We have set out the National Minimum Standards for domiciliary care agencies including Local authority provision and NHS Trusts. 

They form the criteria by which the National Care Standards Commission will determine whether the agency provides personal care to the required standard.  The purpose of these minimum standards is to ensure the quality of personal care and support which people receive whilst living in their own home in the community.

 

These standards will be applied to agencies providing personal care to the wide range of people who need care and support whilst living in their own home, including:

 

• older people

• people with physical disabilities

• people with sensory loss including dual sensory impairment

• people with mental health problems

• people with learning disabilities

• children and their families

• personal or family carers

 

 

 

 

All agencies providing personal domiciliary care services, irrespective of size will be required to have a person as registered as the ‘Fit Person’ who has overall responsibility for the service. This person may be the owner or the most senior manager of the service.

 

Where the Registered Person is not responsible for the day to day management of the service or where they lack the required qualifications and experience or where the service is provided from more than one office location, the Registered Person must appoint an experienced and qualified manager responsible for managing the office location on a day to day basis. This manager must also apply to be registered by the CSCI.

 

 

The Care Standards Act, 2000 did not include a definition of “personal care” (except that regulations may be made excluding prescribed activities from personal care). Its established, ordinary meaning includes four main types of care which are:

 

• assistance with bodily functions such as feeding, bathing and toileting

 

• care falling just short of assistance with bodily functions, but still involving physical and

intimate touching, including activities such as helping a person get out of a bath and helping

them to get dressed

 

• non-physical care, such as advice, encouragement and supervision relating to the foregoing,

such as prompting a person to take a bath and supervising them during this

 

 

 

Each agency providing personal domiciliary care should produce a guide for service users with a statement of purpose, setting out its aims and objectives, the range of services it offers and outlining the terms and conditions on which it does so. In this way service users, their relatives and representatives can make a fully informed choice about whether or not the organisation is suitable and able to meet the individual’s particular needs.

 

A copy of the most recent inspection report should also be made available.

 

The statement of purpose will enable inspectors to assess how far the organisation’s claims are being fulfilled.

 

Providing user focused services also means ensuring that care workers have the flexibility to vary the care provided to meet changing needs on a day to day basis. For example if the need is to assist the service user get up, washed and dressed and give them breakfast, the care worker must be able to respond flexibly and appropriately if on one occasion they find that they feel unwell and want to remain in bed.

 

Research into the views of service users about their personal care has identified that the continuity of care and support worker is extremely important. Service users and their relatives need to feel comfortable, relaxed and secure with the care workers they are inviting into their home. They want to have care workers they can get to know and who are reliable, dependable and arrive and depart at the time expected. Service users and their relatives also want to know in advance if there is to be any change in their care or support worker so they can be prepared.

 

 

 

 

The Statement of Purpose and the Service User’s Guide are written in plain English and are available in appropriate formats e.g. large print, Braille. Where services are or may be provided to people for whom English is not their first language, the documents are made available in the language of their choice.

 

Care needs assessment

 

4.1 Each service user is issued with a written contract (if self –funding) provided by the agency within seven days of commencement of the service.

OUTCOME: Each service user has a written individual service contract or equivalent for the

provision of care, with the agency, except employment agencies solely introducing workers.

 

OUTCOME: Service users, their relatives and representatives know that the agency providing the personal care service has the skills and competence required to meet their care needs

 

STANDARD 5

 

 

5.1 Care and support staff respect information given by service users or their representatives in confidence and handle information about service users in accordance with the Data Protection Act 1998 and the agency’s written policies and procedures and in the best interests of the service user.

OUTCOME: Service users and their relatives or representatives know that their personal information is handled appropriately and that their personal confidences are respected. In the case of standards 5.2 and 5.3, these do not apply to employment agencies solely introducing workers.

 

5.2 Service users have summaries of the agency’s policies and procedures on confidentiality which specifies the circumstances under which confidentiality may be breached and includes the process for dealing with inappropriate breaches of confidentiality.

 

5.3 Care or support workers know when information given them in confidence must be shared with their manager and other social/health care agencies.

 

5.4 The principles of confidentiality are observed in discussion with colleagues and the line manager, particularly when undertaking training or group supervision sessions.

 

5.5 Suitable provision is made for the safe and confidential storage of service user records and information including the provision of lockable filing cabinets and the shielding of computer screens from general view when displaying personal data.

 

 

 

STANDARD 6

 

 

6.1 Staff are reliable and dependable, are able to respond flexibly to the needs and preferences of service users which arise on a day to day basis and services are provided in a way that meets the outcomes identified in the care plan.

 

6.2 Staff arrive at the home within the time band specified and work for the full amount of time allocated.

 

6.3 Upon arrival in the home, care or support staff ask the service user if there are any particular personal care needs or requirements they have on that visit.

 

6.4 The registered manager ensures that there is continuity in relation to the care or support worker(s) who provide(s) the service to each service user.

 

6.5 Care or support workers are only changed for legitimate reasons for example:

 

• the care or support worker is sick, on holiday, undertaking training or has left the organisation

 

• if the service requirements change and the care worker does not have the necessary skills,

physical capacity or specialist training

 

• the care or support worker is unavailable for additional hours or changed times

 

• if the service user requests a change of care or support worker for legitimate reasons

 

• if a non-professional relationship has developed between the service user and the care or support worker.

 

• to provide relief for care or support staff working in stressful situations

 

OUTCOME: Service users receive a flexible, consistent and reliable personal care service. In the case of standards 6.3 and 6.4 these do not apply to employment agencies solely introducing workers and other health related activities is therefore essential.

 

STANDARD 7 (See regulation 14)

 

 

7.1 A personal service user plan outlining the delivery arrangements for the care is developed and agreed with each service user, which provides the basis for the care to be delivered and is generated from the care needs assessment, (Standard 2) service user plan, risk and manual handling risk assessment

 

STANDARD 8 (See regulation 14)

 

 

8.1 Personal care and support is provided in a way which maintains and respects the privacy, dignity and lifestyle of the person receiving care at all times with particular regard to assisting with:

 

• dressing and undressing

 

• bathing, washing, shaving and oral hygiene

 

• toilet and continence requirements

 

• medication requirements and other health related activities

 

• manual handling

 

• eating and meals

 

• handling personal possessions and documents

 

• entering the home, room, bathroom or toilet

8.2 Care and support is provided in the least intrusive way at all times.

 

8.3 Service users, their relatives and their representative are treated with courtesy at all times.

 

8.4 Service users are addressed by the name they prefer at all times.

 

8.5 Care and support workers are sensitive and responsive to the race, culture, religion, age, disability, gender and sexuality of the people receiving care, and their relatives and representatives.

 

 

STANDARD 9 (See regulation 14)

 

9.1 Managers and care and support workers enable service users to make decisions in relation to their own lives, providing information, assistance, and support where needed.

 

9.2 Service users are encouraged, enabled and empowered to control their personal finances unless prevented from doing so by severe mental incapacity or disability. (see Standard 13.5)

 

OUTCOME: Service users are assisted to make their own decisions and control their own lives and are supported in maintaining their independence.

OUTCOME: Service users feel that they are treated with respect and valued as a person, and their right to privacy is upheld

 

 

10.1 The registered person ensures there is a clear, written policy and procedure which is adhered to bystaff and which identifies parameters and circumstances for assisting with medication and health related tasks and identifies the limits to assistance and tasks which may not be undertaken without specialist training.

 

10.2 The policy should include procedures if required for obtaining prescriptions and dispensed medicines and for recording the information.

 

10.3 Staff only provide assistance with taking medication or administer medication or undertake other health related tasks, when it is within their competence; they have received any necessary specialist training and it is:

 

• with the informed consent of the service user or their relatives or representative

 

OUTCOME: The agency’s policy and procedures on medication and health related activities protect service users and assists them to maintain responsibility for their own medication and to remain in their own home, even if they are unable to administer their medication themselves. In the case of standards 10.8, and 10.9, these do not apply to employment agencies solely introducing workers.

 

 

 

 

The health and safety of service users and home care and support workers is a major issue of concern in the provision of personal domiciliary care. Despite the requirements of legislation, accidents occur all too frequently. Failure to observe health and safety requirements is a major cause of long term illness among home care staff. Training on all aspects of health and safety is essential to ensure that home care and support staff are able to respond appropriately and work in a safe manner.

 

Before commencing the provision of care in a new home, to comply with the requirements of legislation a detailed risk assessment must be made by the organisation providing the service, of the risks associated with the delivery of the service. This assessment must be undertaken by someone who is trained for the purpose. This may be the registered manager or it may be an experienced home care or support worker.

 

The risk assessment must be comprehensive and include, where appropriate, the risks associated with assisting with medication as well as any risks associated with travelling to and from the home of the service user, particularly late at night. A separate assessment must be undertaken of the risks associated with manual handling. It is important that care strategies are devised in relation to assisting people with disabilities which are acceptable to the

person concerned and are also safe for the care and support workers involved. Guidance on manual handling from the Health and Safety Executive has been revised and updated in 2002.

 

The Department of Health guidance on Fair Access to Care Services was published in 2002.

The service user also retains responsibilities in relation to the health and safety of the environment in which they live and not place people visiting the home at risk. All the risks identified must therefore be discussed in full with the service user, their relatives or representative, the home care or support worker and their line manager and the commissioner of the care (if involved). A plan to manage the identified risks must be compiled and agreed by all parties. The plan should include review and reassessment of the risks.

 

 

The general public is aware of the effects of child abuse; far less publicity is given to adult and elder abuse and many people, even those employed in providing care to adults, are still relatively unaware of the existence of abuse and its effects. Home care and support workers need to be aware that abuse does not have to be extreme or obvious. It can be unintentional, insidious and the cumulative result of ongoing bad practice. No organisation that is concerned with maintaining standards in the provision of professional care services can afford to ignore any form of abuse which affects the well being of the people for whom they are responsible.

 

 

The role that home care and support workers play in the lives of people they care for, is extremely important. It is the home care workers and support workers who have a key role in recognising and protecting people from abuse. They have a responsibility to the people for whom they provide the care service, to minimise both the likelihood of abusive situations occurring and the effects that it can have, and to contribute to monitoring anyone who may be considered to be ‘at risk.’ It is essential that care is taken in all financial transactions undertaken on behalf of the service user and a full written record kept to safeguard both the service user and the home care or support worker and to ensure no misunderstandings occur. For similar reasons home care or support workers must never seek to profit from the care they provide to service users by the acceptance of significant gifts or bequests.

 

The safety of service users is very important and for this reason care must be taken when entering or leaving the premises of people receiving care. This includes the need to carry and show proper identification at all times.

 

 

STANDARD 11 (See regulations 12, 13, 14 and 15)

11.1 The registered person ensures that the agency has systems and procedures in place to comply with the requirements of the Health and Safety legislation including:

 

11.2 The agency has a comprehensive health and safety policy, and written procedures for health and safetymanagement defining:

 

• individual and organisational responsibilities for health & safety matters

 

• responsibilities and arrangements for risk assessment under the requirements of the

Management of Health and Safety at Work Regulations 1999 (Management Regulations)

 

OUTCOME: The health, safety and welfare of service users and care and support staff is promoted and protected, except for employment agencies solely introducing workers.

 

12.1 The registered person ensures that an assessment is undertaken, by a trained and qualified person, of the potential risks to service users and staff associated with delivering the package of care, (including, where appropriate, the risks associated with assisting with medication and other health related activities) before the care or support worker commences work and is updated annually or more frequently if necessary.

 

OUTCOME: The risk of accidents and harm happening to Service Users and staff in the provision of the personal care, is minimised, except for employment agencies solely introducing workers.

 

13.1 The registered person ensures that there is a policy and there are procedures in place for staff on the safe handling of service users’ money and property covering:

 

• payment for the service/ service user’s contribution (if appropriate)

 

• payment of bills

 

• shopping

 

• collection of pensions

 

• safeguarding the property of service users whilst undertaking the care tasks

 

• reporting the loss or damage to property whilst providing the care

• accepting gifts or cash (beyond a very minimal value)

 

• using loyalty cards except those belonging to the service user

 

• making personal use of the service users property, eg telephone

 

• involving the service user in gambling syndicates (eg national lottery, football pools)

 

• borrowing or lending money

 

• selling or disposing of goods belonging to the service user and their family

 

• selling goods or services to the service user

 

• incurring a liability on behalf of the service user

 

• taking responsibility for looking after any valuable on behalf of the service user

 

• taking any unauthorised person (including children) or pets into the service user’s home

without permission of the service user, their relatives or representative and the manager of

the service

 

13.2 The agency’s policies and practices regarding service users wills and bequests preclude the involvement of any staff or members of their family, in the making of or benefiting from service users wills or soliciting any other form of bequest or legacy or acting as witness or executor or being involved in any way with any other legal document.

 

OUTCOME: The money and property of service users is protected at all times whilst providing the care service, except for employment agencies solely introducing workers.

 

14.1 Service users are safeguarded from any form of abuse or exploitation including physical, financial, psychological, sexual abuse, neglect, discriminatory abuse or self-harm or inhuman or degrading treatment through deliberate intent, negligence or ignorance in accordance with written policies and procedures.

14.2 The Registered Person ensures that the agency has robust procedures for responding to suspicion or evidence of abuse or neglect (including whistle blowing) to ensure the safety and protection of service users. The procedures reflect local multi-agency policies and procedures 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 guidance No Secrets.

 

14.3 All allegations and incidents of abuse are followed up promptly and the details and action taken recorded in a special record/file kept for the purpose and on the personal file of the service user.

 

14.4 The Registered Person ensures that there is a detailed policy, and there are procedures and a management and reporting plan for child protection.

 

14.5 The Registered Manager ensures that care and support staff working with children and their families have copies of the local authority child protection procedures and are fully conversant with the agency’s policy and procedures.

 

14.6 Physical and verbal aggression by a service user, their relatives or friends is responded to appropriately. Physical intervention is only used as a last resort, in accordance with Department of Health guidance and protects the rights and best interests of the service user, including people with special needs and is the minimum necessary consistent with safety. (see Standards 7.4 and 12)

 

OUTCOME: Service users are protected from abuse, neglect and self-harm, except for employment agencies solely introducing workers.

15.1 Care and support workers ensure the security and safety of the home and the service user at all times when providing personal care.

 

15.2 Clear protocols are in place in relation to entering the homes of service users which cover:

 

• knocking/ringing bell and speaking out before entry

 

• written and signed agreements on keyholding

 

• safe handling and storage of keys outside the home

 

• confidentiality of entry codes

 

• alternative arrangements for entering the home

 

• action to take in case of loss or theft of keys

 

• action to take when unable to gain entry

 

• securing doors and windows

 

• discovery of an accident to the service user

 

• other emergency situations (See Standard 4.2)

 

15.3 Identity cards are provided for all care and support staff entering the home of service users. The cards should display:

 

• a photograph of the member of staff

 

• the name of the person and employing organisation in large print

 

• the contact number of the organisation

 

OUTCOME: Service users are protected and are safe and secure in their home, except for

employment agencies solely introducing workers.

 

16.1 With the users consent care or support workers record on records kept in the home of service users, the time and date of every visit of to the home, the service provided and any significant occurrence. Where employed by the agency, live-in care and support workers complete the record on a daily basis. Records include, where appropriate:

 

• assistance with medication including time and dosage on a special medication chart.

(See Standard 10)

 

• other requests for assistance with medication and action taken (See Standard 10)

 

• financial transactions undertaken on behalf of the service user (See Standard 13)

 

• details of any changes in the users or carers circumstances, health, physical condition

and care needs

 

• any accident, however minor, to the service user and/or care or support worker

 

• any other untoward incidents

 

• any other information which would assist the next health or social care worker to ensure

consistency in the provision of care

 

16.2 Service users and/or their relatives or representatives are informed about what is written on the record and have access to it.

 

16.3 All written records are legible, factual, signed and dated and kept in a safe place in the home, as agreed with the service user, their relatives or representative.

 

16.4 Records are kept in the home for one month, or until the service is concluded, after which time they are transferred, with the permission of the service user, to the provider agency or other suitable body (eg local authority or health trust, or other purchaser of the service), for safe keeping.

 

16.5 Any service user or their relatives or representative on their behalf, refusing to have records kept in their home, is requested to sign and date a statement confirming the refusal and this is kept on their personal file in the agency.

 

OUTCOME: The health, rights and best interests of service users are safeguarded by maintaining a record of key events and activities undertaken in the home in relation to the provision of personal care, except for employment agencies solely introducing workers.

The expectations that service users and their families have of home care and support staff is very high. The work places considerable responsibility on all home carers who work, predominantly on their own, in other people’s own homes and in unsupervised settings.

 

The quality of the care provided to service users will directly reflect the calibre of staff employed and their level of competence. It is therefore essential that the people who are recruited to undertake the work are suitable for task. It is also essential that they are able to demonstrate their competence for the work they are employed to undertake. This means ensuring staff at all levels have opportunities to develop and receive the training necessary. To do otherwise would mean providing people living in their own home and requiring personal care with a ‘second-rate’ service.

 

As the care needs of people living at home become increasingly complex and as more people are discharged early from hospital, so there is a commensurate increase in the need for specialist training to meet the particular care needs of people with certain conditions. Training must also consider the needs of family and other carers. The quality of care provided is strongly influenced by the calibre of the managers of the service. It is therefore important that they are also able to demonstrate their management competence and their ability to perform

their responsibilities effectively. One of these responsibilities is the regular supervision and appraisal of staff.

 

This is particularly essential for home care staff who work daily in stressful, but totally unsupervised work settings. Unfortunately things do go wrong from time to time, and to deal with these situations it is necessary to have an effective disciplinary and grievance procedure. A Staff Handbook issued to all staff, helps to ensure that they know what is expected of them and what they should do in certain critical situations. It is also important that it is realised that the application of the standards applies equally to the engagement of temporary or agency staff.

 

17.1 There is a rigorous recruitment and selection procedure which meets the requirements of

 

17.2 Face to face selection interviews are undertaken on premises which are secure and private, for all staff (including volunteers) who are shortlisted and may be engaged.

 

OUTCOME: The well-being, health and security of service users is protected by the agency’s policies and procedures on recruitment and selection of staff.

 

17.3 Two written references are obtained before making an appointment, one of whom should normally be the immediate past employer and are followed up by a telephone call prior to confirmation of employment. Any gaps in the employment record are explored.

 

17.4 New staff and volunteers are confirmed in post only following completion of satisfactory checks. These checks include:

 

• verification of identity

 

• POCA list (where the post applied for is a “regulated position”

 

• work permit (if appropriate)

 

• driving licence (if appropriate)

 

• certificates of training and qualifications claimed

 

• declaration of physical and mental fitness

 

• confirmation service check by UKCC (if holding a nursing, midwifery or health visitor

qualification)

 

• sex offenders register

 

• General Social Care Council Register

 

17.5 Checks on the suitability of temporary staff may be undertaken by an employment or recruitment agency on behalf of the provider agency, provided that the checks comply with the requirements of these standards.

 

17.6 New staff, including temporary workers and volunteers, are provided with a written contract specifying the terms and conditions under which they are engaged, including the need to comply with the agencies’ Staff Handbook for staff. (See Standard 25)

 

17.7 Staff are employed in accordance with the code of conduct and practice set by the General Social Care Council and are given copies of the code.

 

17.8 The registered person complies with any Code of Practice published by the General Social Care Council setting out standards expected of persons employing social care workers, insofar as the code is relevant to the management of domiciliary care.

 

17.9 Staff are required to provide a statement that they have no criminal convictions, or to provide a statement of any criminal convictions that they do have.

 

18.1 All managers and staff are provided with a written job description person and work specification, identifying their responsibilities and accountabilities and with copies of the organisations’ Staff Handbook and grievance and disciplinary procedure.

 

18.2 The person specification includes the personal qualities required to undertake the work and the appropriate attitudes to be adopted.

 

18.3 Activities which should not be undertaken by care and support staff are also identified.

 

18.4 Person and work specifications are developed with reference to the relevant National Occupational Standards.

 

18.5 Staff are required to notify their employer of any new criminal offence they may have committed, including motoring offences.

 

18.6 An immediate investigation is undertaken on any allegations or incidents of misconduct and appropriate disciplinary action taken as necessary.

 

18.7 A record is kept of all disciplinary incidents and details entered in the personal file of the member of staff concerned.

 

18.8 Staff who are believed to have committed any offence prescribed by regulations are immediately reported to the Protection of Children (POCA) list. (See Standard 14.8), and, when it becomes operational, the Protection of Vulnerable Adults (POVA) list.

 

19.1 The registered person ensures that there is a staff development and training programme within the agency, reviewed and updated annually, which meets the workforce training targets of the Training Organisation for Personal Social Services, and ensures staff are able to fulfil the aims of the agency and meets the changing needs of service users, their relatives and representatives.

 

19.2 There is a structured induction process, which is completed by new care and support staff, which encompasses the Training Organisation for Personal Social Services induction standards.

 

OUTCOME: Service users know that staff are appropriately trained to meet their personal care needs, except for employment agencies solely introducing workers.

 

OUTCOME: Service users benefit from clarity of staff roles and responsibilities, except for

employment agencies solely introducing workers.