1. Independence and citizenship

Independence and the ability to maintain/develop roles as citizens is our ultimate aim but this means different things for different people. For some, this may be learning new skills to build upon independence whilst for others, this may mean exploring the potential for further recovery and rehabilitation. With the right support, everyone can achieve some independence. We want to support people to maximise their own potential for control over their lives – Practice Principle

Build services around people not organisations. People are at the heart of commissioning and everything we do should aim to give people greater control of their lives and improve their outcomes. This means building on the strengths and assets of people and communities – with a strong backing for paid and unpaid carers – Commissioning Principle

Tools and Resources:

• Hertfordshire Care Planning toolkit
• An Enabling Care Approach Guide
• Sit Less Move More Guide
• Staying Healthy At Home Booklet for individuals
• Stop Falls Mobile App
• Hertfordshire County Council One Off Direct Payments Guide
• LGBTQ+ learning framework for people in later life
• My Purple Folder
• NICE Guidelines and Toolkit
• PAL Guide for Activity Provision

Potential Evidence:

• Is there evidence to support that the individual has been involved in setting goals? If so, how have these goals been set and how are the improvements being measured? Goals are appropriate to the individual’s ability and age (i.e. Nursing would be looking at low level goals). Goals are personalised – not generic and agreed with individuals and/or family.
• Care plans detail individuals’ strength and independence skills and staff are aware of how to support individuals to maintain skills
• Care plans detail goals and include clear steps as to how these can be achieved; these are updated when any progress is made. Reviews are outcome focused and documented.
• Individuals are offered support and activities that encourage independence and choice at all times and again this is supported by observation of staff interaction.
• Staff are observed to maintain the core care values of the service.
• Staff are aware of and are observed promoting alternative methods to encourage choice and independence
• Culturally appropriate care is understood by staff and evidence within care plans and observations
• Care plans provide information to help staff support the individual to maintain links with families and maintain their interests (i.e. purchase of daily new paper to look at horse racing results). Evidence can be triangulated through the daily records.
• All relevant stakeholders are involved in this process (as appropriate). Care plans evidence what individual can/can’t do independently on a good and bad day.
• Creation of a Family tree/what’s ‘important to me’ and evidence to reflect that this has been used to support the individual in their care and support.
• Information for individuals (e.g. SU guide, care planning format, menu’s etc.) is available and provided in appropriate formats which should always account for individual communication needs, e.g. Easy Read, Perspex filters over the top for dyslexia, written in native language, large print, Moving and Assisting guide with photos of each stage, pictorial guide, menu cards, activities info.
• Information is readily accessible and meets the Accessible Information Standard- Evidence that individuals and family members have been involved in the preparation of the organisation’s information and can evidence how they have ensured that individuals and family have understood the information and that the information provided was helpful in making decisions around the care and support required. If there is no family or no family contact then there is evidence that the individual has been provided information on Advocacy.
• A directory of other services that Provider could access to support individuals with care planning / information guidance and support with local community services.
• The Provider has appropriate tools available to support individual whose main language is not English, e.g. a ‘key ring’ of laminated pictures and words to help with their decision making.

Support:

• Step 2 Skills Employment Education
• Stop Falls Webpage 

2. Every contact is strength based and risk positive

Strengths-based practice emphasises people’s self-determination, skills and assets and should underpin every conversation and contact. Risk-taking is a part of life and a part of social care too.

It’s something we all do. We take risks every day to make our lives better and achieve our goals. Risk involves the potential for benefit as well as harm so we don’t want to remove it completely. By taking a proportionate approach to reducing and mitigating the potential for harm, we can reach a balance between independence and the risk of harm – Practice Principle

Tools and Resources:

• SCIE Strength Based Approaches
• Enabling Care Approach Resource – Older People
• Posture Friends – Enabling Approach – Disabled Adults
• PAL Sensory Activity Level Guide
• Wellbeing and engagement
• Mental health needs for the older person

Potential Evidence:

• Care plans hold risk assessments that are person centred and are reviewed regularly (monthly). Where relevant the risk assessment takes into consideration DoLS and Best Interest decision making.
• Care Assessments clearly state the individuals preferences and abilities and include details that enable staff to promote independence. Strengths, abilities, and interests identified through the Care Assessments are reflected correctly in the Care Plans. Care plans provide information to help staff support the individual to maintain links with families and maintain their interests (i.e. purchase of daily new paper to look at horse racing results). Evidence can be triangulated through the daily records.
• Care plans fully detail individuals strengths and independence skills, staff are aware of how to support an individual to maintain these skills.
• Individuals and visitors spoken with must confirm that their activity choices are respected and implemented. A good variety of promoted activities are delivered as scheduled.
• Care workers are seen to engage with people in a meaningful way and encourage participation appropriately.
• Supporting unwise decisions as appropriate.
• If non-verbal – what other evidence is observed as being used to obtain consent, understanding the individuals body language, use of communication, symbols, Makaton.  Assessing conflict and reassessing risk i.e. re-approach the situation for refusal of meds.
• MUST & Waterlows are included on a health care plan, ensure that care plans clearly state how the home will identify and address issues. Check for individuals room files. All plans consistently reflect the correct information.
• Discussed utilising MUST and Waterlows as a preventative tool. If a resident does not need to use, then the home must clearly state in care plan this is not required. ADS services do not do this as a standard due to client group and needs/abilities.
• Food and Fluid charts include the required intakes, which are recorded during the day (at correct intervals, i.e. not completed retrospectively) by appropriate staff and advise the next steps should intake not reach required level. Electronic records need to be able to state resident refusal.
• Turn charts are completed accurately and state frequency and clear instructions. These triangulate to care plans and guidance from DN’s. Discussed terminology. Regularly is not enough, also day and night.
• Care plans are reviewed regularly and updated to support any change in need that may have been identified. ADS services terminology of reviewing can cause confusion. There is a yearly review with operational colleagues and then internal reviewing which may be in the form of key worker reviews/meetings with individuals.
• Cross reference care plans and risk assessments to ensure all areas are aligned consistently.
• Personal Evacuation Plan (PEEPS) in place and include necessary information, these are held in care plans and a summary in residents’ rooms, reviewed regularly and when a fire drill is undertaken.

Support:

HCPA Services

3. Think community

Develop a rich picture of local resources and move beyond providing just ‘good care’. Build active partnerships with people and communities to engage and empower communities to make the most of their local assets and social capital. Promote and support networks, making strong links with social prescribing activities. Ensure care settings are customer focussed and user friendly – Commissioning Principle

Tools and Resources:

• LGBTQI framework social care
• Herts Sports Partnership
• Herts and West Essex VCFE Alliance
• Churches Together Hertfordshire
• Hertfordshire Directory
• Working Herts – Faith Organisations
• CQC Culturally Appropriate Care

Potential Evidence:

• Discussion with the individuals confirm that they are supported to maintain relationships with family and friends and the community in which they live. This may include:
• Having (regular) access to social & cultural support in community – extend to committees
• A directory of other services that Providers could access to support individuals with care planning / information guidance and support with local community services.
• Care plans evidence non-discriminatory practice and include appropriate person-centred information. This may include for example: the individuals religion, preferred sexual orientation, whether they are married etc. The care plans should also include person-centred information on what these choices mean to the individual and how staff can support them in their preferred choices.

Support:

• Herts Help

4. Safeguarding

Safeguarding people at risk of abuse or neglect is one of our most important tasks and we should adhere to our Safeguarding Adults Policy and guide. Safeguarding is everyone’s responsibility so we all have a role to celebrate good practice and take immediate action where practice falls short of our own standards – Practice Principle

Safeguarding adults at risk of abuse or neglect is one of our most important tasks and we should adhere to our safeguarding policy and guide. Safeguarding is everyone’s responsibility so we all have a role to celebrate good practice and take immediate action when things fall short of our own standards – Commissioning Principle

Tools and Resources:

• Hertfordshire County Council Safeguarding Information 
• HCPA Safeguarding and Capacity Zone
• NHS Data Protection and Security Toolkit
• Safeguarding Adults Self-Assessment Toolkit
• CQC Guidelines for PBS
• Find the Reasons for Challenging Behaviour: Part 2 info sheet
• Positive Behaviour Support Planning: part 3 info sheet
• Out of sight – who cares?: Restraint, segregation and seclusion review

Potential Evidence:

• Staff are able to provide an example of possible abuse and advise what they would do if they had concerns and who they would contact both within the organisation and outside if necessary. Staff are observed providing care and support in a respectful and dignified manner
• Staff are aware of their responsibilities under whistleblowing and safeguarding. Staff can explain what whistleblowing and safeguarding is and they are aware of the organisations polices. They know where the most up to date Local Authority SAFA document is available in the service.
• Staff are able to explain what the different types of abuse are and how they would report concerns. Staff confirm that they have access to SAFA policy and appropriate contact details. Staff can explain what whistleblowing is and how whistle-blowers are protected
• Safeguarding posters on display in appropriate places
• Identify if a Key Worker System is in place. If so, the care plan clearly refers to the key worker and this information is available to individual. There is a description of keyworker role or key worker agreement. The service has considered how to provide this information to individuals living with dementia (i.e. photographs in bedrooms). There should be a clear contingency when a key worker is off and evidence that the Service has effective key worker reviews (including involvement from the individual) at regular intervals.  Individuals are involved in choosing their Key Worker, individualised agreement between individuals and keyworker setting out what outcomes they want the keyworker to achieve and evidence of whether these are achieved on a monthly (regular) basis.
• Safeguarding agenda fixed during key worker meetings
• Team meetings with safeguarding as fixed agenda
• Safeguarding sessions with families and people you support
• MUST and Waterlows as a preventative tool
• Personal Evacuation Plan (PEEPS) in place
• Health plan/passport
• Safeguarding posters on display in appropriate places
• Safeguarding training all up to date
• Safeguarding discussed in supervisions
• Awareness sessions with people we support

Support:

HCPA Provider Hub – 01707 708108 / assistance@hcpa.co.uk

5. Clear Understanding of the legal framework for adult social care

This includes The Care Act 2014, Mental Capacity Act 2005 and the Mental Health Act 1983. Where key decisions such as in eligibility, care assessments, care and support planning, best interests and safeguarding are made, professional case notes must evidence how appropriate social care law has been applied and how required legal and professional processes have been followed.  The wellbeing principle means we should actively seek improvements for people and their carers and this should be central to our involvement. The council’s duty is to promote people’s wellbeing. This doesn’t mean necessarily providing resources for everyone. It does mean giving preventative messages and signposting to potential sources of interest or help. The person should be at the centre and fully involved in their assessment and care planning process. Advocacy services should be used where needed. The person must be provided with a copy of the assessment, eligibility determination and a copy of the Care and Support Plan – Practice Principle

Relevant adult social care legislation includes The Care Act 2014, Mental Capacity Act 2005 and the Mental Health Act 1983. Where key decisions such as best interests and safeguarding are made, providers must evidence how appropriate social care law has been applied and how required legal and professional processes have been followed. A lack of capacity doesn’t mean people can’t exert choice and control. Relevant procurement legislation includes the Public Contracts Regulations 2015 which incorporate the EU Procurement Directives 2014 – Commissioning Principle

Tools and Resources:

• The Care Act 2014
• Mental Capacity Act 2005
• Mental Health Act 1983
• Equality Act 2010
• Process for managing respiratory illness in care homes
• Key principles of IPC
• Health & Social Care Act 2008: prevention & control of infections
• IPC resource for adult social care
• National IPC manual
• National Standards of Healthcare Cleanliness

Potential Evidence:

• Mental capacity assessments evidence a person-centred approach and best interest decisions are fully investigated with all relevant stakeholders and documented correctly. MCA’s are decision specific and are reviewed monthly. Mental capacity is assessed and when the individual has capacity this is also recorded.
• Care plans detail any advanced decisions made and these are reflected across the appropriate care plans and support documents correctly.
• DoLS clearly investigates and records the least restrictive option, DoLS applications are in place and when approved any conditions are clearly recorded and where appropriate built into the care plan, systems are in place that enable the effective management of renewal and conditions (i.e. for expiry). SU participation evidenced where applicable.
• If there are MCA’s on file, are they decision specific (i.e. Bedrails, sensor mats, stairgates, swabbing and other medical interventions, covert and non-covert medication, care, moving and handling (wheelchair belts and straps), locked door (stopping the resident from leaving the building), transfer of care.
• Is there a Best Interest Decision? Are there any conditions? Is there evidence to support these is being adhered to? Are there expiry dates? Is there evidence from the provider that they are monitoring the expiry dates in a timely manner? Note DoLS team need 28 days. Is there an Advocate Involved?
• LPA for finance and / or health & welfare is recorded correctly (If applicable).
• Evidence of correct POA signature on support agreed (where POA is for Health & Wellbeing – NB: make sure POA only involved if the SU does not have capacity for the specific decision).
• Where a DNAR is recorded there is evidence that a GP has signed, and SU / appropriate LPA / family involved. For both east and west a digital copy of a signature is accepted and they can also accept non wet signatures.
• Risk assessments in place if self-medicating.
• Where relevant LPA for Health and Welfare is documented on the care plan.
• Where individuals are unable to make decisions regarding their own health and / or medication, the MCA followed, best Interest documented and where required DoLS process followed.
• Record of how the individual would like to take their medication and where (e.g. description of how people wish to take their medication e.g. with a glass of juice. Whether SU has individual name for medication e.g. blue tablet).
• Instructions for staff on what to do if the individual refuses medication.  SU guide contains information of medication and how the service will support the individual if they wish to self-medicate.  Easy read document for individuals regarding their medication.  How to pronounce the medication written down.
• Ask them if they have read the care plan / read it out to them and ask if it reflects the care that is happening. If they do not have capacity, look for best interest decisions or LPA for health and welfare.
• See evidence that staff understand what capacity is.
• Where DoLS have been submitted but there has been a delay in authorisation there is evidence that this has been followed up with the Supervisory body

Support:

Safeguarding Support

6. Timely and Defensible Decision making and recording

Recording must evidence robust decision-making – with an analysis of why a particular decision has been reached and why other options were not appropriate.

The level of recording is to be proportionate to the complexity of the case and must always be written in plain English to be understandable by the person and their family. Recording on ACSIS must be completed within two working days of contact with the person, including provisional care packages where these are available – Practice Principle

Tool and Resources:

• Scottish Dependency Tool
• Members Zone – Safeguarding
• Learning from Safety Incidents CQC
• Garden House Hospice Care which answers questions around Advanced Care Planning
• Positive and Proactive Support Plan
• Behaviour Support Planning Audit Tools
• Scatter Plot Assessment Tool
• Antecedent Behaviour Consequence (ABC Analysis Chart)
• PAL Checklist

Potential Evidence:

• A range of appropriate audits have been analysed and action plans developed, that action plans include timelines identifying responsible staff and that any progress / completion of the actions is clearly recorded. Audits have clear robust criteria to ensure consistency and triangulate.

Support:

• Care Home Impartial Assessor | HCPA

7. Embed Connected Lives at Every Step

Services, care and pathways should always be designed and commissioned to prevent needs from escalating and enable people to achieve outcomes and live independent lives. We have a responsibility to ensure providers and partners understand their role in this and are able to evidence their Connected Lives approach. Connected Lives principles must be at the heart of every commissioning stage, from designing pathways, procurement, contract management and monitoring – Commissioning Principle

Tools and Resources:

• Digital and Data | HCPA
• Quality Audits & Mock Inspections
• Care Equipment
• Digital Social Care0
• » Ashara’s Story » Magda’s Story » Arthur’s Story

Potential Evidence:

• Communication aids for people you support- social stories, books, PECS, Easy Reads, Voice activated devices and reminders.
• Training for staff regarding any technology used to deliver care-Digital Care Systems
• Care plans detail goals and include clear steps as to how these can be achieved; these are updated when any progress is made. Reviews are outcome focused and documented.
• Healthy eating literature/ pictorials are available.
• Supporting family to come in & the individual to go home with use of appropriate equipment.
• Bring in voluntary sector e.g. Befriending- use of technology
• Advanced support planning,
• Advance decisions and meetings with family, friends and other carers- Records clearly included.
• Care & Support plans include effective arrangements for when individuals are transferred to another service – Hospital grab sheet.
• Staff know who is the next of kin, LPA- evidence such as supervisions/ team meetings/ signed care plans
• Homes Statement of Purpose, Service User Guide
• There is evidence that services are improved by learning from, and acting on, any information including (but not limited to); comments and complaints , quality questionnaires, incidents, adverse events, errors or near misses, audits and local or national reviews.
• Feedback and information used to improve the service can come from individuals, Staff and relatives & other professionals.

8. Working with partners and providers to deliver good outcomes

Our work doesn’t finish with commissioning good care. We have a responsibility to make sure providers and partners understand their role in achieving outcomes and enabling people to live independent lives. Services, care and pathways should always be designed to prevent needs from escalating- Practice Principle

Shared values where outcomes are prioritised- A strong foundation for effective commissioning is based on a shared vision, trust and excellent leadership. Commissioners, people that use services, providers and partners should work together to agree and deliver good outcomes for people and communities. Outcomes must be SMART and clearly evidenced by care providers. Integration with health and partners is our default position – Commissioning Principle

Tools and Resources:

• Sensory Service
• Annual Health Checks
• PPE guidance for unpaid carers
• Health Services
• Education at local hospices
• Care home admissions & discharges
• Bulk Prescribing in Care Homes
• Ordering and Waste Reduction in Care Homes

Potential Evidence:

• Team meeting notes with appropriate structure and topics-partnership working on agenda.
• Partnership working to achieve outcomes-evidence in care plans.
• Lunch and learn sessions/ Zoom/ Teams meetings with other professionals who can upskill staff
• Personal development plans with signposting to where other professionals could be used for CPD
• Other professionals offering services have been subject to a DBS check (e.g. hairdresser, chiropodist, PAT dog, religious representatives).
• Staff to check that other professionals accessing the service have a valid ID Badge from the organisation they are representing, and this is presented to staff on accessing the service.
• Professionals must also sign the visitor’s book on accessing the service.
• DBS & liability insurance provides appropriate cover.
• Registration with relevant professional bodies
• Evidence of partnership working – updates to reviews and care plans where other professionals input information.

Support:

Support Service Directory

Herts Help

9. Support for our staff

Working directly with people and their families is highly skilled and complex work. It can create emotional as well as practical and intellectual challenges. Practitioners can expect clear leadership from managers, regular reflective supervision and good, varied opportunities for development to support us in our roles. The Practice Principles provide support for staff in their practice. Staff and managers can advise, challenge and support any decision made within this framework. When complaints or representations are received – adherence to these principles is what will be tested – Practice Principle

Tools and Resources:

• Support Worker Persona- Connected Lives
• Provider Manager Persona- Connected Lives
• Provider Services persona- Connected Lives
• Education for Mental Health
• Best Practice Guide to Recruiting, Onboarding and Retaining Staff
• Resilience Annual Self-Assessment Toolkit
• Hand hygiene audit tool
• Hand hygiene technique

Potential Evidence:

• Staff files must evidence that regular one to one supervisions are taking place on a bi-monthly basis as a minimum and there is proof that six supervisions are undertaken for each member of staff per year. Where there are gaps due to authorised leave or long-term sickness etc., these are to be clearly documented on files to explain the reasons for gaps. Also, staff must have an annual appraisal. Cross reference a couple of dates against supervision notes for staff files checked.
• Staff training matrix to show all mandatory training for staff is up to date and updated on an ongoing basis. In addition, staff certificates must be consistent to the training matrix. Check role specific and specialist training. Also ensure there is a balanced amount of face-to-face training, NOT just e-learning / DVD Training. Mandatory training should be via face-to-face training method.
• Training matrix of mandatory training/cross ref against certificates. List of attendance.
• Champions within staff – Dignity / Dementia etc., are provided appropriate specialised training.
• Competencies annually for medication and annual competencies for moving and handling.
• Staff competencies are completed in line with company policy, (yearly).
• Holistic assessment of needs with support plan
• Training matrix based on current needs of people supported in the service
• Competency checks such as PBS or medications
• Risk assessments updated in line with need and policy.
• Complaint process discussed with people you support on regular basis
• Care Reviews
• DoLS and Best Interest decision making.
• Key worker system
• Regular forums and feedback including family.
• Advanced statements
• One Page Profiles
• Team meeting notes with appropriate structure and topics,
• Mentoring of staff-one to ones,
• Supervision notes,
• Partnership working to achieve outcomes
• Lunch and learn sessions,
• Personal development plans,
• Review of culture and response to complaints and comments
• Mechanisms are in place to enable people, including staff, to raise concerns about risks to people and poor performance openly
• Safeguarding posters on display in appropriate places.
• In House induction over a set period covering clear timescales – Policies & procedures, Environment, mandatory training, shadowing and to be signed off by Management and the employee.
• Care Certificate – Modules to be signed off by management / appropriate staff and competencies evidenced.  Identified training e.g. moving and assisting.
• All permanent / consistent staff to be given a job description specific to their roles and to undergo a competence-based induction. Temporary /agency staff to be inducted on their responsibilities before commencement of work. Evidence of this to be reflected in files, including:
• Contract of employment
• Staff sign to confirm they have read and understand
• Code of conduct
• Contract of Employment has been issued

Support:

Care Professional Academy 

10. Equity, Equality and Culture

In Hertfordshire we have a commitment to support people’s sense of belonging, and a responsibility to champion equity, equality, diversity and inclusion, across all services and teams. We recognise our role in allyship and proactively challenging discrimination of any kind.

For some people there will be a need for additional support to access the same opportunities as others; it is important to consider how structural inequalities interconnect in different ways. To understand what wellbeing looks like for the person, we should seek to understand their identity and culture. Getting to know the person below the surface, as well as those aspects which are more visible, is key to understanding their values, wishes, beliefs, decision making and the impact of their lived experience.

As a workforce we should feel empowered to have conversations that at times might feel difficult. Reflection upon our own unconscious bias can help us overcome these challenges and create a safe space for conversations. The more we do this, the more we can support people to embrace their authentic self and feel more in control.  It is important we ask how identified solutions would best fit around the person’s life and culture.