Safe Care and Treatment

1. Introduction

The service must provide care and treatment to people using services in a safe way. In particular, this includes:

• risk assessments relating to the health, safety and welfare of adults must be completed and reviewed regularly by people with the qualifications, skills, competence and experience to do so. Risk assessments should include plans for managing risks;
• assessments, planning and delivery of care and treatment should:
  • be based on risk assessments that balance the needs and safety of people using the service with their rights and preferences;
  • include arrangements to respond appropriately and in good time to people’s changing needs;
  • be carried out in accordance with the Mental Capacity Act 2005 (MCA 2005). This includes best interest decision making; lawful restraint; and, where required, application for authorisation for deprivation of liberty through the MCA Deprivation of Liberty Safeguards or the Court of Protection (see Mental Capacity and Deprivation of Liberty Safeguards).

This includes when people are admitted, discharged, transferred or move between services.

However, this list is not exhaustive and the service must demonstrate it has done everything reasonably practicable to provide safe care and treatment.

2. Treating with Respect

Staff must take all reasonable steps to make sure that people who use services are not subjected to any form of degradation or treated in a manner that may reasonably be viewed as degrading, such as:

• not providing help and aids so that people can be supported to attend to their continence needs, and
• making sure people are not:
  • left in soiled sheets for long periods;
  • left on the toilet for long periods and without the means to call for help;
  • left naked or partially or inappropriately covered;
  • made to carry out demeaning tasks or social activities;
  • ridiculed in any way by staff.

This list is not exhaustive.

The service will consult and consider the views of adults, when defining the meaning of ‘degrading’.

Staff should raise any concerns with their manager about their ability to provide planned care. When concerns are raised, the manager should respond appropriately and without delay.

Care and treatment must be planned and delivered in a way that enables all a person’s needs to be met. This includes making sure that enough time is allocated to allow staff to provide care and treatment in accordance with the person’s assessed needs and preferences.

When a person lacks the mental capacity to consent to care and treatment, a best interests process, which includes a best interests assessment, must be followed in accordance with the MCA. Other forms of authority such as advance decisions must also be taken into account. See also Consent and Mental Capacity.

Staff must act at all times in accordance with the Mental Capacity Act 2005 Code of Practice.

3. Mitigating Risks

The service must do all that is reasonably practicable to mitigate risks. It follows good practice guidance and adopts control measures to make sure the risk is as low as is reasonably possible. Managers reviews methods and measures and amended them to address changing practice.

Staff should use risk assessments about the health, safety and welfare of adults to make required adjustments. These adjustments may be to premises, equipment, staff training, processes, and practices and can affect any aspect of care and treatment.

Staff must include relevant health and safety concerns in people’s care and treatment plans. This includes allergies, contraindications and other limitations relating to the person’s needs and abilities.

Staff must follow the care and treatment plan agreed with each adult or their relevant person.

Medication reviews must be part of, and align with, people’s care and treatment assessments and plans and should be completed and reviewed regularly when their medication changes. Staff must comply with relevant Patient Safety Alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS).

Incidents that affect the health, safety and welfare of people using services must be reported internally and to relevant external authorities / bodies. They must be reviewed and thoroughly investigated by competent staff, and monitored to make sure that action is taken to remedy the situation, prevent further occurrences and make sure that improvements are made as a result. Staff involved in incidents should receive information about them and this should be shared with others to promote learning. Incidents include those that have potential for harm.

Outcomes of investigations into incidents must be shared with the person concerned and, where relevant, their families, carers and advocates (see also Duty of Candour).

Anyone can raise concerns about their own care and treatment or the care and treatment of people they care for or represent (see Complaints and Preventing Abuse and Neglect).

Staff must know how to take appropriate action if there is a clinical or medical emergency.

Medicines must be administered accurately, in accordance with any prescriber instructions and at suitable times to make sure that adults are not placed at risk.

When it is agreed to be in a person’s best interests, the arrangements for giving medicines covertly must be in accordance with the Mental Capacity Act 2005.

4. Competent and Qualified Staff

See also Safeguarding Training and Staffing.

Staff must only work within the scope of their qualifications, competence, skills and experience and should be encouraged to seek help when they feel they are being asked to do something that they are not prepared or trained for.

Staff should be appropriately supervised when they are learning new skills, but are not yet competent.

Only relevant regulated professionals with the appropriate qualifications must plan and prescribe care and treatment, including medicines. Only relevant regulated professionals or suitably skilled and competent staff must deliver care and treatment.

5. Equipment and Premises

See also Premises and Equipment.

The service must ensure the safety of their premises and the equipment within it, and assure compliance with statutory requirements, national guidance and safety alerts through its internal systems and processes.

The service retains legal responsibility for premises and equipment where they delegate responsibility through contracts or legal agreements to a third party, independent suppliers, professionals, supply chains or contractors. They must therefore make sure that regulations are adhered to as responsibility for any shortfall rests with the service.

Staff should adhere to induction and training plans for the safe operation of premises and equipment, including incident reporting and emergency and contingency planning, which are updated as required.

Service managers must include capital and revenue costs of maintaining safety in their financial planning for their service.

Managers must make sure that equipment is suitable for its purpose, properly maintained and used correctly and safely. This includes making sure that staff using the equipment have the training, competency and skills needed.

6. Medicines Management

See also Medication.

People’s medicines must be available in the necessary quantities at all times to prevent the risks associated with medicines that are not administered as prescribed. This includes when people manage their own medicines.

Sufficient medication should be available in case of emergencies.

Sufficient equipment and/or medical devices that are necessary to meet people’s needs should be available at all times and devices should be kept in full working order. They should be available when needed and within a reasonable time without posing a risk.

The equipment, medicines and / or medical devices that are necessary to meet people’s needs should be available when they are transferred between services or providers.

Staff responsible for the management and administration of medication must be suitably trained and competent and this should be kept under review.

Staff must follow policies and procedures about managing medicines, including those related to infection control, which address:

• supply and ordering;
• storage, dispensing and preparation;
• administration;
• disposal;
• recording.

7. Infection Control

See Health and Social Care Act 2008: Code of Practice for health and adult social care on the prevention and control of infections and related guidance, concerning the prevention and control of healthcare associated infections.

When assessing risk, staff should consider the link between infection prevention and control, anti-microbial stewardship, how medicines are managed and cleanliness.

8. Working with Adults, Family Members and other Partner Agencies

Staff must actively work with others, both internally and externally, to make sure that care and treatment remains safe for adults who use services.

When care is shared between the service and one or more other providers or where there are integrated services, there should be appropriate arrangements to share relevant information promptly, and to plan and deliver care in partnership.

When more than one provider is responsible for the safety of a person using services, the responsibility for providing safe care rests with the principal care provider at the time it is given. For adults in the service, this would normally be the service itself, but this would not necessarily be so in other services so who the principal care provider is needs to be agreed between all parties.

Arrangements should be in place to support people who are in a transition phase between services and / or other providers.

When people move between services or providers, appropriate risk assessments must be undertaken to make sure their safety is not compromised. This includes when they move between or with other bodies who may not be registered with the Care Quality Commission.

Decisions about a move between services or providers relating to people who may lack mental capacity to make that decision for themselves must be made in accordance with the MCA (see Mental Capacity).

To make sure that people who use services are safe and any risks to their care and treatment are minimised, providers must be able to respond to and manage major incidents and emergency situations. This includes having plans with other providers or bodies in case of events such as fires, floods, major road traffic accidents or major incidents, and natural disasters such as earth quakes or landslides (see Provider Failure and Other Service Interruptions).