Care Service User Guide

Care Service User Guide

Welcome to 1^st Care at Home.

This document will give you all the information you need to know about 1^st Care and what services we provide. Following rigorous assessments from our Care Manager, Martina Taylor, we will tailor a support plan around the recipient’s needs and wishes. This will always have been agreed upon by the client and management before implementation of proposed care plans. This is to ensure that there is no confusion and the services we provide can be carried out with the fullest attention and to the highest possible quality.

Aims & Objectives

1^st Care at Home are a domiciliary care service that believe it’s important to deliver a service to a wide range of clients who require care and support to remain in their own homes. The business has been set up through a passion to support those who wish to remain in their own homes and maintain their dignity in a familiar environment. They can do this surrounded by their own belongings, personal trinkets and loved ones. The service we deliver provides the opportunity for the support staff to maintain welfare and choice, support with daily living skills, support with daily living skills, support with emotional needs, support with personal care whilst maintaining a level of independence at home and empowering the individual.

1^st Care endeavour to offer a managed service offering a future to those who require it and be able to see individuals maintain self-respect, confidence, skills, lifestyle and prospects that are comfortable and at a level they feel is possible for them to manage independently whilst remaining in their own environment plus within their local community.

Our services are suitable for both individuals and couples. With couples, we often find it allows them to stay together for longer and detracts the struggle they often face of looking after each other. We pride ourselves in cases where our support and care has allowed couples to remain together for longer as this greatly increases their quality of life. We like our clients to input into our care packages as there may be specific needs that they feel they would like to be implemented that they cannot themselves fulfil.

Staying at home with 1st Care is a real and affordable option.

We centre our care on the person. The services and staff we provide are committed to our aims and objectives:

• To provide a service of the greatest quality to improve and sustain the client’s quality of life.
• To ensure our services are delivered flexibly, attentively and in a non-discriminatory manner whilst respecting each client’s right to independence, privacy, dignity, fulfilment, and the rights to make informed choices and to take risks.
• To ensure each client’s needs and values are respected in matters of a religion, culture, race or ethnic origin, sexuality and sexual orientation, political affiliation, marital status, parenthood, disabilities, or impairments.
• To match the nominated worker as closely as possible with the client and respecting the need to change the care worker in the event of subsequent non-compatibility.
• To manage the care service efficiently and effectively to make best use of resources and to maximise value for money for the purchaser/client.
• To involve clients and carers in the provisions, management and development of services which will be monitored regularly as part of the quality assurance framework ensuring that the service is run in the best interests of our clients.
• To ensure that all clients are aware of the procedures of making compliments, comments and complaints.

Who are we?

I am Martina Taylor, the Care Manager for 1^st Care at Home (IOM) Limited. I have been involved in care for many years on a ‘hands on’ basis. 1^st Care was set up due to an unrelenting passion for the care of vulnerable adults and children, we truly believe that our company is comparable to no other in terms of passionate and committed care workers. Our carers share our view that, ‘there really is no place like home’.

Here at 1^st Care, we have a brilliant team who help us out with the day-to-day running of the organisation. Our team are committed and dedicated to helping all queries that may come their way, be it service enquiries or any other questions regarding the organisation, e.g. recruitment etc.

Here is a list of our team, complete with contact details:

Director – Tracey Hudson (Registered Care Manager & Director/Owner)
Telephone (m): 411985
Email: martinataylor@1stcare.im

Director – Jamie Taylor (Business Manager/Owner)
Telephone (m): 206256
Email: jamietaylor@1stcare.im

Julie Cubbon – Care and training coordinator
Telephone (m): 450875
Email: juliecubbon@1stcare.im

Victoria Brew – Team Leader
Telephone (m): 308033

Sarah Buchanan – Team leader
Telephone (m): 308034

Alternatively, you can call the office on 01624 851787

Our company would be nothing without our excellent care workers. Our carers are highly qualified and exceptionally well trained. This is a fantastic development as it allows us to send all new carers to receive an elevated level of training and immediately be ready to work as soon as their DBS police check goes through. The inductions our carers go through involves key elements to care:

• Role of a care worker,
• Health & safety,
• Communications & confidentiality,
• Infection control,
• SOVA/Safeguarding (Safety of Vulnerable Adults & children with difficulties),
• Personal care,
• Moving and Handling,
• First Aid

All our team go through this vigorous training as a mandatory part of the job. Enhanced Police checks are essential, and we never allow any of our staff to go into a client’s home without this. Exceptions can be made for cases where there is a new carer who might go into a client’s house to shadow an experienced carer, provided permission has been obtained.

Overview of the delivery of your care.

 The Registered Care Manager (Martina Taylor) or someone else suitably qualified at 1^st Care will visit you and undertake an assessment. This will include a full social care assessment with you to identify what kind of support package would be suitable and appropriate. A copy of this plan will be left at your address for reference by the support workers that will be working with you. They will also carry out a thorough risk assessment to ensure that our care workers can safely undertake their work in your home. If the assessor feels like it’s necessary, a moving and handling risk assessment will also be completed. This is to identify any equipment and/or handling techniques that are felt essential for care to be given. Once again, a copy of these assessments will be left at the address for support workers in case they need to refer to them.

We at 1^st Care believe that to deliver a high quality of care, it’s important for previous carers to know what care has been provided for the client before their visit. Therefore, we leave a daily diary note/log sheet in every client’s home. This is for yours and our protection. Every task and comment of significance will be noted and documented. We leave this at the residence in the case that the client would themselves like to read the notes. This is important for the client to be aware of the care they’re receiving and in the highly unlikely event that there’s any form of dissent on the part of the carers. These log sheets also help others outside our organisation. Relatives can keep up to date with the service that we provide, doctors can be aware of any health implications raised and health visitors can do likewise.

Care plans and risk assessments are formally reviewed regularly, or as required by an assessor suitably qualified to gauge whether your requirements may have changed. If we feel they have, we will make suitable adjustments and alterations to your care plan. Additionally, our support workers will constantly monitor your care plan and if they feel at any time that something might need changing, they will alert management immediately. We feel this is an essential part of our services to ensure that we’re consistently delivering the best quality of care possible.

What range of support needs can we meet?

 As a care company, we have a variety of services that we can provide to our clients through our fantastically trained and well-rounded support workers. We believe it’s important to be able to offer a wide range of services to cater for more people’s needs.

The services we can provide includes:

• Respite services,
• 24 hour care,
• Palliative services,
• Hourly call services.
• Overnight, sleep in and waking night care
• Dementia care

As a sub-branch, we can also offer many specific services:

• Domestic tasks e.g., Meal preparation, cleaning, washing & ironing clothes,
• Shopping,
• 24-hour care (sleep-ins, waking nights),
• Transportation to hospital appointments,
• Fully trained staff to deal with specialist disability cases e.g., cerebral palsy.

Key personal and care support is provided with:

• Dressing and undressing,
• Continence support,
• Bathing, washing and oral hygiene,
• Toilet and continence requirements,
• Medication requirements and other health related activities,
• Manual handling,
• Eating meals, meal & drink preparation

Specialist care

Whilst most of the work we carry out is relatively straightforward, there are some elements that requires specialist training and attention. We at 1^st Care will provide them with specific training, something which will then be certified by a trainer with a relevant qualification. A form will be signed signifying that the care worker has completed the training and is competent in undertaking the specific task.

Some of our specialist tasks includes:

• Assisting with artificial feeding (except medication),
• Catheter care – monitoring output and changing bags,
• Assisting with eye/ear drops,
• Ileostomy and colostomy care – changing of bags

At 1^st Care we will not perform certain tasks that we feel are more suited to the expertise of clinical professionals. These tasks can include:

• Toe/nail cutting,
• Ear syringing,
• Removing or replacing urinary catheters,
• Bowel evacuations,
• Bladder washouts,
• Injections – involving assembling syringes, administering intravenously, controlled drugs,
• Filling of oxygen cylinders,
• Lifting from the floor unaided,
• Tracheotomy care – changing tubes,
• Skin prick tests for diabetes,
• Any invasive procedures.

What you can expect from our support staff

 You can expect a high quality of committed and dedicated care from our care support staff that are there to help you as much as they can. They should arrive at your residence as close as possible to the time mutually agreed.  However, in the event, that they are possibly delayed by a prior client emergency or road conditions then every effort will be made to contact yourself.

All support members will wear a uniform with an ID badge including 1^st Care’s information, which will be provided at the initial assessment. Our workers should be courteous and polite, showing yourself the upmost respect. They should maintain a good standard of appearance.

They will also be expected to keep all your personal and financial matters strictly confidential. Most importantly, emphasis is placed on respecting a client’s needs, rights, dignity and promoting your independence through an acceptable level of risk at all times. Care workers will respond to changes in your care needs and are expected to advise the Registered Care Manager of any change to your care needs.  They will help you make contact with other health professionals such as GP and district nurses when it’s thought necessary and always with your permission. Our team will always pay you and your home, belongings and personal standards the upmost respect, and they will never do anything without your permission. Finally, you can expect a high standard of care and a solid understanding of their work and your needs.

Clients and the operation of 1^st Care at Home

 1^st Care at Home believe that freedom of speech is to be exercised thoroughly, and clients should speak freely about how the service we provide is organised, run and how it will progress over time. We believe this as they themselves will be impacted the most, and they should have the biggest/final say.

In respect of this, 1^st Care believe that offering the following strategies to maintain client involvement is incredibly valuable:

• Frequent discussions with and visits to clients by the Care Manager which allows the client to express how they’re managing, any comments regarding the care they’re receiving, or even just to compliment/complain about an element of their care plan. This includes regular telephone updates as required to ensure all well.  We believe that it’s important to involve the clients, their families as much as possible as they can then input and help us to improve our deliver of care, customer service.  They can also help to suggest more user-friendly policies and procedures. For instance, they can input on suggestions for content and request more friendly publications, e.g., Braille, large print and different languages.  The 1^st Care carers remove the client recording notes entitled (Daily Diary Notes) from the clients Care Plan file which is kept within the clients home each month.  These are checked and reviewed against the care needs, client requirements/needs within the Client Care Plan, Assessment(s). Any possible anomalies are highlighted and dealt with appropriately by the 1^st Care’s Care Manager, client or their representative.
• Care/Support plans are tailored around a client’s needs. Clients can also influence their plans by requesting preferences and informing the care manager of any specific needs they feel need to be addressed. To ensure their care package concentrates on person centred planning we liaise with the client to make best use of the time we have with them.
• We assure quality by using an annual check. This assesses, improves and develops the services that we provide. Obviously, the best person to develop this is you, the client, so as part of the assessment we ensure to include our clientele. This is achieved through meetings, questionnaires and planning. These are all carried out with the aim of ensuring that their needs are met.

These are just three ways we involve out clients here at 1^st Care

Complaints procedure

 Here at 1^st Care we have a dedicated policy and procedure for Complaints. This is in place to support all levels from the client to employees, family, friends and even the care managers. Every complaint made will be received in complete confidence. We will never breach our client’s confidentiality. 1^st Care deal with complaints in a professional manner within the management team in a swift and appropriate manner.

Compliments, complaints and concerns

When our client’s provide commentary, feedback on the quality of care we provide this information is reviewed and determined for content and possible action taken. Feedback is considered as a constructive positive rather than being viewed as a negative.  Complaint forms are kept in all client care plan files in the client’s homes.

Types of feedback:

Compliments– positive input regarding aspects of the Care Service

Comments– still positive, but possible scope for improvement

Concerns– negative feedback where action may be required to address a problem

Complaints– serious concerns on the part of the client, requiring formal action as requested both in writing and verbal statements

The management and handling of complaints for clients is dealt with in a formal manner. They are all documented in the complaint’s procedure. Our policy supplies a relevant and appropriate investigation into the complaint and ensures to deliver a timely response for the complainant. If required, 1^st Care will assist the client to take the complaint to higher regulatory authorities. Clients will always be made aware of the complaints procedures prior to finalising the care service contract. We welcome any suggestions you may feel would make a difference to the services that we provide. As a valued client you are welcome and entitled to make a complaint at any time, be it the first visit or even if you’ve been with us for years. If you do have a complaint, you should follow these steps:

• If the problem is minimal it should be discussed with the person providing the care service or one of the care managers who will do their upmost to resolve the problem quickly. If you feel you’re unable to discuss the issue with the Registered Care Manager or you feel they’re incapable of solving the problem, you should contact another 1^st Care manager.
• If at this stage it’s possible you should record your complaint in writing/email (If possible) and send it into 1^st Care at Unit 7a Union Mills Industrial Estate, Union Mills, Isle of Man, IM4 4AB. If you’re incapable of writing the letter you should ask a relative to write out the complaint for you, which you should attempt to sign.
• If you’re not confident making the complaint yourself and you don’t know someone who is prepared to talk to us on your behalf, then we will work with you and find someone from an organisation independent from 1^st Care that can act as an advocate.
• Written complaints will take longer to process due to administration processes, but we endeavour to answer all complaints within a seven-day period. We will inform you of receipt of the complaint and explain steps that we will be taking to resolve it. If we cannot find an immediate solution, we will investigate the concern fully and contact relevant personal involved.
• Within four weeks we will inform you of findings, relevant action taken and suggestions to resolve the complaint. If you feel for any reason that the complaint isn’t being resolved you can contact the Registration and Inspection, St Georges House, Hill Street, Douglas, Isle of Man.
• 1^st Care strive to receive more compliments than complaints, but we understand perfection is difficult to achieve and maintain so fully respect the situation in which complaints may come forward.

Confidentiality policy

1^st Care accept that there are certain situations that require confidential information to be shared so have acknowledged a policy to protect clients, staff and 1^st Care itself. Confidential information shall only be shared on a basis where it’s in the best interests of the client. 1^st Care shall never confuse confidentiality with secrecy.

It is a policy that informed consent should be obtained but if it’s not possible at the health of the client and others are at risk it may be a necessity to override this. Reviews will be made about who confidential information is shared with on a case-by-case scenario. Confidential information created to protect the interests of an organisation must not be allowed to clash with those created with the interests of the client in mind.

In some situations, it may be essential to disclose personal information about a client. In these situations, the information will be shared in accordance with the Data Protection Act 2018 (as amended).

Guidelines for good practice

Staff should be aware that information made confidentially belongs to the client and as such their views and wishes should be respected when sharing information that they have been given. The client must agree before any information can be shared with other associated professionals. Information can only be shared for the purpose of supporting and protecting the client.

A professional manner is a constant requirement of our staff at 1^st Care. It’s essential that all staff observe the highest levels of discretion regarding all their work. It is mandatory to remember that all confidential information held on clients or colleagues is strictly confidential and isn’t to be shared with anyone that doesn’t have the clearance to know so.

Matters relating to clients or staff should always be conducted in private and in a professional manner. Cross-referencing clients and colleagues are strictly prohibited, and any staff found to be doing this will be dealt with through the appropriate disciplinary procedures. Specific areas of support for clients should remain confidential unless the care manager feels it’s in their best interests for relatives and visitors to be informed. 1^st Care will not Contd.,

Tolerate idle gossip and have a zero-tolerance policy for this. Our staff are aware that, in relation to the terms and conditions of their contracts, breach of this will lead to disciplinary action and if found to be gross misconduct may lead to dismissal.

1^st Care, carers are not permitted to visit clients socially or personally, outside of their rota hours, or when the carer formally leaves the employ of 1^st Care.  Any such potential calls MUST be advised to the 1^st Care office and can constitute disciplinary proceedings for the carers.

Procedure

Case-by-case reviews will be conducted to decide what information can/will be distributed. We have therefore instructed our staff to ask themselves before they do distribute information a few questions, this is both in the best interests of you the client and the safety of our staff.

• Has the client given you permission to disclose personal information?
• Has the Registered Care Manager given you permission to disclose any employment/work related info?
• Is there anyone else who may be at risk because of the information being shared?
• Are you yourself able to legally disclose the information considered confidential?

Information shared must always be reviewed with the client and Registered Care Manager.

Accepting gifts and gratuities.

Sometimes clients may put our staff in a difficult position by requesting that they accept gifts or sometimes even assist in the organisation and preparation of wills, deeds of gifts or any other document construing a transfer of property. Also, clients may pass on gifts to our staff which then could as a result be disputed by the client’s relatives or beneficiaries. Obviously, this will cause embarrassment to all parties concerned, something we here at 1^st Care are keen to avoid.

1^st Care wish to express the dangers that can occur of accepting a gift or gratuities from a client, and to make it exceptionally clear that under no circumstances should you accept money from clients or bequeaths under their wills. If you suspect this may occur, you should notify your care manager immediately. However, if a client insists on making a gift then you must be advised to seek advice from your manager or the client’s proprietors, who may choose to refer the matter to the relevant registration authority.

You must also refuse to help with or advise the preparation of wills, deeds of gifts or any other document construing a transfer of property. If a client wants to make a will, you can recommend to them that they seek advice and assistance elsewhere, which can be organise by the care manager or the directors.  It’s also noted that carers cannot act as a witness to a client’s will and cannot under any circumstances become an executor of a service user’s will. If asked to advise a client, asked to sign documents of any description whatsoever, asked to be a party to a financial agreement of their affairs, or in any doubt at all about a request closely related to these you should inform your care manager immediately or failing this the proprietors. This policy, like all others will be reviewed on an annual basis to ensure that it’s being effectively implemented and is up to date with current laws and regulations.

Safeguarding

1^st Care is committed to protecting its clients, care support workers and office staff from abuse and will co-operate with all other agencies in the investigation of any form of abuse.  It is company policy to train care support workers to recognise abuse and to take appropriate action whenever it is found.

All carers undertake Safeguarding Training as part of mandatory training and have a duty of care to report any signs of abuse in order to protect our clients.

For more information on Safeguarding, please contact the 1^st Care office on 851787 for a copy of our Safeguarding policy.

Should you have any safeguarding issues that you do not feel you can discuss with a member of staff at 1^st care you can contact the IOM safeguarding board for further advice:

If you have any safeguarding concerns in relation to children, please contact:

(01624) 686179 during office hours
(01624) 631212 out of office hours

If you have any safeguarding concerns in relation to adults, please contact:

(01624) 686179 during office hours
(01624) 650000 out of office hours

Medication administration policy

Here at 1^st Care we believe in a person-centred assessment in regard to determining intervention with medication in our clients. This can include supporting clients practically with their medication whilst also respecting and encouraging independence.

Someone suitably qualified will carry out an assessment to determine any risks in self-medication. We liaise with other health care professions to ensure that our assessments are as accurate as possible. Through these assessments we establish some clients are suitable for self-medication whilst others may require slight assistance or supervision, and some may need full administration of medication to be undertaken by the care worker. 1^st Care ensure that if this assistance is required then appropriate accredited training will be provided to ensure that the safety of both the client and the care worker is maintained. To assist with this, social care staff and health work colleagues will seek to work co-operatively to ensure the safe handling, administration of medication

When a client has been assessed as being unable to administer their own medication, be it fully or partially, only then shall arrangements be put in place to assist. On the care plan the exact nature of the support should be stated and if possible elaborated upon. There are certain stages of support, and this should be specified upon.

Stage 1: Support with medication requires help for ordering and collecting prescriptions and self-storage. Family, neighbours or a pharmacy delivery would ideally be the go-to for this stage as the needs are fairly simple and straightforward.

Stage 2: Requires supervision with self-medication or reminding to take their medication and requires help to open containers or total medication management which may require direct administration.

Stage 3: Requires total management of medication, which in turn may require direct administration and invasive procedures.

All forms of assistance with medication will only be provided if written consent is obtained by the client/representative of the client. Consent will only be obtained by the representative/advocate of the client when they’re deemed to lack the mental or physical capacity to consent and it’s deemed to be in their best interests. Details of assistance required should be enclosed in the care plan and agreed upon by the domiciliary care provider. Information which may help assess a client’s needs regarding assisting with medication must be obtained by appropriate medical and healthcare professionals. It’s important to follow exact guides on the assistance of medication to ensure the client’s and our staff’s safety. Help can fall into broad categories, such as:

• Verbal reminders for self-medication at the appropriate times.
• Assisting with opening/preparation of the administration of medication.
• Physical assistance, e.g., removing medication from medidos system and giving to client to self-administer.
• Physical administration of the medication or applying cream/ointment to the skin.

Sometimes clients may wish to self-medicate minor problems with over-the-counter preparations e.g. paracetamol or therapies such as herbal. This is deemed acceptable so long as the appropriate healthcare and medical professionals e.g., GP deems it not to be detrimental to the client’s health. A record must also be kept to ensure that the 1^st Care office are aware to ensure no contra-indicators.  The assistance of non-medical skin care preparations is allowed if the professionals agree to their usage. They must confirm that there is no skin/tissue viability problem, and this is recorded. Any change to skin condition must be noted and the 1^st Care manager must be informed as soon as possible.

If you have any concerns about someone self-medicating the Registered Care Manager, should be informed without delay.

All our staff are face to face trained both in house and through a local dedicated care learning centre. The induction our staff complete covers many aspects essential to care, including the handling and administration of medication. In cases where a client may require stage 3 assistance. Specialist training will be provided for staff who wish to undergo said training and overseen, written off by the District Nursing Teams where appropriate.  This competency training cannot be cascaded down to other carers.  Every carer must undergo separate training.

Approved and labelled containers e.g., Medidos, are the only ways medicines should be administered. These approved containers must be authorised/approved and signed off by a pharmacist.  The medidos are requested via the clients prescribing GP. Family members or others dispensing medication is not allowed under any circumstances, this is known as secondary dispensing.

Labels on medication containers will provide details of the required dosage and may include other instructions regarding health and wellbeing e.g., “take 1 hour before food”, “complete the course” and “do not take with alcohol”. When given instructions are unclear the relevant healthcare professionals should be contacted for clarification. Advice obtained in this manner must be recorded on the medication records. Any instructions about timing of the medications and about its relationship with food are vital and must be adhered to strictly.

Any container that appears to have been tampered with or damaged is rendered unsafe and should not be used unless alterations are signed by the client’s individual GP or the prescribing nurse. Any alterations to labels must also be brought to the attention of the Registered Care Manager, 1^st Care office who will contact the doctor/prescribing nurse or pharmacist and seek their opinions. Any verbal advice obtained this way must be followed up by an email and then recorded on the medication sheets.

As standard procedure some containers may be made with specific closures that prevent children from opening and accessing them, and as such this may prevent those who have difficulty with their hand motor skills from opening them too. In respect of this, some containers will be ‘easy open’ to help maintain independence about self-medicating.

In some cases, the medication regime is complex, and a client may experience difficulties with compliance. Also, in cases where there’s numerous people involved with the administration of the medication, concerns of an overdose by a client or an independent support provider that’s restricted by its insurance, the appropriateness of using alternative dispensing methods should be discussed with the client’s GP and pharmacist, who will have to agree to the final agreement/arrangements.

An Assessor will carry out an initial risk assessment and highlight any problems relating to safe storage. This can include the presence of heat, humidity and decay of certain items that may have a limited shelf life. Social care staff should assist with the safe storage of medicines although this is the responsibility of the client/representative as applicable.   Any concerns found should be raised with the care manager and the client’s GP or district nurse. For example, any powerful medicines that could be seriously detrimental to a child’s health should be kept out of reach and in a secure location. In cases where a client may be confused and likely to take additional doses a safer storage strategy should be thought up with consideration for co-operation with other healthcare professionals to ensure the best procedure is put in place for the better interests of the client. Any signs of tampering with medication or overdoses should be reported immediately to the GP, pharmacist and/or the care manager.  1^st Care has a dedicated Medication Policy & Procedure which all 1^st Care cover in full during their initial Induction training.  The policy & procedure are supported by face-to-face dedicated medication training during Induction too.  This training is updated.

Thank you for choosing the 1^st Care team to support you at home