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Published by eastendrascal, 2017-06-07 09:44:50

AAY Handbook V2.6

AAY Handbook V2.6

All About You Care Services Limited
Staff Handbook

All About You Care Services Limited has published this handbook for the benefit of its
employees to enable them to have a clear understanding policy, procedure, philosophy and
administration of the company. It is also intended to provide the first point of reference for
employees seeking information. Adherence to its content will promote high quality, person
centred and sustainable care that supports people to live independently in their own homes.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system or transmitted by any means electronically, mechanical or chemical without the

specific written permission of the publisher.
© Copyright All About You Care Services Limited 2016

1

Table of Contents

............................................................................................................................................. 1

TABLE OF CONTENTS ....................................................................................................... 2

MISSION STATEMENT........................................................................................................ 9

AIMS AND OBJECTIVES .................................................................................................... 9
Aims of Reablement Service............................................................................................. 9

DIGNITY IN CARE CHARTER ........................................................................................... 11
Dignity ............................................................................................................................. 11
Respect........................................................................................................................... 11
Privacy ............................................................................................................................ 11
Independence ................................................................................................................. 11
Choice............................................................................................................................. 12
Rights.............................................................................................................................. 12
Fulfilment ........................................................................................................................ 12
Nutrition........................................................................................................................... 12
Staffing............................................................................................................................ 12
Policies and Procedures ................................................................................................. 12
Commissioning ............................................................................................................... 12

THE DIGNITY CHALLENGE.............................................................................................. 13

........................................................................................................................................... 13

SERVICE USER’S CHARTER ........................................................................................... 14
Your Rights ..................................................................................................................... 14
Involvement with Your Affairs.......................................................................................... 14
Independence ................................................................................................................. 14
Equality ........................................................................................................................... 14
Confidentially .................................................................................................................. 14
Non discriminatory Practice ............................................................................................ 15
Extent of Services ........................................................................................................... 15
Quality of services........................................................................................................... 15

PRINCIPLES OF SERVICE ............................................................................................... 15
Competence.................................................................................................................... 15
Reliability......................................................................................................................... 16
Responsiveness.............................................................................................................. 16
Co-ordination .................................................................................................................. 16
Planning of care .............................................................................................................. 16

COMPLAINTS, GRIEVANCES AND SUGGESTIONS ...................................................... 17

COMPLAINTS PROCEDURE ............................................................................................ 18

2

POLICIES........................................................................................................................... 19

PERSONALISATION ......................................................................................................... 20

SAFEGUARDING ADULTS POLICY AND PROCEDURE ................................................ 21
Definition of Abuse.......................................................................................................... 22
Base Values.................................................................................................................... 23
Types of Abuse ............................................................................................................... 23
Physical Abuse ............................................................................................................... 23
Indicators of Physical Abuse: .......................................................................................... 23
Financial or Material Abuse............................................................................................. 23
Indicators of Financial Abuse: ......................................................................................... 24
Sexual Abuse.................................................................................................................. 24
Indicators of Sexual Abuse: ............................................................................................ 24
Psychological Abuse ....................................................................................................... 24
Neglect or Acts of Omission............................................................................................ 24
Indicators of Neglect or Acts of Omission ....................................................................... 25
Discriminatory Abuse ...................................................................................................... 25
Indicators of Discriminatory Abuse.................................................................................. 25
Institutional Abuse........................................................................................................... 25
Indicators of Institutional abuse....................................................................................... 25
Mental Capacity Act 2005 ............................................................................................... 25
Recruitment..................................................................................................................... 27
Abuse Reporting Procedure............................................................................................ 27
Body Map Instruction ...................................................................................................... 28
Reporting an Allegation of Abuse Flow Chart ................................................................ 29
........................................................................................................................................ 29
Safeguarding Incident Report Sheet ............................................................................... 32

DUTY OF CANDOUR POLICY & PROCEDURE............................................................... 34

INDEPENDENT MENTAL CAPACITY ADVOCATES POLICY ......................................... 36
1. Policy statement.......................................................................................................... 36
The whole Act is underpinned by a set of five key principles: ......................................... 36
What does the Act do?.................................................................................................... 36
2. Purpose....................................................................................................................... 37
3. Scope.......................................................................................................................... 37
4. Legal context............................................................................................................... 37
5. Mandatory Procedures................................................................................................ 37
6. Eligibility ...................................................................................................................... 38
7. Attorneys, family and friends, existing advocates........................................................ 40
8. Referral to the Advocacy Service (N-COMPASS) ....................................................... 41
9. Role and responsibilities of the referring staff member ............................................... 42
10. Role and responsibilities of the Advocacy Service (N-Compass).............................. 42
11. Role and responsibilities of the IMCA ....................................................................... 43
11. Reports ..................................................................................................................... 43
12. Disagreements .......................................................................................................... 44
13. Complaints ................................................................................................................ 44
14. Practice guidance...................................................................................................... 44
15. Code of Practice........................................................................................................ 44
16. Advance directives and DNAR .................................................................................. 45

3

17. Security and confidentiality ....................................................................................... 45
18.The Deprivation of Liberty Safeguards (DOLS).......................................................... 45

VALUING PEOPLE PLAN ................................................................................................. 46

FOUR KEY PRINCIPLES OF VALUING PEOPLE ............................................................ 47

VALUING PEOPLE OBJECTIVES .................................................................................... 49
Objective 1: Maximising Opportunities for Disabled Children.......................................... 49
Objective 2: Transition into Adult Life.............................................................................. 49
Objective 3: Enabling People to Have More Control Over Their Own Lives.................... 49
Objective 4: Supporting Carers ....................................................................................... 49
Objective 5: Good Health ................................................................................................ 49
Objective 6: Housing ....................................................................................................... 49

OBJECTIVE 7: FULFILLING LIVES .................................................................................. 49
Objective 8: Moving into Employment ............................................................................. 50
Objective 9: Quality ......................................................................................................... 50
Objective 10. Workforce Training and Planning .............................................................. 50
Objective 11: Partnership Working.................................................................................. 50

MEDICATION POLICY....................................................................................................... 51
Introduction ..................................................................................................................... 51
Current Legislation.......................................................................................................... 51
Documentation................................................................................................................ 51
Aims of the Policy............................................................................................................ 51
Responsibilities of the Managers and Supervisors.......................................................... 53
Responsibilities of Domiciliary Care & Support Staff....................................................... 54
In an emergency ............................................................................................................. 55
Level 1: General Support ................................................................................................ 56
Level 2: Administering Medication................................................................................... 56
Level 3: Administering medication by specialised techniques ......................................... 57
Responsibilities of Service Users.................................................................................... 57
Responsibilities of GP/Consultant ................................................................................... 57
Responsibilities of the Company Director ....................................................................... 58
Responsibilities of Pharmacy Services ........................................................................... 58
Risk Assessment & Consent........................................................................................... 58
Consent........................................................................................................................... 59
Obtaining Supplies of Medication.................................................................................... 59
Emergency Supplies ....................................................................................................... 60
Storage of Medication ..................................................................................................... 61
Transportation of Medication........................................................................................... 62
Procedure for Prompting Service Users to take Medication ............................................ 62
Procedure for Assisting Service Users to take Medication.............................................. 62
Procedure for Administering Medication ......................................................................... 64
As required medication (PRN) ........................................................................................ 65
Disposal of Medicines ..................................................................................................... 65
Documentation................................................................................................................ 66
MAR charts ..................................................................................................................... 66
Guidance Notes on Medical Issues................................................................................. 69
Adverse Reactions.......................................................................................................... 69

4

Dealing with Illicit Substances......................................................................................... 69
Medication Errors............................................................................................................ 70
Medication Wrongly Administered or Omitted Doses ...................................................... 70
Lost or Stolen Medication................................................................................................ 71
Training ........................................................................................................................... 71

LONE WORKER POLICY .................................................................................................. 72
Who is a Lone Worker?................................................................................................... 72
Zero Tolerance................................................................................................................ 72
The Law .......................................................................................................................... 72
Individual Responsibilities ............................................................................................... 72

PRIORITISING OF TASKS ................................................................................................ 76

STRESS POLICY ............................................................................................................... 77
Guidance for Employees................................................................................................. 79

EQUAL OPPORTUNITIES POLICY................................................................................... 83
Confidentiality ................................................................................................................. 84
Involvement with Service User’s financial and private affairs .......................................... 84
Receipt of purchases made on behalf of a Service User ................................................ 85
Record of Receipts of Purchases Made on Behalf of a Service User ............................. 86
Financial Guidelines Supporting Service Users to Attend Paid Venues.......................... 87
Use of Service User Debit / Credit and Prepaid Cards.................................................... 88
Inappropriate and Challenging Behavior ......................................................................... 89
Recruitment..................................................................................................................... 89
Communication ............................................................................................................... 90
Supplier Performance and Stock Control ........................................................................ 90
Gifts and gratuities .......................................................................................................... 90
Withdrawal of service ...................................................................................................... 90
Assessment and review .................................................................................................. 91
Risk taking and restraint.................................................................................................. 91
Accessibility of management........................................................................................... 92
Staffing Levels ................................................................................................................ 92
Involvement of Service User and Carer in service provision ........................................... 92
Partnership working with key agencies ........................................................................... 92
Key Holding..................................................................................................................... 92
Key Safes & Coded Door Locks...................................................................................... 93
Insurance ........................................................................................................................ 93
Telephones ..................................................................................................................... 93
Security of Company Vehicles and Load ........................................................................ 93
Driver Responsibility ....................................................................................................... 94
Am I responsible for Roadworthiness?............................................................................ 94
Social, Environmental and Ethical Issues ....................................................................... 94
Green Housekeeping ...................................................................................................... 95
Culturally Appropriate Care............................................................................................. 96
Training ........................................................................................................................... 96

HUMAN RIGHTS ACT 1998 .............................................................................................. 97
Policy Statement ............................................................................................................. 97
Human Rights and Homecare ......................................................................................... 97

5



































Base Values

It is the policy of the company to afford the following base values to all individuals, these
values underpin the basic human rights of all those in our care. Any infringement or denial
of these base values will be considered by the company as ABUSE of the individual:

Privacy The right of individuals to be left alone or undisturbed and free from
intrusion or public attention into their affairs.

Dignity Recognition of the intrinsic value of people regardless of
circumstances by respecting their uniqueness and their personal
needs; treating with respect.

Independence Opportunities to act and think without reference to another person
including a willingness to incur a degree of risk.

Choice Opportunity to select independently from a range of options

Rights The maintenance of all entitlements associated with citizenship

Fulfilment The realisation of personal aspirations and abilities in all aspects of
daily life

Types of Abuse

For the avoidance of any doubt the company has identified the following categories of
abuse for the benefit of staff and has given some examples of indicators (this list is not
exhaustive) that may identify a victim of abuse:

Physical Abuse

An act resulting in the victim’s body or bodily functions suffering pain or impairment. Being
refused medication, receiving too much or too little medication or receiving medication
improperly. Denial of access to appropriate medical care.

Indicators of Physical Abuse:

Visible signs include: Bruising, finger marks burns, cuts and bruises found at different
stages of healing, malnutrition. Bed sores, ulcers and being left in wet clothing
Other indicators include: Excessive requests for repeat prescriptions or under use of
prescribed medicines. Reluctance to seek help from GP or other services. History of
agency or GP hopping.

Financial or Material Abuse

The misuse, deprivation, extortion or denying the right of a person to their money, property,
possessions, pensions, allowances or insurance. Denying the right of a competent person
to handle their own financial affairs.

23

Indicators of Financial Abuse:

Unexplained or sudden inability to pay bill unexplained withdrawals from accounts,
pressure by carers or family to sign over assets.

Sexual Abuse

Sexual harassment, involvement of a person in a sexual activity against his or her will, to
which he or she has not given consent.

Indicators of Sexual Abuse:

A change in the individual’s behaviour, withdrawal and isolation, overt sexual behaviour,
self inflicted injury, disturbed sleep pattern, difficulty in walking or standing, torn stained or
bloody undergarments, love bites, bleeding torn rectal and vaginal area.

Psychological Abuse

The inappropriate exercise of power to violate the human or civil rights of a person. Making
a person feel ashamed of involuntary behaviour. Blaming a person for attitudes, actions or
events beyond their control. Making behaviour, attainment or physical appearance a target
for ridicule. Intimidation of a person by name calling, threats, continued shouting or the use
of abusive language. Racist comments. Depravation of normal, social contact and cultural
identity. Racial or religious harassment, lack of provision to dress, diet, language or
specific religious observances relating to a person’s background or culture. Withdrawal
from normal social interaction or exposure to excessive or inappropriate stimuli.
Psychological Abuse Indicators:
Insomnia or need for excessive sleep. Isolation and withdrawal, Carer always being present
during an interview or conversation.

Individual features: Very eager to please and appear to be subservient, change in appetite,
unusual weight gain or loss, tearfulness, paranoia, low self-esteem, excessive fears,
ambivalence, confusion, resignation, agitation, inappropriately dressed unkempt and
unwashed.

Neglect or Acts of Omission

A vulnerable person may suffer abuse by acts of omission this is when the act of neglect or
omission leads to deterioration in their well-being or development is impaired as a result
of the abuse, examples of neglect and acts of omission are: -

Lack of:
• adequate food or liquids,
• heating and lighting
• appropriate medical care

Being allowed to take unwanted / unreasonable risks

Lack of attention to:
• toe and fingernails
• teeth natural or false

24

Indicators of Neglect or Acts of Omission

• Inadequate food, fluids, heating, lighting.
• Poor physical condition, poor hygiene, varicose ulcers, pressure sores.
• Clothing dirty or in a poor condition
• Failure to seek medical advice or summons assistance as required.
• Failure to access dentistry, chiropody services etc.
• Refusal to allow access to appropriate callers or visitors.

Discriminatory Abuse

Inappropriate treatment of a vulnerable adult because of their race, colour, sex (or
sexuality), disability etc. these can include: racist remarks, sexist remarks, comments about
disability, other forms of harassment, slurs or similar treatment, depravation of normal
social contact and cultural identity.

Indicators of Discriminatory Abuse

Inappropriate remarks or comments poor quality care to certain types of Service Users,
Service User prefers not to be cared for by certain members of staff, staff members may
seem to avoid caring for certain groups of Service Users.

Institutional Abuse

The inappropriate care of a vulnerable adult in an institutional situation (residential home)
the following factors may be relevant: poor management of staff, poor care standards, lack
of positive response to complex needs, rigid routines, inadequate staffing, and insufficient
knowledge base within the service.

Indicators of Institutional abuse

The vulnerable adult, in an institutional setting displays any of the indicators mentioned in
all forms of abuse described above.

Mental Capacity Act 2005

The statutory principle aim of the Mental Capacity Act of 2005 is to protect people who lack
capacity and to help them take part, as much as possible in decisions that affect them.
Every adult (anyone over 18 years of age) has the right to make their own decisions if they
have the capacity to do so. As care and support workers we must assume that all of our
service has the capacity to make decisions, a wrong or bad decision made should not be an
indication that the person is not able to make their own decisions. The starting assumption
must always be that an individual has the capacity, until there is proof that they do not.

We have a legal duty to assist and empower all of our service users to make their own
decisions regarding choices, wishes, preferences or any decision that affect them.

25

In some circumstances it will be necessary to appoint an independent advocate for
someone who lacks capacity, the circumstances and procedure appointing an advocate are
detailed in the Mental Capacity Act Policy. Copies of the Act and the code of practice can
be obtained from the manager’s office; further information and advice can also be obtained
from your manager.

How Does the MCA Define Restraint?

The law says that someone is using restraint if they:

• Use force – or threaten to use force – to make someone do something that they are
resisting, or

• Restrict a person’s freedom of movement, whether they are resisting or not.

It’s that second part that sometimes isn’t recognised. People who lack mental capacity to
make the decision to go out, for example, are very often restrained – in that their freedom of
movement is restricted, for example by a locked front door or garden gate. It is important to
understand that this is a restraint. But it isn’t true that this restraint is always wrong: if you
think the restraint is completely in someone’s best interests.

When an adult lacks mental capacity to give you consent for your actions, then anything
you do to that person, or on their behalf, must be in their best interests, and the least
restrictive of their rights that can be identified.

Extra Conditions for Restraint

Already we know that providers must always look for the ‘least restrictive option’: this is the
golden thread of the MCA, that we must never restrict people’s freedom to live as they
choose, with more than the lightest possible touch.

And we know that we get protection from liability, when someone lacks capacity to consent,
by being clear that we are making the decisions within the principles of the MCA.
The MCA explains what this means when we think we might have to restrain someone, in
their best interests. Alongside the rest of the best interest’s checklist, there are two extra
conditions that must be met for this restraint to be lawful – hence, for you to have protection
from liability.

These extra conditions are:

• The person taking action must reasonably believe that restraint is necessary to
prevent harm to the person who lacks capacity; and

• The amount or type of restraint used, and the amount of time it lasts, must be
a proportionate response to the likelihood and seriousness of that harm.

26

Recruitment

Prior to commencement of employment all new employees will undergo a DBS check, if in
on receipt of the DBS check offences are recorded this will discussed with the company
care manager and company director who will their discretion to decide if the applicant can
be employed by the company. In addition, successful applicants will be checked against the
ISA Barring list. Anyone found to be included on the lists will not be employment by the
company.

Abuse Reporting Procedure

It is the expressed wish of the company that no person for whom it has a duty of care will
suffer any type of abuse at any time whatsoever. Therefore, any form of abuse made
against another person should be brought to the attention of the company management
immediately. If the circumstances are difficult to report you should refer to the company
"Whistle Blowing Policy", however, an incident of abuse must not remain unreported.
Following any allegation of abuse the company will immediately report the incident to the
lead body (Lancashire County Council Social Services) who will investigate the allegation,
further to this the company will also inform the Care Quality Commission of the allegation
immediately. Prior to undertaking work from a local authority the company will endeavour to
make available that authorities "Adult and Child Protections Procedures” available to all
care staff for their information.

If you suspect or witness any form of abuse you should inform your line manager, the
registered manager of the John Lee (Company Director) 01253 889982

If you feel it is not appropriate to report the company, then you can report to one of the
following authorities

Telephone: 03000 616161
Care Quality Commission
National Correspondence
Citygate, Gallowgate
Newcastle upon Tyne
NE1 4PA

or

Lancashire County Council Safeguarding Adults
Telephone number on 0845 0530 028
or visit online at www.lancashire.gov.uk/safeguardingadults

Abuse is a disciplinary offence, those found guilty of abuse will be subject
to summary dismissal, and furthermore, some forms of abuse may also be

a criminal offence and will also be investigated by the appropriate
authority for their action.

27

Body Map Instruction Name of person completing form ………………
Date completed ………………………………….
In suspected cases of abuse please use gender specific body map marking accordingly Service user ID …………………………………...
to indicate where you have witnessed any bruising, scars, injuries, red marks etc. Give
as much detail as to size, colour and so on. Only complete if these injuries are clearly
visible during the course of your duty or have been shown to you freely.

28

Reporting an Allegation of Abuse Flow Chart

Are you a Member of staff or a Service user?

Member of Staff Service User Immediately inform your
carer or contact the
Immediately You can choose several company Registered
inform your line ways to report the alleged manager
manger abuse
Julia Stockdale
If line manager is If the company If the company is 01253 899982
party to abuse is complicit to complicit to the
Immediately the abuse abuse or, if you If manager or staff are
contact company or, if you choose not to party to the abuse
Director J Lee by choose not to report to the Contact company
telephone report to the company then Director by telephone
01253 899982 company then contact:
contact: 01253 899982
If the company is Commission for
complicit to Safeguarding Quality Care Company Director John Lee
abuse Adults who will establish details
Contact telephone Telephone: gather information on your
Safeguarding number on 03000 616161 behalf and report to
Adults telephone 0845 0530 028
number on 0300 Safeguarding Adults
123 6721 telephone number on 0300
123 6721

29

Stage Activity Responsibility Timescale
• Everyone with a duty of
Stage 1 • Act to protect adult at risk Immediately, if emergency
• Deal with immediate care or within same working day
Raising an alert (this should be within four
needs hours)
• Report to registered

manager 01253 899982
• Consider reporting to the

police, if a crime
• Record

Decision • Take any immediate • Alerting manager
management action to Safeguarding Adults
identify and address the lead Member of staff if Immediately or within 24
risk appropriate hours

• Decide if a referral is
needed

Stage 2 • Refer to Safeguarding • Adult at risk (carer, Immediately or within 24
Adults referral point 0845 friend, relative) hours
Making a referral 0530 028 Registered Manager

• Report to the police, if a • Director
crime • Safeguarding Adults

• Notify CQC lead
• Gather initial information • Other professionals
• Any company staff
Clarify facts

Decision • Evaluate risk • Director
• Decide if Safeguarding • registered manager
• relevant partner Within 24 hours of referral
Adults procedures apply
• Agree interim protection organisations

plan
• (Police investigation may

have begun)

Stage 3 Strategy • Evaluate risk

discussion or • Director The same day or within five
meeting • Registered manager working days from receipt
• Relevant partner of the Safeguarding Adults
referral
organisations
• Adult at risk as

appropriate

30

Stage Activity Responsibility Timescale
Decision
• Decide if • Director
investigation needed • Registered manager
• Agree investigation • Relevant partner
plan
• If not Safeguarding organisations
Adults agree appropriate • Adult at risk as
action
• If not Safeguarding appropriate
Adults close process at
this point

Stage 4 • Conduct investigation • Director Within 20 days from receipt
• Re-evaluate risk • Registered manage of referral
Investigation • Collate evidence and • Relevant partner

share with involved organisations
organisations
• Produce and distribute
Report

Stage 5 • Receive investigation • Director Within five working days
evidence • Registered manage from receipt/distribution of
Case conference • Relevant partner the safeguarding
and protection plan • Evaluate risk investigation report (or as
• Formulate protection organisations agreed at strategy
Decision • Adult at risk/family/ discussion or meeting)
plan
Stage 6 • Close Safeguarding advocate

Review of the Adults process • Director Within three months of
protection plan • Keep under review • Registered manage case conference or as
• Agree outcome • Relevant partner agreed at case conference
• Agree review
organisations
• Review the protection • Adult at risk/family/
plan
advocate
• Evaluate risk

Stage 7 • Complete Safeguarding Signed off by Registered On agreement with other
Adults process Manager /Director organisations and adult at
Closing the risk
Safeguarding Adults • Sign off Safeguarding
Adults process
process
• Review process continues
• Dissemination of lessons

learnt
• Process may also be

closed pending outcome
of prosecution

31

Safeguarding Incident Report Sheet

Name, Name ……………………………………………………………..
address and
contact Address …………………………………………………………..
number of …………………………………………………………..
person
reporting Contact Tel Number ……………………………………………..
incident

Nature and
details of
alleged
incident

Date & Time Date …../…../….. Time ………………..
of alleged
incident
The place
incident was
alleged to
have taken
place

Details of Name ……………………………………………………………..
the allegedly Address …………………………………………………………..
abused
person …………………………………………………………..

Contact Tel Number ……………………………………………..

Was the alleged person a Service User (please tick ✓ box) 
Was the alleged person a member of staff (please tick ✓ box) 

Name and Name ……………………………………………………………..
details of the Address …………………………………………………………..
alleged
perpetrator if …………………………………………………………..
known
Contact Tel Number ……………………………………………..

32

Reporting Name of person reported to …………………………………………….
details Date and time reported date …. /…../……. Time ………………….

Permissions I the undersigned give my permission to the following person/s to have
access to details of the above allegation of abuse directed against me.

Print Name …………………. Signature ………………….. Date ………..

Immediate Action
Action taken
to minimise
risk

Implemented by:
33

Duty of Candour Policy & Procedure

Regulation 20 has been introduced under the Health and Social Care Act 2008 (Regulated
Activities) Regulations 2014 (Part 3). This regulation defines what constitutes a notifiable
safety incident in adult services. This applies to providers when they are providing care and
support to people who use the service in the carrying on of a regulated activity.

To comply with the requirements of regulation 20 it is the policy of the company and
the responsibility of the registered manager to:

Act in an open and transparent way with those who use the services in carrying on a
regulated activity (providing personal care)
Notify the relevant person as reasonably practicable after becoming aware that a
notifiable incident has occurred, and provide support to them in relation to the
incident, including when giving notification.
Provide an account of the incident which, to the best of our knowledge. is true of all
the facts about the incident as at the date of the notification
Advise the relevant person what further action we believe is appropriate and intend
to take.
Offer an apology
Follow up the apology by giving the same information in writing, and providing an
update on the enquiries made following the event.
Keep a written record of all communication with the relevant person

34

By acting in this way we aim to encourage a culture of openness and transparency in our
services. We will make all reasonable efforts to foster a culture that supports staff to be
open and transparent in the course of their work. We will take disciplinary action against
any employee who attempts to conceal reportable incidents through bullying tactics or the
use of threatening behaviour to conceal reportable incidents.
For the benefit of doubt, a ‘notifiable safety incident’ is any unintended or unexpected
incident that occurred in respect of a service user during the provision of a regulated activity
that, in the reasonable opinion of an adult care professional, appears to have resulted in:

The death of the service user, where the death relates directly to the incident rather
than to the natural course of the service user’s illness or underlying condition.
An impairment of the sensory, motor or intellectual functions of the service user
which has lasted, or is likely to last, for a period of 28 days.
Changes to the structure of a service users body.
the service user experiencing prolonged pain or prolonged physical harm lasting for
a continuous for a period of 28 days
the shortening of the life expectancy of the service user.
any injury to the service user which, if left untreated, would lead to one or more of
the outcomes mentioned in the paragraph above.
The responsibility for reporting notifiable safety incidents to CQC lies with the registered
manager or the registered provider.

35

Independent Mental Capacity Advocates Policy

1. Policy statement

The Mental Capacity Act 2005 provides a statutory framework to empower and protect
vulnerable people who are not able to make their own decisions. It makes it clear who can
take decisions, in which situations, and how they should go about this. It also provides
options for those who may choose to plan and make provision for a future time when they
may lack capacity. Furthermore, the Act also specifies the principles that must be applied
by everyone who is working with or caring for adults who lack capacity. It is the Policy of the
company to work within the statutory framework of the act and follow the guidelines as set
out in the code of practice. The company will provide all staff working with vulnerable
people sufficient information and guidance to empower those they care for to make their
own decisions and where assistance is required this will be done within the framework of
the act.

The whole Act is underpinned by a set of five key principles:

a. A presumption of capacity - every adult has the right to make his or her own
decisions and must be assumed to have capacity to do so unless it is proved
otherwise;

b. The right for individuals to be supported to make their own decisions - people must
be given all appropriate help before anyone concludes that they cannot make their
own decisions;

c. That individuals must retain the right to make what might be seen as eccentric or
unwise decisions;

d. Best interests – anything done for or on behalf of people without capacity must be in
their best interests; and

e. Least restrictive intervention – anything done for or on behalf of people without
capacity should be the least restrictive of their basic rights and freedoms.

What does the Act do?

Whilst the Act sets out the legal framework, the Code of Practice provides guidance and
information for those acting under its terms and applying its provisions on a daily basis. A
copy of the Act and the Code of Practice is available from your manager and the company
will provide further information and training.

As there are many situations that can arise when caring or supporting for those who may
lack capacity, the Code incorporates good practice along with flexibility to apply the
principles to the particular circumstances of the situation.

A significant number of people suffer a degree of mental impairment, for a range of different
reasons, and therefore may lack capacity to take some decisions about the care they

36

receive at key stages in their lives, such as a change of accommodation or the need for
serious medical treatment. As a provider of care and support services there maybe
circumstances where we have a duty to provide suitable independent specialist advocates
for people who lack mental capacity. These advocates must be able to identify as far as
possible the service user’s views and preferences, and present them to those responsible
for providing care and support.

An Independent Mental Capacity Advocate (IMCA) is someone appointed to support and
represent a person who lacks capacity, possibly because of dementia, a learning disability
or mental health needs, when they are faced with major decisions about their health and
social care but have no family or friends to represent them.

2. Purpose

This policy explains the circumstances in which an Independent Mental Capacity Advocate
must or may be provided, the process for referring and appointing one, their responsibilities
and our duty as a provider of care and support.

3. Scope

This policy applies to all staff who are involved in working with people with a mental
impairment who are eligible for the support of an Independent Mental Capacity Advocate.

4. Legal context

The role of Independent Mental Capacity Advocate (IMCA) was introduced in the Mental
Capacity Act 2005, with associated Regulations (2006) and Code of Practice, and
additional Regulations (Expansion of Role) 2006. The Act lays down the criteria for
assessing a lack of capacity and the situations in which an IMCA must or may be provided.

5. Mandatory Procedures

Circumstances in which an IMCA may be required:

The purpose of the IMCA role is to provide representation and support for particularly
vulnerable people who lack capacity and are facing important decisions about certain
serious, potentially life-changing situations.

The commissioners (this could be the local authority Social Services, the NHS trust or we
as private providers of care and support) have a statutory duty to provide independent
advocates for individual service users who meet the eligibility criteria in circumstances
where a decision needs to be made concerning a change of accommodation.

This may be a move for the first time from the community or hospital into residential
accommodation, or where a change of accommodation is being considered. It may be as a
result of changing care needs or a change in the current provision.

The duty is triggered when the proposed move in question is:

To or between hospitals for a period likely to exceed 28 days

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To or between their home to care homes for a period likely to exceed eight
weeks.
If the placement is initially estimated to be for less than this period but later
needs to be extended, an IMCA should be appointed as soon as this
becomes clear.
There is a similar duty where serious medical treatment may be provided, withdrawn or
withheld. The criteria for ‘serious medical treatment’ are:
there is a fine balance between the benefits and the risks
the choice between treatments is finely balanced
what is proposed would be likely to involve serious consequences for the patient.

The only situation in which the duty to seek advice from an IMCA could be dispensed with
is where the proposed treatment needs to be provided as a matter of urgency, for example
to save the person’s life or prevent a serious deterioration in his/her condition.
As the care provider we have the power to appoint an advocate in Adult Protection
procedures, where protective measures are being put in place and the person concerned
lacks capacity. Where these criteria are met, there is a duty to consider the provision of an
advocate. In addition, as the care provider we may refer a service user to an advocate for a
care review if the service user has lost capacity, and there is no one else appropriate to
consult.

6. Eligibility

In order to qualify for representation by an advocate (IMCA) the service user concerned
must:
a) be assessed as lacking capacity according to the criteria laid down in the Mental
Capacity Act 2005, in relation to the specific decision being considered
b) The service user will lack support, in that they will have no one who can help them
communicate their wishes or be consulted about their best interests other than
professional health or care staff who may be providing services to them.
Anyone not meeting these criteria should be referred to an alternative advocacy provider.

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Every adult has the right to
make his or her decisions, and
must be assumed to have
capacity

39

7. Attorneys, family and friends, existing advocates

In the following circumstances the individual would not be eligible for the provision of an
IMCA:

• Where a person who now lacks capacity in relation to a particular matter has
previously expressed a wish that a named person should be consulted in matters
affecting his/her interests, and that person is available and willing to be consulted

• Where there is an attorney appointed under a Lasting Power of Attorney

• Where there is an attorney appointed under an Enduring Power of Attorney, and
the attorney continues to manage the person’s affairs;

• Where a welfare deputy has been appointed by the Court of Protection

• There may be circumstances where family members or friends who would
normally be consulted are not appropriate. The reasons for this may be distance,
a lack of contact, their own ill-health or mental frailty, an unwillingness to be
consulted, or concerns about the safeguarding of the service user’s best
interests; an IMCA may therefore be appointed.

Where the person who lacks capacity and already has an independent
advocate they may still be entitled to an IMCA, in the following situations:

• where the person who lacks capacity has an independent advocate acting under
restrictions as to the areas where s/he is to be involved (which may include a
Mental Health advocate) and the person is now unable to give instructions. An
IMCA should be appointed, and should consult and work with the independent
advocate in supporting the person, particularly in ascertaining the person’s
wishes and feelings

• If an IMCA has already been appointed and the service user subsequently
becomes subject to the Mental Health Act, it may be appropriate for a Mental
Health Advocate to be appointed in addition. The two advocates would be
expected to work together, using their respective knowledge and skills to
represent the service user’s best interests.

• Where the person has previously appointed an independent advocate
him/herself, and has indicated that s/he wishes the independent advocate to be
consulted on all affairs and decisions which the person concerned lacks capacity
to make, the person lacking capacity would not be entitled to an IMCA. If however
that advocate is unable or unwilling to proceed in the changed circumstances, an
IMCA may be appointed.

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8. Referral to the Advocacy Service (N-COMPASS)

In any situation where a service user is known or believed to lack relevant capacity and a
decision is required where an IMCA may be involved, the decision maker should assess the
individual’s capacity according to the Mental Capacity Act guidance in relation to that
decision. The staff responsible for decision-making may include doctors, nurses, social
workers, care managers and domiciliary care providers.

When the decision maker has identified the need for an IMCA, they will confirm this with
their line manager and then contact:

N-Compass
Advocacy Service

Wyre and Fylde
3 Errigal House
Avroe Crescent
Blackpool Business Park
Blackpool
FY4 2DP
Telephone 01253 362140

Referral should be made by telephone to the above number. This will avoid the potential for
breaches of confidentiality while allowing the sharing of appropriate detail.

The initial information required by the Advocacy Service will include:

Details of the service user
Confirmation of lack of capacity
Preferred communication methods
Brief background to the current situation
Timescale for the decision-making process
Indication of any family, friends or other people who may need to be
consulted.

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9. Role and responsibilities of the referring staff member

a) A record will be made of the decision to appoint an IMCA and the people involved in
that decision.

b) The referring staff member will arrange preliminary contact with the Locality Manager
of the IMCA service or the designated IMCA, to confirm the basic arrangements and
give more detailed information.

c) In future correspondence case number will be used together with reference number
provided by the Advocacy Service to identify the service user concerned.

d) They will also confirm arrangements for a first meeting with the service user, at
which they or another staff member currently involved in the service user’s care, will
also initially be present.

e) Beyond these initial introductions, the IMCA and the service user will be assured of
privacy for their meetings.

f) They will ensure that the IMCA has access to all relevant information and practical
support which may assist them in working with the service user, in line with the
specific protocol between all parties regarding confidentiality.

g) They will facilitate contact between the IMCA and any other relevant individuals or
agencies.

h) They will maintain contact with the IMCA throughout the process and record any
problems and their resolution

i) They will discuss the final report with the IMCA and give it due weight when deciding
on a course of action.

10. Role and responsibilities of the Advocacy Service (N-Compass)

The Advocacy Agency must work in partnership with other agencies, both statutory,
independent and voluntary, assisting those who are likely to refer their service users to
understand the role of the Independent Mental Capacity Advocate and how and when to
access the service.

They must ensure that all IMCAs are suitably trained for the role, and have been CRB
checked as part of their duty in the protection of vulnerable people.

42







DOLS are intended to ensure that confidentiality must be maintained
people receiving treatment and by all staff
support have as much liberty as
possible and as a care provider we
have duty to ensure that this is true
for everyone we support.,
Furthermore, we also have a legal
responsibility for operating and
overseeing the DOLS and for
applying to our local authority (LCC
Social Services) for a Deprivation of
Liberty Authorisation if it is required.
The person responsible for making
an application is the Responsible
registered person who is the
Company Director John Lee

DOLS is about protective care, they
are not about giving health and
social care professional’s arbitrary
powers of detention. Quite the
opposite: they put in place legal
safeguards to ensure that people are
not deprived of their liberty in
hospital or care home settings
unless it is absolutely necessary to
do so.

It is the responsibility of managers to
ensure training is provided to staff
and information is provided, in an
appropriate manner, to those in our care and their families. Staff have a duty to familiarise
themselves with this MCA/DOLS legislation and to share any relevant information and
cooperate with other professionals when legally required to do so.

DOLS are to be used as a last resort they are not to be used as a form of punishment, or
for the convenience of professionals, carers, or anyone else.

Valuing People Plan

As a provider of services to people with learning difficulties All about you care Services
Limited is committed to delivering high quality services that encompass the four key
principles and the objectives of Valuing People (A New Strategy for Learning Disability for
the 21st Century) white Paper.

By implementing these principles and objectives we aim to ensure that all of those we
support are valued and recognised as an individual’s, are given fair access and have the
opportunity to play their full part in society. We will work to ensure the people we support
have are directed to and given access to health and medical facilities, social activities and
all those things associated with everyday living.

46

Through Person Centre Planning we will put those who are receiving our support at the
centre of their services and provide them with information and assistance to enable them to
take control of their own lives and to make choices about all of the things that affect their
everyday lives. To further provide full and active lives we will endeavour to seek out and
provide new opportunities in social, recreational and work-based activities.

We will at all times endeavour to protect all of those we support from being pushed to the
margins of our society and ensure they are protected from prejudice, bullying and
harassment, insensitive treatment and discrimination.

In order to achieve all the above outcomes, we will continue to develop all of our
established skills, knowledge and activities, these include:

Staff training and development
Management training and development
Communication and participation with other professionals i.e. Partnership board,
Health service, local authorities, voluntary organisations and families.

Ensure existing Safeguarding policies and procedures are understood by all within
the organisation and practiced as routine.
Ensure the principles of capacity are practiced throughout the organisation.
Continue to develop Person Centred Planning.

Promote employment opportunities.
Provide assistance to access benefits including housing.
Assist with access to Advocacy services whenever required.
Annual review of Policies and procedures

It is the responsibility of the company Director to ensure information and resources are
made available to implement this plan, it is the responsibility of the Learning Disability
Manager to implement the plan. All staff will be made aware of their responsibilities through
training.

In order to ensure we all are aware and fully understand the key principles and objectives of
the White Paper they are detailed below, objectives 1 and 2 do not presently apply to the
our services:

Four Key Principles of Valuing People

Choice: Like other people, people with learning disabilities want a real say in where they
live, what work they should do and who looks after them. But for too many people with
learning disabilities, these are currently unattainable goals. We believe that everyone
should be able to make choices. This includes people with severe and profound disabilities
who, with the right help and support, can make important choices and express preferences
about their day to day lives.

Inclusion: Being part of the mainstream is something most of us take for granted. We go to
work, look after our families, visit our GP, use transport, and go to the swimming pool or

47

cinema. Inclusion means enabling people with learning disabilities to do those ordinary
things make use of mainstream services and be fully included in the local community.

Legal and Civil Rights: The Government is committed to enforceable civil rights for
disabled people in order to eradicate discrimination in society. People with learning
disabilities have the right to a decent education, to grow up to vote, to marry and have a
family, and to express their opinions, with help and support to do so where necessary. The
Government is committed to providing comprehensive guidance for electoral administrators
on helping disabled people, including those with learning disabilities, through the whole
electoral process – from registering to vote until polling day itself. All public services will
treat people with learning disabilities as individuals with respect for their dignity, and
challenge discrimination on all grounds including disability. People with learning disabilities
will also receive the full
protection of the law
when necessary.

Independence:
Promoting independence
is a key aim for the
Government’s
modernisation agenda.
Nowhere is it of greater
importance than for
people with learning
disabilities. While
people’s individual needs
will differ, the starting
presumption should be
one of independence,
rather than dependence,
with public services
providing the support
needed to maximise this.
Independence in this
context does not mean
doing everything
unaided.

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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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