Crossroads CareAdults’ personal care procedure

B.01b

Adults’ personal care procedure for managers

1.0SCOPE

1.1 This procedure refers to the personal care of adults aged 18 and over. For children and young people aged 17 and under please refer to the children’s personal care policy, procedure and guidance (C.02a, C.02b and C.02c). The intended outcome of this set of documents is to ensure that each service user receives effective, safe, personalised care and support that is appropriate to and meets their individual needs.

1.2 This procedure will be read in conjunction with the following Crossroads Carepolicy documents:

  • autonomy and independence (D.08)
  • diversity and equality (E.05)
  • infection control (D.01a, D.01b and D.01c)
  • safeguarding adults (B.05a, B.05b and B.05c)
  • confidentiality and disclosure (D.11a, D.11b and D.11c)
  • data protection and subject access (A.03a, A.03b, A.03c and A.03d)
  • adults’ medication (B.02a, B.02b and B.02c)
  • adults’ resuscitation (B.03a, B.03b and B.03c)
  • adults’ behaviour management (B.04a, B.04b, B.04c and B.04d)
  • adults’ mobility assistance (F.25a, F.25b and F.25c)
  • manual handling (F.24a, F.24b and F.24c)
  • food handling and basic hygiene (D.06a, D.06b and D.06c).

2.0 Responsibilities OF MANAGERS

2.1 Managers are required to have systems in place to ensure that all staff involved in the provision of care and support to adults with care needs:

  • work according to the adults’ personal care policy, procedure and guidance when planning or providing careand support
  • are clear about the work they are authorised to carry out, including who is authorised to conduct care and risk assessments, draw up care plans, conduct care plan reviews and agree specialised tasks.

2.2 Managers are also responsible for ensuring that staff:

  • receive training that is compliant with the requirements of:
  • the National Minimum Standards for Domiciliary Care Agencies in Wales (see
  • the Care Quality Commission (CQC) Essential standards of quality and safety guidance in England (see
  • receive, at the start of their employment, comprehensive induction training that is completed before they are allowed to work unsupervised – see learning and development procedure (E.13b - Appendix 1)
  • are given opportunity to achieve nationally recognised qualifications – seeQualifications for the Care Sector in England and Wales (IT.03)
  • receive all necessary training updates in relation to the Crossroads Care policy framework – see learning and development procedure (E.13b - Appendix 2)
  • receive ongoing assessment of their individual learning and development needs – see learning and development procedure (E.13b)
  • receive learning opportunities to develop competencies to meet the needs of service users, including thosewho have complex care needs (see Appendix 2) and those who require the provision of specialised tasks (see Appendix 1).

2.3 Mangers are required to ensure:

  • staff are supervised and supported through one to one supervision meetings (one of which will be observation of practice whilst working) held at least quarterly (or more frequently if assessed as necessary) and through informal support as required
  • staff participate in an annual appraisal of their performance
  • a record is kept of the content and outcome of all supervision and appraisal meetings
  • staff have the opportunity to attend regular group meetings with peers and / or team members, at least quarterly
  • all group staff meetings are publicised, minuted and shared with relevant staff members.

3.0 service planning AND REVIEW

3.1 When a service is requested, a designated staff membertrained in risk assessment and care planning (referred to as a care planner) will carry out an initialassessment (BT.02) before care begins. This assessment forms part of the risk assessment process agreed with Crossroads Care insurers and needs to be completed even if the care has already been assessed by another professional such as a Social Services Care Manager.

3.2 On this initial assessment visit the care plannerwill carry out all necessary risk assessments (see 3.4 below) and gather information to draw up an individualisedplan of care, referred to as a care plan(see3.5 below).

3.3 Where schemes are providing an urgent response service that does not allow for an initial assessment to be carried out prior to the first visit, they are required to have robust systems of work in place to ensure the safety of both staff and service users. This includes:

  • obtaining all necessary information from the professional making the referral and communicating relevant details to the staff member/s concerned
  • ensuring staff involved in provision of the service have been trained to carry out risk assessments and to draw up an emergency plan of care
  • ensuring staff are fully aware of the system to follow if they assess that it is not safe to provide the service.

3.4Risk assessments

3.4.1In relation to risk assessments, Crossroads Care recognises that risk taking is an important part of a normal lifestyle and that individuals have the right to take informed risks. We accept that responsible risk taking may be in the interests of the person with care needs within a risk assessment framework that balances rights, preferences and choice with safety and effectiveness. All risk assessments carried out will aim to ensure, so far as is reasonably practicable, that staff, service users and the organisation are not exposed to unnecessary or unjustifiable risks.

3.4.2Risk assessmentswill be carried out by the care planner in consultation with the person with care needs and / or their carer. The assessments will focus on the safety of both service users and care workers, be suitable for the service requested and will include:

  • a general risk assessment (see FT.02a)
  • a safe handling risk assessment (see FT.03a)
  • a manual handling risk assessment (FT.10)
  • a behaviour management risk assessment (see FT.04a) as required.

Copies of all risk assessments will be held in the Crossroads Care office and a summary of their content (see FT.05a) will be kept in the service user’s home.

3.5 Care plans

3.5.1An individual, person-centredcare plan will be drawn up by the care planner, in consultation with the person with care needs and / or their carer as appropriate. Further details relating to person-centred care and support are documented in the accompanying adults’ personal care policy (B.01a – section 2).

3.5.2The care plan will detail the care needs, preferences and desired outcomes of the person with care needs and document the care and support care workers are expected and allowed to deliver. Care workers are only authorised toprovide the care and support specified in the care plan.

3.5.3 When drawing up a care plan, the care planner may take into account the wishes of the carer and any significant others, but cannot go against the wishes of the person with care needs if they have the mental capacity to make decisions. However, should the person with care needs and / or their carer request an activity / task that could place either themselves or others (including the care worker) at risk of harm, then the care planner will discuss the implications of that activity / task with the person with care needs and /or their carer and may decline to plan for it if the risk cannot be reduced to an acceptable level (see 3.4 above).

3.5.4 The care planner will need to identify, where necessary, how the person with care needs communicates (including non-verbally), particularly how they indicate unhappiness, pain or distress. This may include for example the use of words, signs, symbols, body movements or eye pointing. Methods of communication that are effective in relation to each individual service user will be documented in their care plan.

3.6 If a person with care needs is being discharged from another care setting (such as a hospital or nursing home),it may be appropriate to arrange a visit to meet them there prior to their dischargeas well as visiting them once they are home.

3.7Unless an urgent response service is being provided (see 3.3 above), before services begin, the care planner will ensure that:

  • all necessaryrisk assessmentshave been carried out and documented
  • a signed and dated care plan is in place, including written consent for the care and support to be provided (see 4.0 below)
  • a service user guide has been issued to the service user/s (see AT.08)
  • the care plan and risk assessment summary are made available to all staff involved in the provision of care.

Care planners will ensure that all staff delivering care have received the required training and have been assessed as competent to carry out their role safely prior to the service commencing.

3.8 Where care workers are providing care and support to more than one person in the same home( even if they are members of the same family), the care planner needs to ensure that each person receiving care has an individual risk assessment carried out and a person-centred care plan in place and that separate records are kept, with cross-references if necessary.

3.9 Care plans and risk assessments will be reviewed, updated and, where necessary amended annually or when there is a significant change in needs or circumstances, whichever is sooner, to ensure they remain valid.

4.0Consent for care

4.1 Where possible the written consentof the person with care needs will be obtained for all care and support provided. A model care planthat can be used by schemes and which incorporates an appropriate consent form is available at BT.03.

4.2 If the person with care needs is unable to give written consent, but is assessed as having the mental capacity to give or withhold their agreement, the care planner willconsider other ways the person might indicate their consent, for example:

  • witnessed verbal consent
  • clear, active assent (for example nodding the head)
  • consensual behaviour (for example co-operating with the care being provided).

4.3 If there is any doubt about the person with care needs’ ability to consent to care, the care plannerwill need toreport the matter to the relevant health and social care professional/s who will carry out an assessment of capacity. Crossroads Care staff will not be responsible for reaching any conclusions regarding mental capacity.

4.4 If the person with care needs is assessed as lacking capacity to give consent to care, all decisions relating to it must be based upon and taken in their best interests (see 4.6 below) in consultation with relevant others (for example the person’s carer, family or representative/s, their General Practitioner(GP), District Nurse or Social Worker), as appropriate to the situation.

4.5 In some cases a multi-disciplinary ‘best interest’ meeting may be held, comprising professionals involved in the care of the individual, their carer / close family members as appropriate. If the person with care needs has made an Advance Decision or there is a Lasting Power of Attorney this will be noted and acted upon appropriately. A decision will be made as to the benefits of the proposed care and a resolution made as to how that care will be provided if it is decided that it is in the person’s best interests to provide it. the outcome of the ‘best interests’ meeting will be recorded in the person with care needs’ file and all necessary information regarding the provision of personal care entered into their care plan.

4.6 When assessing what is in the best interests of the person with care needs, the information

documented below needs to be taken into account. (Paragraph numbers refer to the Mental

Capacity Act Code of Practice.)

  • Working out what is in someone’s best interests cannot be based simply on someone’s age, appearance, condition or behaviour. All relevant circumstances should be considered when working out someone’s best interests (paragraphs 5.18–5.20).
  • Every effort should be made to encourage and enable the person who lacks capacity to take part in making the decision (paragraphs 5.21–5.24).
  • If there is a chance that the person will regain the capacity to make a particular decision, then it may be possible to put off the decision until later if it is not urgent (paragraphs 5.25–5.28).
  • Special considerations apply to decisions about life-sustaining treatment (paragraphs 5.29–5.36).
  • The person’s past and present wishes and feelings, beliefs and values should be taken into account (paragraphs 5.37–5.48).
  • The views of other people who are close to the person who lacks capacity should be considered, as well as the views of an attorney or deputy (paragraphs 5.49–5.55).

4.7 Managers of services in England will also familiarise themselves with the provisions of guidance published by the Care Quality Commission: “Guidance forCQC staff and providers of registered care, treatment and support services – The Mental Capacity Act 2005”.

5.0 levels of care

5.1 Personal care tasks may fall into three categories:

  • basic
  • specialised
  • prohibited.

5.2 Whatever level of care a task is categorised as, staff will only carry out that task when they have received the necessary training and have been assessed as competent to perform it. This includes all basic as well as specialised tasks.

5.3Basic tasks

5.3.1Crossroads Careprovides trained care workers to go into the home to provide basic personal, social and domestic care. All care workerswill be trained to deliver basic care at induction. (See Appendix 1for a list of basic tasks).

5.3.2 Care staffwill be given access to the care plan of the person to whom they will be providing carebefore the service begins. Good practice suggests they will also be taken on an introductory visitto meet the person with care needsand their carer.

5.3.3Where care tasks are not straightforward, it is good practice to arrange a “shadowing” visit/s so that the careworker can work alongside the carer, senior staff member or relevant healthcare professional (as appropriate) to learn routines.

5.4Specialised tasks

5.4.1 Managers mayundertake to provide specialised tasks within a package of care (see Appendix 1 for list of specialised tasks).The care manager is responsible for agreeing / overseeing the provision ofspecialised tasks and ensuring that all necessary staff training and competency assessments are successfully completed and documented prior to the commencement of care.

5.4.2 The protocol to be followed when carrying out specialised tasks, including training requirements,is detailed in Appendix 3 at the end of this document.

5.5Prohibited tasks

5.5.1 There are certain tasks that are prohibited due to the potential risk implications to service users, staff and the organisation.In some cases, local health or social services policies may be more restrictive than the Crossroads Care policy and additional tasks may be prohibited. In such instances, schemes will comply with the local policy. (See Appendix 1 for list of prohibited tasks).

6.0 INTIMATE PERSONAL CARE

6.1 Providing intimate personal care to people with care needs is one of the factors that potentially makes them more vulnerable to abuse. Managers will ensure that staff who provide intimate personal care:

  • receive on-going training in safeguarding adults
  • are familiar with the adults’ safeguarding guidance (B.05c).

6.2 The care planner will discuss arrangements regarding the provision of intimate care with the person with care needs and / or their carer before the service begins. The discussion will include:

  • identifying the care required
  • agreeing the details of where and how that care will be carried out
  • ascertaining how the person communicates (see 3.5.4 above)
  • establishing the gender of staff required to carry out the care.

6.3Care involving intimate care tasks is frequently carried out by one care worker alone. The practice of providing one-to-one intimate care alone is supported, unless the activity requires two care workers for the greater comfort / safety of the person with care needs or the care worker/s.

6.4 Details of all arrangements regarding the provision of intimate personal care will be fully documented in the person with care needs’ care plan.

6.5 Additional information relating to the use of touch when providing personal care is available at DT.07

7.0 NUTRITION AND HYDRATION

7.1 Good levels of nutrition and hydration are essential to a person’s health and wellbeing.

Service users may have nutritional needs or problems in getting a healthy diet and may require help to prepare their meals or to eat and drink. This includes the administration of parenteral nutrition(for example via a P.E.G. or nasogastric tube).

7.2 The care planner will fully discuss the person with care needs’ food and drink related requirements at the initial assessment in order to ensure that their nutrition and hydration needs are met during each period of care. This discussion will wherever possible involve the person with care needs and may also include their carer, family, friends and representatives as appropriate and in line with the person’s wishes.

7.3 The assessment will seek to identify, as appropriate:

  • whether the person with care needs is at risk from poor nutrition or hydration
  • whether the person is able to plan and / or prepare their own meals and the level of help / support required for them to safely do so
  • whether the person requires help with eating and drinking
  • the level of help or support required with eating and drinking, including ways in which they can be enabled to eat and drink as independently as possible
  • how to encourage the person to eat and drink if they are reluctant / refuse to do so
  • their food preferences
  • any special dietary requirements relating to the person’s illness or condition
  • any cultural or religious requirements relating to food and drink
  • any food intolerances or allergies
  • details of when, where and how the person likes to take their meals
  • details of any snacks and drinks that can be taken during the visit
  • whether the person’s food and fluid intake need to be recorded and monitored.

7.4 Where a service user has special dietary requirements, the care planner may need to consult an appropriate specialist, for example: