

To enable people with learning disabilities to access a health service designed
around their individual needs, with fast and convenient care delivered to a
Consistently high standard, and with additional support where necessary.

Objective 6: Housing

To enable people with learning disabilities and their families to have greater choice and
control over where and how they live.

Objective 7: Fulfilling Lives

To enable people with learning disabilities to lead full and purposeful lives in their
communities and to develop a range of friendships, activities and relationships.

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Objective 8: Moving into Employment

To enable more people with learning disabilities to participate in all forms of employment,
wherever possible in paid work and to make a valued contribution to the world of work.

Objective 9: Quality

To ensure that all agencies commission and provide high quality, evidence based and
continuously improving services which promote both good outcomes and best value.

Objective 10. Workforce Training and Planning

To ensure that social and health care staff working with people with learning disabilities are
appropriately skilled, trained and qualified, and to promote a better understanding of the
needs of people with learning disabilities amongst the wider workforce.

Objective 11: Partnership Working

To promote holistic services for people with learning disabilities through effective
partnership working between all relevant local agencies in the commissioning and delivery
of services.

Medicines Policy

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This policy covers medicines support for adults (aged 18 and over) who receive care and
support from All About You Care Services in the community. It aims to ensure that people
we support take and look after their medicines effectively and safely at home.
It gives advice about who we should help to manage their medicines, the circumstances
when we should provide medicines support, and how we should work with other health and
social care staff.

1. Governance for Managing medicines safely & effectively

1.1. The Directors and Registered Manager of the company will review this policy and
governance arrangements to ensure it is clear who is accountable and responsible
for providing medicines support.

1.2. This policy is based on current legislation and best available evidence. And contains
processes for:
• Assessing a person's medicines support needs
• supporting people to take their medicines, including 'when required', time-
sensitive and over-the-counter medicines
• joint working with other health and social care providers
• sharing information about a person's medicines
• ensuring that records are accurate and up to date
• managing concerns about medicines, including medicines-related
safeguarding incidents
• giving medicines to people without their knowledge (covert administration)
• ordering and supplying medicines
• transporting, storing and disposing of medicines
• medicines-related staff training and assessment of competency.

2. Assessing and reviewing a person's medicines support needs

Many people want to actively participate in their own care. Enabling and supporting people
to manage their medicines is an essential part of this, with help from family members or
carers if needed. The term 'medicines support' is defined as any support that enables a
person to manage their medicines. The amount of support varies for different people
depending on their specific needs and abilities.

2.1. For services commissioned by the local authority; assessment for medicines support
for will be carried out by a local authority social worker as part of the overall
assessment of their needs and preferences for care and treatment.

2.2. Assessment for medicines support by people contracting directly with the company
will be carried out by a company manager/supervisor and the person. If the person
lacks capacity then family, advocates will be involved in joint decision making.

2.3. The company will not instruct care workers to take responsibility for managing a
person's medicines unless the overall assessment indicates the need to do so, and
this has been agreed as part of local governance arrangements.

2.4. Ensure that people assessing a person's medicines support needs (for example,
Company manager / supervisor) have the necessary knowledge, skills and
experience.

2.5. Engage with the person (and their family members or carers if this has been agreed
with the person) when assessing a person's medicines support needs. The

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assessment will focus on how the person can be supported to manage their own
medicines, taking into account:

• the person's needs and preferences, including their social, cultural,
emotional, religious and spiritual needs

• the person's expectations for confidentiality and advance care planning
• the person's understanding of why they are taking their medicines
• what they are able to do and what support is needed, for example, reading

medicine labels, using inhalers or applying creams
• how they currently manage their medicines, for example, how they order,

store and take their medicines
• whether they have any problems taking their medicines, particularly if they

are taking multiple medicines
• whether they have nutritional and hydration needs, including the need for

nutritional supplements or parenteral nutrition
• who to contact about their medicines (ideally the person themselves, if they

choose to and are able to, or a family member, carer or care coordinator)
• the time and resources likely to be needed.
2.6. The supervisor/manager undertaking the medicines needs assessment will record
the decisions about the person's medicines support in the care plan. If it is decided
the person needs medicines support, they will include the following information in
the persons care plan:
• the person's needs and preferences
• the person's expectations for confidentiality
• how consent for decisions about medicines will be sought
• details of who to contact about their medicines (the person or a named

contact)
• what support is needed for each medicine
• how the medicines support will be given
• who will be responsible for providing medicines support, particularly when it is

agreed
• that more than one care provider is involved
• when the medicines support will be reviewed, for example, after 6 weeks.

2.7. The company will review each person's medicines support to check whether it is
meeting their needs and preferences. This will be carried out at the time specified in
the provider's care plan, or sooner if there are changes in the person's
circumstances, such as:
• changes to their medicines regimen
• a concern is raised
• a hospital admission
• a life event, such as a bereavement.

3. Joint working between health and social care

Joint working enables people to receive integrated, person-centred support. Health
professionals working in primary and secondary care have an important role in advising and

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supporting care workers, Company employees will be receptive to help, and advice offered
by other social care practitioners and health practitioners.

3.1. If here is a need the company will notify a person's general practice and supplying
pharmacy when starting to provide medicines support, including details of who to
contact about their medicines (the person or a named contact).

3.2. It is the responsibility of care manager to seek advice about medicines from people
with specialist experience, such as the prescriber, a pharmacist or another health
professional, when it is needed.

3.3. It is the duty of Health professionals to provide ongoing advice and support about a
person's medicines and check if any changes or extra support may be helpful, for
example, by checking if:
• the person's medicines regimen can be simplified
• information about time-sensitive medicines has been shared
• any medicines can be stopped
• the formulation of a medicine can be changed
• support can be provided for problems with medicines adherence
• a review of the person's medicines may be needed.

3.4. When specific skills are needed to give a medicine (for example, using a
percutaneous endoscopic gastrostomy [PEG] tube), the company will only
undertake this task only when all of the following apply:
• the local authority / CCG commission this service as part of the framework
agreement.
• the person (or their family member or carer if they have lasting power of
attorney) has given their consent
• the responsibilities of each person are agreed and recorded
• the care worker is trained and assessed as competent to safely undertake
the task.

4. Sharing information about a person's medicines

It is important that we share information about medicines with the person and their family
members, and between other health and social care practitioners, to support high-quality
care.

4.1. Where the company has been commissioned and have agreed to be responsible for
medicines support, we will adhere to robust processes for communicating and
sharing information about a person's medicines that take account of the person's
expectations for confidentiality. This includes communication with:

• the person and their family members or carers
• company managers and other care workers involved in the care package
• other social care practitioners
• health professionals, for example, the person's GP or supplying pharmacist
• other agencies, for example, when care is shared, or the person moves

between care settings.

4.2. If a person has cognitive decline or fluctuating mental capacity; It is the
responsibility of the Registered Manager to ensure that the person and their family

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members are actively involved in discussions and decision-making. Record the
person's views and preferences to help make decisions in the person's best interest
if they lack capacity to make decisions in the future.
4.3. Where the care plan identifies the company is responsible for medicines support,
then the process for handling changes to a person's medicines received verbally
from a prescriber will be followed, and will include:

• recording details of the requested change (including who requested the
change, the date and time of the request, and who received the request)

• reading back the information that has been recorded to the prescriber
requesting the change to confirm it is correct (including spelling the name of
the medicine)

• asking the prescriber requesting the change to repeat the request to
someone else (for example, to the person and/or a family member or carer)
whenever possible.

4.4. When a person is transferred to another care setting, and the company is
responsible for medicines support; the company manager will arrange for medicines
and information to be passed to the new provider, this includes:

copy of the current MAR chart (Medicines Administration Record)
• current stock of medication (including quantities)
• Medicines information sheets
• Details of any known allergies
• A signature will be obtained from the new provider to confirm receipt

4.5. When changes to a person's medicines need to be made verbally to avoid delays in
treatment (for example, by telephone, video link or online), the company will:

• record details of the requested change (including who requested the change,
the date and time of the request, and who received the request)

• the member of staff receiving the request will read back the information that
has been recorded to the prescriber requesting their confirmation that it is
correct (including spelling the name of the medicine)

• The carer should also ask, whenever possible, the prescriber requesting the
change to repeat the request to someone else (for example, to the person
and/or a family member or carer)

• It is strictly forbidden to change or introduce any prescribed medication
without instructions from the prescriber.

5. Ensuring that records are accurate and up to date

Poor record keeping can put people receiving medicines support and care workers at risk.
As a Social care provider, we are required by law (The Health and Social Care Act 2008
[Regulated Activities] Regulations 2014) to maintain accurate and up-to-date records about
medicines for each person we support with their medication.

5.1. The company will keep records of the medicines we administer to the people we
support, these will be:

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• A record of each medication recorded on a MAR chart including;
• the person's name, date of birth and any other available person-specific

identifiers, such as the person's NHS number
• the name, formulation and strength of the medicine(s)
• how often or the time the medicine should be taken
• how the medicine is taken or used (route of administration)
• the name of the person's GP practice
• any stop or review date
• any additional information, such as specific instructions for giving a medicine

and any
• known drug allergies.
• Body map for creams, ointments and embrocation’s
• Signature for each time a person is supported to take their medication.
• Writing the date of opening on bottled medication
• accessible, in line with the person's expectations for confidentiality.

5.2. It is essential for all staff involved in management and delivery of services to ensure
that adequate documentation is maintained and shared appropriately.
Documentation must be accurate, concise and legible and written in ink. Correction
fluid must not be used; in the event of mistakes in documentation occurring they
must be crossed out, amended and marked with the initials of the person completing
the documentation.

5.3. It is the responsibility of area managers and supervisors to check MAR charts for
accuracy and take corrective action where mistakes and omissions are identified,
anyone checking MAR charts will be trained and assessed as competent to do so.

5.4. Care workers must record the medicines support given to a person on an official
company printed MAR chart, for each individual medicine on every occasion, in line
with Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities)
Regulations 2014.

5.5. This includes details of all support for prescribed and over-the-counter medicines,
such as:
• reminding a person to take their medicine
• giving the person their medicine
• recording whether the person has taken or declined their medicine (see
also recommendation 6.4 on raising concerns).

5.6. When a family member or carer gives a medicine (for example, during a day out),
prior agreement with the person and/or their family member or carer how this will be
recorded. This information established with the person, family and company
supervisor at the time of commissioning, and will be included in the care plan.

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6. Managing concerns about medicines

Medicines use can be complex, particularly when people have several long-term conditions
and are taking multiple medicines. Enabling people to raise any concerns about their
medicines and managing medicines-related problems effectively when they happen are
important to minimise harm and guide future care.

6.1. The company has processes in place for medicines-related safeguarding incidents,
in line with Regulation 13 of The Health and Social Care Act 2008 (Regulated
Activities) Regulations 2014.

6.2. Staff and managers are trained to identify, and report medicine related safeguarding
incidents. The company has adopted the Lancashire Safeguarding Adults Board
Guidance for reporting incidents. Company processes include reviewing and
learning from mistakes, and other medicines-related problems, these processes
support a person-centred, 'fair blame' culture that actively encourages people and/or
their family members or carers and care workers to report their concerns.

6.3. The company will record and review medicines-related problems, this is ongoing, we
will identify and address any trends that may have led to incidents, this learning will
be shared with:
• people working in the organisation
• people receiving medicines support, their family members and carers
• people working in related services, for example, GPs, supplying
pharmacies and
• community health providers.

6.4. It is the duty of all care and support staff to raise any concerns about a person's
medicines with their line manager. These concerns may include:
• the person declining to take their medicine
• medicines not being taken in accordance with the prescriber's instructions
• possible adverse effects including falls after changes to medicines
• the person stockpiling their medicines
• medication errors or near misses
• possible misuse or diversion of medicines
• the person's mental capacity to make decisions about their medicines
• changes to the person's physical or mental health.

6.5. Care and support staff must advise people and/or their family members or carers to
seek advice from a health professional (for example, the prescriber or a pharmacist)
if they have clinical questions about medicines.

6.6. If a person has a concern about their medicines, then care staff should encourage
and support people and/or their family members to raise any concerns about their
medicines. Staff should refer people to the office who will explain how to seek help
or make a complaint, including who to complain to and the role of advocacy services
(if needed), and record this information in the Daily Report Sheet.

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6.7. If the registered manger or any member of the management team are advised of an
adverse effect due to medication then a member of the management team will
advise people and/or their family members how to report adverse effects of
medicines, including using the Medicines and Healthcare Products Regulatory
Agency's yellow card scheme.

7. Consent

7.1. Written consent for the prompting, assistance or administration of medication must
be obtained from the Service User following completion of a risk assessment. The
consent statement is included in service user care plan and ideally should be signed
by the service user before commencement of service, if this is not possible within 24
hours of commencement. A copy of the consent and care plan must be retained in
the office.

7.2. If a Service User lacks capacity and unable to give consent then the consent should
be signed by a relative or authorised person acting on behalf of the Service User i.e.
Guardian, Power of Attorney.

7.3. Where consent is refused medication must not be administered and the refusal
reported to the Social worker or family.

8. Supporting people to take their medicines

Supporting people to take their medicines may involve helping people to take their
medicines themselves (self-administration) or giving people their medicines
(administration).
staff will only administer medicines in accordance with the Service Users care plan.
Agreement on the administration of medicines must be reached with managers, Service
Users and carers as appropriate. The Line Manager is responsible for ensuring only a
designated person administer medicines. The term "designated person" means a suitably
trained member of staff responsible for the administration of medicines. It is the
responsibility of the Manager to ensure that the designated staff have received sufficient
instruction and are competent to undertake this role safely and in accordance with this
policy.

• Care workers will be trained to follow safe working processes, including
the 6 rights (6R's) of administration:
✓ right person
✓ right medicine
✓ right route
✓ right dose
✓ right time
✓ person's right to decline

• what to do if the person is having a meal or sleeping
• what to do if the person is going to be away for a short time, for example,

visiting family
• how to give specific formulations of medicines, for example, patches,

creams, inhalers, eye drops and liquids
• using the correct equipment, for example, oral syringes for small doses of

liquid medicines
• giving time-sensitive or 'when required' medicines

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• what to do if the person has declining or fluctuating mental capacity.

8.1. Care workers will only provide the medicines support that has been agreed and
documented in the persons care plan.

8.2. Care workers should read the written directions on the prescription and dispensing
label on how each prescribed medicine should be taken or given, including:
• for time-sensitive medicines:
• what the medicine is for
• what dose should be taken
• what time the dose should be taken, as agreed with the person
• for 'when required' medicines:
• what the medicine is for
• what dose should be taken (avoiding variable doses unless the person or
their family member or carer can direct the care worker)
• the minimum time between doses
• the maximum number of doses to be given (for example, in a 24-hour
period).

8.3. Care workers should discuss any additional information to help manage time-
sensitive and 'when required' medicines with their line manager, if it is agreed
between the care worker and line manager to include in the care plan; the line
manager will write the information into the care plan.

8.4. Care workers should only give a medicine to a person if:

there is authorisation and clear instructions to give the medicine, for example, on the
dispensing label of a prescribed medicine and the 6 R's of administration have been
met (see also recommendation 8.1) and they have been trained and assessed as
competent to give the medicine (see also the section on training and competency).

8.5. Before supporting a person to take a dose of their medicine, care workers should
ask the person if they have already taken the dose and check the written records to
ensure that the dose has not already been given.

8.6. Care workers should ask the person if they are ready to take their medicine, before
removing it from its packaging, unless this has been agreed and it is recorded in the
provider's care plan.

8.7. Care workers should give medicines directly from the container they are supplied in.
They should not leave doses out for a person to take later unless this has been
agreed with the person after a risk assessment and it is recorded in the provider's
care plan.

8.8. When a person declines to take a medicine, care workers should consider waiting a
short while before offering it again. They should ask about other factors that may

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cause the person to decline their medicine, such as being in pain or discomfort (see
also recommendations 6.4 and 6.5 on raising concerns or seeking advice).

8.9. Care workers should ensure they read the up-to-date patient information leaflet for
each prescribed medicine is kept in the person's home. This includes medicines
supplied in monitored dosage systems. If they are not in the home, staff should
contact their line manager with details who will arrange for the leaflets to be
provided.

8.10. Social care providers should ensure that care workers are able to prioritise
their visits for people who need support with time-sensitive medicines.

8.11. Under no circumstances should Domiciliary Care or Support Staff offer advice
on non-prescribed medicines and remedies. "IT IS DANGEROUS TO DO SO". The
individual Service User concerned may be allergic to the treatment or be taking
other medication, which may cause an adverse reaction. The Domiciliary Care Staff
should advise the Service User to seek advice from the GP / Community Pharmacist
and inform their Manager.

8.12. Eye Drops. On no account must assistance with eye drops or invasive
procedures be offered without prior training, this is because each Service User has
individual needs and requirements will differ from person to person. If assistance
with eye drops is requested, the Domiciliary Care Staff must seek advice from their
manager before proceeding.

8.13. Oxygen Some Service Users use oxygen in their own homes because they
have diseases, which affect the respiratory system. On no account must the
Domiciliary Care Staff interfere with these supplies. For example, if supplies are
kept close to the fire or radiator, the Service User must be advised of the risk of
explosion. If the Domiciliary Care Staff has reason to be concerned about health
and safety issues regarding the position of an oxygen cylinder they must report this
to their Line Manager. This is particularly important when the Service User refuses
to move the oxygen cylinder to a safer location. Supplies of oxygen will be
monitored by the Service User, their family or the Pharmacist. This is not the duty of
the Domiciliary Care Staff, but if it is noticed that supplies appear to be low, the
Service User or their family will be informed about the situation. Supplies of oxygen
are normally obtained through the Pharmacist. Domiciliary Care Staff are allowed to
pass the oxygen mask to a Service User and to ensure that equipment is
conveniently positioned however they are not allowed to turn on the oxygen supply.

Nebulisers Likewise, should a Service User require medication via a nebuliser the staff
member may assist with the preparation of the equipment but not enter the medication into
the nebuliser. Should the service user have difficulty in opening their nebules of medication
to be used in the nebuliser the member of staff may assist provided that this assistance is
agreed in the risk assessment and Care Plan

8.14. Definitions for Types of Support

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Prompt: Prompt Service User by enquiring if they have taken their medication.

Assist: Pass the container to the Service User to self-administer / to assist the Service
User to access medication via a monitored dosage system, ideally a blister pack

Administer: to select, measure and give medicine to a Service User as specified in the
care plan where the Service User is unable to take medication for themselves.

Exceptional Circumstances: exceptional circumstances refer to situations whereby the
level of assistance required to assist a Service User does not fall within the usual remit of
Domiciliary Care & Support Staff. In this situation a thorough risk assessment must be
performed and the level of assistance clearly stated in the care plan. There must be
agreement between the company and the Social Services Care Organiser regarding the
involvement and role of the staff.

Designated Person: the designated person referred to within this policy is the person
responsible for ensuring adequate and accurate supplies of medication are available. In
most circumstances this will be a relative, or friend. Should a relative etc not be available to
perform this role an agreement must be made between the company Care Manager and
the Social Services Care Organiser or health professional as to who will perform the role as
the designated person.

Invasive Procedures: Administration by rectal insertion, e.g. suppositories, diazepam (for
epileptic seizure), Insulin by injection, administration through a Percutaneous Endoscopic
Gastrostomy (PEG).

9. Giving medicines to people without their knowledge (covert administration)

Covert administration of medicines is when medicines are given in a disguised form without
the knowledge or consent of the person receiving them.

9.1. It is the policy of the company to ensure that covert administration of medicines only
takes place in accordance with the requirements of the Mental Capacity Act 2005
and good practice frameworks (Mental Capacity Act 2005: Code of Practice) to
protect both the person and care workers.

9.2. Care workers must not give, or make the decision to give, medicines by covert
administration, unless there is clear authorisation and instructions to do this in the
care plan, supported by a stamped authority from the Court of Protection and in
pursuant to the Mental Capacity Act 2005

9.3. The company will ensure that the process for covert administration clearly defines
who should be involved in, and responsible for, decision-making, including:
• assessing a person's mental capacity to make a specific decision about
their medicines
• seeking advice from the prescriber about other options, for example,
whether the medicine could be stopped
• holding a best interests meeting to agree whether giving medicines
covertly is in the person's best interests
• recording any decisions and who was involved in decision-making
• agreeing where records of the decision are kept and who has access

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• planning how medicines will be given covertly, for example, by seeking
advice from a pharmacist

• providing authorisation and clear instructions for care workers in the
provider's care plan

• ensuring care workers are trained and assessed as competent to give the
medicine covertly see also the section on training and competency)

• when the decision to give medicines covertly will be reviewed.

10. Medication Administration Record (MAR charts)

The importance of keeping accurate MAR charts cannot be emphasised enough, failing to
complete these records could put a person at risk of harm or even death. Failure to
complete MAR charts correctly or falsifying records is a disciplinary offence. Do not try to
cover up mistakes, be open and transparent. If you give the wrong medication or make a
medication errors then inform your line manager immediately who will take appropriate
action.

10.1. The top section of the MAR is clearly marked and only to be used to record
prepacked tablets i.e. multiple blister packs and NOMAD type dispensers.

10.2. The three sections below are for recording any other medication, including
tablets not contained in multiple blister packs i.e. PRN (taken as required)
medication and creams or medication in liquid form.

10.3. Recording medication and MAR Chart codes

If you administer medication you must indicate your actions by signing with your initials to
confirm you have administered the medication. Any other action or assistance should be
recorded by using one of the codes below.

Codes are printed at the bottom of the sheet, please ensure that every box on the sheet is
either signed to say you have administered the medication or it contains a code to indicate
what has happened:

Your Initials

You must sign your initial in the correct box i.e. day, date and time of day to confirm you
have administered medication.

R = Refused

If a service user refuses to take their medication put R in the box and report refusal to office
or on call.

L = Left for later

If someone says they will take their medication later when you have gone put an L in the
box. If meds still not taken when next carer arrives; notify office immediately for further
instructions.

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A = Assisted

Use A when you have assisted, for example you have removed the tablets from the
packaging and placed in front of service user for them to take themselves.
Please do not confuse assisted with administered. If you administer you place in the service
users’ hand or on the tongue. Assist is when you unpack the meds or remove from a
container and place in front of service user for them to take themselves.

D = Discontinue

If we are informed by the GP or your manager that one or more types of medication should
no longer be taken, put a D in the box and score to line through to end on the sheet

O = Other Action

Write a O in the box if there is any other reason for not giving the medication, and record
the reason on the Daily Report Sheet. e.g. service user not at home.
Ensure week commencing date is entered for each week
Use only one sheet per four-week period do not continue next four weeks on the same
sheet.
Supervisors and area managers will return MAR sheets to office when full.

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11. Body Maps (for medication administration)

A body map is printed on the reverse side of the MAR charts, its purpose is to identify the
area where prescribed medication in the form of cream and lotions are to be applied. This
type of medication is often referred to as topical medication or embrocation.
Instructions. The box below contains a body map and is self-explanatory and demonstrates
how it should be completed;

• name of medication
• area to apply
• frequency.
When you have written the information: circle the area on the body map to which the
medication is to be applied (identified on the medication pack) and then draw a from the
application area back to the medication description. Repeat above for additional medication
Each time the medication is applied a record will be made on the MAR chart on the reverse
side of the page.

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12. Guidance Notes on Medical Issues

12.1. Reasons for medication

It is not the role of care staff to Telephone NHS Direct
explain the reason for the on 111 follow their advice
treatment and the likely effects
(including side effects) of any Notify manager
medication prescribed to their immediately
patient, this is the responsibility
of the GP or Hospital
Consultant.

12.2. Confidentiality

Care staff must not disclose a
Service User's medical history
or treatment to a relative or any
other person unless they have
been identified within the Care
Plan and Risk Assessment or
with the express permission of the Service User. Any questions must be directed to the
Service User or the GP.

12.3. Adverse Reactions (Side effects)

Service Users may experience adverse reactions to medication. Adverse reactions vary
in severity and form. Therefore, Service Users must be observed for apparent adverse
reactions during the duration of the visit. This is particularly important if it is the first time
the individual has been prescribed the medicine.
If an adverse reaction is suspected and the situation is not urgent, the Domiciliary Care
Staff should inform their Line Manager who will inform the GP, Social Worker and
relatives. If the individual's condition deteriorates and becomes urgent e.g. individual
develops difficulty in breathing or complains of chest pains, then an ambulance must be
called immediately, and the medication should be left available for the paramedic,
including all the service user’s other medications.

12.4. The Yellow Card Scheme

It is vital in helping the MHRA monitor the safety of all healthcare products in the UK to
ensure they are acceptably safe for patients and those that use them. Reports can be
made for all medicines including vaccines, immunoglobulins, herbal medicines and
homeopathic remedies, and all medical devices available on the UK market. From the
20th of May 2016. The Scheme collects information on suspected problems or incidents
involving side effects (also known as adverse drug reactions or ADRs) medical device
adverse incidents, defective medicines (those that are not of an acceptable quality),
counterfeit or fake medicines or medical devices
It is the responsibly of staff to report any side effects to their manager if a service user
reports a problem with medicines or medical devices. In turn the manager will report the
side effect through the online Yellow Card Scheme:
https://yellowcard.mhra.gov.uk/the-yellow-card-scheme/

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12.5. Reaction to sunlight

Some medicines cause individual's skin to react when exposed to sunlight. Staff must
be made aware of the risk and details must be recorded in the individual's case notes.

12.6. Homely Remedies (Non-Prescribed Medication)

Homely remedies are medicines that can be purchased over the counter from a
community pharmacy, without a prescription from a doctor. Service Users may obtain
homely remedies at their own discretion. Staff will not be allowed to obtain on behalf of,
prompt the use of, assist or administer homely remedies.

12.7. Illicit Substances

Any member of staff who suspects that the Service User has in their possession or is
using illicit drugs must report their suspicions or findings to their Line Manager who will
then inform the appropriate Care Manager. Any member of staff who visits a Service
User who is under the influence of illicit substances has the right to leave the Service
User’s home if they feel threatened. It is essential that they then inform their Manager
immediately.

12.8. Cytotoxic drugs

Cytotoxic drugs are hazardous substances, as defined by the Control of Substances
Hazardous to Health Regulations 2002 (COSHH). Cytotoxic drugs describe a group of
medicines that contain chemicals which are toxic to cells, preventing their replication or
growth, and so are used to treat cancer. They can also be used to treat a number of
other disorders such as rheumatoid arthritis and multiple sclerosis.

12.9. Personal protective equipment (PPE)

Personal protective equipment is provided and must be used wherever risks cannot be
adequately controlled in other ways. It is important that the PPE offers adequate
protection for its intended use. Employees must have Gloves on their person at every
visit and shall be worn in all instances of supporting a person with medication, this is
especially important when handling Cytotoxic drugs.

12.10. Medication Errors

No matter how high the standards of individual staff and how good the policies that they
work to, drug errors can still occur. This refers to errors made from medication wrongly
administered, omitted doses and medication lost or stolen. It is important in this respect
that as a company we maintain an open "no blame" policy, where staff are encouraged
to report such errors without delay. If you make an error, you must report it immediately
to your Line Manager who will notify the Care Quality Commission.

If such a policy is not followed there is a danger of cover-up and concealment with
potentially dangerous results. All errors and incidents require a thorough and careful
investigation, taking full account of the context and circumstances and the position of
the staff involved. Such incidents should receive sensitive management and a
comprehensive assessment of all circumstances before a professional and managerial
decision is reached on the way to proceed. Care should be taken to distinguish between
those cases where the error was a result of reckless or incompetent practice or was
concealed, and where there was immediate honest disclosure in the Service User’s

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interest. Action must be taken to prevent the error or incident occurring again. This could
be through re-training or removing the person from assisting with medication until the
action has been decided. Action taken will depend on the individual circumstances
surrounding the error.

12.11. Medication Wrongly Administered or Omitted Doses

If you wrongly administer or omit to give a dose of medicine to a service user in your
care, or you become aware that an error has been made by another person, you must
adhere to the following: -
Report the incident to your line manager immediately, who will inform you of any further
appropriate action to be taken.
The Line Manager will then:

• Immediately seek advice from the service users GP, pharmacist, Accident &
Emergency Department or NHS Direct Tel: 111 and comply with any advice
given e.g. call an ambulance.

• Enter the details into the appropriate report book and Service User case
notes.

• Make a note of any changes or deterioration in service user’s health or
behaviour.

• Inform the Service User’s next of kin. They should be informed openly and
honestly and must be informed of what is being done to prevent reoccurrence.

• Complete notifiable incident record.

Only negligent error would result in liability and it is the organisation that is liable, not the
individual member of staff. This refers to errors made from medication wrongly
administered, omitted doses and medication lost or stolen. It is important to
acknowledge that while errors should not be made, the policy should not be seen as
being blame culture. It is equally important that an open culture exists in order to
encourage the immediate reporting of errors or incidents in the administration of
medicines. If the incident invokes a regulation 20 duty of candour the registered
Manager will follow the procedures itemised in the company Duty of Candour Policy.

12.12. Lost or Stolen Medication

As soon as you become aware that medication belonging to a Service User has been
lost or stolen, you must inform you’re Line Manager, who, in turn, will speak to the
relevant Care Manager and inform the Police. (If the medication is a controlled drug this
must then be recorded in the appropriate report with the incident number given by the
police). Contact the Service Users GP who may need to provide a prescription to
replace the lost/stolen medication.

13. Ordering and supplying medicines

13.1. Responsibility for ordering medicines usually stays with the person and/or
their family members or carers. However, if it has been agreed that the company is
responsible, an effective medicines management system will be put in place.

13.2. A company manager/supervisor will agree with the person and/or their family
members or carers who will be responsible for ordering medicines, and record this

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information in the care plan. This should be the person, if they agree and are able
to, with support from family members, or care workers (if needed).

13.3. Where the company is responsible for ordering a person's medicines we will
ensure that the correct amounts of the medicines are available when required, in
line with Regulation 12 of The Health and Social Care Act 2008 (Regulated
Activities) Regulations 2014.

13.4. The company will not delegate this task to the supplying pharmacist (or
another provider), unless this has been requested and agreed with the person
and/or their family members or carers.

13.5. The company will ensure care workers designated to ordering a person's
medicines will:
• have enough time allocated for checking which medicines are needed,
ordering medicines and checking that the correct medicines have been
supplied
• are trained and assessed as competent to do so (see also the section on
training and competency).

13.6. When ordering a person's medicines, care workers should:
• record when medicines have been ordered, including the name, strength

and quantity of the medicine
• record when medicines have been supplied
• check for any discrepancies between the medicines ordered and those

supplied.

13.7. The company will ensure Care workers are instructed of what action to take if
a discrepancy is noted between the medicines ordered and those supplied.

13.8. Monitored dosage system will only be supplied when an assessment by a
health professional (for example, a pharmacist) has been carried out, and a specific
need has been identified to support medicines adherence. Taking account of the
person's needs and preferences and involve the person and/or their family members
or carers and the social care provider in decision-making.

13.9. Staff should identify each individual medicine in a monitored dosage system
provided from the description provided by the pharmacy or dispensing doctors.
• Support with over-the-counter medicines requested by a person will be
recorded and treated in the same way as prescribed medicines, including:

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• seeking advice from a pharmacist or GP before administering homely
remedies.

• ensuring that the person understands and accepts any risk associated with
taking the medicine

• what information needs to be recorded, for example, the name, strength
and quantity of the medicine.

14. Emergency Supplies

14.1. Should the agreed person fail to request repeat medication or collect the
same then homecare staff should follow the following procedure

• Contact their manager for advice and to inform them of the situation
• The Manager should then attempt to contact the agreed person to request

that the situation be rectified
• Should the agreed person or no other suitable person be available the

Manager should contact the Social Worker or the Emergency Duty Social
Worker to request authorisation to intervene
• Once authorisation has been provided preferably in writing the Service
Users GP should be contacted and a repeat prescription requested
(usually 48 – 72 hour turnaround)
• Medication should be obtained from the usual pharmacy as identified on
the risk assessment document
• The Domiciliary Care Staff should be informed of the outcome and any
assistance required.
• A review should be set up to discuss the event and plans made to prevent
future reoccurrence.

14.2. Emergency supplies of a Prescription Only Medicine (POM) may be requested
from the Community Pharmacist, for a named service user, before a prescription
is supplied. As a supply in response to such a request should be seen as a
private transaction, one of the procedures set out below must be followed:

• The designated person on duty must contact the GP and request an
urgent prescription, ideally this should be delivered to the pharmacist
before the supply is made.

• If this is not possible, the pharmacist can respond to an emergency supply
request from a GP.

14.3. The law permits POMs to be supplied at the doctor's request in the absence of a
prescription on the proviso a prescription is supplied within 24 hours.

14.4. If the GP cannot be contacted the pharmacist can respond to an emergency
supply request from the service user. The law states that the pharmacist must
personally interview the Service User and be satisfied that:

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• There is an immediate need for the POM and that a prescription cannot be
obtained.

• The medicine has been prescribed previously for the Service User and
that the dose is appropriate.

15. Transporting, storing and disposing of medicines

15.1. Responsibility for transporting, storing and disposing of medicines usually
stays with the person and/or their family members or carers. However, if it has been
agreed that the company is responsible, company procedures for transporting,
storing and disposing of medicines will be followed.

15.2. The company will agree with the person and/or their family members or carers
who will be responsible for transporting medicines to or from the person's home. If
an employee is delegated to transport the medicine they will carry out a risk
assessment, and follow company procedures for transporting, storing and disposing
of medicines.

15.3. The company will encourage the person to take responsibility for disposal and
storage of their medication. Only in exceptional circumstances, and as a last resort
will we assist with disposal and storage of medication. We will agree with the person
and/or their family members how their medicines should be stored and disposed of.

15.4. When a person is assessed to be at risk because of unsecured access to their
medicines, we will agree with the person and/or their family members or carers
whether secure home storage is needed, for example, in a lockable cupboard.

15.5. Where the company is responsible for storing a person's medicines, a robust
process to ensure there is safe access to medicines, particularly for controlled drugs
This will include:
• identifying who should have authorised access to the medicines
• seeking advice from a health professional about how to store medicines
safely, if needed.
• assessing the need for secure storage, for example, in a lockable
cupboard
• identifying the need for fridge storage
• reviewing storage needs, for example, if the person has declining or
fluctuating mental capacity.
• The cost of any equipment for storage is not the responsibility of All About
You Care Services Limited.

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• The company will not support anyone to medicate where it has been
identified safe storage is essential until such time as safe storage facilities
are in place.

15.6. Where the company is responsible for disposing of any unwanted, damaged,
out-of-date or part-used medicines, we will follow robust processes, in line with The
Controlled Waste (England and Wales) Regulations 2012. These should include:

• obtaining agreement from the person (or their family member or carer)
• how the medicines will be disposed of, usually by returning them to a

pharmacy for disposal
• any special considerations, for example, for disposal of controlled drugs,

needles and syringes
• what information needs to be recorded, for example, the name and

quantity of medicine, the name of the person returning the medicine, the
date returned and the name of the pharmacy.

16. Storage of Medicines at Room Temperature

these instructions apply to supported living accommodation and not in service users own
homes, unless marked with an Asterix*

Medicines not requiring refrigerate storage should be kept at room temperature below
+25o Celsius *

16.1. Storage requirements and daily temperature recording:
16.2. • All drugs will be kept in the lockable cupboards.
16.3. • The cupboards will remain locked except for access to medicines
• The senior person on duty will hold the keys
• The keys will be passed from the outgoing senior to the incoming senior at

shift handover.
• The ambient temperature of utility room used to store medicines must be

monitored and recorded at least once daily.
• This should be documented on the temperature recording sheet.
• It is best practice for this recording to take place during the afternoon, to

account for peak temperatures.
What to do when the ambient temperature is out of range:
• Where the ambient room temperature exceeds 25°C, action should be

taken to reduce this by e.g. opening windows (whilst not compromising
medicines security) *
• Where the ambient room temperature exceeds 25°C for more than 7 days
out of any 30 then the team leader should contact the directors of the
company who will risk assess the situation and arrange for temporary
cooling equipment to be installed if necessary.
Storage of fridge medicines *

Some medicines must be stored in a refrigerator because at room
temperature they break down or ‘go off’. Care staff need to know which

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medicines need to be kept cool. To find out if a product needs to be stored in
the fridge, check the packaging, or refer to the Patient Information Leaflet
(PIL) supplied. If you need a copy of a PIL, contact your pharmacist or go to:
www.medicines.org.uk/emc/

16.4. Fridge requirements and daily temperature recording:*

If a service user requires medication on a regular basis that needs to be
refrigerated (e.g. insulin), it should be kept in a fridge.
Because there is not a constant need to refrigerate medicines, a separate
fridge is not necessary. In this case a lockable container will be kept in the
food fridge to store the medication.
The key to the lockable container will be kept in the locked drugs cupboard.
The senior person on duty will have a key to access the drugs cupboard to
obtain the key to open the lockable container kept in the food fridge.
The fridge temperature should be monitored and recorded daily. It is
recommended to record minimum, maximum and current temperatures, using
a minimum/maximum thermometer (see example record chart overleaf).
It is the responsibility of the team leader to ensure staff taking the
thermometer readings understand how to read thermometer and reading the
reading.
The fridge temperature must be kept between the range of 2°C and 8°C. If the
fridge temperature is outside of this range action should be taken immediately
(see below) *

What to do when the fridge temperature is out of range:

• Inform the team leader immediately.
• Quarantine fridge stock while advice is sought.
• Attach a notice to the fridge clearly stating do not use.
• Estimate how many hours the fridge has been out of range (you should

have the reading from the previous day’s check).
• Contact your regular pharmacy for advice or the manufacturer for

individual product advice.
• If medicine is safe to use move temporarily to kitchen fridge and keep

in lockable container.
• Ensure that the stock which is no longer usable is disposed of

promptly.
• Senior on duty contact an engineer, service user or family if in the

community arrange for fridge to be repaired
• Contact the GP to order replacement prescriptions if required.
• Remember to record the action taken on the fridge temperature record

sheet.

Date Time current Current Current Signed Action taken if outside of
// Fridge
temperature cupboard 1 cupboard 2 range:
Fridge:
: temperature temperature 2⁰ C to 8⁰ C

Cupboard: below +25⁰ C

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// :
// :
// :
// :
// :
// :
// :
// :
// :
// :
// :
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// :
// :

17. Training and competency

All About You is committed to training and supporting their staff to ensure the safety,
quality and consistency of care and support, engaged in the supporting people to take
their medication will be assessed for competency to manage medicines

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The company will in place robust processes for medicines-related training, and
competency assessment for care workers, to ensure that they:

• receive appropriate training and support
• have the necessary knowledge and skills
• are assessed as competent to give the medicines support being asked of them,

including assessment through direct observation
• have an annual review of their knowledge, skills and competencies.

18. Terms used in this guideline

Person
The person receiving care and support often called the service user or client
Advance care planning
A voluntary process of discussion about what care a person would or would not want in the
future, if they were unable to make decisions because of illness or a lack of mental capacity
to consent. The person may also choose to involve their family members or friends in
discussions.

Carer
The term 'carer' is used to define an informal, unpaid carer only (see also 'care worker').

Care worker
A person who is employed by the company to provide care and support to people in their
own home

Fair blame culture
In health and social care, this enables open and honest reporting of mistakes that are
treated as an opportunity to learn to improve care.

Health practitioners
The wider health and social care team of health professionals and social care practitioners.
Health professionals include, but are not limited to, GPs, pharmacists, hospital consultants,
community nurses, specialist nurses and mental health professionals.

Social care practitioners
Social care practitioners include, but are not limited to, care workers, case managers, care
coordinators and social workers.

Medicine
All prescription and non-prescription (over-the-counter) healthcare treatments, such as oral
medicines, topical medicines, inhaled products, injections, wound care products, appliances
and vaccines.

Medicines-related problems
Medicines-related problem include:

• potentially avoidable medicines-related hospital admissions
• prescribing errors
• dispensing errors
• administration errors (for example, missed or delayed doses, inappropriate or

incorrect administration)

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• monitoring errors (for example, inadequate review or follow-up, incomplete or
inaccurate documentation)

• adverse events, incident reporting and significant events
• near misses (a prevented medicines-related patient safety incident which could

have led to patient harm)
• deliberate withholding of medicines or deliberate attempt to harm
• restraint or covert administration that has been used inappropriately
• misuse, such as missing or diverted medicines
• other unintended or unexpected incidents that were specifically related to

medicines use,
• which could have, or did, lead to harm (including death).

Medicines support
Any support that enables a person to manage their medicines. This varies for different
people depending on their specific needs.

Mental capacity
The ability of a person to make a decision about their own care, including:
decisions that affect daily life (for example, when to get up, what to wear or whether to go to
the doctor when feeling ill, and more serious or significant decisions)
decisions that may have legal consequences for them or others (for example, agreeing to
have medical treatment, buying goods or making a will).
The Mental Capacity Act 2005 defines a lack of mental capacity as when 'a person lacks
capacity in relation to a matter if at the material time he is unable to make a decision for
himself in relation to the matter because of an impairment of, or a disturbance in the
functioning of, the mind or brain'.

Monitored dosage system
A system for packing medicines, for example, by putting medicines for each time of day in
separate blisters or compartments in a box.
Original packaging
The packaging in which the medicine is supplied by the supplying pharmacy. This could be
a manufacturers packaging or pharmacy supplied packaging after larger amounts of
medicines have been decanted for individual patient use.

Parenteral nutrition Providing nutrients intravenously.

Care plan
A written plan that sets out the care and support that the company and the person have
agreed will be put in place, following a local authority assessment. It includes details of both
personal care and practical support.

Social care provider
A provider organisation, registered with the Care Quality Commission to provide community
adult care services, which directly employs care workers to provide personal care and
support in a person's home.

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Time-sensitive medicine
A medicine that needs to be given or taken at a specific time, where a delay in receiving the
dose or omission of the dose may lead to serious patient harm.

Don’t forget the 6 R’s when administering medication:

✓ right person
✓ right medicine
✓ right route
✓ right dose
✓ right time
✓ person's right to decline

Don’t forget to sign MAR charts, or use one of the
following codes:

R = Refused
L = Left for later
A = Assisted
D = Discontinue
O = Other Action

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Lone Worker Policy

Who is a Lone Worker?

The HSE defines lone workers as people who work by themselves without close or direct
supervision.
Examples include, one person working in a fixed establishment, workers in remote
locations, mobile workers, those working at other employers’ premises or from home, those
on domiciliary visits and those staff alone with service users.
When addressing the issue of lone working, it is important to distinguish between
employees finding themselves alone by chance, or due to the nature of their work. The first
instance may be addressed by simply implementing a procedure whereby employees alert
fellow workers to the fact that they are leaving an area for a given length of time, and the
remaining person will be on his or her own.

Zero Tolerance

The company operates a zero tolerance campaign designed to assist managers in reducing
potential risk to their employees. There are many different situations staff find themselves
in with regard to lone working, and it would be impracticable to address each situation
individually. This Policy, therefore, has been designed to be wide ranging but still assist
managers in meeting their legal obligations and provide them with some practical guidelines
to minimise the risks to their employees.

The Law

There is no general prohibition in health and safety law of working alone, but there is a duty
of care under the Health and Safety at Work Act. However, when determining a safe
system of work, it is likely that there will be a need for additional controls to be put in place.
These controls will be identified once a risk assessment has been undertaken.

Individual Responsibilities

Company Care Manager

Ensure a risk assessment has been completed; including the risk from a service user and
where appropriate their home and community if a home visit is necessary.

• Ensure appropriate control measures are in place; see Appendix 2.
• Ensure staff are aware of this policy and follow it.
• Ensure staff have received appropriate training.
• Keep a written record of any incidents
• Review all incidents and put in place any measure to avoid reoccurrence

Employees
• Follow this policy
• Report to their manager or supervisor any problems or difficulties that they are aware
of caused by working alone.

• Report any incidences to their manager.

Company

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• Provide appropriate training; for example, in general risk assessment, specific risk
assessment (e.g. COSHH) and violence and aggression awareness:

• Monitor the progress

APPENDIX 1
Risk Assessment

Although the local manager should already have completed a risk assessment in order to
identify the hazards of any work, they should ensure that any additional risks to lone
workers (and other groups at risk, such as pregnant workers and young workers) are
identified. They should devise and implement safe working arrangements to ensure that the
risks are either eliminated or adequately controlled. The assessment should consider the
following factors.

• Is it necessary for the individual to work alone?
• Foreseeable emergencies. It must be recognised that a lone worker is more

vulnerable when the unexpected occurs e.g. fire, equipment failure, illness, accidents
and violence, car breakdown.
• The fitness and suitability of the person to work alone. Will working alone require
additional physical or mental stamina? Is there a medical condition that makes the
individual unsuitable for working alone? Is that person competent? Has he or she
received appropriate training?
• Whether the work can be done safely by a lone worker?

When considering the working practices, the following questions should be considered:
• Does the workplace present a special risk to the lone worker?
• Is there a safe means of entry and exit to the workplace?
• Can all equipment, substances and goods be safety handled by one person?
• Will cash or valuables be handled and will there be a risk -of violence?
• Are there arrangements for food and drink and adequate welfare facilities
• Is the worker vulnerable to sexual harassment or assault?

Ensure that:

• Lone workers have full knowledge of the hazards and risks to which they are
being exposed.

• The lone workers know what to do if something goes wrong.

• Someone else knows the whereabouts of the lone workers and what they are
doing.

• The level of supervision for lone workers should be determined to ensure that it is
consistent with the possible risks and that there is a system for maintaining
contact.

The remoteness of the workplace should also be considered when assessing the risks to
lone workers, for example:

• Will the emergency services be able to approach close enough if necessary?
• Is the length of time to do the job defined?

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• Is there adequate access to first aid?

Arrangements should be in place to protect or assist lone workers in the event of fire.
accident, illness or an incident of violence.

Lone workers should receive appropriate training to ensure that they are competent and
able to deal with foreseeable problems.

Staff should appreciate their responsibility for their own safety.

Lone workers should receive training in the use of any necessary tools and equipment. The
tools or equipment used should be safe and correct for the task, and any increased risk to a
lone worker should be identified in the risk assessment.

The manager should define working limits of what can and what cannot be done while
working alone. This may be difficult, but the overriding principle should be "if in doubt ask a
supervisor'. The lone worker should clearly understand when and under what
circumstances to stop work, and should be fully supported by management if any such
decisions are made.
The manager must develop procedures to control the risks and protect employees and
other individuals. The employees should know and understand such procedures.

APPENDIX 2
Control Measures

Consider the following practical guidelines:
Authorisation for lone working is required from a manager.

Lone workers, outside normal working hours and in isolated buildings, should telephone the
24 hour on call line on, giving their name, place of work (and if possible a room number)
and expected duration of stay. They should telephone back, as they leave the building.

A departmental manager should be available for consultation (by telephone) in the event of
a person not registering themselves leaving the department.

Keep exit doors locked. Managers should allocate to someone the job of checking these
doors are locked.

Pregnant workers should not work alone.

Ensure a working telephone is available.

Lone workers should not undertake dangerous work (e.g. using dangerous chemicals) -this
should be indicated by a risk assessment

Checks by on call Manager staff by telephone if they have not heard from an individual after
a designated length of time.

Where substantial car travel is required, the availability of a mobile phone is necessary.

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Home visits can produce particular risks (e.g. unsafe houses, potential for being attacked. A
visit to a home may be necessary to aid the risk assessment. In particular, consider the
point raised in the following checklist:
a) Are staff who visit:

• Trained to deal with violence and aggression.
• Briefed about the areas where they work (the community).
• Aware of attitudes, traits or mannerisms which can annoy Service Users

etc.
• Given all available information about the service user and their family from

all relevant sources (e.g. colleagues, police, the patient’s General
Practitioner).
b) Have staff:
• Understood the importance of previewing cases.
• Left an itinerary.
• Made plans to keep in contact with colleagues.
• Got the means to contact a manager.
• Got the on call telephone number
• An understanding of the company Policies on Abuse, Violence and
Aggression.
• Authority to arrange an accompanied visit.
c) Do staff:
• Know how to control and defuse potentially violent situations
• Know how to complete the company Incident Report form if necessary.
d) Car Users should: -
• Park in well-lit areas
• Ensure their car is in good condition.

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Prioritising of Tasks

Whilst engaged in direct service provision duties; it is important for all personnel to use the
allocated time for the maximum benefit of the Service User and duties carried out in
accordance with the Service Users preferences and wishes. This is not always obvious,
what is important to the Service user may not seem important to you. However, you must
remember that in order to deliver person centred care and support, it is the priorities of the
Service user that have to be considered.
Before commencing each duty, you will know what is expected from you by referring to the
Person Centred Care Plan. Always confirm these tasks with the service user and discuss
their preferences. Once you have established what tasks the service user is looking for, in
what order, and how they should be done you are more likely to satisfy their expectations.
There may be some circumstances when a service User has unrealistic expectations of
you, under these circumstances you should politely point this out to them and establish
which tasks are most important to them. Each duty will be different and Service Users
expectations will vary so you must be prepared to be flexible in your decision making. The
following list ranks the importance pf of groups of tasks, it should be used as a guide to
prioritising and not as a set procedure:

1. Any obvious urgent action
2.Tasks specific to the service User’s Health &

Wellbeing
3.Service agreement tasks, usually referred to as

outcomes
4.Personal care tasks
5.Domestic tasks
6.Tasks unrelated to the Service User

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Stress Policy

All About You Care Services Ltd. is committed to ensuring the health, safety and welfare of
all its employees and other persons who may be affected by the company’s activities.

This Policy sets out the Company’s intentions for the management of stress at work, as part
of its overall management of health and safety.

It is acknowledged that excessive stress often arises outside the work environment, but that
this may then be linked to well being at work. We endeavour to have an organisational
culture that is both supportive and empowering; with a management style that reflects this
culture.

Staff are also encouraged to take personal responsibility for themselves at work and
support others to do the same. By implementing this policy, it is expected that awareness
of the causes of stress will increase, as will awareness of the support available. This will
lead to a reduction in the overall levels of stress within the company which leading to safer
working conditions and happy motivated employees.

As advised by the Health & Safety Executive it is the policy of the company to reduce
stress through the implementation of the following:

Demands
Manage demands on individuals and teams by ensuring:

• the organisation will only provide employees with adequate and achievable demands
in relation to the agreed hours of work.

• people's skills and abilities are matched to the job demands.
• employees' concerns about their work environment are addressed.

Control
Employees and teams will:

• where possible, have control over their pace of work.
• be encouraged to use their skills and initiative to do their work.
• encouraged to develop new skills to help them undertake new and challenging

pieces of work.
• have a say over when breaks and holidays can be taken.
• consulted over their work patterns and rosters.

Support
The company will ensure:

• policies and procedures are in place to adequately support employees.
• systems are in place to enable and encourage managers to support their staff.
• systems are in place to enable and encourage employees to support their

colleagues.
• employees know what support is available and how and when to access it.

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• employees know how to access the required resources to do their job.
• employees receive regular and constructive feedback.

Relationships
The company will:

• promote positive behaviors at work to avoid conflict and ensure fairness and
equality.

• ensure employees share information relevant to their work
• provide and enforce policies and procedures to prevent or resolve unacceptable

behaviour.
• provide systems to enable and encourage managers to deal with unacceptable

behaviour.
• provide systems to enable and encourage employees to report unacceptable

behaviour.

Management Role
The management of company will

• ensures that, as far as possible, the different requirements it places upon employees
are compatible with their skills and ability.

• provide information to enable employees to understand their role and
responsibilities.

• ensure that, as far as possible, the requirements it places upon employees are clear
and concise.

• ensure systems are in place to enable employees to raise concerns about any
uncertainties or conflicts they have in their role and responsibilities.

Change
The company will

• provide employees with timely information to enable them to understand the reasons
for proposed changes;

• ensures adequate employee consultation on changes and provides opportunities for
employees to influence proposals

• ensure employees are aware of the probable impact of any changes to their jobs. If
necessary, employees will be given training to support any changes in their jobs

• ensure employees are aware of timetables for changes
• ensure employees have access to relevant support during changes.

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Guidance for Employees

Introduction

This guidance has been produced to explain what stress is, how it can affect us as
individuals and some of the ways in which we can take the stress out of some everyday
situations.

Stress is talked about frequently today and it would be easy to think that this is a new. In
fact, stress has always been a part of life and those who went before us did not have stress
free lives. We only have to think about the living conditions people had to endure, the
experience of two world wars and the depression to realise that stress is nothing new.

What is stress?

There are many definitions of stress; everyone can in principle experience stress, as no one
is immune. Stress is something that can happen when we are in a position where we
perceive we cannot cope with the demands facing us. Work-related stress exists when
people perceive they cannot cope with what is asked of them, at work.

Stress is very individual. What might be stressful for one person may not be for another.
This does not mean that one person is stronger or weaker than the other, but that we are all
different. We are all conditioned differently from birth, we have different life experiences,
personalities, states of health and we are all unique individuals.

The warning signs

The body gives us early warning signs that we may be suffering from stress. These can be
likened to the lights showing in a car when there is a problem like low fuel or oil, lights left
on etc. In the car we tend not to ignore the warning but, when we are busy, we will ignore
our own early warning signs, often to our cost. These signs might include becoming
anxious, tearful or withdrawn. Learn to recognise your own warnings; this guide will help
you understand the symptoms and causes of stress.

Is it stress?

Identifying the factors which contribute to stress is the first step to addressing it. All
these things can create stress.

• Eating on the run or in a disorganised manner.
• Smoking or drinking excessively.
• Rushing, hurrying, and being available to everyone.
• Doing several jobs at once.
• Missing breaks.
• Taking work home with you.

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• Having no time for exercise and relaxation.
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Spot the symptoms

All these symptoms are indications that you're under stress and not coping with it.

• Anxiety, irritation, anger, feeling flustered.
• Feeling that things are hanging over you.
• Poor concentration and difficulty making decisions.
• Headaches, palpitations, hot flushes.
• Dry mouth, lump in the throat and shaky hands.
• Problems with sleep.
• Excessive intake of caffeine, cigarettes or alcohol.
• A repetitive tic, such as scratching or hair pulling.
• Tearfulness, depression or feeling suicidal.
• Chest pain.
• Problems eating or swallowing.
• Diarrhea or constipation.
• Loss of sex drive.
• Worsening of skin or breathing conditions.

Causes of stress

• The type of work you do. Long hours, heavy workload, infrequent breaks, boring
tasks that don't use your skills, poorly defined goals, too much responsibility.

• Feeling left out of decisions. Not being involved in decision-making, poor
communication, lack of family-friendly policies.

• Receiving no help or support. Lack of support or help from co-workers and
supervisors, conflicting expectations.

• Worries about job stability. Job insecurity, lack of opportunity for growth or
advancement.

• Working in an unhealthy workplace. Unpleasant or dangerous physical conditions,
such as overcrowding, noise, air pollution or ergonomic problems.

Locating the cause of stress

Consider the questions ‘how do I spend my time’ and ‘how would I like to spend my
time’. It is quite easy when we have too much to do and feeling short of time, to lose sight
of the goals we are trying to achieve and end up just muddling through. To prioritise the
items on your list, ask yourself the following questions:

▪ Is this something I must do?
▪ Is it something I should do? Or
▪ Is it something I would like to do?

Must means must, should contains options and want is a free choice. Consider situations
that waste your time make changes where possible, learn to avoid unnecessary activities,
delegate where applicable, and schedule time for specific activities.

Rank the problems and deal with some of the smaller ones first, to quickly reduce the list
and at the same time reduce your stress.

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Try to tackle only one thing at once, consider all possible alternative solutions, including
doing nothing and for each solution consider all the pros and cons. Once you decide on a
course of action, set yourself realistic targets, or you may only add to your stress.

A balanced diet

Change to diet can have beneficial results and can also reduce the effects of stress. Try to
eat a balanced diet, always have breakfast, and eat regularly. Research has shown that
those people who skip breakfast are often far more tired at the end of the day.

Eat complex carbohydrates such as pasta, wholemeal bread, jacket potatoes etc, rather
than refined carbohydrates, (e.g. Sweet biscuits, crisps, cake). Complex carbohydrates
really can help prevent mood swings.

Avoid too many saturated fats and eat plenty of fresh fruit and vegetables, as increased
vitamin C will boost your immune system. Reduce caffeine consumption, avoid drinking
alcohol for the wrong reasons and most importantly, drink water to ensure you are not
dehydrated. These measures provide very positive steps you can take to help yourself, by
replacing bad habits with good habits.

Take time to relax

Ensure you relax when you are not working. When you are suffering from stress, relaxation
may be the last item on your priority list, even if it is the top of your wish list.

There are many ways you can help yourself and the simplest, is to separate work from
leisure – remember most of us are not paid to work at home. Having a period of relaxation
every day is vital to give yourself time to switch off and recharge

Control your worries

Keep your worries into perspective. Can you remember what you were worrying about this
time last year? Probably not! Many of us waste a lot of time and create a lot of stress for
ourselves, worrying about unimportant things in the ‘what if’ cycle. Instead of worrying
about the ‘what if’, ask yourself what the probability of that thing actually happening and
consider if you are wasting energy on something that may not happen.

We all have an inner voice that directs our thoughts or actions and it may be necessary to
question what the inner voice tells us. For example, if a work colleague snaps at you, your
inner voice tells you to snap back whereas if you think about the situation, your colleague
may be having a bad day and you will only add to it by snapping back. Is it worth getting
worked up about it? And do not forget that one of the best stress busters is – laughter

Using and soothing your muscles

Often at the end of the working day, exercise is the last thing on your mind. Research has
however shown those twenty minutes of exercise, three or four times a week can be very
beneficial in managing stress. Individuals report feeling recharged, sleep better and feeling
fitter which in turn can build up self-esteem.

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Holidays away from work are vital, even if you do not travel further than your home. Make
the most of your days off by relaxing and get as far away from your work routine as
possible.

A good night’s sleep is vital to stay healthy, particularly so in times of stress. Unfortunately,
many people experience insomnia when suffering from stress. If this happens to you
consider aromatherapy oils, a hot milky drink, or a warm bath before going to bed.
Caffeinated drinks can also disturb sleep patterns. Deep breathing and relaxation
exercises can also be beneficial, as may gentle exercise such as a short walk. If you can’t
sleep reading or listening to music can help make you feel sleepy.

Using your time well

Do you miss deadlines or arrive late at meetings? This may be due to the fact that you
have too many things to do but it could also be a result of how you manage your time.

Time can be wasted in a variety of ways i.e., do you:

1. Get side-tracked by unimportant things?
2. Stay chatting on the phone after all the important issues have been fully

discussed?
3. Have trouble delegating?
4. Take on just too much?
5. Try to do too many tasks at once?

If any of the above apply to you than here are some suggestions as to what you might do:

▪ Think of situations where you waste time and how you could alter them
▪ Learn to drop unimportant activities; learn to say “no” or delegate
▪ Schedule some time daily when you will not be interrupted
▪ Have a “to do list” of goals that are really achievable

Learn to say no

Many of us say ‘yes’ when we really want to say ‘no’. It is not always easy to say what we
really mean and poor communication is frequently a cause of stress at work.
If you are under a great deal of pressure, you may find yourself being aggressive towards
others and similarly, you may find yourself agreeing to do something because it seems the
easy, or only, solution. This in turn will make your to do list even longer and increase stress
levels as you feel frustrated and annoyed with yourself for making things worse.

Learning to be assertive (not aggressive) can assist with this problem. Assertion is based
on a philosophy of personal responsibility and an awareness of the rights of other people. It
is all about the ability to negotiate, having the confidence to say what you really want or do
not want, but remembering this must not be at the expense of others.

Dealing with Bullying, Harassment and Fear at Work

Bullying and/or harassment can both be possible sources of stress; this type of
inappropriate behaviour will not be tolerated by the company.

If you believe that you are being harassed or bullied:

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▪ Make a record of what has been happening and when
▪ If you feel comfortable, explain to the person that their behaviour is not welcome.
▪ Look up the Harassment and Bullying Policy in your staff hand-book and report your

grievance to your supervisor or manager.

If you do nothing, the stress you are experiencing may get worse.

Some situations have the potential for both physical and verbal violence and it is important
that you share any fears you may have with your manager, you should ensure that any new
risks identified are discussed with your manager and included in the next risk assessment
review.

Work versus home life

With the long hours many employees work plus the demands of home, they have less and
less time to enjoy being with friends and family, let alone having time for themselves.

Individuals should communicate with those at home and at work to discuss any problems
they have and how things might be changed. Often, when an individual is under excessive
pressure, they do not tell anyone how they are feeling, leading to them becoming even
more frustrated when others add to their problem without being aware.

If you have problems with work-life balance, seek support from your manager or your family
and consider any possible alternatives such as job sharing, or flexible working hours etc.

Support

There may be a point in all our lives when we need the help and support of other people. If
you ever feel that you just cannot cope any more or are unsure of which way to turn,
consider talking your problem over with someone. Your choice of a person to confide in is
very important.

If the problem is being caused within the workplace, you could discuss this with the
Company Care Manager who will work with you to identify the causes with a view to
resolving your problem. Close friends and colleges can be very helpful but do consider they
may have problems of their own.

If you feel that your problem is so intimate that you cannot discuss this with any of the
above people, you should consider seeking professional help. Your GP could help with
this, or you could contact one of the many external agencies that deal with both general and
specific issues.

Equal Opportunities Policy

All About You Care Services Limited is committed to ensuring that no forms of
discrimination are practised within its organisation. Equally the company is committed to
ensuring that Service Users and staff be entitled to equality of opportunity irrespective of
age, class, race, religion, gender, sexual orientation, culture, disability or any valued
intrinsic characteristic.

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General Data Protection Regulations (GDPR)

What is data protection?

The GDPR (General Data Protection Regulation) came into force on 25 May 2018. The
regulation replaced the current Data Protection Act. Both employers and employees have
are responsible to help ensure compliance.

Data protection is about ensuring people can trust us to use their data fairly and
responsibly, it is also about the fair and proper use of information about people. It’s part of
their fundamental right to privacy
On a more practical level, it’s really about building trust between the company, our
employees and service users, and other organisations. It’s about treating people fairly and
openly, recognising their right to have control over their own identity and their interactions
with others.
The company has a duty to protect people’s personal data and take responsibility for the
specific ways we use their personal data.

What is ‘personal data’?

In short, personal data means information about a living individual. This might be anyone,
including; employees, service users and their families, company director, business contact,
public official or member of the public.

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GDPR The 6 regulation principles.

❑ Personal data should be processed fairly, lawfully and in a transparent

manner.

❑ Data should be obtained for specified and lawful purposes and not

further processed in a manner that is incompatible with those purposes.

❑ The data should be adequate, relevant and not excessive.
❑ The data should be accurate and where necessary kept up to date.
❑ Data should not be kept for longer than necessary.
❑ Data should be kept secure.

All staff have a responsibility to ensure that their activities comply with the data protection
principles. Staff should not disclose personal data outside the organisation's procedures, or
use personal data held on others for their own purposes.
The following policies have been introduced as guidance to ensure compliance and
evidence our commitment to principles of GDPR
The Data Protection Act requires every data controller who is processing personal
information to register with the Information Commissioner’s Office (ICO) All About You Care
Services limited is registered with the. Our ICO registration number is Z1143150

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Data Protection Policy

1. Introduction
1.1. This Data Protection Policy is the overarching policy for data security and
protection for All About You Care Services Limited (hereafter referred to as "us",
"we", or "our").

2. Purpose
2.1. The purpose of the Data Protection Policy is to support the 7 Caldicott
Principles, the 10 Data Security Standards, the General Data Protection
Regulation (2016), the Data Protection Act (2018), the common law duty of
confidentiality and all other relevant national legislation. We recognise data
protection as a fundamental right and embrace the principles of data protection
by design and by default.

2.2. This policy covers

2.2.1. Our data protection principles and commitment to common law and
legislative compliance;

2.2.2. procedures for data protection by design and by default.

3. Scope
This policy includes in its scope all data which we process either in hardcopy or
digital copy, this includes special categories of data.
3.1. This policy applies to all staff, including temporary staff and contractors.

4. Principles
4.1. We will be open and transparent with service users and those who lawfully act
on their behalf in relation to their care and treatment. We will adhere to our duty
of candour responsibilities as outlined in the Health and Social Care Act 2012.
4.2. We will establish and maintain policies to ensure compliance with the Data
Protection Act 2018, Human Rights Act 1998, the common law duty of
confidentiality, the General Data Protection Regulation and all other relevant
legislation.
4.3. We will establish and maintain policies for the controlled and appropriate
sharing of service user and staff information with other agencies, taking account
all relevant legislation and citizen consent.

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4.4. Where consent is required for the processing of personal data we will ensure
that informed and explicit consent will be obtained and documented in clear,
accessible language and in an appropriate format. The individual can withdraw
consent at any time through processes which have been explained to them and
which are outlined in our Record Keeping Policy: Withdrawal of consent
procedures. We ensure that it is as easy to withdraw as to give consent.

4.5. We will undertake annual audits of our compliance with legal requirements.
4.6. We acknowledge our accountability in ensuring that personal data shall be:

4.6.1. Processed lawfully, fairly and in a transparent manner;
4.6.2. Collected for specified, explicit and legitimate purposes and not further

processed in a manner that is incompatible with those purposes;
4.6.3. Adequate, relevant and limited to what is necessary in relation to the

purposes for which they are processed (‘data minimisation’);
4.6.4. Accurate and kept up to date;
4.6.5. Kept in a form which permits identification of data subjects for no longer

than is necessary for the purposes for which the personal data are
processed (‘storage limitation’);
4.6.6. Processed in a manner that ensures appropriate security of the personal
data.
4.7. We uphold the personal data rights outlined in the GDPR;
4.7.1. The right to be informed;
4.7.2. The right of access;
4.7.3. The right to rectification;
4.7.4. The right to erasure;
4.7.5. The right to restrict processing;
4.7.6. The right to data portability;
4.7.7. The right to object;
4.7.8. Rights in relation to automated decision making and profiling.
4.8. In line with legislation our operation Director also undertakes the role of Data
Protection Officer (DPO) who will report to the highest management level of the
organisation. We will support the DPO with the necessary resources to carry out
their tasks and ensure that they can maintain expertise. We guarantee that the
DPO will not be pressured on how to carry out their tasks, and that they are
protected from disciplinary action when carrying out the tasks associated with
their role.

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Due to our size we are not required to have a Data Protection Officer (DPO),
furthermore, we do not process special categories of data on a large scale.
Nonetheless, to ensure that every individual’s data rights are respected and that
there is the highest levels of data security and protection in our organisation, we
have appointed our operations Director to undertake the role Data Protection
Officer. When acting in his role as DPO he will report to the management team
and Managing Director. We will support the DPO with the necessary resources to
carry out his tasks and ensure he can maintain expertise.

5. Underpinning policies & procedures

5.1. This policy is underpinned by the following:
5.1.1. Data Quality Policy – outlines procedures to ensure the accuracy of
records and the correction of errors;
5.1.2. Data Security Policy – outlines procedures for the ensuring the security of
data including the reporting of any data security breach;
5.1.3. Business Continuity Plan –outlines the procedures in the event of a
security failure or disaster affecting digital systems or mass loss of
hardcopy information necessary to the day to day running of our
organisation;
5.1.4. Staff contract containing confidentiality clause - provides staff with clear
guidance on the disclosure of personal information.
5.1.5. Data Retention Policy-sets out retention periods and disposal of data held
by the company
5.1.6. Service User Charter Confidentiality Statement

6. Data protection by design & by default

6.1. We shall implement appropriate organisational and technical measures to
uphold the principles outlined above. We will integrate necessary safeguards to
any data processing to meet regulatory requirements and to protect individual’s
data rights. This implementation will consider the nature, scope, purpose and
context of any processing and the risks to the rights and freedoms of individuals
caused by the processing.

6.2. We shall uphold the principles of data protection by design and by default
from the beginning of any data processing and during the planning and
implementation of any new data process.

6.3. Prior to starting any new data processing, we will assess whether we should
complete a Data Protection Impact.

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6.4. All new systems used for data processing will have data protection built in
from the beginning of the system change.

6.5. All existing data processing has been recorded on our Record of Processing
Activities. Each process has been risk assessed and is reviewed annually.

6.6. We ensure that, by default, personal data is only processed when necessary
for specific purposes and that individuals are therefore protected against privacy
risks.

6.7. In all processing of personal data, we use the least amount of identifiable data
necessary to complete the work it is required for and we only keep the
information for as long as it is required for the purposes of processing or any
other legal requirement to retain it.

6.8. Where possible, we will use pseudonymised data to protect the privacy and
confidentiality of our staff and those we support.

7. Responsibilities
7.1. Our designated Data Protection Officer is undertaken by our Operations
Director Simon Lee. The key responsibilities of the lead are:

7.1.1. To ensure the rights of individuals in terms of their personal data are
upheld in all instances and that data collection, sharing and storage is in
line with the Caldicott Principles;

7.1.2. To define our data protection policy and procedures and all related
policies, procedures and processes and to ensure that sufficient resources
are provided to support the policy requirements.

7.1.3. To complete the Data Security & Protection Toolkit (DSPT) annually and to
maintain compliance with the DSPT.

7.1.4. To monitor information handling to ensure compliance with law, guidance
and the organisation’s procedures and liaising with the Senior Information
Risk Owner (SIRO)

7.2. Our designated DPO is Simon Lee can be contacted via email: simon@about-
u.co.uk; phone: 01253 899982; or at the following address: 12 Sovereign Court,
Wyrefeilds, Poulton LE Fylde FY6 8JX.
The key responsibilities of the DPO are:

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7.2.1. Overseeing changes to systems and processes;
7.2.2. Monitoring compliance with the GDPR and DPA18;
7.2.3. Completing DPIA;
7.2.4. Reporting on data protection and compliance with legislation to senior

management;
7.2.5. Liaising, if required, with the Information Commissioner’s Office (ICO).
7.3. Our Senior Information Risk Owner (SIRO) is John Lee.
The key responsibilities of the SIRO are:
7.3.1. To manage, assess and mitigate the information risks within our

organisation;
7.3.2. To represent all aspects of information and data protection and security to

senior management and drive engagement in data protection at the
highest levels of the organisation.

8. Approval
8.1. This policy has been approved by the undersigned and will be reviewed at
least annually.

John Lee Managing Director & SIRO

Simon Lee Operation Director & Data Protection Officer

Approval Date 13th January 2020

Review Date 13th January 2021

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Data Quality Policy

1. Introduction
1.1. This Data Quality Policy is All About You Care Services Limited (hereafter
referred to as "us", "we", or "our") policy for the ensuring accuracy of information
which we store and process.

2. Purpose

2.1. The availability of accurate and timely data is vital for the safety of the people
we care for and the safe and responsible running of our organisation. This policy
outlines the following procedures:
2.1.1. Procedures for ensuring data accuracy;
2.1.2. Procedures for correcting errors.

3. Scope

3.1. This policy includes in its scope all data which we process either in hardcopy
or digital copy, this includes special categories of data;

3.2. This policy applies to all staff, including temporary staff and contractors.
4. Data accuracy procedures

4.1. We commit to ensuring that we comply with the Health and Social Care Act
2008 (Regulated Activities) Regulations 2014: Regulation 17 that we will
“maintain securely an accurate, complete and contemporaneous record in
respect of each service user, including a record of the care and treatment
provided to the service user and of decisions taken in relation to the care and
treatment provided”;

4.2. We ensure accuracy in our data in both hardcopy and digital records by
making sure all data has the following characteristics:
4.2.1. Authentic – i.e. the data is what is claims to be, has been created or sent
by the person who said that they created or sent it, and that this was done
at the time claimed;
4.2.2. Reliable – i.e. the data is complete, accurate, has been created close to
the time of the activity it records, and has been created by individuals with
direct knowledge of the event it records;

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4.2.3. Integrity – i.e. the data is complete and unaltered, it is also protected from
being changed or altered by unauthorised persons, any alterations are
clearly marked and the person who made them can be identified;

4.2.4. Useable – i.e. the data can be located when it is required for use and its
context is clear in a contemporaneous record.

4.3. The principal purpose of service user records is to record and communicate
information about the individual and their care. The principal purpose of staff
records is to record employment details for payroll and business planning
purposes.

4.4. To fulfil these purposes, we:
4.4.1. Use standardised structures and layouts for the contents of records;
• Tagtronics Call rostering and monitoring software
• All About You Care Services in house care plan
• Sage Payroll
4.4.2. Ensure documentation reflects the continuum of care, that all care is
person centred and that care records are viewable in chronological order;
4.4.3. Provide a clearly written care plan when care is being delivered by several
members of the team, and we ensure that records are maintained and
updated, and shared with everyone involved;
4.4.4. Train staff on the creation and use of records provide training on good
record keeping to ensure competence;
4.4.5. Have implemented a procedure that enables service users and staff to
have easy access to their records where appropriate. This is outlined in
the Record Keeping Policy and our Privacy Notice.

4.5. All staff who record information - whether hardcopy or electronic - have a
contractual responsibility to ensure that the data is accurate and as complete as
possible. This responsibility extends to any system the staff member has access
to.

5. Procedures for the correction of errors

5.1. In-line with national legislation, individuals have the right to have access to
their personal data which we process and store. Citizens have the right to the
rectification of said records in the instance that their records are inaccurate or
incomplete.

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