Crossroads CareAdults’ personal care guidance

B.01c

Adults’ personal care guidance

for care workers

1.0 SCOPE

1.1 This personal care guidancerefers to adults aged18 and over. There is separate guidance (C.02c)for children and young people aged 17 and under. The intended outcome of this document is to ensure that the service user gets effective, safe, personalised care and support that is appropriate to and meets their individual needs.

1.2You need to read this guidance together with the following Crossroads Care documents:

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

2.0 PERSON-CENTRED CARE AND SUPPORT

2.1 Person-centred care involves putting the person using the service at the centre of their care and support, ensuring that, wherever possible, they get the help they want, as and when they want and need it.

2.2 We expect that, as a care worker, you will:

  • recognise each person as an individual, valuing their uniqueness and diversity
  • treat carers and people with care needs with respect and ensure no one receiving a service from Crossroads Care receives less favourable treatment because of their race, gender, marital status / civil partnership, sexual orientation, gender re-assignment, age, ethnic origin, disability, religion or belief, status as a carer, offending background or any other personal characteristic or circumstance
  • uphold each person’s right to privacy, dignity and confidentiality
  • support each person wherever possible to make their own choices and decisions about their care
  • help each person to make the most of their skills and abilities
  • involve the person with care needs’carer/s, family and friends in their care and support, if that is what the person wants you to do and your line manager has agreed it
  • ensure everything is done to maintain the person with care needs in a safe environment.

2.3 As a staff member involved in the provision of care and support , we want you to see your work as helping those you care for to achieve their own goals and outcomes, and not just as ‘doing jobs’.

2.4 Practical examples of person-centred care

2.4.1 Make sure that you:

  • treat people with care needs, their carers, representatives, relatives and friends with courtesy and politeness at all times
  • call the person with care needs and their carer by the names they prefer you to use
  • know how the person receiving care communicates what they want, as well as what they like and don’t like
  • are aware of how each person lets you know when they are unhappy or in pain or distress.

2.4.2As a care workerit is important that you help the person with care needs to remain as independent as possible for as long as possible. This means that wherever you can you:

  • involve the person with care needs in decisions about their care
  • encourage and support them to help with their own carerather than doing everything for them
  • never rush the person with care needs or take over to speed things up.

2.4 3 Unless the care plan says otherwise, you could, for example encourage the person with care needs where possible to:

  • dry themselves as much as they can after a wash
  • brush their own teeth
  • choose what clothes they want to wear
  • decide what they want to do and where they want to go (in line with the care plan)
  • choose what they would like to eat and drink (see6.0 below).

2.4.4 Always provide personal care and support in a way that maintains and respects the person’s privacy, dignity and lifestyle. Small things make all the difference. For example:

  • knock on doors before entering (don’t forget, you are working in someone else’s home)
  • keep the person as covered up as possible with a towel when you are helping them to wash
  • don’t talk over a person’s head when you are working with someone else and make sure you involve them in any conversation you are having
  • talk to the person respectfully, let them know youvalue their opinion take their views into account and respect their wishes wherever possible.

3.0 service planning AND REVIEW

3.1 A care planner will see all newly referred service users to carry out a risk assessment and to draw up a care planbefore you start to visit.

3.2 The person receiving care and / or their carer will have been fully involved in deciding the content of the care plan, which will record exactly the care and support the person’s care needs wishes to receive and you are allowed to give.

Please note that you are only allowed to provide the care and to do the tasks that are written down in the care plan.

3.3You will be given all the training you need and will have the opportunity to read the care plan and risk assessments before you start to visit. Never carry out any tasks that:

  • are not documented in the care plan
  • you have not been trained to do
  • you do not feel able to do.

You can ask for further training at any time.

3.4 If at any point you are concerned that a person’s care plan is no longer accurate and doesn’t match their requirements let your line manager know.They may need to review the care plan to bring it up to date.

4.0 levels of care

4.1 Personal care tasks fall into three categories:

  • basic
  • specialised
  • prohibited

Please see Appendix 1 at the end of this document for a list of each category of tasks.

4.2 Basic tasks

4.2.1 You will be trained at induction to deliver basic tasks in the home, including personal, social and domestic care.

4.2.2 You may be asked to provide care to people with complex needs (including for example those listed in Appendix 2) and will be given further training to do this. If you have a special interest in developing skills in any of the subjects listed in Appendix 2, let your line manager know.

4.3 Specialised tasks

4.3.1The care planner will decide whether or not a specialised task can be carried out safely. If you areasked to providea specialised task you will first be given the additional training you need.

4.3.2 If you have not been specially trained and assessed as competent to provide a specialised task for an individual person with care needs, you are not allowed to carry out that task because of the risk implications to both yourself and the person concerned.

4.3.3You do not have to carry out specialised tasks if you don’t want to – if this is the case please speak to yourline manager. You will not be penalised for not wanting to provide specialised care, although it may have an effect on the amount of work you are given.

4.4 Prohibited tasks

4.4.1There are certain tasks that are prohibited.Under no circumstances are you allowed to carry out a prohibited task.These are listed in Appendix 1 at the end of this document.

5.0 INTIMATE PERSONAL CARE TASKS

5.1Intimate care canmean different things to different people, depending on theirupbringing and different backgrounds. It can include any of the following:

  • feeding
  • mouth care
  • washing
  • dressing / undressing
  • toileting
  • menstrual care
  • treatments such as enemas, suppositories, enteral feeds
  • administration of medication
  • catheter and stoma care
  • supervision of a person whilst they are carrying out their own intimatecare tasks.

The list is not exhaustive.

5.2 Providing intimate personal care to people with disabilities is one of the factors that potentially makes them more vulnerable to abuse. If you provide intimate personal care to people with care needs, make sure you have read and understand the safeguarding adults guidance (B.05c). If you have any questions or concerns, ask to speak to your line manager.

5.3 The care plan will include details of:

  • what tasks you are expected to do
  • where and how you are expected to do them
  • how the person with care needs communicates, which may include use of words, signs, symbols, body movements, eye pointing
  • the gender of staff required to carry out the task safely.

5.4 The care planner will assess whether you can carry out the intimate care task(s) alone or whether there needs to be two of you to do the job safely

6.0 EATING AND DRINKING

6.1 A healthy diet is essential to a person’s health and wellbeing. Some of the people you visit may need help with eating or drinking or, depending on their illness or condition, may want you to help them prepare their own meals.

6.2 The care planner will carry out an assessment of the person’s needs regarding food and drink and will then document the details in their care plan.

6.3 The care plan will give you the following information as appropriate to the person with care needs:

  • whether the person wants and is able to plan and / or prepare their own meals, and if so, the level of help / support you need to give them
  • whether the person needs help with eating and drinking
  • the level of help or support required with eating and drinking, including ways in which you can help them to eat and drink as independently as possible
  • how to encourage 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 you can give during your visit
  • whether you need to record the person’s food and fluid intake.

6.4 You need to follow the directions given in the care plan at all times in relation to food and drink. If you have any concerns or are unsure about anything get in touch with your line manager to discuss.

6.5 Whatever level of help you are giving with food and drink you need to remember that mealtimes may well be an important focal point of a person’s day and need to be made as relaxed and enjoyable as possible. You need to make sure that:

  • the person has plenty of time to have their meal and that they are not hurried
  • you act with sensitivity and respect for the person with care needs and in a way that preserves their dignity
  • you encourage and help them to eat and drink as independently as possible
  • where necessary, you help the person into an appropriate position that allows them to eat and drink safely.

6.6 You can find more information about food handling and preparation are in the food handling and basic hygiene guidance (D.06c).

7.0 insurance

7.1 You will be covered by insurance whilst you are providing care and support so long as you work in accordance with the following documents:

  • the guidance documentslisted at 1.2 above
  • your job description
  • eachindividual service user’scare plan.

8.0 documentation and record keeping

8.1 You will be trained at induction on how you are expected to fill in client report forms and how to keep accurate records.

8.2At every visit it is your responsibility to record on the client report form what has happened and what you have done. You need to use black ink and to make sure your writing is always readable.

8.3Client report formsneed to contain details of:

  • the date and timeof your visit, using the 24hour clock (for example 14.30hours)
  • the care and support you have given, for examplehelp with showering, the provision of a meal, any activities you have done together with the person with care needs
  • any specialised tasks you have carried out
  • any trips outside the home
  • any domestic tasksyou have done
  • any tasks on the care plan thatyou were supposed to do but were not able to and the reason why
  • any changes in the health, physical condition or care needs of the carer or person with care needs (see also 9.1 below)
  • any help with medication – see the adults’ medication guidance(B.02c) for details
  • any financial transactions you have been involved in on behalf of or with the carer or person with care needs
  • any accident /near miss, however minor, to the carer or person with care needs or to you, the care worker (see also 9.1 below)
  • any other out of the ordinary incidents (see also 9.1 below)
  • any other information that would be ofhelp to the next health or care worker
  • any other information you have been asked to keep a record of,for examplefluid intake.

8.4Client report formsmust not contain:

  • any personal comments about service users, staff or other professionals – if you think there is a problem, report it to your line manager
  • your own opinions
  • any abbreviations.

8.5 If you make a mistake or write something and then want to change it, draw a line through the error so that what you first wrote is still readable. Do not scribble it out or use Tippex so that it cannot be read. You also need to date and initial the changes. If your report finishes partway along a line, then draw in a line to the end so that nothing can be added.

8.6 Once you have written the client report form, you need to sign / initialyour entry and wherever possible ask the person with care needs or their carer to sign it as well to verify that what you have writtenis accurate.

8.7If you are providing a service to more than one person in the same home, even if they are members of the same family, they will each have their own personal care plan in place and you will be directed to keep separate records for them, with cross-references if necessary.

8.8Make sure that each report sheethas the person with care needs’ name on it.

8.9You are required to return client report formsto the scheme office at the end of each month or as directed by your line manager.

9.0 reporting

9.1 You are required to keep records of and report promptly to your line manager / the person on call:

  • all accidents / incidents /near misses, however minor, involving you, the person with care needs or their carer
  • any change in the condition of the person with care needs or their carer.

9.2 If you make a mistake that may affect the health and wellbeing of a service user whilst you are providing care or support, you have a duty to tell the person and / or their carer what has happened and to inform your line manager / the person on call immediately. Your line manager / the person on call will let you know what further action you need to take.

10.0 LEARNING AND DEVELOPMENT

10.1 General learning and development requirements relevant to the personal care of adults are contained in the learning and development guidance (E.13c).

11.0 ACCEPTANCE OF ADULTS’ PERSONAL CARE GUIDANCE

11.1 You are required to sign to indicate that you have received, read and understood the content of the adults’ personal care guidance as directed by your line manager.

11.2 On completion of training, it is your personal responsibility to followthe adults’ personal care guidance. Failure to do so may result in disciplinary proceedings.

APPENDIX 1

Levels of Care

basic tasks

All care workers need to be trained and assessed as competent to provide the basic tasks listed below prior to delivering them.

  1. Assistance with all aspects of personal hygiene including:
  • bathing / showering / washing
  • the use of bath-aids, including the use of bath thermometers
  • care of skin and hair, including shaving
  • care of mouth and teeth, including dentures.
  1. Assistance with management of continence of bladder and bowel, including:
  • the promotion of continence
  • the use of continence aids such as pads, convenes / sheaths.
  1. The management of indwelling urinary catheters, including emptying and changing bags and monitoring urinary output.
  2. The prevention of pressure sores.
  3. Assistance with dressing and undressing, choice of clothes and personal appearance.
  4. Hand care and manicuring (including filing and trimming of finger nails).
  5. Assistance with mobility and transfers, including:
  • use of equipment such as walking aids, wheelchairs, hoists, stair lifts
  • getting in and out of bed.
  1. Food preparation, handling and storage.
  2. Assistance with oral feeding and monitoring of food / fluid intake.
  3. General support with and administration of medication, including:
  • taking tablets, capsules, oral mixtures
  • applying a medicated cream / ointment / lotion
  • applying a transdermal patch
  • inserting drops to ear, nose or eye
  • sub-lingual medication
  • administering inhaled medication, including use of inhalers and nebulisers.
  1. Ensuring a safe environment.
  2. Supporting service users outside their home.
  3. Assistance with appliances (for example hearing aids, spectacles, artificial limbs).
  4. Basic first aid (including basic life support) and summoning emergency services.
  5. Emergency treatment of anaphylactic shock using EpiPen.
  6. Assistance with exercise programmes for the rehabilitation and development of an individualas agreed with the relevant physiotherapist, occupational therapist or speech therapist.

This list is exhaustive of the tasks that can be undertaken by care workers after induction training.