CARE STANDARDS ACT 2000
Structure and Approach
The National Minimum Standards for nurses agencies focus on achievable outcomes for service users –
that is, the impact by agencies on organisations and individuals. The intention is that the attached set of standards will apply to all nurses agencies. Each standard is preceded by a statement of the intended outcome for service users. The standards themselves are numbered and the full set of numbered paragraphs must be met in order to achieve compliance with the standard. While the standards are qualitative – they provide a tool for judging whether service users are receiving safe and quality assured services – they are also measurable. Regulators will look for evidence that the requirements are being met through:
• discussions with service users, staff, managers and others;
• observation of arrangements at the agency;
• scrutiny of written policies, procedures and records.
Nurses agencies and the supply of persons other than Nurses
1.1 The certificate of registration is prominently displayed at all times so as to be readily and easily seen by all persons using the premises, in accordance with section 28(1) of the Care Standards Act.
1.2 A Statement of Purpose as specified in regulation 4 and Schedule 1 is supplied to the Commission, and a copy is available on request for inspection by every service user and any representative of a service user.
1.3 A Service User’s Guide provides comprehensive written and up-to-date information about the agency and the service it provides. This is available to service users and (where the service user is also a patient) to the service user’s carers or advocates in an appropriate language and/or format (e.g. large print, audiotape, Braille), and includes information on:
• A summary of the Statement of Purpose;
• The range of qualifications of the nurses who are supplied, and the types of settings in which
they are supplied to work;
• The circumstances in which the agency may cease to provide services to a service user;
• Arrangements for cancellation of the supply of a nurse by the service user or the agency;
• The agency’s charges, and methods of payment;
• Arrangements which will apply during the sickness or other absence of a nurse supplied to a
service user;
OUTCOME: Prospective service users have the information they need about the agency in order to make an informed decision on whether to engage its services.
• Requirements in relation to timesheets;
• The complaints process operated by the agency, including information about the right of service
users to contact the National Care Standards Commission;
• The address and telephone number of the National Care Standards Commission;
• Details of insurance cover;
• Hours of operation.
The Guide also includes information on the following matters that apply where the agency is an
employment business:
• Procedures to safeguard nurses and patients;
• Procedures to safeguard the property of service users who are patients;
• Procedures for the administration, or assistance with the administration, of medication to
service users who are patients, in accordance with the NMC Code of Professional Conduct;
• Requirements to protect the health and safety of nurses;
• Procedures to be followed in the event of an accident or other specified incident in the homes of service users who are patients;
• Arrangements for qualified nurse support of nurses working out of hours;
• Arrangements for service users to express their views about the service provided by the agency.
1.4 Service users, their carers and advocates are kept fully informed on issues relating to their care from the agency, where the agency is an employment business. They are advised how to contact the agency on all days and at all times when nurses are working on assignments through the agency, including out of hours.
Fitness of Registered Persons
2.1 All persons directly involved in managing and running the agency are able to demonstrate that they are fit persons, i.e. suitable and competent.
2.2 Owners and managers of the agency have a sufficient range of knowledge, experience and expertise between them for the effective and efficient running of the agency. The registered manager:
• obtains a nationally recognised qualification, at level 4 NVQ or equivalent, in management within 5 years from the date of application of these standards or, following that period, within 2 years of employment;
or
• is a first level registered nurse and, within 5 years from the date of application of these standards or, following that period, within two years of employment, has a relevant management qualification.
2.3 The registered manager undertakes periodic management training to update his or her knowledge, skills and competence to manage the agency.
OUTCOME: Service users are assured of the integrity of the agency and have confidence that it is run by a fit person or organisation.
Recruitment
3.1 The recruitment process operates in line with equal opportunities and is non-discriminatory.
3.2 A person who is a registered nurse (with a current NMC registration) undertakes interviews for the recruitment of all grades of agency nurses. This registered nurse has relevant experience to enable the assessment, selection and placement of nurses with clients according to their qualifications, competencies and skills. The nurse undertaking interviews need not be the same person who is responsible for the placement of nurses with particular.
OUTCOME: The process for recruitment and selection of nurses meets all the requirements
of legislation and employment law including that related to equal opportunities and anti discriminatory practice.
Recruitment and supply of nurses
STANDARD 4
4.1 All necessary and appropriate checks are undertaken on the nurse supplied or to be supplied, prior to commencing employment.
4.2 If a nurse is included on the list maintained by the Secretary of State for Health of individuals who are considered unsuitable to work with vulnerable adults (when the POVA list is operational), or the list maintained by the Secretary of State for Health of individuals who are considered unsuitable to work with children, or the Sex Offenders Register, and the agency believes that there are mitigating factors(e.g. a person who is on the list of individuals considered unsuitable to work with children, whose duties will not bring them into contact with children), the agency seeks agreement in writing from the NCSC before engaging or supplying that person.
4.3 The applicant’s health record is checked, including obtaining a copy of the applicant’s immunisation record and current status showing that the necessary immunisations for practice are current – in line with the recommendations in the UK Health Department’s publication Immunisation Against Infectious Disease. A nurse is not engaged or supplied by the agency if she has a history of illness that would make her unsuitable for duties to which she may be assigned. In cases of doubt the agency seeks agreement in writing from the NCSC before engaging or supplying that person.
Identification and qualifications
STANDARD 5
5.1 The agency keeps all necessary records in respect of each nurse supplied or to be supplied by the agency.
5.2 Nurses supplied by the agency have a current registration with the Nursing and Midwifery Council (NMC):
• The agency obtains a caller code from the NMC and obtains confirmation of registration of
new and existing registered nurses via the NMC’s Employer’s Confirmation Service.
• The agency checks notifications of registered nurses who have been removed or suspended from
the register.
• All nurses work within the NMC Code of Professional Conduct.
OUTCOME: The agency has documentary evidence demonstrating the personal identification,
registration, ongoing eligibility to be employed as a nurse, and relevant qualifications of each nurse to be supplied.
OUTCOME: Services users are confident that nurses supplied by the agency will provide good
quality care and will not jeopardise the safety of patients.
Nurses Agencies – National Minimum Standards
5.3 The following information is recorded:
• Record of any formal interview to a consistent and adequate procedure;
• Details of next of kin, together with an emergency contact telephone number;
• A copy of the individual’s immigration status, if appropriate (see Home Office guidance on
Prevention of Illegal Working);
• A copy of the driving licence, if necessary for the duties to be carried out.
• Details of other employment (if any) including current employment by other agencies;
• Details of any unspent convictions, subject to the Rehabilitation of Offenders Act (1974) and
Rehabilitation of Offenders (Exceptions) Order 1975.
Competence
STANDARD 6
6.1 Where the agency is an employment business, there is a written and formal induction process that is completed by every new nurse to be supplied. The induction process covers, as fully as possible, the responsibilities that the nurse supplied will have.
6.2 The agency shall supply details of qualifications and experience of the person being supplied to the service user.
6.3 The agency shall assure itself, by confirming current registration and examining such other certificates as indicate specialist or advanced knowledge and skills, that nurses supplied to service users have been trained to work in the field of practice to which they are being assigned.
6.4 The assessment of service users’ needs for home nursing will be carried out only by a registered nurse. The collection of information on service users’ needs will be carried out by or under the supervision of a registered nurse, who takes professional responsibility for the updating, accuracy and sufficiency of the information.
6.5 The person carrying out the assessment of home nursing needs is responsible for obtaining the patient’s informed consent to assessment, treatment and care.
OUTCOME: Nurses supplied by the agency are competent and trained to undertake the activities for which they are employed and responsible.
Recruitment and supply of nurses
STANDARD 7
7.1 The agency maintains a clear written procedure for handling complaints. Positive action is taken to publicise the complaints procedure and enable service users to make a complaint. Publicity includes advice that complaints may be taken up with the NCSC if the complainant is dissatisfied.
7.2 The procedure sets out a clear investigative process with timescales for action, ensuring that all complaints are thoroughly followed through.
7.3 All complaints are acknowledged promptly. The agency keeps a full written record of the nature of the complaint and details of the action taken as a result.
7.4 The agency operates a system to analyse and identify any recurring area or pattern of complaints. A summary of all complaints and action taken is provided to the NCSC on request.
7.5 Nurses supplied by the agency are fully and promptly informed of complaints relating to themselves.
7.6 A procedure is in place for reporting nurses to the NMC where there is evidence of misconduct.
7.7 A complaints procedure is available to be used by nurses placed by the agency, where it is an employment business.
OUTCOME: Service users are confident that their complaints will be listened to, taken seriously and acted upon.
Complaints and Protection
Protection
STANDARD 8
8.1 The registered person ensures that service users who are also patients are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self-harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies.
8.2 Robust procedures for responding to suspicion or evidence of abuse or neglect (including whistleblowing) ensure the safety and protection of service users, including the involvement of the police and the passing on concerns to the NCSC in accordance with the Public Interest Disclosure Act 1998 and the Department of Health’s guidance “No Secrets”.
8.3 All allegations and incidents of abuse are followed up promptly and the details and action taken are recorded.
8.4 The agency complies with the relevant legal requirements relating to the referral of individuals to the Secretary of State for consideration for inclusion on the lists of persons unsuitable to work with children or vulnerable adults, as appropriate.
8.5 The agency has clear policies and procedures for nurses on the safe handling of money and property belonging to service users who are also patients. These preclude nurses supplied by the agency being involved in assisting in the making of or benefiting from service users’ wills.
8.6 Clear protocols are in place in relation to entering and leaving the homes of service users.
8.7 There are clear procedures for nurses to follow in case of a non-response or discovery of an accident to the service user on arrival at the premises or other emergency situation.
OUTCOME: Service users who are also patients are protected from abuse, where the agency is an employment business.
Assistance with Medication
STANDARD 9
9.1 The agency operates a clear, written policy in accordance with the NMC Code of Professional Conduct. This identifies parameters and circumstances for administering or assisting with medication, and identifies the limits to assistance and the tasks which may not be undertaken without specialist training. It also makes clear that a patient’s informed consent should be sought for all aspects of care.
9.2 The policy makes it clear that any administration of or assistance or support with medication is only given when it is within the competence of the nurse, and with the patient’s informed consent in line with the Department of Health’s guidance on consent to examination and treatment.
9.3 The policy includes a clear process for reporting concerns, responding to incidents and seeking guidance if unanticipated events occur. It covers capacity to consent and drug error procedure.
9.4 The person administering or assisting with medication in a person’s home always records any assistance or advice immediately after the medication is administered. Records should include dosage given, time of medication, and method of administration, and should be recorded on the home care medication record and if necessary in the care plan or personal file of the service user.
Confidentiality
STANDARD 10
10.1 All information relating to service users who are also patients is kept in confidence.
10.2 The agency complies with the requirements of the Data Protection Act 1998, in particular ensuring that service users who are also patients have access to the information that is kept on their personal file if they wish
OUTCOME: Action is taken to protect confidentiality of information relating to service users who are also patients, their carers and advocates.
OUTCOME: Service users who are patients are protected by the agency’s procedures for assistance with medication, where the agency is an employment business.
Safe Working Practices
STANDARD 11
11.1 The registered person ensures so far as is reasonably practicable the health, safety and welfare of service users who are also patients, and of nurses.
11.2 The registered person ensures compliance with relevant legislation relating to the provision of care to people in their own homes. The main statutory provisions are as follows:
• Health and Safety at Work Act 1974;
• Management of Health and Safety at Work Regulations 1999;
• Manual Handling Operations Regulations 1992;
• Control of Substances Hazardous to Health Regulations (COSHH) 1988;
• Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995;
• Lifting Operations and Lifting Equipment Regulations (LOLER) 1998;
• Provision and Use of Work Equipment Regulations 1998.
• Provision and use of Work Equipment Regulations 1998 (PUWER)
11.3 Where the service user is also a patient, to ensure the health and safety of the service users and the nurse, the agency will work with the service user to perform an adequate assessment of the risks at the premises where work is to be performed, or ensure that all relevant information on risks, including information required for infection control, is obtained from the service user and made known in writing to the nurse, before she starts work or as soon as possible where pressure of time does not allow an assessment of risk to be undertaken prior to the provision of care.
11.4 Nurses supplied by the agency to a patient in the patient’s own home ensure that equipment is in a safe condition to use and that inspections have taken place on time, and if necessary remind the organisation providing the equipment that a check is due. Equipment is not used if the necessary checks have not been undertaken.
OUTCOME: The health, safety and welfare of service users who are also patients, and of nurses, are promoted and protected, where the agency is an employment business.
Financial procedures
STANDARD 12
12.1 Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business
12.2 Where the agency is an employment business, payment to a nurse supplied by the agency will be made regardless of whether the client has paid the agency. Receipts are issued in respect of payments made to the agency if the client so requests.
12.3 The agency ensures that adequate insurance cover is held against loss of, or damage to, assets that are used for the purposes of the agency. In particular, the insurance covers the cost of replacing lost or damaged assets, and losses incurred as a result of any interruption of the operation of the agency.
12.4 The agency also ensures that adequate insurance is held against liability which may be incurred to any person as a result of the operation of the agency, including death, injury, public liability, damage or other loss, and that the amount of such cover is commensurate with the level and extent of activities undertaken and not less than £5 million.
12.5 The registered provider is able to demonstrate that there is an adequate process for business and financial planning to cover the operation of the agency.
OUTCOME: Approved accounting and financial procedures are adopted to ensure the effective and efficient running of the business and its continued financial viability.
Management and Administration
Premises
STANDARD 13
13.1 The premises contain equipment and resources necessary for the efficient and effective management of the service.
13.2 The premises provide an accessible, safe and clean working environment for staff. The premises are accessible by the NCSC for inspection purposes as required.
Management Structure
STANDARD 14
14.1 The management structure reflects the size of the agency and the volume and complexity of the care provided.
Organisational policies
STANDARD 15
15.1 The agency operates a clear written set of organisational policies, which are included in a staff handbook to be issued to every nurse who is supplied or available for supply by the agency.
15.2 The staff handbook includes information on:
• The conduct expected of nurses supplied by the agency;
• the role and responsibilities of nurses supplied by the agency;
• record keeping requirements;
OUTCOME: Nurses supplied by the agency know the standards of conduct expected of them and are aware of the agency’s organisational policies, where the agency is an employment business.
OUTCOME: An appropriate management structure and clear lines of accountability are in place.
OUTCOME: There are designated premises suitably equipped for the purpose of the day to day operation and management of the service.
Management and Administration
• training and development requirements and opportunities;
• the specific policies implemented in relation to the supply of nurses to service users who are
patients;
• where the agency is an employment business, disciplinary action which may be taken against them;
• the agency’s policy for dealing with allegations of abuse.
Agreements between the agency and nurses
STANDARD 16
16.1 Where the agency is an employment business, all nurses to be supplied by it are provided with a written contract of service or for services, specifying details of their terms and conditions of service. The terms and conditions of engagement may vary in their title depending on the status of the agency. This only applies to employment businesses because those agencies introducing nurses on a permanent basis will not have a contract of either type with the nurses since the engagement occurs between the nurse and their new employer.
Record keeping
STANDARD 17
17.1 The agency retains, up to date and accurate, all records required by regulation for the protection of service users and for the efficient running of the business, in a form suitable for inspection by the NCSC. Records retained on electronic or photographic media are acceptable. Records are maintained for at least three years.
17.2 Individual records concerning service users and nurses supplied by the agency are kept secure, up to date and in good order, and are constructed, maintained and used in accordance with the Data Protection Act 1998 and other statutory requirements.
OUTCOME: Service users’ and nurses’ interests are safeguarded by the agency’s record keeping policies and procedures.
OUTCOME: There is a written agreement between the Agency and nurses.
Quality Assurance
STANDARD 18
18.1 The agency operates an effective written Quality Assurance system, based on consulting with service users and where appropriate their carers or advocates, in order to measure success in meeting the aims and objectives of the agency.
18.2 The agency should monitor the quality of placements for both service users and nurses.
18.3 The registered person ensures that the agency has a continuous process of self-monitoring, including an internal audit at least annually.
OUTCOME: The agency operates in the best interests of service users and of nurses supplied by it.