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

AAY Handbook V2.6

AAY Handbook V2.6

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.

50

Medication Policy

Introduction

The purpose of the medication policy is to safeguard the interests of Service Users and
staff, by setting out the practice to be followed and the responsibilities of all concerned in
regard of medication and related tasks where appropriate. The policy applies to all
Domiciliary Care staff employed by the company to ensure good practice, the appropriate
involvement and co-operation of GP's, Community Nurses and Community Pharmacists will
be sought.
All medicines are potentially harmful and care must be taken in their storage, management,
control and disposal. The policy will meet the requirements for the Care Quality
Commissions Commission; furthermore, all practice must be in compliance with following
legal requirements.

Current Legislation

The Medicines Act 1968

The Misuse of Drugs Act 1971

The Misuse of Drugs (Safe Custody) Regulations 1973 S11973 No. 798

The Care Standards Act 2000.

Health & Social Care Act 2008(Regulated Activities) Regulations 2014

In accordance with the guidance laid down in national standards this document (medication
Policy) should be readily available to all staff and should be complied with at all times.
The term Domiciliary Care Staff relates to those care staff that has direct contact with
Service Users in a community based setting (those living in their own homes). It is this
group of staff who will be guided by this policy. Previously the company did not undertake
any duties appertaining to the administration of medication. This has now changed at the
request of local authorities, in order to carry out these additional duties safely and in
compliance with current legislation this policy and procedures are intended to give
Domiciliary Care Staff clear advice and guidance on this matter. The policy and procedures
are in accordance with best practice and seeks to gives clear guidance concerning the
administration
Where assistance with medication is required, Domiciliary Care & Support Staff should only
assist or administer medication where it is included in the Service User’s Care Plan.

Documentation

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.

Aims of the Policy

Standard 10 of the National Minimum Standards for Domiciliary Care Agencies —
Medication and Health-Related Activities relates to medication and other health-related

51

activities. The Standard places the following requirements on agencies providing domiciliary
care.

1. To ensure that there is a clear, written policy and procedure which is adhered to by
staff and which identifies parameters and circumstances for assisting and
administering medication and health-related tasks and identifies the limits to
assistance and tasks which may be undertaken with specialist training.

2. To include in the policy procedures, if required, for obtaining prescriptions and
dispensed medicines and for recording the information.

3. To ensure that staff should only provide assistance with taking medication, or
administer medication, or undertake other health-related tasks, when it is within their
competence, when they have received any necessary specialist training and when
the activity is:

(a) with the informed consent of the service user or their relatives or
representative

(b) clearly requested on the care plan

(c) with agreement of the care manager

(d) not contrary to the company’s policy.

4. To identify required assistance with medication and other health-related activities
which should be identified in the Service User's care plan and also as part of the risk
assessment detailed within the Service User Plan.

5. To ensure that care and support staff should leave medication at all times in a safe
place which is known and accessible to the Service User or, if not appropriate for the
Service User to have access, where it is only accessible to relatives and other
personal carers, health personnel and domiciliary care & Support staff.

6. To ensure that domiciliary care staff & Support follow the agency's procedures for
reporting concerns, responding to incidents and seeking guidance.

7. To ensure that domiciliary care staff record, with the Service User's permission,
observation and administration of the Service User taking medication and any
assistance given (including dosage and time of medication and undertaking any
other health-related tasks) on the record of the care visit kept in the home and/or the
home care medication record and the personal file of the Service User held in the
agency — any advice to the service user to see or call in their General Practitioner or
other healthcare professional should also be recorded and the record signed and
dated by the care worker and the Service User or their representative.

8. To agree and follow a policy on medication and health-related tasks where the
delivery of the care package to the Service User involves multiple agencies,
including healthcare professionals who visits on a regular basis. If possible
healthcare professionals should be identified as responsible for taking the lead on
medication whist all care workers should retain responsibility for their own actions in
accordance with the policy. (Legal responsibility rests with the prescriber but only in
respect of prescribing, not administration)

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9. Where necessary and agreed the policy and procedures should be approved by a

suitably experienced pharmacist, if appropriate, and the functions undertaken by
staff in this context will be covered by the company’s insurance policy.

The Standards are supported by Section 14.6 of the Domiciliary Care Agencies
Regulations 2002 which state that the registered person must "specify the circumstances
in which a domiciliary care worker may administer or assist in the administration of the
Service User's medication, or any other tasks relating to the Service User's health care, and
the procedures to be adopted in such circumstances."

Definitions:

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 or give medicine to a Service User, as specified in the care

plan, and risk assessment, where the Service User is unable to make the decision on

medication for themselves or the care plan identifies the level of help required, such as the

Service User is unable to physically put medication into their own mouth due their manual

dexterity, condition or ill health.

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).

Responsibilities of the Managers and Supervisors

The role of the Manager is central, and includes the following duties and responsibilities:
The registered Manager must:

ensure that this policy and the procedures are being applied consistently

53

ensure that the arrangements for assistance and administration of medication is
reviewed as specified in the care plan, or as the service user's needs change.
ensure all other involved professionals, service users and carers are made fully
aware of the role, responsibilities and limitations of the worker in respect of
medicines
provide workers with information, supervision and training which enables them to
competently carry out their duties as described in these guidelines. Training must be
updated regularly to ensure competency, and records of training kept up to date for
each staff member
each worker has the necessary equipment to undertake the tasks requested
ensure that the care plan accurately describes the assistance the worker is being
asked to provide.
ensure that workers act in ways which are within the law and consistent with the
medication policy and procedures
ensure that workers are not undertaking inappropriate medication tasks
the conditions in the person’s home are adequate to meet minimum standards in
respect of medication procedures (e.g. by observing and recording evidence of
misuse or poor control of drugs by the service user or carers)
support service users to take their medication (taking reasonable care to avoid acts
or omissions which may cause harm to service users).
contact the GP or Community Pharmacist if workers are asked to assist with the
purchase of over the counter (OTC) medicines. The advice received must be
documented in the service user's care plan.
ensure written consent is obtained from relatives, representatives or advocate of
service users who lack capacity to consent. The service user or their authorised
relative or representative, by signing the Medication Consent Form, will give consent
to the care staff of the company to undertake any of the tasks set out in this
procedure.

Responsibilities of Domiciliary Care & Support Staff

Involvement by Domiciliary Care & Support Staff in the administration of medicines is a
contentious issue. Domiciliary Care Staff & Support are increasingly coming under pressure
to help out in this regard, it is anticipated by the company that agencies not offering this
service will be limited to the amount of work they will be offered in the future unless staff are
prepared to take on these tasks and undertake appropriate training. A common example is
in the care of someone who is forgetful and where the care worker may be asked to give

54

out medication prescribed by a GP at certain times of the day. However, as a company we
will ensure that our staff are being asked to perform only appropriate duties with which our
staff are competent to perform and for which they are trained. They will also be covered by
appropriate policies, procedures and insurance and supported by appropriate systems of
recording. All medications are potentially dangerous if taken wrongly and mistakes in this
area, perhaps the administration of the wrong tablet, can have serious and even fatal
results.
The involvement of Domiciliary Care & Support Staff in helping with medication should be
clearly stated and understood by all staff as well as Service Users, their families and by
care colleagues such as GPs, District Nurses and social services staff. Domiciliary Care
Staff & Support should never attempt to provide care for which they are not trained or
equipped. In addition, the National Minimum Standards for Domiciliary Care Agencies
makes the point that the provision of personal care for people who live in their own homes
is changing and that the interface between health and personal care is becoming blurred.
This means that, as the health and care needs of people living in their own homes become
more complex, so Domiciliary Care Staff & Support come under pressure to undertake
increasingly complex health-related activities. The National Minimum Standards make the
point that, if this is the case, then it should never happen "by default" but only with the
written agreement of all parties and when the Domiciliary Care Staff have received the
appropriate and necessary training. Clarity in the roles, if any, in relation to medication and
other health-related activities is therefore essential.

Where assisting with or administering medication is part of the role of a care worker, this
should be carefully documented and agreed between all involved in the care, particularly by
the Service User and their relatives and by the GP and relevant key care worker. The care
plan should state exactly what the involvement of the care staff should be and they should
be clear that they should not extend that role without further agreement and documentation.
They should also be appropriately trained and capable of performing the role safely and
covered by a suitable insurance policy.

In an emergency

In the event of a medical emergency or overdose call 999 and ask for advice, an
ambulance or (if non-life threatening) phone the 111 immediately and follow advice given.
Then inform your team leader. An incident report should be completed as soon as possible
after the event
Tasks Undertaken by Domiciliary Care & Support Staff

The following lists are not an exhaustive list as it is not possible to cover all eventualities.
Domiciliary care worker in the community must have received approved medication training
before assisting or administering medicines. Each task needs to be individually assessed
and agreed with the company Care Manager. A written plan is used to define the
permissible actions in each case. In some cases, medicines will need to be by invasive
techniques, only care workers who have received specialist training are allowed to
administer drugs in this way.

55

Level 1: General Support

General support is given when the adult service user takes responsibility for their own
medication and particularly when they contract the support through Direct Payments. The
support given may include some or all of the following:

Requesting repeat prescriptions from the GP
Collecting medicines from the community pharmacy/dispensing GP surgery
Disposing of unwanted medicines safely by return to the supplying
pharmacy/dispensing GP practice (when requested by the service user).
An occasional reminder or prompt from the care worker to an adult to take their
medicines. (A persistent need for reminders may indicate that a service user does
not have the ability to take responsibility for their own medicines and will prompt
review of the service user plan)
Manipulation of a container, for example opening a bottle of liquid medication or
popping tablets out of a blister pack at the request of the service user and when the
care worker has not been required to select the medication.
General support needs will be identified at the care assessment stage and recorded
in the service user plan. Ongoing records will also be required in the continuation
notes when care needs are reviewed.

Adults can retain independence by using compliance aids and these should be considered
if packs and bottles are difficult to open or they have difficulty remembering whether they
have taken medicines, consideration will be given requesting compliance aids at the care
assessment stage and should be discussed with the Care Organiser.

The compliance aid will normally be filled and labelled by the community pharmacist or
dispensing GP. The service user may qualify for a free service from a community
pharmacist if they meet criteria under the Disability Discrimination Act. If a pharmacist or
dispensing GP does not fill the compliance aid, the company care Manager will clarify that
the arrangements are suitable and minimise the potential for error.

Level 2: Administering Medication

Administration may be used when it is identified through the assessment process that the
service user is unable to take responsibility for their medicines and needs assistance due to
impairment, cognitive awareness or because of a physical disability.

The service user must agree to have the care worker administer medication and consent
will be obtained and documented in the service user plan. If an adult is unable to
communicate informed consent, the prescriber must indicate formally that the treatment is
in the best interest of the individual

Administration of medication at level 2 may include some or all of the following:

56

When the care worker selects and prepares medicines for immediate administration,
including selection from a monitored dosage system or compliance aid.
When the care worker selects and measures a dose of liquid medication for the
service user to take.
When the care worker applies a medicated cream/ointment; inserts drops to ear,
nose or eye; and administers inhaled medication.
When the care worker puts out medication for the service user to take them self at a
later (prescribed) time to enable their independence

Level 3: Administering medication by specialised techniques

In exceptional circumstances and following an assessment by a healthcare professional, a
domiciliary care worker may be asked to administer medication by a specialist technique
including:

Rectal administration, e.g. suppositories, diazepam (for epileptic seizure).
Insulin by injection.
Administration through a Percutaneous Endoscopic Gastrostomy (PEG).

If any of the above tasks are delegated to the domiciliary care or Support worker, then the
healthcare professional, for example the GP or district nurse, must train the care worker
and be satisfied they are competent to carry out the task. All care workers have the right to
refuse to assist with the administration of medication by specialist techniques if they do not
feel competent to do so.

Responsibilities of Service Users

In general Service Users will be expected and supported, to manage their own medication
i.e. to be self-medicators. Where this is not possible (e.g. due to incapacity) the situation will
be subject to a review involving the G.P and/or Consultant, Social Worker, Service User,
the Service Users family and the company Care Manager (this can be conducted by phone
as long as the discussion is recorded and any decisions are clearly documented in the Care
Plan and Risk Assessment).

In most circumstances the responsibility for the administration, monitoring and taking of
medication rests with the Service User

Responsibilities of GP/Consultant

The responsibility for prescribing medication rests with the Service User's GP or Hospital
Consultant.

57

Responsibilities of the Company Director

The Directors of the company are responsible for the development and monitoring of the
medication policy and for arranging the training of their staff. This is the basis of developing
best practice in a domiciliary care setting.

It is the responsibility of the Directors to ensure strict adherence by staff to the procedures
for the administration of medication and that appropriate personal liability insurance is in
place for all staff and service users.

Responsibilities of Pharmacy Services

The dispensing and sale of medicines in community pharmacies has, by law, to be
supervised by a qualified pharmacist whose role is to comply with the legal requirements for
the safe storage, dispensing and disposal of medication within the shop. Community
pharmacies have always acted as advisers to the general public wherever medication is
concerned and this role is becoming increasingly extended with many pharmacists now
being actively involved in managing drug therapies for Service Users. It is therefore good
practice to refer back to the pharmacist any queries or concerns relating to medication and
domiciliary care staff are encouraged to build a relationship with the Service User's
pharmacist, especially if they are also the ones to collect the medication.

The responsibility for delivery of oxygen supplies rests with the Community Pharmacist.

Risk Assessment & Consent

In the case of Service Users' self-administration of medication there are obvious risks to
independence in some cases. Common risks include overdose — either deliberate or
accidental — or of not taking essential medication because of forgetfulness or confusion,
especially in Service Users who are elderly, infirm, mentally impaired or have a learning
difficulty. Other risks include medication being mislaid or stolen. All Service Users should
therefore be assessed as to their ability to administer their own medication. Any identified
problems or risks should be discussed and a care package developed jointly between all of
the agencies working in support of a particular Service User. Any part to be played by a
domiciliary care worker should be entered in the Service Users Plan.

It is most important that whatever role is planned for the Domiciliary Care & Support Staff is
appropriate and is within the policies of the company. The company will ensure that
whatever domiciliary care & Support staff are placed in the home are competent and
adequately trained or qualified to perform the role asked of them.

Risk assessment must be completed by the Care Manager or her/ his deputy for every
Service User who requires prompting or assistance with medication, in order to ensure
compliance with the National Minimum Standards. This should be completed with the full
co-operation of the Service User, or where the Service User is unable to provide the
information, the next of kin or carer should assist in completing the form. The form must be
kept with the Care Plan and must be updated at each Service User’s review or when there
is a change in the Service User’s physical or mental health

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Guidance Notes on Medical Issues

It is the responsibility of the GP or Hospital Consultant to explain the reason for the
treatment and the likely effects (including side effects) of any medication prescribed to their
patient.
The Medical Practitioner makes a judgement on whether or not to explain to a patient, the
nature of an illness and the implications of any treatment.

Domiciliary 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.

Adverse Reactions

Service Users may experience adverse reactions to medication. Adverse reactions vary in
severity and form.
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 users other medications.
Some medicines cause individual's skin to react when exposed to sunlight. A written risk
assessment must be completed and all staff must be made aware of the risk. Details must
be recorded in the individual's case notes.
Homely Remedies (Non-Prescribed Medication/Illicit Substances)

Homely remedies are medicines that can be purchased over the counter from a community
pharmacy, without a prescription from a doctor. Service Users and carers 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.

Dealing with 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.

69

Medication Errors

No matter how high the Telephone NHS Direct
standards of individual on 111 follow their advice
staff and how good the
policies that they work to, Notify manager
drug errors can still occur. immediately
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 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.

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.

70

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.

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.

Training

All domiciliary care staff should read the agency's policy on medicines handling and
keeping records of medicine administration. Further training for domiciliary care staff
regarding medication will be provided if it is relevant to their role. It will include:

basic knowledge about common medications and how they are used
how to recognise and deal with problems in use such as side-effects and contra-
indications
procedures for the administration, giving and storing of medicines
what to do in the event of an error in administration.
Completion of care certificate medication module

It is the joint responsibility of managers and staff to ensure those handling and
administering medication are competent to do so.

71

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. Guidance is
provided in Appendix1.

• 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 an 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.

72

Company
• 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.

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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?
• 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.

74

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

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

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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.
• 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.
• Diarrhoea 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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Accessibility of management

During normal working hours (Monday to Friday 9.00 am. to 5.00 pm) a member of the
management team will be contactable at the office on the advertised telephone number.
Outside these hours all calls will be diverted to a manned telephone, urgent calls will be
passed onto a member of the management team who will deal with the matter promptly.
Non urgent calls will be dealt with on the next normal working day.

Staffing Levels

The company believes the quality and consistency of its service is paramount. To this end
the company will retain sufficient numbers of staff to meet contracted hours plus a small
group of bank staff. Keeping the number staff each Service User receives to a minimum
ensures:

• effective monitoring of Service User progress
• consistency for the Service User
• the building of positive Service User/carer relationships
• Service User confidence in the service
• consistent application of planned inputs

Involvement of Service User and Carer in service provision

The company has always encouraged service users and carers to be involved with service
planning and provision. Service Users and carers are encouraged to take part in all
meetings and decisions regarding their own individual care, and on a daily basis how the
service is delivered. In addition to this we seek to take part in group meetings involving
Service Users, carers, social services, primary health etc. These meetings are used to
discuss the broader aspects of the service and how Service Users would like it to develop.

Partnership working with key agencies

The company prides itself on its ability to work openly and closely with others; we have
always made this a priority and welcome input from all interested groups. On a daily basis
company employee at all levels liaise and work closely with many representatives of other
agencies including, social workers, district nurses, community psychiatric nurses,
continence advisors, etc.

Key Holding

There may be occasions when it is necessary for the company or its employees to hold
keys for a Service Users home. Before any such agreement is entered into written
permission will be sought from the Service User or their representative and the service
funder. When not in use these keys will be kept secure at the company’s office. A record of
all keys held by the company will be kept and individual members of staff will sign when
taking and returning keys. The company will endeavour to keep to a minimum the number
of staff who uses client’s keys; this will be regularly monitored and controlled.

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Key Safes & Coded Door Locks

In some circumstances entry to service user’s homes can only be gained by opening a
coded key safe and removing the door key, or by entering a code into the lock.

The code for key safes and coded locks are printed on your round sheet or rota, however,
the codes will need to be deciphered before they will work. Your manager will explain how
to decipher the code, for reasons of security this will change from time to time.

Once the key safe is open you should remove the key open the door and announce your
arrival to the service user. Do not leave the key in the door, on your departure you should
put the key back in the key safe ensuring it is firmly locked.

Divulging a code of a service users key lock or key safe to a third party will be considered
an act of gross misconduct by the company and may result in dismissal, furthermore, this
act is in contravention to the Data Protection Act 1998 and could lead to prosecution.

Insurance

All members of staff whilst engaged in their specified duties are covered against accident or
injury arising from employer’s negligence. It is the duty of the employee, however, to work
in a sensible manner and accept some responsibility for themselves and others around
them. Employees should be aware that any personal accident suffered in circumstances not
covered by this policy will be at their own risk. A full and detailed copy of the insurance
policy document is available for inspection upon request.

Telephones

The use of a Service Users own telephone by company personnel is forbidden unless;

• It is at the Service User's request
• In an emergency situation
• The care package requires it
• To log in and out of a service users home

The company recognises the benefit of personnel carrying their own private cellular mobile
phone. However, whilst on duty in a Service User's home members of staff should only
make and receive urgent calls directly related to their work. Any other incoming calls should
be terminated immediately. If a Service User requests for the domiciliary care worker's
phone to be switched off, then this will be adhered to.

Security of Company Vehicles and Load

When you leave your vehicle, always lock it up and set any alarms. Always take the keys
with you and never leave them in the cab when it's unattended. Load-carrying compartment
keys should always be on the same ring as the ignition key. This way you keep the ignition
key with you when you leave the cab to open up the load compartment.

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In the event that a driver’s vehicle is stolen because they have failed to observe the above
instruction will be deemed as committing an act of gross misconduct and liable to dismissal.
Never pick up any passengers.

Driver Responsibility

When you collect the keys for a vehicle, you become legally responsible for it. If the police
or local transport authorities stop you then you are personally liable for any transgressions
of the law. When driving a company vehicle, you are not only responsible for your own
vehicle. You are responsible for any stock being carried, your life, and other drivers' lives.

Am I responsible for Roadworthiness?

It is an offence to use an unroadworthy vehicle on the road; both the company and the
driver have a legal responsibility to ensure roadworthiness.

The law requires that:

• A daily walk around check is made by a responsible person (this is the driver) before
the vehicle is used.

• This also applies to hired vehicles

• Defects must be reported promptly to your manager immediately and rectification
work will be made as soon as possible, in cases where the vehicle is not roadworthy,
then it must not be used under any circumstances.

You are responsible for any company vehicle when in position of the keys If it is not road
worthy - do not drive it. Trips are important, but lives are more important.

Below are the checks that should be carried out daily to ensure that they are road worthy,
and safe to complete the trip that you are about to go on.
Vehicle checks fall under four categories:

Vehicle exterior
Engine fluid levels
Vehicle interior
Vehicle systems - checked once vehicle is running: lights, indicators, brake
lights, tyre wear, vehicle brakes.

Not only do these checks ensure that the vehicle is road worthy, but they protect you from
blame and fines if the vehicle is broken or damaged. Any user failing to check their vehicle
or report an accident or damage to their vehicle may face disciplinary action.

Social, Environmental and Ethical Issues

The Directors are aware of the significance of social, environmental and ethical matters to
the success of the company, we welcome opportunities to broaden our awareness and
adopt new protocols. This would include all aspects of service delivery and we feel all our
stake-holders should be encouraged to express their views.

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Green Housekeeping

All About You Care Services is committed to playing its part in the preservation of natural
resources and in the prevention of environmental pollution. In working towards this the
company will comply with both the spirit and the letter of all legislative and regulatory
requirements and wherever possible:

• Reflect best industry practice in comparable situations.
• Use environmentally favourable products, favouring those made from recycled

materials. Support the EC eco-labelling scheme by favouring products bearing
such labels.
• Foster employee awareness on environmental issues through instruction and
training.
• Promote environmental awareness amongst suppliers and contractors.

In order to achieve the above the company will endeavour, wherever possible, to adopt the
following practical measures:

• Assess the likely environmental effects of proposed projects.
• Use paper that contains at least 40% recycled material and is manufactured chlorine

free.
• Ensure premises and equipment are energy efficient
• Routinely service vehicles and use 'clean' fuel to reduce emissions.
• Ensure waste products, materials and substances are managed and disposed of

properly.

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Culturally Appropriate Care

The Company believes inclusivity and

equality must be at the centre of

organisational development,

workforce planning and service

delivery. We seek to encourage

diversity through open, honest and

mutually respectful communication

and attitudes. We are committed to

developing and operating our

business in a way that is designed to

lead to a more diverse and inclusive

culture. By promoting diversity and

equality of opportunity in our

recruitment and development

process' our aim is to build a balanced

representative workforce that reflects

the local population profile and

enables our customers to receive

culturally appropriate care and

equality of access to services.

Providing Culturally Appropriate Care
is not about making an assumption
about personal preferences or by
pandering to the media-driven myth of
political correctness, which makes
people nervous about asking ‘culture’
questions in case they offend. It
involves asking questions about
personal preferences from individuals
rather than making assumptions and
once established responding and
respecting those intrinsic values and
beliefs.

Training

The employees of the company represent it greatest asset. By providing opportunities,
facilities and funding for training the Company aims to ensure all members of staff are in
possession of the Knowledge, skills and experience necessary for them to perform their job
to an acceptable standard.
As a result of an annual appraisal, training need will be identified and an outline budgeted
plan will be agreed for the start of each financial year.

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Human Rights Act 1998

Policy Statement

To gain a better understanding of the Human Rights law and how the law impacts on our
services, the following information has been taken from the Equality and Human Rights
resources for older people, the information explains what people receiving our services
should expect from us in relation to their Human Rights. It is the policy of the company to
ensure the following articles are observed by all staff during delivery of the service.

Human Rights and Homecare

The following human rights protections are most relevant to homecare; these rights are set
out in the European Convention on Human Rights Act 1998.

Article 1 of the first Protocol: Right to protection of property

Everyone has the right to keep their belongings from their home such as money and
possessions, if a care worker steals from a Service User whilst on duty, this would be a
breach of this right. It is also a criminal offence and regarded by the company as gross
misconduct.

Article 2: Right to Life

Public authorities must not place your life in danger. If someone dies as a result of
consistent poor treatment by care workers, this may be a breach of their right to life under
article 2. It may also be a criminal offence. As a provider of homecare services on behalf of
the authority we have contractual duty to ensure these rights are observed.

Public authorities must also act to ensure care packages offer enough support for assessed
needs and services are safe. It should check that care workers do not a criminal record and
are trained to work with older people. If a care worker does not raise concerns about a
serious deterioration in someone’s health and this contributes to that person’s death, this
could also be a breach of the person’s right to life.

If someone dies under suspicious circumstances, the state has a duty to investigate the
death. If that investigation is inadequate, this could also be seen as a breach of Article 3.

Article 3: No one shall be subject to inhuman or degrading treatment

homecare should not cause serious physical or mental harm, or humiliate or degrade
anyone. Depending on the circumstances, examples are of inhuman or degrading treatment
by care workers could include:

repeatedly failing to change soiled clothes or bed sheets if someone is incontinent.

not providing a service user with enough food or water.

failing to wash some over a prolonged period of time who cannot wash themselves

Not turning some who is in bed for a prolonged period of time resulting in severe bed
sores.

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Using excessive force to restrain someone.

Only the most serious cases of poor treatment will be considered a breach of this right.
However, other cases may still count as a breach of a person’s right to a private and family
life, home and correspondence. (see article 8)

Article 5: Right to Liberty and Security

Everyone has the right not to have their liberty taken away from them, people should be
free to leave and return home at will. People should not be prevented from leaving or
returning to their home by other people. Care workers cannot lock people inside their home.
They should not stop service users going out because they might fall or get confused. To
do so could be a breach of the right to liberty and security.

There are exceptional circumstances where this right does not apply. For example,
someone can be kept in hospital if they are detained (sectioned) under the Mental Health
Act 1983. This deprivation of liberty would only be applied to someone who was a risk to
themselves and others.

Article 8: Right to a Private and Family Life, home and Correspondence

People should be able to live their lives as they choose. These rights can be in some can
be circumstances, for example to protect the rights of other people because of public safety
or national security. In terms of home care, this might give the right to:

Privacy

Keep post, personal documents and phone calls private.

Service users have the right to request care workers to leave their post unopened and ask
you to leave in order to take a phone call. Even if care workers are trying to be helpful, they
do not have the right share service user information.

See your family

If a person cannot live with their family, they should be allowed to have regular contact
them. For example, if a spouse is moving to a care home because it is unsafe for him or her
to live at home, then the council s should not place their spouse in a care home far away,
where they could not visit them. In offering the spouse a care home placement they must
also consider the right to a family life of the spouse and their partner.

Have adequate care and support

This is essential if a right to a home life is to be protected. Care workers turning up late, not
carrying out all of the tasks listed in their care plan or simply not carrying out tasks properly
could amount to a breach of someone’s private life.

Not to be handled abusively or roughly by care workers.

Care workers must listen and act on the wishes of service users, if they ask them to be
more careful, carers should carry out tasks more carefully and precisely, they should take
account of an individual’s health conditions or difficulties they may have. If carers are asked

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to be more careful, use disability equipment correctly, and not cause discomfort or pain and
they do not respond to the service users request then they could be breaching human
rights. If care worker’s subjects someone to serious ill treatment, this could be inhuman or
degrading treatment (Article 3)
Accept or refuse home care services
Everyone has the right to accept of refuse home care services, some may prefer to make
alternative arrangements such as having meals delivered, a laundry service, using door to
door transport to do their own shopping instead of using the support of a care worker. This
is often because find having people in their houses intrusive.
Having Choice about care
People should be offered choice about their care for example: what day centre to attend,
what agency they wish to receive their care from and who providers their meals, along with
a choice of food they like.
People should be allowed wear what they wish, care workers must not make people wear
items of clothing they don’t like or would not normally wear. Care workers cannot make you
wear slippers on a shopping trip just because it’s easier for them to put then on instead of
outdoor shoes. If a carer stopped someone wearing items of jewellery related to their
religion this would be a breach of someone’s religious freedom (Article 9)

Live your life according to your wishes
Visiting at inappropriate times to give support and assistance could undermine a person’s
right to be in control of their daily lives. For example; being put to bed or being helped to eat
too early or too late could be a breach of their right to a private life. If carers are visiting at
irregular hours, it may stop people from going out to visit friends and family infringing on
their right to have a family life.

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